Pre-operative Simulation of the Appropriate C-arm Position Using Computed Tomography Post-processing Software Reduces Radiation and Contrast Medium Exposure During EVAR Procedures.

OBJECTIVE/BACKGROUND: The aim was to evaluate the feasibility and efficacy of a new method for pre-operative calculation of an appropriate C-arm position for iliac bifurcation visualisation during endovascular aortic repair (EVAR) procedures by using three dimensional computed tomography angiography (CTA) post-processing software. METHODS: Post-processing software was used to simulate C-arm angulations in two dimensions (oblique, cranial/caudal) for appropriate visualisation of distal landing zones at the iliac bifurcation during EVAR. Retrospectively, 27 consecutive EVAR patients (25 men, mean ± SD age 73 ± 7 years) were identified; one group of patients (NEW; n = 12 [23 iliac bifurcations]) was compared after implementation of the new method with a group of patients who received a historic method (OLD; n = 15 [23 iliac bifurcations]), treated with EVAR before the method was applied. RESULTS: In the OLD group, a median of 2.0 (interquartile range [IQR] 1-3) digital subtraction angiography runs were needed per iliac bifurcation versus 1.0 (IQR 1-1) runs in the NEW group (p = .007). The median dose area products per iliac bifurcation were 11951 mGy*cm2 (IQR 7308-16663 mGy*cm2) for the NEW, and 39394 mGy*cm2 (IQR 19066-53702 mGy*cm2) for the OLD group, respectively (p = .001). The median volume of contrast per iliac bifurcation was 13.0 mL (IQR: 13-13 mL) in the NEW and 26 mL (IQR 13-39 mL) in the OLD group (p = .007). CONCLUSION: Pre-operative simulation of the appropriate C-arm angulation in two dimensions using dedicated computed tomography angiography post-processing software is feasible and significantly reduces radiation and contrast medium exposure.

Self-assembled plasmonic templates produced by microwave annealing: applications to surface-enhanced Raman scattering.

Perhaps the simplest method for creating metal nanoparticles on a substrate is by driving their self-assembly with the thermal annealing of a thin metal film. By properly tuning the annealing parameters one hopes to discover a recipe that allows the pre-determined design of the NP arrangement. However, thermal treatment is known for detrimental effects and is not really the manufacturer's route of choice when it comes to large-scale applications. An alternative method is the use of microwave annealing, a method that has never been applied for metal processing, due to the high reflectance of microwave radiation at the surface of a metal. However, in this work we challenge the widely used nanostructuring methods by proving the microwave's annealing ability to produce plasmonic templates, out of extremely thin metal films, by simply using a domestic microwave oven apparatus. We show that this process is generic and independent of the deposition method used for the metal and we further quantify the suitability of these plasmonic templates for use in surface-enhanced Raman scattering applications.

Burden of hospital admissions caused by respiratory syncytial virus (RSV) in infants in England: A data linkage modelling study.

OBJECTIVES: Current national estimates of respiratory syncytial virus (RSV)-associated hospital admissions are insufficiently detailed to determine optimal vaccination strategies for RSV. We employ novel methodology to estimate the burden of RSV-associated hospital admissions in infants in England, with detailed stratification by patient and clinical characteristics. METHODS: We used linked, routinely collected laboratory and hospital data to identify laboratory-confirmed RSV-positive and RSV-negative respiratory hospital admissions in infants in England, then generate a predictive logistic regression model for RSV-associated admissions. We applied this model to all respiratory hospital admissions in infants in England, to estimate the national burden of RSV-associated admissions by calendar week, age in weeks and months, clinical risk group and birth month. RESULTS: We estimated an annual average of 20,359 (95% CI 19,236-22,028) RSV-associated admissions in infants in England from mid-2010 to mid-2012. These admissions accounted for 57,907 (95% CI 55,391-61,637) annual bed days. 55% of RSV-associated bed days and 45% of RSV-associated admissions were in infants <3 months old. RSV-associated admissions peaked in infants aged 6 weeks, and those born September to November. CONCLUSIONS: We employed novel methodology using linked datasets to produce detailed estimates of RSV-associated admissions in infants. Our results provide essential baseline epidemiological data to inform future vaccine policy.

Is pneumonectomy a justified procedure in patients with persistent N2 nonsmall cell lung cancer disease following induction therapy.

Optimal management and the role of surgery in multimodality treatment for N2 disease nonsmall cell lung cancer (NSCLC) are controversial. In this review, we focus on the possible role of pneumonectomy as a justified procedure in patients with persistent N2 disease following induction therapy. We have conducted an OVID PubMedbased search including manuscripts published in English for relevant studies. The interpretation of these trials highlights the lack of clarity and consistency in our management and leaves areas of controversy. There are no Level 1 data to support either performing or not performing pneumonectomy in this setting. The majority of the literature reviewed stresses the high risk of mortality and morbidity following pneumonectomy as a part of a trimodality approach to Stage IIIA/N2 NSCLC disease. However, selected highvolume institutions do follow this strategy with the level of risk seemingly justifying it for a highly selected group of patients, and this approach to Stage III/N2 NSCLC can be offered safely with acceptable mortality. Patient selection, response rate to induction therapy, and R0 resection are crucial for survival in experienced centers.

Monocyte disorders associated with T cell defects in patients with solid tumors.

T cells proliferate in response to autologous monocytes in the autologous mixed lymphocyte reaction (AMLR). AMLR was found to be impaired in patients with advanced cancer (stages III and IV), whereas normal values were found in the early stages of the disease (stages I and II). Peripheral T lymphocytes from patients with advanced stages also exhibited a decreased ability to produce Interleukin-2 (IL-2) during an AMLR response, whereas production of IL-2 by T cells in stages I and II was comparable to that of normal donors. The impaired IL-2 production by T lymphocytes in the AMLR was associated with high concentrations of soluble interleukin-2 receptor (sIL-2R) in culture supernatants and reduced expression of membrane-bound interleukin-2 receptors (IL-2R) on the same AMLR-activated T lymphocytes. These abnormalities in T cells from cancer patients were demonstrated to be associated with dysfunctions of autologous monocytes. Thus monocytes from patients with advanced cancer exhibited diminished expression of HLA-DR antigens and produced low levels of Interleukin-1 beta (IL-1 beta) and Tumor Necrosis Factor a (TNFa). No changes were detected in the expression of HLA-A, -B, -C antigens. The results presented here demonstrate that decreased in vitro T cell responses may be attributed to monocyte dysfunctions in these patients and provide new information for a better understanding of the impaired T cell function in cancer patients.

The role of the mode of delivery in the alteration of intrapartum pathological cervical cytologic findings during the postpartum period.

OBJECTIVE: The aim of the study was to determine whether abnormal antepartum cervical cytologic findings change in the postpartum period and the relation of this alteration to the mode of delivery. STUDY DESIGN: Between 1991 and 2000, 192 pregnant women with antepartum abnormal cervical cytology were identified; complete demographic, clinical and cytologic reports were available for 90 of them. Papanicolaou smear tests were collected and separated in three groups using the Bethesda classification system (ASCUS, L-SIL and H-SIL). RESULTS: Of the 90 women, 52 (61.1%) were delivered vaginally and 38 (38.9%) by cesarean section. No difference was found between women delivered vaginally and those delivered by cesarean section, regardin age, parity and smoking history. The overall postpartum regression rate for the 20 women with antepartum H-SIL cells was 45%. Of the 12 women with H-SIL cells who were delivered vaginally, eight (66.6%) showed regression in the postpartum period while this regression was achieved only in one (12.5%) woman, who was delivered by cesarean section (p < 0.002). CONCLUSION: Postpartum spontaneous regression of suspicious Papanicolaou smears consistent with H-SIL occurs with increased frequency among women who are delivered vaginally compared to those delivered by cesarean section.

Tailgut cysts: a rare cause of pelvic outlet obstruction.

Tailgut cysts are unusual cystic tumors of the retrorectal space. We describe the findings of three cases. Constipation, intrapelvic fullness and low abdominal pain were the most prominent clinical manifestations. One patient developed an abscess. Ultrasound, computed tomography and MR imaging demonstrated the presacral lesions. Transabdominal excision of the tumors in two patients resulted in good outcome whereas in the patient with the abscess there was recurrence with a fistula formation.

A safe method of gut resection in women with complicated post-radiation enteritis after cervix cancer.

BACKGROUND: Resection of the irradiated gut in women with cervical cancer is complicated by high morbidity and mortality mainly due to accidental injuries to the adjacent intrapelvic structures. To eliminate these injuries a new method is proposed. METHOD: Six patients between 41 and 56 years old who had received radiation therapy for cervical cancer were operated on for post-radiation injury of the terminal ileum. All patients underwent partial resection of the irradiated small bowel plus right colectomy. The surgical technique was undertaken so as to leave parts of the small bowel (20 to 45 cm) adherent to the adjacent organs when complete resection was judged precarious. RESULTS: All patients had an uneventful recovery with 6 to 14 days hospitalization. No complications related to the remaining intrabdominal parts of the gut were observed. All patients died of the primary disease over 1 to 5 years postoperatively. CONCLUSION: The method is safe, simple and eliminates injuries to the adjacent structures.

Conformational isomerism, rotational allomerism, and divergent evolution in immunoglobulin light chains.

Immunoglobulin light chains are examples of single polypeptide chains synthesized under the control of two genes. The three-dimensional structure of a human (Mcg) lambda-type chain (Bence-Jones) dimer supports the hypothesis of a common primordial gene for the amino ("variable" or V) and carboxyl ("constant" or C) halves of each monomer. However, sequence homologies have been obscurred by divergent evolution of the V and C regions ("domains"). The types of evolutionary changes that have occurred in the domain can be surmised by a comparison of the sequences, using the three-dimensional structures as a basis for alignment. Despite substantial differences in sequences, the hydrophobic character of key internal sites has been maintained in each domain. Regions present in only one domain are situated in position appropriate for their functions, but not deleterious to the general structural integrity of a common fold. The divergence of the V and C domains can be interpreted in terms of rotational allomerism. The cylinders of beta-pleated sheets have rotated in such a way that homologous regions in the two domains perform different functions in their interactions with a second molecule of light or heavy chain. These regions include complementarity-determining sites for antigen binding in the V domains and crossover sites stabilizing dimer formation in the C domains. Differences in surface properties between the V1-V2 and C1-C2 dimeric modules may partially explain why the V regions have been implicated in the formation of amyloid fibrils and in the characteristic thermal behavior of Bence-Jones proteins.