Editor's choice--Angulation of the C-arm during complex endovascular aortic procedures increases radiation exposure to the head.

OBJECTIVES/BACKGROUND: The increased complexity of endovascular aortic repair necessitates longer procedural time and higher radiation exposure to the operator, particularly to exposed body parts. The aims were to measure directly exposure to radiation of the bodies and heads of the operating team during endovascular repair of thoracoabdominal aortic aneurysms (TAAA), and to identify factors that may increase exposure. METHODS: This was a single-centre prospective study. Between October 2013 and July 2014, consecutive elective branched and fenestrated TAAA repairs performed in a hybrid operating room were studied. Electronic dosimeters were used to measure directly radiation exposure to the primary (PO) and assistant (AO) operator in three different areas (under-lead, over-lead, and head). Fluoroscopy and digital subtraction angiography (DSA) acquisition times, C-arm angulation, and PO/AO height were recorded. RESULTS: Seventeen cases were analysed (Crawford II-IV), with a median operating time of 280 minutes (interquartile range 200-330 minutes). Median age was 76 years (range 71-81 years); median body mass index was 28 kg/m(2) (25-32 kg/m(2)). Stent-grafts incorporated branches only, fenestrations only, or a mixture of branches and fenestrations. A total of 21 branches and 38 fenestrations were cannulated and stented. Head dose was significantly higher in the PO compared with the AO (median 54 µSv [range 24-130 µSv] vs. 15 µSv [range 7-43 µSv], respectively; p = .022), as was over-lead body dose (median 80 µSv [range 37-163 µSv] vs. 32 µSv [range 6-48 µSv], respectively; p = .003). Corresponding under-lead doses were similar between operators (median 4 µSv [range 1-17 µSv] vs. 1 µSv [range 1-3 µSv], respectively; p = .222). Primary operator height, DSA acquisition time in left anterior oblique (LAO) position, and degrees of LAO angulation were independent predictors of PO head dose (p < .05). CONCLUSIONS: The head is an unprotected area receiving a significant radiation dose during complex endovascular aortic repair. The deleterious effects of exposure to this area are not fully understood. Vascular interventionalists should be cognisant of head exposure increasing with C-arm angulation, and limit this manoeuvre.

Pathology specific early outcome after thoracic endovascular aortic repair.

OBJECTIVES: Endovascular intervention is established for treatment of thoracic aortic dissection and aneurysm. The aim of this study was to compare the incidence of all-cause and aortic-related in-hospital mortality, stroke, spinal cord ischaemia, and major adverse event rate for patients undergoing thoracic aortic endovascular intervention to see if there is a pathology-specific effect. METHODS: Data were collected prospectively and analysed retrospectively for a cohort of 309 consecutive patients with either thoracic aortic dissection or aneurysm over a 14-year period. RESULTS: There were 209 men and 100 women with a median age of 72 years (interquartile range [IQR] 63-78 years). Aneurysm affected 62% (193/309) of patients and 37% (116/309) had complicated type B aortic dissection, of whom 43% (50/116) had acute and 57% (66/116) chronic presentations. In patients with aortic dissection compared to aneurysm, there was no significant difference in all-cause in-hospital mortality (6.9% vs. 8.3% respectively, p = 0.827, relative risk [RR] 0.83, 95% confidence interval [CI] 0.37-1.88), stroke (6.0% vs 6.2%, p = 1.00, RR 0.971, CI 0.39-2.39), spinal cord ischaemia (6.0% vs 6.2%, p = 1.00, RR 1.030, CI 0.42-2.54), or major adverse event rate (16.4% vs. 16.6%, p = 1.00, RR 0.988, CI 0.59-1.66). The rate of aortic related death was four times greater in the dissection than in the aneurysm group (4/8 = 50% vs 2/16 = 12.5%, p = 0.06, RR 6.99, CI 0.92-52.5) although this did not reach statistical significance. CONCLUSIONS: There was no difference in the incidence of in-hospital mortality, stroke, and spinal cord ischaemia between aneurysm and dissection. The higher rate of aortic related death in the dissection group may indicate the need to refine the clinical management of these patients, including procedural planning, endograft design, and operative technique.

A 14-year experience with aortic endograft infection: management and results.

OBJECTIVES: The management of thoracic and abdominal aortic endograft infection is complex and associated with high mortality. Cases are rare: a recent systematic review identified 117 reported cases; the largest reported series comprises 12 infected endografts. METHODS: We report 22 consecutive patients with infected abdominal or thoracic aortic endovascular devices implanted from 1998 to 2012. Management included extension with new devices, aneurysm sac drainage of pus/irrigation with antibiotics, endograft explantation, and axillo-(bi)femoral reconstruction. RESULTS: Twenty-two patients (16 men) were identified. Median age was 71 years (range, 43-88 years). Index devices were infra-renal endovascular repair (n = 13), and thoracic endovascular repair (n = 9) all for aneurysmal or pseudoaneurysmal disease. Seven (32%) had prior aortic surgery. Follow-up was complete in all cases; in survivors follow-up was a median of 29 (range, 12-45) months. The mortality from explantation of ten infra-renal devices was 1/10 (10%) on-table and a further 2/10 (20%) within 30 days. Device retention led to disease progression and death in all patients with infected endografts. Sac drainage/irrigation provided only temporary control of sepsis. Device extension can treat rupture, but additional devices became infected. CONCLUSION: Abdominal endograft explantation is high risk but may be curative. Appropriate selection of patients for infected endograft explantation remains a major challenge.

"Blockchain technology in food safety and traceability concern to livestock products".

Livestock products share more than fifteen percent of total agri-foods traded worldwide. A global increase in food demand has increased the risk to food safety. Improvements in food quality, cold chain transit, and preservation are required for safe livestock products. Though, the food safety and regulation authorities demand complete food traceability from farm to fork, but in traditional supply chain it is ignored by fiddling with the transit paperwork and bill invoices. The process of supply chain reformation and activities linked to food recalls during food safety issues are insanely expensive and challenging. Traceability-driven food supply chain management is likely to implement novel technologies like the Internet of Things (IoT). The capability of the Blockchain era within the food sector is emerging with use cases across different regions, as shown via the growing number of studies. Credibility, efficiency, and safety are all improved when food products can be instantly traced from their point of origin through all points of contact on their way to the consumer. Blockchain assures a tamper-proof and transparent system that allows an innovative business solution, together with smart contracts. However, there are significant difficulties with the implementation of blockchain technology for food traceability. It necessitates more and more training platforms as well as trainers, who can make understanding and operability of this technology easy among ground-level participants and food entities. For the tactical application of this technology, it is essential to comprehend the legal and regulatory framework.

Risk of radiation exposure during endovascular aortic repair.

OBJECTIVE: Exposure to radiation doses above 2 Gray (Gy) can cause skin burns. There is also a lifetime cancer risk of ≈5.5% for every Sievert (Sv) of radiation. We assessed the radiation burden associated with endovascular treatment of the aorta. METHOD: Thoracic (TEVAR), Infra-renal (IEVAR) and branched/fenestrated (BEVAR/FEVAR) endovascular aortic repairs were studied. The prospectively recorded dosimetric parameters included: fluoroscopy time and dose area product (DAP). Exposure films, placed underneath 10 patients intra-operatively, recorded skin dose and were used to calculate skin (Gy) and tissue (Sv) doses. RESULTS: The TEVAR cohort (n = 232) were younger (p < 0.0001) than BEVAR/FEVAR (n = 53) and IEVAR (n = 630). The median DAP was higher (p = 0.004) in the BEVAR/FEVAR group compared with IEVAR and TEVAR: 32,060 cGy cm(2) (17,207-213,322) vs 17,300 cGy cm(2) (10,940-33,4340) vs 19,440 cGy cm2 (11,284-35,101), respectively. The equivalent skin doses were BEVAR/FEVAR: 1.3 Gy (0.71-8.75); IEVR: 0.71 Gy (0.44-13.7); TEVAR: 0.8 Gy (0.46-1.44). The whole body effective doses were BEVAR/FEVAR: 0.096 Sv (0.052-0.64); IEVR: 0.053 Sv (0.033-1.00); TEVAR: 0.058 Sv (0.034-0.11). CONCLUSIONS: The radiation exposure during endovascular aortic surgery is relatively low for the majority but some patients are exposed to very high doses. Efforts to minimise intra-operative exposure and graft surveillance methods that do not use radiation may reduce the cumulative lifetime malignancy risk.

A 500 kV, 10 kA, 40 ns coaxial Marx generator pulser for cable fed flash x-ray system.

Flash x-ray (FXR) systems are used for dynamic radiography. Depending on the speed of the object, these systems typically require a very short pulse duration (∼25 ns) for image acquisition without motion blur. The conventional Marx generators with zigzag discharge paths result in higher inductance; hence, they do not meet the requirement of shorter pulse duration (30-40 ns) and low impedance (40-60 Ω) simultaneously. A coaxial Marx generator has been designed and developed, which is capable of generating 500 kV peak voltages and 10 kA peak current within a 40 ns pulse duration. The CST simulation of the coaxial Marx generator has been carried out to validate the design parameters. The FXR electron beam diode is powered by this Marx generator. Experiments were carried out to measure the x-ray parameters like pulse width, source size, x-ray energy spectrum, penetration depth, and cone angle. The maximum measured x-ray dose was 62 mR at 1 m distance from the source window. The x-ray radiograph demonstrates a penetration depth of 32 mm in steel kept at 2.5 m distance from the source for 500 kV diode voltages.

Restoring Carboxylates on Highly Modified Alginates Improves Gelation, Tissue Retention and Systemic Capture.

Alginate hydrogels are gaining traction for use in drug delivery, regenerative medicine, and as tissue engineered scaffolds due to their physiological gelation conditions, high tissue biocompatibility, and wide chemical versatility. Traditionally, alginate is decorated at the carboxyl group to carry drug payloads, peptides, or proteins. While low degrees of substitution do not cause noticeable mechanical changes, high degrees of substitution can cause significant losses to alginate properties including complete loss of calcium cross-linking. While most modifications used to decorate alginate deplete the carboxyl groups, we propose that alginate modifications that replenish the carboxyl groups could overcome the loss in gel integrity and mechanics. In this report, we demonstrate that restoring carboxyl groups during functionalization maintains calcium cross-links as well as hydrogel shear-thinning and self-healing properties. In addition, we demonstrate that alginate hydrogels modified to a high degree with azide modifications that restore the carboxyl groups have improved tissue retention at intramuscular injection sites and capture blood-circulating cyclooctynes better than alginate hydrogels modified with azide modifications that deplete the carboxyl groups. Taken together, alginate modifications that restore carboxyl groups could significantly improve alginate hydrogel mechanics for clinical applications. STATEMENT OF SIGNIFICANCE: Chemical modification of hydrogels provides a powerful tool to regulate cellular adhesion, immune response, and biocompatibility with local tissues. Alginate, due to its biocompatibility and easy chemical modification, is being explored for tissue engineering and drug delivery. Unfortunately, modifying alginate to a high degree of substitution consumes carboxyl group, which are necessary for ionic gelation, leading to poor hydrogel crosslinking. We introduce alginate modifications that restore the alginate's carboxyl groups. We demonstrate that modifications that reintroduce carboxyl groups restore gelation and improve gel mechanics and tissue retention. In addition to contributing to a basic science understanding of hydrogel properties, we anticipate our approach will be useful to create tissue engineered scaffolds and drug delivery platforms.

Total carotene content and quality characteristics of pumpkin flavoured buffalo milk.

As per the World Health Organization (WHO) and Global Hunger Index, the incidence of malnutrition and Vitamin-A deficiency in preschool-age children is higher in South-East Asian countries. Therefore, this study was envisaged to formulate value-added flavoured buffalo milk and to carry out the sensory evaluation, nutritional analysis, storage characteristics and total carotene content of the developed product. Flavoured buffalo milk was prepared by incorporation of Cucurbita pepo (Pumpkin) pulp and ground sugar at a concentration of 15% and 10%, respectively. The formulation was found preeminent by panellists and then subjected to nutritional analysis and storage studies at room temperature following "in bottle heat treatment". Nutritional analysis revealed that the protein, fat, total carbohydrates, total ash and moisture content of pumpkin flavoured buffalo milk were 3.07%, 5.21%, 12.63%, 0.61% and 78.48%, respectively. The storage study of flavoured buffalo milk showed a significantly (p < 0.05) declined score in colour and appearance as well as flavour only after day 90. The overall acceptability score also declined significantly (p < 0.05) after day 60 of storage. Though the sensory score declined gradually during the storage period, the product was liked by the panellist even till day 180. The carotene content of pumpkin flavoured buffalo milk was 1.2 mg/100 g at day 0 and it decreased significantly as storage prolongs. The nutritional components were not affected significantly during the 180 days storage period. Standard plate counts, coliform counts as well as yeast and mould counts were not detected during storage of pumpkin flavoured buffalo milk.

Evaluation of the risk assessment matrix: a mental health triage tool.

BACKGROUND: The Risk Assessment Matrix (RAM) is a mental health triage tool designed to assist emergency department (ED) staff to make rapid and accurate assessment of a patient with a suspected or actual mental health problem, and to identify patients at immediate risk of self-harm. A study was conducted to evaluate the effectiveness of this triage tool. METHODS: Using a naturalistic retrospective study design, all patients attending the ED with an actual or suspected mental health problem over a 2-month period were identified to determine if any association existed with the level of risk ascertained at assessment by ED staff using the RAM and the patient's final outcome of their management. A questionnaire was administered to ED staff to determine face and content validity. RESULTS: 202 patients were identified, 155 of whom met the inclusion criteria. Those classified medium or high risk by ED staff were significantly more likely to be referred to mental health services for further assessment, and to be admitted to an inpatient psychiatric units or have involvement of home intervention/crisis teams. Analysis showed that a significant number of respondents found the RAM useful in making triage and ongoing management decisions, indicating that the tool had strong face and content validity. CONCLUSION: A preliminary interpretation of the results of this study suggests the RAM is sensitive in identifying patients who warrant further urgent mental health intervention and is an effective mental health triage tool. Further prospective studies are needed to provide a more robust evidence base of the use of the RAM in the emergency setting.

Outcomes following two-stage surgical approaches in the treatment of pediatric ulcerative colitis.

INTRODUCTION: Surgery for the treatment of ulcerative colitis (UC) can be performed in one-, two-, or three-stage procedures [1]. The more traditional approach is a total proctocolectomy and creation of an ileo pouch-anal anastomosis and diverting stoma at the initial operation, followed by ileostomy closure several weeks later (TIPPA) [1]. An alternative is an initial subtotal colectomy and end ileostomy [2]. In this alternative approach (NIPAA), a completion proctectomy and definitive ileo pouch-anal anastomosis can be performed without a diverting stoma. We hypothesize that functional outcomes following a NIPAA approach when performed in children, in our experience, are likely similar or improved when compared to those treated by TIPAA. METHODS: After IRB approval, a review of patients who underwent a two-stage Laparoscopic IPAA from 2004 to 2017 occurred. Data included demographics, diagnosis, surgical intervention time to full diet, level of continence, use of antidiarrheals and complications. RESULTS: N = 41 (NIPAA = 14, TIPAA = 27). After establishment of bowel continuity, no significant differences in appetite recovery, continence, or complications were noted. The number of antidiarrheals prescribed were significantly higher in the TIPAA group (p = 0.01). Thirteen patients (31.7%) had pouchitis: 4 NIPAA and 9 TIPAA (p = NS). Of the 41 patients, 11 required subsequent surgery; 2 patients (18.2%) received NIPAA and 9 (81.8%) received TIPAA (p = 0.20). Two TIPAA patients received a diverting ileostomy owing to chronic anal pain and failure to achieve continence. CONCLUSION: This study suggests children with medically refractory UC treated by NIPAA or TIPAA have similar outcomes. Minimal differences in overall outcome were noted following either approach. However, NIPAA may reduce reliance on antidiarrheals to achieve satisfactory defecation outcomes. LEVEL OF EVIDENCE: III Retrospective comparative study.

PrEP Eligibility and Interest Among Clinic- and Community-Recruited Young Black Women in Atlanta, Georgia, USA.

BACKGROUND: Atlanta has been identified as an HIV "hot spot" for Black women and ranks 5th in the US with new infections. Yet little is known about PrEP eligibility or interest among young Black women in Atlanta. METHODS: A convenience sample of 1,261 Black women (ages 14-24 years) were recruited from two settings: community venues and sexual health clinics. They provided self-reported sexual behavior data and specimens for laboratory testing for chlamydia (CT) and gonorrhea (GC) infections. For each woman, the number of key self-reported behavioral HIV risk factors was calculated (0-6 factors for the clinic sample, 0-3 factors for the community sample). A single item assessed PrEP interest in the community sample only. RESULTS: Bacterial STI positivity, an indicator for PrEP eligibility, was 20.5% (17.1% CT, 6.3% GC) and 20.9% (18.8% CT, 5.2% GC) for the clinic and community samples, respectively. Of the 144 STI positive women from the clinic sample, 20.1% reported no behavioral risk indicators and 47.2% reported > 2 behavioral indicators. Of the 117 STI positive women from the community sample, 21.4% reported no behavioral risk indicators. 60.7% of the community sample reported they would be likely or very likely to use PrEP if available. CONCLUSION: Young Black women in Atlanta, whether sampled from community or sexual health settings, are at substantial risk for HIV infection and meet several PrEP eligibility criteria. Scaling up PrEP among women in Atlanta could have significant implications for HIV in this high burden region.

Inhibition of prolyl hydroxylase domain proteins selectively enhances venous thrombus neovascularisation.

BACKGROUND: Hypoxia within acute venous thrombi is thought to drive resolution through stabilisation of hypoxia inducible factor 1 alpha (HIF1α). Prolyl hydroxylase domain (PHD) isoforms are critical regulators of HIF1α stability. Non-selective inhibition of PHD isoforms with l-mimosine has been shown to increase HIF1α stabilisation and promote thrombus resolution. OBJECTIVE: The aim of this study was to investigate the therapeutic potential of PHD inhibition in venous thrombus resolution. METHODS: Thrombosis was induced in the inferior vena cava of mice using a combination of flow restriction and endothelial activation. Gene and protein expression of PHD isoforms in the resolving thrombus was measured by RT-PCR and immunohistochemistry. Thrombus resolution was quantified in mice treated with pan PHD inhibitors AKB-4924 and JNJ-42041935 or inducible all-cell Phd2 knockouts by micro-computed tomography, 3D high frequency ultrasound or endpoint histology. RESULTS: Resolving venous thrombi demonstrated significant temporal gene expression profiles for PHD2 and PHD3 (P < 0.05), but not for PHD1. PHD isoform protein expression was localised to early and late inflammatory cell infiltrates. Treatment with selective pan PHD inhibitors, AKB-4924 and JNJ-42041935, enhanced thrombus neovascularisation (P < 0.05), but had no significant effect on overall thrombus resolution. Thrombus resolution or its markers, macrophage accumulation and neovascularisation, did not differ significantly in inducible all-cell homozygous Phd2 knockouts compared with littermate controls (P > 0.05). CONCLUSIONS: This data suggests that PHD-mediated thrombus neovascularisation has a limited role in the resolution of venous thrombi. Directly targeting angiogenesis alone may not be a viable therapeutic strategy to enhance venous thrombus resolution.

Development of cable fed flash X-ray (FXR) system.

Flash X-ray sources driven by pulsed power find applications in industrial radiography, and a portable X-ray source is ideal where the radiography needs to be taken at the test site. A compact and portable flash X-ray (FXR) system based on a Marx generator has been developed with the high voltage fed to the FXR tube via a cable feed-through arrangement. Hard bremsstrahlung X-rays of few tens of nanosecond duration are generated by impinging intense electron beams on an anode target of high Z material. An industrial X-ray source is developed with source size as low as 1 mm. The system can be operated from 150 kV to 450 kV peak voltages and a dose of 10 mR has been measured at 1 m distance from the source window. The modeling of the FXR source has been carried out using particle-in-cell and Monte Carlo simulations for the electron beam dynamics and X-ray generation, respectively. The angular dose profile of X-ray has been measured and compared with the simulation.

Imaging of Myocardial Fibrosis in Patients with End-Stage Renal Disease: Current Limitations and Future Possibilities.

Cardiovascular disease in patients with end-stage renal disease (ESRD) is driven by a different set of processes than in the general population. These processes lead to pathological changes in cardiac structure and function that include the development of left ventricular hypertrophy and left ventricular dilatation and the development of myocardial fibrosis. Reduction in left ventricular hypertrophy has been the established goal of many interventional trials in patients with chronic kidney disease, but a recent systematic review has questioned whether reduction of left ventricular hypertrophy improves cardiovascular mortality as previously thought. The development of novel imaging biomarkers that link to cardiovascular outcomes and that are specific to the disease processes in ESRD is therefore required. Postmortem studies of patients with ESRD on hemodialysis have shown that the extent of myocardial fibrosis is strongly linked to cardiovascular death and accurate imaging of myocardial fibrosis would be an attractive target as an imaging biomarker. In this article we will discuss the current imaging methods available to measure myocardial fibrosis in patients with ESRD, the reliability of the techniques, specific challenges and important limitations in patients with ESRD, and how to further develop the techniques we have so they are sufficiently robust for use in future clinical trials.

Systematic review: outcomes and post-operative complications following colectomy for ulcerative colitis.

BACKGROUND: Colectomy for ulcerative colitis is associated with short- and long-term complications. Estimates of the frequency of such complications are variable and may have changed since the introduction of biological therapy. Understanding the true burden of surgical complications is important to clinicians in assessing risks and benefits of colectomy vs. continued medical therapy. AIM: To ascertain the outcomes of colectomy and ileal pouch surgery in patients with ulcerative colitis in the biologics era. METHODS: Embase, MEDLINE and The Cochrane Library were searched for studies (2002-2015) reporting the outcomes of colorectal procedures (total and subtotal colectomy, IPAA with J-, S-, W-pouch) in adults with ulcerative colitis. Conferences proceedings (2011-2015) were hand-searched. RESULTS: We identified 28 studies (20,801 patients) reporting outcomes from procedures conducted from 2002-2015. Early complications (≤30 days post-operatively), reported in 10 studies, occurred in 9-65% of patients with ulcerative colitis; late complications (>30 days post-operatively) occurred in 17-55% of patients. Most frequent short-term complications: infectious complications and ileus (mean incidence 20% and 18%). Most frequent long-term complications: pouchitis, faecal incontinence and small bowel obstruction (mean incidence 29%, 21% and 17%). Rates of early infection and late pouch failure decreased from 22% and 13% in 2002-2009 to 11% and 2% in 2010-2015. The mean incidence of post-operative mortality was 1.0% across 11 studies. CONCLUSIONS: Early and late complications arise in about one-third of patients undergoing surgery for ulcerative colitis. While colorectal surgical procedures are recommended for a specific group of patients, the post-operative complications associated with these procedures should not be underestimated.

Overexpression of EMS1/cortactin in NIH3T3 fibroblasts causes increased cell motility and invasion in vitro.

Cortactin, a p80/85 protein first identified as a src kinase substrate, is thought to be involved in the signaling pathway of mitogenic receptors and adhesion molecules mediating cytoskeletal reorganization. The cortactin gene, EMS1, maps to chromosome 11q13, a region amplified in head and neck squamous cell carcinomas (HNSCC) and breast cancer, which display lymph node metastasis and an unfavorable clinical outcome. To further address the role of cortactin in the malignant phenotype of cells, we stably overexpressed cortactin in NIH3T3 fibroblasts and evaluated the effects of elevated cortactin on cellular proliferation, motility and invasiveness. Cortactin overexpressing cells did not display any striking morphological changes, nor any significant differences in cell proliferation or saturation density as compared to control NIH3T3 cells. Furthermore, the cortactin overexpressing cells were anchorage dependent for growth. Interestingly, cortactin overexpressing cells were more motile and invasive in modified Boyden chamber assays. These results suggest that overexpression of cortactin may play a role in tumor progression by influencing tumor cell migration and invasion.

Systematic review: the financial burden of surgical complications in patients with ulcerative colitis.

BACKGROUND: Patients undergoing colectomy for ulcerative colitis (UC) may experience complications associated with reduced quality of life (QoL), and maybe a considerable economic burden to healthcare systems. Appreciation of these burdens is important to evaluate the cost effectiveness of newer interventions for UC vs. colectomy. AIM: To identify data representing resource utilisation or costs of complications arising from colorectal procedures in patients with UC, and data representing patient QoL, as reported by health state utility values (HSUVs). METHODS: Embase, MEDLINE and The Cochrane Library were searched for studies (1995-2014) reporting resource use/costs of surgical complications, and HSUVs data in adult patients with UC, undergoing colorectal procedures. Conference proceedings (January 2011-January 2014) were hand-searched. RESULTS: Twelve studies reported resource use/costs, and three reported HSUVs data in patients with UC experiencing surgical complications. Additional mean costs of postoperative complications ranged from $18 650/patient with complications at a 6-month follow-up (46% incidence) to $34 714/patient with complications over a 5-year period (49% incidence). Pouchitis, pouch failure and small bowel obstruction carried the greatest burden. Marked reductions in HSUVs were observed for patients with UC experiencing surgical complications, vs. patients with UC in a remission state. CONCLUSIONS: There is a paucity of well reported studies on resource use/cost, and QoL burden of surgical complications in patients with UC. However, surgical complications represent a substantial burden both in terms of cost and of quality of life, with reoperations, physician fees, additional in-patient hospital stays and infertility treatment being the main cost drivers.

Optimum anesthesia with intrapleural lidocaine during chemical pleurodesis with tetracycline.

Chemical pleurodesis with tetracycline is frequently complicated by pleuritic chest pain. The most promising approach to control pain is to optimize the use of intrapleural lidocaine. While administering amounts of intrapleural lidocaine larger than commonly reported, we attempted to determine a safe and more effective dose, by using a subjective and objective assessment of pain, by measuring serum concentrations of lidocaine, and by observing patients for possible toxic effects of lidocaine. Chemical pleurodesis with tetracycline was performed on ten patients receiving an intrapleural dose of 200 mg of lidocaine (group 1) and on ten patients receiving a 250-mg dose (group 2). A significantly greater number of patients in group 2 were free of pain following pleurodesis (7/10 vs 1/10; p = 0.006). Of the 80 serum lidocaine levels obtained, only one value (6.1 micrograms/ml), in an asymptomatic patient in group 1, exceeded the therapeutic range (1.5 micrograms/ml to 5.5 micrograms/ml). One patient in group 2 experienced transient numbness of the right hand, a possible side effect of lidocaine. We conclude that to achieve optimum anesthesia during chemical pleurodesis with tetracycline, it is necessary to use doses of intrapleural lidocaine large than previously reported. Until the feasibility of a further escalation is demonstrated, 250 mg should be considered the standard dose.

Water properties of hydrogel contact lens materials: a possible predictive model for corneal desiccation staining.

A set of properties of the water contained within hydrogel contact lens materials was determined with the aim of developing a model which would predict the propensity of a hydrogel contact lens material to induce corneal desiccation staining. We postulated that materials containing a larger proportion of water with the properties of bulk water would tend to induce corneal desiccation more readily than materials with the same overall water content but containing a larger proportion of water that interacts strongly with the polymer. The water structure [as measured by differential scanning calorimetry (DSC)] and the permeabilities of water and glucose were determined for a series of commercial hydrogel lenses. Both glucose permeability and DSC measurements are sensitive indicators of water structure and able to distinguish between various materials. To illustrate the potential of our model, the results of a short-term clinical study are presented. Lower levels of staining were noted for a material with a lower glucose permeability and a larger amount of water melting below 0 degrees C than for a control lens, even though both materials were similar in water content and water permeability. Further clinical studies are needed to validate this model.