Hemodynamic course during ablation and selective hepatic artery embolization for metastatic liver carcinoid: a retrospective observational study

Abstract Background: Manipulation of carcinoid tumors during ablation or selective hepatic artery embolization (transarterial embolization, TAE) can release vasoactive mediators inducing hemodynamic instability. The main aim of our study was to review hemodynamics and complications related to minimally invasive treatments of liver carcinoids with TAE or ablation. Methods: Electronic medical records of all patients with metastatic liver carcinoid undergoing ablation or TAE from 2003 to 2019 were abstracted. Noted were severe hypotension (mean arterial pressure [MAP] ≤ 55 mmHg), severe hypertension (systolic blood pressure ≥ 180 mmHg), and perioperative complications. Associations of procedure type and pre-procedure octreotide use with intraprocedural hemodynamics were assessed using linear regression. A robust covariance approach using generalized estimating equation method was used to account for multiple observations. Results: A total of 161 patients underwent 98 ablations and 207 TAEs. Severe hypertension was observed in 24 (24.5%) vs. 15 (7.3%), severe hypotension in 56 (57.1%) vs. 6 (2.9%), and cutaneous flushing observed in 2 (2.0%) vs. 48 (23.2%) ablations and TAEs, respectively. After adjusting for preprocedural MAP, ablation was associated with lower intraprocedural MAP compared to TAE (estimate −27 mmHg, 95%CI −30 to −24 mmHg, p < 0.001). Intraprocedural declines in MAP were not affected by preprocedural use of octreotide (p = 0.7 for TAE and p = 0.4 for ablation). Conclusions: Ablation of liver carcinoids was associated with substantial hemodynamic instability, especially hypotension. In contrast, a higher number of TAE patients had cutaneous flushing. Preprocedural use of octreotide was not associated with attenuation of intraprocedural hypotension.

Chinese consensus guidelines for therapeutic drug monitoring of polymyxin B, endorsed by the Infection and Chemotherapy Committee of the Shanghai Medical Association and the Therapeutic Drug Monitoring Committee of the Chinese Pharmacological Society / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Polymyxin B, which is a last-line antibiotic for extensively drug-resistant Gram-negative bacterial infections, became available in China in Dec. 2017. As dose adjustments are based solely on clinical experience of risk toxicity, treatment failure, and emergence of resistance, there is an urgent clinical need to perform therapeutic drug monitoring (TDM) to optimize the use of polymyxin B. It is thus necessary to standardize operating procedures to ensure the accuracy of TDM and provide evidence for their rational use. We report a consensus on TDM guidelines for polymyxin B, as endorsed by the Infection and Chemotherapy Committee of the Shanghai Medical Association and the Therapeutic Drug Monitoring Committee of the Chinese Pharmacological Society. The consensus panel was composed of clinicians, pharmacists, and microbiologists from different provinces in China and Australia who made recommendations regarding target concentrations, sample collection, reporting, and explanation of TDM results. The guidelines provide the first-ever consensus on conducting TDM of polymyxin B, and are intended to guide optimal clinical use.

Dysphagia: an unusual presentation of metastatic uterine cervical carcinoma

Worldwide, cervical cancer is the third most common cancer among women and the fourth leading cause of death from cancer. The most common sites of metastasis are the pelvic lymph nodes, vagina, and the pelvic sidewalls. Distant metastases are uncommon but can involve the bone, lung, and liver. Characteristics associated with increased rate of distant metastasis include bulky tumor, endometrial extension, lymph node involvement, and advanced disease. We report the case of a woman with stage II cervical carcinoma, who presented with dysphagia due to cervical cancer metastases to the mediastinum

Clostridium thermocellum Cel5L – Cloning and Characterization of a New, Thermostable GH5 Cellulase.

Aims: Clostridium thermocellum is a thermophilic, anaerobic bacterium that ferments cellulose and produces ethanol. While many of the predicted cellulases have been characterized from C. thermocellum, characterization of additional members is still needed to unravel the function of these enzymes. Study Design: This report describes the first cloning, expression, characterization, and evaluation in cellulose degradation of Clostridium thermocellum Cel5L as well as its relationship to other cellulases. Results: Cel5L, a 526 amino acid protein that shows low homology to other cellulases of C. thermocellum, possesses both endo and exo activity on -glucan, carboxymethylcellulose, and cellooligosaccharides; the enzyme does not hydrolyze xylan, xyloglucan or glucomannan. When combined with exo-cellulases and -glucosidase, Cel5L generates more glucose from cellulose than other tested C. thermocellum GH5 cellulases, which is surprising due to the lack of an annotated carbohydrate binding module. The Cel5L phylogenetic tree shows orthologs in both mesophilic and thermophilic cellulose degraders. Conclusion: The presence of these orthologs in a variety of molecular constructs demonstrates the importance of Cel5L and its orthologs in cellulose degradation, both in C. thermocellum as well as other gram-positive cellulose degraders.

Intubación endotraqueal con broncoscopio fibróptico flexible en paciente con bocio no tóxico severo / Endotracheal intubation with flexible fiberoptic bronchoscope in patients with severe nontoxic goiter

Introducción: Los pacientes con bocio severo no tóxico pueden manifestar síntomas obstructivos de la vía aérea con implicaciones importantes para la conducta anestesiológica. El uso del broncoscopio flexible es la alternativa de primera línea para la intubación endotraqueal de estos enfermos. Paciente: Mujer de 34 años con bocio severo que ingresó para exéresis quirúrgica de un nódulo frío en el polo inferior del lóbulo derecho del tiroides. Se intubó la tráquea con el uso de un broncoscopio flexible mientras se mantuvo respirando espontáneamente, sedada con una infusión continua de dexmedetomidina. Conclusiones: La intubación fibróptica se considera el «patrón de oro¼ para el abordaje de la vía aérea difícil anticipada. El estudio y la práctica de esta técnica por el anestesiólogo resultan una necesidad perentoria.

Background: Patients with severe nontoxic goiter can present obstructive symptoms of the airways with important implications for the anaesthesiology behaviour. The use of the flexible fiberoptic bronchoscope is a first line alternative for the endotracheal intubation in these patients. Patient: 34-year-old woman suffering from severe goiter who was atmitted to hospital to undergo a surgical exerecis of a cold nodule located in the lower pole of the right lobe of the thyroid gland. The trachea was intubated using a flexible bronchoscope while she was breathing spontaneously and sedated with a continuous infusion of Dexmedetomidine. Conclusions: The fiberoptic intubation is considered "the gold pattern" for the approach of the anticipated difficult airway. The study and practice of this technique by the anaesthesiologist constitute an urgent need.

GEPRO: Gene Expression Profiler for DNA microarray data / GEPRO: Analizador de Expresión Genética para datos provenientes demicroarreglos de DNA / GEPRO: Analisador de Expressão Gênica para dados provenientes de microarranjosde DNA

The DNA microarray technology has been widely employed in recent biological research. However,the unprecedented large amount of data produced by the technology has presented inevitable challengesto biological scientists, forcing individual researchers to take extensive training or rely on databasespecialists for the use of the data. Microsoft Excel® has a number of convenient functions and may be themost widely used spreadsheet package for data storage and manipulation. Therefore, we developed a userfriendly,Excel spreadsheet-based microarray data-managing program. The program, gene expressionprofiler (GEPRO), is designed to facilitate organizing miocroarray data, performing statistical analysis,and displaying the results. Using GEPRO’s filtering and sorting capabilities, a user can easily identifydifferentially expressed genes, display the expression profiles of the genes of interest, and present andsave the analyzed data in a user-defined way. The versatility and utility of GEPRO should enable benchwork researchers to maximize the use of their microarray data. The GEPRO is freely available for noncommercialusers at http://www.mc.uky.edu/cls/ko/gepro1.html.

La tecnología de microarreglos de DNA es actualmente empleada de manera amplia en investigaciónbiológica. Sin embargo, el manejo de la enorme cantidad de datos generados por la misma representa un desafió para los investigadores, forzándolos a invertir valioso tiempo en capacitación sobre dicho manejo, o aconfiar el uso de la misma a especialistas en bases de datos. El programa Excel® de Microsoft, la hoja de calculomas ampliamente utilizada a nivel mundial, que cuenta con muchas funciones útiles para almacenamiento ymanipulación de datos, fue utilizado por nosotros para desarrollar una aplicación amigable para el manejode datos generados por microarreglos de DNA. Nuestro programa, llamado “Gene Expression Profiler”(GEPRO), esta diseñado para facilitar la organización de datos de microarreglos, realizar su análisisestadístico, y presentar los resultados. Utilizando la posibilidad de filtrado y ordenamiento de datos queofrece GEPRO, el usuario puede identificar fácilmente diferentes genes, observar los perfiles de expresión delos genes de interés, así como presentar y guardar los datos de diversas maneras. La versatilidad y utilidad deGEPRO ayuda a los investigadores a maximizar la utilización de sus datos de microarreglos. GEPRO es unaaplicación gratuita, disponible para uso no comercial en http://www.mc.uky.edu/cls/ko/gepro1.html.

A Tecnologia dos Mircroarranjos de DNA é muito empregada em pesquisa biológica. Mas o manejo dagrande quantidade de dados gerados é um desafio para os pesquisadores, os quais estão sendo forçados arealizar grandes investimentos econômicos e de tempo para sua capacitação ou em confiar em expertos dainformática para analisar seus dados. O programa Excel® da Microsoft, amplamente utilizada no mundofoi utilizado para desenvolver uma aplicação amigável para o manejo de dados gerados por Mircroarranjosde DNA. O nosso programa, chamado “Gene Expression Profiler” (GEPRO), está desenhado para facilitara organização de dados, permite realizar as respectivas análises estatísticas e apresentar os resultados.Utilizando a possibilidade de filtrar e organizar os dados que oferece GEPRO, o usuário pode identificarpares de genes, observarem os perfis da expressão dos genes de interesse, assim como a possibilidadede apresentar e salvar os dados de diferentes formas. A versatilidade e a utilidade do programa, ajudaaos pesquisadores a maximizar a utilização dos dados. GEPRO é uma aplicação gratuita para uso nãocomercial, disponível em http://www.mc.uky.edu/cls/ko/gepro1.html.

The Optimization of Scan Timing for Contrast-Enhanced Magnetic Resonance Angiography

OBJECTIVE: To determine the optimal scan timing for contrast-enhanced magnetic resonance angiography and to evaluate a new timing method based on the arteriovenous circulation time. MATERIALS AND METHODS: Eighty-nine contrast-enhanced magnetic resonance angiographic examinations were performed mainly in the extremities. A 1.5T scanner with a 3-D turbo-FLASH sequence was used, and during each study, two consecutive arterial phases and one venous phase were acquired. Scan delay time was calculated from the time-intensity curve by the traditional (n = 48) and/or the new (n = 41) method. This latter was based on arteriovenous circulation time rather than peak arterial enhancement time, as used in the traditional method. The numbers of first-phase images showing a properly enhanced arterial phase were compared between the two methods. RESULTS: Mean scan delay time was 5.4 sec longer with the new method than with the traditional. Properly enhanced first-phase images were found in 65% of cases (31/48) using the traditional timing method, and 95% (39/41) using the new method. When cases in which there was mismatch between the target vessel and the time-intensity curve acquisition site are excluded, erroneous acquisition occurred in seven cases with the traditional method, but in none with the new method. CONCLUSION: The calculation of scan delay time on the basis of arteriovenous circulation time provides better timing for arterial phase acquisition than the traditional method.

Pattern and psycho-social, behavioral environmental risk factors for schistosomiasis infection among Egyptian school children

This article presented schistosomiasis infection pattern and described different infection/reinfection risk factors among a cohort of school children over a period of one year. Baseline data revealed a prevalence of 43.9% and a geometric mean egg count [GMEC] per gram stool among infected children of 319. Two months and one year later, the prevalence was 8.1% with GMEC of 54.5 and 15.9% with GMEC of 60.2, respectively, with 63.7% relative reduction in prevalence. Incidence rate was 12.9%, reinfection rate was 17.2% with GMEC of 74.2. Both infected boys and infected girls were more significantly involved with farming and irrigation with canal water during the growth of certain crops than were their uninfected counter-parts. Washing animals was also found to increase one's risk for schistosomiasis. Although most houses had access to tap water, the inconsistency of adequate water supply appears to be a common problem. Dirty floors that would become muddy with a good deal of washing was also a factor. The lack of alternative, affordable, competitive sports were identified as a reason why some boys choose to swim in the canals