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.

Epidural Analgesia and Abnormal Coagulation in Patients Undergoing Minimal Invasive Repair of Pectus Excavatum

Background:Epidural analgesia (EA) is effective in patients undergoing minimal invasive repair of pectus excavatum(MIRPE) but is associated with major complications such as epidural hematomas. It is recommended to assess coagulation status in patients receiving anticoagulant therapy prior to EA, although no consensus exists in patients without a history of bleeding tendency or anticoagulant therapy. Thus, the aim of this paper was to assess 1) the prevalence of abnormal routine coagulation parameters, i.e., international normalized ratio (INR) and platelet count, and 2) the safety of EA in patients undergoing MIRPE. Methods: In this retrospective study, we identified 1,973 patients undergoing MIRPE at our center between 2001 and 2019. Complications related to EA were registered for all patients. Information on coagulation parameters was present in 929 patients. Patients with spontaneously elevated INR ?1.5 were referred for assessment of coagulation factor VII in order to assess the cause of the elevated INR. Results: Of 929 patients with coagulation information available, 18 patients had spontaneously elevated INR ?1.5 (1.9%). In patients with INR ?1.5, 12 patients underwent further assessment of factor VII, with all patients having a slightly reduced factor VII close to the lower reference range. The majority of the 1,973 patients undergoing MIRPE received EA (99.6%) with very low complication rates (0.2%) and no incidence of epidural hematomas. Conclusion: In patients undergoing MIRPE, coagulation screening prior to EA should not be mandatory as it revealed no clinically relevant consequences. EA is safe with very low complication rates

Pauliceia 2.0: mapeamento colaborativo da história de São Paulo, 1870-1940 / Pauliceia 2.0: collaborative mapping of the history of São Paulo, 1870-1940

Resumo O artigo apresenta novas abordagens para investigar o passado usando tecnologias digitais. O projeto "Pauliceia 2.0: mapeamento colaborativo da história de São Paulo (1870-1920)" é de código aberto e visa engajar o público de maneira ampla, usando metodologias colaborativas. O texto discute a concepção do projeto, seu estágio atual e suas perspectivas. Além disso, também se oferece o Pauliceia 2.0 como um estudo de caso para discutir a relação entre tecnologias digitais e métodos históricos. O resultado desse percurso, ao menos essa é a intenção dos autores listados e dos demais integrantes da equipe do projeto, nomeados ao final do artigo, almeja ressignificar o trabalho em questão na confluência entre humanidades digitais, história pública e ciência aberta.

Abstract This article presents new approaches for investigating the past using digital technologies. "Pauliceia 2.0: collaborative mapping of the history of São Paulo (1870-1920)" is an open-source project intended to broadly engage with the public through collaborative methodologies. This text discusses the concept, current status, and prospects of this project, and presents it as a case study to discuss the relationship between digital technologies and historical methods. The product of this journey (at least the outcome intended by the authors and the other team members listed at the end of the article) is meant to assign new meaning to the project at the juncture between digital humanities, public history, and open science.

Human Gut Microbiota and Gastrointestinal Cancer / 基因组蛋白质组与生物信息学报·英文版

Human gut microbiota play an essential role in both healthy and diseased states of humans. In the past decade, the interactions between microorganisms and tumors have attracted much attention in the efforts to understand various features of the complex microbial communities, as well as the possible mechanisms through which the microbiota are involved in cancer prevention, carcinogenesis, and anti-cancer therapy. A large number of studies have indicated that microbial dysbiosis contributes to cancer susceptibility via multiple pathways. Further studies have suggested that the microbiota and their associated metabolites are not only closely related to carcinogenesis by inducing inflammation and immune dysregulation, which lead to genetic instability, but also interfere with the pharmacodynamics of anticancer agents. In this article, we mainly reviewed the influence of gut microbiota on cancers in the gastrointestinal (GI) tract (including esophageal, gastric, colorectal, liver, and pancreatic cancers) and the regulation of microbiota by diet, prebiotics, probiotics, synbiotics, antibiotics, or the Traditional Chinese Medicine. We also proposed some new strategies in the prevention and treatment of GI cancers that could be explored in the future. We hope that this review could provide a comprehensive overview of the studies on the interactions between the gut microbiota and GI cancers, which are likely to yield translational opportunities to reduce cancer morbidity and mortality by improving prevention, diagnosis, and treatment.

Risk of avascular necrosis of the femoral head in children with sickle cell disease on hydroxyurea: mri evaluation

Background: There are conflicting reports on the role of hydroxyurea [HU] in the pathogenesis of avascular necrosis of the femoral head [AVNFH] in patients with sickle cell disease [SCD]

Procedure: The present study is a prospective cohort study of Kuwaiti children with SCD who were treated with HU. They had magnetic resonance imaging of the hips before starting HU and at regular intervals during a follow-up period, ranging from 1 to 15 years

Results: There were 40 patients [18 SS, 19 S?0-thalassemia, and three SD genotypes], aged 6-20 years. Pre-HU, 11 [27.5%] had varying grades of AVNFH, while post HU, the prevalence was 32.5%. Two patients developed new lesions during the study, while five [45.5%] that had lesions pre-HU remained static, another five [45.5%] progressed, and one [9%] improved radiologically. The older patients who had been on HU the longest were more likely to deteriorate. The only hematological parameter that was consistently associated with AVNFH was the reticulocyte count

Conclusions: The frequency and rate of progression of AVNFH in this study is much less than that previously reported for our patients not treated with HU. There is no evidence that HU therapy is a risk factor for AVNFH. It may, in fact, prevent new lesions and deter the progression of existing AVNFH

HRL-Local Infinite Triangular Array Languages

ABSTRACT A new subclass of infinite triangular arrays called hrl-local infinite triangular arrays is introduced. We introduce infinite triangular domino systems to recognize the infinite triangular picture language. Also we introduce strictly domino testable ωω-triangular array languages.

Correlation of in vivo and in vitro methods in measuring choroidal vascularization volumes using a subretinal injection induced choroidal neovascularization model / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In vivo quantification of choroidal neovascularization (CNV) based on noninvasive optical coherence tomography (OCT) examination and in vitro choroidal flatmount immunohistochemistry stained of CNV currently were used to evaluate the process and severity of age-related macular degeneration (AMD) both in human and animal studies. This study aimed to investigate the correlation between these two methods in murine CNV models induced by subretinal injection.</p><p><b>METHODS</b>CNV was developed in 20 C57BL6/j mice by subretinal injection of adeno-associated viral delivery of a short hairpin RNA targeting sFLT-1 (AAV.shRNA.sFLT-1), as reported previously. After 4 weeks, CNV was imaged by OCT and fluorescence angiography. The scaling factors for each dimension, x, y, and z (μm/pixel) were recorded, and the corneal curvature standard was adjusted from human (7.7) to mice (1.4). The volume of each OCT image stack was calculated and then normalized by multiplying the number of voxels by the scaling factors for each dimension in Seg3D software (University of Utah Scientific Computing and Imaging Institute, available at http://www.sci.utah.edu/cibc-software/seg3d.html). Eighteen mice were prepared for choroidal flatmounts and stained by CD31. The CNV volumes were calculated using scanning laser confocal microscopy after immunohistochemistry staining. Two mice were stained by Hematoxylin and Eosin for observing the CNV morphology.</p><p><b>RESULTS</b>The CNV volume calculated using OCT was, on average, 2.6 times larger than the volume calculated using the laser confocal microscopy. The correlation statistical analysis showed OCT measuring of CNV correlated significantly with the in vitro method (R 2 =0.448, P = 0.001, n = 18). The correlation coefficient for CNV quantification using OCT and confocal microscopy was 0.693 (n = 18, P = 0.001).</p><p><b>CONCLUSIONS</b>There is a fair linear correlation on CNV volumes between in vivo and in vitro methods in CNV models induced by subretinal injection. The result might provide a useful evaluation of CNV both for the studies using CNV models induced by subretinal injection and human AMD studies.</p>

Oral mucocele treated using diode laser: a case report

The mucocele is a salivary gland pathology that results from rupture of salivary gland duct and spillage of mucin into the surrounding tissues. The term mucous extravacation is also used to describe this lesion. The rupture of the gland or duct may be due to local trauma. The most common site of mucocele is lower lip. The treatment of mucocele includes cryosurgery , intra-lesional corticosteroid injection, micro-marsupialization, marsupialization of the mucocele, conventional surgical removal of the lesion , and laser ablation. The advantages of laser ablation over other methods include less treatment time, avoidance of suturing, minimal complications and relapse. Here we report a case of mucocele on lower lip treated using diode laser.

Actigraphy in post traumatic stress disorder

Patients with posttraumatic stress disorder [PTSD] frequently complain of sleep disturbances such as insomnia and nightmares. Evaluation of sleep disturbances is often difficult due to the subjective nature of the complaints. Polysomnography [PSG] and other sleep studies are generally not indicated in the evaluation of insomnia or nightmares associated with PTSD. Actigraphy, [electronic activity monitoring] has been used in research to evaluate sleep disturbances in patients with PTSD. We reviewed the literature on the use of actigraphy in evaluation of sleep problems in patients with PTSD. A literature search for articles on the topic was conducted on PubMed using the search algorithm [actigraphy [Title/Abstract] OR actigraphic [Title/Abstract]] AND PTSD [Title/Abstract]. Out of 11 search results, 9 studies in which application of actigraphy had relevance to the primary objective and outcome in PTSD patients with sleep problems were selected for review. We also handpicked one additional article from personal communication with our colleagues who have done some of these studies. Actigraphy has been used to evaluate circadian rhythm sleep disorders. Use of actigraphy in psychiatry clinics is uncommon. There is no data to support that there are specific actigraphic sleep related findings in PTSD patients. However, it can be a useful tool to complement the use of sleep diaries when assessing sleep and wake patterns in patients with PTSD

The Spectrum of Liver Diseases in HIV Infected Individuals at an HIV Treatment Clinic in Kampala; Uganda

Background: Liver diseases are common in patients with HIV due to viral hepatitis B and C co-infections; opportunistic infections or malignancies; antiretroviral drugs and drugs for opportunistic infections. Objective: To describe the spectrum of liver diseases in HIV-infected patients attending an HIV clinic in Kampala; Uganda. Method: Consecutive patients presenting with jaundice; right upper quadrant pain with fever or malaise; ascites and/or tender hepatomegaly were recruited and underwent investigations to evaluate the cause of their liver disease. Results: Seventy-seven consecutive patients were recruited over an eleven month period. Of these; 23 (30) had increased transaminases because of nevirapine (NVP) and/or isoniazid (INH) hepatotoxicity. Although 14 (61) patients with drug-induced liver disease presented with jaundice; all recovered with drug discontinuation. Hepatitis B surface antigen was positive in 11 (15) patients while anti-hepatitis C antibody was reactive in only 2 (3). Probable granulomatous hepatitis due to tuberculosis was diagnosed in 7 (9) patients and all responded to anti-TB therapy. Other diagnoses included alcoholic liver disease; AIDS cholangiopathy; hepatocellular carcinoma; schistosomiasis; haemangioma and hepatic adenoma. Twelve (16) patients died during follow-up of which 7 (9) died because of liver disease. Conclusion: Drug history; liver enzyme studies; ultrasound; and hepatitis B and C investigations identified the probable etiology in 60 (78) of 77 patients with HIV infection presenting with symptoms and/or signs of liver disease

Efectos del plomo en la salud de la niñez / Effects of lead exposure on children's health

El plomo es un elemento que no tiene ninguna función fisiológica conocida en los seres humanos, pero cuyos efectos adversos inciden sobre una diversidad de procesos bioquímicos esenciales. Existe evidencia considerable acerca de los efectos adversos sobre la salud de los niños del plomo en niveles que son comunes a distintas poblaciones en todo el mundo. La intoxicación aguda por plomo, que ocasiona encefalopatía, a pesar de no ser frecuente, sí pone en riesgo la vida y requiere de un tratamiento agresivo y oportuno. Es necesario tenerla presente en el diagnóstico diferencial de toda enfermedad no explicada que incluya anemia, convulsiones, letargo, dolor abdominal, o vómito recurrente. Existe una gran cantidad de niños que padecen los efectos subclínicos crónicos debidos a la exposición de bajo nivel al plomo, y que incluyen un desarrollo cognitivo deficiente, trastornos en la conducta, ligera deficiencia en la agudeza auditiva, y talla reducida. La evidencia disponible indica que las únicas intervenciones efectivas para evitar la intoxicación de bajo nivel por plomo son aquellas que se aplican para controlar la exposición a este metal.

Two-dimensional map of direction selectivity in cortical visual area MT of Cebus monkey

We studied the spatial organization of direction of motion in visual area MT of the Cebus apella monkey. We used arrays of 6 (700 æm apart) parallel electrodes in penetrations tangential to the cortical layers to record multi-unit responses to moving bars, at 200 æm steps. We determined the direction selectivity at each recording site. The data from single penetrations showed cyclic and gradual changes in the direction selectivity of clusters of cells, intermixed with abrupt 180º discontinuities along the electrode track. In order to obtain maps of direction of motion selectivity, we examined the spatial distribution of direction of motion in MT and we applied a method to determine the location of the centers of radial arrangements of direction selectivity. This tangential organization is characterized by slow continuous changes in direction of motion, interrupted by discontinuities. The changes in direction selectivity are organized radially in a pinwheel fashion and in slabs of linear variation. The pinwheel arrangements have 800-1400 æm in diameter. The size of the radial arrangement is comparable to the point image size in area MT at each eccentricity

Air Traffic Controller Shiftwork: What are the Implications for Aviation Safety? A Review

Most civilian and air traffic control facilities in the United States use rapid shift schedules. These schedules have generally been chosen for social reasons. Safety concerns have been raised because the air traffic controllers (ATCs) often carry an acute sleep dept onto the night-shift where they have little active work to do as they sit in the dark at the nadir of their circadian rhythms. This paper reviews advancing and delaying rapid shiftwork schedules, ATC workload factors as they relate to error rates and safety, and potential countermeasures. Recent studies indicate that ATC performance declines on the night-shift and that ATCs may be falling asleep while on-duty. There is indirect evidence that ATC error rates are highest on the night-shift. There are only limited studies which have evaluated potential countermeasures. The operational significance of the problems associated with ATC shiftwork is not yet clear. Further study is needed

Effect of irradiation on microbial indicators during sewage treatment

A study was carried out to assess the changes in the population densities of certain microbial groups of hygienic significance throughout the successive steps of treatment in Virginia Key Wastewater Plant in Miami, Florida. Samples were taken from raw sewage, oxygenated tanks, settling tanks and chlorinated effluent. Total count, total coliform, Streptococcus faecalis, Aeromonas hydrophila and coliphage increased or remained unchanged after oxygenation but they sharply decreased in settling and chlorination tanks were more than 99% reduction in counts initially present was observed. A. hydrophila and coliphage were still detected in the final effluent. With respect to the last stages of treatment till the production of dewatered sludge, all tested groups of microorganisms attained their highest values in the effluent of concentration tanks. They decreased throughout the steps of treatment till the dewatered sludge to attain 106-105 cfu/g for total counts and total coliform as well as 104 cfu/g for A. hydrophila and S. faecalis and 103 pfu/g for coliphage. An experiment was conducted to study the efficiency of gamma radiation in reducing the microbial load in the chlorinated effluent and dewatered sludge. In the chlorinated effluent, total counts, S. faecalis and coliphage were eliminated with 2 kGy while 1 kGy was sufficient to eradicate total coliform and A. Hydrophila. Regarding the dewatered sludge, a dose of 6 kGy was quite sufficient to decrease total counts from 6x105 to few cells/g. Whereas, total coliform, S. Faecalis and A. hydrophila could not be detected after irradiation with 2,4 and 1 kGy respectively. Coliphage was eliminated after irradiation with 6 kGy. Another experiment was carried out to compare the effect of gamma radiation with that of electron beam on microbial groups in chlorinated effluent. At any given dose of radiation, gamma rays proved to be of more lethal than electron beam for all types of organisms

Fighting; no battling for child survival in Sierra Leone; what ammunition?

The sustainability of the child survival and development interventions has always been an imoprtant concern and an awareness of its crucial importance has led to greater efforts to integrate them into PHC programmes. But the cynic will ask: what after UCI in 1990? What after achieving our national coverage of 80 per cent immunization rate? What of the other child saving measures? Without doubt reaching a state of herd community will more than half the alarming infant morbidity and mortality rates and can be a significant benchmark on the road to Health For All by Year 2000. The government of Sierra Leone/UNICEF social mobilization drive; without doubt; has created the awareness in every nook and cranny in Sierra Leone that the GOBBI/FFF septet is very crucial to children's survival and development

Health human resources in the United States of America

En el artículo se examinan de manera sintética los recursos humanos de salud en los Estados Unidos de América. Se señala que el tipo de provisión de servicios y de financiamiento ha cambiado y, por esta causa, también la práctica profesional y la utilización de las profesiones. Se indica que el número de personal que ejerce y de graduados en todas las profesiones de salud continuó aumentando en el decenio de 1980, aunque el ritmo fue más lento que en el decenio de 1970; la oferta refleja esa misma curva. En una sociedad tan desarrollada y compleja, que posee la mayor cantidad y variedad de información del mundo, cada factor de la sociedad tiene repercusiones múltiples sobre la oferta y la demanda del sector salud, que el autor menciona. Entre ellas se pueden citar las intervenciones del Gobierno Federal, la influencia del seguro de salud (Medicare), los cambios demográficos, las restricciones a la inmigración de profesionales, la presencia de grupos minoritarios, la participación creciente de la mujer en la fuerza de trabajo, etc