Safety of percutaneous versus transjugular liver biopsy: A propensity score matched analysis.

PURPOSE: This study sought to identify the complication, mortality, and readmission rates of patients undergoing either percutaneous (PCLB) or transjugular liver biopsy (TJLB) when propensity matched for demographics and hepatic comorbidities. METHODS: A retrospective review of New York's Statewide Planning and Research Cooperative System ICD9 coded database from the years 2009-2013 was conducted. Patients over the age of 18 undergoing either PCLB or TJLB were included. Patients with hepatic neoplasm or metastasis were excluded. 2:1 PCLB:TJLB propensity match for age, race, payment, coagulopathy, thrombocytopenia/purpura, hypercoagulability, ascites, acute liver failure, chronic hepatitis, cirrhosis, and bone marrow disease was conducted. Univariate analysis compared demographics, complications, readmissions, and mortality. RESULTS: 1467 patients met inclusion criteria (PCLB = 978, TJLB = 489). Propensity match was successful in that there were no significant differences in demographics or hepatic comorbidities. TJLB had significantly lower rates of hematoma (0.20 % vs 1.20 %, p = 0.049) and higher rates of cardiac complications (0.40 % vs 0.00 %, p = 0.045). Other complication, readmission, and mortality rates did not differ significantly. Logistic regression found no significant predictors of readmission within 7 days or any complication within 5 days. CONCLUSION: This retrospective, multi-center database review of adult patients undergoing PCLB or TJLB propensity matched for demographics and hepatic comorbidities found that TJLB patients had a significantly higher rate of cardiac complications while PCLB patients had a significantly higher rate of hematoma. These findings support prior literature suggesting a trend towards safety of TJLB compared to PCLB in patients with hemostatic disorders and/or advanced liver disease.

Optical imaging of dose distributions in Fricke gels.

Ferrous-sulphate infused gels, or 'Fricke gels', encounter great interest in the field of radiation dosimetry, due to their potential for 3D radiation dose mapping. Typically, magnetic resonance (MR) relaxation rates are determined in these systems in order to derive the absorbed dose. However, when large concentration gradients are present, diffusion effects before and during the MR imaging may not be negligible. In these cases, optical techniques may represent a viable alternative. This paper describes research aimed at measuring 3D dose distributions in a Fricke-xylenol orange gel by measuring optical density with a CCD camera. This method is inexpensive and fast. A series of early experiments is described, in which optical density profiles were measured with a commercial microdensitometer for film dosimetry. The light box of the device was modified to work at 567 nm, close to the maximum absorbance of the ferric ion-xylenol orange complex. Under these conditions, the gel shows linearity with dose and high sensitivity.

Energetics of nanocrystalline TiO2.

The energetics of the TiO(2) polymorphs (rutile, anatase, and brookite) were studied by high temperature oxide melt drop solution calorimetry. Relative to bulk rutile, bulk brookite is 0.71 +/- 0.38 kJ/mol (6) and bulk anatase is 2.61 +/- 0.41 kJ/mol higher in enthalpy. The surface enthalpies of rutile, brookite, and anatase are 2.2 +/- 0.2 J/m(2), 1.0 +/- 0.2 J/m(2), and 0.4 +/- 0.1 J/m(2), respectively. The closely balanced energetics directly confirm the crossover in stability of nanophase polymorphs inferred by Zhang and Banfield (7). An amorphous sample with surface area of 34,600 m(2)/mol is 24.25 +/- 0.88 kJ/mol higher in enthalpy than bulk rutile.

Image registration of BANG gel dose maps for quantitative dosimetry verification.

BACKGROUND: The BANG (product symbol SGEL, MGS Research Inc., Guilford, CT) polymer gel has been shown to be a valuable dosimeter for determining three-dimensional (3D) dose distributions. Because the proton relaxation rate (R2) of the gel changes as a function of absorbed dose, MR scans of the irradiated gel can be used to generate 3D dose maps. Previous work with the gel, however, has not relied on precise localization of the measured dose distribution. This has limited its quantitative use, as no precise correlation exists with the planned distribution. This paper reports on a technique for providing this correlation, thus providing a quality assurance tool that includes all of the steps of imaging, treatment planning, dose calculation, and treatment localization. METHODS AND MATERIALS: The BANG gel formulation was prepared and poured into spherical flasks (15.3-cm inner diameter). A stereotactic head ring was attached to each flask. Three magnetic resonance imaging (MRI) and computed tomography (CT) compatible fiducial markers were placed on the flask, thus defining the central axial plane. A high-resolution CT scan was obtained of each flask. These images were transferred to a radiosurgery treatment-planning program, where treatment plans were developed. The gels were irradiated using our systems for stereotactic radiosurgery or fractionated stereotactic radiotherapy. The gels were MR imaged, and a relative 3D dose map was created from an R2 map of these images. The dose maps were transferred to an image-correlation program, and then fused to the treatment-planning CT scan through a rigid body match of the MRI/CT-compatible fiducial markers. The fused dose maps were imported into the treatment-planning system for quantitative comparison with the calculated treatment plans. RESULTS: Calculated and measured isodose surfaces agreed to within 2 mm at the worst points within the in-plane dose distributions. This agreement is excellent, considering that the pixel resolution of the MRI dose maps is 1.56 x 1.56 mm, and the treatment-planning dose distributions were calculated on a 1-mm dose grid. All points within the dose distribution were well within the tolerances set forth for commissioning and quality assurance of stereotactic treatment-planning systems. Moreover, the quantitative evaluation presented here tests the accuracy of the entire treatment-planning and delivery process, including stereotactic frame rigidity, CT localization, CT/MR correlation, dose calculation, and radiation delivery. CONCLUSION: BANG polymer gel dosimetry coupled with image correlation provides quantitative verification of the accuracy of 3D dose distributions. Such quantitative evaluation is imperative to ensure the high quality of the 3D dose distributions generated and delivered by stereotactic and other conformal irradiation systems.

Radiation dose distributions in three dimensions from tomographic optical density scanning of polymer gels: I. Development of an optical scanner.

A new method of dosimetry of ionizing radiations has been developed that makes use of tissue-equivalent polymer gels which are capable of recording three-dimensional dose distributions. The dosimetric data stored within the gels are measured using optical tomographic densitometry. The dose-response mechanism relies on the production of light scattering microparticles which result from the polymerization of acrylic comonomers dispersed in the gel. The attenuation of a collimated light beam caused by scattering in the irradiated optically turbid medium is directly related to the radiation dose over the range 0-10 Gy. An optical scanner has been developed which incorporates an He-Ne laser, photodiode detectors, and a rotating gel platform. Using mirrors mounted on a translating stage, the laser beam scans across the gel between each incremental rotation of the platform. Using the set of optical density projections obtained, a cross sectional image of the radiation field is then reconstructed. Doses in the range 0-10 Gy can be measured to better than 5% accuracy with a spatial resolution approximately 2 mm using the current prototype scanner. This method can be used for the determination of three-dimensional dose distributions in irradiated gels, including measurements of the complex distributions produced by multi-leaf collimators, dynamic wedge and stereotactic treatments, and for quality assurance procedures.

Long-term follow-up of families in an endemic area.

Gandhi Memorial Leprosy Foundation started its leprosy control work around Sevagram village in Wardha District (State of Maharashtra) in 1952. Long-term followup records of families of twenty-seven villages in this area were analyzed to assess the leprosy profile. In this paper, the data on household contacts followed from 1952 to 1986 are presented. This study is based on 6284 healthy contacts of 1184 primary cases detected during the period 1952 to 1984. Of the 1184 primary cases, 242 were detected initially in 1952, the starting year of leprosy control work in the Sevagram leprosy control unit. The total attack rate among household contacts of all types of leprosy was 4.46 per 1000 person years of risk (PYR). In contacts of L/BL/BB types of leprosy (corresponding to present day multibacillary) cases it was 9.86 per 1000 PYR; and in contacts of 'N' type of cases (corresponding to present day paucibacillary leprosy) it was 3.9 per 1000 PYR. Amongst non-exposed population, the rate was 1.98 per 1000 PYR. Attack rate was found to be increasing with BI of primary cases but it was not influenced by regularity of treatment of primary cases. Taking family as a unit, the risk of developing cases or additional cases of leprosy was similar in 'no-case' families and 'case families'.

p-maleimidophenyl isocyanate: a novel heterobifunctional linker for hydroxyl to thiol coupling.

p-Maleimidophenyl isocyanate (PMPI, 1) is a heterobifunctional cross-linking agent useful for thiol to hydroxyl coupling. Several maleimide-activated compounds were prepared and characterized and then shown to be reactive with thiol-containing proteins. Examples include activation of vitamin B12, digoxigenin, digitoxigenin, estradiol, progesterone, and some serine-containing peptides.

Integrated surveys as a tool for early case detection in leprosy control programme.

A project for total leprosy case detection particularly early leprosy cases was undertaken in Wardha District which has a rural population of about 6 lacs in 905 villages, through an integrated survey with the help of all health workers like Leprosy Technicians, Sanitary Inspectors, Co-ordinators, Malaria Workers, Smallpox Vaccinators and Auxillary Nurse Midwives. The training given to the Non Leprosy Health Worker was for a period of 3 days making them just fit to suspect all leprosy cases. The final diagnosis was to be made by the fully trained Leprosy Technicians. The surveys were conducted in batches of 3 to 4 workers. Surveys were conducted for 4 weeks at a stretch and working for 5 days every week. Every year two such integrated surveys were conducted. From November 1973 to December 1975, four such surveys were undertaken. During the other period, Leprosy Technicians were conducting the normal surveys. It was found that through these integrated survey it is possible to undertake the survey of all the villages once in two years and the case detection rate at the end of the 4th survey was found to be 85.5% of the estimated cases in the rural areas. Normally, it would have taken about 5 years to complete the survey of all the villages by the Leprosy Technicians alone, and the case detection rate could not have been more than 70 to 75%. Through this programme, Leprosy patients in every early stages have been detected. The paper discusses the methods, planning and the results obtained.