The effects of the Trendelenburg position and intrathoracic pressure on the subclavian cross-sectional area and distance from the subclavian vein to pleura in anesthetized patients.

BACKGROUND: The effects of maneuvers to increase intrathoracic pressure and of Trendelenburg position on the cross-sectional area (CSA) of the subclavian vein (SCV) and the relationship between the SCV and adjacent structures have not been investigated. METHODS: In ultrasonography-guided SCV catheterization (N = 30), the CSA of the SCV and the distance between the SCV and pleura (DSCV-pleura) were determined during 10-second airway opening, and 10-second positive inspiratory hold with 20 cm H2O in the supine position (S-0, and S-20) and the 10° Trendelenburg position (T-0, and T-20). In addition to a statistical significance of P < 0.05, CSA and DSCV-pleura differences of ≥15% were defined as clinically relevant changes. RESULTS: CSA (mean [95% confidence interval]) in S-20, T-0, and T-20 (1.02 [0.95-1.14] cm(2), 1.04 [0.95-1.15] cm(2), and 1.14 [1.04-1.24] cm(2), respectively) was significantly larger than a CSA in S-0 (0.93 [0.86-1.00] cm(2), all P < 0.001). However, only the increase of CSA in T-20 vs S-0 (0.21 cm(2), 23.2%) was clinically meaningful (≥15%). The number of patients who showed CSA increase ≥15% was more in S-0 to T-20 (57%) compared with those in S-0 to S-20 (23%) and S-0 to T-0 (27%). DSCV-pleura measurements (mean) in S-20 and T-20 (0.61 and 0.60 cm) were significantly shorter than those in S-0 (0.70 cm, all P < 0.001), but the reductions of DSCV-pleura were not clinically meaningful (≥15%). CONCLUSIONS: The combined application of inspiratory hold and Trendelenburg position provided a greater and more relevant degree of CSA increase without compromising DSCV-pleura, which may facilitate SCV catheterization. Further investigations are needed to determine whether these results affect the success rate of catheterization and the risk of procedural injury.

Characterization of a Test for Invasive Breast Cancer Using X-ray Diffraction of Hair-Results of a Clinical Trial.

OBJECTIVE: To assess the performance of a test for breast cancer utilizing synchrotron x-ray diffraction analysis of scalp hair from women undergoing diagnostic radiology assessment. DESIGN AND SETTING: A double-blinded clinical trial of women who attended diagnostic radiology clinics in Australia. PATIENTS: 1796 women referred for diagnostic radiology, with no previous history of cancer. MAIN OUTCOME MEASURES: Sensitivity, specificity and accuracy of the hair test analysis compared to the gold standard of imaging followed by biopsy where indicated. RESULTS: The hair-based assay had an overall accuracy of >77% and a negative predictive value of 99%. For all women, the sensitivity of both mammography and X-ray diffraction alone was 64%, but when used together the sensitivity rose to 86%. The sensitivity of the hair test for women under the age of 70 was 74%. CONCLUSION: In this large population trial the association between the presence of breast cancer and an altered hair fibre X-ray diffraction pattern previously reported has been confirmed. It appears that mammography and X-ray diffraction of hair detect different populations of breast cancers, and are synergistic when used together.

Strategies for data collection and calibration with a pinhole-geometry SAXS instrument on a synchrotron beamline.

Undulator X-ray sources on third-generation synchrotrons have pushed small-angle X-ray scattering (SAXS) to the forefront of techniques in nanoscience and technology. With higher X-ray fluxes and improved focusing, it is usually the scattered intensity detector that places the most serious limitations on the overall capabilities of the instrument. Incorporating relatively simple components like point detectors, scattering standards, masking filters and in-line sample visualization into the flight tube of a pinhole-geometry SAXS camera can do much to mitigate these limitations. How these enhancements can be incorporated into routine data collection is demonstrated on the ChemMatCARS SAXS instrument, which utilizes pinhole geometry with an undulator insertion device at sector 15 of the Advanced Photon Source. In addition, with an X-ray energy range of 6-32 keV (2.0-0.4 A) and an energy resolution of 10(-4) DeltaE/E, this instrument can measure anomalous SAXS over a wide variety of atom species, with reliable normalization of scattered data.