Piezoelectric signals of HAp and collagen with different glucose concentrations: A method for diabetes detection.

Piezoelectric signals were obtained from samples based on hydroxyapatite (HAp) and collagen (C) containing different glucose (G) concentrations. HAp was obtained by coprecipitation using Ca2+ and HPO42- as precursor ions in solution. C and G were added at the beginning of the coprecipitation method during the HAp growth. The presence of glucose in HAp and collagen samples drastically reduces the voltage amplitudes and considerably increases the relaxation times of the piezoelectric signals. HAp and collagen are the main constituents of bone, muscle, etc., then, it is possible to use piezoelectric technology for local and early detection of high glucose concentrations: small pressures applied by electrodes or by actuators placed in appropriate places on the body to establish a background concentration and, from this, to determine regions of the body with high local glucose concentrations: weak signals and large relaxation times are associated with a diminishing in the sensitivity, and are indicative of the presence of regions of abnormally high glucose concentrations.

Malignant Phyllodes Tumor in the male: A case report

@#Phyllodes tumors are breast tumors accounting for about 1% of all breast neoplasms in women and are rare in males. Reported here is a case of a 45-year-old male presenting with a rapidly enlarging right breast mass with invasion of the anterior chest wall. Core Needle Biopsy revealed Malignant Phyllodes Tumor. He underwent wide excision and chest wall resection. Reconstruction was performed using polyropelene mesh, a latissimus dorsi flap and split thickness skin grafting. Patient was discharged on the 33rd post-operative day due to delayed expansion of the right lung from splinting and subsequent near-complete loss of the split thickness skin graft over the latissimus muscle flap. On the recommendation of the plastic surgeon, the wound was allowed to heal by secondary intention. This report draws attention to the rarity of malignant phyllodes tumor in males, and the difficulty of recognizing a malignant pathology in males presenting with breast mass. It also highlights a cost-effective treatment option in the management of these tumors.

Omission of chemotherapy for hormone receptor-positive and human epidermal growth factor receptor 2-negative breast cancer: patterns of treatment and outcomes from the Korean Breast Cancer Society Registry.

Purpose: Although adjuvant chemotherapy (CTx) is still recommended for high-risk patients with hormone receptor-positive and human epidermal receptor (HER)-2-negative breast cancer, recent studies found that selected patients with low disease burden may be spared from CTx and receive hormonal treatment (HT) alone. This study aims to evaluate the trends of treatment (CTx + HT vs. HT alone) in Korea and to assess the impact on overall survival (OS) according to treatment pattern. Methods: The Korean Breast Cancer Society Registry was queried (2000 to 2018) for women with pT1-2N0-1 hormone receptor-positive and HER2-negative disease who underwent surgery and adjuvant systemic treatment (CTx and HT). Clinicopathologic factors, change in pattern of treatment over time, and OS for each treatment option were analyzed. Results: A total of 40,938 women were included in the study; 20,880 (51.0%) received CTx + HT, while 20,058 (49.0%) received HT only. In recent years, there has been a steady increase in the use of HT alone, from 21.0% (2000) to 64.6% (2018). In Cox regression analysis, age, type of breast and axillary operations, T and N stages, body mass index, histologic grade, and presence of lymphovascular invasion were prognostic indicators for OS. There was no significant difference between CTx + HT and HT alone in terms of OS (P = 0.126). Conclusion: Over the years, there has been a shift from CTx + HT to HT alone without a significant difference in OS. Therefore, HT alone could be a safe treatment option in selected patients, even those with T2N1 disease.

The use of machine learning to detect foraging behaviour in whale sharks: a new tool in conservation.

In this study we present the first attempt at modelling the feeding behaviour of whale sharks using a machine learning analytical method. A total of eight sharks were monitored with tri-axial accelerometers and their foraging behaviours were visually observed. Our results highlight that the random forest model is a valid and robust approach to predict the feeding behaviour of the whale shark. In conclusion this novel approach exposes the practicality of this method to serve as a conservation tool and the capability it offers in monitoring potential disturbances of the species.

Exploring the size adaptability of the B ring binding zone of the colchicine site of tubulin with para-nitrogen substituted isocombretastatins.

We have synthesized and assayed dimethylaminophenyl, pyrrolidin-1-ylphenyl and carbazole containing phenstatins and isocombretastatins as analogues of the highly potent indoleisocombretastatins with extended or reduced ring sizes. This is an attempt to explore beyond the structural constraints of the X-ray crystal structures the zone of the colchicine site where the tropolone ring of colchicine binds to tubulin (zone 1). The isocombretastatins display up to 30 fold increased water solubility when compared with combretastatin A-4, potent inhibition of tubulin polymerization, and nanomolar cytotoxicities against several human cancer cell lines irrespective of the size of the B ring. On the other hand, substitutions ortho to the nitrogen cause an important reduction in potency. We have also shown that representative compounds inhibit autophagy. These results show that zone 1 can adapt to systems of different size as far as they stay in a common plane, but does not tolerate substituents protruding above or below it. These results can help in the understanding of the binding modes of structures with similar systems and in the design of new colchicine site ligands.

Treatment with aliskiren/amlodipine combination in patients with moderate-to-severe hypertension: a randomised, double-blind, active comparator trial.

AIMS: To assess the extent of reduction in blood pressure (BP) of aliskiren/amlodipine combination therapy compared with amlodipine monotherapy in moderate-to-severe hypertensive patients. METHODS: This was an 8-week multicentre, randomised, double-blind study. After a 1-to 4-week washout period, eligible patients [mean sitting systolic blood pressure (msSBP) ≥ 160 to < 200 mmHg] were randomised to receive a once-daily dose of aliskiren/amlodipine 150/5mg (n = 244) or amlodipine 5 mg (n = 241) for 1 week, followed by up-titration to aliskiren/amlodipine 300/10 mg or amlodipine 10 mg for 7 weeks. Efficacy outcome measures included change from baseline to week 8 endpoint in msSBP (primary endpoint), mean sitting diastolic blood pressure (msDBP), and BP control rate (< 140/90 mmHg). Safety was assessed by monitoring and recording all adverse events (AEs) and laboratory abnormalities. RESULTS: Patients' demographic characteristics were balanced between the two groups, mean baseline BP being 171.0/94.3 mmHg for aliskiren/amlodipine and 171.8/95.6 mmHg for amlodipine. Of 485 randomised patients, 433 (89.3%) completed the study. At week 8 endpoint, combination therapy resulted in significantly greater msSBP/msDBP reductions and BP control rate, compared with monotherapy (all: p ≤ 0.0001). The overall incidence of AEs was similar between the two groups. The most commonly reported AE was peripheral oedema with the incidence lower for combination therapy (14.4%) than for monotherapy (18.3%). CONCLUSION: In this population with considerably elevated BP, use of aliskiren/amlodipine combination showed significantly greater BP reductions and allowed more patients to achieve BP control compared with amlodipine monotherapy, with no additional safety concerns.

Definitive surgery in stage IV breast cancer: A systematic review

Methods: Using the key words "surgery stage IV breast cancer", a PubMed search for all related articles published in the English language, between January 1999 to December 2009, was done. Of 292 articles yielded by the search, 25 articles focused on the impact of surgery in stage IV breast cancer. Full texts of these of these articles were then collated for this review. Results: No randomized controlled trials comparing the outcome of surgery versus no surgery in metastatic breast cancer have been published thus far. The search yielded only heterogenous data from several retrospective studies for which no systematic reviews or meta-analysis had been done. A summary of these retrospective data was done and reported herein. The reports are grouped into two: those based on population registries, and those coming from single institutions.

The value of touch imprint cytology in EUS-guided Trucut biopsy.

BACKGROUND: EUS-guided Trucut biopsy (TCB) enables the acquisition of tissue cores for histologic assessment. Touch imprint cytology (TIC) can be performed at the time of a biopsy to assess the adequacy of the sample; however, limited information is available on the diagnostic value of TIC of these specimens. OBJECTIVE: To investigate the diagnostic accuracy of TIC compared with a TCB. PATIENTS AND DESIGN: Consecutive EUS-guided TCB and TIC (n = 109) were retrospectively and independently reviewed by a surgical pathologist (for the TCB) and a cytopathologist (for TIC) blinded to the final diagnoses. SETTING: University of Iowa Hospitals and Clinics, Iowa. MAIN OUTCOME MEASUREMENTS: Diagnostic accuracy of a TCB, TIC, and combined TCB + TIC. RESULTS: The diagnostic accuracy of a TCB was 92.7% (95% CI, 83.1%-97.3%), TIC was 82.6% (95% CI, 74.3%-88.6%), and TCB + TIC was 95.4% (95% CI, of 89.4%-98.3%). The diagnostic accuracy of a TCB alone was superior to TIC alone (P = .038); a TCB was diagnostic in 14 cases that were nondiagnostic by TIC. The addition of TIC allowed for the identification of 3 malignancies (2.8%) that were not identified on TCB alone. In 22 cases, TIC was considered diagnostic, but a TCB provided additional specific diagnostic information. LIMITATIONS: Retrospective study and relatively low numbers. CONCLUSIONS: TIC is a valuable tool for use in a EUS-guided TCB; TIC is independently diagnostically accurate, which allows for confidence in a rapid preliminary diagnosis, and it provides additional diagnostic value when combined with TCB.

Endoscopic argon plasma coagulation of Marlex mesh erosion after vertical-banded gastroplasty.

BACKGROUND: Marlex mesh erosions may occur as late complications after vertical-banded gastroplasty. Experience with the endoscopic treatment is limited. OBJECTIVE: To describe the use of argon plasma coagulation in the endoscopic treatment of eroded Marlex mesh. DESIGN: Case report. SETTINGS: Endoscopy Unit, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. PATIENTS: We describe the endoscopic treatment of eroded Marlex mesh in 2 patients who presented with symptoms of gastric-outlet obstruction. INTERVENTIONS: In both cases, argon plasma coagulation was used to break down the eroded Marlex mesh. Fragments were subsequently removed with forceps and electrocautery snares. We did not encounter any complications with this method. RESULTS: The endoscopic treatment resulted in lasting symptomatic improvement in both patients. LIMITATIONS: Our experience is limited to 2 cases. CONCLUSIONS: Argon plasma coagulation appears to be a promising option for the endoscopic treatment of eroded Marlex mesh. It allows the fragmentation of large mesh portions and enables subsequent removal with a snare and a forceps. This method can result in symptomatic improvement and may obviate the need for surgery. Further data are necessary to evaluate the safety and the efficacy of this approach.

Palliative endoscopic ultrasound-guided drainage of a malignant pancreatic cyst causing gastric outlet obstruction.

BACKGROUND: Endoscopic ultrasound (EUS)-guided drainage of pancreatic pseudocysts has been well described but it is not an established therapy for malignant pancreatic cystic neoplasms. We report the first EUS-guided cystogastrostomy for the palliative treatment of a cystic pancreatic adenocarcinoma. CASE REPORT: We describe a 70-year-old male with a nonresectable cystic pancreatic adenocarcinoma causing partial gastric outlet obstruction treated successfully with palliative EUS-guided cystogastrostomy stent placement. The diagnosis was confirmed by EUS-guided fine needle aspiration. Computerized tomography (CT) and EUS staging revealed vascular invasion precluding the patient from surgical resection. Cystogastrostomy was performed entirely under EUS guidance utilizing a 10-Fr double pigtail stent. After cystogastrostomy stent placement, the patient developed dramatic symptomatic improvement of gastric outlet obstructive symptoms, although subsequent imaging did not reveal complete collapse of the cystic structure. CONCLUSION: EUS-guided cystogastrostomy can be considered in the palliative treatment of nonresectable pancreatic cystic neoplasms. Cyst decompression may result in significant symptomatic improvement, although the architecture of malignant cysts may prevent complete resolution.

EUS characteristics of celiac ganglia with cytologic and histologic confirmation.

BACKGROUND: Celiac ganglia have not been previously identified by EUS. OBJECTIVE: To assess whether celiac ganglia can be detected by EUS and to define their characteristics. DESIGN: Retrospective review followed by prospective study. METHODS: Retrospective characterization was performed of all celiac ganglia that were incidentally identified by EUS-guided FNA or tru-cut needle biopsy from January 2004 to October 2005. We also prospectively assessed if these structures could be visualized in consecutive patients undergoing curved linear-array EUS. PATIENTS: Seven patients with celiac ganglia diagnosed by EUS-guided FNA (n = 7) and/or tru-cut needle biopsy (n = 1) were reviewed. Twenty-two patients were prospectively evaluated by curved-linear-array EUS. SETTINGS: Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. MAIN OUTCOME MEASUREMENTS: EUS features and detection rate of celiac ganglia. RESULTS: All retrospectively evaluated celiac ganglia were identified anterior to the aorta, slightly to the left, and cephalad to the celiac artery take-off, and medial to the left adrenal gland. The mean distance from the celiac artery take-off was 10 mm (+/-3 mm); mean size was 13 mm (+/-3 mm) by 6 mm (+/-2 mm). They appeared as hypoechoic and multilobulated structures with hyperechoic strands. Celiac ganglia with sonographic features as described above were identified in 16 of 22 prospectively evaluated patients (73%). LIMITATIONS: Small number of patients; no tissue confirmation of prospectively evaluated patients. CONCLUSIONS: Celiac ganglia can be identified with curved linear-array EUS in the majority of patients. Their typical EUS appearance allows distinction from celiac lymph nodes.

Pancreatic metastasis of an ovarian malignant mixed Mullerian tumor identified by EUS-guided fine needle aspiration and Trucut needle biopsy.

CONTEXT: Malignant mixed Mullerian tumors are rare ovarian neoplasms that account for less than 2% of ovarian malignancies. They have a generally poor prognosis and often develop recurrent disease. To our knowledge, this is the first report of a malignant mixed Mullerian tumor with metastasis to the pancreas. The metastatic tumor was identified by endoscopic ultrasound guided fine needle aspiration (EUS-FNA) and Trucut needle biopsy of the pancreas. CASE REPORT: We describe a 69-year-old female with concomitant Duke's C adenocarcinoma of the colon and stage III-C malignant mixed Mullerian tumor that presented with malignant ascites, increasing abdominal girth and a pancreatic head mass. EUS revealed an 11 cm cystic mass in the head of the pancreas that was characterized as a carcinosarcoma/malignant mesodermal mixed tumor by EUS-FNA and Trucut needle biopsy. The tumor was morphologically identical to the surgical specimen of her ovarian mass. The patient was treated with palliative chemotherapy and a three-month follow up CT scan did not reveal any new metastatic lesions. CONCLUSION: The pancreas is a rare site of metastasis and more commonly seen in renal cell carcinoma, melanoma or lung tumors; amongst others. Although ovarian adenocarcinoma has been reported as a primary site of pancreatic metastasis, it has not been previously described originating from a mixed Mullerian tumor of the ovary presenting as a cystic pancreatic head mass.

Low-volume oral colonoscopy bowel preparation: sodium phosphate and magnesium citrate.

BACKGROUND: Low-volume oral colonoscopy preparations are easier to tolerate and are gaining popularity at the expense of large-volume lavage solutions. The aims of this two-part study were to compare two oral colonoscopy bowel preparations, sodium phosphate (NaP) and magnesium citrate (Mg), and to assess the effects of timing and dilution of NaP. METHODS: Part 1 included 300 ambulatory patients randomized to receive NaP or Mg on the day before colonoscopy. Patients completed a questionnaire before colonoscopy. The endoscopist, blinded to the type of bowel preparation, rated bowel cleansing and recorded the presence of any rectosigmoid aphthous ulcers. In part 2, a total of 297 patients received NaP diluted into 3 doses 10 minutes apart the evening before and the morning of the day of colonoscopy. This group was compared with the group in part 1 that received NaP in two separate single doses entirely the day before colonoscopy. RESULTS: NaP and Mg were well tolerated. When preparations were taken the day before colonoscopy, Mg achieved better bowel cleansing (p < 0.001). Taking NaP entirely the day before colonoscopy resulted in poor right colon cleansing (27%). In contrast, taking NaP the evening before and morning of colonoscopy improved cleansing in the right colon (p < 0.001). Vomiting occurred less frequently with dilution of NaP. Rectosigmoid aphthous ulcers occurred more often with NaP (5.5%) than Mg (1%), p < 0.01. For patients who, according to questionnaire, had received a previous bowel preparation, NaP and Mg were both preferred over large-volume lavage solutions, whereas NaP was preferred over Mg. CONCLUSIONS: When taken entirely the day before colonoscopy, Mg is superior to NaP. Taking NaP the evening before and morning of colonoscopy improved bowel cleansing compared with taking it entirely the day before. Dilution of NaP reduces vomiting. NaP induces rectosigmoid aphthous ulcers more often than Mg.

Experience with small-incision and conventional cholecystectomies in a community hospital

We reviewed the results of 25 small-incision cholecystectomies and 79 conventional cholecystectomies performed at Visayas Community Medical Center from January 1, 2000 to January 31, 2002. There were no differences in the mean age and the male to female ratio in both groups. The mean duration of operation for the small-incision cholecystectomy group was 132.2 minutes while it took 133.4 minutes in the conventional cholecystectomy group. Resumption of regular diet in the small-incision cholecystectomy group was 2.5 days while it took 4 days in the conventional cholecystectomy group. Postoperative hospital stay ranged from 3 to 6 days with a mean of 4 days in the small-incision cholecystectomy group. On the other hand, postoperative hospital stay ranged from 4 to 10 days with a mean of 7.3 days in the conventional cholecystectomy group. Complications seen included postoperative fever, intraoperative bleeding, wound infection and bile leak. Overall, our study confirmed the earlier resumption to regular diet and shorter postoperative stay, thus, faster recovery in the small-incision cholecystectomy group. However, no conclusion can be made because of limitations in the study design and the small sample size. (Author)

A 10 year review of primary soft tissue sarcomas at the Vicente Sotto Memorial Medical Center

A retrospective record review of the clinical characteristics and management of primary soft tissue sarcomas in patients admitted to the surgical department of a government hospital, from January 1991 to December 2000, was done. A total of 54 cases were studied. Data showed that patients had a mean age of 45 years with an equal sex distribution. Forty two percent of sarcomas affected the lower limbs. Thirty-three percent of all cases were fibrosarcomas, and most were more than 5 cm in size and situated deep in to the fascial layer. Twenty patients (37 percent) had distant metastases on admission, 45 percent of which involved the lungs. Wide excision was the most common surgical procedure during the last three years of the study period, with less patients refusing surgery than previous years when amputation was the usual treatment. Wide excision resulted in complete gross tumor extirpation in 94 percent of cases. However, after discharge, most patients did not return for follow-up nor complied with the prescribed adjuvant treatments. (Author)

Family patterns of schizophrenic patients seen in the Philippine General Hospital

Analysis of the family, interactions of 117 cases (52 males, 65 females) of Filipino schizophrenics was made at random. These cases constitute various types of schizophrenia covering the period 1961-1966.It was observed that these schizophrenics come from a turbulent, conclusing family setting characterized by an inadequacy on the part of the parents to fulfill their respective parental roles.

Clinical profile and factors affecting mortality in acute renal failure.

The records of 110 patients with acute renal failure (ARF) admitted to the Department of Medicine of the Philippine General Hospital during a 5-year period (1983-1988) were reviewed. The objectives were to evaluate the clinical profile of ARF patients and to determine what factors influenced mortality. Infection significantly influenced the causation and prognosis of ARF. Fifteen patients died, for an overall mortality rate of 14%. Forty-six clinical variables were analyzed in order to identify factors correlated with mortality. Four variables significantly increased the risk of death from ARF: older age, hyperkalemia, oliguria, and presence of sepsis on admission. These characteristics define a subset of patients for whom more aggressive treatment of ARF is warranted.