Delivery of selective internal radiation therapy complicated by variant hepatic vascular anatomy.

"Difficult vascular anatomy" is a challenge for Interventional Radiologists especially in liver directed therapies such as trans arterial radio embolization. Trans arterial radio embolization is a long and difficult procedure in which the basic knowledge of hepatic and gastro-enteric vascularization, with its high degree of variations, is very important in order to correctly administer the therapeutic drug selectively. In this report, we present a case of an atypical patient affected by an unresectable hepatocellular carcinoma, candidate for Radio-embolization treatment. His vascular anatomy was very difficult to manage, but the Interventional Radiologist was not only able to go over the "difficult anatomy," but also to take advantage of it.

Successful endovascular treatment of a recurrent giant celiac artery aneurysm.

Visceral artery aneurysms are very rare and aneurysms of the celiac trunk are the rarest ones: they are in most cases asymptomatic and their detection is frequently incidental. In this article we report the case of a man affected by severe abdominal pain with a huge aneurysm of the celiac trunk, first successfully treated with coil embolization, but, after 10 months, another endovascular embolization was required for deployment of the metallic coils previously released, ahead into the fund of the sac with recanalization of the aneurysm. A second endovascular treatment was performed with other coils and Amplatzer-Plug. The high risk of rupture makes treatment of such aneurysms mandatory and surgery is still considered the gold standard therapy of VAA, but, due to its high morbidity and mortality risks, in the last years, it has been widely replaced by endovascular embolization. An effective endovascular embolization requires not only the complete filling of the aneurysmal sac, but also the complete vascular exclusion of its in-flow and out-flow tracts, to reduce the risk of its anterograde or retrograde reperfusion.

Magnetic resonance arthrography accuracy in the detection of labral tears in young patients with chronic unstable shoulder: correlation with arthroscopy.

The aim of this study is to determine the diagnostic performance of Magnetic Resonance Arthrography (MRA) in evaluating lesions of the glenoid labrum, in young active patients with chronic unstable shoulder, compared to shoulder arthroscopy. We retrospectively considered 65 MRA examinations, performed between December 2011 and January 2018. Among them, thirty-five patients (31 men, 4 women; mean age, 27.3 years; range, 16-53 years; 4 patients with a previous arthroscopy of the same shoulder) underwent shoulder arthroscopy after MRA. Arthroscopic reports were collected and analyzed for the correlation with MRA results.

Osteoid osteoma treated with radiofrequency ablation in non-operating room anesthesia. A different way of approaching ablative therapy on osteoid osteoma.

OBJECTIVE: The purpose of this study is to verify the effectiveness and complications occurrence of radiofrequency ablation (RFA) in the treatment of osteoid osteoma (OO) in non-operating room anesthesia (N.O.R.A.). PATIENTS AND METHODS: From 2014 to 2017, 61 patients affected by OO (40 men and 21 women) with an age of 20.7 years on average (range, 4-51 years; 12 patients aged 20 years or younger) underwent computed tomography-guided percutaneous radiofrequency ablation (RFA) in N.O.R.A. (Non-Operating Room Anesthesia). Lesion sites treated were: femur (27), tibia (22), pelvis (2), talar bone (3), distal radius (1), and humerus (6). Mean follow-up time was 36 months. In each case, anesthesiologic support followed a new protocol (N.O.R.A. protocol), approved by our Institute. Primary success rate, complications, symptom-free intervals, and follow-up results were evaluated. RESULTS: Pain relief (evaluated with Visual Analogue Scale - VAS) was significant in 97% of patients; it disappeared within 24 hours of the procedure in 44 patients, within 3 days in 10 patients, and within 7 days in 7 patients. After 6 months of observation time, 60 of 61 patients were successfully treated and had no more complaints. In 2 patients, two major complications were found: infection of the site treated, healed with antibiotics, and a nerve lesion, healed with steroid therapy. No other complications were observed. CONCLUSIONS: RFA is a highly effective, efficient, minimally invasive and safe method for the treatment of OO following N.O.R.A.

The common SLC30A8 Arg325Trp variant is associated with reduced first-phase insulin release in 846 non-diabetic offspring of type 2 diabetes patients--the EUGENE2 study.

AIMS/HYPOTHESIS: A recent genome-wide association study identified the SLC30A8 rs13266634 polymorphism encoding an Arg325Trp polymorphism in the zinc transporter protein member 8 (ZnT-8) to be associated with type 2 diabetes. Here, we investigate whether the polymorphism is related to altered insulin release in response to intravenous and oral glucose loads in non-diabetic offspring of type 2 diabetic patients. METHODS: We genotyped SLC30A8 rs13266634 in 846 non-diabetic offspring of type 2 diabetic patients from five different white populations: Danish (n = 271), Finnish (n = 217), German (n = 149), Italian (n = 109) and Swedish (n = 100). Participants were subjected to both IVGTTs and OGTTs, and measurements of insulin sensitivity. RESULTS: Homozygous carriers of the major type 2 diabetes C risk-allele showed a 19% decrease in first-phase insulin release (0-10 min) measured during the IVGTT (CC 3,624 +/- 3,197; CT 3,763 +/- 2,674; TT 4,478 +/- 3,032 pmol l(-1) min(-1), mean +/- SD; p = 0.007). We found no significant genotype effect on insulin release measured during the OGTT or on estimates of insulin sensitivity. CONCLUSIONS/INTERPRETATION: Of European non-diabetic offspring of type 2 diabetes patients, 46% are homozygous carriers of the Arg325Trp polymorphism in ZnT-8, which is known to associate with type 2 diabetes. These diabetes-prone offspring are characterised by a 19% decrease in first-phase insulin release following an intravenous glucose load, suggesting a role for this variant in the pathogenesis of pancreatic beta cell dysfunction.

Patterns of leaf conductance and water potential of five Himalayan tree species.

We studied variations in water relations and drought response in five Himalayan tree species (Schima wallichii (DC.) Korth. (chilaune) and Castanopsis indica (Roxb.) Miq. (dhale katus) at an elevation of 1400 m, Quercus lanata Smith (banjh) and Rhododendron arboreum Smith (lali gurans) at 2020 m, and Quercus semecarpifolia Smith (khasru) at 2130 m) at Phulchowki Hill, Kathmandu, Nepal. Soil water potential at 15 (Psi(s15)) and 30 cm (Psi(s30)) depths, tree water potential at predawn (Psi(pd)) and midday (Psi(md)), and leaf conductance during the morning (g(wAM)) and afternoon (g(wPM)) were observed from December 1998 to April 2001, except during the monsoon months. There was significant variation among sites, species and months in Psi(pd), Psi(md), g(wAM) and g(wPM), and among months for all species for Psi(s15). Mean Psi(pd) and Psi(md) were lowest in Q. semecarpifolia (-0.40 and -1.18 MPa, respectively) and highest in S. wallichii (-0.20 and -0.63 MPa, respectively). The minimum Psi value for all species (-0.70 to -1.79 MPa) was observed in March 1999, after 4 months of unusually low rainfall. Some patterns of Psi(pd) were related to phenology and leaf damage. During leafing, Psi(pd) often increased. Mean g(wAM) and g(wPM) were highest in Q. semecarpifolia (172 and 190 mmol m(-2) s(-1), respectively) and lowest in C. indica (78 and 74 mmol m(-2) s(-1), respectively). Soil water potential (Psi) at 15 cm depth correlated with plant Psi in all species, but rarely with g(wAM) and not with g(wPM). Plant Psi declined with increasing elevation, whereas g(w) increased. As Psi(pd) declined, so did maximal g(w), but overall, g(w) was correlated with Psi(pd) only for R. arboreum. Schima wallichii maintained high Psi, with low stomatal conductance, as did Castanopsis indica, except that C. indica had low Psi during dry months. Rhododendron arboreum maintained high Psi(pd) and g(w), despite low soil Psi. Quercus lanata had low g(w) and low Psi(pd) in some months, but showed no correlation between tree Psi and g(w). Quercus semecarpifolia, which grows at the highest elevation, had low soil and plant Psi and high g(w).

Variation in water relations characteristics of terminal shoots of Port-Orford-cedar (Chamaecyparis lawsoniana) seedlings.

We measured water relations attributes of the terminal shoots of 3-year-old Port-Orford-cedar (Chamaecyparis lawsoniana (A. Murr.) Parl.) seedlings that represented its geographic range. Pressure-volume curves were developed and osmotic potentials at full (psi(sf)) and zero turgor (psi(sz)), relative water content at zero turgor, and an index of tissue elasticity (IE) were calculated for 38 families during early, mid- and late summer at an inland nursery, and for 12 of these families during mid- and late summer at a coastal nursery. Compared with other conifer species, psi(sz) was high (-1.4 to -1.5 MPa) and declined in seedlings at both nurseries as the season progressed. Both IE and osmotic amplitude (psi(sf)-psi(sz)) increased during the season. Osmotic potential at zero turgor was lower and osmotic amplitude greater in seedlings at the inland nursery than at the coastal nursery. Correlations of water relations attributes with geographic location of the seed sources were weak and usually not significant. High elevation southern sources exhibited smaller differences in psi(sz) between nurseries than low elevation northern sources. The small differences in water relations attributes among sources and between nurseries suggest that some may be of marginal physiological importance; however, sources that produced larger seedlings appeared to be less desiccation tolerant. We conclude that, when moving genotypes during reforestation, decisions based on patterns in tree size and timing of growth will account for these small differences in water relations.

Accurate experimental electronic properties of dl-proline monohydrate obtained within 1 Day

A 1-day x-ray diffraction experiment on dl-proline monohydrate was performed at 100 kelvin with synchrotron radiation and a charge-coupled device area detection technique. The accuracy of the charge density distribution and of the related electronic properties extracted from these data is comparable or even superior to the accuracy obtained from a 6-week experiment on dl-aspartic acid with conventional x-ray diffraction methods. A data acquisition time of 1 day is comparable to the time needed for an ab initio calculation on the isolated molecules. This technique renders larger molecular systems of biological importance accessible to charge density experiments.

Organic pesticide modification of species interactions in annual plant communities.

A method is proposed and tested for assessing multispecies responses to three pesticides (atrazine, 2,4-D and malathion). Pesticides were applied at two concentrations, on model plant communities grown in raised beds using soil containing a natural seed bank. Cover by species was monitored over time in nested 10 and 20 cm diameter neighbourhoods around Poa annua and Calandrinia ciliata target plants. All tested compounds modified relative species abundance, altered dominance and simplified the treated communities. Community biomass decreased with atrazine and 2,4-D treatments, but not with malathion. Each chemical altered species interactions for all treated communities, including the identities of interacting species and the timing of interactions. Each target species had its own suite of interacting species that individually changed with chemical treatment. When cover was used as a predictor of neighbour influence, analysis of species interactions using 10 cm neighbourhoods indicated more interactions than using 20 cm neighbourhoods. When biomass was used as the predictor, use of the 20 cm neighbourhoods indicated more interactions. This method of using model plant communities for field toxicity testing is simple, economical and effective. It uses naturally occurring plants while reducing the environmental heterogeneity common in most field studies.

Effect of epinephrine on pancreatic beta-cell and alpha-cell function in patients with NIDDM.

The purposes of this study were to determine whether patients with non-insulin-dependent diabetes mellitus (NIDDM) have an enhanced glycemic response to epinephrine (EPI) and to quantitate the effect of physiological elevations of EPI on pancreatic islet function in these patients. The increment of plasma glucose (PG) in response to 45 min of EPI infusion (mean plasma EPI 2490 pM) was more than twofold greater in nine NIDDM patients than in 20 nondiabetic control subjects (mean +/- SE delta PG 3.9 +/- 0.3 vs. 1.7 +/- 0.1 mM, P less than 0.0001). The effects of EPI on beta-cell and alpha-cell function were compared in nine NIDDM patients and 9 age- and weight-matched control subjects during infusions of saline or two doses of EPI on separate days (mean plasma EPI 270, 1120, and 2490 pM). On each day, the acute insulin response (AIR) and acute glucagon response (AGR) to 5 g i.v. arginine were measured at three matched steady-state PG levels (means of 9, 14, and 29 mM). Beta-Cell sensitivity to glucose (slope of glucose potentiation) and beta-cell secretory capacity, or AIRmax (AIR at the highest clamped PG level), were calculated. In control subjects, EPI inhibited the AIR at PG concentrations of 9 and 14 mM (both P less than 0.05) but had no effect on the AIRmax, resulting in a rightward shift of the curve relating the AIR and PG and a decrease in the slope of glucose potentiation (P less than 0.01). In contrast in NIDDM patients, EPI inhibited the AIR at all PG levels, including the AIRmax (all P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Progression of osteoarthritis of the hand and metacarpal bone loss. A twenty-year followup of incident cases.

We examined the prospective relationship between metacarpal bone mass and osteoarthritis (OA) of the hand, using incidence data from the historical cohort in the Tecumseh Community Health Study (Tecumseh, MI). Women were examined for radiographic evidence of OA and for bone mass twice, 20-23 years apart (1962-1965 and 1985; 683 subjects with an age range of 55-74 in 1985). Two measures of OA were evaluated: the highest score assigned to any of the 32 wrist/hand joints, and the sum of scores for all wrist/hand joints. After adjustment for age, women who were classified as having OA (by either measure of OA) in 1985 were more likely to have more cortical area at baseline, which indicates greater bone mass. Women who developed OA in the 23-year period were more likely to experience a significantly greater widening of the medullary cavity over time, an indicator of increased bone resorption. Women with increasing levels of OA involvement also had an increased likelihood of greater cortical area loss. We conclude that women who later developed OA were more likely to have higher baseline bone mass than women who did not develop OA, but these women also had a greater likelihood of bone loss over time.

Treatment modality patterns and transplantation among the United States pediatric end-stage renal disease population: a longitudinal study.

Between 1985 and 1988, there were 3,393 children (Medicare insured) under age 20 who began treatment for chronic ESRD. Patterns of modality use, modality switch, mortality rates, and various aspects of transplantation were analyzed for different age and incident groups of this pediatric cohort. The pediatric cohort as a whole exhibited a distinct pattern of modality use when compared to adults in general, a point evidenced most clearly by their substantially higher rates of transplantation. Furthermore, notable differences were found within the pediatric cohort when the younger than 5, 5-9, 10-14, and 15- to 19-year-old age groups were analyzed separately. Younger pediatric patients, particularly those younger than 5 years, received peritoneal dialysis as initial ESRD therapy more frequently than their older pediatric counterparts. This result would be expected given vascular access problems often associated with very young patients. In addition, those patients younger than 5 years who began RRT with some form of hemodialysis had the highest likelihood of switching to CAPD/CCPD within the first year of therapy. Conversely, older pediatric patients were most likely to begin RRT therapy with some form of hemodialysis. By day 91, slightly over half of the 15- to 19-year-old age group was utilizing center hemodialysis; the CAPD/CCPD, other peritoneal, and functioning transplant modalities each contained about 10% of the patients with the remainder falling into the death and unknown dialysis categories. The overall pattern of switching to transplantation during the first year of RRT was similar for pediatric patients initiating RRT with center hemodialysis versus peritoneal dialysis (CAPD/CCPD), but differed by age group within each dialysis type. Pediatric patients on peritoneal dialysis were somewhat more likely to receive a transplant during the first year of ESRD compared to hemodialysis, although the difference was small. Mortality rates during the first year for patients who began treatment with center hemodialysis versus CAPD/CCPD were similar. The well-documented dominance of transplantation as a method of RRT for pediatric patients was further verified by this study. Results show that transplantation was implemented rapidly during the initial months of ESRD. Nearly 50% of surviving pediatric patients had a functioning transplant at 1 year following onset and 64% at 3 years. These percentages were exceeded for the 5- to 9-year-old age group, of which 74% had a functioning graft 3 years following onset.(ABSTRACT TRUNCATED AT 400 WORDS)

Comparative effects of sexual assault on sexual functioning of child sexual abuse survivors and others.

This study quantitatively and qualitatively examined the effects of sexual assault on the sexual functioning of 37 sexually active women an average of 8.21 years postevent (Mdn = 4.08 years). More than 80% of the sample reported some sexual dysfunction with a partner as a result of the assault. Greatest impairment was reported by subjects who either had a history of child sexual abuse or had no prior sexual victimization before the current assault as compared with subjects who had prior sexual assaults. When data were examined by type of perpetrator, adverse effects were greatest for subjects assaulted by a health care professional. Qualitative analysis revealed that, for the total sample, greatest effects were in the area of adverse feeling states (part of desire dysfunction) as early response inhibitors, with subjects who had a history of child sexual abuse being the only group to report orgasmic dysfunction and guilt. There was no statistically significant difference in sexual dysfunction between subjects who filed civil suits and those who did not. Implications for treatment are discussed.

Effects of environment, seedling age, and seed source on leaf resistance of three species of Chamaecyparis and Tsuga chinensis.

The objectives of this study were to determine how stomata of Chamaecyparis spp. react to environmental changes and to determine in what ways leaf resistance patterns may have adaptive value for these confers. Leaf resistances were measured of Chamaecyparis taiwanensis, C. formosensis and C. lawsoniana seedlings in a forest nursery, and of saplings of the first two species and Tsuga chinensis growing in natural forest and clearcuts. Light, temperature, humidity, and sometimes xylem pressure potential were measured concurrently.In the nursery, C. lawsoniana, the species from the driest climate, had the lowest resistance, daily means for well-watered yearold plants being 2-5 s cm-1. Leaf resistances of well-watered C. formosensis and C. taiwanensis from more humid habitats were two and three times greater. Leaf resistance was more sensitive to environment in those nursery populations of C. formosensis from habitats where a dry season is more severe. There were no clear patterns of variation within the other species. Resistance of scale leaves increased with seedling size and age. Primary leaves of C. formosensis had higher average resistance than its scale leaves, and were more responsive to changes in the environment.In the field, C. taiwanensis had higher resistance than C. formosensis. Leaf resistance of Tsuga chinesis was quite similar to that of C. formosensis. Resistance decreased from winter to spring except during a severe dry spell in March.Changes in leaf resistance were most consistently correlated with humidity, which often increased during the day as humid air rose from the lowlands. Stomata opened as humidity rose even when plant xylem pressure potentials were -15 to -23 bars. Stomatal reaction of Chamaecyparis spp. varies in ways apparently adaptive to their environment.