Diagnostic efficacy of gadoxetic acid-enhanced MRI in the detection of hepatocellular carcinomas: comparison with gadopentetate dimeglumine

This study compared the efficacy of gadoxetic acid-enhanced MRI and gadopentetate dimeglumine-enhanced MRI in the detection of small hepatocellular carcinoma (HCC). Both MRI techniques were performed on 43 patients with a total of 59 HCCs (size range, 0.5-2.0 cm), with a mean interval between the two MRI studies of 3 days (range, 2-7 days). Two observers reviewed both data sets in consensus. Diagnostic accuracy and sensitivity were evaluated using the alternative-free response receiver operator characteristic (ROC) method. The gadoxetic acid set showed a trend toward increased area under the ROC curve (Az value = 0.958) compared with the gadopentetate dimeglumine set (Az value = 0.927), but the difference was not significant (p = 0.362). The sensitivity of the gadoxetic acid set (n = 51, 86.4%) was significantly higher than that of the gadopentetate dimeglumine set (n = 38, 64.4%) (p = 0.0001). Gadoxetic acid-enhanced MRI is a more sensitive diagnostic tool for detection of HCC than gadopentetate dimeglumine-enhanced MRI.

Effects of dielectric discontinuities on two charged plates

Counterions in a biological system are charged in water and interact with charged macroions, which are generally made up of hydrocarbons. The dielectric difference between water and the hydrocarbon substrates occurs naturally, and may greatly affect the electrostatic properties of biological systems. Particularly for a slab geometry, bulk counterions that are dissolved in water are driven to the midplane of the slab because of their repulsive interaction with their image charges. The pressure between two charged plates becomes less repulsive since the low dielectric constant of the hydrocarbon substrate creates stronger association between counterions and surface charges as compared to the case of no dielectric discontinuity.

Multicenter phase II study of docetaxel plus oxaliplatin combination chemotherapy in patients with advanced gastric cancer

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Background: The present study was conducted to evaluate the efficacy and safety of a combination regimen of docetaxel plus oxaliplatin in patients with advanced gastric cancer. Methods: Patients with previously untreated metastatic or recurrent, measurable gastric cancer received intravenous docetaxel 65 mg/m2 plus oxaliplatin (Oxalpla®, Yuhan.Co. Seoul, Korea) 120 mg/m2 on days 1 in a 3-week cycle. Treatment was continued until disease progression, patient refusal, or an unacceptable toxicity up to 9 cycles. Results: Forty-two patients were enrolled in the current study. Of these, 39 were assessable for efficacy and 41 assessable for toxicity. Seventeen partial responses were confirmed, giving an overall response rate of 40.5% (95% CI: 26.0% to 54.1%, intention-to-treat analysis). At a median follow-up of 160.5 days, the median time to progression was 6.1 months, whereas median overall survival was not reached yet. Grade 3/4 neutropenia occurred in 10 patients, plus febrile neutropenia was observed in 3 patients. Most common non-hamatologic toxicity was nausea (grade 1/2 56.9%). There were two treatment-related deaths. Conclusions: Docetaxel and oxaliplatin combination was found to be well-tolerated and effective in patients with advanced gastric cancer. Accordingly, this regimen can be regarded as an important first-line treatment option for advanced gastric cancer.

No significant financial relationships to disclose.

IL-10-transduced bone marrow mesenchymal stem cells can attenuate the severity of acute graft-versus-host disease after experimental allogeneic stem cell transplantation

Recent data suggest that adult mesenchymal stem cells (MSCs) might enhance allogeneic hematopoietic engraftment and prevent graft-versus-host disease (GVHD) owing to their immunosuppressive nature. Using a murine model of acute GVHD, this study examined whether or not the immunosuppressive properties of MSCs could reduce the severity of experimental GVHD. The early injection of MSCs after transplant did not attenuate the severity of acute GVHD. Therefore, this study investigated whether or not the use of IL-10-transduced MSCs (IL-10 MSCs) could reduce the severity of acute GVHD. Lethally irradiated recipients were transplanted and injected with IL-10 MSCs, the MSC-expressing vector alone (vector MSCs), or the diluent (controls), respectively, on day +1. Compared with the vector MSCs or controls, there was a significantly lower mortality in the recipients of the IL-10 MSCs at day 50 after the transplant (percent survival, 0 or 10 vs 70%, P=0.0004 or 0.0064, respectively). The decrease in mortality was confirmed by the semi-quantitative GVHD score (P<0.05), and was associated with decreased serum levels of the pro-inflammatory cytokines, IFN-gamma, on day +7 (P=0.015). Therefore, beneficial effects on GVHD were observed when MSCs were engineered to express the anti-inflammatory cytokine, IL-10.

A comparison of hypnotic and analgesic based sedation in a general intensive care unit †

BACKGROUND

Sedation of the critically ill patient has several components including hypnosis and analgesia. Hypnotic-based sedation (HBS), where midazolam and/or propofol are used, with morphine or another analgesic added as needed has been common. The advent of remifentanil has allowed greater use of analgesia-based sedation (ABS) where relief of discomfort from the tracheal tube or pain are the important objectives, and hypnosis is given as necessary. Method. We compared HBS and ABS (remifentanil-based sedation) within a general intensive care unit (ICU). During the first study period of 12 weeks, 111 patients received HBS. After the development of new guidelines for the use of remifentanil in the ICU, a second 12 week study period used an analgesia-based regimen, with hypnotics added only if needed.

RESULTS

Ninety-six patients received ABS, and 79 received remifentanil. It was possible to manage 29 (37%) of the patients receiving remifentanil without the use of supplementary hypnotic agents. In the remaining 63% the use of remifentanil was associated with a reduction in the amount and duration of propofol used. Significantly more patients receiving ABS had satisfactory levels of sedation during synchronized intermittent mandatory ventilation (19 [2,55] vs 50 [14,83], P<0.001).

CONCLUSIONS

The use of ABS allowed patients to be managed more comfortably, either without a hypnotic drug or with less hypnotic drug, than using conventional HBS.

Priority environmental issues for monitoring - mismatch between farmers and catchment management perspectives

Monitoring is an essential part of an environmental management system (EMS) if landholders are to demonstrate improved environmental performance. This paper reports results of two surveys to determine environmental issues and priorities for monitoring. The first survey was conducted on 12 EMS pilot projects, and the second on 18 catchment management organisations in Australia. With the exception of pastoral zones, EMS facilitators identified moderate to major issues in land condition, water balance, riparian zone, native vegetation condition and pests. Water quality issues were rated as minor to moderate problems. Issues raised by the greatest number of respondents were water balance problems and weed and pest issues. Catchment managers reported widespread degradation issues in land condition, water balance problems, altered water flow, water quantity and availability and water quality. Degradation of the riparian zone and native vegetation were also reported. Both EMS facilitators and catchment management organisations understood the need for environmental monitoring; however, few EMS pilot projects have addressed it. This was due, in part, to a lack of readily available tools and concentration on the EMS process itself. Tools of most interest to facilitators were soil erosion risk, soil test interpretation, soil structure assessment, soil health, water leakage and perenniality, water quality, riparian zone management, herbicide resistance, greenhouse emissions and energy use. Facilitators also suggested that tools should be delivered in several formats, but workshops delivered by experts were of most interest. Catchment managers had realistic and pragmatic views about the role of landholder monitoring in assessing catchment outcomes and there is a mismatch between landholder monitoring and catchment reporting requirements. Landholders are likely to monitor only what is in their direct interests and this will be mainly on land condition. We conclude that on-farm environmental monitoring conducted by landholders will be of limited use for catchment management organisation reporting. However, it will be very important in helping farmers to make more informed decisions about their environmental management, together with education and support. The issue of catchment condition monitoring and reporting requires serious attention as current monitoring and reporting is likely to be inadequate.

Comparison between ozone and ferrate in oxidising geosmin and 2-MIB in water

Among the chemicals causing taste and odour (T&O) in drinking water, the most commonly identified and problematic ones are geosmin and 2-MIB (2-methylisoborneol). Since the reported odour thresholds of geosmin and 2-MIB are as low as 4 and 8.5 ng/L, respectively, they are not readily removed by conventional water treatment processes. In this study, ozone (O3) and ferrate (Fe(VI)) were applied to oxidise geosmin and 2-MIB. Their performances were compared in terms of removal efficiency of geosmin and 2-MIB. In the case of O3, removal efficiency of geosmin and 2-MIB ozonation at different initial O3 doses, H2O2/O3 ratios and water temperatures were evaluated. The oxidation rates of geosmin and 2-MIB by Fe(VI) were measured within pH 6-8. The effect of H2O2 addition was also evaluated. In summary, O3, especially with H2O2, could almost completely oxidise geosmin and 2-MIB, while Fe(VI) could not oxidise them more than 25% at any pH that was considered in this study. This was attributed to the structure of the organics and high reaction selectivity of Fe(VI). Further study should be conducted to find the reason of inhibition of oxidation by Fe(VI).

Interaction between two inhomogeneously charged parallel surfaces in the strong coupling regime

The counterion density profile and pressure between two inhomogenously charged parallel plates are analyzed analytically and numerically in the strong-coupling regime. Point charges are used and the surface charges are immobile. It is found that when the surface charge distribution is inhomogeneous, the charge coupling effect becomes stronger, the counterion spatial distribution is more localized toward the plate surfaces, and, thus, the pressure between two plates becomes lower than in the case when the surface charge distribution is homogeneous.