[Incidence and distribution of 1026 lower limb venous thrombi diagnosed by ultrasonography in 3263 patients with cancer]

The study objective was to evaluate the incidence, characteristics and distribution of lower limb deep venous thrombi diagnosed by ultrasound among known cancer patients, in order to determine additional criteria that could be used to help select patients with unprovoked deep venous thrombosis caused by occult cancer.

PATIENTS AND METHODS

From January 2001 to May 2012, standardized report forms (n=38,424) were entered into a database. A total of 3263 report forms corresponding to cancer patients with suspected venous thrombo-embolic disease were selected from which 1026 cases of deep venous thrombosis were diagnosed by ultrasonography. Baseline characteristics, incidence, and anatomic distribution of venous thrombi were analyzed.

RESULTS

For 3263 patients with cancer, the venous thrombosis incidence was: total 31.4% (n=1026), proximal 14.5% (n=472), bilateral 8.5% (n=278) and multiple venous sites 4.6% (n=149). The rate of clinical suspicion of pulmonary embolism was 49.9% (n=1628). For 1026 patients with thrombosis, proximal thrombi were nearly as frequent as distal thrombi, with 17.6% (n=181) iliocaval thrombi. Gastrocnemial, popliteal and femoral veins were almost equally concerned by thrombosis with respective rates of 28.7% (n=278), 27.1% (n=294) and 25.6% (n=263). Superficial veins were concerned in 23.5% (n=241). Partial or floating clots occurred frequently in 4 localizations: common femoral, external iliac, femoral and popliteal veins.

CONCLUSION

Proximal, multiple, partial, mobile thrombi, and such unusual locations as gastrocnemial or superficial thromboses, are potentially indicators for selecting patients that may benefit from a cancer check-up because their venous thrombosis could be due to cancer.

Methodology for the evaluation of vascular surgery manpower in France

OBJECTIVES

The French population is growing and ageing. It is expected to increase by 2.7% by 2020, and the number of individuals over 65 years of age is expected to increase by 3.3 million, a 33% increase, between 2005 and 2020. As the number of vascular surgery procedures is closely associated with the age of a population, it is anticipated that there will be a significant increase in the workload of vascular surgeons.

STUDY DESIGN

A model is presented to predict changes in vascular surgery activity according to population ageing, including other parameters that could affect workload evolution.

METHODS

Three types of arterial procedures were studied: infrarenal abdominal aortic aneurysm (AAA) surgery, peripheral arterial occlusive disease (PAOD) procedures and carotid artery (CEA) procedures. Data were selected and extracted from the national PMSI (Medical Information System Program) database. Data obtained from 2000 were used to predict data based on an ageing population for 2008. From this model, a weighted index was defined for each group by comparing expected and observed workloads.

RESULTS

According to the model, over this 8-year period, there was an overall increase in vascular procedures of 52.2%, with an increase of 89% in PAOD procedures. Between 2000 and 2009, the total increase was 58.0%, with 3.9% for AAA procedures, 101.7% for PAOD procedures and 13.2% for CEA procedures. The weighted model based on an ageing population and corrected by a weighted factor predicted this increase.

CONCLUSION

This weighted model is able to predict the workload of vascular surgeons over the coming years. An ageing population and other factors could result in a significant increase in demand for vascular surgical services.

[Effects of unilateral fatigue of triceps surae on undisturbed stance]

OBJECTIVE

Fatigue of lower limb presents various impacts on postural control. The purpose of this study was to explore the effects of a unilateral lower-limb muscle fatigue on undisturbed stance.

METHODS

Nine healthy men performed until exhaustion a fatiguing exercise of the limb extensor muscles of one leg (exercised leg). Just before and after the fatiguing exercise, postural sway measures (centre of pressure) were recorded simultaneously from a double force platform and an in-shoe pressure system in quiet standing conditions. Maximal plantar pressure was computed from each sensor of the in-shoe system, before being averaged for the medial and lateral heel, the external mid-foot, the external and internal foreparts.

RESULTS

In undisturbed stance, the fatiguing exercise induced postural destabilisation for the non-exercised leg (P < 0.001). Changes in antero-posterior mean position of the exercised leg were also observed reflecting a mean loading in a more rear foot stance (P < 0.01). The in-shoe system parameters revealed for the exercised foot, an increase of the maximal pressure value for the heel region (P < 0.05) and a decrease for the mid-foot and forepart (P < 0.05). For the non-exercised foot, the maximal pressure decreased only in forepart (P < 0.05).

CONCLUSIONS

Unilateral triceps surae fatigue revealed an immediate destabilisation of undisturbed stance and the observed postural strategy appears similar to these developed by patients who presented pain pathology and/or sensory deficits in lower limb.

Systematic measurements of ion-proton differential streaming in the solar wind

The small amount of heavy ions in the highly rarefied solar wind are sensitive tracers for plasma-physics processes, which are usually not accessible in the laboratory. We have analyzed differential streaming between heavy ions and protons in the solar wind at 1 AU. 3D velocity vector and magnetic field measurements from the Solar Wind Electron Proton Alpha Monitor and the Magnetometer aboard the Advanced Composition Explorer were used to reconstruct the ion-proton difference vector v(ip) = v(i) - v(p) from the 12 min 1D Solar Wind Ion Composition Spectrometer observations. We find that all 44 analyzed heavy ions flow along the interplanetary magnetic field at velocities which are smaller than, but comparable to, the local Alfvén speed C(A). The flow speeds of 35 of the 44 ion species lie within the range of ±0.15C(A) around 0.55C(A), the flow speed of He(2+).

[Vocational training of future GPs in Swiss hospitals: the view of assistant physicians]

BACKGROUND

We sought to assess views of young physicians, performing vocational training in hospitals, regarding primary care.

METHODS

Semi quantitative questionnaires sent to 535 assistant physicians (hospitals in cantons Zurich and Berne).

RESULTS

318 (62.4%) questionnaires were returned. 143 (45.0%) of the assistant physicians considered becoming a general practitioner (GP). There from, 58 (40.3%) decided in their undergraduate phase, 56 (38.9%) decided postgraduate. They felt generally supported by supervisors. A lack of specific learning objectives and hospital GP-traineeships were revealed.

CONCLUSIONS

Our study shows that the decision for a career in primary care is made in equal parts undergraduate and postgraduate. These future and potential GPs should be attracted by an appropriate GP curriculum during their vocational training.

Minimising exposure of amphibians to pathogens during field studies

Many of the recent global amphibian mass mortalities, declines and extinctions have been attributed to the emerging infectious disease chytridiomycosis. There have been mass mortalities due to ranaviral disease but no major declines or extinctions. Controlling the transmission and spread of disease is of utmost importance, especially where there is the potential for human involvement. We have reviewed current hygiene guidelines for working with wild frogs, identified potential flaws and recommended those most suitable and effective for the field environment. Our within-site hygiene measures aim to reduce the risk of transmission among individuals. These measures encompass the capture, handling and holding of amphibians, skin disinfection before and after invasive procedures, marking frogs, sealing open wounds and treatment of accessory equipment. Our between-site hygiene measures aim to mitigate the risk of pathogen spread among populations. We have designed a risk calculator to help simplify and standardise the decision-making process for determining the level of risk and appropriate risk mitigation strategies to reduce the risk of increasing pathogen spread above background levels. Calculation of an overall risk score for pathogen spread takes into account the prior activity of field workers, the proposed activity, remoteness of the site, presence of known pathogens and the consequences of increased pathogen spread for amphibians in a given area.

Application of the Monte Carlo method to study the alpha particle energy spectra for radioactive aerosol sampled by an air filter

An alpha spectrometer including a semi-conductor detector is commonly used for measurements of the emergent alpha particles from an air filter, on which was sampled a radioactive aerosol. The alpha spectrometry and the detection efficiency are necessary input information for real radioactivity measurements. The MCNPX code based on the Monte Carlo method has been applied to simulate the detection process in order to obtain spectrum peaks and determine the detection efficiency for modeled geometry. First simulations with MCNPX have been carried out in order to validate the alpha particle energy spectrometry of an electrodeposited solid source and an initial simulated filter model. Furthermore, to improve our first filter model, the real spatial distribution of radioactive aerosols across the filter thickness, found experimentally, is taken into account in a multi-layer filter model. Such an alpha particle distribution allows achieving an adequate simulation of the filter. Comparison between measured and simulated alpha spectra highlights the good agreement in spectral parameters and in detection efficiency even under different aerosol spatial distributions inside the volume of the filter.

Tunability of mobility and conductivity over large ranges in poly(3,3'''-didodecylquaterthiophene)/insulating polymer composites

Semiconducting polymers are currently being considered as active layers in field-effect transistors, in which high charge carrier mobility and low off conductivity are important. For other applications, such as certain spintronic mechanisms, the opposite characteristics are desirable. Blending such polymers with insulating polymers would be expected to lower the mobility. In this paper, we report that the use of hydrocarbon polymers such as polystyrene as insulators generally raises the mobility when the semiconducting polymer is poly(bisdodecylquaterthiophene). A high mobility value of nearly 0.1 cm(2)/V.s was obtained for an optimal blend. While this is counterintuitive, it is consistent with a few other recent reports. In order to lower the mobility significantly, a much more polar and irregular blending agent is needed. The further addition of tetrafluorotetracyanoquinodimethane as a dopant gave a rare low mobility/high conductivity combination of properties, with a charge carrier density on the order of 10(19) cm(-3). Thus, mobility and conductivity were tuned somewhat independently over 3 and 4 orders of magnitude, respectively.

Chytridiomycosis in frogs of Mount Gede Pangrango, Indonesia

Batrachochytrium dendrobatidis (Bd) is a fungus recognised as one of the causes of global amphibian population declines. To assess its occurrence, we conducted PCR diagnostic assays of 147 swab samples, from 13 species of frogs from Mount Gede Pangrango National Park, Indonesia. Four swab samples, from Rhacophorus javanus, Rana chalconota, Leptobrachium hasseltii and Limnonectes microdiscus, were positive for Bd and had low to moderate levels of infection. The sample from L. hasseltii was from a tadpole with mouthpart deformities and infection was confirmed by histology and immunohistochemistry. An additional sample from Leptophryne cruentata showed a very low level of infection (< or = 1 zoospore equivalent). This is the first record of Bd in Indonesia and in Southeast Asia, dramatically extending the global distribution of Bd, with important consequences for international amphibian disease control, conservation and trade. Consistent with declines in amphibian populations caused by Bd in other parts of the world, evidence exists for the decline and possible extirpation of amphibian populations at high elevations and some decline with recovery of populations at lower elevations on this mountain. Therefore, it is essential to manage Bd in Indonesia where it is likely to be threatening amphibian populations. This will require a national strategy to mitigate the spread of Bd in Indonesia and neighboring countries as well as the impact of that spread. It is also important to collect information on the extent of the impact of Bd on frog populations in Indonesia.

John Hunter's post-mortem examination of George Grenville (1712–1770)

The Hunterian Museum at The Royal College of Surgeons of England contains approximately 3,500 specimens of human and comparative anatomy and pathology collected by the surgeon, John Hunter (1728–1793). A significant part of the collection comprises pathological specimens. These include specimens removed during surgery or as incidental findings from anonymous bodies being dissected during anatomical teaching. However, the majority comes from the bodies of patients on which Hunter performed post-mortem examinations. These include patients at St George's Hospital, where Hunter worked as a surgeon from 1768 until his death. A surprising number also come from the bodies of private patients. These were presumably removed with consent, at autopsies that would have taken place in the patient's own home and often with the patient's family or friends present.

Changes of bone metabolism in seven patients with Gaucher disease treated consecutively with imiglucerase and miglustat

Bone manifestations are frequent in Gaucher disease (GD), the most prevalent lysosomal storage disorder. Currently, therapy with enzyme replacement (ERT) or substrate reduction (SRT) is available. We investigated changes of laboratory parameters associated with bone metabolism in GD patients switching from ERT to SRT. Seven GD patients consecutively treated with ERT and SRT were studied. All patients had different degrees of bone involvement. Laboratory results were acquired at the time of change from ERT to SRT (0 months) and while on SRT (6 months, 12-18 months). Markers of GD activity remained stable or showed statistically insignificant increases. Six patients had stable skeletal manifestations and reported no bone-associated symptoms. One patient presented progressive bone manifestations on magnetic resonance imaging and experienced increasing bone pain. Osteocalcin, alkaline phosphatase, and C-terminal telopeptide of collagen I were initially within the lower part of the normal range and decreased during SRT (alkaline phosphatase P = 0.0169, osteocalcin nonsignificant, C-terminal telopeptide of collagen I nonsignificant). Tartrate-resistant acid phosphatase 5b was initially normal or slightly increased, and macrophage colony-stimulating factor was within the normal lower range; both parameters remained stable. Interleukin-6 was elevated only in the patient with progressive bone disease. Macrophage inflammatory protein 1alpha (MIP-1alpha) was elevated without change after switching to SRT. MIP-1beta was within the normal range, and no values were above 85 ng/mL, indicative of active skeletal disease. From a clinical and metabolic point of view, most skeletal manifestations and bone-associated laboratory parameters remain stable after switch from ERT to SRT.