Adenosine-induced cardiac arrest in complex cerebral aneurysms surgery: an Italian single-center experience

AIM

Even if endovascular techniques are improving, treatment of complex intracranial aneurysms still remains a neurosurgeon challenge. Adenosine administration, producing a brief and profound systemic hypotension, seems to improve surgical aneurysm visualization facilitating its exclusion with less risks of rupture. In our retrospective study we confirmed that adenosine advantages could be determinant for an optimal surgical result.

METHODS

We retrospectively reviewed all unruptured complex cerebral aneurysms surgically treated in our institution between August 2009 and April 2012. Treatment of those aneurysms was surgical, with proximal temporary artery occlusion or adenosine induced flow arrest. We compared the two different techniques, evaluating intra- and postoperative data; a three-month follow-up including a neurological assessment, cerebral angiography and echocardiography for the adenosine group was performed.

RESULTS

Twenty-four patients were collected in our study. Eleven patients underwent traditional temporary proximal clipping while in 13 patients intraoperative adenosine was used. Most common location was paraclinoid region. We did not observe any complication in the adenosine group. Adenosine was well tolerated, spontaneous recovery of sinusal cardiac rhythm was observed even at high and subsequent doses. The Intensive Care Unit and Hospital length of stay were shorter in adenosine group. A three-month follow-up did not show cardiac abnormalities with good angiographic aneurysms exclusion.

CONCLUSION

We observed that adenosine administration allowed an easier clipping thanks to a reduced wall tension in a clearer surgical field without cardiological adverse events. In our opinion adenosine induced arrest technique could be an efficacious, harmless and reliable alternative strategy for surgical treatment of complex cerebral aneurysms.

An inexpensive and worldwide available digital image analysis technique for histological fibrosis quantification in chronic hepatitis C

Hepatic fibrosis staging is based on semiquantitative scores. Digital imaging analysis (DIA) appears more accurate because fibrosis is quantified in a continuous scale. However, high cost, lack of standardization and worldwide unavailability restrict its use in clinical practice. We developed an inexpensive and widely available DIA technique for fibrosis quantification in hepatitis C, and here, we evaluate its reproducibility and correlation with semiquantitative scores, and determine the fibrosis percentage associated with septal fibrosis and cirrhosis. 282 needle biopsies staged by Ishak and METAVIR scores were included. Images of trichrome-stained sections were captured and processed using Adobe(®) Photoshop(®) CS3 and Adobe(®) Bridge(®) softwares. The percentage of fibrosis (fibrosis index) was determined by the ratio between the fibrosis area and the total sample area, expressed in pixels calculated in an automated way. An excellent correlation between DIA fibrosis index and Ishak and METAVIR scores was observed (Spearman's r = 0.95 and 0.92; P < 0.001, respectively). Excellent intra-observer reproducibility was observed in a randomly chosen subset of 39 biopsies with an intraclass correlation index of 0.99 (95% CI, 0.95-0.99). The best cut-offs associated with septal fibrosis and cirrhosis were 6% (AUROC 0.97, 95% CI, 0.95-0.99) and 27% (AUROC 1.0, 95% CI, 0.99-1), respectively. This new DIA technique had high correlation with semiquantitative scores in hepatitis C. This method is reproducible, inexpensive and available worldwide allowing its use in clinical practice. The incorporation of DIA technique provides a more complete evaluation of fibrosis adding the quantification to architectural patterns.

First Report of Wood Canker Caused by Neoscytalidium dimidiatum on Grapevine in California

In May 2012 in the Coachella valley, Riverside County, California, the decline of vines in table grape (Vitis vinifera) vineyards was observed. Foliar symptoms consisted of shoot blight with wilting and necrosis of leaves and drying and shriveling of berries. In some cases, the entire vine collapsed in the middle of the growing season (apoplexia). Wood cankers in the spurs, cordons, and trunks of affected vines were also present. The nine isolates recovered from the cankers were identified as Neoscytalidium dimidiatum (Penz.) Crous & Slippers based on morphological characteristics and DNA sequence comparisons. Two isolates were grown on potato dextrose agar (PDA) medium and a total of 50 conidia were measured per isolate. Conidia were ellipsoid to ovoid, with a truncate base and an acutely rounded apex, initially aseptate, becoming brown and two-celled at maturity, 7.2 ± 1.2 μm × 3.8 ± 0.4 μm. The rDNA internal transcribed spacer (ITS), and β-tubulin (BT) loci were amplified using primer pairs and methods previously described (4). A total of five isolates were sequenced. The DNA sequences of one N. dimidiatum grapevine isolate (UCR-Neo1) were deposited in the GenBank database (ITS, KC937066; BT, KC937067). Pathogenicity tests were performed by inoculating 12 grape cuttings cv. Thompson Seedless with isolate UCR-Neo1 and 12 control cuttings with sterile medium using a technique previously described (1). The experiment was repeated twice. After 20 weeks of incubation period in the greenhouse, the lesions length produced by N. dimidiatum averaged 13.5 mm and was significantly longer (P < 0.05) from the control (average 3 mm). N. dimidiatum was reisolated from all the inoculated plants and identified by colony morphology. The incidence of N. dimidiatum in table grape vineyards of the Coachella valley has been estimated at 15%, with nine vines infected out of 60 vines total. This pathogen has been identified in California in walnut nursery causing the death of trees due to the development of canker at the graft union (2). N. dimidiatum has also been identified as the causal agent of shoot blight, canker, and gummosis on citrus in Italy (3). The crop is also being grown in the Coachella valley and these findings warrant further investigation in order to determine the host range, distribution, and incidence of this pathogen in the area. References: (1) K. Baumgartner et al. Plant Dis. 97:912, 2013. (2) S. F. Chen et al. Plant Dis. 97:993, 2013. (3) G. Polizzi et al. Plant Dis 93:1215, 2009. (4) J. R. Urbez-Torres et al. Plant Dis. 92:519, 2008.

Soil diversity and hydration as observed by ChemCam at Gale crater, Mars

The ChemCam instrument, which provides insight into martian soil chemistry at the submillimeter scale, identified two principal soil types along the Curiosity rover traverse: a fine-grained mafic type and a locally derived, coarse-grained felsic type. The mafic soil component is representative of widespread martian soils and is similar in composition to the martian dust. It possesses a ubiquitous hydrogen signature in ChemCam spectra, corresponding to the hydration of the amorphous phases found in the soil by the CheMin instrument. This hydration likely accounts for an important fraction of the global hydration of the surface seen by previous orbital measurements. ChemCam analyses did not reveal any significant exchange of water vapor between the regolith and the atmosphere. These observations provide constraints on the nature of the amorphous phases and their hydration.

Selection of relevant features in a fuzzy genetic learning algorithm

Genetic algorithms offer a powerful search method for a variety of learning tasks, and there are different approaches in which they have been applied to learning processes. Structural learning algorithm on vague environment (SLAVE) is a genetic learning algorithm that uses the iterative approach to learn fuzzy rules. SLAVE can select the relevant features of the domain, but when working with large databases the search space is too large and the running time can sometimes be excessive. We propose to improve SLAVE by including a feature selection model in which the genetic algorithm works with individuals (representing individual rules) composed of two structures: one structure representing the relevance status of the involved variables in the rule, the other one representing the assignments variable/value. For this general representation, we study two alternatives depending on the information coded in the first structure. When compared with the initial algorithm, this new approach of SLAVE reduces the number of rules, simplifies the structure of the rules and improves the total accuracy.

P2-12-17: Prospective Evaluation of the Conversion Rate of HER2, ER and PR between Primary Tumors and Corresponding Metastases. CONVERTHER/GEICAM 2009–03 Study

Introduction: A substantial number of small studies, most retrospective, have shown variable degrees of discordance in HER2, ER and PR expression between primary and metastatic breast cancer. This may have prognostic and therapeutic implications. These discordances could be triggered by tumor somatic mutations, intratumoral heterogeneity, or technical issues with receptor assayes. In this prospective study, we centrally analyzed and determined the changes in receptor status between primary tumor and corresponding metastases.

Methods: In 32 Spanish hospitals, patients where primary tumor sample was available, were prospectively included prior to the biopsy of the presumably metastatic lesion. Determinations of ER and PR status (assessed by immuhistochemistry [IHC]) and HER2 status (IHC and FISH) were centrally and blindly performed in both primary tumor and metastases. Concordance rate between local laboratories and central laboratory receptor determinations were analyzed. We also determined whether the biopsy results modified the oncologist initial treatment strategy.

Results: A total of 236 patients were included. To today, 183 paired cases were centrally evaluated. Patients in first recurrence were 65% and the mean age was 57.2 years. Biopsy samples were taken from locoregional recurrence (25%), liver metastases (28%), bone metastases (11%), lung metastases (7%) and other locations (29%). In 6.6% of the biopsies normal tissue, benign lesion or secondary malignant neoplasm were seen. The changes in HER2, ER and PR were 17%, 26% and 35% (local lab) and 4%, 12% and 26% (central lab), respectively; and were independent of treatment given or biopsy localization. Concordance rate in HER2, ER and PR between local and central determination were 83%, 92% and 78% (kappa index 0.58, 0.80 and 0.55), respectively. Changes in receptor status lead to a modification in medical management in 16% of patients.

Conclusions: A remarkable discordance in receptor status, especially in the hormonal receptors, was found between primary tumor and metastases that implies a change in medical management in 16% of patients. These discordances were reduced but remained after performing in a high-quality central laboratory, so that they could only be partly explained by technical discrepancies in receptor assessments.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-12-17.

Sic Power Diodes Improvement by Fine Surface Polishing

Surface treatment is a key technological parameter in the microelectronics technology and especially for SiC devices since high temperatures must be used for implanted impurities annealing and crystal damage recovery. In this work we take profit of a novel fine polishing process developed by NOVASIC to improve the electrical characteristics of Boron and Aluminium implanted Schottky diodes, which are surface quality highly sensitive devices. The mentioned fine polishing process allows to remove a layer thickness of 100nm to 3000nm on the surface of a processed SiC wafer, reducing the surface roughness to RMS of 1Å. The impact of this process on the electrical properties of the samples shows a general improvement of characteristics reproducibility, reduction of leakage current and improvement of breakdown of Boron implanted diodes.

Fetal thymus size in uncomplicated twin and singleton pregnancies

OBJECTIVES

The main objective of this study was to determine whether fetal thymic measurements could be obtained in twins, with a secondary goal to determine whether thymic measurements from uncomplicated singleton and twin pregnancies are comparable.

METHODS

The transverse diameter and perimeter of the fetal thymus were measured prospectively in 678 singleton and 56 twin pregnancies, and their relationships with gestational age were determined and compared between groups.

RESULTS

Thymic measurements were possible in 757 (95.8%) of the 790 fetuses. Measurements were not possible in 19 of 678 singletons (2.8%) and in 14 of the 112 (12.5%) twins (P < 0.001). After construction of nomograms for the transverse diameter and perimeter of the fetal thymus, similar measurements were noted for singletons and twins.

CONCLUSIONS

These results suggest that sonographic measurements of the thymus are feasible in twin pregnancies and that, in uncomplicated pregnancies, these measurements are similar to those noted for singletons. These findings pave the way for future studies aimed at determining the clinical utility of thymic measurements in complicated singleton and twin pregnancies.