Integration of traditional and innovative characterization techniques for flux-based assessment of dense non-aqueous phase liquid (DNAPL) sites

Key attributes of the source zone and the expanding dissolved plume at a trichloroethene (TCE) site in Australia were evaluated using trends in groundwater monitoring data along with data from on-line volatile organic compound (VOC) samplers and passive flux meters (PFMs) deployed in selected wells. These data indicate that: (1) residual TCE source mass in the saturated zone, estimated using two innovative techniques, is small ( approximately 10 kg), which is also reflected in small source mass discharge ( approximately 3 g/day); (2) the plume is disconnecting, based on TCE concentration contours and TCE fluxes in wells along a longitudinal transect; (3) there is minimal biodegradation, based on TCE mass discharge of approximately 6 g/day at a plume control plane approximately 175 m from source, which is also consistent with aerobic geochemical conditions observed in the plume; and (4) residual TCE in the vadose zone provides episodic inputs of TCE mass to the plume during infiltration/recharge events. TCE flux data also suggest that the small residual TCE source mass is present in the low-permeability zones, thus making source treatment difficult. Our analysis, based on a synthesis of the archived data and new data, suggests that source treatment is unwarranted, and that containment of the large TCE plume (approximately 1.2 km long, approximately 0.3 km wide; 17 m deep; approximately 2000-2500 kg TCE mass) or institutional controls, along with a long-term flux monitoring program, might be necessary. The flux-based site management approach outlined in this paper provides a novel way of looking beyond the complexities of groundwater contamination in heterogeneous domains, to make intelligent and informed site decisions based on strategic measurement of the appropriate metrics.

Economic analysis of esophageal stenting for management of malignant dysphagia

Over half of patients diagnosed with esophageal cancer are unsuitable for curative resection. A significant proportion of these patients will subsequently require palliative stenting to alleviate dysphagia. There is growing consensus in the literature that the deployment of a Self-Expanding Metal Stent is the optimum stenting strategy; however, it remains unclear whether covered or uncovered metal stents are more cost-effective. In order to determine which type of prosthesis is more cost-effective, we compared the different stenting strategies in terms of 1-year stent-related mortality, health-related quality of life, and cost. A decision analytical model was constructed to compare the 1-year stent-related mortality, health-related quality of life, and cost between covered and uncovered stents. Probabilistic sensitivity analysis was performed to quantify the uncertainty associated with our results. Value of Information analysis was performed to assess the value of further research. In order to fully characterize the uncertainty associated with this decision, plastic stents were included in our analysis. Stent-related mortality was slightly lower following covered stent deployment compared with uncovered stent deployment (1.00% vs. 1.26%). Covered stents were more effective by 0.0013 Quality-Adjusted Life Years (Standard Deviation [SD] 0.0013 Quality-Adjusted Life Years). They were also less expensive by $729.58 (SD $390.63). Probabilistic sensitivity analysis suggested that these results were not sensitive to model parameter uncertainty. Plastic stents deployment was $2832.64 (SD $1182.72) more expensive than uncovered metal stent deployment. Value of Information analysis suggests that the maximum value of further research in the UK is $61,124.30. The results of this study represent strong evidence for the cost-effectiveness of covered compared with uncovered self-expanding metal stents for the palliation of patients with malignant dysphagia. The findings support previously published literature asserting the dominance of self-expanding metal stents over plastic stents. Value of Information analysis suggests that further research may not be cost-effective. These findings have significant implication for both current clinical practice and future clinical research.

Arterial calcification in race horses

Calcification of large arteries has been sporadically reported in horses. The pathogenesis is still unknown, but recent studies in humans suggest that this is a regulated biomineralizing process. This study surveyed the prevalence, distribution, and severity of vascular calcification in Thoroughbred and Standardbred racehorses. Histopathologic, ultrastructural imaging, and energy dispersive X-ray elemental analyses were used to examine the lesions. Calcification of the tunica media, predominantly the pulmonary artery, was found in 82% of horses (83/101). Young adult horses (mean [SD] age in years, 4.44 +/- 2.17) of both breeds and sexes were similarly affected. Lesions appeared as white-to-yellowish, hard, and gritty plaques of variable size. On microscopic examination, elastic fibers within the tunica media were thinned, fragmented, and calcified, and surrounded by dense collagen matrix. Elemental analysis showed distinct peaks for calcium and phosphorus, consistent with hydroxyapatite mineral. The frequent occurrence of calcification in the tunica media of large pulmonary arteries of young racing horses indicates the need to investigate its pathogenesis and potential clinical implications.

Interstitial cells of Cajal and intestinal function in Trinidadian children

OBJECTIVE

This study was carried out to compare the density of the interstitial cells of Cajal (ICCs) in the bowel wall of children with Hirschsprung's disease (HD), anorectal malformations (ARM) and normal controls in Trinidad and Tobago.

SUBJECTS AND METHOD

Segments of bowel wall excised from eight children with HD, three controls and two children with ARM were immunostained with c-Kit primary antibody. Cells with features of ICCs were counted.

RESULTS

All three controls and the two children with ARM had dense distribution of ICCs. Most children (6/8; 75%) with HD had markedly reduced counts in aganglionic bowel. Two (25%) also had a decrease in ganglionic bowel. Possible influences were patient age and gender and the level of bowel sectioned.

CONCLUSION

Analysis of this sample suggests that immunostaining for c-Kit positive cells might be a useful screening test in the assessment of bowel motility disorders. The possible effects of age, gender and the level of bowel sampled await determination.

Revision of Oxford medial unicompartmental knee arthroplasty to total knee arthroplasty - results of a multicentre study

The advantages of Unicompartmental Knee Replacement (UKR) over Total Knee Replacement (TKR) includes the preservation of soft tissue as well as bone stock, and better function with improved range of motion and more natural gait. It is therefore believed that the revision of failed UKR to TKR is technically easier than revision of failed TKR. In our study we tested this hypothesis by assessing the reconstruction requirements and early clinical and radiological outcome following the revision of UKR to TKR. During a 15-year period 1060 primary Oxford medial UKR procedures were performed at three centres, 36 of which underwent revision to TKR due to aseptic failure. The mean operating time for revision surgery was 113 min. Among the revision prostheses used, 28 were standard TKRs, six were constrained, and two were semi-constrained. Thirty had no intramedullary stems whereas six had intramedullary stems. In 30 cases reconstruction for bone loss was not required whereas metal augmentation was used in two knees, contained peg defects in the femur were filled with cement in two knees and contained keel defects in the tibia were grafted using the bone from revision cuts in two knees. After a mean follow-up of 2 years, the mean 'total knee score' was 86.3 and the mean functional score was 78.5. These findings suggest that the complexity of operation and complications encountered during Oxford medial UKR revision and the clinical outcome compare favorably with those of TKR revision.

Clinico-pathologic pattern of gastrointestinal stromal tumors (GIST) in southern India: A single-institution experience

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Background: There have been major advances in understanding the behavioral pattern, pharmacological intervention, and clinical response of GIST; yet Indian data in this regard is sparse. This study analyses the clinico-pathologic features in 36 patients (21 male, 15 female) of GIST seen at our institution. Methods: GIST was defined as a mesenchymal spindle or epithelioid cell lesion arising in the GI tract with CD117 immuno-reactivity. Retrospective data from January 03 to March 06 was analyzed for age, tumor site, morphology, immuno- reactivity, prognostic factors, response to treatment (by RECIST), and recurrence or metastasis. All patients had surgery; those with residual, recurrent, or metastatic disease got imatinib till tumor progression. Results: GIST presented at a mean age of 48.2 yrs (SD 6.4, range 34–65). The mean tumor size was 13.9 cm (range 2–42). The most common site was the small intestine (ileum 8, jejunum 7, duodenum 4). 24 patients (66.7%) had localized disease at baseline. Of these, 14 had local recurrence after surgery, and were given imatinib. 5 of them are in complete remission, 4 had partial response (PR), 3 patients died, and 2 had stable disease. Most patients with recurrent GIST had a mitotic rate of >10/50hpf. 8 patients developed metastasis, and received imatinib. Of these, 2 got a PR, 3 had progressive disease and died, and 3 had stable disease. 12 patients (33.3%) had metastasis at baseline (to liver and abdominal cavity), and underwent debulking. Of these, 6 patients with stable disease are on treatment with imatinib, 3 died and 3 were lost to follow-up. Conclusions: Average age of presentation was less than in Western reports. The commonest site was the small intestine as opposed to stomach in western literature. Mitotic rate was a better prognostic factor than gross tumor size. GIST with a mixed cell morphology showed aggressive behavior. Imatinib mesylate is useful in the post-operative management of GIST.

[Table: see text]

No significant financial relationships to disclose.

Early outcomes in the elderly: a meta-analysis of 4921 patients undergoing coronary artery bypass grafting--comparison between off-pump and on-pump techniques

OBJECTIVE

To assess early outcomes in the elderly population undergoing coronary revascularisation with and without cardiopulmonary bypass (CPB).

METHODS

Meta-analysis of all retrospective, non-randomised studies comparing off-pump coronary artery bypass (OPCAB) versus CPB techniques in the elderly (> 70 years) between 1999 and 2005. Age-related early outcomes of interest were death, stroke, atrial fibrillation (AF), renal failure and length of stay in hospital. The random effects model was used. Sensitivity and heterogeneity were analysed.

RESULTS

Analysis of 14 non-randomised studies comprising 4921 patients (OPCAB, 1533 (31.1%) and CPB, 3388 (68.9%)) showed a significantly lower incidence of death in the OPCAB group (odds ratio (OR) 0.48, 95% CI 0.28 to 0.84). This effect was greater in OPCAB octogenarians (OR 0.26, 95% CI 0.12 to 0.57). The pattern of incidence of stroke among the OPCAB octogenarians (OR 0.19, 95% CI 0.07 to 0.56) was similar. The incidence of AF was lower in the OPCAB group (OR 0.77, 95% CI 0.61 to 0.97). The incidence of renal failure did not differ. Length of hospital stay was shorter in the OPCAB group, although with significant heterogeneity.

CONCLUSIONS

OPCAB may be associated with lower incidence of death, stroke and AF in the elderly, which may result in shorter length of hospital stay. A large randomised trial would confirm whether the elderly would benefit more from OPCAB surgery.

Fungal and endotoxin measurements in dust associated with respiratory symptoms in a water-damaged office building

We investigated the associations of fungal and endotoxin levels in office dust with respiratory health in 888 (67% participation) occupants of a water-damaged building. We analyzed floor and chair dusts from 338 workstations for culturable fungi and endotoxin. Based on averages, we ranked each floor of the building as low, medium, or high for occupants' exposure to each of these agents. Multivariate logistic regression models for building-related symptoms included this ranking of fungi and endotoxin, age, gender, race, smoking status, and duration of occupancy. Using floor dust measures, we found significantly increased odds for lower respiratory symptoms [wheeze, chest tightness, attacks of shortness of breath, and attacks of cough: odds ratios (OR) = 1.7 (95% confidence interval (CI): 1.02-2.77) to 2.4 (95% CI: 1.29-4.59)], throat irritation [OR = 1.7, (95% CI: 1.06-2.82)], and rash/itchy skin [OR = 3.0, (95% CI: 1.47-6.19)] in the highest fungal exposure group compared to the lowest, with generally linear exposure-response relationships. Nonlinear relationships were observed for many of these symptoms and endotoxin in floor dust. Interaction models showed that endotoxin modified effects of fungi on respiratory symptoms. Our findings of exposure interactions and exposure-response relationships of fungal and endotoxin with increased risk of building-related symptoms contribute to an understanding of the role of microbial agents in building-related asthma and respiratory and systemic symptoms.

PRACTICAL IMPLICATIONS

Our demonstration of exposure-response relationships between measurements of fungi and/or endotoxin in floor dusts and building-related symptoms implies that microbial agents in floor dust may be a good surrogate measure for dampness-related bioaerosol exposure, considering that measurements of microbial agents in air often fail to demonstrate the associations between exposure and health. In addition, our finding that endotoxin exposure may change the effect of fungal exposure (and vice versa) on respiratory heath suggests that exposure to both fungi and endotoxin should be assessed in epidemiological investigations examining the effect of fungal or endotoxin exposure on respiratory health in indoor environments.

Effects of sub-chronic antipsychotic drug treatment on body weight and reproductive function in juvenile female rats

RATIONALE

Weight gain caused by some antipsychotics is not only confined to adults but can also adversely affect both children and adolescents. Indeed, olanzapine and risperidone have been associated with extreme weight gain in adolescents even greater than that reported in adults. We have recently shown substantial weight gain in adult female rats following treatment with olanzapine and risperidone but not ziprasidone.

OBJECTIVES

The aim of the present study was to compare the effects of several antipsychotics on weight gain and reproductive function in juvenile (aged 7 weeks) female hooded Lister rats.

METHODS

Olanzapine (4 mg/kg), risperidone (0.5 mg/kg), ziprasidone (2.5 mg/kg), sulpiride (10 mg/kg), haloperidol (0.5 mg/kg) or vehicle was administered i.p. once per day for 21 days. Body weight, food and water intake were measured daily, in addition to the determination of stage of the oestrous cycle.

RESULTS

Sub-chronic administration of olanzapine, risperidone, sulpiride and haloperidol, but not ziprasidone, significantly increased body weight compared to vehicle-treated animals during weeks 1-3. Sulpiride significantly increased food and water intake. Significantly increased percentage intra-abdominal fat weight was observed in olanzapine, risperidone, sulpiride and haloperidol, but not ziprasidone-treated animals. Marked disruption of the oestrous cycle was observed in all but the ziprasidone-treated group, which continued to have regular 4-day oestrous cycles.

CONCLUSIONS

Weight gain observed in these juvenile animals was 1.5-2 times greater than that previously observed in adult rats. These findings have important implications for the use of antipsychotics in children and adolescent patients.

Importance of adsorption (hole-filling) mechanism for hydrophobic organic contaminants on an aquifer kerogen isolate

Sorption and desorption behaviors of four hydrophobic organic compounds (HOCs) were investigated for an isolated kerogen material from Borden aquifer material with total organic carbon of 0.021%. The solubility-normalized modified Freundlich equation and the combined linear and Polanyi-Dubinin (PD) equation can quite well describe the sorption or desorption isotherms. The partition component is estimated and compared using desorption data, dual-mode modeling, and the reported partition coefficients. The result suggests that the dual-mode modeling and the combined linear and PD modeling may overestimate the partitioning component. The partition component is not so important as assumed before in sorption of HOCs for the studied sorbent. As the fitted PD equation has an exponent parameter b' approaching 1, it is equivalent to the modified Freundlich equation. The small molecules 1,2-dichlorobenzene (DCB) and naphthalene (Naph) have higher adsorption volumes. The lower adsorption volumes for 1,3,5-trichlorobenzene (TCB) and phenanthrene (Phen) suggest that accessibility to the holes of kerogen by large HOC molecules is reduced. The desorption hysteresis is approximately constant for DCB when the relative aqueous concentration ranges from 0.0007 to 0.6, but for Phen is only obvious at higher relative aqueous concentrations. The varied sorption and desorption behaviors for DCB and Phen are satisfactorily explained by an adsorption/ hole filling mechanism and entrapment of some adsorbates in the kerogen matrix and by possible pore deformation mechanism at high concentrations.

Monitoring expression of HER-2 on circulating epithelial cells in patients with advanced breast cancer

Nineteen breast cancer patients with measurable metastatic disease who were starting an initial or new line of therapy were evaluated for circulating epithelial cells (CECs) a minimum of 4 times over the course of treatment. In 7 of the 10 CEC+ patients, HER-2 expression was detected on the CECs. CECs expressing HER-2 varied among patients and in serial samples from the same patient including a shift from HER-2- to HER-2+ CECs. These results demonstrate that it is possible to quantify receptors essential for rationally designed therapy using CECs and that reliance on the immunophenotype of the primary tumor can be misleading.

Placental protein 14 induces apoptosis in T cells but not in monocytes

Substantial evidence exists in literature to suggest that placental protein 14 (PP14) (recently renamed glycodelin A), exhibits immunosuppressive properties and is an indispensable macromolecule in the maternal system for the establishment, maintenance, and progression of pregnancy. Though there are several reports substantiating the above, the mechanism of its action at the molecular level has not been elucidated as yet. In this paper we provide data that suggest that amniotic fluid PP14 and recombinant PP14 expressed in Pichia pastoris induce apoptosis in human peripheral blood lymphocytes upon activation, independent of monocytes. That PP14 has a direct apoptotic action on T cells but not on monocytes was also demonstrated by utilizing human cell lines. PP14 was shown to induce apoptosis in the human T cell lines, Jurkat and MOLT-4 cells, but not in the human monocytic cell line, U937.

Adaptive-optics compensation by distributed beacons for non-kolmogorov turbulence

In optical propagation through atmospheric turbulence, the performance of compensation with adaptive optics depends on a beacon's spatial distribution. With distributed beacons, the inefficiency of the modal correction, which is defined as the ratio of the anisoplanatic error of the jth mode and the Zernike-coefficient variance, is derived by use of the wave-front expansion on the Zernike polynomials for non-Kolmogorov turbulence. Numerical results are presented for laser beam propagation through constant turbulence with an offset point beacon and an on-axis uniform circular beacon. The results show that compensation for an on-axis uniform circular beacon is much more effective than that for an offset point beacon. The low-order modes are much more correlated than the higher-order modes. The larger the power-law exponent of the refractive-index power spectrum beta, the smaller the propagation path length L and the larger the diameter D of the telescope aperture, the more effective the compensation is. For a specific extended degree of beacon for which there are a maximum number of modes N(max) to be corrected, only low-order-correction systems are useful.

Peripheral blood tumor cell load reflects the clinical activity of the disease in patients with carcinoma of the breast

Peripheral blood was examined for the presence of tumor cells at multiple time points over a one-year period in 45 patients with a history of surgical resection of breast carcinoma. The number of circulating epithelial cells in 8 of 8 patients with clinically active disease concurred or preceded changes in the disease activity. In 12 of 37 patients with no evidence of disease epithelial cells were found at least at one time point at a frequency larger than the control group. One patient had a recurrence of the breast cancer 4 weeks after circulating epithelial cells were detected in the blood.

Management of tongue base obstruction in obstructive sleep apnoea syndrome

Studies have shown that the obstruction in OSA is more often than not multicentric. Tongue base obstruction is relatively more difficult to diagnose accurately and treat effectively. In this presentation, an effort is made to suggest two methods of management of this problem. One deals with the surgical management and the second, an alternative non-surgical method.

Measuring the power-law exponent of an atmospheric turbulence phase power spectrum with a Shack Hartmann wave-front sensor

For non-Kolmogorov turbulence we develop a differential angle-of-arrival fluctuation coefficient, which is the ratio between the transverse and longitudinal differential angle-of-arrival variances, and a slope structure-correlation coefficient, which is the ratio between the transverse and longitudinal differences of the slope correlation function and the slope structure function, to measure the power-law exponent of a phase power spectrum with a Shack-Hartmann wave-front sensor: The differential arrival-of-angle fluctuation coefficient and the slope structure-correlation coefficient are both related to power-law exponent beta and are independent of strength parameter rho(0) of the turbulence. We compare the methods developed and use them to evaluate beta in recently completed horizontal atmospheric experiments for 1000-m laser beam propagation.

Prosthetic valve replacement in Ebstein's malformation: 30-year follow-up

This report addresses a 42-year-old asymptomatic patient who underwent prosthetic replacement of his tricuspid valve 31 years previously for Ebstein's malformation. A ball valve prosthesis was implanted to replace the abnormal valve. Furthermore, he had concomitant closure of a large atrial septal defect with a perforated patch together with plication of the atrialized ventricular segment. The patient is asymptomatic, and it remains noteworthy that he has not been on coumadin for about 30 years.

Flow cytometry--principles and feasibility in transfusion medicine. Enumeration of epithelial derived tumor cells in peripheral blood

Immunomagnetic selection of epithelial cells from peripheral blood was combined with flowcytometric or microscopic analysis to characterize and enumerate epithelium derived tumor cells in the circulation of patients with carcinoma of the breast. Highly significant differences in the number of circulating epithelial cells were found between normal controls and patients with breast cancer. In addition, significant differences in the number of circulating epithelial cells were found in patients in whom the tumor is confined to the primary tumor and those with metastatic disease to local lymphnodes or distant sites [1]. The malignant nature of the cells was demonstrated by their cytology and immunophenotype. In following up the number of epithelial cells in the blood of patients with metastatic carcinoma of the breast, it was shown that it was well correlated with the activity of the disease.

The white matter changes in microencephalic HIV infected infants. A preliminary report

The brains of six infants 14-34 months of age and with microencephaly (brain weight deficit 20-55.5%) were chosen from a group of cases vertically infected with HIV. The center of our investigations was focused on the white matter changes of which two types were observed in the examined brains. Within the periventricular white matter of four cases evident lesions consisting of myelin pallor and concomitant gliosis were recognized as HIV-1 infection related leukoencephalopathy. In all those cases myelination delay was also noted. In one case HIV encephalitis was diagnosed. Our observations suggest that in the majority of HIV infected infants changes resulting in the brain "too small for age" corelate with myelination delay coexisting with early-onset leukoencephalopathy. Because of the small number of cases in this study the results should be considered preliminary, and will require further investigations.