[From fishing trip to the critical care unit : Successful resuscitation after a near drowning accident]

BACKGROUND

In the context of the European Resuscitation Council (ERC) guidelines, modifications of the proposed treatment algorithm need to be performed in order to respond to different parameters. In this respect several factors interacting with cardiac arrest are essential and need to be included in the therapy. This case report demonstrates an example of resuscitation in the situation of hypothermia.

CASE REPORT

After a near drowning accident and approximately 30 min underwater, a patient suffering from severe hypothermia initially required resuscitation after the rescue. A return of spontaneous circulation (ROSC) was successfully achieved within a short length of time and after 15 days on the intensive care unit the patient was discharged to a rehabilitation facility without any signs of focal neurological deficits.

DISCUSSION

Section 8 of the ERC guidelines provides additional information for resuscitation under specific conditions. In this case report, hypothermia was one of the main criteria leading to an adjusted pharmacological therapy. Furthermore, selection of the appropriate hospital for an optimal advanced treatment including controlled warming of the patient and management of hypothermia-induced complications had to be evaluated.

Facilitating return of bowel function after colorectal surgery: alvimopan and gum chewing

Postoperative ileus is common after colorectal surgery, and has a huge impact on hospital LOS. With the impeding cost crisis in the United States, safely reducing length of stay is essential. Chewing gum and pharmacological treatment with alvimopan are safe, simple tools to reduce postoperative ileus and its associated costs. Future research will determine if integrating these tools with laparoscopic procedures and enhanced recovery pathways is a best practice in colorectal surgery.

Microtubule-associated protein tau correlates with estrogen receptor status but not with in vitro paclitaxel sensitivity in primary breast cancer

BACKGROUND

Factors or signatures predicting response to chemotherapeutic agents are of great interest for breast cancer patient care. There is conflicting data regarding microtubule-associated protein tau as predictive marker of paclitaxel sensitivity. Paclitaxel plays an important role in the adjuvant and metastatic therapy of breast cancer. However, a substantial proportion of patients treated with paclitaxel do not derive benefit from this therapy. Therefore, evaluating potential predictive factors is increasingly important. The authors attempted to validate these findings in vitro utilizing the ATP tumorchemosensitivity assay (ATP-TCA).

MATERIALS AND METHODS

The in vitro drug sensitivity to paclitaxel was evaluated in 48 fresh primary breast cancer specimens using the ATP-TCA. ATP-TCA results were analysed using the area under the curve (AUC) of growth inhibition. These results were correlated with the expression of tau mRNA measured by quantitative reverse transcriptase-polymerase chain reaction (RT-PCR). Tau was also compared between patients with progesterone receptor (PgR) positive and negative and estrogen receptor (ER) positive and negative breast cancer, respectively.

RESULTS

The correlation of tau with the AUC for paclitaxel was weak, Spearman Rho was -0.267 with a p-value of 0.064. As described before, multiple regression analysis confirmed T-stage (p = 0.01) and PR status (p = 0.01) as independent predictors of paclitaxel chemosensitivity. Using multiple regression analysis and defining tau mRNA expression as dependent variable estrogen receptor status as measured by immunohistochemistry was a highly significant predictor for tau mRNA expression (p < 0.001). Grade (p = 0.002) as well as PgR expression (p < 0.001) were also found to be predictors of tau mRNA expression. CON- CLUSIONS: In the present data set the authors were not able to show that MAP-tau mRNA could predict benefit from the addition of a taxane to adjuvant chemotherapy. They found that ER expression is associated with tau protein expression. Estrogen gene transcription is reported to carry weak predictive significance for endocrine sensitivity, therefore it might be worth pursuing whether, tau mRNA could possibly be a predictor for endocrine therapy response.

Hard two-body photodisintegration of 3He

We have measured cross sections for the γ(3)He → pd reaction at photon energies of 0.4-1.4 GeV and a center-of-mass angle of 90°. We observe dimensional scaling above 0.7 GeV at this center-of-mass angle. This is the first observation of dimensional scaling in the photodisintegration of a nucleus heavier than the deuteron.

Lessons learned from microsatellite development for nonmodel organisms using 454 pyrosequencing

Microsatellites, also known as simple sequence repeats (SSRs), are among the most commonly used marker types in evolutionary and ecological studies. Next Generation Sequencing techniques such as 454 pyrosequencing allow the rapid development of microsatellite markers in nonmodel organisms. 454 pyrosequencing is a straightforward approach to develop a high number of microsatellite markers. Therefore, developing microsatellites using 454 pyrosequencing has become the method of choice for marker development. Here, we describe a user friendly way of microsatellite development from 454 pyrosequencing data and analyse data sets of 17 nonmodel species (plants, fungi, invertebrates, birds and a mammal) for microsatellite repeats and flanking regions suitable for primer development. We then compare the numbers of successfully lab-tested microsatellite markers for the various species and furthermore describe diverse challenges that might arise in different study species, for example, large genome size or nonpure extraction of genomic DNA. Successful primer identification was feasible for all species. We found that in species for which large repeat numbers are uncommon, such as fungi, polymorphic markers can nevertheless be developed from 454 pyrosequencing reads containing small repeat numbers (five to six repeats). Furthermore, the development of microsatellite markers for species with large genomes was also with Next Generation Sequencing techniques more cost and time-consuming than for species with smaller genomes. In this study, we showed that depending on the species, a different amount of 454 pyrosequencing data might be required for successful identification of a sufficient number of microsatellite markers for ecological genetic studies.

Measurement of exclusive π(0) electroproduction structure functions and their relationship to transverse generalized parton distributions

Exclusive π(0) electroproduction at a beam energy of 5.75 GeV has been measured with the Jefferson Lab CLAS spectrometer. Differential cross sections were measured at more than 1800 kinematic values in Q(2), x(B), t, and ϕ(π), in the Q(2) range from 1.0 to 4.6  GeV(2), -t up to 2  GeV(2), and x(B) from 0.1 to 0.58. Structure functions σ(T)+ϵσ(L), σ(TT), and σ(LT) were extracted as functions of t for each of 17 combinations of Q(2) and x(B). The data were compared directly with two handbag-based calculations including both longitudinal and transversity generalized parton distributions (GPDs). Inclusion of only longitudinal GPDs very strongly underestimates σ(T)+ϵσ(L) and fails to account for σ(TT) and σ(LT), while inclusion of transversity GPDs brings the calculations into substantially better agreement with the data. There is very strong sensitivity to the relative contributions of nucleon helicity-flip and helicity nonflip processes. The results confirm that exclusive π(0) electroproduction offers direct experimental access to the transversity GPDs.

Splenic injury during colonoscopy--a complication that warrants urgent attention

INTRODUCTION

Colonoscopy is a safe procedure that is performed routinely worldwide. There is, however, a small but significant risk of splenic injury that is often under-recognized. Due to a lack of awareness about this injury, the diagnosis may be delayed, which can lead to an increased risk of morbidity as well as mortality. This paper presents a comprehensive review of the medical literature on colonoscopy-associated splenic injury and describes the clinical presentation and management of this rare but potentially life-threatening complication.

MATERIALS AND METHODS

A comprehensive literature search identified 102 patients worldwide, including patients from our experience, with splenic injury during colonoscopy. A meta-regression analysis was completed using a mixed generalized linear model for repeated measures to identify risk factors for this rare complication.

RESULTS

A total of 75 articles were identified and 102 patients were studied. The majority of the papers were in English (92 %). Only 23.4 % of patients (26/102) were reported prior to the year 2000. Among the patients reported after the year 2000, the majority (84.2 %, 64/76) were reported after 2005. There were more females (76.5 %), median age was 65 years (range, 29-90 years), and most of the colonoscopies were performed without difficulty (66.6 %). Nearly 67 % of patients presented within 24 h of colonoscopy with complaints ranging from abdominal pain to dizziness. The most common symptom was left upper quadrant pain (58 %), and CT scan was found to be the most sensitive tool for diagnosis. Seventy-three patients underwent operative intervention; 96 % of these were treated with splenectomy. Hemoglobin drop of more than 3 gm/dL was identified as the only significant predictor of operative intervention. The overall mortality rate was 5 %.

CONCLUSION

Splenic injury during colonoscopy is rare; however, it is associated with significant morbidity and mortality. Splenic injury warrants a high degree of clinical suspicion critical to prompt diagnosis, and early surgical consultation is warranted.

Geographical influence on racial disparity in breast cancer presentation in the United States

Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among women in the United States. It has been shown that breast cancer presentation varies between racial groups nationwide. Several studies have suggested that this is more a function of geographic rather than true racial disparity. The current study was undertaken to examine racial disparity in breast cancer presentation and to determine whether such disparity continues to be seen once geographic factors are taken into account. Breast cancer data were reviewed for all programs reporting to the American College of Surgeons Commission on Cancer National Cancer Database (NCDB) between 2000 and 2007, inclusive. These data were readily available online. Variables reviewed were: stage at the time of presentation; race; histology; and geographic location within the United States. Four broad regions of the country were chosen, corresponding to the U.S. Census Regions: Northeast, South, Midwest, and West. Patient data were classified as either "early" (stages 0, I, and II) or "late" (stages III and IV) at the time of presentation. A total of 1,388,186 patients were reported during the study period; 1,132,128 white and 256,058 nonwhite. There was a statistically significant difference in presentation between the two racial cohorts; a significantly higher percentage of whites presented with "early" disease (88.8%) when compared with nonwhites (83.8%). This statistically significant difference persisted even when the data were corrected for geographic location within the United States. There is a racial disparity with regard to breast cancer presentation throughout the United States which seems to be independent of geographic location. Nonwhites in all geographic regions present with later-stage disease than whites.

Geographical Influence on Racial Disparity in Breast Cancer Presentation in the United States

Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among women in the United States. It has been shown that breast cancer presentation varies between racial groups nationwide. Several studies have suggested that this is more a function of geographic rather than true racial disparity. The current study was undertaken to examine racial disparity in breast cancer presentation and to determine whether such disparity continues to be seen once geographic factors are taken into account. Breast cancer data were reviewed for all programs reporting to the American College of Surgeons Commission on Cancer National Cancer Database (NCDB) between 2000 and 2007, inclusive. These data were readily available online. Variables reviewed were: stage at the time of presentation; race; histology; and geographic location within the United States. Four broad regions of the country were chosen, corresponding to the U.S. Census Regions: Northeast, South, Midwest, and West. Patient data were classified as either “early” (stages 0, I, and II) or “late” (stages III and IV) at the time of presentation. A total of 1,388,186 patients were reported during the study period; 1,132,128 white and 256,058 nonwhite. There was a statistically significant difference in presentation between the two racial cohorts; a significantly higher percentage of whites presented with “early” disease (88.8%) when compared with nonwhites (83.8%). This statistically significant difference persisted even when the data were corrected for geographic location within the United States. There is a racial disparity with regard to breast cancer presentation throughout the United States which seems to be independent of geographic location. Nonwhites in all geographic regions present with later-stage disease than whites.