Update on anesthetic complications of robotic thoracic surgery

In the last decade, there has been increasing use of the da Vinci® robot surgical system to perform minimally invasive thoracic surgery. The robotic technology can be applied for surgery of the lungs, mediastinum, and esophagus. A number of case reports have been shown steep learning curve, and promising surgical outcome with this new technology. However, anesthesia management of the robotic thoracic surgery can be complex and requires further education. For example, most of the cases require sufficient lung collapse in order to provide adequate surgical field. In addition, a unique operative setting, such as patient positioning and capnothorax can make anesthesia management further challenging. Hence, anesthesiologists should have better awareness of adverse events or complications related to the robotic surgery to accomplish successful anesthesia management. This review will focus on the potential complications of robotic thoracic surgery involving the lungs, mediastinum and esophagus.

Abstract P4-04-16: Highly variably expressed exons (HVEE) of cancer genes and survival disparity in human breast cancer

Background: RNA-Seq is a powerful technology for accurately quantifying the transcriptome of human cancers. The human breast cancer section of the TCGA has generated RNA-Seq data for over 950 samples from primary tumors and adjacent normal tissues. Analysis of these data has provided insights into transcript isoforms and gene fusions related to the etiology of breast cancer. These rich data no doubt contain other insights into the expression of cancer genes and how it relates to cancer clinical outcomes.

Methods: TCGA RNA-Seq data were downloaded from TCGA data portal. A total of 712 samples were available when this project started, including data from 607 primary breast tumors of which 108 were Basal-like, 316 Luminal A, 139 Luminal B, and 54 HER2-enriched. Data from 65 adjacent normal tissues were also included to be used as controls. We examined the exon-level expression for a group of 137 strongly cancer related genes that can be grouped into 12 pathways (Vogelstein et al. 2013). We focused on exons that display a significant (p <0.05) difference in their expression variation, compared to the other exons of the same gene (> 2 fold changes in terms of standard deviation based on bootstrap resampling). We refer to these exons as HVEEs (Highly variably expressed exons). Using both unsupervised and supervised algorithms (e.g. non-negative matrix factorization), we classified the samples from various subtypes based on the expression patterns of the HVEEs and looked for patterns that associate with clinical outcomes.

Results: For many cancer genes, such as BRCA2 and PTEN, the distribution of within-gene exon expression is similar across all tumor samples and the control group. Subtype-specific amplification of oncogenes (e.g. ERBB2 in the HER2 subtype) and lower expression of cancer genes (e.g. AR in the basal subtype) have also been observed. We observed that exon expression across genes and across samples has in general small variations. Out of the 2,153 exons from the 137 cancer genes, we identified only 41 genes with HVEEs. Most of these genes have only one HVEE but a small number of them have multiple HVEEs (48 in total). Interestingly, HVEEs in 31 of these genes are consistent across the four breast cancer subtypes, as well as the normal group. However, the medians of such HVEE expression across the normal samples are in general significantly lower than those across the tumor samples in any tumor subtypes. Further, using the exon expression data of only the HVEEs, we identified distinct clusters for the basal-like subtype. The 108 basal-like subtype samples can be classified into two clusters with 41 and 67 samples, respectively, based on the expression level of the HVEEs from the above mentioned 31 genes. Overall survival for patients in these two clusters trends toward significance (log-rank test p = 0.058).

Discussion: The consistency of HVEEs across breast cancer and the normal samples and the ability of the HVEE expression level to stratify basal-like breast cancer in a clinically meaningful way is intriguing. We are extending the study to a larger dataset for validation.

The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of Defense, or US Government.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-04-16.

A single analytical model for sparkle and graininess patterns in texture of effect coatings

Flakes in effect coatings, which are responsible for its color shift, are not perfectly horizontally oriented, producing a non uniform texture when observed from a distance of around one meter or less. If the coating is illuminated by a diffuse source, a granular appearance is observed, called graininess. But when the coating is illuminated by unidirectional light, some luminous spots on a dark background appear, effect that is known as sparkle. The characterization of these two textures is getting more important for automotive industry because of the high percentage of cars with effect coatings and because improvements in imaging technology allows this effect to be measured by, for instance, commercial instruments as BYK-mac. A single analytical model to understand and radiometrically characterize both sparkle and graininess in effect coatings is presented and studied in this work. It allows both patterns to be explained and, despite its simplicity, includes variables related to the optical system (Point Spread Function (PSF) and size of the entrance pupil), its distance to the coating, the diffusion grade of the illumination, the illumination and observation directions, and coating parameters.

Endometrial inflammatory markers of the early immune response in mares susceptible or resistant to persistent breeding-induced endometritis

Transient endometritis after breeding is necessary for clearance of bacteria and spermatozoa; however, in a subpopulation of mares, the inflammation fails to resolve in a timely fashion. The objective of this study was to describe the uterine inflammatory response in mares susceptible or resistant to persistent breeding-induced endometritis (PBIE) during the first 24 h after induction of uterine inflammation.Twelve mares were classified as susceptible (nZ6) or resistant (nZ6) to PBIE. Mares were inseminated over five estrous cycles and endometrial biopsies were collected at one time point per cycle before (0) and 2, 6, 12, and 24 h after insemination. qPCR analysis for IL1B, IL6, IL8, IFNG, TNF (TNFA), IL10, and IL1RN was performed, and endometrial inflammatory cells were counted for each sample. Relative quantification values reported fold changes in mRNA expression from 0 h values. A general pattern of expression post insemination was observed in both groups of mares. Cytokine mRNA increased at 2 h, peaked between 2 and 12 h, and then decreased.Differences were detected between groups of mares 6 h after challenge; resistant mares had higher mRNA expression of IL6, IL1RN,and IL10 than susceptible mares. Susceptible mares had an increased number of polymorphonuclear neutrophils in the endometrium 2 and 12 h after breeding when compared with resistant mares. These findings describe an inherent difference in the initial immune response to insemination and may help explain the transient nature of inflammation in resistant mares, whereas susceptible mares develop a persistent inflammation.

Consideraciones acerca del brebaje ayahuasca y perspectivas terapéuticas

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Super resolution imaging achieved by using on-axis interferometry based on a Spatial Light Modulator

An interferometry based method to achieve resolution beyond the diffraction barrier is proposed. Object is illuminated with different tilted beams, generated by using a Spatial Light Modulator (SLM). In addition, some constant phases are also assigned to each tilted beam with the SLM display. Then, the object is simultaneously illuminated with all tilted beams, producing an on-axis interferometry scheme. An interferogram at the image plane is formed for each set of constant phases added to the tilted beams. Using proper selection of constant phases for each of the interferograms, the synthetic aperture can be calculated. During the post processing, we take the Fourier transforms of the each image and the portions of the spectrum are spatially shifted and combined to obtain synthesized spectrum whose inverse Fourier transform gives high resolution image.

Polarimetric method for liquid crystal displays characterization in presence of phase fluctuations

A polarimetry based method able to characterize optical properties of linear Liquid Crystal Displays (LCDs), even in presence of time-fluctuations of the phase, is proposed in this work. In particular, mean linear retardance, Liquid Crystal (LC) fast axis orientation and phase fluctuation amplitude of LCDs can be obtained with the proposed alternative technique. This technique enables to achieve these important features of LCDs with a set-up significantly less complicated to build up and with faster measurements than previously proposed techniques, which are based on diffraction or interferometry experiments. The validity of the technique is tested by measuring two different LCDs: one monopixel PA-LC panel working in transmission and a reflective PA-LCoS display. The technique provides similar results than those obtained by using previously proposed methods, confirming the validity of our alternative technique.

Prospective, multicenter clinical trial to validate new products for skin tests in the diagnosis of allergy to penicillin

BACKGROUND

Allergy to penicillin is the most commonly reported type of drug hypersensitivity. Diagnosis is currently confirmed using skin tests with benzylpenicillin reagents, ie, penicilloyl-polylysine (PPL) as the major determinant of benzylpenicillin and benzylpenicillin, benzylpenicilloate and benzylpenilloate as a minor determinant mixture (MDM).

OBJECTIVE

To synthesize and assess the diagnostic capacity of 2 new benzylpenicillin reagents in patients with immediate hypersensitivity reactions to B-lactams: benzylpenicilloyl octa-L-lysine (BP-OL) as the major determinant and benzylpenilloate (penilloate) as the minor determinant.

METHODS

Prospective multicenter clinical trial performed in 18 Spanish centers. Efficacy was assessed by detection of positive skin test results in an allergic population and negative skin test results in a nonallergic, drug-exposed population. Sensitivity, specificity, and negative and positive predictive values were determined.

RESULTS

The study sample comprised 94 allergic patients: 31 (35.23%) presented anaphylaxis, 4 (4.55%) anaphylactic shock, 51 (58.04%) urticaria, and 2 (2.27%) no specific condition. The culprit 8-lactams were amoxicillin in 63 cases (71.60%), benzypencillin in 14 cases (15.89%), cephalosporins in 2 cases (2.27%), other drugs in 3 cases (3.42%), and unidentified agents in 6 cases (6.82%). The results of testing with BP-OL were positive in 46 cases (52.3%); the results of testing with penilloate were positive in 33 cases (37.5%). When both reagents were taken into consideration, sensitivity reached 61.36% and specificity 100%. Skin testing with penilloate was significantly more often negative when the interval between the reaction and the study was longer.

CONCLUSIONS

The sensitivity of BP-OL and penilloate was 61%. Considering that amoxicillin was the culprit drug in 71% of reactions, these results indicate that most patients were allergic to the whole group of penicillins. These data support the use of benzylpenicillin determinants in the diagnosis of allergy to beta-lactams, even in predominantly amoxicillin-allergic populations.

Enhancing a declarative memory in humans: the effect of clonazepam on reconsolidation

A consolidated memory recalled by a specific reminder can become unstable (labile) and susceptible to facilitation or impairment for a discrete period of time. This labilization phase is followed by a process of stabilization called reconsolidation. The phenomenon has been shown in diverse types of memory, and different pharmacological agents have been used to disclose its presence. Several studies have revealed the relevance of the GABAergic system to this process. Consequently, our hypothesis is that the system is involved in the reconsolidation of declarative memory in humans. Thus, using our verbal learning task, we analyzed the effect of benzodiazepines on the re-stabilization of the declarative memory. On Day 1, volunteers learned an association between five cue- response-syllables. On Day 2, the verbal memory was labilized by a reminder presentation, and then a placebo capsule or 0.25 mg or 0.03 mg of clonazepam was administered to the subjects. The verbal memory was evaluated on Day 3. The volunteers who had received the 0.25 mg clonazepam along with the specific reminder on Day 2, exhibited memory improvement. In contrast, there was no effect when the drug was given without retrieval, when the memory was simply retrieved instead of being reactivated or when short-term memory testing was performed 4 h after reactivation. We discuss the GABAergic role in reconsolidation, which shows a collateral effect on other memories when the treatment is aimed at treating anxiety disorders. Further studies might elucidate the role of GABA in the reconsolidation process associated with dissimilar scenarios. This article is part of a Special Issue entitled 'Cognitive Enhancers'.

Spinal subarachnoid hemorrhage mimicking an acute abdomen

A 39-year-old woman with a history of systemic lupus erythematosum developed an acute abdomen. An intestinal ischemia was suspected and an exploratory laparotomy was performed. No abnormalities were found during surgery and five days later the patient was transferred to our institution. On admission, the patient presented a distended abdomen and paraparesis. The spinal tap showed hemorrhagic CSF and the MRI a subacute subarachnoid hemorrhage (SAH) of the dorsal-lumbar spine. Two days later, the patient suffered an episode of sudden headache. The CT scan revealed an acute SAH at the posterior fossa and digital subtraction angiography a dissection of the right V4 segment. Spinal subarachnoid hemorrhage is a rare syndrome particularly when associated with dissecting aneurysms of the intracranial segment of the vertebral artery. SSAH should be considered early in the differential diagnosis of any case with sudden back or abdominal pain of unknown etiology, even in the absence of neurological deficits.

Susceptibility to persistent breeding-induced endometritis in the mare: relationship to endometrial biopsy score and age, and variations between seasons

The objectives were to: (1) investigate the associations of age and endometrial biopsy score with uterine fluid retention after insemination; and (2) determine if a strict classification of susceptibility to persistent breeding-induced endometritis (PBIE) based on biopsy score, endometrial cytology, and fluid retention after inseminations, is consistent over subsequent breeding seasons. In Experiment 1, 57 mares were inseminated with 10(9) freeze-killed sperm during estrus and evaluated for uterine fluid retention 48 h and 96 h after insemination. Comparisons were made between fluid retention and biopsy score or age. In Experiment 2, a subset of 14 mares was classified for susceptibility to persistent breeding-induced endometritis in two subsequent breeding seasons. Biopsy score and age were associated with fluid retention (P < 0.001). In addition, age was related to biopsy score (P < 0.001). Of the mares examined for susceptibility, 36% (5 of 14) changed status during subsequent seasons. Three mares changed to a more severe classification (intermediate to susceptible, or resistant to intermediate), whereas two mares changed to a less severe classification (susceptible to intermediate).

Leukocoria in a child with sturge-weber syndrome

A five-year-old girl with Sturge-Weber syndrome (SWS) presented with unilateral leukocoria. Imaging excluded retinoblastoma and revealed a choroidal hemangioma, a non-traumatic vitreous hemorrhage and a cataract. To the best of our knowledge, this is the first case report in the radiologic literature of these ophthalmologic findings presenting together and conditioning leukocoria in the setting of SWS. We discuss possible mechanisms and review the literature, emphasizing the role of neuroimaging in pediatric patients with SWS and ophthalmologic complaints.