Observation of a resonancelike structure in the pi +- psi' mass distribution in exclusive B-->Kpi +- psi' decays

A distinct peak is observed in the pi +/- psi' invariant mass distribution near 4.43 GeV in B-->K pi +/- psi' decays. A fit using a Breit-Wigner resonance shape yields a peak mass and width of M=4433+/-4(stat)+/-2(syst) MeV and Gamma=45-13+18(stat)-13+30(syst) MeV. The product branching fraction is determined to be B(B 0-->K -/+Z+/-(4430)) x B(Z+/-(4430)-->pi+/-psi')=(4.1+/-1.0(stat)+/-1.4(syst)) x 10(-5), where Z+/-(4430) is used to denote the observed structure. The statistical significance of the observed peak is 6.5 sigma. These results are obtained from a 605 fb(-1) data sample that contains 657 x 10(6) BB pairs collected near the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric energy e+ e- collider.

Measurement of time-dependent CP-violating parameters in B(0)-->K_(S)(0)K_(S)(0) decays

We report a measurement of the CP-violating parameters in B;{0}-->K_{S}{0}K_{S}{0} decays based on a data sample of 657x10{6} BB[over ] pairs collected at the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric-energy e;{+}e{-} collider. In this Letter, one neutral B meson is fully reconstructed in the B;{0}-->K_{S}{0}K_{S}{0} decay mode, and the flavor of the accompanying B meson is identified by its decay products. The CP-violating parameters are measured from the asymmetry in the distributions of the proper-time interval between the two B decays: S_K_{S}{0}K_{S}{0}}=-0.38_{-0.77}{+0.69}(stat)+/-0.09(syst) and A_{K_{S}{0}K_{S}{0}}=-0.38+/-0.38(stat)+/-0.05(syst).

Observation of anomalous upsilon(1S)pi+pi(-) and upsilon(2S)pi+pi(-) production near the upsilon(5S) resonance

We report the first observation of e;{+}e;{-}-->Upsilon(1S)pi;{+}pi;{-}, Upsilon(2S)pi;{+}pi;{-}, and first evidence for e;{+}e;{-}-->Upsilon(3S)pi;{+}pi;{-}, Upsilon(1S)K+K-, near the peak of the Upsilon(5S) resonance at sqrt[s] approximately 10.87 GeV. The results are based on a data sample of 21.7 fb;{-1} collected with the Belle detector at the KEKB e;{+}e;{-} collider. Attributing the signals to the Upsilon(5S) resonance, the partial widths Gamma(Upsilon(5S)-->Upsilon(1S)pi;{+}pi;{-})=0.59+/-0.04(stat)+/-0.09(syst) MeV and Gamma(Upsilon(5S)-->Upsilon(2S)pi;{+}pi;{-})=0.85+/-0.07(stat)+/-0.16(syst) MeV are obtained from the observed cross sections. These values exceed by more than 2 orders of magnitude the previously measured partial widths for dipion transitions between lower Upsilon resonances.

Observation of a new DsJ meson in B+-->D0D0K+ decays

We report the observation of a new DsJ meson produced in B+-->D0DsJ-->D0D0K+. This state has a mass of M=2708+/-9(-10)(+11) MeV/c2, a width Gamma=108+/-23(-31)(+36) MeV/c2 and a 1- spin-parity. The statistical significance of this observation is 8.4 sigma. The results are based on an analysis of 449 x 10(6) BB events collected at the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric-energy e+e- collider.

Observation of the psi(4415)-->DD2*(2460) decay using initial-state radiation

We report measurements of the exclusive cross section for e(+)e(-)-->D(0)D(-)pi(+) over the center-of-mass energy range 4.0 GeV to 5.0 GeV with initial-state radiation and the first observation of the decay psi(4415)-->D(0)D(-)pi(+). From a study of the resonant substructure in psi(4415) decay we conclude that the psi(4415)-->D(0)D(-)pi(+) decay is dominated by psi(4415)-->DD(2)(*)(2460). We obtain B(psi(4415)-->D(0)D(-)pi(nonresonant)(+))/B(psi(4415)-->DD(2)(*)(2460)-->D(0)D(-)pi(+))<0.22 at 90% C.L. The analysis is based on a data sample collected with the Belle detector with an integrated luminosity of 673 fb(-1).

Time-dependent CP-violating asymmetry in B0-->rho0gamma decays

We report the first measurement of CP-violation parameters in B0-->rho0gamma decays based on a data sample of 657x10(6)BB pairs collected with the Belle detector at the KEKB asymmetric-energy e+e- collider. We obtain the time-dependent and direct CP-violating parameters, Srho0gamma=-0.83+/-0.65(stat)+/-0.18(syst) and Arho0gamma=-0.44+/-0.49(stat)+/-0.14(syst), respectively.

Search for the CP-violating decays Upsilon(4S)-->B0B0-->J/psiKS0+J/psi(etac)KS0

We report the first search for CP-violating decays of the Upsilon(4S) using a data sample that contains 535 x 10(6) Upsilon(4S) mesons with the Belle detector at the KEKB asymmetric-energy e(+)e(-) collider. A partial reconstruction technique is employed to enhance the signal sensitivity. No significant signals were observed. We obtain an upper limit of 4 x 10(-7) at the 90% confidence level for the branching fractions of the CP violating modes, Upsilon(4S)-->B(0)B(0)-->J/psiK(S)(0)+J/psi(eta(c))K(S)(0). Extrapolating the result, we find that an observation with 5sigma significance is expected with a 30 ab(-1) data sample, which is within the reach of a future super B factory.

Do AshSplit haemodialysis catheters provide better flow rates in the long term?

BACKGROUND

Recently, interventional radiologists have adopted an increasingly prominent role in the placement and management of hemodialysis catheters, as well as in the research and development of new and better catheters. The purpose of this study was to evaluate the viability and hemodialysis efficiency of the AshSplit catheter and the Permcath catheter.

METHODS

204 consecutive patients requiring radiological insertion of hemodialysis catheters were followed, retrospectively, over a 42-month period. Both hemodialysis catheters were placed using a combination of ultrasonic and fluoroscopic guidance and tunneled appropriately. Information collected included catheter insertion sites, insertion complications, catheter duration, and final outcome.

RESULTS

Over the study period of two years, 269 catheters were placed into 204 patients with end stage renal failure. Patients received either an AshSplit (101 patients, 127 catheters) or a Permcath (103 patients, 142 catheters). Vascular access route of choice was the right internal jugular vein (67% AshSplit, 71% Permcath). Insertion complications occurred in 18 patients overall (6.6%), with only 1 requiring further intervention (hemopneumothorax). Flow rates averaged 259 mls/min for AshSplits and 248 mls/min for Permcaths (p < 0.001). Follow-up of catheter viability for 42 months yielded a mean AshSplit catheter duration of 246 days (range 6-932) and 239 days (range 1-1,278) for Permcath (p = 0.46). Reasons for catheter failure and elective catheter removal were similar in both groups; however, Permcaths required significantly more thrombolysis than AshSplits, p < 0.001.

CONCLUSION

The AshSplit provides significantly better flow rates and less thrombolysis compared to the Permcath, with similar catheter dwell times.

Observation of two resonant structures in e+ e- -->pi+ pi- psi(2S) via initial-state radiation at Belle

The cross section for e+ e- --> pi+ pi- psi(2S) between threshold and sqrt[s]=5.5 GeV is measured using 673 fb(-1) of data on and off the Upsilon(4S) resonance collected with the Belle detector at KEKB. Two resonant structures are observed in the pi+ pi- psi(2S) invariant-mass distribution, one at 4361 +/- 9 +/- 9 MeV/c2 with a width of 74 +/- 15 +/- 10 MeV/c2, and another at 4664 +/- 11 +/- 5 MeV/c2 with a width of 48 +/- 15 +/- 3 MeV/c2, if the mass spectrum is parametrized with the coherent sum of two Breit-Wigner functions. These values do not match those of any of the known charmonium states.

Measurement of Einstein-Podolsky-Rosen-type flavor entanglement in Upsilon(4S) --> B0 B0 decays

The neutral B meson pair produced at the Upsilon(4S) should exhibit a nonlocal correlation of the type discussed by Einstein, Podolsky, and Rosen. We measure this correlation using the time-dependent flavor asymmetry of semileptonic B(0) decays, which we compare with predictions from quantum mechanics and two local realistic models. The data are consistent with quantum mechanics, and inconsistent with the other models. Assuming that some B pairs disentangle to produce B(0) and B(0) with definite flavor, we find a decoherent fraction of 0.029 +/ -0.057, consistent with no decoherence.

Measurement of D0-D0 mixing parameters in D0 --> Ks pi+ pi- decays

We report a measurement of D0-D(0) mixing parameters in D(0) --> K(s)(0) pi(+) pi(-) decays using a time-dependent Dalitz-plot analysis. We first assume CP conservation and subsequently allow for CP violation. The results are based on 540 fb(-1) of data accumulated with the Belle detector at the KEKB e(+)e(-) collider. Assuming negligible CP violation, we measure the mixing parameters x = (0.80 +/- 0.29(-0.07-0.14)(+0.09+0.10))% and y = (0.33+/-0.24(-0.12-0.08)(+0.08+0.06))%, where the errors are statistical, experimental systematic, and systematic due to the Dalitz decay model, respectively. Allowing for CP violation, we obtain the CP-violating parameters |q / p| = 0.86(-0.29-0.03)(+0.30+0.06) +/- 0.08 and arg(q/p) = (-14(-18-3-4)(+16+5+2)) degrees .

Measurements of branching fractions for B --> K pi and B --> pi pi decays

We report measurements of branching fractions for B --> K pi and B --> pi pi decays based on a data sample of 449 x 10(6) BB[over] pairs collected at the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric-energy e(+)e(-) collider. We also measure the ratios of partial widths for B-->Kpi decays, namely R(c) identical with 2Gamma(B(+) --> K(+) pi(0))/Gamma(B(+) --> K(0) pi(+)) = 1.08+/-0.06+/-0.08 and R(n) identical with Gamma(B(0) --> K(+) pi(-))/2 Gamma(B(0) --> K(0) pi(0)) = 1.08+/-0.08+/-0.08, where the first and the second errors are statistical and systematic, respectively. These ratios are sensitive to enhanced electroweak penguin contributions from new physics; the new measurements are, however, consistent with standard model expectations.

Quality of life of women treated with radiotherapy for breast cancer

GOALS OF WORK

Radiotherapy is routinely used in the treatment of early breast cancer, particularly in women who have undergone lumpectomy. Its impact on the quality of life of patients is important and is taken into consideration when making informed choices about treatment from both a patient's and health professional's point of view. This study reports on the quality of life of women at baseline, the completion of radiotherapy and 7 months after the completion of radiotherapy.

MATERIALS AND METHODS

European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C-30 and BR-23 questionnaires were used to evaluate quality of life of 61 women treated with radiotherapy for breast cancer. Additionally, demographic and treatment variables were analysed in relation to quality of life outcomes to determine if there were any significant predictors of quality of life.

MAIN RESULTS

There was no difference in quality of life of women at baseline, completion and 7 months after completion of radiotherapy. Fatigue and breast symptoms increased during radiotherapy but returned to baseline levels at 7 months. Fatigue was the strongest predictor of poor quality of life in women after radiotherapy.

CONCLUSION

Women retain a high quality of life and return to baseline function by 7 months after radiotherapy. Treatment may best be targeted to alleviate fatigue and breast symptoms during radiotherapy.

Crossing ureteric strictures: microcatheters to the rescue when conventional methods fail

Tight distal ureteric strictures can be most challenging to traverse both from above, by interventional radiologists, and below, by urologists. Despite the advent of numerous guidewires, manufactured from different materials, often ureteric strictures are too tight to allow conventional guidewires to pass through. We describe an alternative approach to cross tight ureteric strictures, using a microguidewire and microcatheter combination.

Limits on interactions between weakly interacting massive particles and nucleons obtained with CsI(Tl) crystal detectors

The Korea Invisible Mass Search (KIMS) experiment presents new limits on the weakly interacting massive particle (WIMP)-nucleon cross section using data from an exposure of 3409 kg.d taken with low-background CsI(Tl) crystals at the Yangyang Underground Laboratory. The most stringent limit on the spin-dependent interaction for a pure proton case is obtained. The DAMA signal region for both spin-independent and spin-dependent interactions for the WIMP masses greater than 20 GeV/c2 is excluded by the single experiment with crystal scintillators.

Traumatic inferior gluteal artery pseudoaneurysm and arteriovenous fistula managed with emergency transcatheter embolization

We present a case of blunt trauma to the buttock resulting in an inferior gluteal artery pseudoaneurysm and arteriovenous fistula. The characteristic diagnostic features on CT angiography and digital subtraction angiography (DSA), along with the emergency percutaneous management of this traumatic vascular injury, are described. A review of the literature demonstrates inferior gluteal artery pseudoaneurysm is a rare condition, while successful treatment with glue embolization is previously unreported.

Rasmussen’s Aneurysm: A Forgotten Entity?

We present the case of a rare entity which is a complication of a disease process that had almost disappeared from the Western World. With the recent resurgence in reported cases of Mycobacterium tuberculosis (TB) in Western communities, it is important to recognize complications and sequelae. A young alcoholic male with confirmed active TB suffered a cardiac arrest following massive haemoptysis. Multidetector computed tomography angiography diagnosed a Rasmussen's aneurysm, confirmed by digital subtraction angiography and then successfully embolized with glue. We outline this rare case and the embolization technique and review previously documented reports.

Measurement of the tau lepton mass and an upper limit on the mass difference between tau+ and tau-

The mass of the tau lepton has been measured in the decay mode tau-->3pinutau using a pseudomass technique. The result obtained from 414 fb-1 of data collected with the Belle detector is Mtau=[1776.61+/-0.13(stat)+/-0.35(sys)] MeV/c2. The upper limit on the relative mass difference between positive and negative tau leptons is |Mtau+-Mtau-|/Mtau<2.8 x 10-4 at 90% confidence level.

Experimental constraints on the spin and parity of the Lambdac(2880)+

We report the results of several studies of the Lambda(c)(+)pi(+)pi(-)X final state in continuum e(+)e(-) annihilation data collected by the Belle detector. An analysis of angular distributions in Lambda(c)(2880)(+)-->Sigma(c)(2455)(0,++)pi(+,-) decays strongly favors a Lambda(c)(2880)(+) spin assignment of 5/2 over 3/2 or 1/2. We find evidence for Lambda(c)(2880)(+)-->Sigma(c)(2520)(0,++)pi(+,-) decay and measure the ratio of Lambda(c)(2880)(+) partial widths Gamma(Sigma(c)(2520)pi)/Gamma(Sigma(c)(2455)pi)=0.225+/-0.062+/-0.025. This value favors the Lambda(c)(2880)(+) spin-parity assignment of 5/2(+) over 5/2(-). We also report the first observation of Lambda(c)(2940)(+)-->Sigma(c)(2455)(0,++)pi(+,-) decay and measure Lambda(c)(2880)(+) and Lambda(c)(2940)(+) mass and width parameters. These studies are based on a 553 fb(-1) data sample collected at or near the Upsilon(4S) resonance at the KEKB collider.

Evidence for CP violation in B0-->D+D- decays

We report measurements of the branching fraction and CP violation parameters in B(0)-->D+ D- decays. The results are based on a data sample that contains 535 x 10(6) BB pairs collected at the Upsilon(4S) resonance, with the Belle detector at the KEKB asymmetric-energy e+e- collider. We obtain [1.97+/-0.20(stat) +/- 0.20(syst)] x 10(-4) for the branching fraction of B0-->D+D-. The measured values of the CP violation parameters are S=-1.13+/-0.37+/-0.09, A=0.91+/-0.23+/-0.06, where the first error is statistical and the second is systematic. We find evidence of CP violation in B0-->D+D- at the 4.1sigma confidence level. While the value of S is consistent with expectations from other measurements, the value of the parameter A favors large direct CP violation at the 3.2sigma confidence level, in contradiction to standard model expectations.

Measurement of CP asymmetry in a time-dependent Dalitz analysis of B0-->(rhopi)0 and a constraint on the quark mixing matrix angle phi2

We present a measurement of CP asymmetry using a time-dependent Dalitz plot analysis of B0-->pi+pi-pi0 decays based on a 414 fb(-1) data sample containing 449 x 10(6) BB pairs. The data was collected on the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric energy e+ e- collider. Combining our analysis with information on charged B decay modes, we perform a full Dalitz and isospin analysis and obtain a constraint on the CKM angle phi2, 68 degrees < phi2 < 95 degrees as the 68.3% confidence interval for the phi2 solution consistent with the standard model (SM). A large SM-disfavored region also remains.

Thyroid Dose During Neurointerventional Procedures: Does Lead Shielding Reduce the Dose?

PURPOSE

To assess radiation dose to the thyroid in patients undergoing neurointerventional procedures and to evaluate dose reduction to the thyroid by lead shielding.

METHODS AND MATERIALS

A randomized patient study was undertaken to evaluate the dose reduction by thyroid lead shields and assess their practicality in a clinical setting. Sixty-five patients attending for endovascular treatment of arteriovenous malformations (AVMs) and aneurysms were randomized into one of 2 groups a) No Thyroid Shield and b) Thyroid Lead Shield. Two thermoluminescent dosimeters (TLDs) were placed over the thyroid gland (1 on each side) at constant positions on each patient in both groups. A thyroid lead shield (Pb eq. 0.5 mm) was placed around the neck of patients in the thyroid lead shield group after the neurointerventional radiologist had obtained satisfactory working access above the neck. The total dose-area-product (DAP) value, number and type of digital subtraction angiography (DSA) runs and fluoroscopy time were recorded for all patients.

RESULTS

Of the 72 patients who initially attended for neurointerventional procedures, 7 were excluded due to failure to consent or because of procedures involving access to the external carotid circulation. Of the remaining 65 who were randomized, a further 9 were excluded due to; procedureabandonment, unfeasible shield placement or shield interference with the procedure. Patient demographics included mean age of 47.9 yrs (15-74), F:M=1.4:1. Mean fluoroscopy time was 25.9 min. Mean DAP value was 13,134.8 cGy x cm(2) and mean number of DSA runs was 13.4. The mean relative thyroid doses were significantly different (p< 0.001) between the unshielded (7.23 mSv/cGy2 x 105) and shielded groups (3.77 mSv/cGy2 x 105). A mean thyroid dose reduction of 48% was seen in the shielded group versus the unshielded group.

CONCLUSION

Considerable doses to the thyroid are incurred during neurointerventional procedures, highlighting the need for increased awareness of patient radiation protection. Thyroid lead shielding yields significant radiation protection, is inexpensive and when not obscuring the field of view, should be used routinely.

Staff radiation doses to the lower extremities in interventional radiology

The purpose of this study was to investigate the radiation doses to the lower extremities in interventional radiology suites and evaluate the benefit of installation of protective lead shielding. After an alarmingly increased dose to the lower extremity in a preliminary study, nine interventional radiologists wore thermoluminescent dosimeters (TLDs) just above the ankle, over a 4-week period. Two different interventional suites were used with Siemens undercouch fluoroscopy systems. A range of procedures was carried out including angiography, embolization, venous access, drainages, and biopsies. A second identical 4-week study was then performed after the installation of a 0.25-mm lead curtain on the working side of each interventional table. Equivalent doses for all nine radiologists were calculated. One radiologist exceeded the monthly dose limit for a Category B worker (12.5 mSv) for both lower extremities before lead shield placement but not afterward. The averages of both lower extremities showed a statistically significant dose reduction of 64% (p < 0.004) after shield placement. The left lower extremity received a higher dose than the right, 6.49 vs. 4.57 mSv, an increase by a factor of 1.42. Interventional radiology is here to stay but the benefits of interventional radiology should never distract us from the important issue of radiation protection. All possible measures should be taken to optimize working conditions for staff. This study showed a significant lower limb extremity dose reduction with the use of a protective lead curtain. This curtain should be used routinely on all C-arm interventional radiologic equipment.

Evidence for D0-D0 mixing

We observe evidence for D(0)-D(0) mixing by measuring the difference in the apparent lifetime when a D(0) meson decays to the CP eigenstates K(+)K(-) and pi(+)pi(-) and when it decays to the final state K(-)pi(+). We find the relative difference of the lifetimes y(CP) to be [1.31+/-0.32(stat)+/-0.25(syst)]%, 3.2 standard deviations from zero. We also search for a CP asymmetry between D(0) and D(0) decays; no evidence for CP violation is found. These results are based on 540 fb(-1) of data recorded by the Belle detector at the KEKB e(+)e(-) collider.

Observation of direct CP violation in B0 --> pi+pi- decays and model-independent constraints on the quark-mixing angle phi2

We report a new measurement of the time-dependent CP-violating parameters in B(0)-->pi(+)pi(-) decays with 535 x 10(6) BB pairs collected with the Belle detector at the KEKB asymmetric-energy e(+)e(-) collider operating at the Upsilon(4S) resonance. We find 1464+/-65 B(0)-->pi(+)pi(-) events and measure the CP-violating parameters S(pipi)=-0.61+/-0.10(stat)+/-0.04(syst) and A(pipi)=+0.55+/-0.08(stat)+/-0.05(syst). We observe large direct CP violation with a significance greater than 5 standard deviations for any S(pipi) value. Using isospin relations, we measure the Cabibbo-Kobayashi-Maskawa quark-mixing matrix angle phi(2)=(97+/-11) degrees for the solution consistent with the standard model and exclude the range 11 degrees <phi(2)<79 degrees at the 95% confidence level.

Observation of B decays to two kaons

Using 449x10(6) BB[over ] pairs collected with the Belle detector at the KEKB asymmetric-energy e(+)e(-) collider, we observe clear signals for B(+)-->K[over ](0)K(+) and B(0)-->K[over ](0)K(0) decays with 5.3sigma and 6.0sigma significance, respectively. We measure the branching fractions B(B(+)-->K[over ](0)K(+))=(1.22(-0.28-0.16)(+0.32+0.13))x10(-6) and B(B(0)-->K[over ](0)K(0))=(0.87(-0.20)(+0.25)+/-0.09)x10(-6), and partial-rate asymmetries A(CP)(B(+)-->K[over ](0)K(+))=0.13(-0.24)(+0.23)+/-0.02 and A(CP)(B(0)-->K[over ](0)K(0))=-0.58(-0.66)(+0.73)+/-0.04. From a simultaneous fit, we also obtain B(B(+)-->K(0)pi(+))=(22.8(-0.7)(+0.8)+/-1.3)x10(-6) and A(CP)(B(+)-->K(0)pi(+))=0.03+/-0.03+/-0.01. The first and second error in the branching fractions and the partial-rate asymmetries are statistical and systematic, respectively. No signal is observed for B(0)-->K(+)K(-) decays, and for this branching fraction, we set an upper limit of 4.1x10(-7) at the 90% confidence level.

CT of pelvic extraperitoneal spaces: an anatomical study in cadavers

AIM

To evaluate the pelvic extraperitoneal compartments and communications with abdominal retroperitoneal spaces.

MATERIAL AND METHODS

Helical computed tomography (CT) was used to image the abdomen and pelvis after injection of 800 ml of dilute (1 in 25) contrast material into prevesical, perivesical and perirectal spaces in eight embalmed cadavers. Axial images and multiplanar reconstructions were reviewed to determine flow pathways.

RESULTS

The prevesical space was injected in four cadavers, the perivesical space in two and the perirectal in two. After the four prevesical space injections, communication was seen with the perivesical (four of four), perirectal (one of four) and abdominal extraperitoneal spaces (posterior pararenal space in all, anterior pararenal space in two of four, and perirenal space in three of four). After the two perivesical injections, communication was seen with the prevesical (two of two), perirectal (two of two) and abdominal extraperitoneal spaces (posterior pararenal in two of two, anterior pararenal in two of two, and perirenal space in two of two). After the two perirectal space injections, communication was seen with the prevesical (two of two), perivesical (one of two) and abdominal extraperitoneal spaces (posterior pararenal in two of two, anterior pararenal in two of two, and perirenal space in one of two).

CONCLUSION

The extraperitoneal spaces of the pelvis comprise three communicating compartments: the prevesical space, the perivesical space, and the perirectal space. The perirectal space, previously thought to be separate, communicates with the perivesical and the prevesical spaces. Intercommunication occurs both between the pelvic extraperitoneal spaces and with abdominal retroperitoneal spaces.

Search for invisible decay of the Upsilon(1S)

We report results of a search for the invisible decay of the Upsilon(1S) via the Upsilon(3S)-->pi+ pi- Upsilon(1S) transition using a data sample of 2.9 fb-1 at the Upsilon(3S) resonance. The data were collected with the Belle detector at the KEKB asymmetric-energy e+ e- collider. No signal is found, and an upper limit for the branching fraction at the 90% confidence level is determined to be B(Upsilon(1S)-->invisible)<2.5 x 10(-3).

Observation of the decay B(0)-->J/psieta

We report the first observation of B(0)-->J/psieta decay. These results are obtained from a data sample that contains 449 x10(6) BB[over] pairs accumulated at the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric-energy e(+)e(-) collider. We observe a signal with a significance of 8.1 sigma and obtain a branching fraction of (9.5+/-1.7(stat)+/-0.8(syst)) x 10(-6).

Measurement of the near-threshold e+e- --> D(*)+/-D(*)-/+ cross section using initial-state radiation

We report a measurement of the exclusive e+e- -->D(*)+/-D*-/+ cross section as a function of center-of-mass energy near the D(*)+/-D*-/+ threshold with initial-state radiation. A partial reconstruction technique is used to increase the efficiency and to suppress background. The analysis is based on a data sample collected with the Belle detector with an integrated luminosity of 547.8 fb(-1).

Measurement of inclusive Ds, D0, and J/psi rates and determination of the Bs(*)Bs(*) production fraction in bb Events at the Upsilon(5S) resonance

The inclusive production of D(s), D(0), and J/psi mesons is studied using a 1.86 fb(-1) data sample collected on the Upsilon(5S) resonance with the Belle detector at the KEKB asymmetric-energy e(+)e(-) collider. The number of bb events in this Upsilon(5S) data sample is determined. We measure the branching fractions B(Upsilon(5S)-->D(s)X)/2=(23.6+/-1.2+/-3.6)%, B(Upsilon(5S)-->D(0)X)/2=(53.8+/-2.0+/-3.4)%, and B(Upsilon(5S)-->J/psiX)/2=(1.030+/-0.080+/-0.067)%. From the D(s) and D(0) inclusive branching fractions the ratio f(s)=(18.0+/-1.3+/-3.2)% of B(s)(*)B(s)(*) to the total bb quark pair production at the Upsilon(5S) energy is obtained in a model-dependent way.

Observation of time-dependent CP violation in B0 --> eta'K0 decays and improved measurements of CP asymmetries in B0 --> phiK0, KS0KS0KS0 and B0 --> J/psiK0 decays

We present improved measurements of CP-violation parameters in B(0) --> phiK(0), eta(')K(0), KS(0)KS(0)KS(0) decays based on a sample of 535 x 10(6) BB pairs collected at the Upsilon(4S) resonance with the Belle detector at the KEKB energy-asymmetric e(+)e(-) collider. We obtain sin2phi1(eff)=+0.64+/-0.10(stat)+/-0.04(syst) for B(0) --> eta(')K(0), +0.50+/-0.21(stat)+/-0.06(syst) for B(0) --> phiK(0), and +0.30+/-0.32(stat)+/-0.08(syst) for B(0) --> KS(0)KS(0)KS(0) decays. We have observed CP violation in the B(0) --> eta(')K(0) decay with a significance of 5.6 standard deviations. We also perform an improved measurement of CP asymmetries in B(0) --> J/psiK(0) decays and obtain sin2phi1=+0.642+/-0.031(stat)+/-0.017(syst).

Pectoral stretching program for women undergoing radiotherapy for breast cancer

Surgery and radiotherapy commonly cause adverse musculoskeletal problems, particularly loss of strength and range of motion, in the upper quadrant of breast cancer patients. Few well-designed studies have investigated whether these impairments can be prevented. Stretching is an effective technique for increasing range of motion, hence the aim of this study was to investigate whether a stretching program reduced acute musculoskeletal impairments in patients undergoing radiotherapy for breast cancer. Sixty-four women were recruited prior to commencement of radiotherapy following breast cancer surgery. Participants were randomised to either a control or stretch group. Participants in both groups were reviewed by the physical therapist on a weekly basis for approximately 6 weeks, and were given general information about skin care and lymphedema. The control group received no advice about exercise. The stretch group received instruction on low-load, prolonged pectoral stretches, which were to be performed daily and were checked at weekly visits. Shoulder range of motion, strength, arm circumference, and quality of life measurements were taken prior to, and at completion of radiotherapy, and at 7 months after radiotherapy. There was no difference in any outcome between groups. Breast symptoms increased for both groups during radiotherapy, without loss of strength or range of movement. The incidence of lymphedema during the study was low for both groups and did not differ between groups. The pectoral stretching program did not influence the outcomes measured because the symptoms reported by patients were not a consequence of contracture.

Gunther Tulip Retrievable Inferior Vena Caval Filters: Indications, Efficacy, Retrieval, and Complications

PURPOSE

We evaluated the Gunther Tulip (GT) retrievable inferior vena cava (IVC) filter with regard to indications, filtration efficacy, complications, retrieval window, and use of anticoagulation.

METHOD

A retrospective study was performed of 147 patients (64 men, 83 women; mean age 58.8 years) who underwent retrievable GT filter insertion between 2001 and 2005. The indications for placement included a diagnosis of pulmonary embolism or deep venous thrombosis with a contraindication to anticoagulation (n = 68), pulmonary embolism or deep venous thrombosis while on anticoagulation (n = 49), prophylactic filter placement for high-risk surgical patients with a past history of pulmonary embolism or deep venous thrombosis (n = 20), and a high risk of pulmonary embolism or deep venous thrombosis (n = 10). Forty-nine of the 147 patients did not receive anticoagulation (33.7%) while 96 of 147 patients did, 82 of these receiving warfarin (56.5%), 11 receiving low-molecular weight heparins (7.58%), and 3 receiving antiplatelet agents alone (2.06%).

RESULTS

Filter placement was successful in 147 patients (100%). Two patients had two filters inserted. Of the 147 patients, filter deployment was on a permanent basis in 102 and with an intention to retrieve in 45 patients. There were 36 (80%) successful retrievals and 9 (20%) failed retrievals. The mean time to retrieval was 33.6 days. The reasons for failed retrieval included filter struts tightly adherent to the IVC wall (5/9), extreme filter tilt (2/9), and extensive filter thrombus (2/9). Complications included pneumothorax (n = 4), failure of filter expansion (n = 1), and breakthrough pulmonary embolism (n = 1). No IVC thrombotic episodes were recorded.

DISCUSSION

The Gunther Tulip retrievable filter can be used as a permanent or a retrievable filter. It is safe and efficacious. GT filters can be safely retrieved at a mean time interval of 33.6 days. The newly developed Celect filter may extend the retrieval interval.

Transvaginal aspiration of ovarian cysts: long-term follow-up

BACKGROUND AND PURPOSE

Transvaginal aspiration of ovarian cysts has been advocated as a viable alternative to surgery in patients who are high-risk surgical candidates. We describe a retrospective study evaluating the results of transvaginal aspirations of benign ovarian cysts in patients at increased surgical risk, focusing on long-term follow-up for recurrence of the cyst and/or development of malignancy.

METHODS

Twenty-four women with ovarian cysts underwent 34 transvaginal drainages between October 1998 and December 2004. All patients were referred following diagnosis of a persistent ovarian cyst with a benign appearance on ultrasound. All patients were unsuitable candidates for surgery (history of previous pelvic surgery, n = 21; high risk for anesthesia, n = 1; and unsuitable for laparoscopy due to obesity, n = 2). Patients with a history of pregnancy, acute abdominal symptoms, or previous gynecologic malignancy were excluded. A 20G x 20 cm Chiba needle was used for transvaginal aspiration using an endocavity probe (Acuson XP, Mountain View, CA, USA; Siemens Sololine, Erlangen, Germany) and intravenous sedoanalgesia. Cysts were aspirated to dryness.

RESULTS

Long-term follow-up of patients was performed and revealed a recurrence rate of 75%. Eighty-three percent of cysts on the left and 42% of those on the right recurred. Nine of 15 (60%) patients with recurrence required further intervention. Two of 9 underwent surgical intervention only, 4 of 9 had repeat transvaginal aspiration(s) performed, and 3 of 9 had a combination of both transvaginal aspiration and surgery. No patient developed ovarian malignancy.

CONCLUSION

Transvaginal cyst aspiration has many advantages including short hospital stay, rapid recovery, excellent patient tolerance, and a low rate of procedure-related complications. Our study demonstrates that ovarian cyst recurrence following transvaginal drainage is a more significant problem than previously documented, especially if the cyst is on the left side. However, when recurrences do occur, repeat transvaginal aspirations may be considered in the symptomatic patient.

Vascular endothelial growth factor (VEGF) is associated with reduced severity of acute graft-versus-host disease and nonrelapse mortality after allogeneic stem cell transplantation

This study investigated whether or not there is a correlation between the changes in the serum levels of vascular endothelial growth factor (VEGF) and the outcome of allogeneic stem cell transplantation (allo-SCT). Eighty-five patients undergoing allo-SCT were prospectively studied. The serum VEGF levels were measured on days 0, +7 and +14 after transplantation. The VEGF levels decreased significantly on day +7 and recovered on day +14. The highest levels from day +7 through day +14 were categorized by cluster analysis, which were then correlated with the nonrelapse mortality (NRM). There was a significant correlation between a low VEGF level and the occurrence of severe acute graft-versus-host disease (GVHD) including grade III-IV (P=0.029). The 1-year probability of NRM in patients with a low VEGF level was 22.5% compared with 3.5% for those with a high VEGF level (P=0.024). Multivariate analysis revealed clinically defined infections (P=0.011), advanced disease (P=0.014) and a low VEGF cluster (P=0.05) to be significantly associated with the occurrence of NRM in the cohort. In conclusion, low VEGF levels after allo-SCT are associated with NRM with an exacerbated severity of acute GVHD. VEGF monitoring after a transplant might identify those patients at risk of severe transplant-related mortality.

Interventional radiology techniques for provision of enteral feeding

Gastrostomy placement in patients who are unable to maintain their nutrition orally has been attempted using a variety of techniques over the past century. This includes surgical, endoscopic, and, more recently, percutaneous radiologically guided methods. Surgical gastrostomy placement was the method of choice for almost a century, but has since been superseded by both endoscopic and radiological placement. There are a number of indications for gastrostomy placement in clinical practice today, with fewer contraindications due to the recent innovations in technique placement and gastrostomy catheter type. We describe the technique of gastrostomy placement, which we use in our institution, along with appropriate indications and contraindications. In addition, we will discuss the wide variety of catheter types available and their perceived advantages. There remains some debate with regard to gastropexy performance and the use of primary gastrojejunal catheters, which we will address. In addition, we will discuss the advantages and disadvantages of the three major types of gastrostomy placement currently available (i.e., surgical, endoscopic, and radiological) and their associated complications.

Maternal anxiety and ultrasound markers for aneuploidy in a multiethnic population

OBJECTIVE

Discussion of isolated ultrasound (US) markers for fetal aneuploidy can provoke significant patient anxiety. The objective of this study is to quantify maternal anxiety associated with the detection of these markers.

METHODS

All patients undergoing routine second-trimester US examination for fetal anatomical survey over a one-year period were administered the State-Trait Anxiety Inventory (STAI) for Adults before and after the procedure. Women with isolated fetal markers for aneuploidy were notified of the findings but discouraged from pursuing amniocentesis. Rates of normal US examination, aneuploidy markers, anomalies, amniocentesis, and pregnancy outcomes were assessed across the ethnic groups. Pre- and post-ultrasound STAI surveys were scored and standardized with previously established norms. Student t-tests, Chi-square, and analysis of variance (ANOVA) were used where appropriate.

RESULTS

Among the 798 patients tested, 57% were Hispanic, 30% were Asian, 6% were Black, and 7% were White. Maternal anxiety level was decreased in women after a normal US. The anxiety level increased with aneuploidy markers and was the highest with anomalies. Aneuploidy markers were more common among Hispanic and Asian fetuses, without any associated aneuploidy. Women with isolated aneuploidy markers underwent amniocentesis as often as women with advanced maternal age.

CONCLUSION

The detection and communication of isolated aneuploidy markers is associated with increased maternal anxiety and unnecessary amniocentesis.

Bouveret's syndrome: a rare complication of cholecystolithiasis

Bouveret's syndrome is obstruction of the stomach or the duodenum from a gallstone that has migrated through a biliogastric or bilioduodenal fistula. This rare syndrome has been described in a number of case reports.

Treatment of “High-Flow” Priapism with Superselective Transcatheter Embolization: A Useful Alternative to Surgery

PURPOSE

To review the efficacy of treatment of high-flow priapism with superselective transcatheter embolization.

METHODS

Over a 2-year period, we reviewed five patients who were treated for traumatic high-flow priapism with superselective embolization. All patients underwent diagnostic angiography that demonstrated a communication between the cavernosal artery and the corpora cavernosa. Each identified fistula was embolized using gel-foam, blood clot, microcoils, or a combination of these.

RESULTS

All five patients had successful detumesence of priapism postprocedure. There was normal recurrence of early morning erection with successful detumescence for each patient within a 2- to 4-week period. Two of five patients (40%) presented with recurrence of priapism at 6 months and required a repeat embolization procedure. At 1 year, four of the five patients (80%) had normal erectile function.

CONCLUSION

Superselective transcatheter embolization is a useful therapeutic modality in the treatment of high-flow priapism. It provides equivalent rates of detumesence when compared to surgical techniques, and appears to have a greater success in preserving erectile function.

Imaging patients with "post-cholecystectomy syndrome": an algorithmic approach

AIM

To assess the role of ultrasound (US), magnetic resonance cholangiopancreatography (MRCP) and liver function tests (LFTs) in the evaluation of selected patients presenting with late post-cholecystectomy syndrome (PCS) who were referred for endoscopic retrograde cholangiopancreatography (ERCP).

MATERIALS AND METHODS

In a retrospective study a final group of 42 patients with PCS referred for diagnostic ERCP underwent MRCP and abdominal US. ERCP and MRCP images were assessed for bile duct diameters and the presence of strictures and stones. A common bile duct (CBD) diameter of < 10mm was considered normal, whereas > or = 10mm was considered abnormal on US. Findings were correlated to LFTs with contingency table results performed for single techniques and combination of methods.

RESULTS

In total 14 stones and one stricture were seen. US had a high negative predictive value (86.4%). MRCP had a sensitivity of 100% and specificity of 88.0%. ERCP is the most accurate test but failed in 11 patients, five of whom had a stone. The accuracy of US and LFTs increases to 93.8% if test results agree in either negative or positive outcome.

CONCLUSION

US and LFTs are first-line tests in PCS. If the CBD on US is > or = 10mm, but no cause is identified, MRCP should be performed. If US and LFTs are normal then MRCP is not necessary. The availability of LFTs raises the diagnostic value of imaging.

A Prospective Comparison of Two Types of Tunneled Hemodialysis Catheters: The Ash Split Versus the PermCath

PURPOSE

In a prospective randomized study a standard dual-tip hemodialysis catheter (PermCath, Sherwood Medical, St. Louis, MO, USA) was compared with a newer split-lumen catheter (Ash Split, Medcomp, Harleysville, PA, USA).

METHODS

Sixty-nine patients (42 men, 27 women; mean age 62 years) were randomized to receive either the Ash Split (AS) or the PermCath (PC) catheter. The catheters were inserted into the internal jugular vein. The primary outcome evaluated was blood flow measurements during the first six hemodialysis sessions. Secondary outcomes included: technical difficulties encountered at insertion, early complications and late complications requiring catheter removal or exchange.

RESULTS

A total of 69 hemodialysis catheters, 33 AS and 36 PC, were successfully inserted in the internal jugular vein (right 60, left 9) of 69 patients. Mean blood flow during dialysis (Qb) was 270.75 ml/min and 261.86 ml/hr for the AS and PC groups respectively (p = 0.27). Mean duration of catheter use was 111.7 days (range 5.4-548.9 days) and 141.2 days (range 7.0-560.9 days) in the AS and PC groups respectively (p = 0.307). Catheter failures leading to removal or exchange occurred in 20 patients: 14 in the AS group and six in the PC group. Survival curves with censored endpoints (i.e., recovery, arteriovenous fistula formation, peritoneal dialysis and transplantation) showed significantly better outcome with PermCath catheters (p = 0.024). There was no significant difference in ease of insertion or early complication rates.

CONCLUSION

The Ash Split catheter allows increased rates of blood flow during hemodialysis but this increase was not significant at the beginning (p = 0.21) or end (p = 0.27) of the first six hemodialysis sessions. The Ash Split catheter is more prone to minor complications, particularly dislodgment, than the PermCath catheter.

Crystallization and preliminary X-ray diffraction analysis of spermidine synthase fromHelicobacter pylori

Polyamines, such as putrescine, spermidine and spermine, are essential for the regulation of cell proliferation and differentiation in most organisms. Spermidine synthase catalyzes the transfer of the aminopropyl group from decarboxylated S-adenosylmethionine to putrescine in the biosynthesis of spermidine. In this study, spermidine synthase of Helicobacter pylori has been overexpressed in Escherichia coli and purified. Two kinds of spermidine synthase crystals were obtained. One belongs to the monoclinic P2(1) space group, with unit-cell parameters a = 62.78, b = 58.24, c = 74.28 A, beta = 90.9 degrees , and the other belongs to the orthorhombic C222(1) space group, with unit-cell parameters a = 100.43, b = 128.55, c = 143.60 A.

Pregnancy-related thrombosis in a woman with congenital afibrinogenemia: a report of two successful pregnancies

We managed two pregnancies in a woman with congenital afibrinogenemia with increasing amounts of cryoprecipitate to achieve a pre-infusion fibrinogen level of 60 mg/dL. The first pregnancy resulted in placental abruption at 36 weeks, in spite of recent cryoprecipitate infusion. Both placentas showed infarction. Post-partum ovarian and renal vein thromboses complicated the second pregnancy. Mean FVIII (344%) and vWF Antigen (323%) were elevated prior to cryoprecipitate infusion, with mean post-infusion levels of 367% and 363%. The clearance of fibrinogen after cryoprecipitate infusion increased during the course of pregnancy. A paradoxical prothrombotic state with embolization may play a role in the observed complications of pregnancy.

Arterial embolization for Dieulafoy bleeding

BACKGROUND

Dieulafoy's lesion is a rare cause of gastrointestinal haemorrhage. It has traditionally been treated either endoscopically or with open surgery.

AIM

To describe a case treated by arterial embolization.

RESULTS

Initially the patient was embolized with Gelfoam pledgets but re-bled at 7 days, the procedure was repeated with fibre coils, there was no further bleeding.

CONCLUSION

Arterial embolization is being used increasingly as a first line of treatment as it is fast and minimally invasive with few complications.

Compliance with prenatal care visits in substance abusers

OBJECTIVE

We sought to determine whether pregnant, inner-city substance abusers, cared for in a multidisciplinary setting, had comparable numbers of missed appointments and similar outcomes in comparison with a low-risk patient population.

METHODS

A retrospective review was conducted on a sample of 97 patients with uncomplicated prenatal care over a 7-year period (1994-2001). They were compared to a sample of 88 substance abusers cared for and delivered at Bellevue Hospital over the same period. Demographic information was recorded, as well as frequency of prenatal visits, number of missed appointments, birth weight, and gestational age at delivery.

RESULTS

In our population, substance abusers were found to be significantly older (28.9 vs. 25.6 years, p < 0.0001), had had more pregnancies (4.3 vs. 2.4, p < 0.0001) and had had more children (2.0 vs. 0.7, p < 0.0001) than controls. Both substance abusers and control patients had a similar number of scheduled appointments (11.4 in each group, p = 0.99), but substance abusers missed more appointments (1.6 vs. 0.7, p < 0.0005).

CONCLUSIONS

When cared for in a multidisciplinary setting, substance abusers will attend an adequate number of prenatal visits. However, they are still more likely than non-substance abusers to miss visits, although the difference may not be clinically significant.

A study of NH3-N and P refixation by struvite formation in hybrid anaerobic reactor

This research is concerned with the removal of ammonia nitrogen and phosphorus in foodwaste by crystallization. Reductions have been achieved by struvite formation after the addition of magnesium ions (Mg2+). Magnesium ions used in this study were from magnesium salts of MgCl2. The results of our analysis using scanning electron microscopy and energy dispersive X-ray analysis showed that the amount of struvite in precipitated sludge grew enough to be seen with the naked eye (600-700 microm). EDX analysis also showed that the main components of the struvite were magnesium and phosphorus. NH3-N removal efficiency using MgCl2 was 67% while PO4-P removal efficiency was 73%. It was confirmed that nitrogen and phosphorus could be stabilized and removal simultaneously through anaerobic digestion by Mg, NH3 and PO4-P, which were necessary for struvite formation.

The role of the interventional radiologist in enteral alimentation

The provision of enteral nutrition through the placement of gastrostomy/gastrojejunostomy tubes is a well-established procedure. Traditionally, these catheters have been placed either surgically or endoscopically; however, over the past two decades interventional radiologists have increasingly performed these procedures successfully. The perceived advantages of this route lie in the reported lower morbidity and mortality rates. In addition, percutaneous radiologically guided (PRG) catheters may be placed in certain subgroups of patients in whom it would be technically difficult or impossible by other routes, e.g., patients with head and neck or oesophageal tumours. The aim of this review is to describe the techniques of radiologically placed gastrostomy/gastrojejunostomy, discuss its indications and contraindications, describe any associated potential complications and compare PRG results with the more established techniques of open surgical and endoscopic placement. We also describe some recent procedural and catheter modifications.