Leg Lymphoedema After Inguinal and Ilio-Inguinal Lymphadenectomy for Melanoma: Results from a Prospective, Randomised Trial

BACKGROUND

The Evaluation of Groin Lymphadenectomy Extent for Melanoma (EAGLE FM) study sought to address the question of whether to perform inguinal (IL) or ilio-inguinal lymphadenectomy (I-IL) for patients with inguinal nodal metastatic melanoma who have no clinical or imaging evidence of pelvic disease. Primary outcome measure was disease-free survival at 5 years, and secondary endpoints included lymphoedema.

METHODS

EAGLE FM was designed to recruit 634 patients but closed with 88 patients randomised because of slow recruitment and changes in melanoma management. Lymphoedema assessments occurred preoperatively and at 6, 12, 18, and 24 months postoperatively. Lymphoedema was defined as Inter-Limb Volume Difference (ILVD) > 10%, Lymphoedema Index (L-Dex®) > 10 or change of L-Dex® > 10 from baseline.

RESULTS

Prevalence of leg lymphoedema between the two groups was similar but numerically higher for I-IL at all time points in the first 24 months of follow-up; highest at 6 months (45.9% IL [CI 29.9-62.0%], 54.1% I-IL [CI 38.0-70.1%]) and lowest at 18 months (18.8% IL [CI 5.2-32.3%], 41.4% I-IL [CI 23.5-59.3%]). Median ILVD at 24 months for those affected by lymphoedema was 14.5% (IQR 10.6-18.7%) and L-Dex® was 12.6 (IQR 9.0-17.2). There was not enough statistical evidence to support associations between lymphoedema and extent of surgery, radiotherapy, or wound infection.

CONCLUSIONS

Despite a trend for patients who had I-IL to have greater lymphoedema prevalence than IL in the first 24 months after surgery, our study's small sample did not have the statistical evidence to support an overall difference between the surgical groups.

Nutritional Status and Risks of Cognitive Decline and Incident Neurocognitive Disorders: Singapore Longitudinal Ageing Studies

BACKGROUND

Studies suggest that nutritional interventions using the whole diet approach such as the Mediterranean diet may delay cognitive decline and dementia onset. However, substantial numbers of older adults are non-adherent to any ideally healthy dietary pattern and are at risk of malnutrition.

OBJECTIVE

The present study investigated the relationship between global malnutrition risk and onsets of cognitive decline and neurocognitive disorders (NCD), including mild cognitive impairment (MCI) or dementia in community-dwelling older adults.

METHODS

Participants aged ≥ 55 years in the Singapore Longitudinal Ageing Studies (SLAS) were assessed at baseline using the Elderly Nutritional Indicators for Geriatric Malnutrition Assessment (ENIGMA) and followed up 3-5 years subsequently on cognitive decline (MMSE drop ≥ 2) among 3128 dementia-free individuals, and incident neurocognitive disorders (NCD) among 2640 cognitive normal individuals.

RESULTS

Individuals at high nutritional risk score (≥ 3) were more likely to develop cognitive decline (OR=1.42, 95%CI=1.01-1.99) and incident MCI-or-dementia (OR=1.64, 95%CI=1.03-2.59), controlling for age, sex, ethnicity, low education, APOE-e4, hearing loss, physical, social, and mental activities, depressive symptoms, smoking, alcohol, central obesity, hypertension, diabetes, low HDL, high triglyceride, cardiac disease, and stroke. Among ENIGMA component indicators, low albumin at baseline was associated with cognitive decline and incident NCD, and 5 or more drugs used, few fruits/vegetables/milk products daily, and low total cholesterol were associated with incident NCD.

CONCLUSION

The ENIGMA measure of global malnutrition risk predicts cognitive decline and incident neurocognitive disorders, suggesting the feasibility of identifying vulnerable subpopulations of older adults for correction of malnutrition risk to prevent neurocognitive disorders.

Development, Validation and Field Evaluation of the Singapore Longitudinal Ageing Study (SLAS) Risk Index for Prediction of Mild Cognitive Impairment and Dementia

BACKGROUND

Mild cognitive impairment (MCI) is a critical pre-dementia target for preventive interventions. There are few brief screening tools based on self-reported personal lifestyle and health-related information for predicting MCI that have been validated for their generalizability and utility in primary care and community settings.

OBJECTIVE

To develop and validate a MCI risk prediction index, and evaluate its field application in a pilot community intervention trial project.

DESIGN

Two independent population-based cohorts in the Singapore Longitudinal Ageing Study (SLAS). We used SLAS1 as a development cohort to construct the risk assessment instrument, and SLA2 as a validation cohort to verify its generalizability.

SETTING

community-based screening and lifestyle intervention Participants: (1) SLAS1 cognitively normal (CN) aged ≥55 years with average 3 years (N=1601); (2) SLAS2 cohort (N=3051) with average 4 years of follow up. (3) 437 participants in a pilot community intervention project.

MEASUREMENTS

The risk index indicators included age, female sex, years of schooling, hearing loss, depression, life satisfaction, number of cardio-metabolic risk factors (wide waist circumference, pre-diabetes or diabetes, hypertension, dyslipidemia). Weighted summed scores predicted probabilities of MCI or dementia. A self-administered questionnaire field version of the risk index was deployed in the pilot community project and evaluated using pre-intervention baseline cognitive function of participants.

RESULTS

Risk scores were associated with increasing probabilities of progression to MCI-or-dementia in the development cohort (AUC=0.73) and with increased prevalence and incidence of MCI-or-dementia in the validation cohort (AUC=0.74). The field questionnaire risk index identified high risk individuals with strong correlation with RBANS cognitive scores in the community program (p<0.001).

CONCLUSIONS

The SLAS risk index is accurate and replicable in predicting MCI, and is applicable in community interventions for dementia prevention.

Traction suture modification to tongue-in-groove caudal septoplasty

Caudal septal deviation leads to unfavorable esthetic as well as functional effects on the nasal airway. A modification to the tongue-in-groove (TIG) technique to correct these caudal septal deformities is described. With placement of a temporary suspension suture to the caudal septum, manual traction is applied, assuring that the caudal septum remains in the midline position while it is being secured with multiple through-and-through, trans-columellar and trans-septal sutures. From 2003 to 2016, 148 patients underwent endonasal septoplasty using this modified technique, with excellent functional and cosmetic outcomes and a revision rate of 1.4%. This modified TIG technique replaces the periosteal suture that secures the caudal septum to the midline nasal crest in the original TIG technique. This simplifies the procedure and minimizes the risk of securing the caudal septum off-midline when used in endonasal septoplasty.

Terminology and Classification of Congenital Vascular Malformations

Venous malformation (VM) is a congenital vascular malformation (CVM) that develops along the venous system through the various stages of embryogenesis. Older terminology and classification were often misleading and confusing. A newer classification system has emerged that is based on advances in the study of these conditions and is useful in contemporary management. The Hamburg classification was introduced after reappraisal of older terminology and has become the standard system for contemporary classification, which is based on anatomical, pathological and embryological criteria.

Almost sure asymptotic likelihood theory for diffusion processes

We consider maximum likelihood estimators for parameters of diffusion processes that are generated by nth-order Ito equations. We establish asymptotic consistency as well as convergence in distribution to normality for the estimators. Examples are presented and discussed.

Enhanced genetic algorithm optimization model for a single reservoir operation based on hydropower generation: case study of Mosul reservoir, northern Iraq

Achievement of the optimal hydropower generation from operation of water reservoirs, is a complex problems. The purpose of this study was to formulate and improve an approach of a genetic algorithm optimization model (GAOM) in order to increase the maximization of annual hydropower generation for a single reservoir. For this purpose, two simulation algorithms were drafted and applied independently in that GAOM during 20 scenarios (years) for operation of Mosul reservoir, northern Iraq. The first algorithm was based on the traditional simulation of reservoir operation, whilst the second algorithm (Salg) enhanced the GAOM by changing the population values of GA through a new simulation process of reservoir operation. The performances of these two algorithms were evaluated through the comparison of their optimal values of annual hydropower generation during the 20 scenarios of operating. The GAOM achieved an increase in hydropower generation in 17 scenarios using these two algorithms, with the Salg being superior in all scenarios. All of these were done prior adding the evaporation (Ev) and precipitation (Pr) to the water balance equation. Next, the GAOM using the Salg was applied by taking into consideration the volumes of these two parameters. In this case, the optimal values obtained from the GAOM were compared, firstly with their counterpart that found using the same algorithm without taking into consideration of Ev and Pr, secondly with the observed values. The first comparison showed that the optimal values obtained in this case decreased in all scenarios, whilst maintaining the good results compared with the observed in the second comparison. The results proved the effectiveness of the Salg in increasing the hydropower generation through the enhanced approach of the GAOM. In addition, the results indicated to the importance of taking into account the Ev and Pr in the modelling of reservoirs operation.

The importance of shaving the zygomatic process during reduction malarplasty

Reduction malarplasty surgery has become increasingly popular in recent years, especially in many East Asian countries. This is, in part, because many Asians consider a small, smooth, and feminine face to be more attractive and aesthetically desirable. Among the various reduction malarplasty methods, the L-shaped osteotomy technique, through intraoral and sideburn incisions, is now one of the most frequently performed surgical techniques. During the surgical procedure, it is important to shave the zygomatic process of the temporal bone through the sideburn incision. By carrying out this simple adjunctive procedure, several remarkable results can be achieved. The facial width is reduced, especially in those patients with protrusion of the posterior portion of the arch. The outward curvature of the zygomatic arch is changed to point inward. And finally, the bony step that originates from the medial repositioning of the zygomatic arch is reduced, resulting in decreased palpability.

Defining gross tumor volume using positron emission tomography/computed tomography phantom studies

Tumor volume and standard uptake value (SUV) calculated from positron emission tomography/computed tomography (PET/CT) images differ from their real values. Besides errors introduced by scintillation materials, photomultiplier tubes, and image reconstruction algorithms, measurements are affected by patients' prostheses, body movements, and body shape. To address these problems, we calculated tumor volume and SUV using the standard phantom (PET Phantom-NEMA IEC/2001) and obtained calibration constants. We found that while tumor volume increases with increasing SUV and tumor diameter, it also increases with increasing SUV and decreasing tumor diameter. Conversely, tumor volume decreases with decreasing SUV and tumor diameter and with decreasing SUV and increasing diameter. These results suggest that a correction factor should be applied to SUV and tumor volume obtained from PET/CT images.

Drilling Optimization via Particle Swarm Optimization

The drilling process based on Material Reduction Rate (MRR) is modeled in this work. The modeling of this process is rather time-consuming and expensive as it involves 32 experiments with appropriate apparatus. Having had the model, the authors employed the well-known algorithm, namely Particle Swarm Optimization (PSO) to solve the maximization problem with some constraints present. All the results obtained showed non-violation to the constraints imposed. It means the solutions found are all feasible. The developed program may be useful for some practical purposes such as estimating the drilling duration, proper time to change the drill etc.

Glass-type wireless PPG measuring system

This paper is about a glass-type wireless bio-signal transmitter that can monitor the user's health state in daily life. The device implemented in this study consists of the transmission part and the receiving part. The transmission part includes a photoplethysmography(PPG) sensor for detecting pulse wave signals, accelerometer for detecting kinetic signals, and a wireless controller for transmitting acquired bio-information. The receiving part is designed to check and process transmitted data through interoperation with a PC. In the experiments, we collected data during a sitting posture and repeated sit-to-stand motion in laboratory environment, and analyzed the data. As to accuracy, the correlation between the peak-to-peak intervals in the signals of the Biopac equipment and the developed device measured in a sitting posture was 97.5%, and that measured in sit-to-stand motion was 87%. In addition, when bio-signals were transmitted through wireless communication, the transmission was successful 100% without any error. When pulse wave signals and kinetic signals were obtained and compared, the results proved the accuracy and daily applicability of the developed device, and the glass-type wireless bio-signal transmission system is expected to be applicable to unobtrusive health monitoring for the user.

Portable digital esophageal stethoscope system

Heart sound occurs when the heart contracts and expands. It provides information on myocardial contractility and blood vessels, which is not obtainable from ECG. For this reason, stethoscopy of heart sound in anesthesiology is a very crucial means for acquiring cardiac information and preventing intraoperative medical accidents, and it requires a system for precise objective measurement and analysis of heart sound and murmur. Thus, this study purposed to develop portable digital esophageal stethoscope (PDES) that can objectify and quantify heart sound and murmur. In this study, we designed PDES for precise measurement and analysis of heart sound and murmur data. Heart sound information obtained by inserting the sensor of the PDES into the patient's esophagus can be transmitted to a terminal or a PC and displayed on the screen The amplitude and waveform of heart sound are displayed using self-developed software Heart Sound 1.0. The results of experiment with the developed PDES showed that data on the amplitude and waveform of heart sound and murmur were produced stably in real-time. In addition, when heart sound was heard using a headphone, the sound was clear without external murmur. The PDES developed in this study, which complements the disadvantages of traditional esophageal stethoscope while preserving its advantages, could not only examine heart sound and murmur using an esophageal catheter but also display the amplitude and waveform of heart sound and murmur and measure the patient's body temperature. Accordingly, the developed PDES is expected to be useful in the continuous stethoscopy of heart sound during operation and to contribute to research on heart sound by providing heart sound data.

Taguchi-Particle Swarm Optimization for Numerical Optimization

In this work, a hybrid Taguchi-Particle Swarm Optimization (TPSO) is proposed to solve global numerical optimization problems with continuous and discrete variables. This hybrid algorithm combines the well-known Particle Swarm Optimization Algorithm with the established Taguchi method, which has been an important tool for robust design. This paper presents the improvements obtained despite the simplicity of the hybridization process. The Taguchi method is run only once in every PSO iteration and therefore does not give significant impact in terms of computational cost. The method creates a more diversified population, which also contributes to the success of avoiding premature convergence. The proposed method is effectively applied to solve 13 benchmark problems. This study’s results show drastic improvements in comparison with the standard PSO algorithm involving continuous and discrete variables on high dimensional benchmark functions.

Elucidating therapeutic effects on patients with hepatocellular carcinoma and main portal vein thrombosis

BACKGROUND/AIMS

The survival duration for patients diagnosed with hepatocellular carcinoma (HCC) with main portal vein thrombosis (MPVT) was usually less than 3 months. The aim of this study is to elucidate whether treatment can prolong the survival for such patients.

METHODOLOGY

Retrospectively we analyzed the clinical features and outcomes of 63 patients with HCC and MPVT over a 7-year period. Three therapeutic modalities--transcatheter arterial chemotherapy (TAC) with or without radiotherapy (RT), and systemic chemotherapy--were applied.

RESULTS

The patients were divided into two groups: 34 (54%) patients were treated, while the remaining 29 (46%) were not. Multivariate analysis revealed that Child-Pugh class, Okuda stage for HCC and the presence of treatment were the principal factors to predict survival. The survival was significantly longer in treated patients than those untreated both in the Child-Pugh class A or B patients. Significantly longer survival is evident in patients treated by TAC combing RT compared to those underwent TAC alone, systemic chemotherapy or no treatment.

CONCLUSIONS

The survival of Child-Pugh class A or B patients can be extended by the use of an appropriate therapeutic modality. TAC combined with RT did the best benefit to prolong survival in such patients.

The effect of vertebral material description during vertebroplasty

Vertebroplasty has attracted much attention as a medical treatment for the collapse of the spine by strengthening the vertebral body, correcting deformities, and relieving pain in patients through the injection of bone cement. The finite element method has become popular for analysing vertebroplasty. The numerical modelling of vertebrae under loading, as in many other cases of representing a composite bone with anatomically scattered properties through a simplified material model, entails difficulties in material assignment for analysis. The aim of this study is to compare and contrast material-assignment methods in the course of modelling through a tetrahedral meshing algorithm. In particular, the study seeks to contrast the element-wise material model with a uniform material assignment for trabecular bone and the bone—poly(methyl methacrylate) (PMMA) composite. The geometries of the vertebral body are constructed from computed tomography image data, which are obtained through scanning at intervals of 1 mm. The finite element models are constructed through a tetrahedral meshing algorithm. Various types of material assignment, which encompass the case of normal persons as well as the case of patients following vertebroplastic surgery, are analysed. The results clearly show that the oversimplification of the trabecular bone and the bone—PMMA composite body may lead to significant deviations in the assessment of the effectiveness of vertebroplastic surgery.

Terminology and classification of congenital vascular malformations

Venous malformation (VM) is a congenital vascular malformation (CVM) that develops along the venous system through the various stages of embryogenesis. Older terminology and classification were often misleading and confusing. A newer classification system has emerged that is based on advances in the study of these conditions and is useful in contemporary management. The Hamburg classification was introduced after reappraisal of older terminology and has become the standard system for contemporary classification, which is based on anatomical, pathological and embryological criteria.

A potential role for skeletal muscle caveolin-1 as an insulin sensitivity modulator in ageing-dependent non-obese type 2 diabetes: studies in a new mouse model

AIMS/HYPOTHESIS

Type 2 diabetes mellitus is a common age-dependent disease. We discovered that male offspring of non-diabetic C57BL/6 and DBA/2 mice, called JYD mice, develop type 2 diabetes when they grow old. JYD mice show characteristics of insulin resistance, hyperglycaemia and hyperinsulinaemia in old age without obesity. We postulated that the mechanism of age-dependent type 2 diabetes in this model relates to caveolin-1 status in skeletal muscle, which appears to regulate insulin sensitivity in the mice.

METHODS

We compared insulin sensitivity in aged C57BL/6 and JYD mice using glucose and insulin tolerance tests and (18)F-fluorodeoxyglucose positron emission tomography. We also determined insulin signalling molecules and caveolin proteins using western blotting, and altered caveolin-1 levels in skeletal muscle of C57BL/6 and JYD mice using viral vector systems, to examine the effect of this on insulin sensitivity.

RESULTS

In 30-week-old C57BL/6 and JYD mice, the basal levels of IRS-1, Akt and peroxisome proliferator-activated receptor-gamma decreased, as did insulin-stimulated phosphorylation of Akt and insulin receptor beta. However, caveolin-1 was only increased about twofold in 30-week-old JYD mice as compared with 3-week-old mice, whereas an eightfold increase was seen in C57BL/6 mice. Downregulation of caveolin-1 production in C57BL/6 mice caused severe impairment of glucose and insulin tolerance. Upregulation of caveolin-1 in aged diabetic JYD mice significantly improved insulin sensitivity with a concomitant increase of glucose uptake in the skeletal muscle.

CONCLUSIONS/INTERPRETATION

The level of skeletal muscle caveolin-1 is correlated with the progression of age-dependent type 2 diabetes in JYD mice.

A cell culturing system that integrates the cell loading function on a single platform and evaluation of the pulsatile pumping effect on cells

In this paper, we present a novel microfluidic system with pulsatile cell storing, cell-delivering and cell culturing functions on a single PDMS platform. For this purpose, we have integrated two reservoirs, a pulsatile pumping system containing two soft check valves, which were fabricated by in situ photopolymerization, six switch valves, and three cell culture chambers all developed through a simple and rapid fabrication process. The sample volume delivered per stroke was 120 nl and the transported volume was linearly related to the pumping frequency. We have investigated the effect of the pulsatile pneumatic micropumping on the cells during transport. For this purpose, we pumped two types of cell suspensions, one containing human breast adenocarcinoma cells (MCF-7) and the other mesenchymal stem cells (hMSCs) derived from bone marrow. The effect of pulsatile pumping on both cell types was examined by short and long-term culture experiments. Our results showed that the characteristics of both cells were maintained; they were not damaged by the pumping system. Evaluations were carried out by morphological inspection, viability assay and immunophenotyping analysis. The delivered MCF-7 cells and hMSCs spread and proliferated onto the gelatin coated cell culture chamber. This total micro cell culture system can be applied to cell-based high throughput screening and for co-culture of different cells with different volume.

Hereditary neuropathy with liability to pressure palsies: description of seven patients without known family history

OBJECTIVES

Hereditary neuropathy with liability to pressure palsies (HNPP) is an inherited disorder resulting in a polyneuropathy with particular involvement at sites of entrapment, and is often underdiagnosed or misdiagnosed. We report findings on seven patients referred for evaluation of focal mononeuropathies or polyneuropathies of undetermined etiology, in whom we established a diagnosis of HNPP.

MATERIALS AND METHODS

We retrospectively reviewed clinical, electrophysiological and laboratory data for patients diagnosed with HNPP over a 4-year period at our institution.

RESULTS

All patients had transient or recurrent neurological symptoms, some with residual deficits. No patients had a family history of any neuropathy. Electrodiagnostic studies revealed abnormal conduction findings at symptomatic and asymptomatic sites. Testing for the Peripheral Myelin Protein (PMP22) deletion was positive in all patients.

CONCLUSIONS

A high index of clinical suspicion and thorough electrodiagnostic evaluation can lead to correct diagnosis of HNPP, despite the absence of a positive family history.

The concept of "stability" in asynchronous distributed decision-making systems

Asynchronous distributed decision-making (ADDM) systems constitute a special class of distributed problems and are characterized as large, complex systems wherein the principal elements are the geographically dispersed entities that communicate among themselves, asynchronously, through message passing and are permitted autonomy in local decision making. Such systems generally offer significant advantages over the traditional, centralized algorithms in the form of concurrency, scalability, high throughput, efficiency, low vulnerability to catastrophic failures, and robustness. A fundamental property of ADDM systems is stability that refers to their behavior under representative perturbations to their operating environments, given that such systems are intended to be real, complex, and to some extent, mission-critical, and are subject to unexpected changes in their operating conditions. This paper introduces the concept of stability in ADDM systems and proposes an intuitive yet practical and usable definition that is inspired by those used in control systems and physics. An ADDM system is defined as a stable system if it returns to a steady state in finite time, following perturbation, provided that it is initiated in a steady state. Equilibrium or steady state is defined through placing bounds on the measured error in the system. Where the final steady state is equivalent to the initial one, a system is referred to as strongly stable. If the final steady state is potentially worse then the initial one, a system is deemed marginally stable. When a system fails to return to steady state following the perturbation, it is unstable. The perturbations are classified as either changes in the input pattern or changes in one or more environmental characteristics of the system, such as hardware failures. For a given ADDM system, the definitions are based on the performance indices that must be judiciously identified by the system architect and are likely to be unique. To facilitate the understanding of stability in representative real-world systems, this paper reports the analysis of two basic manifestations of ADDM systems that have been reported in the literature: (1) a decentralized military command and control problem, MFAD and (2) a novel distributed algorithm with soft reservation for efficient scheduling and congestion mitigation in railway networks, RYNSORD. Stability analysis of MFAD and RYNSORD yields key stable and unstable conditions. A system determined to be stable provides the reassurance that the system will perform well under adverse conditions. In contrast, a system deemed unstable reflects the need to address key weaknesses in the system design. Thus, stability analysis is a necessary and critical step in the development of any ADDM system.

Asynchronous, distributed, decision-making systems with semi-autonomous entities: a mathematical framework

For many military and civilian large-scale, real-world systems of interest, data are first acquired asynchronously, i.e., at irregular intervals of time, at geographically-dispersed sites, processed utilizing decision-making algorithms, and the processed data then disseminated to other appropriate sites. The term real-world refers to systems under computer control that relate to everyday life and are beneficial to the society in the large. The traditional approach to such problems consists of designing a central entity which collects all data, executes a decision-making algorithm sequentially to yield the decisions, and propagates the decisions to the respective sites. Centralized decision-making algorithms are slow and highly vulnerable to natural and artificial catastrophes. Recent literature includes successful asynchronous, distributed, decision-making algorithm designs wherein the local decision making at every site replaces the centralized decision making to achieve faster response, higher reliability, and greater accuracy of the decisions. Two key issues include (1) the lack of an approach to synthesize asynchronous, distributed, decision-making algorithms, for any given problem, and (2) the absence of a comparative analysis of the quality of their decisions. This paper proposes MFAD, a Mathematical Framework for Asynchronous, Distributed Systems, that permits the description of centralized decision-making algorithms and facilities the synthesis of distributed decision-making algorithms. MFAD is based on the Kohn-Nerode distributed hybrid control paradigm.

Respiratory rate detection algorithms by photoplethysmography signal processing

Photoplethysmography (PPG) offers the clinically meaningful parameters, such as, heart rate, and respiratory rate. In this study, we presented three respiratory signal detection algorithms using photoplethysmography raw data generated from commercial PPG sensor: (1)Min-Max (2)Peak-to-Peak (3)Pulse Shape. As reference signal, nasal sensor signal was acquired simultaneously and compared and analyzed. We used two types of moving average filtering technique to process three PPG parameters. In laboratory experiment, 6 subjects' PPG signals were measured when they respire ten and fifteen, and arbitrary times per minute. From the results, following conclusions were drawn. Min-Max and Peak-to-Peak algorithms perform better than Pulse shape algorithm. They can be used to detect respiratory rate. But, Pulse Shape algorithm was accurate for subject 4 only. More experimental data is necessary to improve the accuracy and reliability.

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.

Survey of arm activity after breast cancer

9054

Background: Post-operative education of women with breast cancer is inconsistent as guidelines provide conflicting advice regarding how vigorously women can use their arm. Current post-operative advice about lymphoedema focuses on the avoidance of strenuous arm activity and exercise, but common physiotherapy practice advocate this to address possible impairments after surgery such as loss of shoulder range and weakness. Methods: A 30-minute survey based on the Protection Motivation Theory was developed to explore the relationship between patients’ perception of what they can do with their affected arm following breast cancer treatment and their intention to use their affected arm. In addition, patients’ cancer and treatment characteristics, demographics, arm and chest symptoms, and arm function were assessed by the survey. The survey was pre-tested, and then distributed to 175 consecutive breast cancer survivors at 6–15 months after breast cancer treatment. Results: Of the women surveyed, 91(52%) had sentinel node biopsies, 67 (38%) had axillary dissection, 14 (8%) had no surgery to the lymph nodes, and 3 (2%) were unknown. There was a high incidence of shoulder restriction and upper limb pain in both women who had sentinel node biopsies and women who had axillary dissections ( Table 1 ). The majority of women who had sentinel node biopsies (51%) and axillary dissections (61%) perceived it was necessary for them to avoid strenuous arm activity. Overall, women who intended to avoid strenuous arm activity were found to have a greater likelihood of reporting upper limb swelling (LR=17.6, p=0.000) and weakness (LR=10.9, p=0.001). Conclusion: Women who had sentinel node biopsies intended to avoid strenuous arm activities even though they have a negligible risk of lymphoedema, placing them at risk of developing secondary musculoskeletal problems.

[Table: see text]

No significant financial relationships to disclose.

A longitudinal observational study of preference for elective caesarean section among nulliparous Hong Kong Chinese women

OBJECTIVE

To establish whether women's preference for elective caesarean section (ELCS) changes as gestation advances.

DESIGN

A prospective longitudinal observational study.

SETTING

Two units providing obstetric care in Hong Kong, one public and one private.

SAMPLE

Five hundred and one nulliparous Chinese pregnant women attending their routine fetal anomaly scan in either unit.

METHODS

Consented subjects had two interviews using a structured questionnaire at 18-22 weeks and 35-37 weeks of gestation, respectively. Multivariate analysis was performed to identify determinants for preferring ELCS at the two gestational ages.

MAIN OUTCOME MEASURE

The preferences for the mode of delivery at the two gestational ages.

RESULTS

The prevalence of maternal preference for ELCS in the study cohort was 17.2% (95% CI 13.9-20.5) and 12.7% (95% CI 9.6-15.8) at mid-trimester and at term, respectively. Significantly more women who preferred ELCS at mid-trimester changed to a trial of vaginal delivery (VD) at term than vice versa (42.0 versus 3.8%). The partner's preference for ELCS was a significant determinant for women preferring ELCS throughout the antenatal period. Among the women booked in the public sector, more women who preferred ELCS at term changed to deliver in private hospitals than those who preferred VD (46.2 versus 9.7%).

CONCLUSIONS

Many women changed from preferring ELCS to preferring VD as their pregnancy approached term. The partner's preference was a significant determinant for the women's choice. If a decrease in the proportion of women preferring ELCS is desired, the intervention programme should target the women and their partners who hold such a preference at 20 weeks.

A 3D analysis of oxygen transfer in a low-cost micro-bioreactor for animal cell suspension culture

A 3D numerical model was developed to study the flow field and oxygen transport in a micro-bioreactor with a rotating magnetic bar on the bottom to mix the culture medium. The Reynolds number (Re) was kept in the range of 100-716 to ensure laminar environment for animal cell culture. The volumetric oxygen transfer coefficient (k(L)a) was determined from the oxygen concentration distribution. It was found that the effect of the cell consumption on k(L)a could be negligible. A correlation was proposed to predict the liquid-phase oxygen transfer coefficient (k(Lm)) as a function of Re. The overall oxygen transfer coefficient (k(L)) was obtained by the two-resistance model. Another correlation, within an error of 15%, was proposed to estimate the minimum oxygen concentration to avoid cell hypoxia. By combination of the correlations, the maximum cell density, which the present micro-bioreactor could support, was predicted to be in the order of 10(12) cells m(-3). The results are comparable with typical values reported for animal cell growth in mechanically stirred bioreactors.

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.

Impact of hemoglobin on survival of cervical carcinoma patients treated with concurrent chemoradiotherapy is dependent on lymph node metastasis findings by magnetic resonance imaging

The objective of this study was to confirm whether hemoglobin (Hb) levels during chemoradiotherapy are associated with survival in patients with locally advanced cervical carcinoma and to assess impact of the Hb level on survival according to lymph node (LN) metastasis. A retrospective review of 85 cervical carcinoma patients treated with concurrent chemoradiotherapy was conducted. The stage of disease ranged between FIGO stage IB and stage IVA. Disease-free and overall survivals were evaluated by univariate and multivariate analyses. After median follow-up of 35.7 months, 24 patients developed recurrence of disease and 14 patients died from their disease. Stage, LN metastasis, and squamous cell carcinoma antigen and Hb levels during chemoradiation were correlated significantly with survival (P < 0.05). Maintenance of Hb above 10.0 g/dL was associated with better survival (P < 0.05). However, no such benefits were observed in patients with LN metastasis by magnetic resonance imaging (MRI). Multivariate Cox regression hazard model showed that Hb levels during chemoradiation were an independent prognostic factor in patients without LN metastasis by MRI. Maintenance of Hb during chemoradiation is of benefit in cervical carcinoma patients without LN metastasis but not with LN metastasis by MRI.

Assessing clinical performance of gynecology residents: sonographic evaluation of adnexal masses based on morphological scoring systems

OBJECTIVE

To assess the performance of inexperienced gynecology residents in the evaluation of adnexal masses using sonographic scoring systems.

METHODS

From April 2003 to October 2004, transvaginal sonography was performed preoperatively by junior gynecology residents on 1-month shifts on 123 patients suspected of having adnexal masses. A total of 137 adnexal masses were found and evaluated using two different morphological scoring systems (those of DePriest and Lerner). The diagnostic performance of the sonographic scoring systems was assessed using the McNemar test and receiver-operating characteristics (ROC) curve analysis was used for lesion characterization. The diagnostic accuracy when the results of both scoring systems satisfied malignancy cut-off values was also investigated.

RESULTS

Histopathological analysis revealed that, of the 137 lesions, 109 were benign, 23 were malignant and five were borderline. Best clinical cut-off levels were > or = 5 on the DePriest and > or = 3 on the Lerner scores. Both systems achieved good performance for characterizing malignancy. No significant difference was found in terms of the accuracy of the two systems as determined by mean areas under the ROC curves (0.816 and 0.783, P = 0.562). The combined approach using both scoring systems resulted in higher specificity (77.1%, P < 0.05) and positive predictive value without a significant decrease in sensitivity (82.1%) compared with either system alone. Of the 43 histologically confirmed false-positive cases, mature cystic teratoma was most common, with 13/22 (59%) cases being misinterpreted as malignancies.

CONCLUSION

Junior residents, inexperienced at sonography, performed fairly in terms of evaluating adnexal masses with the help of morphological scoring systems.

Low-power hybrid wireless network for monitoring infant incubators

We have created a pilot wireless network for the convenient monitoring of temperature and humidity of infant incubators. This system combines infrared and radio frequency (RF) communication in order to minimize the power consumption of slave devices, and we therefore call it a hybrid wireless network. The slave module installed in the infant incubator receives the calling signal from the host with an infrared receiver, and sends temperature and humidity data to the host with an RF transmitter. The power consumption of the host system is not critical, and hence it uses the maximum power of infrared transmission and continuously operating RF receiver. In our test implementation, we included four slave devices. The PC calls each slave device every second and then waits for 6 s, resulting in a total scan period of 10 s. Slave devices receive the calling signals and transmit three data values (temperature, moisture, and skin temperature); their power demand is 1 mW, and can run for about 1000 h on four AA-size nickel-hydride batteries.

Differential regulation by Ca(2+) of calmodulin- and PKC-dependent contractile pathways in cat lower oesophageal sphincter

1. In the present investigation we examined the regulation of calmodulin (CaM)- and protein kinase C (PKC)-dependent pathways by cytosolic Ca(2+) in the contraction of cat lower oesophageal sphincter (LES). 2. Force developed in response to increasing doses of acetylcholine (ACh) was directly related to the increase of the [Ca(2+)](i) measured by fura-2. Thapsigargin, which depletes Ca(2+) stores, reduced the contraction and the [Ca(2+)](i). In addition, contraction in response to maximal ACh was reduced by the CaM inhibitor CGS9343B but not by the PKC inhibitor chelerythrine. The contraction in response to submaximal ACh was reduced by chelerythrine but not by CGS9343B. 3. In permeabilized cells, the contraction in response to low Ca(2+) (0.54 microm) was also reduced by CGS9343B. 4. The response to high Ca(2+) (1.0 microm) was reduced by CGS9343B. ACh also inhibited PKC activation induced by diacylglycerol, which activation is inhibited by the N-myristoylated peptide inhibitor derived from pseudosubstrate sequences of PKCalphabetagamma (myr-PKC-alphabetagamma), but not of myr-PKC-alpha. 5. These data are consistent with the view that activated CaM-dependent pathways inhibit PKC-dependent pathways, this switch mechanism might be regulated by Ca(2+) in the LES.

NO/cyclic GMP pathway mediates the relaxation of feline lower oesophageal sphincter

1. We examined the role of the NO/cyclic GMP (cyclic GMP) pathway in nitric oxide (NO)- and vasoactive intestinal peptide (VIP)-induced relaxation of feline lower oesophageal sphincter (LES). Furthermore, it was studied whether methylene blue, LY83583 and ODQ, which are soluble guanylate cyclase (sGC) inhibitors, could inhibit NO-induced relaxation. 2. The nitric oxide synthase (NOS) inhibitor, N omega-nitro-L-arginine (L-NNA) had no effect in sodium nitropruside (SNP)-induced relaxation, but 3-morpholinosydnonimine-N-ethylcarbamide (SIN-1)-induced relaxation was decreased by the pretreatment of L-NNA, which showed that SIN-1, not SNP, could activate NOS to cause relaxation. Methylene blue and LY83583 did not inhibit the relaxation by SNP and SIN-1. However, the more specific sGC inhibitor ODQ blocked the relaxation induced by NO donors. 3. To identify the relationship of NOS, sGC and adenylate cyclase in VIP-induced relaxation, tissue were pretreated with L-NNA and ODQ and SQ22536. These inhibitors produced significant inhibition of this response to VIP. The adenylyl cyclase inhibitor SQ 22536 also inhibited relaxation by VIP. 4. In conclusion, our data showed that SNP- and SIN-1-induced relaxation was mediated by sGC. Of sGC inhibitors, methylene blue and LY83583 were not adequate for the examination of NO donor-induced feline LES smooth muscle relaxation. VIP also caused relaxation by the pathway involving NO and cGMP and cAMP.

Web-based remote monitoring of infant incubators in the ICU

A web-based real-time operating, management, and monitoring system for checking temperature and humidity within infant incubators using the Intranet has been developed and installed in the infant Intensive Care Unit (ICU). We have created a pilot system which has a temperature and humidity sensor and a measuring module in each incubator, which is connected to a web-server board via an RS485 port. The system transmits signals using standard web-based TCP/IP so that users can access the system from any Internet-connected personal computer in the hospital. Using this method, the system gathers temperature and humidity data transmitted from the measuring modules via the RS485 port on the web-server board and creates a web document containing these data. The system manager can maintain centralized supervisory monitoring of the situations in all incubators while sitting within the infant ICU at a work space equipped with a personal computer. The system can be set to monitor unusual circumstances and to emit an alarm signal expressed as a sound or a light on a measuring module connected to the related incubator. If the system is configured with a large number of incubators connected to a centralized supervisory monitoring station, it will improve convenience and assure meaningful improvement in response to incidents that require intervention.

Organic and detergent degradation in combined O3/UF for domestic laundry wastewater reclamation

This paper focuses on the evaluation of organic and detergent degradation in a combined Ozone/UF system for domestic laundry wastewater reclamation. Formation of by-product was investigated by GC/MS for the reclaimed water. Ozone was injected into the raw wastewater in a 10 L contact tank and the wastewater was circulated through the membrane module for inner pressurized cross-flow filtration. The concentrate was returned back to the contact tank. The membrane used in this experiment was hollow fiber polysulfone UF membrane with MWCO 10,000. It has an effective filtration area of 0.06 m2. The experiment was carried out with intermittent ozone injection, 5 min injection and 10 min idling. Ozone was dosed at the concentration of 1.5 mg/L. The flux of the UF could be maintained at 0.24 m/d under filtration pressure 40-45 kPa and water temperature, 20-22 degrees C. The organic removal efficiency by the system was 90% in terms of COD. Ozone was considerably effective to degrade organics in the wastewater. Molecular weight of organics in the raw waste was mostly greater than 10,000 (72% of 950 mgCOD/L). However 86% of effluent COD (94-100 mg/L) was composed of organics smaller than MWCO 500 by ozone injection. No harmful by-products by ozone contact were detected from the analysis of treated water using GC/MS. It was identified that residual organics in the treated water were 1,1'-Oxybisbenzene, Octadecanoic acid, Squalene and Benzenmethanol, etc., which were additives contained originally in the detergent. Consequently the reclaimed water quality could be estimated safe enough to recycle for the rinsing cycle in a washing machine.

Bipolar clavicular injury

While clavicular injuries are fairly common, bipolar clavicular injuries are not. They may involve dislocations at both ends of the clavicle, or a fracture at one end and a dislocation at the other. We present two cases; a patient with a bipolar clavicular dislocation, and another with a fracture in both medial and lateral ends of the clavicle with anterior dislocation of the sternoclavicular joint. Both were treated conservatively, with fairly good range of motion and return to normal activity.

Acid-activated spent bleaching earth as a sorbent for chromium (VI) in aqueous solution

Spent bleaching earth, an industrial waste produced after the bleaching of crude palm oil, was investigated for its potential in removing Cr(VI) from aqueous solution. The earth was treated with different amounts of sulfuric acid and under different activation temperatures. Results show that the optimum treatment process involved 10% sulfuric acid at 350 degrees C. The effects of contact time, pH, initial concentration, sorbent dosage, temperature, sorption isotherms and the presence of other anions on its sorption capacity were studied. Isotherm data could be fitted into a modified Langmuir isotherm model implying monolayer coverage of Cr(VI) on acid activated spent bleaching earth. The maximum sorption capacity derived from the Langmuir isotherm was 21.2 mg g(-1). This value was compared with those of some other low cost sorbents. Studies of anion effect on the uptake of Cr(VI) on acid activated spent bleaching earth provided the following order of suppression: EDTA >PO4(3-)>SO4(2-)>NO3(-)>Cl(-).

Non-woven fabric filter separation activated sludge reactor for domestic wastewater reclamation

A non-woven fabric filter was experimentally evaluated for solid-liquid separation in an activated sludge reactor as an alternative membrane. A polypropylene fabric filter (70, 50 and 35 g/m2) was used for the experiment. The pilot system was operated in A/O (Anaerobic/Oxic) type in which the filter module was submerged into the oxic compartment. The filtration module consists of 10 plate type rectangular filter elements with effective filtration area, 2 m2. Gravity filtration was carried out for solid-liquid separation by changing the water head 0.05-0.5 m without backwashing during the system operation. Initial permeate flux was set at 0.4 m/d. C/N ratio of raw wastewater was controlled at 4.5 in terms of BOD/T-N. The fabric filter system showed a good performance enough for domestic wastewater treatment. Effluent solid concentration was 3.2 mg/L (93.5% removal). COD removal efficiency was 91.6% producing an effluent concentration around 13 mg/L. 66% of total nitrogen removal could be obtained at the adjusted C/N ratio of influent wastewater. However phosphorus removal was very low at 23%. It was found that the initial flux of 0.4 m/d should be maintained for stable performance of the system.