Langerhans cell histiocytosis involving only the thymus in an adult: A case report

BACKGROUND

Langerhans cell histiocytosis (LCH) is a rare disease of unknown etiology. LCH involving the thymus is mainly seen in pediatric patients and is extremely rare in adults. In this report, we describe a rare case of LCH originating from the thymus in an adult.

CASE SUMMARY

A 56-year-old man was admitted in April 2022 with complaints of intermittent dizziness since 2020, which had worsened in the previous 10 d. The physical chest examination was negative, and there was a history of hypertension for > 2 years. Chest computed tomography showed a nodular soft tissue density shadow in the anterior mediastinum measuring approximately 13 mm × 9 mm × 8 mm. Postoperative pathological findings confirmed the diagnosis of LCH.

CONCLUSION

It is challenging to differentiate LCH involving the thymus from thymoma in imaging features. Pathological biopsy remains the gold standard when an anterior mediastinal occupying lesion is found.

Pleural effusion and ascites in extrarenal lymphangiectasia caused by post-biopsy hematoma: A case report

BACKGROUND

The renal system has a specific pleural effusion associated with it in the form of “urothorax”, a condition where obstructive uropathy or occlusion of the lymphatic ducts leads to extravasated fluids (urine or lymph) crossing the diaphragm via innate perforations or lymphatic channels. As a rare disorder that may cause pleural effusion, renal lymphangiectasia is a congenital or acquired abnormality of the lymphatic system of the kidneys. As vaguely mentioned in a report from the American Journal of Kidney Diseases, this disorder can be caused by extrinsic compression of the kidney secondary to hemorrhage.

CASE SUMMARY

A 54-year-old man with biopsy-proven acute tubulointerstitial nephropathy experienced bleeding 3 d post hoc, which, upon clinical detection, manifested as a massive perirenal hematoma on computed tomography (CT) scan without concurrent pleural effusion. His situation was eventually stabilized by expeditious management, including selective renal arterial embolization. Despite good hemodialysis adequacy and stringent volume control, a CT scan 1 mo later found further enlargement of the perirenal hematoma with heterogeneous hypodense fluid, left side pleural effusion and a small amount of ascites. These fluid collections showed a CT density of 3 Hounsfield units, and drained fluid of the pleural effusion revealed a dubiously light-colored transudate with lymphocytic predominance (> 80%). Similar results were found 3 mo later, during which time the patient was free of pulmonary infection, cardiac dysfunction and overt hypoalbuminemia. After careful consideration and exclusion of other possible causative etiologies, we believed that the pleural effusion was due to the occlusion of renal lymphatic ducts by the compression of kidney parenchyma and, in the absence of typical dilation of the related ducts, considered our case as extrarenal lymphangiectasia in a broad sense.

CONCLUSION

As such, our case highlighted a morbific passage between the kidney and thorax under an extraordinarily rare condition. Given the paucity of pertinent knowledge, it may further broaden our understanding of this rare disorder.

Circulating Tumor Cells as a Screening and Diagnostic Marker for Early-Stage Non-Small Cell Lung Cancer

Background

Circulating tumor cells (CTCs) have become potential diagnostic biomarker for several types of cancer, including lung cancer. In this study, we aim to determine whether CTCs detected by CellCollector can be used for early-stage diagnosis of lung cancer.

Methods

In this study, we recruited 64 volunteers, among whom 44 were suspected lung cancer patients requiring surgical treatment and 20 were healthy volunteers. We simultaneously analyzed PD-L1 expression in CTCs isolated using the GILUPI CellCollector and copy number variation by next-generation sequencing (NGS).

Results

We enrolled a total of 44 patients with suspected lung cancer who required surgery and 20 healthy volunteers. The patients were classified into 4 groups based on their pathological results: benign disease, in situ cancer, microinvasive, and invasive. The CTCs detection rate for each group was 10.00% (1/10), 45% (5/11), 50% (7/14), and 67% (6/9), respectively. Among the patients with lung cancer, the CTCs detection rate increased with disease progression. The rate of CTCs positivity was 52.94% (18/34) in patients who were diagnosed with lung cancer by pathology and 10% (1/10) in patients with benign disease. CTCs were not detected in the control group. The area under the receiver operating characteristic (ROC) curve, a measure for distinguishing patients with primary lung cancer, was 0.715 (95% CI 0.549-0.880, P=0.041). The sensitivity and specificity of the in vivo CTCs detection strategy for the diagnosis of early-stage lung cancer were 52.94% and 90%, respectively. CTCs were associated with clinical pathology but not with the size and location of the nodules.

Conclusion

CTCs isolation using the CellCollector in vivo detection method might be effective for distinguishing between benign and malignant nodules and may be used for early-stage diagnosis of lung cancer.

System-Pharmacology Dissection of Traditional Chinese herbs SINI Decoction for Treatment of Cardiovascular Diseases

Abstract: Cardiovascular diseases (CVDs) are leading causes of death in the world, owing to noticeable incidence and mortality. Traditional Chinese Medicine (TCM) SINI Decoction (SND) is used to prevent and treat CVDs, which has attracted extensive attention for its moderate and little side effects. However, the involved molecular mechanisms are exceedingly complicated and remain unclear. Systems pharmacology, as a novel approach that integrates systems biology and pharmacology plays a significant role in investigating the molecular mechanism of TCM. In systems pharmacology approach, we use to systematically uncover the mechanisms of action in Chinese medicinal formula SND as an effective treatment for CVDs, which mainly includes:1) molecular database building; 2) ADME evaluation; 3) target-fishing 4) network construction and analysis. The results show that 78 underlying valid ingredients and their corresponding 71 direct targets of SND were obtained. And SND take part in cardiomyocyte protection, blood pressure regulation, and lipid regulation module in treatment of CVDs by cooperative way. Systems pharmacology as an emerging field that investigates the molecular mechanisms of TCM through pharmacokinetic evaluation target prediction, and pathway analysis, which will facilitate the development of traditional Chinese herbs in modern medicine.

Hemostasis biomarkers and risk of sepsis: the REGARDS cohort

Essentials Few studies have investigated the risk of sepsis by baseline hemostasis biomarkers measures. Baseline hemostasis biomarkers and risk of sepsis was examined using case-control study design. Increased fibrinogen, factor IX, and factor XI levels may be associated with risk of sepsis. Hemostasis biomarkers may provide a target for sepsis mitigation or prevention.

SUMMARY

Background Sepsis is a major public health concern, responsible for more than 750 000 hospitalizations and 200 000 annual deaths in the USA. Few studies have investigated the association between baseline measurements of hemostasis biomarkers and the future risk of sepsis. Objective To determine whether hemostasis biomarkers levels measured at baseline in a cohort of community-dwelling participants are associated with the risk of future sepsis events. Methods We performed a nested case-control study within the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We identified sepsis hospitalizations occurring over a 10-year period. There were 50 incident sepsis cases with baseline measurements of hemostasis (fibrinogen, factor VIII, FIX, FXI, protein C, and D-dimer). Using incidence density sampling, we matched the 50 sepsis cases with 200 controls by age, sex, and race. We used conditional logistic regression to evaluate the association between baseline hemostasis biomarkers and future sepsis events. Results Comparison of 50 sepsis cases with 200 non-sepsis controls showed that sepsis cases had lower education and income, were more likely to live in the stroke belt, had chronic lung disease, and had higher albumin level/creatinine level ratios (ACRs). Individuals with higher baseline fibrinogen levels (adjusted odds ratio [OR] per standard deviation: 1.40, 95% confidence interval [CI] 1.01-1.94), FIX levels ([OR] 1.46, 95% [CI] 1.03-2.07) and FXI levels ([OR]1.52, 95% [CI] 1.04-2.23) were more likely to experience a sepsis event. Conclusion Baseline fibrinogen, FIX and FXI levels are associated with future episodes of sepsis. Hemostasis biomarkers may provide targets for sepsis mitigation or prevention.

Prognostic role of platelet to lymphocyte ratio in non-small cell lung cancers: A meta-analysis including 3,720 patients

Platelet to lymphocyte ratio (PLR) was recently reported as a useful index in predicting the prognosis of lung cancer. However, the prognostic role of PLR in lung cancer remains controversial. The aim of this study was to evaluate the association between PLR and clinical outcome of lung cancer patients through a meta-analysis. Relevant literatures were retrieved from PubMed, Ovid, the Cochrane Library and Web of Science databases. Meta-analysis was performed using hazard ratio (HR) and 95% confidence intervals (CIs) as effect measures. A total of 5,314 patients from 13 studies were finally enrolled in the meta-analysis. The summary results showed that elevated PLR predicted poorer overall survival (OS) (HR: 1.526, 95%CI: 1.268-1.836, p < 0.001) in patients with lung cancer and OS (HR: 1.631, 95%CI: 1.447-1.837, p < 0.001) in patients with nonsmall cell lung cancer (NSCLC). Subgroup analysis revealed that increased PLR was also associated with poor OS in NSCLC treated by surgical resection (HR: 1.884, 95%CI: 1.308-2.714, P < 0.001) and non-surgery (HR: 1.570, 95%CI: 1.323-1.863, P < 0.001). In addition, PLR Cut-off value ≤ 160 (HR: 1.506, 95%CI: 1.292-1.756, P < 0.001) and PLR Cut-off value>160 (HR: 1.842, 95%CI: 1.523-2.228, P < 0.001). In contrast, elevated PLR was not associated with OS (HR: 1.117, 95%CI: 0.796-1.569, P > 0.05) in patients with small cell lung cancer (SCLC).This meta-analysis result suggested that elevated PLR might be a predicative factor of poor prognosis for NSCLC patients.

Diagnostic value of SHOX2 DNA methylation in lung cancer: a meta-analysis

The diagnostic value of SHOX2 DNA methylation in patients with lung cancer remains controversial. Thus, we performed a systematic review and meta-analysis to assess diagnostic accuracy of SHOX2 DNA methylation in the lymph node, bronchial aspirates, pleural effusion, plasma, and tumor tissue for lung cancer. We conducted a comprehensive literature search in PubMed, Ovid, the Cochrane library, and Web of Science databases in May 2015. The diagnostic sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curve were pooled using STATA 12.0 software. A total of 2,296 subjects included 1,129 lung cancer patients in eight studies were recruited in this meta-analysis. The summary estimates for SHOX2 DNA methylation in the diagnosis of lung cancer in these studies were pooled SEN =0.70 (95% confidence interval [CI]: 0.46–0.87), SPE =0.96 (95% CI: 0.91–0.99), PLR 20.01 (95% CI: 6.96–57.52), NLR 0.31 (95% CI: 0.15–0.64), and DOR 65.11 (95% CI: 13.10–323.61), and the area under the curve (AUC) was 0.96 (95% CI: 0.94–0.97). SHOX2 DNA methylation has greater diagnostic value in detecting lung cancer. In addition, considering the potential publication bias and high heterogeneity, further research studies with more well-designed and large sample sizes are needed in the future.

Prognostic role of neutrophil to lymphocyte ratio in lung cancers: a meta-analysis including 7,054 patients

Background

Neutrophil to lymphocyte ratio (NLR) has recently been reported to be a poor prognostic indicator in lung cancer. However, the prognostic value of the NLR in patients with lung cancer still remains controversial. We performed a meta-analysis to evaluate the prognostic value of NLR in patients with lung cancer.

Methods

We performed a comprehensive literature search in PubMed, Ovid, the Cochrane Library, and Web of Science databases in May 2015. Studies were assessed for quality using the Newcastle–Ottawa Scale.

Results

Twenty-two studies with a total of 7,054 patients were included in this meta-analysis. The meta-analysis was performed to generate combined hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS). Our analysis results indicated that high NLR predicted poorer OS (HR, 1.51; 95% confidence interval [CI], 1.33–1.71; P<0.001) and PFS (HR, 1.33; 95% CI, 1.07–1.67; P=0.012) in patients with lung cancer. High NLR was also associated with poor OS in lung cancer treated by surgical resection (HR, 1.59; 95% CI, 1.26–1.99; P<0.001) and chemotherapy (HR, 1.15; 95% CI, 1.08–1.22; P<0.001). In addition, NLR cut-off value =5 (HR, 1.57; 95% CI, 1.16–2.12; P=0.003) and NLR cut-off value <5 (HR, 1.47; 95% CI, 1.28–1.69; P<0.001).

Conclusion

This meta-analysis result suggested that NLR should have significant predictive ability for estimating OS and PFS in patients with lung cancer and may be as a significant biomarker in the prognosis of lung cancer.

Dental diagnostic X-ray exposure and risk of benign and malignant brain tumors

BACKGROUND

This study evaluates the risk of benign brain tumors (BBTs) and malignant brain tumors (MBTs) associated with dental diagnostic X-ray, using a large population-based case-control study.

MATERIALS AND METHODS

We identified 4123 BBT cases and 16 492 controls without BBT (study 1) and 197 MBT cases and 788 controls without MBT (study 2) from Taiwan National Health Insurance claim data. The risks of both types of tumor were estimated in association with the frequency of received dental diagnostic X-ray.

RESULTS

The mean ages were ~44.2 years in study 1 and 40.6 years in study 2. Multivariable unconditional logistic regression analysis showed that the risk of BBT increases as the frequency of received dental diagnostic X-ray increases. The BBT odds ratio increased from 1.33 [95% confidence interval (CI) 1.22-1.44] for those with annual mean X-ray examination of less than one to 1.65 (95% CI 1.37-1.98) for those with three or more X-ray examinations, after controlling for comorbidities. No significant association was found between MBTs and dental diagnostic X-ray exposure.

CONCLUSIONS

Exposure to dental diagnostic X-rays in oral and maxillofacial care increases the risk of BBTs, but not MBTs.

Facile and rapid synthesis of highly porous wirelike TiO2 as anodes for lithium-ion batteries

Highly porous wirelike TiO(2) nanostructures have been synthesized by a simple two-step process. The morphological and structural characterizations reveal that the TiO(2) wires typically have diameters from 0.4 to 2 μm, and lengths from 2 to 20 μm. The TiO(2) wires are highly porous and comprise of interconnected nanocrystals with diameters of 8 ± 2 nm resulting in a high specific surface area of 252 m(2) g(-1). The effects of experimental parameters on the structure and morphology of the porous wirelike TiO(2) have been investigated and the possible formation processes of these porous nanostructures are discussed. Galvanostatic charge/discharge tests indicate that the porous wirelike TiO(2) samples exhibit stable reversible lithium ion storage capacities of 167.1 ± 0.7, 152.1 ± 0.8, 139.7 ± 0.3, and 116.1 ± 1.1 mA h g(-1) at 0.5, 1, 2, and 5 C rates, respectively. Such improved performance could be ascribed to their unique porous and 1D nanostructures facilitating better electrolyte penetration, higher diffusion rate of electrons and lithium ion, and variation of accommodated volumes during the charge/discharge cycles.

Ambulance stretcher adverse events

INTRODUCTION

Ambulance personnel use wheeled stretchers for moving patients in the out-of-hospital setting. The nature of adverse events and associated injuries occurring during ambulance stretcher operation was characterised.

METHODS

Data from the United States Food and Drug Administration's Manufacturer and User Facility Device Experience Database (MAUDE) were used. All adverse events involving ambulance stretchers during the years 1996-2005 were identified. The nature of the event, the method of stretcher handling, the individuals injured and the nature of the resulting injuries were identified.

RESULTS

There were 671 reported adverse events. The most common adverse events were stretcher collapse (54%; 95% CI 50 to 57%), broken, missing or malfunctioning part (28%; 95% CI 25 to 32%) and dropped stretcher (7%; 95% CI 5 to 9%). Adverse events most commonly occurred during unloading of the stretcher from the ambulance (16%; 13 to 19%). Injuries occurred in 121 events (18%; 95% CI 15 to 21%), most often involving sprains/strains (29%), fractures (16%) and lacerations/avulsions (13%). There were three traumatic brain injuries and three deaths. Patients sustained injuries in 52 events (43%), and ambulance personnel sustained injuries in 64 events (53%). More than one individual sustained injuries in 12 events.

CONCLUSION

Adverse events may occur during ambulance stretcher operation and can result in significant injury to patients and ambulance personnel.

The synthesis and characterization of [(124)I]IMPY, a thioflavin-S derivative, in transgenic mouse models of Alzheimer's disease

6-[(124)I]iodo-2-(4'-N,N-dimethylamino)-phenylimidazo[1,2-a]pyridine ([(124)I]IMPY) was synthesized and characterized as a positron-emitting probe to identify Alzheimer's disease in transgenic mouse models. A significant reduction in radioactivity retention in the hippocampus and frontal cortex by co-incubation with nonradioactive IMPY was observed. Highly specific retention of radioactivity in beta-amyloid-rich regions of brain sections was also noted. This study demonstrated that [(124)I]IMPY was a promising probe for the mouse model and may be useful for positron emission tomography to image beta-amyloid plaques in the human brain.

The robotic radiosynthesis of 5-[(18)F]fluoro-2'-deoxyuridine and its biological characterization

5-[(18)F]fluoro-2'-deoxyuridine ([(18)F]FUdR) was synthesized using a robotic system as a proliferation probe for PET. [(18)F]FUdR was prepared via radiofluorodestannylation reaction from its organotin precursor. Biodistribution study and microPET imaging of [(18)F]FUdR in NG4TL4 sarcoma-bearing FVB/n mice were performed. The tumor-to-blood and tumor-to-muscle ratio increased steadily from 15 (1.81 and 3.42) to 120min (9.10 and 11.9) post injection. The dynamic microPET imaging demonstrates remarkable radioactivity retention in the tumor, which is consistent with the results of biodistribution study.

A robotic synthesis of [18F]fluoromisonidazole ([18F]FMISO)

This study aimed to develop an automated synthesis of [18F]fluoromisonidazole ([18F]FMISO) using a Scanditronix Anatech RB III robotic system. [18F]HF was produced via the 18O(p,n)18F reaction using a Scanditronix MC17F cyclotron. On average, a typical run produced [18F]FMISO with an uncorrected radiochemical yield of 30+/-5% at end of synthesis (EOS) from the irradiation of 95% enriched [18O]water. The total synthesis time was 65 min. The retention time of [18F]FMISO (the radio-peak) was 4.9 min, which was consistent with the authentic FMISO (the ultraviolet peak). The radiochemical purity was greater than 97%. Preparation of [18F]FMISO using the automated robotic system is highly reliable and reproducible, and the radiation burden for the operator can be largely reduced. Sufficient radioactivities of [18F]FMISO could be obtained for non-invasive tumor hypoxia imaging in vivo with positron emission tomography (PET).

A high yield robotic synthesis of 9-(4-[18F]-fluoro-3-hydroxymethylbutyl)guanine ([18F]FHBG) and 9-[3-[18F]fluoro-1-hydroxy-2-propoxy)methyl]guanine([18F] FHPG) for gene expression imaging

The aim of this study was to develop an automated synthesis of 9-(4-[(18)F]-fluoro-3-hydroxymethylbutyl)guanine ([(18)F]FHBG) and 9-[(3-[(18)F]fluoro-1-hydroxy-2-propoxy)methyl]guanine ([(18)F]FHPG) using a Scanditronix Anatech RB III robotic system. [(18)F]HF was produced via (18)O(p, n)(18)F using a Scanditronix MC17F cyclotron. On average, a typical run produced [(18)F]FHBG and [(18)F]FHPG with an uncorrected radiochemical yield of 19% and 16%, respectively, at end of synthesis (EOS) from irradiation of 95% enriched [(18)O]water. The total synthesis time was 80 min. The retention time of [(18)F]FHBG and [(18)F]FHPG (the radio-peak) was 3.9 and 4.0 min, respectively, which was consistent with the [(19)F]FHBG and [(19)F]FHPG ultraviolet peak. The radiochemical purity was greater than 97%. A robotic, automated method for [(18)F]FHBG and [(18)F]FHPG radiosynthesis is therefore feasible. The radiation burden for the operator can be reduced as much as possible. Sufficient radioactivities of [(18)F]FHBG and [(18)F]FHPG could be obtained for non-invasive monitoring the expression of transfected gene in vivo with positron emission tomography (PET).

A simple model for quantification of the radiobiological effectiveness of the 10B(n,α)7Li capture reaction in BNCT

A simple model has been developed for predicting radiobiological effectiveness of the neutron capture reaction in boron neutron capture therapy. This model was derived from the relationship between the cell survival from the boron capture reaction, the intracellular boron concentration, and the thermal neutron fluence. We found that the cell-killing effect of the boron capture reaction was well described using a power function of the intracellular boron concentration. Hence the relationship between cell survival from the boron capture reaction, intracellular boron concentration, and the thermal neutron fluence could be determined using a simple mathematical equation. We consider that our current approach is more appropriate and realistic than the conventional theoretical mathematical model used to estimate the radiobiological effectiveness of the neutron capture reaction in boron neutron capture therapy.

MicroPET-based pharmacokinetic analysis of the radiolabeled boron compound [18F]FBPA-F in rats with F98 glioma

Boron neutron capture therapy (BNCT) is one of the effective methods of radiation therapy for the treatment of tumors such as malignant glioma. Boronophenylalanine ((10)B-BPA) solution has been used as a potential boron carrier for such a treatment. The aim of this study is to investigate 4-borono-2-[(18)F]-fluoro-l-phenylalanine-fructose ([(18)F]FBPA-F) in rats injected in the brain with glioma using in vivo small animal positron emission tomography (PET) imaging (microPET). Male Fischer 344 rats with F98 glioma in the left brain were used for these studies. Dynamic PET imaging of [(18)F]FBPA-F was performed on the 13th day after tumor inoculation. Arterial blood sampling was performed to obtain an input function for tracer kinetic modeling. The accumulation ratios of [(18)F]FBPA-F for the glioma-to-normal brain approached 3. The uptake characteristics of BPA-F and [(18)F]FBPA-F were similar. The results indicate that 4h after BPA-F injection would be the optimal irradiation time for BNCT. Rate constants were estimated using a three-compartment model. This study provides useful information for the clinical application of BNCT in patients with brain tumors.

Sensitization of a tumor, but not normal tissue, to the cytotoxic effect of ionizing radiation using Panax notoginseng extract

The aim of the present study was to investigate any sensitization effect of the Panax notoginseng extract (PNE) and the purified Saponin (Rb1) on the radiation response of an experimental tumor (KHT sarcoma) in mice, in comparison with any effects on a normal tissue (bone marrow). PNE at a concentration of 0.1-100 mg/kg produced an increase in tumor radiosensitivity. The sensitization effect was maximal at 10 mg/kg and at 30 minutes after injection. Higher doses were toxic to the bone marrow stem cells. Similarly Rb1 at a concentration 0.001 to 1 mg/kg also produced an increase in tumor radiosensitivity, with maximum effect at 1 mg/kg. Higher doses were not toxic to the bone marrow stem cells in this case. Radiosensitization factors were calculated as ratios of D0 (the radiosensitivity parameter), and these were highly significant for the tumor and very similar for both compounds at the doses used, namely 1.18-1.19. There was no significant effect for bone marrow stem cells (sensitization factors of 0.99 +/- 0.01 for both compounds). The differential effect on tumor, and the magnitude of the radiosensitization, suggest that further purified or synthetic versions of this extract may be useful not only in vascular-related diseases but also in cancer therapy.

Tsg101 and the vacuolar protein sorting pathway are essential for HIV-1 budding

Like other enveloped viruses, HIV-1 uses cellular machinery to bud from infected cells. We now show that Tsg101 protein, which functions in vacuolar protein sorting (Vps), is required for HIV-1 budding. The UEV domain of Tsg101 binds to an essential tetrapeptide (PTAP) motif within the p6 domain of the structural Gag protein and also to ubiquitin. Depletion of cellular Tsg101 by small interfering RNA arrests HIV-1 budding at a late stage, and budding is rescued by reintroduction of Tsg101. Dominant negative mutant Vps4 proteins that inhibit vacuolar protein sorting also arrest HIV-1 and MLV budding. These observations suggest that retroviruses bud by appropriating cellular machinery normally used in the Vps pathway to form multivesicular bodies.

Efficacy of Re-188-labelled sulphur colloid on prolongation of survival time in melanoma-bearing animals

In this study, the effectiveness of a 188Re labeled sulfur colloid with two particle size ranges was used to evaluate the effectiveness of this agent on melanoma tumors in mice in terms of animal lifespan.

METHODS

Two separate group of animals were used for investigating biodistribution and survival time. A total of 188 B16F10-melanoma-bearing BDF(1) mice were injected intraperitoneally with 3.7 MBq (0.1mCi)/2mL of radiolabeled sulfur colloid ten days after intraperitoneal inoculation of 5x10(5) B16F10 melanoma cells/2ml. For group 1, 30 mice were sacrificed at 1, 4, 24, 48 and 72 hours for biodistribution studies. In group 2, 158 mice were divided into 9 groups (n=16 approximately 18/groups)each receiving respectively tumor alone, tumor with normal saline, cold colloid or hot colloid with 16, 23, 31, 46, 62, or 124 MBq activity. Each of these colloid groups was further divided into two groups, one receiving smaller particle sizes (<3 microm:80.4 +/-7.2%, colloid 1) and the other receiving larger particle sizes (<3 microm:12.3+/-1.0%, colloid 2). The animals were checked daily until death and their survival recorded.

RESULTS

Colloid 2 showed higher accumulation in almost all tissues, the highest accumulation organ was tumor ( approximately 40%), then spleen ( approximately 20%), stomach ( approximately 15%), diaphragm ( approximately 3%), and liver ( approximately 2%). There was a significant increase in survival time with increasing amount of the larger-particle-size colloid. Administered levels of 16-31 MBq/mouse were most efficacious and with higher amounts the survival times decreased significantly below that of the controls. There was a significant difference in the dose-response curves for the two preparations. Protection factors (1/Relative-risk) of nearly 5 were achieved using the larger colloid size, and nearly 30 using the smaller colloid size. An amount of 16-31 MBq of the colloid 2 was the optimal activity in these studies. On the one hand, the survival data agreed well with the biodistribution data, where higher accumulation was found in tumor with colloid 2.

CONCLUSION

Rhenium-188 offers on-site availability, medium half-life, higher beta-particle energy of 2.12 MeV for therapy and emission of 155keV gamma photon suitable for imaging. The present study demonstrated that 188Re-sulfur colloid is an effective agent in controlling tumor cells in the abdominal cavity in animals.

Effects of biphasic vs monophasic defibrillation on the scaling exponent in a swine model of prolonged ventricular fibrillation

OBJECTIVE

Mathematical analyses of ventricular fibrillation (VF) have resulted in the derivation of a measure termed the scaling exponent (ScE) that characterizes the duration of VF and probability of defibrillation success. The purpose of this study was to compare the effects of biphasic defibrillation waveform (BDW) and monophasic defibrillation waveform (MDW) rescue shocks on ScE in a swine model of prolonged VF.

METHODS

Utstein guidelines for the laboratory study of cardiopulmonary resuscitation were followed. Twenty mixed-breed domestic swine (mass range 20.5-26.8 kg) were instrumented and randomized to receive either MDW or BDW rescue shocks. Ventricular fibrillation was induced and untreated for a nonintervention interval of 8 minutes. Rescue shocks were delivered at 8, 10, and 12 minutes of elapsed VF time. The energy sequence for the three MDW shocks was 70, 100, and 150 J (approximately 3, 4, and 6 J/kg). All BDW shocks were delivered at 50 J (approximately 2.5 J/kg). Only VF was shocked. Chest compressions and drugs were not provided. Rhythm analysis and ScE calculation were performed offline. Continuous and discontinuous linear regression models were fit to plots of ScE vs time. Defibrillation success and progression of ScE slope were analyzed using Fisher's exact test, paired t-tests, and repeated-measures analysis of variance (ANOVA).

RESULTS

Baseline characteristics were similar for both groups. Successful termination of VF occurred on the first rescue shock in 1 of 10 (10%) in the MDW group and 3 of 10 (30%) in the BDW group; this difference was not statistically significant (p = 0.58). No other defibrillation successes were observed. No animals achieved return of spontaneous circulation. The ScE values during the protocol progressed from 1.330 (95% CI = 1.287 to 1.373) to 1.724 (95% CI = 1.603 to 1.845) for MDW and 1.338 (95% CI = 1.261 to 1.415) to 1.639 (95% CI = 1.530 to 1.745) for BDW. Both groups showed a trend toward increasing ScE values with successive rescue shocks. Repeated-measures ANOVA using both continuous and discontinuous models demonstrated no difference in overall ScE slope progression between study groups.

CONCLUSIONS

Mode of defibrillation waveform (BDW vs MDW) does not appear to impact ScE trends. Additional studies must be performed to better evaluate the clinical implications of this finding.

Failed prehospital intubations: an analysis of emergency department courses and outcomes

OBJECTIVE

To examine the reasons for failed prehospital endotracheal intubation (ETI) and to identify how the airway was subsequently managed in the emergency department (ED).

METHODS

Data were collected from January to December 1998 for a county-wide paramedic system. Failed prehospital ETIs and perceived reasons for failure were identified. Subsequent ED airway management was reviewed.

RESULTS

During the study period there were 13,112 patient contacts resulting in ETI attempts on 592 patients, of whom 536 (90.5%) were successfully intubated. Of the 56 failed field intubations, 49 (87.5%) had ED charts available for review. Endotracheal intubation failure was associated with inadequate relaxation in 24 (49%), difficult anatomy in ten (20%), and obstruction in five (10%). Successful ETI was achieved in the ED in 42 cases (86%). Twenty cases (41%) were facilitated by rapid-sequence intubation (RSI) in the ED. For those with incomplete relaxation in the field, 13 of 24 (54%) were intubated in the ED using RSI. Factors associated with the use of ED RSI include attempted prehospital nasotracheal intubation or attempted prehospital midazolam-facilitated intubation (p < 0.001). The predicted need for RSI in this prehospital system is approximately 3.9%. In eight cases, three or more ETI attempts or the use of rescue airways was required in the ED. The predicted minimum incidence of "truly difficult" intubation in this system is approximately 0.8-1.6%.

CONCLUSIONS

Paramedic intubation failures result from a variety of factors. Less than half of field intubation failures were remedied in the ED by the use of neuromuscular-blocking agents. A similar number were intubated without the use of RSI. A fraction of failed field ETIs may have resulted from inadequate operator training or experience. A small percentage of field patients were "truly difficult" and required advanced resources in the ED to facilitate airway management. Medical directors should be cognizant of the numerous factors affecting intubation performance when designing and implementing approaches to difficult prehospital airways.

Preclinical evaluation of locoregional delivery of radiolabeled iododeoxyuridine and thymidylate synthase inhibitor in a hepatoma model

We report improved incorporation of the radiolabeled-thymidine analog [125I/131I]5-iodo-2'-deoxyuridine ([125I/131I]IdUrd) into DNA by the addition of Thymitaq, a thymidylate synthase inhibitor, as a strategy of molecular radiotherapy for hepatoma treatment.

METHODS

The synergistic effect of combination [125I]IdUrd and Thymitaq in clonogenic survival and DNA incorporation was shown on the human hepatoma cell line Hep3B. Radiobiodistribution of intrahepatic arterially injected [125I]IdUrd and Thymitaq was studied in a rat N1S1 hepatoma model. In vivo therapeutic effects of locoregional delivery of both drugs were evaluated in mouse subcutaneous hepatoma and ascitic hepatoma models.

RESULTS

In a clonogenic assay, Thymitaq showed a synergistic effect with [125I]IdUrd but not cold IdUrd. Thymitaq had a dose-dependent modulation effect on DNA-[125I]IdUrd incorporation. The biodistribution study indicated a slower clearance rate of [125I]IdUdR in the hepatoma as well as an initially higher uptake of [125I]IdUrd into DNA when the [125I]IdUrd was combined with Thymitaq. In vivo studies showed a superior therapeutic effect of combination Thymitaq and [125I]IdUrd in both subcutaneous and ascites tumor models, but the combination of [131I]IdUrd and [125I]IdUrd may be more effective than Auger electron emitters alone for the treatment of subcutaneous tumor.

CONCLUSION

The strategy of locoregional delivery of [125I/131I]IdUrd to a tumor site through an intrahepatic arterial, intratumoral, or intraperitoneal route in combination with Thymitaq is promising and may also have a favorable therapeutic index in vivo.

Patient status and time to intubation in the assessment of prehospital intubation performance

Assessment of paramedic endotracheal intubation (ETI) performance often does not account for varied clinical conditions or the time required to complete the procedure.

OBJECTIVE

To demonstrate the utility of patient status and time to intubation (TTI) for evaluating prehospital ETI performance.

METHODS

Paramedic charts were reviewed for the period January-December 1998. Patient clinical status was defined as cardiac arrest (absence of perfusing rhythm) or non-cardiac arrest (presence of perfusing rhythm). Method, route, and success of ETI were noted. The TTI was determined as the elapsed time from on-scene arrival to securing of the endotracheal tube. Time elapsed from on-scene arrival to emergency department arrival was noted for instances of failed ETI. Statistical analysis was performed using chi-square and survival analysis (Kaplan-Meier estimator).

RESULTS

Computer records were available for 26,026 patient contacts. Of 893 documented ETI attempts, 771 (86%) were successful. The ETI success rate was significantly higher (p<0.001) for cardiac arrests (551 of 591, 93.2%) than for non-cardiac arrests (220 of 302, 72.9%). Median TTIs were 5 minutes (95% CI: 5, 5) for cardiac arrests and 17 minutes (95% CI: 14, 20) for non-cardiac arrests; this difference was significant (p<0.001). For non-cardiac arrests, ETI success was significantly (p = 0.002) higher for orotracheal intubation (OTI) (168 of 214, 78.5%) than for nasotracheal intubation (NTI) (52 of 88, 59.1%). Median TTIs were 15 minutes (95% CI: 13, 17) for OTI and 25 minutes (95% CI: 23, 27) for NTI; this difference was significant (p = 0.002). For non-cardiac arrests, the difference i

The use of diltiazem for treating rapid atrial fibrillation in the out-of-hospital setting

STUDY OBJECTIVE

We sought to evaluate the use of intravenous diltiazem for treatment of rapid atrial fibrillation or flutter (RAF) in the out-of-hospital setting.

METHODS

This study is a retrospective review of data with historical control subjects. Data were drawn from out-of-hospital patients reported to a statewide paramedic system who presented with atrial fibrillation or flutter and a ventricular response rate (VRR) of 150 beats/min or greater. The intervention (diltiazem) group included patients who received diltiazem during a 9-month period in 1999. The control group included patients from 1998 who did not receive diltiazem. Patients who were intubated or underwent cardioversion were omitted. Therapeutic response was defined as the occurrence of change to sinus rhythm, reduction of VRR to 100 beats/min or less, or reduction of baseline VRR by 20% or greater. Data were analyzed by using the chi(2) test, the Student's t test, and odds ratios (ORs). A Bonferroni adjusted P value of.005 was used to define statistical significance.

RESULTS

Forty-three patients receiving diltiazem and 27 control subjects were included in the study. The mean total diltiazem dose was 19.8 mg (95% confidence interval 17.8 to 21.8). The diltiazem and control groups did not significantly differ with respect to age; sex; history of atrial fibrillation; prior use of digitalis, beta-blockers, or calcium channel blockers; concurrent out-of-hospital therapies; or baseline VRR or systolic blood pressure (P =.09 to 1.00). The difference in VRR reduction between the diltiazem and control groups was 38 beats/min (95% confidence interval 24 to 52); this difference was statistically significant (P <.001). The mean percentage reduction of VRR in the diltiazem group was -33.1%. The difference in systolic blood pressure change between the diltiazem and control groups was not statistically significant (P =.17). The diltiazem group had a higher prevalence of achieving VRR reduction to 100 beats/min or less than did the control group (OR 22.6; P <.001), of achieving a VRR reduction of 20% or greater (OR 19.3; P <.001), and of achieving overall therapeutic response (OR 19.3; P <.001). Few changed to sinus rhythm in either group (estimated OR 6.3; P =.15). No patients in the diltiazem group required treatment for hypotension, endotracheal intubation, resuscitation from cardiac arrest, or emergency treatment of unstable dysrhythmias.

CONCLUSION

The effects of diltiazem on RAF can be appreciated within the constraints of the out-of-hospital environment. Diltiazem should be considered as a viable field therapy for rate control of RAF.

Robotic synthesis of 6-[18F]fluoro-L-dopa

The aim of this study was to develop a method of semi-automated 6-[18F]fluoro-L-dopa (6-[18F]FDOPA) synthesis using a robotic system (Scanditronix Anatech RB III, Uppsala, Sweden). [18F]Fluorine was produced via 20Ne(d,alpha)18F using a Scanditronix MC17F cyclotron (Uppsala). The radiosynthesis was performed by the Scanditronix Anatech RB III robotic system. On average, a typical run produced 16-19 mCi of 6-[18F]FDOPA at end of synthesis (EOS) after 2 h irradiation of the F2/neon gas target. The total synthesis time was 110 min. The retention time of 6-[18F]FDOPA (the radio peak) was 8.2 min, which was consistent with the 6-[19F]FDOPA ultraviolet peak. The radiochemical purity was greater than 97%. A robotic, semi-automated method for 6-[18F]FDOPA radiosynthesis is therefore feasible. The radiation burden for the operator can be reduced as much as possible. Sufficient activity of 6-[18F]FDOPA could be obtained for positron emission tomography studies of dopaminergic function.

Early catastrophic failure of rotating hinge total knee prosthesis

The mechanical failure of a prosthesis component is usually observed as a late complication of total knee arthroplasty (TKA). In knees with severe ligament instability and bone deficiency, either a true hinge prosthesis or a rotating hinge implant is commonly used. Failure of the polyethylene bearing bush in a hinge-type prosthesis is a complication that has not been reported to date. We report the cases of 2 rotating hinge TKA prostheses that dislocated as a result of mechanical failure of the prosthetic component within 5 months of initial implantation. Clinicians should be aware of this potential complication when selecting rotating hinge prostheses for certain patients.

[Expression of EGFR and PCNA, and DNA content in squamous cell carcinoma of larynx]

OBJECTIVE

To investigate the expression of epidermal growth factor (EGF), proliferating cell nuclear antigen (PCNA) and DNA index (DI) in laryngeal carcinoma, to analyse the correlation between these index and the biological characteristics of laryngeal carcinoma and their values of clinical prognosis.

METHOD

Immunohistochemical staining was used to detect the expression of EGFR and PCNA in laryngeal cancer and normal tissue, and with MIPS-I image analysis system DNA contents of cancer cell were measured and made out DNA index.

RESULT

The positive rate of EGFR in laryngeal carcinoma was 54.8%, and it was negative in all 10 normal laryngeal mucosa specimens (P < 0.01). The expression of EGFR did not correlate with histological grading and 5-years survival rate (P > 0.05), The positive expression of PCNA and DNA contents in the laryngeal carcinoma were increased with the decrease of tumorous differentiation (P < 0.05). With the increasing of PCNA positive expression and DI, the prognosis of the patients were poorer (P < 0.05).

CONCLUSION

EGFR may be related to the process of carcinogenesis in laryngeal carcinoma and was used as an early biomarker identifying premalignant lesions which had the greatest risk of carcinogenesis. PCNA and DI were simultaneously detected can be used as the prediction of tumor malignancy and prognosis.

The utilization of midazolam as a pharmacologic adjunct to endotracheal intubation by paramedics

OBJECTIVE

Pharmacologic agents have been used in the prehospital setting for facilitating endotracheal intubation (ETI). The purpose of this study was to determine the utility of intravenous midazolam for prehospital patients who require pharmacologic relaxation to facilitate ETI.

METHODS

Data were reviewed retrospectively using paramedic charts from an eight-month period for a three-county state EMS system.

RESULTS

There were 26,133 paramedic dispatches during the study period. Six hundred eighty-three ETIs were attempted, including 72 midazolam-facilitated intubations (MFIs). The most common indications for MFI were "clenched teeth," "gag," and "combativeness." Successful MFI was achieved in 45 of 72 cases (62.5%). Midazolam-facilitated intubation was less successful for trauma patients (41.2%) than for medical patients (69.1 %) (p = 0.04). Of the 58 failed conventional ETIs that occurred during the study period, 25 (43.1%) were identified as having one or more indications for the use of MFI. Although the use of intravenous midazolam was effective in facilitating ETI, a high MFI failure rate (37.5%) was noted.

CONCLUSION

Although it is of limited efficacy, MFI is underutilized and should be considered by medical direction as a pharmacologic adjunct to ETI in selected field patients.

Angiotensin converting enzyme inhibitor-induced angioedema: a report of two cases

Angioedema is a rare but potentially fatal side effect of angiotensin converting enzyme (ACE) inhibitors. We report for the first time, two children with systemic lupus erythematosus who developed acute angioedema after the long-term use of enalapril. Prompt recognition and appropriate management of ACE-induced angioedema prevented life-threatening complications. This report highlights the potential risks of angioedema associated with the use of ACE inhibitors in children. Patients should be advised to seek medical treatment immediately if they experience swelling of the face, neck, or tongue, and especially if they have trouble breathing, speaking, or swallowing.

Subclavian central venous catheterization complicated by guidewire looping and entrapment

The placement of central venous catheters is a technically challenging procedure with known risks and complications. We report an attempted left subclavian central venous catheterization that was complicated by looping and entrapment of the guidewire. We hypothesize that this complication occurred because the straight guidewire that was used may have perforated the wall of the vein, allowing the guidewire to loop upon itself. Although catheter looping and knotting are well known potential complications of central venous catheterization, similar complications are rarely reported with guidewires. Clinicians should be aware of these potential complications when performing or teaching central venous catheterization.

Dislocation of total knee arthroplasty. A report of 6 cases with 2 patterns of instability

We report 6 cases of dislocation of total knee arthroplasty (TKA). We identified 2 patterns of instability in the sagittal plane, one with posterior translation of the tibia, occurring mainly in the postoperative period and usually resulting from a trauma, and the other with anterior translation of the tibia, occurring 6 months to 7 years postoperatively and with no preceding trauma. In the latter group, instability was manifested gradually as a lengthening of the posterior cruciate ligament and the posterior capsule, leading to a recurvatum deformity of the knee.

Angiotensin II stimulates the release of phospholipid-derived second messengers through multiple receptor subtypes in heart cells

The octapeptide angiotensin II (Ang-II) induces both acute functional changes and longer lasting molecular changes in cultured mammalian heart myocytes, yet the underlying molecular mechanisms are poorly understood. In this study, Ang-II was found to stimulate a sustained release (> 30 min) of arachidonic acid (ARA) from cultured neonatal rat cardiac myocytes, with a half-maximal response observed at 0.1 nM. Mass spectroscopy analysis showed that Ang-II stimulated a specific release equivalent to 104 fmol of ARA/micrograms of protein in 10 min. Only Ang-II type 1 (AT1) receptor-specific antagonists were potent inhibitors of hormone-evoked [3H]inositol phosphate accumulation (DuP 753 IC50 approximately 7 nM compared to CGP 42112A IC50 > 1 microM). In contrast, only AT2 receptor-specific antagonists were potent inhibitors of [3H]ARA release (CGP 42112A IC50 approximately 7 nM, EXP 3880 IC50 approximately 2 nM, and PD 123177 IC50 approximately 10 nM). Further studies with phospholipase inhibitors (p-amylcinnamoylanthranilic acid and U73122) revealed that the production of [3H]-inositol phosphates and [3H]ARA occurs through parallel and independent pathways involving phospholipase C and phospholipase A2, respectively. Ang-II also increased the level of lysophosphatidylcholine by 49%, direct evidence that this peptide activated phospholipase A2. Thus, Ang-II stimulates distinct phospholipases in parallel through AT1 and AT2 receptors. These results reveal coordinate signaling roles for multiple Ang-II receptor subtypes in heart.

Olfactory evoked potentials in the rat

Routine clinical assessment of the integrity of the olfactory pathway using olfactory evoked potentials remains an elusive goal. One important difficulty arises from the uncertainty of the exact origin of the potentials: are they produced by olfactory or trigeminal elements? To resolve this problem, an animal model using the rat was developed. Amylacetate was used as an odorant stimulus, and potentials were measured and computer averaged after elimination of trigeminal and vomeronasal activity. A positive-negative wave was recorded from the olfactory bulb surface, and a negative wave often followed by a positive wave was recorded from the surface of the cerebral cortex. Measurements from the scalp surface gave comparable results. Lesioning experiments of the olfactory pathway indicate that the evoked potentials recorded at the vertex originate in the ventral forebrain, specifically in the prepyriform cortex, olfactory tubercle, and anterior olfactory nucleus.