Cause of death during upper tract urothelial carcinoma survivorship: A contemporary, population-based analysis

Background

Very few studies have been published on the causes of death of upper tract urothelial carcinoma (UTUC). We sought to explore the mortality patterns of contemporary UTUC survivors.

Methods

We performed a retrospective cohort study involving patients with upper urinary tract carcinoma from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database (2000 and 2015). We used standardized mortality ratios (SMRs) to compare death rates among patients with UTUC in the general population and excess absolute risks (EARs) to quantify the disease-specific death burden.

Results

A total of 10,179 patients with UTUC, including 7,133 who died, were included in our study. In total, 302 (17.17%) patients with the localized disease died of UTUC; however, patients who died from other causes were 4.8 times more likely to die from UTUC (n = 1,457 [82.83%]). Cardiovascular disease was the most common non-cancer cause of death (n = 393 [22.34% of all deaths]); SMR, 1.22; 95% confidence intervals [CI], 1.1–1.35; EAR, 35.96). A total of 4,046 (69.99%) patients with regional stage died within their follow-up, 1,413 (34.92%) of whom died from UTUC and 1,082 (26.74%) of whom died from non-cancer causes. UTUC was the main cause of death (SMR, 242.48; 95% CI, 230–255.47; EAR, 542.47), followed by non-tumor causes (SMR, 1.18; 95% CI, 1.11–1.25; EAR, 63.74). Most patients (94.94%) with distant stage died within 3 years of initial diagnosis. Although UTUC was the leading cause of death (n = 721 [54.29%]), these patients also had a higher risk of death from non-cancer than the general population (SMR, 2.08; 95% CI, 1.67–2.56; EAR, 288.26).

Conclusions

Non-UTUC deaths accounted for 82.48% of UTUC survivors among those with localized disease. Patients with regional/distant stages were most likely to die of UTUC; however, there is an increased risk of dying from non-cancer causes that cannot be ignored. These data provide the latest and most comprehensive assessment of the causes of death in patients with UTUC.

[Two-dimensional equivalent mechanical modeling and finite element analysis of normal female pelvic floor system]

Objective: To construct the geometric model of the pelvic floor by a two-dimensional equivalent mechanics method, and to explore the effect of the shape and position of pelvic floor organs and tissues on the biomechanical properties of the pelvic floor under different abdominal pressure. Methods: A 28-year-old healthy and symmetrical married infertile female volunteer was included. The pelvic floor tissue was scanned in the supine position using a 3.0T magnetic resonance scanner (Philips Company, Holland). Based on the method of magnetic resonance imaging (MRI) two-dimensional parameter measurement and computer aided design, the geometric model and finite element model of the female pelvic floor were established, and the biomechanical characteristics of the pelvic floor support system under different abdominal pressure were analyzed. Results: In this study, four different working conditions of the pelvic floor force were simulated under 60, 99, 168, and 208 cmH₂O (1 cmH₂O=0.098 kPa) abdominal pressure loads. The trend was as follows: under the abdominal pressure load, the retrograde flexion of the uterus occurred, the cervical, the middle and upper vaginal segment and the levator anus muscle had the characteristic change of mechanical axial direction pointing to the sacrum and coccyx, and the deformation of the levator anus muscle in the horizontal direction was greater than that in the vertical direction. With the increase of the abdominal pressure, the maximum stress values of the pelvic floor whole system of healthy subjects under four different working conditions were 0.194 3, 0.389 6, 0.557 1, and 0.627 5 MPa, respectively, and the maximum displacement values were 10, 14, 21 and 25 mm, respectively. The maximum stress values of the cervical and vaginal middle and upper segment were 0.111 7, 0.161 8, 0.250 6, and 0.304 1 MPa, respectively, and the maximum displacement values were 3, 6, 9, and 11 mm, respectively. The maximum stress of the perineal body was 0.063 4, 0.119 6, 0.235 2, and 0.288 0 MPa, and the maximum displacement was 1, 2, 4, and 5 mm. The maximum stress values of the levator anus muscle were 0.194 3, 0.389 6, 0.557 1, and 0.627 5 MPa, and the maximum displacement values were 2, 4, 7, and 8 mm, respectively. The maximum stress and maximum displacement of pelvic organs increased with the increase of the abdominal pressure under different working conditions. The stress axial relationship of normal female pelvic floor was that the middle and upper segment of uterus and vagina mainly acted on the sacrococcyx and the levator anus muscle, and the lower vaginal segment acts on the perineal body. Conclusions: The two-dimensional equivalent mechanical modeling and finite element analysis of the female pelvic floor system can accurately reflect the biomechanical characteristics of the female pelvic floor, and the resultant stress direction of the pelvic organs points to the sacrum and coccyx. The sacrum and coccyx, levator anus and perineal body play important stress supporting roles in the pelvic floor system.

[A study on measles and rubella antibody level in 319 pairs of mothers and infants in Songjiang District of Shanghai]

Objective: To explore serum levels of measles and rubella IgG antibodies among mothers and infants. Methods: According to the inclusion and exclusion criteria, we selected 319 puerperae and their infants in maternal hospitals of Songjiang district November 2016 to February 2017, venous blood were collected and serum measles and rubella IgG antibodies were measured using ELISA. To study the correlation between the level of measles and rubella antibodies in infants and mothers' by using the Spearman's correlation analysis. Results: The age at delivery was (29.71±4.25) years old; and the gestational age at delivery was (39.06±1.30) weeks. The positive rate and protection rate of measles antibody in puerperae were 82.5% (243/319) and 43.3% (135/319), the GMC [M (QR)] was 655.74 (251.21-1 299.02) mIU/ml. The positive rate of rubella antibody in puerperae was 61.1% (195/319), the GMC [M (QR)] was 31.34 (11.65-73.61) IU/ml. The positive rate and protection rate of measles antibody in infants were 84.1% (270/321) and 46.1% (148/321), the GMC [M (QR)] was 665.07 (279.63-1 544.07) mIU/ml. The positive rate of rubella antibody in infants was 69.5% (223/321), the GMC [M (QR)] was 40.30 (16.12-98.48) IU/ml. There was statistical difference in measles (Z=-14.64, P<0.001) and rubella (Z=-8.66, P<0.001) antibody levels between mothers and infants. There was positive correlation in measles (r=0.76, P<0.001) and rubella (r=0.86, P<0.001) antibody level between mothers and infants. Conclusion: The maternal antibody of measles and rubella had a concentration effect. The level of measles and rubella antibodies in the infants was higher than that in the mothers' and increased with the increase of the level of measles and rubella antibodies in the mothers.

[Association between serum adipocyte fatty acid binding protein level and insulin resistance in patients with OSAS]

Objective: To investigate the association between serum adipocyte fatty acid binding protein (A-FABP) level and insulin resistance in patients with obstructive sleep apnea syndromes (OSAS). Methods: Eighty patients with snoring were monitored by overnight polysomnography (PSG) from September 2015 to July 2017, and there were 59 males and 21 females, aged from 22 to 77 years old (mean age 47±14 years old). Based on the apnea-hypopnea index (AHI), these patients were divided into three groups: primary snoring group (AHI<5/h, n=19), mild-moderate OSAS groups (5/h≤AHI≤30/h, n=23) and severe OSAS groups (AHI>30/h, n=38). The levels of A-FABP, the fasting plasma glucose (FPG), fasting insulin (FINS) and insulin resistance index (IRI) were compared between the primary snoring group and OSAS patients with different severities, and the correlations between serum A-FABP and IRI as well as PSG parameters were further evaluated using partial correlation analysis. Results: Compared with the primary snoring group [(15.6±3.5) μg/L] and mild-moderate group [(17.4±4.3) μg/L], there was a significant increase of the serum A-FABP level in the severe OSAS group [(21.4±4.6) μg/L](P=0.001, P=0.025). Additionally, after adjustment for BMI and age, serum A-FABP level showed significant positive correlations with FINS and IRI (r=0.478, P<0.001; r=0.356, P=0.035); serum A-FABP level was positively correlated with AHI and the arterial oxygen saturation (SaO(2)) < 90% time ratio in night (TS90%) (r=0.251, P=0.041 and r=0.271, P=0.035). Nevertheless, serum A-FABP level showed significant negative correlation with the lowest SaO(2) and the mean SaO(2) (r=-0.244, P=0.038 and r=-0.280, P=0.018). Conclusion: Insulin resistance and the increased level of serum A-FABP are common in OSAS patients, the level of serum A-FABP is significantly correlated with insulin resistance and nocturnal intermittent hypoxia, both of which suggest that A-FABP plays a potential role in insulin resistance in patients with OSAS.

The Relationship between Emergency Response Time and Out-Of-Hospital Cardiac Arrest Prognosis: A Meta-Analysis

Objective

To assess the relationship between emergency response time and prognosis of patients with out-of-hospital cardiac arrest.

Design

Systematic review.

Methods

Relevant observational studies were identified by a search of PubMed and ISI databases to 30 January 2014. Primary outcome was survival to discharge. The weighted mean differences (WMD) for response time were calculated for those survivals to discharge and death in hospital. We also carried out a dose response meta-analysis for assessing summary odds ratio (OR) of survival by response time.

Results

A total of 13 studies with 804,998 patients included in the meta-analysis. The WMD of response time between survivals to discharge group and death in hospital group was 1.976 (95% confidence interval [CI] = 1.161-2.792; p<0.001). Sensitivity analyses by only included prospective cohorts showed the WMD of response time between two groups was 1.115 (95% CI=0.508-1.723; p<0.001). Dose-response relationship between response time and survival to discharge risk was observed statistically significant (χ2=39.86, p<0.001). In linear model, the summary OR was 0.914 (95% CI=0.889-0.940) for every 1 minutes delay in response time. In spline model, the survival OR decreased along with the response time, especially when response time less than 7 minutes.

Conclusions

Emergency response time is an important risk factor for prognosis after OHCA in adults. The EMS team must arrive as soon as possible to the site of the event. (Hong Kong j.emerg.med. 2015;22:345-351)

Bacterial and archaeal assemblages in sediments of a large shallow freshwater lake, Lake Taihu, as revealed by denaturing gradient gel electrophoresis

AIMS

To explore the association of microbial community structure with the development of eutrophication in a large shallow freshwater lake, Lake Taihu.

METHODS AND RESULTS

The bacterial and archaeal assemblages in sediments of different lake areas were analysed using denaturing gradient gel electrophoresis (DGGE) of amplified 16S rDNA fragments. The bacterial DGGE profiles showed that eutrophied sites, grass-bottom areas and relatively clean sites with a eutrophic (albeit dredged) site are three respective clusters. Fifty-one dominant bacterial DGGE bands were detected and 92 corresponding clones were sequenced, most of which were affiliated with bacterial phylotypes commonly found in freshwater ecosystems. Actinobacteria were detected in the centre of the lake and not at eutrophied sites whereas the opposite was found with respect to Verrucomicrobiales. Twenty-five dominant archaeal DGGE bands were detected and 31 corresponding clones were sequenced, most of which were affiliated with freshwater archaeal phylotypes.

CONCLUSIONS

The bacterial community structures in the sediments of different areas with similar water quality and situation tend to be similar in Taihu Lake.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study may expand our knowledge on the relationship between the overall microbial assemblages and the development of eutrophication in the shallow freshwater lake.

Toxicological profile of pollutants in surface water from an area in Taihu Lake, Yangtze Delta

The environment in urbanized areas is often contaminated with a complex mixture of toxic compounds originating from industries, agriculture and private households. Most of the contaminants end up in surface waters, such as lakes, rivers and finally the sea. Toxic contaminants may disturb the biological condition of aquatic ecosystems and be harmful for humans, if they are transported to human food or drinking water. A variety of biological tests have been introduced for monitoring the toxicological profile of aquatic ecosystems. In the present investigation, genotoxic, hormone disrupting and Ah-receptor activity was analyzed in water collected in January 1999 at Meiliang Bay, Taihu Lake, China, near to the city of Wuxi in the Shanghai area. Significant mutagenic activity could be detected in water extracts with the Salmonella/microsome assay and the arabinose resistance test. Frame shift mutations were the predominant mode of action. Ah-receptor active compounds were detected by using a luciferase reporter gene assay (CALUX-assay). The estimated toxic equivalent factor-values ranged between 134 and 232 pg TCCD-equivalents per liter lake water. The estrogen-like potential of Taihu water was estimated with two luciferase reporter gene assays using transgenic human cell lines expressing estrogen receptor alpha. Estradiol equivalents obtained with water extracts were in the range of 2.2-12.1 ng/l. We also analyzed the concentrations of 17-beta-estradiol and ethinylestradiol in the extracts using a high-pressure liquid chromatography-method. The values obtained correlated with the biologically determined estradiol equivalents, indicating that the estrogenic activity is mainly due to natural and synthetic hormones rather than xenoestrogens.

Optic nerve sheath fenestration with a novel wavelength produced by the free electron laser (FEL)

BACKGROUND AND OBJECTIVE

To determine whether 6.45-microm free electron laser (FEL) energy can successfully perform optic nerve sheath fenestration and to compare the acute and chronic cellular responses with this surgery.

STUDY DESIGN/MATERIALS AND METHODS

Optic nerve sheath fenestration was performed in rabbits by using either FEL energy (< 2.5 mJ, 10 Hz, 325-microm spot size) or a knife. The optic nerve integrity and glial response were evaluated histologically acutely or 1 month postoperatively.

RESULTS

The FEL at low energy effectively cut the optic nerve sheaths with minimal reaction in the underlying nerve. With FEL or knife surgical techniques, a mild astrocytic hypertrophy only adjacent to the fenestration was observed acutely in the glial fibrillary acidic protein (GFAP) -immunoreacted sections. The chronic healing responses after either technique appeared similar with: (1) a thin fibrous scar at the fenestration site, (2) cells uniformly distributed (hematoxylin and eosin), and (3) up-regulation of GFAP and S100beta in astrocytes adjacent to the fenestration site.

CONCLUSION

The FEL at low energy performs an optic nerve sheath fenestration in a small space with ease. Both FEL and knife incisions cause a similar rapid glial response near the fenestration site that remains 1 month later.

Hollow-glass waveguide delivery of an infrared free-electron laser for microsurgical applications

The purpose of this research is to deliver free-electron-laser (FEL) pulses for intraocular microsurgery. The FEL at Vanderbilt University is tunable from 1.8 to 10.8 microm. To deliver the FEL beam we used a metallic-coated hollow-glass waveguide of 530-mum inner diameter. A 20-gauge cannula with a miniature CaF2 window shielded the waveguide from water. Open-sky retinotomy was performed on cadaver eyes. The system delivered as much as 6 x 10(5) W of FEL peak power to the intraocular tissues without damage to the waveguide or to the surgical probe.

Preliminary randomized double-blind placebo-controlled trial of tryptophan combined with fluoxetine to treat major depressive disorder: antidepressant and hypnotic effects

OBJECTIVE

Because the initial phase of treatment of depression with a selective serotonin reuptake inhibitor is often complicated by a delayed onset of action of the antidepressant or severe insomnia or both, we investigated whether tryptophan, an amino acid with both antidepressant-augmenting and hypnotic effects, would benefit patients with depression at the beginning of treatment with fluoxetine.

DESIGN

Randomized, double-blind, placebo-controlled trial.

PATIENTS

Thirty individuals with major depressive disorder.

INTERVENTIONS

Treatment over 8 weeks with 20 mg of fluoxetine per day and either tryptophan (2 to 4 g per day) or placebo.

OUTCOME MEASURES

Mood was assessed using the 29-item Hamilton Depression Rating Scale (HDRS-29) and the Beck Depression Inventory (BDI). Laboratory sleep studies were done at baseline and after 4 and 8 weeks of treatment using standard procedures.

RESULTS

During the first week of treatment, there was a significantly greater decrease in HDRS-29 depression scores, and a similar trend in BDI scores, in the tryptophan/fluoxetine group than in the placebo/fluoxetine group. No significant differences were noted at later time points. With respect to sleep measures, there was a significant group-by-time interaction for slow-wave sleep at week 4. Further analysis revealed a significant decrease in slow-wave sleep after 4 weeks of treatment in the placebo/fluoxetine group, but not in the tryptophan/fluoxetine group. No cases of serotonin syndrome occurred, and the combination was well tolerated, although the 4 g per day dosage of tryptophan produced daytime drowsiness.

CONCLUSIONS

Combining 20 mg of fluoxetine with 2 g of tryptophan daily at the outset of treatment for major depressive disorder appears to be a safe protocol that may have both a rapid antidepressant effect and a protective effect on slow-wave sleep. Further large-scale studies are needed to confirm these initial findings.

Endoscopic goniotomy with the free electron laser in congenital glaucoma rabbits

PURPOSE

Goniotomy is a surgical treatment of choice to treat primary infantile glaucoma. Goniotomy has been studied in vitro in animal and human cadaver eyes with several lasers. The objective of this study was to investigate the functional and morphologic effectiveness of goniotomy with the free electron laser in comparison with conventional needle goniotomy in early congenital glaucoma rabbits.

MATERIALS AND METHODS

Ten rabbits with early congenital glaucoma underwent goniotomy over 100 to 120 degrees with a needle or the free electron laser. The wavelength was 6.45 microm, and the energy level ranged from 2.2 to 3.5 mJ at 30 Hz. Because most corneas were edematous in these rabbits, an Olympus 0.8-mm diameter endoscope was coupled to the laser waveguide or the needle and inserted into the anterior chamber filled with a viscoelastic material to perform the goniotomy. Intraocular pressures were followed up to 3 weeks before an acute goniotomy was performed in the contralateral eye. All eye specimens were processed for light microscopic evaluation.

RESULTS

Incision of the pectinate ligaments and underlying trabecular meshwork was visualized through the endoscope on a video monitor during the surgeries. The mean intraocular pressure decreased after free electron laser goniotomy and after needle goniotomy, and the edematous corneas became clear in some cases. Histologic study showed successful lysing of the pectinate ligaments by the free electron laser with no obvious collateral thermal damage. However, some areas of peripheral anterior synechiae occurred. Similar results were observed in needle goniotomy cases.

CONCLUSIONS

The free electron laser is capable of performing goniotomy in rabbit eyes with lower intraocular pressures in treated eyes 3 weeks after surgery. The histologic results of free electron laser goniotomy are comparable to those of conventional goniotomy. The endoscope provides beneficial visualization to perform the goniotomy in eyes with edematous corneas. The rabbit with early congenital glaucoma is also a useful infantile glaucoma surgical model.

Genotoxicity of surface water samples from Meiliang Bay, Taihu Lake, Eastern China

Taihu Lake is the third largest freshwater lake in China. Taihu Basin is one of the most densely populated and urbanized areas in this country. This area provides 15% of the GDP. Meiliang Bay is located in the north part of the Lake. It provides the municipal water source for Wuxi City. Some parts of the lake have been found to be highly polluted due to eutrophication for over a decade. Surface water (0-0.5 m) samples were collected from the Meiliang Bay by the aid of Global Position System (GPS) for positioning. Water samples were concentrated 5000 times with XAD-2 resin columns. A reverse mutation test using histidine-dependent Salmonella typhimurium strains was employed to assay the genotoxicity of the samples. The results showed that the sample from position 6 had the highest genotoxicity either in the case of activating with eucaryotic S9 system or without S9. The genotoxic effect included, at least, two different molecular mechanisms: nucleotide point substitution on DNA molecules and reading frame shifting caused by nucleotide insertion or deletion. The genotoxicity of the water body in Meiliang Bay, Taihu Lake should be kept in close monitoring.

Ablation rate of PMMA and human cornea with a frequency-quintupled Nd:YAG laser (213 nm)

BACKGROUND AND OBJECTIVE

As an alternative to the standard excimer laser used for PRK, we investigated the ablation rate at 213 nm of PMMA, and human corneas under controlled hydration.

STUDY DESIGN/MATERIALS AND METHODS

The output of a frequency-quintupled Nd:YAG laser (213 nm) was transformed into a quasi-Gaussian beam. PMMA and corneal lenticules maintained under controlled hydration were ablated until perforation was detected.

RESULTS

The ablation rate of PMMA and cornea at 213 nm were similar to that at 193 nm when radiant exposure was below 200 mJ/cm2 and increased gradually between one and two times faster than that at 193 nm when radiant exposure was > 200 mJ/ cm2.

CONCLUSIONS

PMMA and cornea ablation at 213 nm are similar to that at 193 nm and are different from that at 248 nm. The difference between PMMA and cornea ablation rates should be considered when using PMMA to test ablated diopter and smoothness for photorefractive surgery.

Maximum likelihood estimation of receiver operating characteristic (ROC) curves from continuously-distributed data

We show that truth-state runs in rank-ordered data constitute a natural categorization of continuously-distributed test results for maximum likelihood (ML) estimation of ROC curves. On this basis, we develop two new algorithms for fitting binormal ROC curves to continuously-distributed data: a true ML algorithm (LABROC4) and a quasi-ML algorithm (LABROC5) that requires substantially less computation with large data sets. Simulation studies indicate that both algorithms produce reliable estimates of the binormal ROC curve parameters a and b, the ROC-area index Az, and the standard errors of those estimates.

Half corneal light shield as a delivery system for standardized application of mitomycin C

PURPOSE

The authors develop a simple and economical method of applying reproducible intraoperative doses of mitomycin C for glaucoma filtering surgery.

METHODS

A three-part protocol was developed to study several properties of half corneal light shields (HCLSs). Part A tested the amount of mitomycin C (0.4 mg/ml) absorbed, the expansion dimensions attained, and the amount released to filter paper. In part B, the in vitro release of mitomycin C to an enucleated pig eye was examined. In part C, the in vivo release during intraoperative filtering surgery was tested.

RESULTS

The amount of mitomycin C solution absorbed by the HCLSs ranged from 1.07 x 10(-2) mg to 1.19 x 10(-2) mg; expansion width ranged from 6.8 mm to 7.0 mm; expansion height ranged from 3.6 mm to 3.8 mm; expansion thickness was constant at 0.6 mm. The amount of solution released to filter paper ranged from 6.8 x 10(-3) mg to 8.6 x 10(-3) mg. The amount of solution transferred to the pig eye ranged from 1.0 x 10(-3) mg to 2.7 x 10(-3) mg. The amount of solution released in filtering surgery ranged from 2.0 x 10(-3) mg to 4.8 x 10(-3) mg.

CONCLUSIONS

The contact surface area, the amount absorbed, and the amount released by each HCLS was reproducible. The uniform thickness theoretically provides a uniform distribution of mitomycin C. This method may allow standardization of intraoperative mitomycin C application, and may reduce the incidence of complications.

Five taccalonolides from Tacca plantaginea

The isolation of five bitter-tasting steroids as minor constituents from the Chinese medicinal plant Tacca plantaginea (Taccaceae), taccalonolides G, H, I, J, and K is described. Their structures were elucidated mainly by spectroscopic methods.

Toxicokinetics of isoprene in rodents and humans

A physiological toxicokinetic model (PT model) was developed for inhaled isoprene in mouse, rat and man. Partition coefficients blood:air and tissue:blood were determined in vitro by a headspace method. Parameters of a saturable isoprene metabolism in B6C3F1 mice, Sprague-Dawley rats and volunteers were obtained from gas uptake experiments in closed systems, analyzed by means of a two-compartment model. Incorporation of these parameters into the PT model revealed that isoprene was metabolized not only in the liver but also in extrahepatic organs. Endogenous production of isoprene in man was quantified from experiments with volunteers breathing into a closed system. The PT model was validated for mice, rats and humans by comparing simulated values with data determined by other authors.

Optical profilometry of poly(methylmethacrylate) surfaces after reshaping with a scanning photorefractive keratectomy (SPRK) system

A prototype frequency-quintupled Nd:YAG laser was used with a scanning system to create, on poly(methylmethacrylate) (PMMA) blocks, ablations corresponding to a correction of 6 diopters of myopia by photorefractive keratectomy. The topography of the ablated samples was measured with an optical profilometer to evaluate the smoothness and accuracy of the ablations. The ablation depth was larger than expected. With a 50% to 70% spot overlap, large valleylike variations with a maximum peak-to-peak amplitude of 20 µm were observed. With an 80% spot overlap, the rms surface roughness was 1.3 µm, and the central flattening was 7 diopters. This study shows that optical profilometry can be used to determine precisely the ablation per pulse and the smoothness and accuracy of surface ablations. Knowing the exact ablation per pulse is necessary to produce a smooth and accurate corneal surface by scanning photorefractive keratectomy.

Development of an algorithm for corneal reshaping with a scanning laser beam

The corneal-ablation rate, the beam-intensity distribution, and the initial and the desired corneal topographies are used to calculate a spatial distribution map of laser pulses. The optimal values of the parameters are determined with a computer model, for a system that produces 213-nm radiation with a Gaussian beam-intensity distribution and a peak radiant exposure of 400 mJ/cm(2). The model shows that with a beam diameter of 0.5 mm, an overlap of 80%, and a 5-mm treatment zone, the roughness is less than 6% of the central ablation depth, the refractive error after correction is less than 0.1 D for corrections of myopia of 1, 3, and 6 D and less than 0.4 D for a correction of myopia of 10 D, and the number of pulses per diopter of correction is 2500 when the beam-intensity distribution is Gaussian and 580 when it is flat.

Laser energy and dye fluorescence transmission through blood in vitro

PURPOSE

Because of the potential usefulness of evaluating and treating choroidal neovascularization obscured by blood, we designed this study to quantify the transmission of dye fluorescence and laser energy through blood.

METHODS

Blood preparations anticoagulated with ethylenediaminetetraacetic acid with hematocrits of 0% (plasma), 46%, and 99% were placed in open cuvettes with path lengths of 100, 200, or 500 microns and were exposed for one minute to either 100% oxygen or 100% carbon dioxide. Each cuvette was then sealed. Photographs of the cuvettes of blood in front of a flask of fluorescein or indocyanine green solution were decoded and used to calculate the percent transmission of fluorescence through blood. Cuvettes of blood were also placed in the path of argon, krypton, and diode lasers for energy transmission measurements.

RESULTS

Plasma transmission of fluorescein and indocyanine green fluorescence and argon, krypton, and diode laser energy was 89% to 100% for all samples tested. Transmission of fluorescein fluorescence and argon laser energy through 99% hematocrit samples were both less than 5%. Transmission of indocyanine green fluorescence through 100-, 200-, and 500-microns-thick cuvettes filled with 99% hematocrit blood was 57%, 34%, and 4%. Transmission of krypton laser energy was 50%, 25%, and 6%; and transmission of diode laser energy was 60%, 35%, and 12% through 99% hematocrit blood. Intermediate transmission values were obtained for 46% hematocrit samples.

CONCLUSIONS

Krypton and, to a slightly greater degree, diode laser energy penetrate a thin film of blood. Indocyanine green fluorescence also penetrates a thin film of blood. If a layer of blood appears thinner than 500 microns, then indocyanine green angiography may be useful in imaging underlying pathologic features. If a lesion can be imaged with indocyanine green, then it can probably be treated with a krypton or diode laser.

Gains in accuracy from replicated readings of diagnostic images: prediction and assessment in terms of ROC analysis

From the perspective of signal detection theory, human variation in image reading degrades diagnostic accuracy by broadening the statistical distributions of perceived evidence upon which decisions were based. A new multivariate "random-effects" model formulates the total variation in a diagnostic decision variable as a sum of three uncorrelated components that represent differences among cases, readers, and repeated readings by a given reader. This model provides a basis for quantitative predictions concerning the amount by which diagnostic accuracy, as specified by ROC analysis, can be enhanced by the replication of image readings. Although these predictions apply exactly only to the hypothetical situation in which normally distributed decision variables from equivalent readers are averaged, computer-simulation studies and an analysis of mammographic image-reading data from five radiologists show that similar gains in accuracy can be achieved by averaging discrete confidence ratings.

Detection of hepatic metastases: comparison of contrast-enhanced CT, unenhanced MR imaging, and iron oxide-enhanced MR imaging

Diagnostic accuracy of contrast-enhanced CT, unenhanced MR imaging, and MR images enhanced with superparamagnetic iron oxide was evaluated in 10 patients with histologically proved hepatic metastases. First, diagnostic performance of the imaging technique with respect to the ability of radiologists to recognize the presence or absence of a metastasis was measured by using receiver-operating-characteristic (ROC) analysis of single images. Second, the total number of lesions (N = 108) detected by "complete" CT and MR examinations was counted. Finally, lesion-liver contrast-to-noise ratios (CNR) were measured in all MR sequences. The area under the ROC curve was .67 +/- .03 for contrast-enhanced CT, .81 +/- .07 for the unenhanced SE 260/14 sequence, and .92 +/- .01 for the iron oxide-enhanced SE 1500/40 sequence. The enhanced SE 1500/40 sequence yielded significantly (p less than .005) greater accuracy than did contrast-enhanced CT. The same sequence detected significantly (p less than .05) more lesions than all other imaging techniques (19% more than the best unenhanced MR sequence and 36% more than contrast-enhanced CT). The enhanced SE 1500/40 sequence also yielded the highest CNR value (19.5 +/- 10.2) of all MR sequences. These results indicate that iron oxide-enhanced MR imaging is a superior imaging technique for the detection of hepatic lesions.

Capability of human blood cells to form the DNA adduct, C8-(N2-aminofluorenyl)-deoxyguanosine-3'-5'-diphosphate from 2-aminofluorene

Human blood cells, separated by Ficoll-Hypaque centrifugation, were tested for their ability to catalyze the formation of DNA adducts of 2-aminofluorene (AF), using the 32P-postlabeling procedure for adduct analysis. Incubation of neutrophils with AF, hydrogen peroxide and exogenous DNA yielded a single DNA adduct identified as C8-(N2-aminofluorenyl)-deoxyguanosine-3'-5'-diphosphate (AFdG) by cochromatography with a standard sample. AFdG levels in intact cells, lysed cells and in the granule fraction prepared from cell lysates were 102, 894 and 240 AFdG adducts/10(9) nucleotides/30 min respectively. AFdG levels corresponded to the activity of neutrophil peroxidase in these preparations. The monocyte/lymphocyte fraction yielded a low amount of 30 and 40 AFdG/10(9) nucleotides/30 min in the presence of hydrogen peroxide and of NADPH respectively. Erythrocytes did not generate a detectable level of AFdG, neither as intact cells nor as cell lysates. Whole blood samples likewise did not generate AFdG. Our findings reveal that, among blood cells, only neutrophils are capable of forming a biologically significant DNA adduct of aminofluorene in reasonable amounts and suggest that myeloperoxidase was the catalyzing enzyme.

Spectrophotometric determination of pyrrole-like substances in urine of rat and man: an assay for the evaluation of 2,5-hexanedione formed from n-hexane

Male Wistar rats exposed to atmospheric n-hexane excreted in their urine substances which gave rise to absorption spectra like those of pyrroles after the reaction with Ehrlich's reagent. A simple spectrophotometric assay was developed to determine these "pyrrole-like substances" in urine. Their excretion kinetics were evaluated by exposing rats for 8 h to atmospheric n-hexane concentrations between 50 and 3000 ppm. The dose-response curve revealed saturation kinetics according to Michaelis-Menten, Vmax being 1.12 [delta E526.ml urine/8 h n-hexane exposure] and "Km", the atmospheric n-hexane concentration at Vmax/2, being 250 ppm. The excretion of pyrrole-like substances closely correlated with that of 2,5-hexanedione measured by Fedtke and Bolt (1987). Pyrrole-like substances were also found in the urine of a male volunteer. When exposing the person for 3 h to atmospheric n-hexane at a concentration of 146 ppm (equivalent to 55 ppm/8 h) the excreted amount was twice the background value. Due to the sensitivity of this assay it is possible to determine pyrrole-like substances in urine according to the present German MAK or US TLV conditions for n-hexane (50 ppm/8 h).

Immunolocalization of renal mineralocorticoid receptors with an antiserum against a peptide deduced from the complementary deoxyribonucleic acid sequence

We have synthesized three peptides corresponding to putative antigenic regions in the immunogenic domain, hinge region, and carboxy-terminus of the protein. A rabbit immunized with a peptide derived from the hinge region of the receptor produced an antiserum which showed 50% displacement with 20 pg peptide at a final serum dilution of 1:35,000. When the antiserum was immunopurified and applied to sections of intact rat and human kidney it stained cells lining segments corresponding to distal tubule, connecting piece, and initial cortical collecting duct, consistent with the known sites of mineralocorticoid action. In both human (formaldehyde-fixed) and rat (Bouin's solution) there was ample evidence for both nuclear and cytoplasmic staining. The thymus, in which previously we have found [3H]aldosterone binding to be below detection limits, showed little or no staining. Western blot analyses demonstrated that the polyclonal antibody recognized an epitope of the expected molecular size. The availability of antibodies to the mineralocorticoid receptor should, thus, facilitate investigation of the steroid specificity-conferring mechanism which allows mineralocorticoids, but not glucocorticoids, access to the nonselective receptor in the kidney.

Contrast enhancement of noisy images by windowing: limitations due to the finite dynamic range of the display system

A theoretical model has been developed to explain the effects of simple linear windowing on the apparent contrasts of signals in displayed digital images. The model predicts, and experimental results demonstrate, that the effective displayed contrast of a digital radiographic signal depends in a complex way upon interactions among the endpoints of the display scale, the signal contrast and noise level of the original data, the window center and display center selected, and the contrast enhancement factor applied. The results obtained from this work apply quantitatively to the highly idealized situation in which (i) a uniform signal is superimposed on a uniform background containing Gaussian pixel-value noise, and (ii) a linear (or exponential) relationship exists between the optical density of a film display (or the light intensity of a luminous display) and pixel value in some finite range. However, the qualitative effects demonstrated here may be expected to arise in a broad variety of situations involving strong digital contrast enhancement.