Risk for surgical complications after previous stereotactic body radiotherapy of the spine

OBJECT

Stereotactic body radiotherapy (SBRT) for vertebral metastases has emerged as a promising technique, offering high rates of symptom relief and local control combined with low risk of toxicity. Nonetheless, local failure or vertebral instability may occur after spine SBRT, generating the need for subsequent surgery in the irradiated region. This study evaluated whether there is an increased incidence of surgical complications in patients previously treated with SBRT at the index level.

METHODS

Based upon a retrospective international database of 704 cases treated with SBRT for vertebral metastases, 30 patients treated at 6 different institutions were identified who underwent surgery in a region previously treated with SBRT.

RESULTS

Thirty patients, median age 59 years (range 27-84 years) underwent SBRT for 32 vertebral metastases followed by surgery at the same vertebra. Median follow-up time from SBRT was 17 months. In 17 cases, conventional radiotherapy had been delivered prior to SBRT at a median dose of 30 Gy in median 10 fractions. SBRT was administered with a median prescription dose of 19.3 Gy (range 15-65 Gy) delivered in median 1 fraction (range 1-17) (median EQD2/10 = 44 Gy). The median time interval between SBRT and surgical salvage therapy was 6 months (range 1-39 months). Reasons for subsequent surgery were pain (n = 28), neurological deterioration (n = 15) or fracture of the vertebral body (n = 13). Open surgical decompression (n = 24) and/or stabilization (n = 18) were most frequently performed; Five patients (6 vertebrae) were treated without complications with vertebroplasty only. Increased fibrosis complicating the surgical procedure was explicitly stated in one surgical report. Two durotomies occurred which were closed during the operation, associated with a neurological deficit in one patient. Median blood loss was 500 ml, but five patients had a blood loss of more than 1 l during the procedure. Delayed wound healing was reported in two cases. One patient died within 30 days of the operation.

CONCLUSION

In this series of surgical interventions following spine SBRT, the overall complication rate was 19%, which appears comparable to primary surgery without previous SBRT. Prior spine SBRT does not appear to significantly increase the risk of intra- and post-surgical complications.

Treatment of swine wastewater using MLE process and membrane bio-reactor

The aim of this study was to develop the optimum integrated treatment system for slurry type swine wastewater through field testing. Although composting and liquid composting are the most desirable processes to treat swine wastewater, inadequate composting has been blamed as critical non-point source pollutants. In the area with limited crop land and grass land, the most feasible method to handle slurry type swine wastewater would be that the solids portion from the solids/liquid separation process is treated by composting and then the liquid portion is treated by a series of wastewater treatment processes, including physicochemical treatment system and biological nutrient removal systems such as the modified Ludzack Ettinger (MLE) process and MLE process coupled with a membrane, to satisfy the different effluent criteria. When using the appropriate solids/liquid separation system, the removal efficiency of SS, COD(Cr), and TKN was 92.4%, 73.6%, and 46.0%, respectively and the amount of bulking agent required for composting and organic loading rate for the following wastewater treatment system can be reduced by 94.8% and 84.7%, respectively. When treating the effluent from solids/liquid separation process by MLE process, the optimal volume fraction for denitrification was 20% of total reactor volume and the optimum ratio of F/M and F(N)/M were increased with increase of C/N ratio. Since the effluent quality of MLE process is not enough to discharge, the DAF process was operated with addition of FeCl3 and cationic polyelectrolyte. The effluent from the DAF process was treated in the MLE process coupled with a crossflow ultrafiltration membrane to satisfy more stringent effluent criteria. When external carbon source is added to keep 6.0 of C/N ratio, the efficiency of denitrification is best. The optimum linear velocity and transmembrane pressure for MBR process was 1.8 m/sec and 2.1 atm, respectively. By addition of external carbon source, nitrogen compounds, especially NOx-N, were considerably removed. And by addition of powdered activated carbon, the removal efficiency of COD(Cr) and COD(Mn) and the membrane flux were increased dramatically.

Light and electron microscopic observations of Leptotheca koreana n. sp. (Myxosporea) in the kidney of cultured rockfish Sebastes schlegeli

The structure and sporogenesis of Leptotheca koreana n. sp. from cultured rockfish Sebastes schlegeli from South Korea were studied by light and transmission electron microscopy. Broadly oval spores and disporous pseudoplasmodia were observed in the lumen of renal tubules. Spores were 8.59 +/- 1.25 microm in length, 13.42 +/- 1.0 microm in width in sutural view and 8.13 +/- 0.52 pm in thickness in the plane perpendicular to the suture. The width of each valve was always smaller than spore length. Two spherical polar capsules were equal in size (3.86 +/- 0.45 microm in diameter) containing a polar filament with 6 to 7 turns, opening at the anterior end of the spore. Two uninucleate sporoplasms filled the spore cavity. The asynchronous division of secondary and tertiary cells and asynchronous development in spore formation of the present Leptotheca koreana resembled the disporous sphaerosporids. Cytoplasmic projections of pseudoplamodia were considered to be rhizoids, as they seem to strengthen the attachment to the epithelial cells of the renal tubules. The capsulogenic cells in early sporoblast had large amounts of rough endoplasmic reticulum but had a few Golgi apparatus.

Treatment of Microcotyle sebastis infestation in cultured rockfish Sebastes schlegeli by oral administration of praziquantel in combination with cimetidine

The effect of cimetidine on the treatment efficacy of praziquantel against Microcotyle sebastis infestation in cultured rockfish Sebastes schlegeli was investigated. Juvenile rockfish were divided into 7 groups, and orally administered praziquantel alone (50, 100 and 200 mg kg(-1) body wt, BW) or in combination with cimetidine at a dose of 200 mg kg(-1) BW for each praziquantel dose. The fish in the control group were administered only saline. The results clearly showed that coadministration of cimetidine with praziquantel led to a significantly increased treatment efficacy of the latter drug, and consequently would lead to a lowering of the total dose of praziquantel, and a reduction in the administration times and costs for the treatment of M. sebastis infestation in cultured rockfish.

Treatment of Microcotyle sebastis (Monogenea: Polyopisthocotylea) infestation with praziquantel in an experimental cage simulating commercial rockfish Sebastes schlegeli culture conditions

The antiparasitic efficacy of praziquantel against the blood-sucking polyopisthocotylean Microcotyle sebastis was tested in an experimental cage simulating commercial rockfish-culture conditions. Juvenile rockfish Sebastes schlegeli were separated into 4 pilot net-pens, and the fish in the groups were either fed a control diet (Group C), fed a praziquantel-adsorbed diet (Group F), bathed in 100 ppm praziquantel for 4 min (Group B), or bathed in 100 ppm praziquantel for 4 min and then fed a praziquantel-adsorbed diet (Group BF). The results of the present study indicate that feeding a praziquantel-adsorbed diet significantly reduces the abundance of M. sebastis infestation, and bathing in 100 ppm praziquantel for 4 min is effective for controlling M. sebastis infestation in practical rockfish culture systems.

Immunization of cultured juvenile rockfish Sebastes schlegeli against Microcotyle sebastis (Monogenea)

To determine whether immunization with Microcotyle sebastis antigen could induce protection against the parasite's establishment, naive juvenile rockfish were immunized by injection or immersion with whole worm antigen of M. sebastis. The infestation intensities of immunized groups following a challenge (2 wk after boosting) with 5000 M. sebastis eyed-eggs were significantly lower than those of control groups, when determined 7 wk postinfection. The fish in the groups boosted with M. sebastis antigen showed stronger protection than unboosted groups. The control group injected with FCA only showed a significantly smaller number of worms than the control group, which was immersed in PBS containing seawater. The results strongly suggest that both specific and nonspecific immune factors participate in the protection of rockfish against M. sebastis establishment.

Determination of amphetamine, methamphetamine and dimethamphetamine in human urine by solid-phase microextraction (SPME)-gas chromatography/mass spectrometry

A simple and rapid assay method for three stimulant drugs (amphetamine, methamphetamine, and dimethamphetamine) in human urine using solid-phase microextraction was developed. In solid-phase microextraction, the drugs were equilibrated between the adsorbent coated-fiber and aqueous sample matrix. After adsorption of the analytes, the fiber was directly transferred to the injector of a gas chromatograph, where the analytes were thermally desorbed and subsequently separated by the gas chromatograph and detected by mass spectrometer. The solid-phase microextraction method, which did not require solvents, was found to be a fast and simple analytical method. We optimized the solid-phase microextraction technique, for factors such as the NaCl salt effect (30%), pH effect (pH=12.4), equilibration time (30 min), desorption time (1 min) and coated-fiber type (100 microm poly(dimethylsiloxane)) and detected the stimulants in human urine, obtained from human subjects. The detection limits of each drug were below 1-10 ng/ml. The developed method can be applied to the abused drug test.

Neoplagioporus zacconis (Trematoda: Opecoelidae) from the intestine of the pale chub, Zacco platypus, in Korea

Neoplagioporus zacconis (Yamaguti, 1934) (Trematoda: Opecoelidae) was found from the intestine of the pale chub, Zacco platypus, for the first time in Korea. The worms were characterized morphologically by oval body shape, bipartited seminal vesicle, sinistrally located genital pore, and lobed ovary, and distinguished from the two other species of Neoplagioporous by body shape and distribution of vitelline follicles. The morphological characteristics, except the ovary, well corresponded to those of the previous descriptions. The morphological difference of the ovary was considered as a character of geographical phenotypic variation.