Correlation of diaphragm surgical findings with preoperative CT scans in ovarian cancer

Correlation of diaphragm surgical findings in ovarian cancer patients with and without diaphragm metastases with pre-operative CT diaphragm findings to assess sensitivity and specificity for diaphragm disease. Material and Methods: A retrospective study of 120 ovarian cancer patients (60 with and 60 without diaphragm metastases at surgery), FIGO Stage IIIC or IV, undergoing cytoreductive surgery at Mayo Clinic, Arizona, between January 2000 and October 2014. All patients had preoperative imaging with CT scan of abdomen and pelvis including the lower lung fields. CTs were not reviewed retrospectively. Results: Among 60 patients with diaphragm metastases, preoperative CTs were positive for diaphragm disease in 17 patients, with a sensitivity rate of 28% (CI 95%: 0.17-0.41). All 60 patients with no diaphragm metastases had negative CTs, with a specificity of 100% (CI 95%: 94.0%-100%). When analyzed by lesion size, CTs were negative in 66.7-80% of patients with diaphragm lesions ranging from 1-15 mm. There was a trend towards increased detection rate with increasing size of lesions, but it did not reach significance (p = 0.529). CT detection rate for single metastatic lesion was 18.2% (6/33) and for multiple lesions it was 25.9% (7/27). There was no difference for CT identification of right, left, or bilateral metastases (p = 0.399). The sensitivity and specificity of CT for pleural effusion was 100% (CI 95%: 72.2%-100%) and 88% (CI 95%: 76.2%- 94.4%), respectively. The area under the receiver operating characteristic (ROC) curve was 0.680 (CI 95%: 55.3%-72.2%) for CT detection of diaphragm metastases and 0.957 (CI 95%: 79.9%-95.3%) for pleural effusions. Conclusion: CT has a low sensitivity and a high specificity for the prediction of diaphragm metastases in ovarian cancer. The size, location, and number of diaphragm lesions do not significantly improve CT detection rat

Comparison of vaginal microbiota sampling techniques: Cytobrush versus swab

© 2017 The Author(s). Evidence suggests the vaginal microbiota (VM) may influence risk of persistent Human Papillomavirus (HPV) infection and cervical carcinogenesis. Established cytology biobanks, typically collected with a cytobrush, constitute a unique resource to study such associations longitudinally. It is plausible that compared to rayon swabs; the most commonly used sampling devices, cytobrushes may disrupt biofilms leading to variation in VM composition. Cervico-vaginal samples were collected with cytobrush and rayon swabs from 30 women with high-grade cervical precancer. Quantitative PCR was used to compare bacterial load and Illumina MiSeq sequencing of the V1-V3 regions of the 16S rRNA gene used to compare VM composition. Cytobrushes collected a higher total bacterial load. Relative abundance of bacterial species was highly comparable between sampling devices (R 2 = 0.993). However, in women with a Lactobacillus-depleted, high-diversity VM, significantly less correlation in relative species abundance was observed between devices when compared to those with a Lactobacillus species-dominant VM (p = 0.0049). Cytobrush and swab sampling provide a comparable VM composition. In a small proportion of cases the cytobrush was able to detect underlying high-diversity community structure, not realized with swab sampling. This study highlights the need to consider sampling devices as potential confounders when comparing multiple studies and datasets

Plantar calcaneal spurs in older people: longitudinal traction or vertical compression?

<p>Abstract</p> <p>Background</p> <p>Plantar calcaneal spurs are common, however their pathophysiology is poorly understood. This study aimed to evaluate the prevalence and correlates of plantar calcaneal spurs in a large sample of older people.</p> <p>Methods</p> <p>Weightbearing lateral foot radiographs of 216 people (140 women and 76 men) aged 62 to 94 years (mean age 75.9, <smcaps>SD</smcaps> 6.6) were examined for plantar calcaneal and Achilles tendon spurs. Associations between the presence of spurs and sex, body mass index, radiographic measures of foot posture, self-reported co-morbidities and current or previous heel pain were then explored.</p> <p>Results</p> <p>Of the 216 participants, 119 (55%) had at least one plantar calcaneal spur and 103 (48%) had at least one Achilles tendon spur. Those with plantar calcaneal spurs were more likely to have Achilles tendon spurs (odds ratio [OR] = 2.0, 95% confidence interval [CI] 1.2 to 3.5). Prevalence of spurs did not differ according to sex. Participants with plantar calcaneal spurs were more likely to be obese (OR = 7.9, 95% CI 3.6 to 17.0), report osteoarthritis (OR = 2.6, 95% CI 1.6 to 4.8) and have current or previous heel pain (OR = 4.6, 95% CI 2.3 to 9.4). No relationship was found between the presence of calcaneal spurs and radiographic measures of foot posture.</p> <p>Conclusion</p> <p>Calcaneal spurs are common in older men and women and are related to obesity, osteoarthritis and current or previous heel pain, but are unrelated to radiographic measurements of foot posture. These findings support the theory that plantar calcaneal spurs may be an adaptive response to vertical compression of the heel rather than longitudinal traction at the calcaneal enthesis.</p

Interpol and the Emergence of Global Policing

This chapter examines global policing as it takes shape through the work of Interpol, the International Criminal Police Organization. Global policing emerges in the legal, political and technological amalgam through which transnational police cooperation is carried out, and includes the police practices inflected and made possible by this phenomenon. Interpol’s role is predominantly in the circulation of information, through which it enters into relationships and provides services that affect aspects of governance, from the local to national, regional and global. The chapter describes this assemblage as a noteworthy experiment in developing what McKeon called a frame for common action. Drawing on Interpol publications, news stories, interviews with staff, and fieldwork at the General Secretariat in Lyon, France, the history, institutional structure, and daily practices are described. Three cases are analyzed, concerning Red Notices, national sovereignty, and terrorism, in order to explore some of the problems arising in Interpol’s political and technical operating arrangements. In conclusion, international and global policing are compared schematically, together with Interpol’s attempts to give institutional and procedural direction to the still-evolving form of global policing

Mouse model of carbon tetrachloride induced liver fibrosis: Histopathological changes and expression of CD133 and epidermal growth factor

<p>Abstract</p> <p>Background</p> <p>In the setting of chronic liver injury in humans, epidermal growth factor (EGF) and EGF receptor (EGFR) are up-regulated and have been proposed to have vital roles in both liver regeneration and development of hepatocellular carcinoma (HCC). Chronic liver injury also leads to hepatic stellate cell (HSC) differentiation and a novel subpopulation of HSCs which express CD133 and exhibit properties of progenitor cells has been described in rats. The carbon tetrachloride (CCl₄)-induced mouse model has been historically relied upon to study liver injury and regeneration. We exposed mice to CCl₄to assess whether EGF and CD133+ HSCs are up-regulated in chronically injured liver.</p> <p>Methods</p> <p>CCl₄in olive oil was administered to strain A/J mice three times per week by oral gavage.</p> <p>Results</p> <p>Multiple well-differentiated HCCs were found in all livers after 15 weeks of CCl₄treatment. Notably, HCCs developed within the setting of fibrosis and not cirrhosis. CD133 was dramatically up-regulated after CCl₄treatment, and increased expression of desmin and glial fibrillary acidic protein, representative markers of HSCs, was also observed. EGF expression significantly decreased, contrary to observations in humans, whereas the expression of amphiregulin, another EGFR ligand, was significantly increased.</p> <p>Conclusions</p> <p>Species-specific differences exist with respect to the histopathological and molecular pathogenesis of chronic liver disease. CCl₄-induced chronic liver injury in A/J mice has important differences compared to human cirrhosis leading to HCC.</p

Risk Prediction for Acute Kidney Injury in Acute Medical Admissions in the UK

Background Acute Kidney Injury (AKI) is associated with adverse outcomes; identifying patients who are at risk of developing AKI in hospital may lead to targeted prevention. This approach is advocated in national guidelines but is not well studied in acutely unwell medical patients. We therefore aimed to undertake a UK-wide study in acute medical units (AMUs) with the following aims: to define the proportion of acutely unwell medical patients who develop hospital-acquired AKI (hAKI); to determine risk factors associated with the development of hAKI; and to assess the feasibility of using these risk factors to develop an AKI risk prediction score. Methods In September 2016, a prospective multicentre cohort study across 72 UK AMUs was undertaken. Data were collected from all patients who presented over a 24-hour period. Chronic dialysis, community-acquired AKI (cAKI) and those with fewer than two creatinine measurements were subsequently excluded. The primary outcome was the development of h-AKI. Results 2,446 individuals were admitted to the AMUs of the 72 participating centres. 384 patients (16%) sustained AKI of whom 287 (75%) were cAKI and 97 (25%) were hAKI. After exclusions, 1,235 participants remained in whom chronic kidney disease (OR 3.08, 95% CI 1.96-4.83), diuretic prescription (OR 2.33, 95% CI 1.5-3.65), a lower haemoglobin concentration and an elevated serum bilirubin were independently associated with development of hAKI. Multivariable model discrimination was moderate (c-statistic 0.75), and this did not support the development of a robust clinical risk prediction score. Mortality was higher in those with hAKI (adjusted OR 5.22; 95% CI 2.23-12.20). Conclusion AKI in AMUs is common and associated with worse outcomes, with the majority of cases community acquired. The smaller proportion of hAKI cases, only moderate discrimination of prognostic risk factor modelling and the resource implications of widespread application of an AKI clinical risk score across all AMU admissions suggests that this approach is not currently justified. More targeted risk assessment or automated methods of calculating individual risk may be more appropriate alternatives