Retrospective Analysis of Emergency Department Ultrasound for Acute Appendicitis

OBJECTIVES: To determine whether emergency physicians (EPs) who have skills in the other applications of ultrasound can apply these in appendicitis diagnosis. METHODS: EPs did not have focused training in bedside ultrasound for appendicitis. We identified patients receiving an ED bedside ultrasound evaluation for appendicitis from our ultrasound log. Criterion reference was radiology ultrasound (RUS), CT scan, or pathology report. RESULTS: We performed 155 ED ultrasounds for appendicitis. There were 27/155 cases where the ED ultrasound was true positive and agreed with pathology (sensitivity = 39%, 95% CI 28 – 52%). In 42/155 (27%) the ED ultrasound was non-diagnostic (false negative) with pathology positive. In 77 cases the ED ultrasound was true negative with non-visualization of the appendix in concert with non-visualization by RUS or CT scan (specificity = 90%, 95% CI 81-95%). In nine cases (6%), ED ultrasound was falsely positive, compared to CT scan with surgical consult. CONCLUSION: ED ultrasound by EPs prior to focused appendicitis ultrasound training is insufficiently accurate

Clinical Characteristics and Major Adverse Cardiovascular Events in Diabetic and Non-Diabetic Patients with Vasospastic Angina [Response to Letter]

Hiroki Teragawa, Yuko Uchimura, Chikage Oshita, Yu Hashimoto, Shuichi Nomura Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima, JapanCorrespondence: Hiroki Teragawa, Department of Cardiovascular Medicine, JR Hiroshima Hospital, 3-1-36 Futabanosato, Higashi-ku, Hiroshima, 732-0057, Japan, Tel +81 82 262 1171, Fax +81 82 262 1499, Email [email protected]

USO DE TRES MÉTODOS PARA EVALUAR EL MANATI AMAZÓNICO (Trichechus inunguis) EN EL ÁREA DE CONSERVACIÓN REGIONAL TAMSHIYACU TAHUAYO, LORETO, PERÚ

The Amazon manatee (Trichechus inunguis) is endemic to the Amazon Basin, with limited information on population dynamics and currently listed as Vulnerable by the Red List of the International Union for the Conservation of Nature (IUCN). The aim of this study was to compare three methodologies: visual detection (VD), side scan sonar technology (SBL), and surveys to local communities; to detect the presence of the Amazonian manatee and assess the use of these methods for future studies along the species distribution range. The study was carried out within the Tamshiyacu Tahuayo Communal Regional Conservation Areain Iquitos, Peru. The VD resulted in zero sightings at both seasons after a sampling effort of 30 and 29 hours during the rainy and dry seasons respectively. After using the SBL, two individuals were recorded in August, after a total sampling of 103.38 km in the dry season (0.02 ind/km). Surveys to artisanal fishermen in three neighboring communities indicated the presence of manatees and the perception of reduction in sightings within the protected area during 2018 (previous year of this study). We discussed the advantages and disadvantages of each methodology, the logistics associated with its use in complex habitats, and its effectiveness and potential use to detect manatees in future studies in the area.El manatı́ amazónico (Trichechus inunguis) es endémico de la cuenca amazónica, cuenta con una limitada información de dinámica poblacional y actualmente está categorizado como Vulnerable por la Lista Roja de la Unión Internacional para la Conservación de la Naturaleza (UICN). El presente estudio tiene como objetivo comparar tres metodologıá s: registro visual (RV), sonar de barrido lateral (SBL) y encuestas en comunidades locales; para detectar la presencia de la especie y evaluar su aplicación para futuros estudios en su zona de distribución. El estudio fue llevado a cabo dentro del Área de Conservación Regional Comunal Tamshiyacu Tahuayo en Iquitos, Perú. El RV resultó en cero avistamientos en ambas estaciones luego de un esfuerzo de muestreo de 30 y 29 horas en la estación creciente y vaciante respectivamente. Tras el uso del SBL, dos individuos se registraron en agosto, luego de un recorrido total de 103,38 km en la estación vaciante (0,02 ind/km). Las encuestas realizadas a los pescadores artesanales en tres comunidades aledañas indicaron lapresencia de la especie, ası́ como la percepción de una reducción en avistamientos en el área protegida durante el 2018 (año previo a las encuestas).Se discute las ven‑ tajas y desventajas de cada metodología , la logística asociada a su uso en hábitats complejos, y su efectividad y uso potencial para la detección de manatíes en futuros estudios en la zon

Increased expression of integrin-linked kinase is associated with shorter survival in non-small cell lung cancer

BACKGROUND: Integrin-linked kinase (ILK) promotes tumor growth and invasion. Increased ILK expression is correlated with progression of several tumor types, but the expression of ILK has not been investigated in patients with non-small cell lung cancers (NSCLCs). METHODS: We investigated ILK expression in patients with NSCLC by means of immunohistochemistry. RESULTS: ILK expression was significantly associated with tumor grade, T status, lymph node metastasis and stage. (p = 0.0169 for tumor grade; p = 0.0006 for T status; p = 0.0002 for lymph node metastasis; p < 0.0001 for stage). The 5-year survival rates for patients with strong and weak or no ILK expression levels were 20% and 59%, respectively: the difference was statistically significant (p < 0.0001). A multivariate analysis of survival revealed that ILK expression, T status, N status and vascular invasion were statistically significant prognostic factors (p = 0.0218 for ILK; p = 0.0046 for T status; p < 0.0001 for N status; p < 0.0001 for vascular invasion). CONCLUSIONS: Our study demonstrates that increased expression of ILK is a poor prognostic factor in patients with NSCLC

Adult bone marrow stromal cell-based tissue-engineered aggrecan exhibits ultrastructure and nanomechanical properties superior to native cartilage

Objective: To quantify the structural characteristics and nanomechanical properties of aggrecan produced by adult bone marrow stromal cells (BMSCs) in peptide hydrogel scaffolds and compare to aggrecan from adult articular cartilage. Design: Adult equine BMSCs were encapsulated in 3D-peptide hydrogels and cultured for 21 days with TGF-β1 to induce chondrogenic differentiation. BMSC-aggrecan was extracted and compared with aggrecan from age-matched adult equine articular cartilage. Single molecules of aggrecan were visualized by atomic force microcopy-based imaging and aggrecan nanomechanical stiffness was quantified by high resolution force microscopy. Population-averaged measures of aggrecan hydrodynamic size, core protein structures and CS sulfation compositions were determined by size-exclusion chromatography, Western analysis, and fluorescence-assisted carbohydrate electrophoresis (FACE). Results: BMSC-aggrecan was primarily full-length while cartilage-aggrecan had many fragments. Single molecule measurements showed that core protein and GAG chains of BMSC-aggrecan were markedly longer than those of cartilage-aggrecan. Comparing full-length aggrecan of both species, BMSC-aggrecan had longer GAG chains, while the core protein trace lengths were similar. FACE analysis detected a ∼1:1 ratio of chondroitin-4-sulfate to chondroitin-6-sulfate in BMSC-GAG, a phenotype consistent with aggrecan from skeletally-immature cartilage. The nanomechanical stiffness of BMSC-aggrecan was demonstrably greater than that of cartilage-aggrecan at the same total sGAG (fixed charge) density. Conclusions: The higher proportion of full-length monomers, longer GAG chains and greater stiffness of the BMSC-aggrecan makes it biomechanically superior to adult cartilage-aggrecan. Aggrecan stiffness was not solely dependent on fixed charge density, but also on GAG molecular ultrastructure. These results support the use of adult BMSCs for cell-based cartilage repair.National Institutes of Health (U.S.) (NIH grant EB003805)National Institutes of Health (U.S.) (Grant AR33236)National Science Foundation (U.S.) (NSF grant NIRT-0403903)National Science Foundation (U.S.) (CMMI-0758651)National Institutes of Health (U.S.) (NIH Molecular, Cell, and Tissue Biomechanics Training Grant)Massachusetts Institute of Technology (Whitaker Health Science Fund Fellowship

Bcl-2 and β1-integrin predict survival in a tissue microarray of small cell lung cancer.

INTRODUCTION: Survival in small cell lung cancer (SCLC) is limited by the development of chemoresistance. Factors associated with chemoresistance in vitro have been difficult to validate in vivo. Both Bcl-2 and β(1)-integrin have been identified as in vitro chemoresistance factors in SCLC but their importance in patients remains uncertain. Tissue microarrays (TMAs) are useful to validate biomarkers but no large TMA exists for SCLC. We designed an SCLC TMA to study potential biomarkers of prognosis and then used it to clarify the role of both Bcl-2 and β(1)-integrin in SCLC. METHODS: A TMA was constructed consisting of 184 cases of SCLC and stained for expression of Bcl-2 and β(1)-integrin. The slides were scored and the role of the proteins in survival was determined using Cox regression analysis. A meta-analysis of the role of Bcl-2 expression in SCLC prognosis was performed based on published results. RESULTS: Both proteins were expressed at high levels in the SCLC cases. For Bcl-2 (n=140), the hazard ratio for death if the staining was weak in intensity was 0.55 (0.33-0.94, P=0.03) and for β(1)-integrin (n=151) was 0.60 (0.39-0.92, P=0.02). The meta-analysis showed an overall hazard ratio for low expression of Bcl-2 of 0.91(0.74-1.09). CONCLUSIONS: Both Bcl-2 and β(1)-integrin are independent prognostic factors in SCLC in this cohort although further validation is required to confirm their importance. A TMA of SCLC cases is feasible but challenging and an important tool for biomarker validation

The First Result of Global Commissioning of the ATLAS Endcap Muon Trigger System in ATLAS Cavern

We report on the ATLAS commissioning run from the view point of the Thin Gap Chamber (TGC), which is the ATLAS end cap muon trigger detector. All the TGC sectors with on-detector electronics are going to be installed to the ATLAS cavern by the end of September 2007. To integrate all sub-detectors before the physics run starting from early 2008, the global commissioning run together with other sub-detectors has been performed from June 2007. We have evaluated the performance of the complete trigger chain of the TGC electronics and provide the trigger signal using cosmic-ray to the sub-systems in the global run environment

Final Test at the Surface of the ATLAS Endcap Muon Trigger Chamber Electronics

For the detector commissioning planned in 2007, sector assembly of the ATLAS muon-endcap trigger chambers and final test at the surface for the assembled electronics are being done in CERN and almost completed. For the test, we built up the Data Acquisition (DAQ) system using test pulse of two types and cosmic rays in order to check functionality of the various aspects of the electronics mounted on a sector. So far, 99% of all 320,000 channels have been tested and most of them were installed into the ATLAS cavern. In this presentation, we will describe the DAQ systems and mass-test procedure in detail, and report the result of electronics test with some actual experience

A Novel Therapy for Melanoma Developed in Mice: Transformation of Melanoma into Dendritic Cells with Listeria monocytogenes

Listeria monocytogenes is a gram-positive bacteria and human pathogen widely used in cancer immunotherapy because of its capacity to induce a specific cytotoxic T cell response in tumours. This bacterial pathogen strongly induces innate and specific immunity with the potential to overcome tumour induced tolerance and weak immunogenicity. Here, we propose a Listeria based vaccination for melanoma based in its tropism for these tumour cells and its ability to transform in vitro and in vivo melanoma cells into matured and activated dendritic cells with competent microbicidal and antigen processing abilities. This Listeria based vaccination using low doses of the pathogen caused melanoma regression by apoptosis as well as bacterial clearance. Vaccination efficacy is LLO dependent and implies the reduction of LLO-specific CD4+ T cell responses, strong stimulation of innate pro-inflammatory immune cells and a prevalence of LLO-specific CD8+ T cells involved in tumour regression and Listeria elimination. These results support the use of low doses of pathogenic Listeria as safe melanoma therapeutic vaccines that do not require antibiotics for bacterial removal

cGMP-Dependent Protein Kinase I Is Crucial for Angiogenesis and Postnatal Vasculogenesis

Background Endothelium-derived nitric oxide plays an important role for the bone marrow microenvironment. Since several important effects of nitric oxide are mediated by cGMP-dependent pathways, we investigated the role of the cGMP downstream effector cGMP-dependent protein kinase I (cGKI) on postnatal neovascularization. Methodology/Principal Findings In a disc neovascularization model, cGKI -/- mice showed an impaired neovascularization as compared to their wild-type (WT) littermates. Infusion of WT, but not cGKI -/- bone marrow progenitors rescued the impaired ingrowth of new vessels in cGKI-deficient mice. Bone marrow progenitors from cGKI -/- mice showed reduced proliferation and survival rates. In addition, we used cGKI alpha leucine zipper mutant (LZM) mice as model for cGKI deficiency. LZM mice harbor a mutation in the cGKI alpha leucine zipper that prevents interaction with downstream signaling molecules. Consistently, LZM mice exhibited reduced numbers of vasculogenic progenitors and impaired neovascularization following hindlimb ischemia compared to WT mice. Conclusions/Significance Our findings demonstrate that the cGMP-cGKI pathway is critical for postnatal neovascularization and establish a new role for cGKI in vasculogenesis, which is mediated by bone marrow-derived progenitors