Effect of Contrast-Enhanced Echocardiograms on the Prognosis of Infective Endocarditis

Objective - Infective endocarditis (IE) is an infectious disease of the cardiac valves where bacteria colonize the valves; typically, via the formation of vegetations. Recent research has shown that the microbubbles in a contrast-enhanced ultrasound (CEUS) examination can move and dislodge bacterial vegetations in vitro. This study investigated whether CEUS resulted in faster resolution of IE in vivo by dislodging the vegetations. Methods - This IRB approved retrospective study reviewed 36 patients who were diagnosed with IE via echocardiography. Data was sourced from patients within the Jefferson University Hospital’s Cardiology EMR system by searching for contrast and vegetation from January 1st, 2013 – January 1st, 2018. Fifteen patients were not given contrast, whereas 21 patients were given contrast via agitated saline (n=16) or an ultrasound contrast agent (n=5). All patients received an echocardiogram after blood cultures confirmed an infection, but before resolution of infection (defined by negative blood cultures). A student’s t-test was used for analyses. Results - The study population was heterogeneous in terms of sex (67.5% male) and race (70% Caucasian, 25% African American, and 5% Asian), with an average age of 51±20 years, and an average BMI of 29.65±7.43 in the contrast group and 27.67±3.16 in the non-contrast group (p=0.37). Following ultrasound, no patients had documented stroke, pulmonary embolism, or systemic blood clot, which physicians could have attributed to a thrombus resulting from dislodging of bacterial vegetation. Overall, blood cultures did not clear faster in patients receiving CEUS compared to those undergoing standard echocardiography, (2.63±2.69 days vs. 1.34 ±1.11 days, p=0.09). CEUS also did not shorten the admission length in patients with IE, (16.9±7.7 days vs. 19.9±12.1 days; p=0.36). Conclusion - Based on this limited sample size, patients who underwent CEUS did not have a different prognosis when compared to patients who received a non-contrast echocardiogram

New approaches for estimating risk from exposure to diethylstilbestrol.

A subgroup from a National Institute of Environmental Health Sciences, workshop concerned with characterizing the effects of endocrine disruptors on human health at environmental exposure levels considered the question, If diethylstilbestrol (DES) were introduced into the market for human use today and likely to result in low-dose exposure of the human fetus, what would be required to assess risk? On the basis of an analysis of the quality of data on human DES exposure, the critical times and doses for inducing genital tract malformations and cancer must be determined. This would be facilitated through analysis of the ontogeny of estrogen receptor expression in the developing human genital tract. Models of low-dose estrogenic effects will have to be developed for human and rodent genital tract development. Mouse models offer many advantages over other potential animal models because of the wealth of the earlier literature, the availability of sensitive end points, the availability of mutant lines, and the possibility of generating genetically engineered model systems. Through multidisciplinary approaches, it should be possible to elucidate the cellular and molecular mechanisms of endocrine disruption elicited by estrogens during development and facilitate an assessment of risk to humans

Evaluation of Hepatocellular Carcinoma Transarterial Chemoembolization using Quantitative Analysis of 2D and 3D Real-time Contrast Enhanced Ultrasound.

Quantitative 2D and 3D contrast-enhanced ultrasound (CEUS) was assessed to evaluate early transarterial chemoembolization (TACE) treatment response. Seventeen patients scheduled for TACE for the treatment of hepatocellular carcinoma participated in the study. 2D and 3D CEUS were performed for each patient at three time points: Prior to TACE, 1-2 weeks post TACE, and 1 month post TACE. Peak-intensities of the tumor and surrounding liver tissue were calculated from 2D and 3D data before and after TACE and used to evaluate tumor treatment response. Residual tumor percentages were calculated from 2D and 3D CEUS acquired 1-2 weeks and 1 month post TACE and compared with results from MRI 1 month post TACE. Nine subjects had complete response while 8 had incomplete response. Peak-intensities of the tumor from 3D CEUS prior to TACE were similar between the complete and incomplete treatment groups (p = 0.70), while 1-2 weeks (p \u3c 0.01) and 1 month post treatment (p \u3c 0.01) were significantly lower in the complete treatment group than in the incomplete treatment group. For 2D CEUS, only the peak-intensity values of the tumor from 1 month post TACE were significantly different (p \u3c 0.01). The correlation coefficients between 2D and 3D residual tumor estimates 1-2 weeks post TACE and the estimates from MRI were 0.73 and 0.94, respectively, while those from 2D and 3D CEUS 1 month post TACE were 0.66 and 0.91, respectively. Quantitative analysis on 2D and 3D CEUS shows potential to differentiate patients with complete versus incomplete response to TACE as early as 1-2 weeks post treatment

Diffusion of particles in an expanding sphere with an absorbing boundary

We study the problem of particles undergoing Brownian motion in an expanding sphere whose surface is an absorbing boundary for the particles. The problem is akin to that of the diffusion of impurities in a grain of polycrystalline material undergoing grain growth. We solve the time dependent diffusion equation for particles in a d-dimensional expanding sphere to obtain the particle density function (function of space and time). The survival rate or the total number of particles per unit volume as a function of time is evaluated. We have obtained particular solutions exactly for the case where d=3 and a parabolic growth of the sphere. Asymptotic solutions for the particle density when the sphere growth rate is small relative to particle diffusivity and vice versa are derived.Comment: 12 pages. To appear in J. Phys. A: Math. Theor. 41 (2008

Antigone’s Diary– A Model for Democratic Decision Making in Suburban Stockholm

”Antigone has disappeared, but we found her diary. Join us in the search of her traces.” Sophocles’ drama has been transferred to a suburb of Stockholm. Students in a local highschool have recreated the classical tale in their own environment, guided by director Rebecca Forsberg from the RATS Theatre. RATS stands for “Research in Artistic TechnologieS”, a section of the Department of Computer and System Science at Stockholm University. Cellular phones are not prohibited in this theatrical enterprise, on the contrary, they constitute the particular means of communication in this event. Whether you download an app into your own phone or lend a phone from the organizers – what you will hear are the fragments of Antigone’s diary. You will find sculptures, parks, kiosks and other places through the GPS and every time you come close to the next site of performance, your phone knows when you are there. And every time you leave the place, Antigone will ask you a question: “What makes you angry?” – “When can one break the rules?” Etc. You can answer the questions by means of text messages and once you have done so, you can see what other participants have answered before you. How does it end? Haimon, Antigone’s friend and lover, whispers into your ear: “What does freedom mean to you?” It is up to us, the participants, to find appropriate responses to this eternal question. This theatrical event, highly technified and reversing the relationship between agents and beholders, gives rise to a number of intricate questions. The problems at stake concern the creative process of this mobile drama, the technical challenges to make it work, the theoretical implications of this multimedia performance, and, finally, the outcome in terms of civic engagement and its potentials of public decision making.</p

Contrast-enhanced ultrasound identifies early extrahepatic collateral contributing to residual hepatocellular tumor viability after transarterial chemoembolization.

The mainstay of treatment for unresectable hepatocellular carcinoma is locoregional therapy including percutaneous ablation and transarterial chemo- and radioembolization. While monitoring for tumor response after transarterial chemoembolization is crucial, current imaging strategies are suboptimal. The standard of care is contrast-enhanced magnetic resonance imaging or computed tomography imaging performed at least 4 to 6 weeks after therapy. We present a case in which contrast-enhanced ultrasound identified a specific extra-hepatic collateral from the gastroduodenal artery supplying residual viable tumor and assisting with directed transarterial management

Harmonic generation of gravitational wave induced Alfven waves

Here we consider the nonlinear evolution of Alfven waves that have been excited by gravitational waves from merging binary pulsars. We derive a wave equation for strongly nonlinear and dispersive Alfven waves. Due to the weak dispersion of the Alfven waves, significant wave steepening can occur, which in turn implies strong harmonic generation. We find that the harmonic generation is saturated due to dispersive effects, and use this to estimate the resulting spectrum. Finally we discuss the possibility of observing the above process.Comment: 7 page