Drainage of the hepatic cyst by laparoscopy - clinical case

Liver cysts are formations of serous content surrounded by normal liver parenchyma, without communication with the bile duct. The cyst wall is generally lined with cuboidal epithelium surrounded by layers of connective tissue. They are rare entities in adult patients, generally, they are asymptomatic in 3%, and between 10-15% of all patients will generate symptoms that lead them to consult. A 38-year-old man with an external abdominal tomography study that reported a giant hepatic cyst. Laboratory blood tests: hemoglobin 7.9 g/dl; leukocytosis 11,000/ul; serum electrolytes, liver transaminases, and bilirubin were normal, alkaline phosphatase, and gamma glutamyl-transpeptidase 94 U/l and 241 U/l, respectively. Non-reactive anti-human immuno-deficiency virus (HIV 1) and two antibodies, venereal disease research laboratory (VDRL), cancer antigen (CA) 19-9 antigen, hepatitis B-C surface antigen, and carcinoembryonic antigen were negative. He underwent surgery by laparoscopic drainage of the liver cyst, through a median infraumbilical incision with the Hasson technique and placement of three 12 mm trocars, hepatomegaly was observed without finding an exit site for purulent material, it was punctured through liver segment V, and 2000 ml of citrine fluid was extracted. The hepatic wound is addressed with a 1-0 caliber chromic catgut thread, placing a Penrose-type drain. At 48 hours postoperatively, it evolves favorably, so it is decided to discharge. Hepatic cysts are fluid-filled cavities lined by a single-layered cuboidal or columnar biliary epithelium in the liver. A majority of hepatic cysts are found incidentally on liver imaging, such as abdominal ultrasonography, computed tomography, or magnetic resonance imaging

Raman and infrared spectroscopy of Sr2B′UO6 (B′ = Ni; Co) double perovskites

Temperature dependent normal modes and lattice thermal expansion of Sr 2B′UO6 (B′ = Ni, Co) double perovskites were investigated by Raman/infrared spectroscopies and synchrotron X-ray diffraction, respectively. Monoclinic crystal structures with space group P21/n were confirmed for both compounds, with no clear structural phase transition between 10 and 400 K. As predicted for this structure, the first-order Raman and infrared spectra show a plethora of active modes. In addition, the Raman spectra reveal an enhancement of the integrated area of an oxygen stretching mode, which is also observed in higher-order Raman modes, and an anomalous softening of ∼1 cm-1 upon cooling below T* ∼ 300 K. In contrast, the infrared spectra show conventional temperature dependence. The band profile phonon anomalies are possibly related to an unspecified electronic property of Sr2B′UO6 (B′ = Ni, Co).Centro de Química Inorgánic

Raman and infrared spectroscopy of Sr2B′UO6 (B′ = Ni; Co) double perovskites

Temperature dependent normal modes and lattice thermal expansion of Sr 2B′UO6 (B′ = Ni, Co) double perovskites were investigated by Raman/infrared spectroscopies and synchrotron X-ray diffraction, respectively. Monoclinic crystal structures with space group P21/n were confirmed for both compounds, with no clear structural phase transition between 10 and 400 K. As predicted for this structure, the first-order Raman and infrared spectra show a plethora of active modes. In addition, the Raman spectra reveal an enhancement of the integrated area of an oxygen stretching mode, which is also observed in higher-order Raman modes, and an anomalous softening of ∼1 cm-1 upon cooling below T* ∼ 300 K. In contrast, the infrared spectra show conventional temperature dependence. The band profile phonon anomalies are possibly related to an unspecified electronic property of Sr2B′UO6 (B′ = Ni, Co).Centro de Química Inorgánic

Radiographers supporting radiologists in the interpretation of screening mammography: a viable strategy to meet the shortage in the number of radiologists.

BackgroundAn alternative approach to the traditional model of radiologists interpreting screening mammography is necessary due to the shortage of radiologists to interpret screening mammograms in many countries.MethodsWe evaluated the performance of 15 Mexican radiographers, also known as radiologic technologists, in the interpretation of screening mammography after a 6 months training period in a screening setting. Fifteen radiographers received 6 months standardized training with radiologists in the interpretation of screening mammography using the Breast Imaging Reporting and Data System (BI-RADS) system. A challenging test set of 110 cases developed by the Breast Cancer Surveillance Consortium was used to evaluate their performance. We estimated sensitivity, specificity, false positive rates, likelihood ratio of a positive test (LR+) and the area under the subject-specific Receiver Operating Characteristic (ROC) curve (AUC) for diagnostic accuracy. A mathematical model simulating the consequences in costs and performance of two hypothetical scenarios compared to the status quo in which a radiologist reads all screening mammograms was also performed.ResultsRadiographer's sensitivity was comparable to the sensitivity scores achieved by U.S. radiologists who took the test but their false-positive rate was higher. Median sensitivity was 73.3 % (Interquartile range, IQR: 46.7-86.7 %) and the median false positive rate was 49.5 % (IQR: 34.7-57.9 %). The median LR+ was 1.4 (IQR: 1.3-1.7 %) and the median AUC was 0.6 (IQR: 0.6-0.7). A scenario in which a radiographer reads all mammograms first, and a radiologist reads only those that were difficult for the radiographer, was more cost-effective than a scenario in which either the radiographer or radiologist reads all mammograms.ConclusionsGiven the comparable sensitivity achieved by Mexican radiographers and U.S. radiologists on a test set, screening mammography interpretation by radiographers appears to be a possible adjunct to radiologists in countries with shortages of radiologists. Further studies are required to assess the effectiveness of different training programs in order to obtain acceptable screening accuracy, as well as the best approaches for the use of non-physician readers to interpret screening mammography

Ex vivo drug response profiling detects recurrent sensitivity patterns in drug-resistant acute lymphoblastic leukemia

Drug sensitivity and resistance testing on diagnostic leukemia samples should provide important functional information to guide actionable target and biomarker discovery. We provide proof of concept data by profiling 60 drugs on 68 acute lymphoblastic leukemia (ALL) samples mostly from resistant disease in cocultures of bone marrow stromal cells. Patient-derived xenografts retained the original pattern of mutations found in the matched patient material. Stromal coculture did not prevent leukemia cell cycle activity, but a specific sensitivity profile to cell cycle-related drugs identified samples with higher cell proliferation both in vitro and in vivo as leukemia xenografts. In patients with refractory relapses, individual patterns of marked drug resistance and exceptional responses to new agents of immediate clinical relevance were detected. The BCL2inhibitor venetoclax was highly active below 10 nM in B-cell precursor ALL (BCP-ALL) subsets, including MLL-AF4 and TCF3-HLF ALL, and in some T-cell ALLs (T-ALLs), predicting in vivo activity as a single agent and in combination with dexamethasone and vincristine. Unexpected sensitivity to dasatinib with half maximal inhibitory concentration values below 20 nM was detected in 2 independent T-ALL cohorts, which correlated with similar cytotoxic activity of the SRC inhibitor KX2-391 and inhibition of SRC phosphorylation. A patient with refractory T-ALL was treated with dasatinib on the basis of drug profiling information and achieved a 5-month remission. Thus, drug profiling captures disease-relevant features and unexpected sensitivity to relevant drugs, which warrants further exploration of this functional assay in the context of clinical trials to develop drug repurposing strategies for patients with urgent medical needs.Peer reviewe

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation : Data From ROCKET AF

M. Kaste on työryhmän ROCKET AF Steering Comm jäsen.Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS(2) score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P= 75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, approximate to 7 in 10 deaths were cardiovascular, whereasPeer reviewe