Severe Takayasu's arteritis of the pulmonary arteries: Report of a case with successful surgical treatment

Although involvement of the aorta and its large branches is more common, Takayasu's arteritis involving the pulmonary arteries is well recognized. This report describes an adolescent girl with an uncommonly severe form ofTakayasu's arteritis involving the pulmonary arteries. A successful surgical treatment is presented

Reviews

The following publications have been reviewed by the mentioned authors;Design: Science: Method by R. Jacques and J. A. Powell, reviewed by Sydney GregoryAfrican Textiles and Dyeing Techniques by Claire Polakoff, reviewed by Dorothea KayThe Complete Calligrapher by Fredrick Wong, reviewed by John LancasterSacred Calligraphy of the East by John Stevens, reviewed by John LancasterSchool Crafts - A Folio of Ideas by the Educational Insitutte of Design, Craft and Technology, reviewed by J. W. ThompsonDesign Briefs by the Educational Insitutte of Design, Craft and Technology, reviewed by J. W. ThompsonA Further Portfolio of Ideas by the Educational Insitutte of Design, Craft and Technology, reviewed by J. W. ThompsonThe Medieval Monastery, Five Shropshire Monasteries by the Department of Education, University of Keele, reviewed by Nigel HallProjects and Designs in Metalwork by Ian Punter, reviewed by Ray BlandColor Science for Lighting the Stage by W. B. Warfel and W. R. Klappert, reviewed by A. VargoScottish Technical Education Modules reviewed by John Cav

Gamma Knife Radiosurgery for Arteriovenous Malformations Using a Four- Dimensional Dynamic Volume Computed Tomography Angiography Planning System as an Alternative to Traditional Catheter Angiogram

Background Gamma knife radiosurgery (GKRS) remains a critical intervention in the long-term management of arteriovenous malformations (AVMs). For planning a treatment, identification of the nidus is essential, and it is dependent on high-resolution blood flow imaging, usually in the form of a traditional angiogram. The development of dynamic 320-slice computed tomography (CT) angiography has offered a noninvasive alternative to intra-arterial fluoroscopic imaging, and it is capable of providing equivalent temporal resolution. In this study, we describe the feasibility of using four-dimensional CT angiography (4D-CTA) in GKRS planning for AVM treatment and a comparative analysis with a traditional angiogram. Methods A retrospective review was performed on AVM patients treated via GKRS with a 4D-CTA prior to the day of treatment, on the day of treatment, or with a day-of-treatment angiogram. Treatment times, along with total times in the Leksell® coordinate frame G, were obtained from the medical records. The frame-on time was calculated by subtracting the treatment time from the total time starting from application to removal, and the statistical analysis was performed across groups using analysis of variance (ANOVA). All treatments were performed on the Perfexion™ model with a dynamic flow imaging procured via a 320-slice CT scanner or traditional angiography platform. Results Some 27 patients underwent a total of 29 GKRS procedures for AVM treatment at our institution between September 2011 and January 2017. Mean age at the time of treatment was 35.5 (6-65) years, and male:female ratio was 5:4. Some 12 patients had 4D-CTA performed prior to the day of treatment, eight patients had the same CTA completed after frame placement on the day of treatment, while seven patients underwent traditional angiography. The mean frame-on times of each group were 190, 336, and 426 minutes, respectively (p \u3c 0.0001). No procedures were aborted based on the image quality. Conclusions 4D-CTA is an effective tool in identifying the AVM nidus for GKRS planning. These studies can be performed prior to the day of treatment, allowing for a significant reduction in frame-on time and eliminating the risk of angiogram complication on the day of GKRS

Efficacy of Stereotactic Radiosurgery in Patients with Multiple Metastases: Importance of Volume Rather Than Number of Lesions

The role of stereotactic radiosurgery (SRS) in the treatment of multiple brain metastases is controversial. While whole brain radiation therapy (WBRT) has historically been the mainstay of treatment, its value is increasingly being questioned as emerging data supports that SRS alone can provide comparable therapeutic outcomes for limited (one to three) intracranial metastases with fewer adverse effects, including neurocognitive decline. Multiple recent studies have also demonstrated that patients with multiple (\u3e 3) intracranial metastases with a low overall tumor volume have a favorable therapeutic response to SRS, with no significant difference compared to patients with limited metastases. Herein, we present a patient with previously controlled breast cancer who presented with multiple recurrences of intracranial metastases but low total intracranial tumor volume each time. This patient underwent SRS alone for a total of 40 metastatic lesions over three separate procedures with good local control and without any significant cognitive toxicity. The patient eventually opted for enrollment in the NRG-CC001 clinical trial after multiple cranial recurrences. She received conventional WBRT with six months of memantine and developed significant neurocognitive side effects. This case highlights the growing body of literature supporting the role of SRS alone in the management of multiple brain metastases and the importance of maximizing neurocognition as advances in systemic therapies prolong survival in Stage IV cancer

LADEE UVS (UltraViolet Visible Spectrometer) and the Search for Lunar Exospheric Dust: A Detailed Spectral Analysis

The Lunar Atmosphere and Dust Environment Explorer (LADEE) executed science observations in lunar orbit spanning 2013-Oct-16- 2014-04-18 UT. LADEE's Ultraviolet/Visible Spectrometer (UVS) studies the composition and temporal variations of the tenuous lunar exosphere and dust environment, utilizing two sets of optics: a limb-viewing telescope, and a solar-viewer. The limb-viewing telescope observes illuminated dust and emitting gas species while the Sun is just behind the lunar limb. The solar viewer, with its diffuser, allows UVS to also stare directly at the solar disk as it approaches the limb, sampling progressively lower exosphere altitudes. Solar viewer "Occultation" activities occur at the lunar sunrise limb, as the LADEE spacecraft passes into the lunar night side, facing the Sun (the spacecraft orbit is near-equatorial retrograde). A loss of transmission of sunlight occurs by the occultation of dust grains along the line-of-sight. So-called "Inertial Limb" activities have the limb-viewing telescope pointed at the lit exosphere just after the Sun has set. Inertial Limb activities follow a similar progression of diminishing sampling altitudes but hold the solar elongation angle constant so the zodiacal light contribution remains constant while seeking to observe the weak lunar horizon glow. On the dark side of the moon, "Sodium Tail" activities pointed the limb-viewing telescope in the direction of the Moon's sodium tail (similar to anti-sunward), during different lunar phases. Of the UVS data sets, these show the largest excess of scattered blue light, indicative of the presence of small (approximately 100 nm) dust grains in the tail. Correlations are sought between dust in the sodium tail and meteor streams and magnetotail crossings to investigate impact- versus electrostatic-lofting. Once lofted, nanoparticles can become charged and picked up by the solar wind. The LADEE UVS Occultation, Inertial Limb, and Sodium Tail spectral datasets provide evidence of a lunar dust exosphere

Interactions Between Zooplankton and Karenia brevis in the Gulf of Mexico.

Blooms of the toxic dinoflagellate K. brevis are common in the Gulf of Mexico, yet no in situ studies of the interactions between zooplankton and K. brevis in the Gulf of Mexico have been conducted. Zooplankton numerical abundance, biomass and taxonomic composition of nonbloom and K. brevis bloom stations within the ECOHAB study area were compared. At nonbloom stations, the most important determinant species were Parvolcalanus crassirostris, Oithona colcarva and Paracalanus quasimodo at the 5-m isobath and P. quasimodo, O. colcarva and Oikopleura dioka at the 25-m isobath. There was considerable overlap between the 5 and 25-m isobaths, with 9 species contributing to the top 90% of numerical abundance at both isobaths. Within K. brevis blooms Acartia tonsa, Centropages velificatus, Temora turbinata, Evadne tergestina, O. colcarva, O. dioika, and P. crassirostris were consistently dominant. Variations between non-bloom and bloom assemblages were evident, including variations in numerical abundance and biomass and the reduction in numerical abundance of 3 key species. Calculated grazing pressure proved insufficient to terminate K. brevis blooms, despite occasional grazing hot spots

Stakeholder Theory and Marketing: Moving from a Firm-Centric to a Societal Perspective

This essay is inspired by the ideas and research examined in the special section on “Stakeholder Marketing” of the Journal of Public Policy & Marketing in 2010. The authors argue that stakeholder marketing is slowly coalescing with the broader thinking that has occurred in the stakeholder management and ethics literature streams during the past quarter century. However, the predominant view of stakeholders that many marketers advocate is still primarily pragmatic and company centric. The position advanced herein is that stronger forms of stakeholder marketing that reflect more normative, macro/societal, and network-focused orientations are necessary. The authors briefly explain and justify these characteristics in the context of the growing “prosociety” and “proenvironment” perspectives—orientations that are also in keeping with the public policy focus of this journal. Under the “hard form” of stakeholder theory, which the authors endorse, marketing managers must realize that serving stakeholders sometimes requires sacrificing maximum profits to mitigate outcomes that would inflict major damage on other stakeholders, especially society

A multicenter, prospective, randomized comparison of a novel signal transmission capsule endoscope to an existing capsule endoscope.

BACKGROUND: MiroCam, a capsule endoscope, uses a novel transmission technology, electric-field propagation, which uses the human body as a conduction medium for data transmission. OBJECTIVE: To compare the ability of the MiroCam (MC) and PillCam (PC) to identify sources of obscure GI bleeding (OGIB). DESIGN: Prospective, multicenter, comparative study. SETTING: Six academic hospitals. PATIENTS: A total of 105 patients with OGIB. INTERVENTION: Patients ingested both the MC and PC capsules sequentially in a randomized fashion. MAIN OUTCOME MEASUREMENTS: Concordance of rates in identifying a source of OGIB, operational times, and rates of complete small-bowel examination. RESULTS: Data analysis resulted in 43 (48%) abnormal cases identifying a source of OGIB by either capsule. Twenty-four cases (55.8%) were positive by both capsules. There was negative agreement in 46 of 58 cases (79.3%). The κ index was 0.547 (χ(2) = 1.32; P = .36). In 12 cases, MC positively identified a source that was not seen on PC, whereas in 7 cases, PC positively identified a source that was not seen on MC. MC had a 5.6% higher rate of detecting small-bowel lesions (P = .54). MC captured images at 3 frames per second for 11.1 hours, and PC captured images at 2 frames per second for 7.8 hours (P \u3c .0001). Complete small-bowel examination was achieved in 93.3% for MC and 84.3% for PC (P = .10). LIMITATIONS: Readers were not blinded to the particular capsule they were reading. CONCLUSION: A positive diagnostic finding for OGIB was identified by either capsule in 48% of cases. The concordance rate between the 2 capsules was comparable to that of prior studies in identifying sources of small-bowel bleeding. The longer operational time of the MC may result in higher rates of complete small-bowel examination, which may, in turn, translate into a higher rate of detecting small-bowel lesions. (Clinical trial registration number: NCT00878982.)

Clinical outcomes of EUS-guided drainage of debris-containing pancreatic pseudocysts: a large multicenter study

Background and study aims Data on clinical outcomes of endoscopic drainage of debris-free pseudocysts (PDF) versus pseudocysts containing solid debris (PSD) are very limited. The aims of this study were to compare treatment outcomes between patients with PDF vs. PSD undergoing endoscopic ultrasound (EUS)-guided drainage via transmural stents. Patients and methods Retrospective review of 142 consecutive patients with pseudocysts who underwent EUS-guided transmural drainage (TM) from 2008 to 2014 at 15 academic centers in the United States. Main outcome measures included TM technical success, treatment outcomes (symptomatic and radiologic resolution), need for endoscopic re-intervention at follow-up, and adverse events (AEs). Results TM was performed in 90 patients with PDF and 52 with PSD. Technical success: PDF 87 (96.7 %) vs. PSD 51 (98.1 %). There was no difference in the rates for endoscopic re-intervention (5.5 % in PDF vs. 11.5 % in PSD; P = 0.33) or AEs (12.2 % in PDF vs. 19.2 % in PSD; P = 0.33). Median long-term follow-up after stent removal was 297 days (interquartile range [IQR]: 59 - 424 days) for PDF and 326 days (IQR: 180 - 448 days) for PSD (P = 0.88). There was a higher rate of short-term radiologic resolution of PDF (45; 66.2 %) vs. PSD (21; 51.2 %) (OR = 0.30; 95 % CI: 0.13 - 0.72; P = 0.009). There was no difference in long-term symptomatic resolution (PDF: 70.4 % vs. PSD: 66.7 %; P = 0.72) or radiologic resolution (PDF: 68.9 % vs. PSD: 78.6 %; P = 0.72) Conclusions There was no difference in need for endoscopic re-intervention, AEs or long-term treatment outcomes in patients with PDF vs. PSD undergoing EUS-guided drainage with transmural stents. Based on these results, the presence of solid debris in pancreatic fluid collections does not appear to be associated with a poorer outcome