Radiological imaging following pelvic prolapse surgery

CLINICAL/METHODICAL ISSUE Pelvic organ prolapse is a common condition in women, for which both conservative and surgical interventions are available. Knowledge of the different surgical procedures and the materials used is essential for adequate radiological diagnosis after prolapse surgery in order to differentiate potential complications from normal postoperative changes. STANDARD RADIOLOGICAL METHODS In the immediate postoperative period, computed tomography (CT) is often the modality of choice for evaluating acute complications such as bleeding or organ injuries. Magnetic resonance imaging (MRI) provides excellent soft tissue contrast and is therefore generally preferred for assessing subacute and chronic complications. METHODICAL INNOVATIONS Innovative techniques such as dynamic MRI protocols can improve the radiological assessment after prolapse surgery by enabling the evaluation of organ mobility. PERFORMANCE Radiological standard procedures such as computed tomography (CT) and MRI provide detailed and reliable information about the postoperative site and potential complications following prolapse surgery. ACHIEVEMENTS Radiological imaging plays an important role in the evaluation of patients after prolapse surgery, particularly when complications are suspected. Accurate radiological diagnosis can guide further appropriate therapeutic measures

A randomized controlled trial

Objective We report on the effect of hemoadsorption therapy to reduce cytokines in septic patients with respiratory failure. Methods This was a randomized, controlled, open-label, multicenter trial. Mechanically ventilated patients with severe sepsis or septic shock and acute lung injury or acute respiratory distress syndrome were eligible for study inclusion. Patients were randomly assigned to either therapy with CytoSorb hemoperfusion for 6 hours per day for up to 7 consecutive days (treatment), or no hemoperfusion (control). Primary outcome was change in normalized IL-6-serum concentrations during study day 1 and 7. Results 97 of the 100 randomized patients were analyzed. We were not able to detect differences in systemic plasma IL-6 levels between the two groups (n = 75; p = 0.15). Significant IL-6 elimination, averaging between 5 and 18% per blood pass throughout the entire treatment period was recorded. In the unadjusted analysis, 60-day-mortality was significantly higher in the treatment group (44.7%) compared to the control group (26.0%; p = 0.039). The proportion of patients receiving renal replacement therapy at the time of enrollment was higher in the treatment group (31.9%) when compared to the control group (16.3%). After adjustment for patient morbidity and baseline imbalances, no association of hemoperfusion with mortality was found (p = 0.19). Conclusions In this patient population with predominantly septic shock and multiple organ failure, hemoadsorption removed IL-6 but this did not lead to lower plasma IL-6-levels. We did not detect statistically significant differences in the secondary outcomes multiple organ dysfunction score, ventilation time and time course of oxygenation

Risk factors for prostate cancer in men with false-negative mpMRI: A retrospective single center cohort study of image quality scores and clinical parameters

PURPOSE To identify predictors of prostate cancer (PCa) and clinically significant prostate cancer (csPCa) in men with prior false-negative multiparametric MRI (mpMRI), focusing on image quality scoring systems and clinical parameters. METHODS In this IRB-approved retrospective single-center study, patients with a negative mpMRI (PI-RADS score ≤2) and subsequent prostate biopsies were included. Histopathological results served as reference standard. Welch's t-Test was conducted to identify significant differences in image quality scores (PI-QUAL and PSHS) between patients with and without PCa/csPCA. In addition, clinical parameters (age, BMI, PSA density) and image quality scores (PI-QUAL and PSHS) were examined as potential predictors of PCa/csPCa detection after a false-negative mpMRI in uni- and multivariate analyses. RESULTS Among 96 patients with negative mpMRI results, 44.8 % had PCa and 16.7 % had csPCa upon biopsy with histopathological confirmation. PI-QUAL scores were significantly lower in patients with PCa (p = 0.03) and csPCa (p = 0.005). PSHS scores were lower in patients with csPCa, but the difference was not statistically significant (p = 0.1). Higher age (p = 0.035) and a lower PI-QUAL score (p < 0.004) were predictors of subsequent csPCa detection upon biopsy, however, a lower PI-QUAL score was the only independent predictor of missed csPCa in false-negative mpMRIs. CONCLUSIONS Lower image quality scores were associated with missed PCa/csPCa in patients with false-negative mpMRIs, with PI-QUAL being an independent predictor of failed csPCa detection. This highlights the importance of image quality for prostate MRI and advocats the inclusion of its measurement into the standardized report

Range assessment in particle therapy based on prompt gamma-ray timing measurements

Proton and ion beams open up new vistas for the curative treatment of tumors, but adequate technologies for monitoring the compliance of dose delivery with treatment plans in real time are still missing. Range assessment, meaning the monitoring of therapy-particle ranges in tissue during dose delivery (treatment), is a continuous challenge considered a key for tapping the full potential of particle therapies. In this context the paper introduces an unconventional concept of range assessment by prompt-gamma timing (PGT), which is based on an elementary physical effect not considered so far: therapy particles penetrating tissue move very fast, but still need a finite transit time-about 1-2 ns in case of protons with a 5-20 cm range-from entering the patient's body until stopping in the target volume. The transit time increases with the particle range. This causes measurable effects in PGT spectra, usable for range verification. The concept was verified by proton irradiation experiments at the AGOR cyclotron, KVI-CART, University of Groningen. Based on the presented kinematical relations, we describe model calculations that very precisely reproduce the experimental results. As the clinical treatment conditions entail measurement constraints (e.g. limited treatment time), we propose a setup, based on clinical irradiation conditions, capable of determining proton range deviations within a few seconds of irradiation, thus allowing for a fast safety survey. Range variations of 2 mm are expected to be clearly detectable

Structural Basis for Regulation of the Opposing (p)ppGpp Synthetase and Hydrolase within the Stringent Response Orchestrator Rel

The stringent response enables metabolic adaptation of bacteria under stress conditions and is governed by RelA/SpoT Homolog (RSH)-type enzymes. Long RSH-type enzymes encompass an N-terminal domain (NTD) harboring the second messenger nucleotide (p)ppGpp hydrolase and synthetase activity and a stress-perceiving and regulatory C-terminal domain (CTD). CTD-mediated binding of Rel to stalled ribosomes boosts (p)ppGpp synthesis. However, how the opposing activities of the NTD are controlled in the absence of stress was poorly understood. Here, we demonstrate on the RSH-type protein Rel that the critical regulative elements reside within the TGS (ThrRS, GTPase, and SpoT) subdomain of the CTD, which associates to and represses the synthetase to concomitantly allow for activation of the hydrolase. Furthermore, we show that Rel forms homodimers, which appear to control the interaction with deacylated-tRNA, but not the enzymatic activity of Rel. Collectively, our study provides a detailed molecular view into the mechanism of stringent response repression in the absence of stress

Progress in hybrid plasma wakefield acceleration

Plasma wakefield accelerators can be driven either by intense laser pulses (LWFA) or by intense particle beams (PWFA). A third approach that combines the complementary advantages of both types of plasma wakefield accelerator has been established with increasing success over the last decade and is called hybrid LWFA→PWFA. Essentially, a compact LWFA is exploited to produce an energetic, high-current electron beam as a driver for a subsequent PWFA stage, which, in turn, is exploited for phase-constant, inherently laser-synchronized, quasi-static acceleration over extended acceleration lengths. The sum is greater than its parts: the approach not only provides a compact, cost-effective alternative to linac-driven PWFA for exploitation of PWFA and its advantages for acceleration and high-brightness beam generation, but extends the parameter range accessible for PWFA and, through the added benefit of co-location of inherently synchronized laser pulses, enables high-precision pump/probing, injection, seeding and unique experimental constellations, e.g., for beam coordination and collision experiments. We report on the accelerating progress of the approach achieved in a series of collaborative experiments and discuss future prospects and potential impact

Das Verhalten von Chlor und Edelgasen während der Serpentinisierung von Olivin

Halogene und Edelgase sind aufgrund ihres inkompatiblen Verhaltens gute Tracer für die Transportprozesse wasserhaltiger Fluide aus dem Slab in den Erdmantel (Kobayashi et al., 2016). Obwohl Serpentine als die Hauptakteure in den Volatilkreisläufen der oberen Subduktionszonen gelten (Kendrick et al, 2011, 2017; Dechamps et al., 2013; Galvez et al., 2013, 2016; Ryan and Chauvel, 2014; Barnes et al., 2018), wurde das Einbauverhalten von Chlor und Edelgasen in Serpentin experimentell bisher kaum untersucht. In dieser Arbeit wurde die Stellung von Serpentin als sogenanntes „Carrier“-Mineral experimentell überprüft. Dazu wurden Goldkapseln mit Olivin, NaCl-Lösung und zum Teil zusätzlich mit einem Edelgasmix befüllt. Anschließend wurden diese bei 300C (+/-1C) und 820 bar (+/-20 bar) für 82-130 Tage in der Hydrothermalanlage synthetisiert. Für die Analyse der Gas-Kapseln wurde das High Vacuum Piercing Device entwickelt. Es ermöglicht ein Anstechen der Kapseln im Hochvakuum und anschließende massenspektrometrische Analyse während der thermischen Destabilisierung der Serpentinminerale. Bei den Chlorkapseln wurde sowohl durch Variation von vier unterschiedlichen Olivinen als Startmaterial der Einfluss von Spurenelementen und Fe bzw. Fe3+, als auch durch Beigabe eines MH-Puffers der Einfluss der Sauerstofffugazität auf die Reaktion untersucht. Durch Variation des NaCl-Gehalts wurden verschiedene Bildungsmilieaus simuliert und gezeigt, dass die maximale Löslichkeit von Chlor in Serpentin bereits mit Meerwasseranaloger NaCl-Lösung erreicht wird. Die ermittelten Chlorgehalte von 150-1400 ppm stimmen mit den Werten von Huang (2017) gut überein, wobei die Messwerte deutlich einem Trend von 500 ppm Cl im Serpentin folgen, unabhängig vom Chlorgehalt des Fluids (33g bzw 330g NaCl/l). Der NaCl-Gehalt des Fluids und der Fe-Gehalt im ursprünglichen Olivin beeinflussen hingegen, welche Art von Serpentinmineral sich bildet. Zudem wird gezeigt, dass dreiwertige Kationen im ursprünglichen Olivin einen positiven Einfluss auf die Kinetik der Reaktion haben und diese in erster Linie das Einbauverhalten von Chlor bestimmt. Das Mg/Si-Verhältnis des initialen Olivins hingegen, scheint keinen Einfluss auf die Kinetik zu haben. Die Edelgasmessungen konnten bislang nicht quantifiziert werden, es konnten aber nach drei Heizschritten (250C, 330C und 400C) Edelgase gemessen werden. Dies beweist den Einbau von Edelgasen in Serpentin und bestätigt die Funktion der Analysemethode.The incompatible behavior of halogens and noble gases makes them powerful tracers of slab-derived aqueous fluids in the mantle (Kobayashi et al., 2016). Even though Serpentinites have a key role in volatile cycles in upper subduction zones (Kendrick et al, 2011, 2017; Dechamps et al., 2013; Galvez et al., 2013, 2016; Ryan and Chauvel, 2014; Barnes et al., 2018), the behavior of chlorine during serpentinization of olivine has hardly been researched. In this study, the role of serpentine as a “carrier”-mineral was determined by experimental approaches. Therefore, gold capsules were filled up with olivine and NaCl-solution, while some of them were filled with additional mixture of noble gases. Afterwards they were synthesized in a hydrothermal oven at 300C (+/-1C) and 820 bar (+/-20 bar) for 82-130 days. For analyzing the noble gas capsules, a high vacuum piercing device was engineered. This allows to pierce the capsule under high vacuum while it is connected to the mass spectrometer and analyze the noble gas which is released by the thermal destabilization of serpentine. The NaCl-capsules where used to investigate the influence of trace elements, oxygen fugacity, Fe and Fe3+ by varying the initial olivine composition and adding a MH-buffer. By varying the NaCl-concentration of the fluid, different geological environments were simulated and it was demonstrated that the maximum solubility of chlorine in Serpentine is already reached at seawater analog NaCl-concentrations. The measured Cl-concentrations in serpentine were between 150-1400 ppm, but most of them seem to show a clear trend towards 500 ppm Cl independent of the NaCl-concentration of the fluid. Nevertheless, this is in good agreement with the results of Huang (2017) with 0,08 +/- 0,03 wt% Cl. The NaCl-concentration of the fluid and the Fe-concentration of the initial olivine affects which kind of serpentine mineral forms. Moreover, the positive effect of trivalent cations on the reaction kinetics of serpentinization is shown. The noble gas measurements could not be quantified yet, but noble gases were measured after three heating steps (250C, 330C and 400C). This proves that noble gases can be incorporated in serpentine and shows the functionality of the analyzing method.Arbeit an der Bibliothek noch nicht eingelangt - Daten nicht geprüftInnsbruck, Univ., Masterarb., 2020(VLID)470820