The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Cancer Stem Cells, Epithelial to Mesenchymal Markers, and Circulating Tumor Cells in Small Cell Lung Cancer

Background Small cell lung cancer (SCLC) has a poor prognosis, and even with localized (limited) disease, the 5-year survival has only been around 20%. Elevated levels of circulating tumor cells (CTCs) have been associated with a worse prognosis, and markers of cancer stem cells (CSCs) and epithelial to mesenchymal transition have been associated with increased chemoresistance and metastatic spread in SCLC. Patients and Methods The biopsy specimens of 38 SCLC patients were used for marker evaluation by immunohistochemistry. The markers for CSCs were CD44 and SOX2. The markers for epithelial to mesenchymal transition were E-cadherin, epithelial cell adhesion molecule, cytokeratins 8, 18, and 19, vimentin, and c-MET. Staining was scored as low (weak) or high (strong) intensity for SOX2, epithelial cell adhesion molecule, cytokeratins 8, 18, and 19, and c-MET and using the immunoreactive score for CD44, E-cadherin, and vimentin, expressed as low or high expression. Results High expression of c-MET (c-METH) and low expression of E-cadherin (E-cadL) showed a trend toward a better prognosis (P = .07 and P = .09, respectively). The combination of c-METH and E-cadL resulted in significantly better survival (P = .007). The tested markers were not associated with CTCs, although a trend was seen for c-METHE-cadL (P = .09) with low CTCs. The CSC markers SOX2 and CD44 were not associated with overall survival in this patient cohort. Conclusion SCLC with a mesenchymal-like phenotype (c-METHE-cadL) is associated with longer survival and showed a trend toward lower CTCs

Circulating tumor cells in small-cell lung cancer: a predictive and prognostic factor

Background: Initial response of small-cell lung cancer (SCLC) to chemotherapy is high, and recurrences occur frequently, leading to early death. This study investigated the prognostic value of circulating tumor cells (CTCs) in patients with SCLC and whether changes in CTCs can predict response to chemotherapy. Patients and methods: In this multicenter prospective study, blood samples for CTC analysis were obtained from 59 patients with SCLC before, after one cycle, and at the end of chemotherapy. CTCs were measured using CellSearch® systems. Results: At baseline, lower numbers of CTCs were observed for 21 patients with limited SCLC (median = 6, range 0–220) compared with 38 patients with extensive stage (median = 63, range 0–14 040). Lack of measurable CTCs (27% of patients) was associated with prolonged survival (HR 3.4; P ≤ 0.001). CTCs decreased after one cycle of chemotherapy; this decrease was not associated with tumor response after four cycles of chemotherapy. CTC count after the first cycle of chemotherapy was the strongest predictor for overall survival (HR 5.7; 95% CI 1.7–18.9; P = 0.004). Conclusion: Absolute CTCs after one cycle of chemotherapy in patients with SCLC is the strongest predictor for response on chemotherapy and survival. Patients with low initial CTC numbers lived longer than those with higher CTCs

Nuclear structure of

The nuclear structure of 122Xe has been investigated with measurements of the β+/EC decay of 122Cs with the 8 π γ-ray spectrometer at the TRIUMF-ISAC facility. The data collected have enabled the determination of relative B(E2) values of some low-energy transitions, and the in-band transitions of the excited 0+ bands have been observed. As a result, the 2+ rotational band members for the 0+2 and 0+3 states have been firmly identified

Nuclear structure of 122Xe studied via high-statistics β+/EC-decay

The nuclear structure of 122Xe has been investigated with measurements of the β+/EC decay of 122Cs with the 8 π γ-ray spectrometer at the TRIUMF-ISAC facility. The data collected have enabled the determination of relative B(E2) values of some low-energy transitions, and the in-band transitions of the excited 0+ bands have been observed. As a result, the 2+ rotational band members for the 0+2 and 0+3 states have been firmly identified

Study of the β−\beta^{-} decay of116m1^{116m1}In: A new interpretation of low-lying 0+^{+} states in116^{116}Sn

International audienceThe$^{116}$Sn nucleus contains a collective rotational band originating from proton $\pi$ 2p-2h excitations across the proton $Z=50$ shell gap. Even though this nucleus has been extensively investigated in the past, there was still missing information on the low-energy interband transitions connecting the intruder and normal structures. The low-lying structure of$^{116}$Sn was investigated through a high-statistics study of the $\beta^{-}$ decay of$^{116m1}$In with the $8\pi$ spectrometer and its ancillary detectors at TRIUMF. These measurements are critical in order to properly characterize the $\pi$ 2p-2h rotational band. Weak $\gamma$ -decay branches are observed utilizing $\gamma$ - $\gamma$ coincidence spectroscopy methods, leading to the first direct observation of the 85 keV $2_{2}^{+}\rightarrow 0_{3}^{+}$ $\gamma$ ray with a transition strength of $B(E2) = 99.7(84)$ W.u. The analysis of these results strongly suggests that the 2027 keV $0_{3}^{+}$ state should replace the previously assigned 1757 keV $0_{2}^{+}$ state as the band-head of the $\pi$ 2p-2h rotational band

Nuclear structure of 122

The nuclear structure of 122Xe has been investigated with measurements of the β+/EC decay of 122Cs with the 8 π γ-ray spectrometer at the TRIUMF-ISAC facility. The data collected have enabled the determination of relative B(E2) values of some low-energy transitions, and the in-band transitions of the excited 0+ bands have been observed. As a result, the 2+ rotational band members for the 0+2 and 0+3 states have been firmly identified

New Opportunities in Decay Spectroscopy with the GRIFFIN and DESCANT Arrays

AbstractThe GRIFFIN (Gamma-Ray Infrastructure For Fundamental Investigations of Nuclei) project is a major upgrade of the decay spectroscopy capabilities at TRIUMF-ISAC. GRIFFIN will replace the 8π spectrometer with an array of up to 16 large-volume HPGe clover detectors and use a state-of-the-art digital data acquisition system. The existing ancillary detector systems that had been developed for 8π, such as the SCEPTAR array for β-tagging, PACES for high-resolution internal conversion electron spectroscopy, and the DANTE array of LaBr3/BaF2 scintillators for fast γ-ray timing, will be used with GRIFFIN. GRIFFIN can also accommodate the new neutron detector array DESCANT (Deuterated Scintillator Array for Neutron Tagging), enabling the study of β-delayed neutron emitters. DESCANT consists of up to 70 detectors, each filled with approximately 2 liters of deuterated benzene, a liquid scintillator that provides pulse-shape discrimination (PSD) capabilities to distinguish between neutrons and γ-rays interacting with the detector. In addition, the anisotropic nature of n-d scattering as compared to the isotropic n-p scattering allows for the determination of the neutron energy spectrum directly from the pulse-height spectrum, complementing the time-of-flight (TOF) information. The installation of GRIFFIN is under way and first experiments are planned for the fall of 2014. The array will be completed in 2015 with the full complement of 16 clovers. DESCANT will be tested coupled with GRIFFIN in spring of 2015