Iatrogenic Subtotal Stenosis of the Right Subclavian Artery Treated With Percutaneous Transluminal Angioplasty

This report describes a rare vascular complication of surgical placement of a marking clip and a possible approach to problem solving. A 55-year-old patient presented with loss of sensation in the fingers and loss of peripheral pulsations in the right arm 4 days after right upper lobectomy for a pT2N1 moderately differentiated adenocarcinoma of the lung. Duplex examination and computed tomography were performed the same day and showed a subtotal stenosis of the right subclavian artery, which was caused by the surgical placement of a metal clip to mark the surgical boundary. Selective angiography was subsequently performed. Percutaneous transluminal angioplasty (PTA) successfully dilated the stenosis and pushed the clip off. Flow in the right subclavian artery (RSA) was completely restored as were neurology and peripheral pulses. In conclusion, arterial stenosis by a surgical (marking) clip may be feasibly treated with PTA

Matrix Protein 2 Vaccination and Protection against Influenza Viruses, Including Subtype H5N1

Vaccination of mice with influenza matrix protein 2 induced cross-reactive antibody responses

Incidence, Risk Factors, and Impact of Severe Neutropenia After Hyperthermic Intraperitoneal Mitomycin C

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are considered the standard of care for patients with peritoneal dissemination of appendiceal cancer and are increasingly being evaluated for use in patients with carcinomatosis from colon cancer. Mitomycin C (MMC) is one of the most frequently used HIPEC agents in the management of peritoneal-based gastrointestinal malignancies. This study analyzes the incidence and risk factors for developing neutropenia following MMC-HIPEC combined with CRS. All patients undergoing CRS and MMC-HIPEC for appendiceal cancer between January 1993 and October 2006 were retrospectively reviewed. Logistic regression was used to identify risk factors for the development of neutropenia, defined as an absolute neutrophil count (ANC) <1,000/mm3. One hundred and twenty MMC-HIPEC were performed in 117 patients with appendiceal cancer. The incidence of neutropenia was 39%. Neutropenia occurred in 57.6% of female and 21.3% of male patients (p < 0.0001). Female gender and MMC dose per body surface area (BSA) were independent risk factors for neutropenia on multivariable logistic regression [odds ratio (OR) of neutropenia in females = 3.58 (95% confidence interval, CI: 1.52, 8.43); OR for 5 unit (mg/m2) increase in MMC dose per BSA = 3.37 (95% CI: 1.72, 6.63)]. Neutropenia did not increase the risk of mortality, postoperative infection or length of hospital stay. Neutropenia is a frequent complication associated with MMC-HIPEC. Female sex and MMC dose per BSA are independent risk factors for neutropenia. These differences must be considered in the management of patients undergoing MMC-HIPEC to minimize the toxicity of the procedure

Characterization of genome-wide p53-binding sites upon stress response

The tumor suppressor p53 is a sequence-specific transcription factor, which regulates the expression of target genes involved in different stress responses. To understand p53's essential transcriptional functions, unbiased analysis of its DNA-binding repertoire is pivotal. In a genome-wide tiling ChIP-on-chip approach, we have identified and characterized 1546 binding sites of p53 upon Actinomycin D treatment. Among those binding sites were known as well as novel p53 target sites, which included regulatory regions of potentially novel transcripts. Using this collection of genome-wide binding sites, a new high-confidence algorithm was developed, p53scan, to identify the p53 consensus-binding motif. Strikingly, this motif was present in the majority of all bound sequences with 83% of all binding sites containing the motif. In the surrounding sequences of the binding sites, several motifs for potential regulatory cobinders were identified. Finally, we show that the majority of the genome-wide p53 target sites can also be bound by overexpressed p63 and p73 in vivo, suggesting that they can possibly play an important role at p53 binding sites. This emphasizes the possible interplay of p53 and its family members in the context of target gene binding. Our study greatly expands the known, experimentally validated p53 binding site repertoire and serves as a valuable knowledgebase for future research

Toxicity of copper sulfate and rotenone to Chinese mystery snail (\u3ci\u3eBellamya chinensis\u3c/i\u3e)

The Chinese mystery snail (Bellamya chinensis) is a freshwater snail native to Southeast Asia, Japan, and Russia and is currently classified as an invasive species in at least 27 states in the USA. The species tolerates a wide range of environmental conditions, making management of established populations difficult. We tested the efficacy of two traditional chemical treatments, rotenone and copper sulfate, on the elimination of adult Chinese mystery snails in laboratory experiments. All snails (N=50) survived 72-hour exposure to rotenone-treated lake water, and 96% (N=25) survived 72-hour exposure to pre-determined rotenone concentrations of 0.25, 2.5, and 25.0 mg/L. All snails (N=10) survived exposure to 1.25 mg/L copper sulfate solution, 90% (N=10) survived exposure to 2.50 mg/L copper sulfate solution, and 80% (N=5) survived exposure to 5.0 mg/L copper sulfate solution. Neither rotenone nor copper sulfate effectively killed adult Chinese mystery snails in laboratory experiments, most likely due to their relatively large size, thick shell, and operculum. Therefore, it appears that populations will be very difficult to control once established, and management should focus on preventing additional spread or introductions of this species

Patient reported toxicity and quality of life after hypofractionated high-dose intensity-modulated radiotherapy for intermediate- and high risk prostate cancer

Background and purpose: For irradiation of localized prostate-cancer, moderately-hypofractionated regimens with a variety of dose per fraction are used. We adopted a regimen of 70 Gy in 28 fractions of 2.5 Gy, using state of the art radiotherapy (RT) and closely monitored the efficacy, toxicity and health-related quality of life (HRQoL) in a large cohort, using patient-reported outcomes. Materials and methods: Between 2008 and 2016, 462 patients with intermediate- to high-risk localized prostate cancer were treated with RT, 28 fractions of 2.5 Gy, using IMRT/VMAT, an online fiducial-maker based correction protocol and a daily inserted endorectal balloon. Overall freedom from failure (no biochemical or clinical recurrence) , as well as self-reported genitourinary (GU) and gastrointestinal (GI) related toxicity and HRQoL are reported. Results: Overall freedom from failure rates at 3 and 5 years were 92.0% (89.1–94.9%) and 83.5% (78.6–88.4%), respectively. Prevalence rates of grade ≥ 2 GU/GI-toxicity were 16.3%/6.3% and 22,1%/3.2% after 3 and 5 years respectively. The 5-year actuarial incidences of grade ≥ 2 GU/GI-toxicity were 43.5%/18.5%. HRQoL worsened during RT and gradually recovered thereafter, In accordance with the prevalence rates. Conclusion: Treatment of intermediate- or high-risk localized prostate cancer with RT to 70 Gy in 28 fractions with IMRT/VMAT, using fiducial markers and an endorectal balloon leads to good long-term tumor control rates and acceptable patient reported toxicity rates. Furthermore, patient-reported outcomes, including HRQoL, are essential for a good comparison between different studies. Finally, prevalence rates show a better correlation with HRQoL than actuarial incidence rates do and might therefore better represent the burden of toxicity

Flow profiles in the left anterior descending and the right coronary artery assessed by MR velocity quantification: Effects of through-plane and in-plane motion of the heart

Purpose: The purpose of this work was to compare the temporal profiles of volume flow in the left anterior descending artery (LAD) and the right coronary artery (RCA) and to assess the effect of through-plane and in-plane myocardial motion. Method: In eight healthy volunteers, MR phase-difference velocity quantification was applied with prospective ECG triggering, pixel size of 1.16 x 0.98 mm2 (LAD) or 1.25 x 0.98 mm2 (RCA), velocity sensitivity of 40 cm/s, and data acquisition time window of 64 ms for LAD (3 k(y) lines per heartbeat) and 24 ms for RCA. In-plane motion was measured from the magnitude images. Results: In the LAD, systolic peak and mean flow values were 0.94 ± 0.28 and 0.30 ± 0.22 ml/s, respectively. Diastolic peak and mean flows were 2.42 ± 0.56 and 1.38 ± 0.43 ml/s. The systolic to diastolic ratio was 0.37 ± 0.12 for peak flow and 0.22 ± 0.15 for mean flow. Mean flow through the cardiac cycle was 59.1 ± 15.0 ml/min. In the RCA, systolic peak and mean flow values were 1.96 ± 0.69 and 0.74 ± 0.31 ml/s, respectively. Diastolic peak and mean flows were 1.80 ± 0.53 and 0.83 ± 0.20 ml/s. The systolic to diastolic ratio was 0.97 ± 0.58 for peak flow and 0.85 ± 0.39 for mean flow. Mean flow through the cardiac cycle was 38.4 ± 10.8 ml/min. The in-plane velocity of the coronary artery cross-section was 6.4 ± 1.8 cm/s for the LAD and 14.9 ± 4.0 cm/s for the RCA (given by peak values in diastole). Conclusion: It is confirmed noninvasively with MR that the LAD shows a predominantly diastolic flow, whereas the RCA shows about equal flow values in systole and diastole. Through-plane motion correction is required for assessing the true flow patterns. The in-plane velocities of the coronary artery cross-sections imply a maximum data acquisition time window, estimated at 58 ms for the LAD and at 23 ms for the RCA

Population estimate of Chinese mystery snail (\u3ci\u3eBellamya chinensis\u3c/i\u3e) in a Nebraska reservoir

The Chinese mystery snail (Bellamya chinensis) is an aquatic invasive species in North America. Little is known regarding this species’ impacts on freshwater ecosystems. It is believed that population densities can be high, yet no population estimates have been reported. We utilized a mark-recapture approach to generate a population estimate for Chinese mystery snail in Wild Plum Lake, a 6.47-ha reservoir in southeast Nebraska. We calculated, using bias-adjusted Lincoln-Petersen estimation, that there were approximately 664 adult snails within a 127 m2 transect (5.2 snails/m2). If this density was consistent throughout the littoral zone (depth) of the reservoir, then the total adult population in this impoundment is estimated to be 253,570 snails, and the total Chinese mystery snail wet biomass is estimated to be 3,119 kg (643 kg/ha). If this density is confined to the depth sampled in this study (1.46 m), then the adult population is estimated to be 169,400 snails, and wet biomass is estimated to be 2,084 kg (643 kg/ha). Additional research is warranted to further test the utility of mark-recapture methods for aquatic snails and to better understand Chinese mystery snail distributions within reservoirs

Fecundity of the Chinese mystery snail in a Nebraska reservoir

The Chinese mystery snail (Bellamya chinensis) is a non-indigenous, invasive species in freshwater ecosystems of North America. We provide fecundity estimates for a population of these snails in a Nebraska reservoir. We dissected 70 snails, of which 29 were females. Nearly all female snails contained developing young, with an average of 25 young per female. Annual fecundity was estimated at between 27.2 and 33.3 young per female per year. Based on an estimated adult population and the calculated fecundity, the annual production for this reservoir was between 2.2 and 3.7 million young

Survival Analysis of Pseudomyxoma Peritonei Patients Treated by Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

OBJECTIVE: To evaluate the survival of patients with pseudomyxoma peritonei (PMP) treated by cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC), and to identify factors with prognostic value. SUMMARY BACKGROUND DATA: PMP is a clinical syndrome characterized by progressive intraperitoneal accumulation of mucous and mucinous implants, usually derived from a ruptured mucinous neoplasm of the appendix. Survival is dominated by pathology. METHODS: A total of 103 patients (34 men and 69 women) treated at The Netherlands Cancer Institute between 1996 and 2004 were identified. Survival was calculated from date of initial treatment and corrected for a second procedure. PMP was pathologically categorized into disseminated peritoneal adenomucinosis (DPAM), peritoneal mucinous carcinomatosis (PMCA), and an intermediate subtype (PMCA-I). Clinical and pathologic factors were analyzed to identify their prognostic value for survival. RESULTS: Median follow-up was 51.5 months (range, 0.1–99.5 months). Recurrence developed in 44%. A second procedure for recurrence was performed in 11 patients. The median disease-free interval was 25.6 months (95% confidence interval [CI], 14.8–43.6 months). The 3-year and 5-year disease-free survival probability was 43.6% (95% CI, 34.4%–55.2%) and 37.4% (95% CI, 28.2%–49.5%), respectively. The disease-specific 3-year and 5-year survival probability was 70.9% (95% CI, 62.0%–81.2%) and 59.5% (95% CI 48.7%–72.5%), respectively. Factors associated with survival were pathological subtype, completeness of cytoreduction, and degree and location of tumor load (P < 0.05). The main prognostic factor, independently associated with survival, was the pathologic subtype (P < 0.01). CONCLUSION: Cytoreductive surgery in combination with intraoperative HIPEC is a feasible treatment strategy for PMP in terms of survival. The pathologic subtype remains the dominant factor in survival. Patients should be centralized to improve survival by a combination of surgical experience and adequate patient selection