Energy Design Guides for Army Barracks: Preprint

The U.S. Army Corps of Engineers and NREL are developing target energy budgets and design guides to achieve 30% energy savings. This paper focuses the design guide for one type of barracks called unaccompanied enlisted personal housing

In vivo confocal microscopy in scarring trachoma.

OBJECTIVE: To characterize the tissue and cellular changes found in trachomatous scarring (TS) and inflammation using in vivo confocal microscopy (IVCM). DESIGN: Two complimentary case-control studies. PARTICIPANTS: The first study included 363 cases with TS (without trichiasis), of whom 328 had IVCM assessment, and 363 control subjects, of whom 319 had IVCM assessment. The second study included 34 cases with trachomatous trichiasis (TT), of whom 28 had IVCM assessment, and 33 control subjects, of whom 26 had IVCM assessment. METHODS: All participants were examined with ×2.5 loupes. The IVCM examination of the upper tarsal conjunctiva was carried out with a Heidelberg Retina Tomograph 3 with the Rostock Cornea Module (Heidelberg Engineering GmbH, Dossenheim, Germany). MAIN OUTCOME MEASURES: The IVCM images were graded in a masked manner using a previously published grading system evaluating the inflammatory infiltrate density; the presence or absence of dendritiform cells (DCs), tissue edema, and papillae; and the level of subepithelial connective tissue organization. RESULTS: Subjects with clinical scarring had a characteristic appearance on IVCM of well-defined bands and sheets of scar tissue visible. Similar changes were also seen in some clinically normal subjects consistent with subclinical scarring. Scarred subjects had more DCs and an elevated inflammatory infiltrate, even after adjusting for other factors, including the level of clinical inflammation. Cellular activity was usually seen only in or just below the epithelium, rarely being seen deeper than 30 μm from the surface. The presence of tissue edema was strongly associated with the level of clinical inflammation. CONCLUSIONS: In vivo confocal microscopy can be quantitatively used to study inflammatory and scarring changes in the conjunctiva. Dendritic cells seem to be closely associated with the scarring process in trachoma and are likely to be an important target in antifibrotic therapies or the development of a chlamydial vaccine. The increased number of inflammatory cells seen in scarred subjects is consistent with the immunopathologic nature of the disease. The localization of cellular activity close to the conjunctival surface supports the view that the epithelium plays a central role in the pathogenesis of trachoma. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article

Факторы риска развития и методики коррекции послеоперационного стеноза везикоуретрального анастомоза (обзор литературы)

Considerable life expectancy after radical prostatectomy dictates a necessity to preserve high quality of life of these patients. Conversely, attention is paid to functional results of the surgery, including preservation of the erectile function and quality of urination. Urinary obstruction in the postoperative period, caused primarily by postoperative vesicourethral anastomotic strictures, not only negatively impacts patients’ health but also has a pronounced maladaptation effect. The main factors of maladaptation are weak urine stream; frequent, often painful urination; episodes of acute urine retention. Currently, there are no strict guidelines for prevention of vesicourethral anastomotic strictures or for selection of an optimal method of correction of this postoperative complication of radical prostatectomy. This study highlights the main existing theories concerning development of vesicourethral anastomotic strictures and effectively used methods/ regimens for its treatment. Большая ожидаемая продолжительность жизни пациентов после проведения радикальной простатэктомии диктует необходимость сохранения высокого качества их жизни. Соответственно, внимание уделяется функциональным результатам операции, под которыми подразумевают как сохранение эректильной функции, так и качество мочеиспускания пациентов. Обструктивное мочеиспускание в послеоперационном периоде, одной из главных причин которого является развитие послеоперационного стеноза везикоуретрального анастомоза, помимо отрицательного воздействия на здоровье пациентов также оказывает выраженное дезадаптирующее влияние. Основные дезадаптирующие факторы – ослабление струи мочи, частое, нередко болезненное мочеиспускание, эпизоды острой задержки мочи. Четких руководств по профилактике формирования стеноза везикоуретрального анастомоза и выбору оптимальной методики коррекции этого послеоперационного осложнения радикальной простатэктомии пока не существует. Настоящая работа освещает основные теории развития и наиболее широко и эффективно применяемые методики/схемы лечения стеноза везикоуретрального анастомоза.

In vivo confocal microscopy and histopathology of the conjunctiva in trachomatous scarring and normal tissue: a systematic comparison.

AIM: To compare in vivo confocal microscopy (IVCM) with the histopathological examination of tissue and cellular changes in normal and diseased conjunctiva. METHODS: Participants underwent clinical examination and IVCM of the tarsal conjunctiva. A biopsy of the upper tarsal conjunctiva was collected and stained with tinctorial stains and by immunohistochemical staining for CD45 and CD83. Connective tissue scarring, inflammatory cell density and the presence of dendritiform cells were quantitatively assessed in a masked manner by both IVCM and histological assessments for comparative analysis. RESULTS: Thirty-four participants with severe trachomatous conjunctival scarring and 33 participants with healthy conjunctiva were recruited. The IVCM connective tissue scarring score was strongly associated with the histological grading of scarring (p<0.001). There was limited evidence of an association between the IVCM inflammatory cell infiltrate and the histological inflammatory cell grade (p=0.05). We did not find any evidence to support the hypothesis that dendritiform cells seen with IVCM are mature, conventional dendritic cells. CONCLUSIONS: The results show that IVCM can be used to robustly quantitate connective tissue scarring and also has a role in measuring the inflammatory cell infiltrate. The discordance between IVCM dendritiform cells and immunohistochemical dendritic cells may be a result of study limitations or may be because these dendritiform structures represent another cell type, such as fibroblasts, rather than dendritic cells

Возможности применения новых диагностических индексов при выявлении рака предстательной железы

Introduction and Objectives. The low specificity of PSA for the early diagnosis of prostate cancer was a reason for elaboration of new diagnostic methods. The aim of the study was to create novel diagnostic indices of random mathematic combinations of numeric clinical patient parameters and to estimate these values as a diagnostic tool for the detection of prostate cancer.Material and Methods. A total of 326 male patients aged 47—83 years (mean age was 65.56.5 years) who had undergone TRUS-guided 12-core systematic transrectal prostate biopsy were included in the study. The detection rate of prostate cancer was 43,6%. To compare the accuracy of the diagnostic indices, receiver-operator characteristic (ROC) curves were plotted for any of the indices and the areas under ROC curves were calculated. Age, prostate volume, transition zone volume, peripheral and central zone volume, concentration of PSA, and biopsy result were recorded in the patients.Results. A total of 37 indices were generated. The maximal accuracy equal to 0,664 was in «PSA Density in Transition Zone (PSAD-TZ) × Age». «PSAD × Age» and «PSAD-TZ» with an accuracy equal to 0,656 and 0,655 were on 2nd and 3rd rank positions, respectively. PSA with an accuracy of 0,583 was on 31st rank position only. With 90% specificity, the sensitivity of «PSAD × Age», «PSAD-TZ × Age», and «PSA» were 24, 22, and 19%, respectively. With 80% specificity, the sensitivity of «PSAD-TZ × Age», «PSAD × Age», and «PSA» were 47, 40, and 30%, respectively. With 90% sensitivity, there were no differences in the reduction in unnecessary biopsies. At the same time, with 80% sensitivity, «PSAD-TZ*Age» showed a 17% reduction in unnecessary biopsies as compared with «PSA» (р = 0,001).Conclusions. The indices «PSAD-TZ × Age» and «PSAD × Age» may be used in counseling patients with suspected prostate cancer. Further multicenter studies may be required to evaluate the effectiveness of the novel indices widely used in clinical practice.

КЛИНИЧЕСКОЕ СТАДИРОВАНИЕ РАКА ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ ПРИ ЕЕ ПЕРВИЧНОЙ БИОПСИИ

Clinical staging of cancer is the important element of a diagnostic process that determines the nature and scope of therapeutic measures required for a patient. Objective: to assess the role of clinical, clinical laboratory, and morphological findings in the diagnosis of prostate cancer (PC) and to analyze the pattern of its clinical stages in patients having different levels of serum prostate-specific antigen (PSA) and the results of digital rectal examination (DRE) and ultrasound study (USS) of the gland. Subjects and methods. The examination and follow-up records were analyzed in 2579 males aged 38-88 years who had indications for primary puncture biopsy of the prostate. Results. PC was detected in 997 (38.66%) patients. Clinically localized adenocarcinoma was diagnosed in 50.85% of cases, locally advanced one being in 49.15%, including that with its invasion into the seminal vesicles in 8.73%. The findings of DRE and transrectal USS and serum PSA values allow one to substantially define the likely extent of cancer.Клиническое стадирование онкологического заболевания является важным элементом диагностического процесса, позволяющим определять характер и объем необходимых пациенту лечебных мероприятий. Цель исследования - оценка роли клинических, клинико-лабораторных и морфологических данных в диагностике рака предстательной железы (РПЖ), а также анализ структуры его клинических стадий у больных с различными содержанием в сыворотке крови простатического специфического антигена (ПСА) и результатами пальцевого (ПРИ) и ультразвукового (УЗИ) исследований железы. Материалы и методы. Проанализированы материалы обследования и наблюдения 2579 мужчин в возрасте 38-88 лет, у которых имелись показания к первичной пункционной биопсии предстательной железы. Результаты. РПЖ выявлен у 997 (38,66%) пациентов. В 50,85% случаев диагностирована клинически локализованная аденокарцинома, в 49,15% - местно-распространенная, в том числе в 8,73% - с инвазией в семенные пузырьки. Использование результатов ПРИ, трансректального УЗИ, а также показателей ПСА сыворотки крови позволяет в значительной мере определять вероятную степень распространенности онкологического процесса

Confocal Laser Scanning Microscopy for Detection of Schistosoma mansoni Eggs in the Gut of Mice

Background: The gold standard for diagnosing Schistosoma mansoni infections is the detection of eggs from stool or biopsy specimens. The viability of collected eggs can be tested by the miracidium hatching procedure. Direct detection methods are often limited in patients with light or early infections, whereas serological tests and PCR methods fail to differentiate between an inactive and persistent infection and between schistosomal species. Recently, confocal laser scanning microscopy (CLSM) has been introduced as a diagnostic tool in several fields of medicine. In this study we evaluated CLSM for the detection of viable eggs of S. mansoni directly within the gut of infected mice. Methodology/Principal Findings: The confocal laser scanning microscope used in this study is based on the Heidelberg Retina Tomograph II scanning laser system in combination with the Rostock Cornea Module (image modality 1) or a rigid endoscope (image modality 2). Colon sections of five infected mice were examined with image modalities 1 and 2 for schistosomal eggs. Afterwards a biopsy specimen was taken from each colon section and examined by bright-field microscopy. Visualised eggs were counted and classified in terms of viability status. Conclusions/Significance: We were able to show that CLSM visualises eggs directly within the gut and permits discrimination of schistosomal species and determination of egg viability. Thus, CLSM may be a suitable non-invasive too