Routine use of intravascular ultrasound for endovascular aneurysm repair: angiography is not necessary.

INTRODUCTION: to assess the outcome of endovascular aortic aneurysm repair (EVAR) using intravascular ultrasound (IVUS) without angiography. MATERIALS/METHODS: eighty consecutive patients (median age 69 years (range 25-90): male 72 (90%), female 8 (10%)) underwent endovascular aneurysm repair (AAA 68 (85%), TAA 12 (15%)) using either angiography in 31/80 patients (39%) or IVUS in 49/80 patients (61%) in accordance to the surgeons preference. RESULTS: hospital mortality was 2/80 (3%), 1/68 for AAA (2%), 1/12 for TAA (8%), 2/31 for angiography (7%), and 0/49 for IVUS (0.0%: NS). Median quantity of contrast medium was 190 ml (range: 20-350) for angiography versus 0 ml for IVUS (p<0.01). Median X-ray exposure time 24 min (range 9-65 min) versus 8 min (range 0-60 min) for IVUS (p<0.05). No coverage of renal or suprarenal artery orifices occurred in either group. Conversion to open surgery was necessary in 4/80 patients (5%), 1/31 for angiography (3%) and 3/49 patients for IVUS (6%: NS). Early endoleaks were observed in 13/80 patients (16%): 8/31 patients for angiography (26%) versus 5/49 for IVUS (10%: p<0.05): 5/13 endoleaks resolved spontaneously (39%) whereas 8/13 (61%) required additional procedures. CONCLUSIONS: IVUS is a reliable tool for EVAR. In most cases, perprocedural angiography is not necessary.

Immunoscintigraphie avec tomographie d'émission dans les cancers de la thyroïde

Immunoscintigraphy (IS) consists of in vivo body structure imaging using a specific labelled antibody to an antigen concentrated in the structure under study. Technically, the image contrast is better when IS is performed with a computerized emission tomography system. High concentrations of carcinoembryonic antigen (CEA) have been reported in medullary thyroid carcinoma and thyroglobulin (Tg) is a marker for differentiated thyroid carcinoma. We used injections of 131-I labelled monoclonal antibodies to CEA and Tg to detect thyroid tumours. A feasibility trial using anti-CEA antibodies gave very encouraging results. However, only tumours larger than 10 cm3 could be detected. Contradictory results were obtained using anti-Tg antibodies but this data must be considered as preliminary. Various means of improving the method and the concept of accessibility of the antigen to the antibody in vivo are discussed. This study shows IS to be a promising experimental technique. Further studies are required to define its clinical indications before it can be advocated for routine use.

Crises non épileptiques psychogènes: le défi des troubles fonctionnels en neurologie

Psychogenic non epileptic seizures (PNES) look like epilepsy, but are not accompanied by the electrophysiological alterations found in epilepsy. The diagnosis requires a complex process at the interface between neurology and psychiatry. Diagnostic restitution to the patient and treatment of the condition should be a collaboration between neurologist and psychiatrist including as much as possible a general practitioner. Vulnerability and triggering psycho-social factors, as well as frequent psychiatric co morbidity implicate that psychiatric-psychological care is needed in a majority of situations, however this cannot be done without a strong "somatic back-up" with rapid access to somatic facility for advice and care when needed. The neurological presentation of the disease, with psychiatric causes underlying the condition, bear the risk for the patient that neither neurological nor psychiatric care is offered. Current knowledge about the condition is still scarce, but the field is progressively enriched by studies with stronger methodologies. Recent neuroimaging studies open fascinating avenues on our understanding of the interplay between emotional regulation, representation of the self, and dissociative symptoms. These new avenues help our understanding of these disorders which challenge classical frontiers between neurology and psychiatry. In this paper we try to formulate a framework for the care of patient with dissociative disorders including NEPS.

Crescimento e alterações no fígado e na carcaça de alevinos de jundiá alimentados com dietas com aflatoxinas

O objetivo deste trabalho foi avaliar o efeito das aflatoxinas sobre o crescimento de alevinos de jundiá (Rhamdia quelen), e sua deposição no fígado e na carcaça de peixes alimentados com ração com diferentes teores da micotoxina. Foram utilizados 960 alevinos, em dois experimentos, o primeiro com duração de 45 dias e o segundo com 35 dias. As instalações experimentais foram compostas por um sistema termorregulado de recirculação de água. No primeiro experimento, foram avaliados os teores de 41, 90 e 204 ppb de aflatoxinas kg-1 de alimento e no segundo experimento, 350, 757 e 1.177 ppb de aflatoxinas kg-1 de alimento. Foram estimados os seguintes parâmetros: peso médio, comprimento total e padrão, rendimento de carcaça, fator de condição, ganho diário, sobrevivência e deposição de aflatoxinas no fígado e na carcaça. Observou-se, no primeiro experimento, diminuição do peso e comprimento dos peixes alimentados com 204 ppb aflatoxinas kg-1. No segundo experimento, não ocorreu diferença significativa nas variáveis analisadas. A partir de 350 ppb kg-1, ocorreram alterações no fígado e tecidos, sem comprometer o crescimento, durante os 35 dias.

Geoepidemiology of autoimmune hemolytic anemia.

Autoantibodies against red blood cell antigens are considered the diagnostic hallmark of AIHA: Direct antiglobulin test (DAT) completed by cytofluorometry and specific diagnostic monoclonal antibodies (mAbs) allow for a better understanding of autoimmune hemolytic anemia (AIHA) triggers. Once B-cell tolerance checkpoints are bypassed, the patient loses self-tolerance, if the AIHA is not also caused by an possible variety of secondary pathogenic events such as viral, neoplastic and underlying autoimmune entities, such as SLE or post-transplantation drawbacks; treatment of underlying diseases in secondary AIHA guides ways to curative AIHA treatment. The acute phase of AIHA, often lethal in former times, if readily diagnosed, must be treated using plasma exchange, extracorporeal immunoadsorption and/or RBC transfusion with donor RBCs devoid of the auto-antibody target antigen. Genotyping blood groups (www.bloodgen.com) and narrowing down the blood type subspecificities with diagnostic mAbs help to define the triggering autoantigen and to select well compatible donor RBC concentrates, which thus escape recognition by the autoantibodies.

MCL1 is deregulated in subgroups of diffuse large B-cell lymphoma.

Myeloid cell leukemia-1 (MCL1) is an anti-apoptotic member of the BCL2 family that is deregulated in various solid and hematological malignancies. However, its role in the molecular pathogenesis of diffuse large B-cell lymphoma (DLBCL) is unclear. We analyzed gene expression profiling data from 350 DLBCL patient samples and detected that activated B-cell-like (ABC) DLBCLs express MCL1 at significantly higher levels compared with germinal center B-cell-like DLBCL patient samples (P=2.7 × 10(-10)). Immunohistochemistry confirmed high MCL1 protein expression predominantly in ABC DLBCL in an independent patient cohort (n=249; P=0.001). To elucidate molecular mechanisms leading to aberrant MCL1 expression, we analyzed array comparative genomic hybridization data of 203 DLBCL samples and identified recurrent chromosomal gains/amplifications of the MCL1 locus that occurred in 26% of ABC DLBCLs. In addition, aberrant STAT3 signaling contributed to high MCL1 expression in this subtype. Knockdown of MCL1 as well as treatment with the BH3-mimetic obatoclax induced apoptotic cell death in MCL1-positive DLBCL cell lines. In summary, MCL1 is deregulated in a significant fraction of ABC DLBCLs and contributes to therapy resistance. These data suggest that specific inhibition of MCL1 might be utilized therapeutically in a subset of DLBCLs.

Structure of intracellular mature vaccinia virus observed by cryoelectron microscopy.

Intracellular mature vaccinia virus, also called intracellular naked virus, and its core envelope have been observed in their native, unfixed, unstained, hydrated states by cryoelectron microscopy of vitrified samples. The virion appears as a smooth rounded rectangle of ca. 350 by 270 nm. The core seems homogeneous and is surrounded by a 30-nm-thick surface domain delimited by membranes. We show that surface tubules and most likely also the characteristic dumbbell-shaped core with the lateral bodies which are generally observed in negatively stained or conventionally embedded samples are preparation artifacts.

La sucesión en los bosques de Pinus uncinata del Pirineo. De los anillos de crecimiento a la historia del bosque

El patrón de sucesión a largo plazo en los bosques subalpinos de Pinus uncinata y su relación con el régimen de perturbaciones al que se ven sometidos se analizan aquí, tomando como referencia el modelo de sucesión de PEET & CHRISTENSEN (1987). Por métodos dendrocronológicos, utilizando datos de árboles vivos y muertos, se han reconstruido los últimos 140-220 años de la historia de tres bosques suficientemente viejos y poco alterados, al menos recientemente, por el hombre. Los resultados ponen de manifiesto ciertas regularidades importantes en la secuencia y en la duración de las fases de la sucesión observadas en la escala espacial que nos permite el muestreo realizado (un transecto lineal de 280-350 metros. De una larga fase de iniciación (110140 años) se pasa casi directamente a una fase de transición, con escasa evidencia de una fase intermedia de exclusión. Este patrón de sucesión, causado por la lentitud y la heterogeneidad espacial de la fase de iniciación y por un régimen de pequeñas perturbaciones dispersas y frecuentes que aparecen muy pronto, es similar al observado en otros bosques subalpinos y ambientes extremos y representa una desviación respecto del modelo de referencia. La tasa media de mortalidad natural de los áboles adultos durante las últimas 4-6 décadas ha sido, respectivamente para los tres bosques, de 6,2, 1,4 y 5,7% por década. Estas tasas son lo sufientemente bajas como para permitir una larga persistencia en la fase de transición de la cohorte dominante - la instalada durante la fase de iniciación -, en declive pero al mismo tiempo inhibiendo la aparición masiva de regeneración. Ello hace previsible una dinámica de la estructura y la funcionalidad del bosque muy fluctuante a largo plazo en la escala espacial estudiada, aunque en su origen puede encontrarse la mano del hombre a través de una perturbación inicial homogeneizadora

Early Strengths of Class F, C, and B Portland Cement Concrete, MLR-87-07, 1987

Fast track concrete has proven to be successful in obtaining high early strengths. This benefit does not come without cost. Type III cement and insulation blankets to accelerate the cure add to its expense when compared to conventional paving. This research was intended to determine the increase in time required to obtain opening strength when a fast track mix utilized conventional Type I cement and also used a conventional cure. Standard concrete mixes also were tested to determine the acceleration of strength gain when cured with insulation blankets. The goal was to determine mixes and procedures which would result in a range of opening times. This would allow the most economical design for a particular project and tailor it to that projects time restraint. Three mixes were tested: Class F, Class C, and Class B. Each mix was tested with one section being cured with insulation blankets and another section without. All used Type I cement. Iowa Department of Transportation specifications required 500 psi of flexural strength before a pavement can be opened to traffic. The Class F mix with Type I cement and using insulation blankets reached that strength in approximately 36 hours, the Class C mix using the blankets in approximately 48 hours, and the Class F mix without covers in about 60 hours. (Note: Class F concrete pavement is opened at 400 psi minimum and Class F bonded overlay pavement at 350 psi.) The results showed a significant improvement in early strength gain by the use of insulation blankets. The Type I cement could be used in mixes intended for early opening with sacrifices in time when compared to fast track but are still much sooner than conventional pavement. It appears a range of design alternatives is possible using Type I cement both with and without insulating blankets.

Effectiveness of Electrochemical Chloride Extraction for the Iowa Avenue Pedestrian Bridge, TR-499, 2005

The main objective of this study is to determine the effectiveness of the Electrochemical Chloride Extraction (ECE) technique on a bridge deck with very high concentrations of chloride. This ECE technique was used during the summer of 2003 to reverse the effects of corrosion, which had occurred in the reinforcing steel embedded in the pedestrian bridge deck over Highway 6, along Iowa Avenue, in Iowa City, Iowa, USA. First, the half cell potential was measured to determine the existing corrosion level in the field. The half-cell potential values were in the indecisive range of corrosion (between -200 mV and -350 mV). The ECE technique was then applied to remove the chloride from the bridge deck. The chloride content in the deck was significantly reduced from 25 lb/cy to 4.96 lb/cy in 8 weeks. Concrete cores obtained from the deck were measured for their compressive strengths and there was no reduction in strength due to the ECE technique. Laboratory tests were also performed to demonstrate the effectiveness of the ECE process. In order to simulate the corrosion in the bridge deck, two reinforced slabs and 12 reinforced beams were prepared. First, the half-cell potentials were measured from the test specimens and they all ranged below -200 mV. Upon introduction of 3% salt solution, the potential reached up to -500 mV. This potential was maintained while a salt solution was being added for six months. The ECE technique was then applied to the test specimens in order to remove the chloride from them. Half-cell potential was measured to determine if the ECE technique can effectively reduce the level of corrosion.