Preoperative T staging of advanced gastric cancer using double contrast-enhanced ultrasound

PURPOSE

To determine the accuracy of double contrast-enhanced ultrasound (DCEUS), in which intravenous microbubbles are used together with an oral contrast agent, in the preoperative T staging of advanced gastric cancer.

MATERIALS AND METHODS

This prospective, ethics committee-approved study recruited 350 patients who gave informed consent. All had gastric cancer proved by endoscopic biopsy and underwent preoperative ultrasound staging using the TNM classification (UICC 2002). The results of DCEUS were compared with postoperative pathologic findings. The staging accuracy of oral contrast-enhanced ultrasound (OCEUS) and DCEUS were compared to each other. Sensitivity and specificity for assessing serosal involvement by DCEUS were evaluated, and the concordance of this method was analyzed using Kappa statistics.

RESULTS

The accuracies of OCEUS and DCEUS in determining the T stage of advanced gastric cancer were 75.1 % (70.4 % for T2, 79.5 % for T3, 68.1 % for T4) and 87.4 % (83.3 % for T2, 89.7 % for T3, 87.2 % for T4), respectively, and the difference between the two methods was statistically significant (χ2 = 17.364, p< 0.001). The performance of DCEUS for staging lesions in the cardia (69.81 %), fundus (85.71 %) and body (85.56 %) had lower accuracy than that of other parts (93.94 % for antrum; 92.11 % for pylorus). Sensitivity and specificity for assessing serosal involvement by DCEUS were 98.76 % and 83.33 % respectively. The reliability was almost perfect with Kappa values of 0.89 (p< 0.001) for intra-observer and 0.82 (p< 0.001) for inter-observer agreement.

CONCLUSION

DCEUS could be considered as an accurate, non-invasive, and reliable diagnostic method for preoperative staging of advanced gastric cancer.

Cytokines induced by long-term potentiation (LTP) recording: a potential explanation for the lack of correspondence between learning/memory performance and LTP

The relationship between learning/memory performance and long-term potentiation (LTP) induction is ambiguous. Although a large body of data supports a strong correspondence between learning/memory performance and LTP, many studies have also provided evidence to the contrary. In this study, we found that 2-month-old senescence-accelerated mice/prone 8 (SAMP8 mice) displayed both impaired performance in a Morris Water Maze (MWM) and enhanced LTP compared to senescence-accelerated mice/resistance 1 (SAMR1). BALB/c mice challenged with Complete Freund's Adjuvant (CFA) performed better in the shuttle-box test but displayed impaired LTP compared to intact animals. It is interesting that BALB/c mice challenged with Incomplete Freund's Adjuvant (IFA) performed better than intact animals, with no LTP impairment. Cytokine analysis showed no significant differences between the interleukin-6 (IL-6), interleukin-10 (IL-10) or TNF-α content in the intact hippocampal tissues of either the SAMR1 and SAMP8 mice or the immune-challenged BALB/c and intact animals. Further analysis demonstrated that the increase in cytokine content was higher in the hippocampal tissues used for LTP recording in the SAMR1 and CFA-challenged animals compared to the SAMP8 and intact BALB/c mice. A correlation analysis demonstrated that pro-inflammatory cytokines (IL-6 and TNF-α) displayed a negative correlation with LTP, while an anti-inflammatory cytokine (IL-10) displayed a positive correlation with LTP. These results suggest that pro-inflammatory cytokines induced by LTP manipulation in experiments (e.g., via tissue injury caused by electrode insertion) may be one of the factors contributing to the observed lack of correspondence between memory/learning ability and LTP.

Impact of atomic structure on the magnon dispersion relation: a comparison between Fe(111)/Au/W(110) and Fe(110)/W(110)

We present a combined experimental and theoretical study of the interplay between the atomic structure and the magnon excitations in low dimensional ferromagnets. Two monolayer thick Fe films on W(110) with and without a Au buffer layer are investigated. Our experiments show that adding the Au layer leads to a significant softening of the magnons. First-principles calculations confirm the experimental results revealing a strong dependency of exchange interactions on the atomic structure. It is observed that the intralayer exchange interactions increase with increasing distance between Fe layers. This unusual relationship is attributed to the complexity of the electronic structure and the contribution of different orbitals to the hybridization and exchange interaction. Our results suggest a way of tailoring magnetic excitations in low-dimensional magnetic structures.

Elevated serum concentrations of inflammatory cytokines and chemokines in patients with haemorrhagic fever with renal syndrome

OBJECTIVE

Prospective case-control study, undertaken to investigate serum cytokine and chemokine concentrations during all clinical phases and in different clinical types of haemorrhagic fever with renal syndrome (HFRS).

METHODS

Serum was collected at various disease phases from patients with HFRS (n = 35) and healthy control subjects (n = 10). Tumour necrosis factor (TNF)-α, interleukin (IL)-6, IL-4, interferon (IFN)-γ, IL-8, interferon inducible protein-10 (IP-10) and chemokine (C-C motif) ligand 5 (also known as 'regulated upon activation, normal T-cell expressed and secreted' [RANTES]) were quantified using commercial enzyme-linked immunosorbent assay kits.

RESULTS

Serum concentrations of TNF-α, IL-6, IFN-γ, IL-8, IP-10 and RANTES (but not IL-4) were significantly higher in patients compared with controls. Highest concentrations were generally found during the febrile, hypotensive and oliguric disease phases, as well as in clinically severe and critical cases.

CONCLUSION

Serum concentrations of proinflammatory cytokines and chemokines increased in line with disease severity in HFRS patients.

Spin fluctuations of paramagnetic Rh clusters revealed by x-ray magnetic circular dichroism

The magnetic moment induced on Rh atoms, forming 1.6 nm average diameter clusters, embedded in an Al(2)O(3) matrix, has been determined using x-ray magnetic circular dichroism measurements. The magnetic moment varies linearly with the applied magnetic field. At 2.3 K and under 17 T, the spin magnetic moment amounts to 0.067(2) μ(B)/Rh atom. The orbital moment does not exceed 2% of the spin moment. The susceptibility is highly temperature dependent. This is in agreement with a prediction due to Moriya and Kawabata, that in itinerant electron systems, close to the onset of magnetism, the renormalization of the magnetic susceptibility by electron correlations, leads to a Curie-like behavior.

Severity of portal hypertension and prediction of postoperative liver failure after liver resection in patients with Child–Pugh grade A cirrhosis

Background

Patients with Child–Pugh grade A cirrhosis and clinical evidence of portal hypertension are likely to develop posthepatectomy liver failure (PHLF). Whether such patients are suitable candidates for partial hepatectomy is controversial. This study explored the impact of portal venous pressure (PVP) on PHLF and the possibility of stratifying patients with Child–Pugh grade A cirrhosis for risk of PHLF using clinical data alone.

Methods

Between April 2009 and May 2011, consecutive patients who underwent partial hepatectomy for hepatocellular carcinoma and intraoperative measurement of PVP were included in this prospective study. Using signs of clinically significant portal hypertension (CSPH), patients with Child–Pugh grade A cirrhosis were subclassified into three groups: no, mild and severe CSPH. Risk factors for PHLF were subjected to univariable and multivariable analysis, and receiver operating characteristic (ROC) curve analysis.

Results

Sixty-seven (35·3 per cent) of 190 patients developed PHLF, which was persistent in 12 patients (6·3 per cent). Four patients (2·1 per cent) died from PHLF within 3 months of surgery. Multivariable analysis showed both PVP and CSPH to be independent predictors of PHLF (P &lt; 0·001). PVP values, incidence of PHLF and persistent PHLF were significantly higher in the severe CSPH group than in the other two groups (P &lt; 0·001). Severe CSPH (odds ratio 27·68, P = 0·005) and a preoperative neutrophil : lymphocyte ratio (NLR) of 2·8 or above (odds ratio 49·75, P = 0·002) were independent factors affecting the incidence of persistent PHLF.

Conclusion

The severity of CSPH, corresponding to different PVP levels, could be used to stratify patients with Child-Pugh grade A cirrhosis and to predict the incidence of PHLF. Patients with severe CSPH or a NLR of 2·8 or above were more likely to develop persistent PHLF after partial hepatectomy.

Data-driven order set generation and evaluation in the pediatric environment

Order sets as part of the Computerized Provider Order Entry (CPOE) system can improve care delivery through allowing faster and easier physician order entry guided by known best practices. This study examines current utilization patterns of order sets and "a la carte" orders in a pediatric environment with a preliminary investigation of methods to automate the creation and modification of order sets using historical ordering data. We examine the current usage of order sets associated with Asthma Minor and Appendectomy Minor patients to understand how physicians are utilizing order sets, and how order set usage is associated with the time of ordering and characteristics of order sets. K-means clustering was applied to orders to generate evidence-based order sets that are learned from historical hospital data. We demonstrate that coverage rate of order sets and ordering efficiency can be increased through modifications of existing sets and creation of new sets.

Second-harmonic generation in a laterally azo-bridged trimer ferroelectric liquid crystal: phase matching in the presence of a helicoidal structure

Optical second-harmonic generation (SHG) has been studied in a trimer smectic C* liquid crystal especially designed for nonlinear optical applications. The molecule has a long conjugated donor-acceptor unit that transversally links three parallel rod-shaped moieties. A strong SHG signal has been observed at a fundamental wavelength of 1369 nm even in the presence of the spontaneous helicoidal structure of the smectic C* phase. This unusual behavior has been interpreted as due to the existence of phase matching, in which the wave vector mismatch is compensated by the wave vector of the helix. This point has been confirmed by the study of the SHG intensity versus sample thickness and light polarization characteristics. The main coefficient of the second-order susceptibility tensor of the material has been estimated to be d(22) = 28 pm/V.

Observation of excited Λ(b)(0) baryons

Using pp collision data corresponding to 1.0 fb(-1) integrated luminosity collected by the LHCb detector, two narrow states are observed in the Λ(b)(0)π(+)π(-) spectrum with masses 5911.97±0.12(stat)±0.02(syst)±0.66(Λ(b)(0) mass) MeV/c(2) and 5919.77±0.08(stat)±0.02(syst)±0.66(Λ(b)(0) mass) MeV/c(2). The significances of the observations are 5.2 and 10.2 standard deviations, respectively. These states are interpreted as the orbitally excited Λ(b)(0) baryons, Λ(b)(*0)(5912) and Λ(b)(*0)(5920).

Evidence for the direct two-photon transition from ψ(3686) to J/ψ

The two-photon transition ψ(3686)→γγJ/ψ is studied in a sample of 1.06×10(8) ψ(3686) decays collected by the BESIII detector. The branching fraction is measured to be (3.1±0.6(stat)(-1.0)(+0.8)(syst))×10(-4) using J/ψ→e(+)e(-) and J/ψ→μ(+)μ(-) decays, and its upper limit is estimated to be 4.5×10(-4) at the 90% confidence level. This work represents the first measurement of a two-photon transition among charmonium states. The orientation of the ψ(3686) decay plane and the J/ψ polarization in this decay are also studied. In addition, the product branching fractions of sequential E1 transitions ψ(3686)→γχ(cJ) and χ(cJ)→γJ/ψ(J=0,1,2) are reported.