Custom Repair of Mandibular Bone Defects with 3D Printed Bioceramic Scaffolds

Implanting artificial biomaterial implants into alveolar bone defects with individual shape and appropriate mechanical strength is still a challenge. In this study, bioceramic scaffolds, which can precisely match the mandibular defects in macro and micro, were manufactured by the 3-dimensional (3D) printing technique according to the computed tomography (CT) image. To evaluate the stimulatory effect of the material substrate on bone tissue regeneration in situ in a rabbit mandibular alveolar bone defect model, implants made with the newly developed, mechanically strong ~10% Mg-substituted wollastonite (Ca_90%Mg_10%SiO₃; CSi-Mg10) were fabricated, implanted into the bone defects, and compared with implants made with the typical Ca-phosphate and Ca-silicate porous bioceramics, such as β-tricalcium phosphate (TCP), wollastonite (CaSiO₃; CSi), and bredigite (Bred). The initial physicochemical tests indicated that although the CSi-Mg10 scaffolds had the largest pore dimension, they had the lowest porosity mainly due to the significant linear shrinkage of the scaffolds during sintering. Compared with the sparingly dissolvable TCP scaffolds (~2% weight loss) and superfast dissolvable (in Tris buffer within 6 wk) pure CSi and Bred scaffolds (~12% and ~14% weight loss, respectively), the CSi-Mg10 exhibited a mild in vitro biodissolution and moderate weight loss of ~7%. In addition, the CSi-Mg10 scaffolds showed a considerable initial flexural strength (31 MPa) and maintained very high flexural resistance during soaking in Tris buffer. The in vivo results revealed that the CSi-Mg10 scaffolds have markedly higher osteogenic capability than those on the TCP, CSi, and Bred scaffolds after 16 wk. These results suggest a promising potential application of customized CSi-Mg10 3D robocast scaffolds in the clinic, especially for repair of alveolar bone defects.

The productions of atrial natriuretic peptide and arginine vasopressin in small cell lung cancer with brain metastases and their associations with hyponatremia

OBJECTIVE

Hyponatremia is one of the most frequently encountered electrolyte disorder in small cell lung cancer (SCLC) patients. It was shown that some SCLC cell lines could produce atrial natriuretic peptide (ANP) and arginine vasopressin (AVP). The aim of the study was to assess the secretion of ANP, AVP and their relative contributions to hyponatremia in SCLC patients, especially in patients with brain metastases.

PATIENTS AND METHODS

In total, 194 SCLC patients including 51 patients with brain metastases were collected. The levels of ANP and AVP were measured with radioimmunoassay kits. And then their associations with serum sodium were investigated. The progression-free survival (PFS) was compared between the hyponatremia group and the normal serum sodium group.

RESULTS

Serum sodium was negatively correlated with the plasma levels of ANP (r=-0.171, p=0.017) and AVP (r = -0.244, p=0.001) in all SCLC patients. In the brain metastatic subgroup, there was also a negative correlation between serum sodium and ANP (r=-0.399, p=0.004), while there was no correlation between serum sodium and AVP (r=-0.232, p=0.101). The occurrence rate of hyponatremia (serum sodium values below 135 mmol/l) in patients with brain metastases (21/51, 41.18%) was higher than that in patients without brain metastases (37/143, 25.87%) (p=0.040). The progression-free survival (PFS) in the hyponatremia group was significantly shorter than that in patients of the group without hyponatremia (p=0.010). Moreover, compared with patients which regained normal serum sodium after the treatment, the PFS of patients still with hyponatremia after the treatment was significantly shorter (p=0.049).

CONCLUSIONS

ANP might play a leading role in the formation of hyponatremia of SCLC patients with brain metastases. Correcting hyponatremia timely and appropriately could improve SCLC patients' prognosis.

A generalisable methodology for stability assessment of walking aid users

To assist balance and mobility, older adults are often prescribed walking aids. Nevertheless, surprisingly their use has been associated with increased falls-risk. To address this finding we first need to characterise a person's stability while using a walking aid. Therefore, we present a generalisable method for the assessment of stability of walking frame (WF) users. Our method, for the first time, considers user and device as a combined system. We define the combined centre of pressure (CoP_system) of user and WF to be the point through which the resultant ground reaction force for all feet of both the WF and user acts if theresultant moment acts only around an axisperpendicular tothe ground plane. We also define the combined base of support (BoS_system) to be the convex polygon formed by the boundaries of the anatomical and WF feet in contact with the ground and interconnecting lines between them. To measure these parameters we have developed an instrumented WF with a load cell in each foot which we use together with pressure-sensing insoles and a camera system, the latter providing the relative position of the WF and anatomical feet. Software uses the resulting data to calculate the stability margin of the combined system, defined as the distance between CoP_system and the nearest edge of BoS_system. Our software also calculates the weight supported through the frame and when each foot (of user and/or frame) is on the floor. Finally, we present experimental work demonstrating the value of our approach.

Differential gene expression in the peripheral blood of Chinese Sanhe cattle exposed to severe cold stress

Livestock is an important food resource for the inhabitants of cold regions, such as northern Asia and alpine regions, where agriculture is limited. In these regions, cold stress largely affects livestock production, thereby reducing the productivity and survival of animals. Despite the importance of breeding cold-tolerant animals, few studies have investigated the effects of cold stress on cattle. Furthermore, whether severe cold stress alters gene expression or affects molecular genetic mechanisms remains unknown. Thus, we investigated gene expression changes in the peripheral blood samples of the Chinese Sanhe cattle exposed to severe cold. A total of 193 genes were found to exhibit significant alteration in expression (P < 0.05; fold change > 1.3), with 107 genes showing upregulation and 86 showing downregulation after cold exposure. The differences in the expression of 10 selected genes were further validated by real-time qRT-PCR. Further analyses showed that these differentially expressed genes (DEGs) were predominantly associated with important biological pathways and gene networks, such as lipid metabolism and cell death and survival, which are potentially associated with severe cold-stress resistance. Identification and description of these cold stress-induced DEGs might lead to the discovery of novel blood biomarkers that could be used to assess cold-stress resistance in cattle. To our knowledge, this is the first genomic evidence of differences in the transcript expression pattern in cattle exposed to severe cold stress. Our findings provide insights on the potential molecular mechanisms underlying cold-stress response in cattle.

Characterization of slow cycling corneal limbal epithelial cells identifies putative stem cell markers

In order to identify reliable markers of corneal epithelial stem cells, we employed an inducible transgenic “pulse-chase” murine model (K5Tta × TRE-H2BGFP) to localize, purify, and characterize slow cycling cells in the cornea. The retention of GFP labeling in slowly dividing cells allowed for localization of these cells to the corneal limbus and their subsequent purification by FACS. Transcriptome analysis from slow cycling cells identified differentially expressed genes when comparing to GFP^- faster-dividing cells. RNA-Seq data from corneal epithelium were compared to epidermal hair follicle stem cell RNA-Seq to identify genes representing common putative stem cell markers or determinants, which included Sox9, Fzd7, Actn1, Anxa3 and Krt17. Overlapping retention of GFP and immunohistochemical expression of Krt15, ΔNp63, Sox9, Actn1, Fzd7 and Krt17 were observed in our transgenic model. Our analysis presents an array of novel genes as putative corneal stem cell markers.

Quercetin alleviates pulmonary angiogenesis in a rat model of hepatopulmonary syndrome

Quercetin shows protective effects against hepatopulmonary syndrome (HPS), as demonstrated in a rat model. However, whether these effects involve pulmonary vascular angiogenesis in HPS remains unclear. Therefore, this study aimed to assess the effect of quercetin on pulmonary vascular angiogenesis and explore the underlying mechanisms. Male Sprague-Dawley rats weighing 200-250 g underwent sham operation or common bile duct ligation (CBDL). Two weeks after surgery, HIF-1α and NFκB levels were assessed in rat lung tissue by immunohistochemistry and western blot. Then, CBDL and sham-operated rats were further divided into 2 subgroups each to receive intraperitoneal administration of quercetin (50 mg/kg daily) or 0.2% Tween for two weeks: Sham (Sham+Tween; n=8), CBDL (CBDL+Tween; n=8), Q (Sham+quercetin; n=8), and CBDL+Q (CBDL+quercetin; n=8). After treatment, lung tissue specimens were assessed for protein (immunohistochemistry and western blot) and/or gene expression (quantitative real-time PCR) levels of relevant disease markers, including VEGFA, VEGFR2, Akt/p-Akt, HIF-1α, vWf, and IκB/p-IκB. Finally, arterial blood was analyzed for alveolar arterial oxygen pressure gradient (AaPO₂). Two weeks after CBDL, HIF-1α expression in the lung decreased, but was gradually restored at four weeks. Treatment with quercetin did not significantly alter HIF-1α levels, but did reduce AaPO₂ as well as lung tissue NF-κB activity, VEGFA gene and protein levels, Akt activity, and angiogenesis. Although hypoxia is an important feature in HPS, our findings suggest that HIF-1α was not the main cause for the VEGFA increase. Interestingly, quercetin inhibited pulmonary vascular angiogenesis in rats with HPS, with involvement of Akt/NF-κB and VEGFA/VEGFR-2 pathways.

Variation of rDNA Internal Transcribed Spacer Sequences in Rhizoctonia cerealis

Fifty-four single protoplast isolates (SPIs) were regenerated from three Rhizoctonia cerealis strains. A total of 169 rDNA-ITS regions were cloned and sequenced from these 54 SPIs. Variations in the ITS1 and ITS2 regions that flank the 5.8S gene were found within clones from the same strain, as well as within clones from the same SPI. These include variations in GC content and ITS length, and single-nucleotide polymorphisms (SNPs). The different strains and SPIs GC contents range from 40.25 to 41.74% and from 42.40 to 45.02%, in the ITS1 and ITS2 regions, respectively. All SNPs occur in the ITS1 and ITS2 regions, with 3-6 and 4-6 polymorphic sites in each region, respectively, in the different strains. SNP variation is relatively stable within the same strain. For example, the 89 ITS sequences generated from isolate WK-207, regardless of SPI or clone, predominantly cluster into two separate clades on a phylogenetic tree, suggesting that nuclei genetic heterogeneity is related to ITS variation in R. cerealis. Although rDNA-ITS sequences from the three strains and different SPIs are somewhat variable, all of our ITS sequences cluster together in anastomosis subgroup AG-DI during phylogenetic analysis. The ITS variation we observed does not negatively influence R. cerealis anastomosis group or subgroup classification.

INTU is essential for oncogenic Hh signaling through regulating primary cilia formation in basal cell carcinoma

Inturned (INTU), a cilia and planar polarity effector (CPLANE), performs prominent ciliogenic functions during morphogenesis, such as in the skin. INTU is expressed in adult tissues but its role in tissue maintenance is unknown. Here, we report that the expression of the INTU gene is aberrantly elevated in human basal cell carcinoma (BCC), coinciding with increased primary cilia formation and activated hedgehog (Hh) signaling. Disrupting Intu in an oncogenic mutant Smo (SmoM2)-driven BCC mouse model prevented the formation of BCC through suppressing primary cilia formation and Hh signaling, suggesting that Intu performs a permissive role during BCC formation. INTU is essential for IFT-A complex assembly during ciliogenesis. To further determine whether Intu is directly involved in the activation of Hh signaling downstream of ciliogenesis, we examined the Hh signaling pathway in mouse embryonic fibroblasts, which readily respond to Hh pathway activation. Depleting Intu blocked SAG-induced Hh pathway activation, whereas the expression of Gli2ΔN, a constitutively active Gli2, restored Hh pathway activation in Intu-deficient cells, suggesting that INTU functions upstream of Gli2 activation. In contrast, overexpressing Intu did not promote ciliogenesis or Hh signaling. Taken together, data obtained from this study suggest that INTU is indispensable during BCC tumorigenesis and that its aberrant upregulation is likely a prerequisite for primary cilia formation during Hh-dependent tumorigenesis.

Leptin levels in patients with systemic lupus erythematosus inversely correlate with regulatory T cell frequency

Leptin levels are increased in patients with systemic lupus erythematosus (SLE) but little is known on how this correlates with several disease characteristics including the frequency of regulatory T cells (Tregs). Here we compared serum leptin levels with frequency of circulating Tregs in 47 lupus patients vs. 25 healthy matched controls. Correlations with lupus disease activity were also analyzed, as well as Treg proliferation potential. It was found that leptin was remarkably increased in SLE patients as compared to controls, particularly in SLE patients with moderate and severe active SLE, and the increase correlated with disease activity. Importantly, increased leptin in lupus patients inversely correlated with the frequency of Tregs but not in controls, and leptin neutralization resulted in the expansion of Tregs ex vivo. Thus, hyperleptinemia in lupus patients correlates directly with disease activity and inversely with Treg frequency. The finding that leptin inhibition expands Tregs in SLE suggests possible inhibition of this molecule for an enhanced Treg function in the disease.

Reduction of hypoglycaemic events with a behavioural intervention: a randomized clinical trial for paediatric patients with Type 1 diabetes mellitus

AIMS

To determine if a low-intensity, clinic-integrated behavioural intervention reduced the incidence of hypoglycaemic events in children with Type 1 diabetes.

METHODS

A total of 390 families with children with Type 1 diabetes were enrolled in a 2-year, randomized clinical trial of a behavioural intervention. The intervention was designed to improve diabetes management practices by targeting the family's diabetes problem-solving skills. Hypoglycaemic events were categorized in two groups: those treated by oral ingestion and those treated by parenteral therapy. Events were self-reported by participants at each clinic visit, which occurred approximately every 3-4 months. Analyses included two-sample t-tests, the mean cumulative function test, and the Cox proportional hazards model for recurrent events to compare the incidence between groups.

RESULTS

Across the entire 2-year study period, the incidence of hypoglycaemic events treated by oral ingestion of glucose-rich foods and events requiring parenteral therapy did not significantly differ between study conditions; however, during the second year of participant enrolment, the incidence of events treated by oral ingestion in the intervention group was 13.6 per 100 person-years compared with 27.3 per 100 patient-years in the control group (P = 0.02). The hazard ratio of these events during the second year was 0.49 (95% CI 0.27-0.90; P = 0.02).

CONCLUSIONS

Our findings suggest the need for a long-term (> 1 year) focus on the implementation of interventions targeting diabetes management in young people. Behavioural interventions targeting problem-solving skills could be considered as practical, non-pharmacological strategies to reduce hypoglycaemia in adolescents with Type 1 diabetes.

Replacement of quaternary ammonium headgroups by tri-ornithine in cationic lipids for the improvement of gene delivery in vitro and in vivo

Replacement of quaternary ammonium headgroups by tri-ornithine in lipids improved gene delivery in vitro and in vivo with little toxicity.

Construction of core-shell hybrid nanoparticles templated by virus-like particles

Catalytically active gold in silica core–shell nanoparticles are prepared by pH controlled templating on virus-like particles.

Nonlinear Transition from Mitigation to Suppression of the Edge Localized Mode with Resonant Magnetic Perturbations in the EAST Tokamak

Evidence of a nonlinear transition from mitigation to suppression of the edge localized mode (ELM) by using resonant magnetic perturbations (RMPs) in the EAST tokamak is presented. This is the first demonstration of ELM suppression with RMPs in slowly rotating plasmas with dominant radio-frequency wave heating. Changes of edge magnetic topology after the transition are indicated by a gradual phase shift in the plasma response field from a linear magneto hydro dynamics modeling result to a vacuum one and a sudden increase of three-dimensional particle flux to the divertor. The transition threshold depends on the spectrum of RMPs and plasma rotation as well as perturbation amplitude. This means that edge topological changes resulting from nonlinear plasma response plays a key role in the suppression of ELM with RMPs.

Change in serum TSH levels within the reference range was associated with variation of future blood pressure: a 5-year follow-up study

Controversy exists on the relationship between serum thyrotropin (TSH) and blood pressure, and only a few prospective studies are available up to now. The study aimed to investigate the association between serum TSH within the reference range and blood pressure through a 5-year follow-up study. A total of 623 subjects with normal TSH were followed up for 5 years, including the measurement of demographic data, blood pressure, height, weight and serum TSH. Finally, 531 subjects were included in this prospective study. Body mass index (BMI), prevalence of hypertension, and systolic and diastolic blood pressure were all higher at follow-up than at baseline. Adjusted for age, gender, smoking status, BMI and homoeostasis model assessment of insulin resistance (HOMA-IR) at baseline, multiple linear regression analyses found no relationship between serum TSH at baseline and levels of blood pressure at follow-up, but the changes in serum TSH levels during follow-up was positively associated with the changes in systolic blood pressure (B=2.134, P<0.05), which became more significant in women but not significant in men. The change of systolic blood pressure in group of TSH increase >0.5 mIU l^-1 was significantly higher than in group of TSH decrease >0.5 mIU l^-1 within reference, after adjusting for age, gender, smoking status, BMI and HOMA-IR at baseline. This result became more significant in women, but no statistical significance was observed in men. Co-variation with serum TSH levels and blood pressure was observed during 5-year follow-up among people with normal TSH.

RELAP5 investigation on subchannel flow instability

Two-phase flow instability is a vitally important area of study for a large number of industrial systems. Density Wave Oscillation (DWO) is the most common type of flow instability caused by the change in flow rate or power in boiling systems. The code RELAP5 is used to simulate single channel, 2 × 2 subchannels, and 3 × 3 subchannels with typical BWR subchannel geometry. The onset of flow instability determinating criterion and the results of simulations are utilized to create a stable boundary. The stable boundary of a single channel is compared with those from results of other researchers. Some conclusions are made as follows. 3 × 3 subchannels are more stable than single channel and 2 × 2 subchannels. Open subchannels possess a larger stable region than close channels. The heating model is analyzed determining that asymmetrical heating has negative effect on stability as compared to symmetric heating. With the analysis of transit time, period and subcooling number, there is a positive linear relationship between the subcooling number and oscillation period.

Does physical function impact the acceptability of routine patient-reported outcome surveys in cancer patients?

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Background: Patient-reported outcome measures (PROMs) are used to collect cancer-related symptom and symptomatic toxicity data. Understanding factors that affect the acceptability of PROMs is useful for improving the participation of such routine screening practices. We investigated the association between patient’s functional status on their acceptance and perception of usefulness of tablet technology to routine collection of PROM data in the clinical setting. Methods: 279 adult cancer outpatients at Toronto’s Princess Margaret Cancer Centre completed two physical function surveys, the HAQ-DI and WHODAS, using touchscreen tablet technology. Patient socio-demographics and their willingness of completing PROMs on a routine basis were also collected. Results: The median age was 62 (range: 20–94); 50% male, and 68% Caucasian. Patients were recruited from breast (10.4%), gastrointestinal (10.4%), genitourinary (14%), gynecology (14.3%), head & neck (17.9%), hematology (17.6%), and thoracic (15.4%) cancer clinics. 87% were willing to complete the survey on a touchscreen tablet, 74% did not find it time-consuming, and 4% found completion of the survey made their clinic visit more difficult. Only 1% found the questions upsetting or distressful; however, less than 60% were willing to complete similar surveys at every visit. Being Caucasian (p = 0.015) and Canadian-born (p = 0.021) were significantly associated with acceptability of the survey on a regular basis. However, HAQ-DI and WHODAS are not significantly associated with willingness to complete PROMs regularly (p = 0.30 & p = 0.16 respectively). Conclusions: Physical function status is not associated with acceptability; however, ethnicity does play a role where Canadian-born and Caucasian patients are more likely to complete PROMs regularly. Despite this, over 40% of patients were not willing to fill in the PROMs at each visit. Socio-cultural factors may impact on patients’ perceptions of the value of routine screening; however, assessment burden may also limit willingness to complete surveys on an ongoing basis. Further research is underway to gain more insight into the limiting factors of patients to complete the survey routinely.

Identifying tools for capturing the overall experience of dyspnea in a lung cancer population: The patient’s perspective

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Background: Efficient methods of tracking dyspnea can improve quality of care. We asked lung cancer patients to assess five validated patient-reported outcome (PRO) tools and determine whether these tools captured different domains of their dyspnea experience. Methods: This cross-sectional study of adult lung cancer outpatients of all stages utilized touch screen tablets to administer five dyspnea tools (Borg severity (B), Reduced Cancer Dyspnea (R), Breathlessness intensity (I), breathlessness distress (D), and MRC breathlessness (M) scales) that focused on the severity, experience, intensity, extent, and functional impairment of dyspnea, respectively. Patients were then asked whether each tool captured their dyspnea experience. Results: Of 226 lung cancer patients, 120 reported some level of dyspnea, and their responses were analyzed. Median age (range) was 67 (30-97) years; 53% were males; 37% were stage I-II; 56%, were stage III-IV. All the tools except B were completed by over 90% of patients (R 95%, I 93%, D 91%, M 91%). 71% of patients thought that M captured functional impairment well, while 58-62% of patients thought that R, S, A captured experience, intensity and distress well. B had the lowest completion rate (83%) and the lowest patient perception that is captured severity of dyspnea well (49%). Qualitative analysis suggests that most dyspnea is activity-related in this population, which would be consistent with patients favoring M (functional assessment) over B (dyspnea at present in clinic). I+D+M takes under 5 minutes to complete, whilst R takes 5+ minutes alone to complete. Conclusions: In a sample of cancer patients with high prevalence of dyspnea, patients felt four of five tools were useful in capturing various domains of their dyspnea experience. The majority of patients felt that the questions were relevant to their circumstances. I, D, M are appropriate screening tools, whilst R may be useful under specific circumstances. Our next step is the application and evaluation of self management tools in the dyspnea setting using these four tools.

A longitudinally split rabbit segmental gracilis to simulate penile erectile function: anatomic basis and animal models

OBJECTIVE

The gracilis was once applied in reconstructing erectile function but its appearance was bulky. We aimed to design a model meeting the requirements of both reducing volume and retaining function.

MATERIALS AND METHODS

The gracilis muscles of 6 rabbits were harvested, applied colorful vascular perfusion and modified Sihler's intramuscular nerve staining. According to their intramuscular nerves and blood vessels, 9 rabbit right gracilis muscles were then longitudinally split into two halves. The anterior muscle bundle was selected as the functional unit and blood supply.

RESULTS

The intramuscular nerves and vessels were simultaneously presented on a same specimen. Their relationship suggested gracilis muscle to be composed of two relatively independent subunits. The reconstructed penis survived well, simulating erectile action satisfactorily.

DISCUSSION

The penis model reconstructed with longitudinally split rabbit segmental gracilis myocutaneous flap had met the requirements of both restoring erectile function and improving the appearance.

Polysaccharide-induced apoptosis in H22 cells through G2/M arrest and BCL2/BAX caspase-activated Fas pathway

The aim of the present work was to investigate the effect and the mechanism of growth inhibition on mouse H22 hepatocarcinoma cell of ascitic tumor induced by cartilage polysaccharides (PS). Our results showed that PS prolonged the survival time of the mice and increased the life span. In addition, PS induced the apoptosis of the H22 cells with the typical apoptotic morphological and biochemical changes confirmed by HE staining and TUNEL assay. The subsequent analysis of cell cycle distribution and relevant proteins revealed that decrease of cells in G0/G1phase and a G2/M arrest might due to the down-regulation of Cyclin D1 and AFP and up-regulation of P21 proteins. Moreover, BCL2/BAX caspase-activated Fas pathway was activated in PS-induced H22 apoptosis.

Frequency-dependent learning achieved using semiconducting polymer/electrolyte composite cells

Frequency-dependent learning has been achieved using semiconducting polymer/electrolyte composite cells. The cells composed of polymer/electrolyte double layers realized the conventional spike-rate-dependent plasticity (SRDP) learning model. These cells responded to depression upon low-frequency stimulation and to potentiation upon high-frequency stimulation and presented long-term memory. The transition threshold θm from depression to potentiation varied depending on the previous stimulations. A nanostructure resembling a bio-synapse in its transport passages was demonstrated and a random channel model was proposed to describe the ionic kinetics at the polymer/electrolyte interface during and after stimulations with various frequencies, accounting for the observed SRDP.

Comparison of prevalence of pain symptoms and completion rates using a patient-reported outcomes (PRO) tool of pain in palliative and curative patients

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Background: Regular self-reporting of symptoms using validated computerized assessment tools can improve individualized symptom management. Yet there are concerns that palliative patients who may benefit most from such self-reporting may be reluctant to adopt such approaches or have barriers to proper reporting. We compared actual prevalence and completion rates of a PRO-tool between patients being managed with a palliative (PAL) or curative intent (CUR). Methods: A pain PRO-tool was administered cross-sectionally using tablet technology across outpatient clinics in a comprehensive cancer centre. Questions were adapted from the Brief Pain Inventory (BPI) and Edmonton Symptom Assessment System (ESAS), recording responses on pain severity and interference in life. PRO-tool completion rates and prevalence of pain symptoms were compared between CUR and PAL. Results: Of 200 patients, 82 were PAL and 118 were CUR; median age was 60 (21-86) years; 48% were female. A greater proportion of PAL were found with gastrointestinal, gynecological and lung cancers than CUR (p = 0.04). Each question had greater than 95% completion rates for both groups, capturing a wide range of scores. 16% of PAL reported no pain as their worst pain in the last 24 hours as opposed to 31% of CUR (p = 0.02). 82% (PAL) and 68% (CUR) reported their average pain as being at least “some pain” (p = 0.03), and there were no differences in the proportion of patients reporting interference with their general activity between PAL and CUR (p > 0.05). Presence of current pain was equivocal when assessed via the ESAS adapted question (76% PAL vs 66% CUR, p = 0.16), but was significantly different when assessed using the BPI adapted question (72% PAL vs 56% CUR; p = 0.02). Conclusions: A Pain PRO-tool was completed with similarly high rates in PAL and CUR patients. As expected, prevalence of recent and current pain was high in both groups, and in some instances, higher in PAL than CUR patients. These results suggest that a Pain PRO-tool could be implemented with ease in the palliative setting, and would capture pain comprehensively.

Are palliative patients less accepting to self-report symptom measures for clinical management than curative patients?

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Background: Patient reported outcome measures (PROMs) are a tool used for collecting patient symptom data in the clinic, prior to the patient’s appointment. Patients being treated with a palliative intent are often assumed to find completing PROM surveys more burdensome than patients being treated with a curative intent. We compared patient acceptability of palliative versus curative patients to complete PROM surveys. Methods: 202 cancer out-patients (120 curative and 82 palliative) at the Princess Margaret Cancer Centre completed a PROM survey using a touchscreen tablet regarding their symptoms of pain. Ten questions assessed patient acceptance of completing PROM surveys. Results: The median age was 60 (range 21-86) and 48% were female. There were no clinically relevant demographic differences between the palliative and curative patients; however there were a higher proportion of palliative patients than curative patients with gynecological (8.3% palliative, 16% curative), lung (5.8% palliative, 10% curative), and gastrointestinal (14% palliative, 28% curative) cancers. There were no significant differences in acceptability between palliative and curative patients (p>0.05, all 10 comparisons). Only 3.6% of palliative patients and 3.3% of curative patients reported that completing the survey made their clinic visit more difficult; 16% of palliative patients and 11% of curative patients found the survey to be time consuming; no palliative patients and only 0.83% of curative patients found the questions upsetting or distressful. 93% of palliative patients and 92% of curative patients were happy to complete the surveys on a touchscreen tablet. Overall 62% of patients surveyed were willing to complete surveys at every visit (56% palliative and 67% curative, p>0.05). Conclusions: Palliative and curative patients appear to have an equally high level of acceptance of PROM surveys, though a significant minority would have problems with completing them at every visit. Further research using mixed-methods analysis will be done to better understand the factors limiting the overall willingness of both palliative and curative patients to complete the survey on a regular basis.

Effect of hemodynamics on the recurrence of posterior communicating artery aneurysm: a computational fluid dynamics simulation study

AIM

To compare the hemodynamic characteristics of posterior communicating artery aneurysm before and after embolization and investigate its relationship with aneurysm recurrence using a computational fluid dynamics simulation study.

METHODS

Thirteen patients undergone embolization of posterior communicating artery aneurysm between January 2008 and February 2010 were enrolled and divided into recurrent and recovered group according to their follow-up angiographic data. Aneurysm models were established using three-dimensional cerebral angiography data collected before and after embolization. Preoperative and postoperative hemodynamic modalities at aneurysm neck region were analyzed with computational fluid dynamics software using the finite element algorithm. In this study, computational models were set according to transcranial Doppler pulsatile flow, and the part of aneurysm occluded by spring coil is completely independent of the blood flow.

RESULTS

In recurrent group, peak systolic wall shear stress and blood flow velocity at the aneurysm neck region were significant increased after the embolization. On the contrary, in recovered group peak systolic wall shear stress and blood flow velocity were significantly reduced after the embolization. The recurrent group also had higher post-embolization peak systolic wall shear stress and blood flow velocity than the recovered group.

CONCLUSION

High wall shear stress and blood flow velocity after embolization at the neck region of posterior communicating artery aneurysm may promote early aneurysm recurrence.