Estimation of the biomechanical mammographic deformation of the breast using machine learning models

BACKGROUND

A typical problem in the registration of MRI and X-ray mammography is the nonlinear deformation applied to the breast during mammography. We have developed a method for virtual deformation of the breast using a biomechanical model automatically constructed from MRI. The virtual deformation is applied in two steps: unloaded state estimation and compression simulation. The finite element method is used to solve the deformation process. However, the extensive computational cost prevents its usage in clinical routine.

METHODS

We propose three machine learning models to overcome this problem: an extremely randomized tree (first model), extreme gradient boosting (second model), and deep learning-based bidirectional long short-term memory with an attention layer (third model) to predict the deformation of a biomechanical model. We evaluated our methods with 516 breasts with realistic compression ratios up to 76%.

FINDINGS

We first applied one-fold validation, in which the second and third models performed better than the first model. We then applied ten-fold validation. For the unloaded state estimation, the median RMSE for the second and third models is 0.8 mm and 1.2 mm, respectively. For the compression, the median RMSE is 3.4 mm for both models. We evaluated correlations between model accuracy and characteristics of the clinical datasets such as compression ratio, breast volume, and tissue types.

INTERPRETATION

Using the proposed models, we achieved accurate results comparable to the finite element model, with a speedup of factor 240 using the extreme gradient boosting model. These proposed models can replace the finite element model simulation, enabling clinically relevant real-time application.

Kappa-carrageenan for benign preparation of CdSeNPs enhancing the electrochemical measurement of AC symmetric supercapacitor device based on neutral aqueous electrolyte

This study presents the development of an electrochemical supercapacitor with a cadmium selenide nanoparticles (CdSeNPs) electrode utilizing a straightforward and economical method based on kappa-carrageenan (κ-CGN). The structural, morphological, and optical characteristics of CdSeNPs were assessed. Activated carbon (AC) and green-prepared CdSeNPs were easily mixed to achieve excellent electrochemical properties. The nanoelectrode (AC@CdSe) was tested in an aqueous electrolyte of sodium sulfate (Na₂SO₄) with a concentration of 1 Molar. Specific capacitance (Csp) for the AC electrode and the AC@CdSe electrode at 1 A g^-1 was calculated to be 103 and 480 F g^-1, respectively. Besides, the symmetric supercapacitor AC@CdSe/AC@CdSe device has a high specific energy of 52 Wh kg^-1 and a maximum specific power of 2880 W kg^-1, with a specific capacitance of 115.5 F g^-1. With a coulombic efficiency of between 82 % and 100 %, the device continues to maintain excellent capacitance after 10.000 cycles.

Novel Vanadia/meso-Co3O4 catalysts for the conversion of benzene-toluene-xylene to environmental friendly components via catalytic oxidation

Three - dimensional meso-porous Co₃O₄ was prepared by nanocasting pathway based on the use of mesoporous silica (KIT-6) as hard template with different Cobalt concentrations (0.5-2.5 mol ratio based on mesoporous silica KIT-6). The prepared samples was used as supports for preparing V₂O₅/Co₃O₄ (1, 6 wt% of V₂O₅) catalysts. The prepared samples were characterized by different techniques. The catalytic activity of the prepared samples were evaluated in the complete oxidation reaction of toluene, benzene, and/or p-xylene; (as model reactants of volatile organic compounds) in terms of CO₂. The catalytic reaction was carried out in a fixed-bed micro-reactor operated under atmospheric pressure and within the reaction temperature range of 200-400 °C. The data confirmed that the three dimensional-mesoporous Co₃O₄ (1.0 mole ratio) replicated sample possessed improved different parameters compared to those of the Co₃O₄ sample with other mole ratios. The data reflected the yield of Co2 is decreased upon the increase in reaction temperature to 400°C. 1 wt.% V₂O₅/m-Co₃O₄ catalyst shows a reverse direction, the CO₂ yield slowly increased in the range 150-250 °C, then jumped at 300 °C until maximum yield (100%) is observed at 400 °C. 1 wt.% V₂O₅/m-Co₃O₄ catalyst was found to be the active and selective promised catalyst for the complete oxidation of either individual aromatic volatile organic compounds (benzene, toluene, and/or xylene) and/or their mixtures to 100% CO₂.

Can simulation-based education or other education interventions replace clinical placement in medical radiation sciences? A narrative review

OBJECTIVES

In response to increasing student enrolment and workload pressures from the Covid-19 pandemic, a recent focus on health student preparation programs has been on curricula adaptations and replacement of clinical placement time with alternative education activities. The aim of the narrative review was to explore the current evidence relating to education activities in Medical Radiation Sciences (MRS) used to replace clinical placements or part of clinical placements. Medline, CINAHL and Web of Science databases were used to search for articles published between 2017 and 2022. Data from the literature was summarised into (1) planning and development of clinical replacement learning activities in MRS, (2) evaluation of clinical replacement activities, and (3) benefits and challenges of clinical replacement in MRS.

KEY FINDINGS

Planning and development of clinical replacement learning activities in MRSrequires support from a wide range of stakeholders, and evidence from activities already implemented exists. Activities largely encompass an institution-specific focus. Developed clinical replacement activities use a blended approach, with simulation-based education (SBE) as a main teaching platform. Evaluation of clinical replacement activities are largely focused on students' achievement of learning objectives relating to practical and communication skills. Emerging evidence based on small student samples shows that clinical and clinical replacement activities provide similar results in terms of learning objectives.

CONCLUSION

Benefits and challenges of clinical replacement in MRS are similar to those presented in the other health professions. The balance between quality and quantity of teaching and learning experiences for clinical skill development in MRS needs to be further investigated.

IMPLICATIONS FOR PRACTICE

To meet the dynamic challenges of the health care environment and MRS profession, a major goal in the future will be to affirm the benefit of clinical replacement activities for MRS students.

The pan-immune-inflammation value and systemic immune-inflammation index in advanced melanoma patients under immunotherapy

PURPOSE

To evaluate the pan-immune-inflammation value (PIV) and systemic immune-inflammation index (SII) in patients with cutaneous melanoma (CM) under immune checkpoint inhibitor (ICI) therapy.

METHODS

PIV and SII were calculated before the start of ICI therapy and at time of progression/death in patients with metastatic CM (stage III/IV). Sex-age-matched CM patients in stage I/II and healthy subjects (HC) served as controls.

RESULTS

The median PIV of stage III/IV patients was significantly (P = 0.0011) higher than in stage I/II patients and HC. SII was significantly (P = 0.00044) lower in HC than in CM patients. At baseline, PIV and SII did significantly correlate with lactate dehydrogenase (P = 0.045/0.017). However, ROC curve statistics revealed that SII and PIV were not significantly associated with clinical parameters, including best response to ICI treatment (P = 0.87/0.64), progression-free survival (P = 0.73/0.91), and melanoma-specific survival (P = 0.13/0.17). Moreover, there were no significant changes of PIV and SII from baseline to progression/death (P = 0.38/0.52).

CONCLUSIONS

Even though both immune-inflammation biomarkers showed some power to differentiate between CM stages and HC, respectively, PIV and SII seem not to be significant predictors for clinical outcome measures of CM patients under ICI therapy.

Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Tanaka score predicts surgical intensive care admission following abdominal wall reconstruction

PURPOSE

With the advancement of abdominal wall reconstruction, more complex hernia patients are undergoing repairs that may require a postoperative surgical intensive care unit (SICU) admission. The volume ratio (VR) of the hernia sac to the abdominal cavity is an easily applied method to quantify disease severity and the ensuing physiologic insult. This study aimed to predict postoperative SICU admission using VR and other preoperative variables.

METHODS

A single-center retrospective review was conducted for patients undergoing large abdominal hernias (width ≥ 18 cm) repaired from September 2014 to October 2019. Patient demographics, comorbidities, abdominal surgical history, and VR were analyzed through univariate and multivariable methods to identify predictors of SICU admission within the first two postoperative days. A predictive model was generated and validated.

RESULTS

Of 434 patients meeting inclusion criteria, 127(29%) required a SICU admission within the first two postoperative days. VR was significantly higher in SICU patients (Median 30.6% [IQR 14.4-59.0] vs. 10.6% [IQR 4.35-23.6], P < 0.001). Male sex, history of chronic obstructive pulmonary disease, prior component separation, recurrent incisional hernia, hernia grade 3, and VR showed higher odds of SICU admission. When validated on a testing dataset, these variables showed strong SICU admission predictions, with an area under the curve, sensitivity, and specificity of 0.82, 81.7% and 68.5%, respectively.

CONCLUSIONS

The volume ratio in combination with preoperatively available variables can reliably predict postoperative SICU admission following abdominal wall reconstruction. Anticipating such events preoperatively allows for bed space allocation as well as optimizing postoperative care.

Pan-immune-inflammation value independently predicts disease recurrence in patients with Merkel cell carcinoma

Purpose

We aimed to determine whether the pan-immune-inflammation value (PIV) of patients with Merkel cell carcinoma (MCC) at primary diagnosis differs from controls and whether it is associated with disease stage and outcome.

Methods

In this retrospective study, we recruited MCC patients with stage I–III. PIV was calculated from absolute complete blood cell counts obtained within one week at MCC diagnosis as follows: [neutrophils (10³/mm³) × platelets (10³/mm³) × monocytes (10³/mm³)]/lymphocytes (10³/mm³). As controls, we studied age–gender-matched cutaneous melanoma (CM, stage I–III) patients and healthy controls (HC). Univariate and multivariate statistics were used.

Results

The median PIV in MCC patients was significantly increased compared to both CM patients as well as healthy controls. PIV of MCC patients in stage II and III was significantly higher compared to stage I patients. ROC analysis revealed that MCC recurrence was significantly associated with a PIV greater than 372 [p < 0.0001, Youden index 0.58; hazard ratio: 4 (95% confidence interval: 1.7 to 9.2)]. In multivariate analysis, only a PIV greater than 372 and higher MCC stage were determined as independent predictors for disease recurrence.

Conclusion

We determined, for the first time, the prognostic ability of the promising blood-based biomarker PIV in MCC patients and observed that PIV is increased in MCC patients in dependence on disease stage and independently predicts MCC recurrence.

Effect of Body Condition Score on Reproductive Performance and Chest Girth of Bali cows in Different Rearing Systems

<p class="abstrak2"><span>Nutrition and rearing systems are some of the main factors affecting productivity of cows. Body condition score (BCS) is a method used to assess nutritional status and evaluate rearing systems of each animal. This study was done to analyze effect of BCS on reproductive performance and chest girth of Bali cow in different rearing systems. This study was conducted at the Field Station of Sekolah Peternakan Rakyat Kuamang Abadi, Bungo Regency, Jambi, Indonesia. A total of 62 heads of Bali cow with BCS of 2, 3, and 4 (scale 1-5) reared on intensive, semi-intensive and extensive systems were used in this study. This study was conducted using survey and direct observation. Variables observed were as follows: BCS, calving interval (CI), days open (DO), service per conception (S/C) and chest girth (CG). Data were analyzed using simple correlation and regression analysis in SPPS, followed by descriptive analysis. Result showed that the BCS of Bali cow in different rearing systems did not affect CI, DO, S/C and CG. BCS had a weak correlation coefficient (r), with the reproductive performance of CI, DO, and S/C at 0.09, 0.09, and 0.08, respectively. In addition, the relationship between BCS and CG was highly significant, with a correlation coefficient (r) of 0.532. Therefore, BCS had a positive relationship with CI, DO, S/C, and CG. Moreover, BCS cannot be used as the only indicator to assess the reproductive performance of Bali cow in different rearing systems.</span></p>

Facile synthesis of ZnMoO4/AlPO4-5 nanorod composites as visible-light-driven photocatalysts and high-performance energy storage materials

The present article describes the facile one-step hydrothermal synthesis of single-crystalline ZnMoO₄/AlPO₄-5 nanorod composites. The physicochemical properties of the synthesized materials, such as structure, morphology, and bandgap, were determined using techniques such as X-ray diffraction (XRD), field emission scanning electron microscopy (FE-SEM), N₂ adsorption–desorption isotherms, X-ray photoelectron (XPS), ultraviolet-visible (UV-vis), and photoluminescence (PL). The XRD pattern of synthesized ZnMoO₄/AlPO₄-5 verifies the synthesis of nanocomposites. Diffuse UV-vis spectra reveal that ZnMoO₄/AlPO₄-5 nanorod composites exhibit an indirect semiconductor with an optical bandgap between 3.15 and 3.7 eV depending on Mo : Zn ratio. In comparison to pure AlPO₄-5, ZnMoO₄/AlPO₄-5 nanocrystal composites showed significantly higher photocatalytic activity for the degradation of para-nitrophenol (PNP, 0.04 g l⁻¹), with 14, 99, 70, and 54% for AlPO₄-5, Mo : Zn (2)/AlPO₄-5, Mo : Zn (4)/AlPO₄-5, and Mo : Zn (6)/AlPO₄-5, respectively. This result might be attributed to the composite's efficient charge transfer and optimized electron–hole pair recombination. The supercapacitive ability of ZnMoO₄/AlPO₄-5 nanorod composites was also investigated in this work. For the prepared electrodes using AlPO₄-5, Mo : Zn (2)/AlPO₄-5, Mo : Zn (4)/AlPO₄-5, and Mo : Zn (6)/AlPO₄-5, the capacitance values were 400, 725, 450, and 481.25 F g⁻¹, respectively, at a current density of 0.5 A g⁻¹. This study shows that ZnMoO₄/AlPO₄-5 nanorod composites are a potential visible-light-responsive photocatalyst. The electrochemical results further demonstrate the high capacitance of ZnMoO₄/AlPO₄-5 nanorod composites toward energy-storage applications.

Photocatalytic degradation of PNP over single-crystalline ZnMoO₄/AlPO₄-5.

The Haemostasis Traffic Light, a user-centred coagulation management tool for acute bleeding situations: a simulation-based randomised dual-centre trial

The Haemostasis Traffic Light is a cognitive aid with a user-centred design to enhance and simplify situation awareness and decision-making during peri-operative bleeding. Its structure helps to prioritise therapeutic interventions according to the pathophysiology and the severity of the bleeding. This investigator-initiated, randomised, prospective, international, dual-centre study aimed to validate the Haemostasis Traffic Light by adapting it to the local coagulation protocols of two university hospitals. Between 9 January and 12 May 2020, we recruited 84 participants at the University Hospital Zurich, Switzerland, and the Italian Hospital of Buenos Aires, Argentina. Each centre included 21 resident and 21 staff anaesthetists. Participants were randomly allocated to either the text-based algorithm or the Haemostasis Traffic Light. All participants managed six bleeding scenarios using the same algorithm. In simulated bleeding scenarios, the design of the Haemostasis Traffic Light algorithm enabled more correctly solved cases, OR (95%CI) 7.23 (3.82-13.68), p < 0.001, and faster therapeutic decisions, HR (95%CI) 1.97 (1.18-3.29, p = 0.010). In addition, the tool improved therapeutic confidence, OR (95%CI) 4.31 (1.67-11.11, p = 0.003), and reduced perceived work-load coefficient (95%CI) -6.1 (-10.98 to -1.22), p = 0.020). This study provides empirical evidence for the importance of user-centred design in the development of haemostatic management protocols.

The impulsivity rating scale (IRS): preliminary results

Until now, the instruments for the clinical evaluation of impulsivity have relied essentially on either personality inventories or to a lesser extent on specific questionnaires. Therefore this paper presents the preliminary results of a new rating scale: the Impulsivity Rating Scale (IRS). This is a 7-item hetero-evaluation of impulsivity based on the behaviour of the patient in usual life situations. The administration of the scale is easy and short: 15 minutes. The IRS was tested in five different population samples: 31 impulsive inpatients, 36 adults with major depressive episode, 15 healthy control subjects, 56 smokers before and after one week of tobacco withdrawal, and 47 adolescent depressed inpatients before and four weeks after antidepressant treatment. The results show good construct validity, good concurrent validity, good inter-rater reliability and sensitivity to change. A threshold of 8 for the total score (range 0 to 21) gives good specificity and sensitivity. The principal component analysis shows the existence of a main factor composed of all items, with lower correlation for two items which may belong to a second factor needing further investigations.

Genotyping in the Insulin-like Growth Factor 1 (IGF1/SnaBI) gene of Pasundan cattle with PCR-RFLP method

<p class="instansi">Gen Insulin-like Growth Factor 1 (IGF1) pada mamalia berfungsi untuk mengontrol pertumbuhan tulang dan otot. Oleh karena itu gen IGF1 banyak digunakan sebagai salah satu kandidat gen untuk seleksi ternak. Penelitian ini bertujuan untuk mengidentifikasi genotip gen IGF1 (ekson 1) menggunakan metode PCR-RFLP dengan enzim restriksi SnaBI (TAC*GTA). Sebanyak 90 ekor sampel DNA sapi Pasundan dari Kabupaten Ciamis dan Pangandaran, Jawa Barat telah digunakan pada penelitian ini. Hasil penelitian ini menunjukkan bahwa seluruh sampel yang dianalisis memiliki genotip CC dengan alel C sebagai alel yang umum pada gen IGF1/SnaBI. Genotip CC yang diperoleh pada penelitan ini disebabkan karena terdapat mutasi transisi pada posisi basa ke g.218T/C (GenBank: KF202095). Mutasi ini menyebabkan perubahan asam amino dari methionine (AUG) menjadi valine (GUG). Disimpulkan bahwa gen IGF1/SnaBI pada sapi Pasundan bersifat monomorfis dan tidak dapat digunakan untuk seleksi molekuler.</p><strong><span><em><br /></em></span></strong>

A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.

Synthesis and functionalization of ordered mesoporous carbons supported Pt nanoparticles for hydroconversion of n-heptane

Reaction pathway of n-heptane hydroconversion.

Pain Perception in Children with Autism (Prospective Study of 40 Cases)

Introduction

Recent studies show a different mode of expression of pain associated with disorders of verbal and nonverbal communication, body schema and some cognitive impairment in autistic children.

The aim of our study was to evaluate the reactivity of an autistic child in a slightly painful stimulation in a standardized situation where there is a dual relationship with an adult.

Methods

We conducted a study, on 40 children with autism. The diagnosis of autism was established following a multidisciplinary assessment including scale ADIR (Autism Diagnostic Interview Revised) and ADOS (Autism Diagnostic Observation Schedule). Severity of autism was assessed by the CARS (Childhood Autism Rating Scale). All subjects were submitted to a pinch with a clothespin camouflaged by the palm of the hand of the examiner. The reactivity to pain was assessed by the NCCPC (Non-communicating children's pain checklist).

Results

All children have responded to pain, 57.5% had moderate to severe pain and 42.5% had mild pain. The evaluation of the expression of pain according to the items of the NCCPC showed that 95% of children responded with motor responses, 90% responded with vocal productions, only half of the children (55%) presented facial expressions and 12. 5% of the children showed physiological indices. The analysis of the type of motor and vocal reactions was not moving toward pain in almost all children (removal or protection of the area of the body affected, the precise location of the painful area are almost absent in our sample).

Conclusion

These results are in favor of a different mode of expression of pain in children with autism.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Overexpression of PIK3CA in murine head and neck epithelium drives tumor invasion and metastasis through PDK1 and enhanced TGFβ signaling

Head and neck squamous cell carcinoma (HNSCC) patients have a poor prognosis, with invasion and metastasis as major causes of mortality. The phosphatidylinositol 3-kinase (PI3K) pathway regulates a wide range of cellular processes crucial for tumorigenesis, and PIK3CA amplification and mutation are among the most common genetic alterations in human HNSCC. Compared to the well-documented roles of the PI3K pathway in cell growth and survival, the roles of the PI3K pathway in tumor invasion and metastasis have not been well delineated. We generated a PIK3CA-genetically engineered mouse model (PIK3CA-GEMM) in which wildtype PIK3CA is overexpressed in head and neck epithelium. Although PIK3CA overexpression alone was not sufficient to initiate HNSCC formation, it significantly increased tumor susceptibility in an oral-carcinogenesis mouse model. PIK3CA overexpression in mouse oral epithelium increased tumor invasiveness and metastasis by increasing epithelial-mesenchymal transition and by enriching a cancer stem cell phenotype in tumor epithelial cells. In addition to these epithelial alterations, we also observed marked inflammation in tumor stroma. AKT is a central signaling mediator of the PI3K pathway. However, molecular analysis suggested that progression of PIK3CA-driven HNSCC is facilitated by PDK1 and enhanced TGFβ signaling rather than by AKT. Examination of human HNSCC clinical samples revealed that both PIK3CA and PDK1 protein levels correlated with tumor progression, highlighting the significance of this pathway. In summary, our results offer significant insight into how PIK3CA-overexpression drives HNSCC invasion and metastasis, providing a rationale for targeting PI3K/PDK1 and TGFβ signaling in advanced HNSCC patients with PIK3CA amplification.

[The molecular bypass: an established method for revascularisation of non-operable PAD patients or merely a future vision]

Collateral vessel growth is a physiological process that is not equally pronounced in all people. After the development of a haemodynamically relevant stenosis in vascular systems, blood flow is directed through a collateral circulation to supply ischaemic tissue. This collateral circulation exists on the capillary level and by definition, is not composed of real new vessels. Postnatal vasculogenesis (true neovascularisation) occurs in the adult organism in tumour vascularisation, wound healing, in the endometrium, and in the context of chronic diseases such as rheumatoid arthritis and psoriasis. Reopening of the occluded vessel or use of artificial bypass grafts are the most attractive therapeutic approaches for treating peripheral arterial and coronary artery disease. These strategies have been exhausted in many patients; therefore augmentation of arteriogenesis can be more useful. Arteriogenesis, the promotion of natural collateral growth, is a hot topic in vascular research. Monocytes play a key role in arteriogenesis by "homing" to areas of collateral vessel growth and locally secrete multiple essential growth factors. Furthermore, stem cells of different origins, endothelial progenitor cells or mononuclear cells are currently being used to promote vessel growth. Also, the application of growth factors such as VEGF, MCP-1, GM-CSF have been already used in clinical trials. This review article describes the physiology and pathophysiology of vascular stenoses and their compensation mechanisms. The review also gives an overview of current treatment approaches and new strategies for non-operable PAD patients. The article presents the current cell and growth factor-related studies, as well as results of balloon dilatation and stent implantation or bypass surgery studies for improvement of revascularisation.

Paramediastinal air cyst with traumatic bronchial injury: a rare complication of neonatal resuscitation

Paramediastinal air cysts and pneumatoceles are known complications of chest trauma and mechanical ventilation. After an initial period of enlargement, these lesions tend to resolve completely with conservative management. We present a case of a premature newborn who developed an enlarging paramediastinal air cyst as a result of resuscitation around the time of delivery that ultimately required surgical excision via a right thoracotomy. To our knowledge, this is the first reported case in a neonate.

Peptide neurons in peripheral tissues including the urinary tract: immunohistochemical studies

Using the indirect immunofluorescence technique of Coons and collaborators, neurons containing substance P-, enkephalin-, vasoactive intestinal polypeptide (VIP)--and somatostatin-like immuno-reactivity have been identified in the peripheral nervous system. They have a widespread distribution, particularly in the gastrointestinal and urinary tracts. Whereas part of these peptide containing fibres may belong to sensory neurons, the majority seem to have their origin in peripheral autonomic ganglia, indicating a complex built up of the autonomic nervous system. There is evidence that some noradrenergic neurons contain somatostatin, which may suggest that one neuron can synthesize and store two transmitters. The significance of such neurons, as well as of peripheral peptide neurons in general, remains to be elucidated.

Alterations in growth and branching of Neurospora crassa caused by sub-inhibitory concentrations of antifungal agents

Six antifungal agents at subinhibitory concentrations were used for investigating their ability to affect the growth and branching in Neurospora crassa. Among the antifungals herein used, the azole agent ketoconazole at 0.5 microg/ml inhibited radial growth more than fluconazole at 5.0 microg/ml while amphotericin B at 0.05 microg/ml was more effective than nystatin at 0.05 microg/ml. Morphological alterations in hyphae were observed in the presence of griseofulvin, ketoconazole and terbinafine at the established concentrations. The antifungal agents were more effective on vegetative growth than on conidial germination. Terbinafine markedly reduced growth unit length (GU) by 54.89%, and caused mycelia to become hyperbranched. In all cases, there was a high correlation between hyphal length and number of tips (r > 0.9). All our results showed highly significant differences by ANOVA, (p < 0.001, alpha = 0.05). Considering that the hyphal tip is the main interface between the fungus and its environment/through which enzymes and toxins are secreted and nutrients absorbed, it would not be desirable to obtain a hyperbranched mycelia with inefficient doses of antifungal drugs.

Fetoscopic laser treatment of twin-to-twintransfusion syndrome (TTTS)

The aim of this study was to report the results of the first 10 cases of fetoscopic laser surgery for twin-to-twin transfusion syndrome by the Rotunda Hospital Fetal Treatment Programme. All cases of severe TTTS managed by our team from 2006 to 2007 were included. All fetoscopic laser surgeries were performed by a single specialist in fetal medicine. All pregnancies were followed up to pregnancy completion and a minimum of six weeks neonatal life. Laser surgeries were performed with ultrasound guidance and percutaneously using local anaesthesia via a 2.8mm rigid fetoscope. Selective laser ablation of placental vessels was accomplished with a neodymium:YAG laser. The first 10 cases of severe TTTS managed by our team are reported. Laser ablation of placental vessels was accomplished successfully in all cases. Two pregnancies were complicated by preterm premature rupture of membranes before 22 weeks and both pregnancies were lost. Of the remaining 16 fetuses, one was diagnosed with significant ventriculomegaly postoperatively and underwent selective termination in the United Kingdom. The overall intact neonatal survival rate was 65%. Fetoscopic laser ablation of placental vessels for severe twin-to-twin transfusion syndrome is now available in Ireland, and our programme has delivered results that are in keeping with international best practices in this regard.

Near miss maternal morbidity

Audit of severe maternal morbidity is a potent tool in determining standards of maternity care. This study determines the incidence of severe acute maternal morbidity in our population, identifies the underlying organ dysfunction and associated obstetric risk factors, and compares them to published international reports. Over a 5 year period, 1999-2003, data were collected prospectively from patients with severe acute maternal morbidity. There were 36,802 women who delivered infants weighing more than 500 g over the 5 years with 53 cases of severe maternal morbidity. There were two indirect maternal deaths yielding an incidence of 1.4/1000 for severe maternal morbidity and 5.4/100,000 for maternal mortality. The severe maternal morbidity to mortality ratio was 26.5:1. Massive obstetric haemorrhage requiring acute blood transfusion of > or = 5 units of packed red cells occurred in 77% of cases. This study identifies the feasibility of audit of severe maternal morbidity using simple defined clinical criteria. The incidence and underlying aetiology of severe maternal morbidity in our unit is comparable to other developed countries. It is essential that data on severe maternal morbidity are reviewed and analysed continuously at local hospital and national level to assess, maintain and improve clinical standards.

Germination, duplication cycle and septum formation are altered by caffeine, caffeic acid and cinnamic acid in Aspergillus nidulans

Phenolic and benzene compounds from vegetables have been described as being responsible for many biological activities including antifungal effects. Caffeine, cinnamic and caffeic acids were here investigated for their action on a model fungus, Aspergillus nidulans, at its initial stage of germination. Conidia did not germinate in the presence of (1 mM) cinnamic acid. Caffeine and caffeic acid exerted a negative effect on germination, on the nuclear duplication cycle and on first septum formation. The effects of caffeine were dose-dependent; effects of (1 mM) caffeic acid were more intense than those of (10 mM) caffeine.