Systematic evaluation of the miRNA‐ome and its downstream effects on mRNA expression identifies gastric cancer progression

We investigated the differential expression of Dicer and Drosha, as well as that of microRNA (miRNA), in adjacent normal and tumour samples of patients with gastric cancer. The expression of Dicer and Drosha was studied by immunohistochemistry in 332 gastric cancers and correlated with clinico‐pathological patient characteristics. Differential expression of miRNAs was studied using the Invitrogen NCode^? Multi‐Species miRNA Microarray Probe Set containing 857 mammalian probes in a test set of six primary gastric cancers (three with and three without lymph node metastases). Differential expression was validated by RT‐PCR on an independent validation set of 20 patients with gastric cancer. Dicer and Drosha were differentially expressed in non‐neoplastic and neoplastic gastric tissue. The expression of Drosha correlated with local tumour growth and was a significant independent prognosticator of patient survival. Twenty miRNAs were up‐ and two down‐regulated in gastric carcinoma compared with non‐neoplastic tissue. Six of these miRNAs separated node‐positive from node‐negative gastric cancers, ie miR‐103, miR‐21, miR‐145, miR‐106b, miR‐146a, and miR‐148a. Five miRNAs expressed differentially in node‐positive cancers had conserved binding sites for mRNAs differentially expressed in the same set of tumour samples. Gastric cancer shows a complex derangement of the miRNA‐ome, including Dicer and Drosha. These changes correlate independently with patient prognosis and probably influence local tumour growth and nodal spread. Copyright © 2010 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.     

A coupled electromechanical model for the excitation-dependent contraction of skeletal muscle

This work deals with the development and implementation of an electromechanical skeletal muscle model. To this end, a recently published hyperelastic constitutive muscle model with transversely isotropic characteristics, see Ehret et al. (2011), has been weakly coupled with Ohm’s law describing the electric current. In contrast to the traditional way of active muscle modelling, this model is rooted on a non-additive decomposition of the active and passive components. The performance of the proposed modelling approach is demonstrated by the use of three-dimensional illustrative boundary-value problems that include electromechanical analysis on tissue strips. Further, simulations on the biceps brachii muscle document the applicability of the model to realistic muscle geometries.     

Phenotypic and genotypic characterization of carcinomas of the papilla of Vater has prognostic and putative therapeutic implications

We further characterize the heterogeneous carcinomas of the papilla of Vater (CPVs) in relation to various clinicopathologic patient characteristics and patient survival. Of the 71 reevaluated CPVs, 32 were intestinal, 26 were pancreatobiliary, 6 were mixed, 4 were mucinous, and 3 were poorly differentiated carcinomas. The prevalence of cytokeratin 20 and cytokeratin 7 correlated with the intestinal (25/32 [78%] vs 13/32 [41%]) and pancreatobiliary (6/26 [23%] vs 24/26 [92%]) phenotypes. CDX2 was found in mucinous (3/4 [75%]), intestinal (7/32 [22%]), and some mixed (1/6 [1%]) CPVs. A KRAS mutation was detected in all poorly differentiated CPVs and in about 20% of each of the other types. In multivariate analyses, tumor type, local tumor spread, and lymph node metastases were independent prognostic factors of patient survival. We provide further evidence of the prognostic relevance of the phenotypic and genotypic diversity of CPVs. Besides the poorly differentiated CPV, the most common KRAS wild type makes them a putative target for an anti-epidermal growth factor receptor therapy.     

Three- and Four-Dimensional Ultrasound in the Diagnosis of Fetal Tetralogy of Fallot With Absent Pulmonary Valve and Microdeletion 22q11

Tetralogy of Fallot (TOF) with concomitant absent pulmonary valve syndrome (APVS) constitutes a rare prenatal condition characterized by rudimentary cusps of the pulmonary valve, pulmonary regurgitation, and a variable degree of dilatation of the main and branch pulmonary arteries. Although early prenatal diagnosis of this complex malformation is feasible, the antenatal course of affected fetuses clearly depends on the presence of associated structural (absence of the ductus venosus) and chromosomal anomalies (microdeletion 22q11, DiGeorge syndrome). Postnatally, the outcome is closely related to the degree of airway obstruction and subsequent bronchomalacia. We describe the beneficial contribution of three- and four-dimensional ultrasound in establishing the diagnosis of TOF-APVS in a fetus at age 22 gestational weeks.     

Low-attenuation oral GI contrast agents in abdominal-pelvic computed tomography

Background We designed and evaluated a low-attenuation oral contrast agent for abdominal-pelvic computed tomography (CT). Methods In vitro studies, were performed initially to evaluate the imaging characteristics of multiple solutions. These studies resulted in two solutions being compared with the presently accepted oral CT agents of dilute iodinated contrast and water. Ninety-eight consecutive subjects already scheduled for routine outpatient abdominal-pelvic CT were enrolled. Subjects were randomized to water (n = 30), fiber solution (n = 32), polyethylene glycol (PEG; n = 11), or dilute iodinated solution (DI; n = 25). Examinations were then evaluated for gastric distention, small bowel distention, small bowel wall visualization, and colonic transit. A questionnaire was given to the study subjects for feedback concerning taste and potential side effects from these agents. Results PEG tended to provide better bowel distention, wall visualization, and colonic transit compared with water, fiber solution, and DI. Areas of statistical significance included: (1) average bowel diameter in the left upper quadrant for water was 17.50 mm, whereas that for PEG was 21.88 mm (p < 0.05); (2) average bowel diameter in the pelvis for water was 14.79 mm, that for fiber was 15.67 mm, and that for PEG was 18.48 mm (p < 0.05); (3) wall visualization was better with PEG than with fiber (p < 0.05); (4) successful transit of contrast to the colon occurred in every subject who received PEG compared with only 20% of those received water and 39% of those who received fiber (p < 0.05). Similar trends for the superiority of PEG over DI were noted, although many of these did not reach statistical significance. Conclusion PEG solution has imaging characteristics related to bowel wall visualization, luminal distention, and colonic transit that make it an effective oral agent for abdominal pelvic CT examination.     

Aerodynamic and sound intensity measurements in tracheoesophageal voice

BACKGROUND: In laryngectomized patients, tracheoesophageal voice generally provides a better voice quality than esophageal voice. Understanding the aerodynamics of voice production in patients with a voice prosthesis is important for optimizing prosthetic designs and successful voice rehabilitation. OBJECTIVES: To measure the aerodynamics and sound intensity in tracheoesophageal voice production. STUDY DESIGN AND METHODS: We built a special setup, which consisted of a Pentium 200 MHz computer with an AD-DA interface card and Labview 4.01 software. In an oral/nasal mask we constructed several mass flow sensors and a microphone. This measured both the oral airflow and the level of sound. For the measurement of endotracheal pressure, which is the driving force behind the airflow, we used a transducer which was connected to the tracheostoma. The endoesophageal pressure was measured at the level of the prosthesis in the esophagus by a Mikrotip transducer. Using this we could determine how much the voice prosthesis contributes to the overall pressure drop of the phonatory tract. Furthermore, the average airflow rate as a function of the sound pressure levels could be determined. RESULTS: In our population, 6 out of 7 patients showed a positive relationship between trans-source airflow and generated sound intensity. We compared our prosthesis pressure drop values with in vitro data and found that there are some differences, possibly due to difference in age of the prosthesis and physiological circumstances in vivo. The overall contribution of the voice prosthesis to the airway resistance depends on the level of phonation and the type of device. In our patient group it is apparent that the pharyngoesophageal (PE) segment has the greatest share of the total pressure drop, especially at higher airflow rates. We measured a 27% pressure drop in airflow over the voice prosthesis. Different tracheostoma occlusion methods did not have any effect on the aerodynamics and sound intensity. One patient that had had a jejunal graft for reconstruction showed, not unexpectedly, extremely different aerodynamic values. We were unable to define optimal airflow rates or optimal resistance values for sound production in the PE segment. CONCLUSION: The aerodynamic characteristics of voice production in laryngectomized patients with voice prostheses are determined by both prosthetic factors and PE segment tissue factors. In our patient group the PE segment is responsible for the greatest pressure drop. We found no significant difference in pressure drop and sound intensity for different tracheostoma occlusion methods.     

The Use of Artificial Intelligence in Automation in the Fields of Gynaecology and Obstetrics – an Assessment of the State of Play

The long-awaited progress in digitalisation is generating huge amounts of medical data every day, and manual analysis and targeted, patient-oriented evaluation of this data is becoming increasingly difficult or even infeasible. This state of affairs and the associated, increasingly complex requirements for individualised precision medicine underline the need for modern software solutions and algorithms across the entire healthcare system. The utilisation of state-of-the-art equipment and techniques in almost all areas of medicine over the past few years has now indeed enabled automation processes to enter – at least in part – into routine clinical practice. Such systems utilise a wide variety of artificial intelligence (AI) techniques, the majority of which have been developed to optimise medical image reconstruction, noise reduction, quality assurance, triage, segmentation, computer-aided detection and classification and, as an emerging field of research, radiogenomics. Tasks handled by AI are completed significantly faster and more precisely, clearly demonstrated by now in the annual findings of the ImageNet Large-Scale Visual Recognition Challenge (ILSVCR), first conducted in 2015, with error rates well below those of humans. This review article will discuss the potential capabilities and currently available applications of AI in gynaecological-obstetric diagnostics. The article will focus, in particular, on automated techniques in prenatal sonographic diagnostics.Key words: pregnancy, sonography, gynecology, malformation     

Polytraumaversorgung in der Luftrettung in Zeiten der COVID-19-Pandemie: Auswirkungen und Entwicklung der Fallzahlen

Notfall + Rettungsmedizin - Sowohl innerklinisch als auch präklinisch kam es durch das SARS-CoV-2-Virus zu Veränderungen in der Patientenversorgung. Durch das Herunterfahren des...     

COVID-19: Akzeptanz und Compliance von persönlicher Schutzausrüstung (PSA) und AHA-L-Regeln (Abstands- und Hygieneregeln) im deutschen Rettungsdienst – eine bundesweite Umfrage

Notfall + Rettungsmedizin - Die COVID-19-Pandemie (coronavirus disease-2019) hat auch den deutschen Rettungsdienst deutlich belastet und gefordert. Die persönliche Schutzausrüstung (PSA)...     

The other colon cancer: a population-based cohort study of appendix tumour trends and prognosis

Aim

Appendiceal neoplasms are rare subtypes of colorectal tumours that mainly affect younger patients some 20 years earlier than other colon tumours. The aim of this study was to gain more insight into the histological subtypes of this rare disease and include cases previously excluded, such as mucinous neoplasia.

Method

The cohort study included 1097 patients from the Munich Cancer Registry (MCR) diagnosed between 1998 and 2020. Joinpoint analysis was used to determine trend in incidence. Baseline demographic comparisons and survival analyses using competing risk and univariate/multivariate methods were conducted according to tumour histology: adenocarcinoma (ADENO), neuroendocrine neoplasia (NEN), mixed adeno-neuroendocrine carcinoma (MANEC), and low- (LAMN) and high-grade mucinous neoplasia (HAMN).

Results

Up to 2016 the number of cases increased significantly [annual per cent change (APC) = 6.86, p < 0.001] followed by a decline in the following years (APC = −14.82, p = 0.014; average APC = 2.5, p = 0.046). Comparison of all patients showed that NEN (48.4%) and mucinous neoplasms (11.6%) had a considerably better prognosis than ADENO (36.0%) and MANEC (3.0%, p < 0.0001). A multivariate analysis within the NEN and ADENO subgroups revealed that further histological classification was not prognostically relevant, while older age and regional tumour spread at diagnosis were associated with a poor prognosis. ADENO histology with high tumour grade and appendectomy only was also associated with poorer survival.

Conclusion

Appendiceal neoplasms are histologically heterogeneous; however, this diversity becomes less relevant compared with the marked difference from cancers of the remaining colon. The previously observed increase in cases appears to be abating; fewer cases of appendicitis and/or appendectomies or changes in histopathological assessment may be behind this trend.