Ultrasound-guided aspiration of ovarian cysts:results in ultrasonically benign cysts

Ultrasound-guided ovarian cyst aspiration is an increasingly important means of diagnosingand treating ovarean cysts.We report the results of 140 ultrasound-guided ovarian cyst aspirations in112 symptomatic patients,with an age range of 19-87 years(mean 38).Cysts had benign character-istics and ranged from 4 to 20 cm in diameter.The majority of cysts were aspirated once.In 20 casescysts were aspirated twice,in five cases three times and in one case four times.The cyst aspirate wesexamined cytologically and correlated with histology where available.The only complication was an o-varian abscess,giving a eomplieation rate of 0.7%.Cytology was not found to be useful in excludingneoplastic lesions(sensitivity 46.6%.)The aspirate type was more useful.A serous aspirate was asso-ciated with a cure rate of 73.7%(45 of 61);28%(17 of 61)eventually had surgery;at surgery 9(14.75%)neoplastic lesions were found,all were benign.A haemorrhagic aspirate with no histo~ ofendometriosis was associated with a cure rate of 70.6% (12 of 17);there were 4(24%)neoplastic cystsat surgery,1 of these was malignant.Endometriotic cysts had a recurrence rate of 90%(19 of 21).Withmutinous aspirates 75%(3 of 4)were mueinous neoplasms.Aspiration was performed in 14 post-menopausal patients.Two neoplasms were found in this group and one of these was a malignant neoplasm,which had yielded a haemorrhagic aspirate.The majority of cysts even in the postmenopausal patientswere innocuous.Uetrasound-guided cyst aspiration is safe and useful in the management of ovarian cysts with benigncharacteristics.The finding of a haemorrhagic aspirate is more likely to indicate a neoplastic lesion,andespecially in the postmenopausal patient should be viewed with caution.The risk of missing a malignantlesion in non-haemorrhagie cysts with benign eharacteristies on ultrasound is negligible.     

Ultrasound-guided injection of triamcinolone and bupivacaine in the management of de Quervain′s disease

Objective

The aim of this study was to describe the technique and usefulness of ultrasound-guided intrasynovial injection of triamcinolone and bupivacaine in treatment of de Quervain′s disease.

Materials and methods

A total of 17 patients with symptomatic De Quervain′s disease were included in this study. The procedure involved confirmation of diagnosis with ultrasound followed by guided injection of a mixture of 20 mg of triamcinolone (40 mg/ml) and 1 ml of 0.5% bupivacaine. Ultrasound guidance with a high resolution 15-Mhz footprint probe was used for injection into the first dorsal extensor compartment tendon sheath (E1). The response to ultrasound-guided injection was ascertained at the post procedure outpatient clinic appointment according to the follow-up clinic notes.

Results

There were 14 female and 3 male patients aged 29 to 74 years. Mean duration of symptoms was 8.9 months. One patient had an atypical septum in the first extensor compartment and the extensor pollicis brevis alone was involved. The mean post-injection follow-up was at 6.75 weeks. One patient was lost to follow-up. Fifteen out of 16 patients had significant symptomatic relief (93.75%). There were no immediate or delayed complications. Recurrence of symptoms was seen in 3 (20%) patients.

Conclusion

Ultrasound-guided injection of triamcinolone and bupivacaine is safe and useful in controlling symptoms of De Quervain′s disease. Correct needle placement with ultrasound guidance avoids intratendinous injection as well as local complications like fat atrophy and depigmentation.     

Evaluation of the Precision ID Identity Panel for the Ion Torrent™ PGM™ sequencer

In cases where only a partial or incomplete STR profile is obtained from a sample, information contained in single nucleotide polymorphisms (SNPs) can prove informative for human identification. Thermo Fisher Scientific, which developed the high throughput Ion Torrent^™ PGM^™ sequencer, released the Precision ID Identity Panel, a multiplex SNP panel for human identity. We evaluated the reproducibility and sensitivity of this multiplex, which contains primers for the amplification of 90 autosomal SNPs and 34 Y-clade SNPs. The manufacturer’s protocol was tested using five commercially available pure native DNAs and six forensic type samples at a range of DNA input amounts (0.2–1.0 ng; n, 90). In addition to analyzing the data using the manufacturer’s software, HID SNP Genotyper (v4.3.1), we also used CLC Genomics Workbench (Qiagen). Although library yields and templating of ion sphere particles (ISPs) were low, downstream sequencing was still successful. Across all samples, only 1.5% of all possible quality control (QC) flags were raised by both the plugin QC filter and CLC; 85% of those flags were raised as the SNP had a major allele frequency outside the thresholds specified by the manufacturer. For the remaining SNPs, coverage of >1500 X and >780 X was obtained for autosomal and Y-clade SNPs respectively, and 100% congruence among genotype calls from both analysis programs was observed. Our results demonstrate that it is possible to obtain reliable and reproducible genotypes using the Precision ID Identity Panel, when using low quantities (≥0.2 ng) of either pure native DNA or forensic type DNA samples.     

Accuracy of the SenseWear Armband™ during ergocycling

The present study aims to show the accuracy of a portable motion sensor, the SenseWear Armband, for the estimation of energy expenditure vs. energy expenditure measured by indirect calorimetry during ergocycling. 31 healthy adults (52% women; age: 26.7±6.3 years; Body Mass Index: 23.9±3.3?kg/m2) completed a 45-min ergocycling session at 50% of their VO2(peak). Despite a significant underestimation of 18.7±13.2?kcal during the first 10?min of the activity (T=5.06; p<0.001), we observed an overall good agreement between energy expenditure estimated by the SenseWear Armband during ergocycling and indirect calorimetry (260.3±80.1 vs. 287.8±97.1?kcal, respectively) (T=-2.148; p=0.04) and a significant intra-class correlation (r=0.81; p<0.001). The results of the present study indicate that the SenseWear Armband underestimated energy expenditure during a 45-min ergocycling session at a 50% VO2(peak) intensity, mainly during the first 10?min. Underestimation at the onset of the activity warrants further research.     

Ultrasound-guided ovarian cyst aspiration in pregnancy

Ovarian cysts in pregnancy if symptomatic may require treatment because of the risks oftorsion,rupture and obstructed labour.There is also a risk that such cysts are neoplastic and thereforepotentially malignant.These lesions ate a management dilemma because of the risks of surgery to bothmother and fetus.Ultrasound-guided ovarian cyst aspiration is being increasingly recognized as a meansof diagnosing and treating ovarian cysts in the non-pregnant patient.There are few published reports onits use in pregnant patients.We report the results of 14 ultrasound guided cyst aspirations in 12 pregnantpatients.The technique and results are dicussed.Two of the 12 cysts(17%)were eventually found to bedue to neoplasms and one of these showed borderline malignancy at histology.Therefore,all cysts must beassessed to ensure that they have benign characteristics,and if not we would recommend these cysts beconsidered for surgery in the second trimester.There were no complications and all the pregnaeies pro-ceeded to term with normal deliveries.It is concluded that ultrasound-guided needle aspiration of ovariancysts can be simply and safely performed in pregnancy.     

Ultrasound-guided radiofrequency ablation in the management of interdigital (Morton��s) neuroma

Objective

To identify the benefits of ultrasound-guided radiofrequency ablation of Morton??s neuroma as an alternative to surgical excision.

Materials and methods

We studied a consecutive cohort of surgical candidates for Morton??s neurectomy who we referred, instead, for radiofrequency ablation (RFA). Under local anaesthetic, RFA was performed under ultrasound guidance, by a single radiologist. This out-patient procedure was repeated after 4?weeks if necessary. We followed patients for a minimum of 6?months to assess their change in visual analogue pain scores (VAS), symptom improvement, complications and progression to surgical excision.

Results

Thirty feet in 25 patients were studied. There were 4 men and 21 women with an average age of 55?years (range 33?C73?years). All had tried previous methods of conservative management. Forty percent presented with 2nd space neuromas and 60% with 3rd space ones. The average number of treatment sessions was 1.6 (range 1?C3, mode 1). Prior to treatment, all patients had pain on activity (VAS average: 6.0, range 3?C9). Post-treatment there was a statistically significant reduction in pain scores (post-RFA VAS average: 1.7, range 0?C8, p?<?0.001). The average overall symptom improvement was 76%. There was one minor complication of temporary nerve irritation. Three neuromas (10%) have progressed to surgical excision; 1 patient has ongoing, unchanged pain with no obvious cause. At 6?months, 26 out of 30?feet had a satisfactory outcome.

Conclusion

Ultrasound-guided RFA has successfully alleviated patients?? symptoms of Morton??s neuroma in >85% of cases. Only 10% have proceeded to surgical excision in the short term.     

The imaging features of MACROLANE™ in breast augmentation

Macrolane? is an injectable, biocompatible, soft-tissue filler that has been available in the UK since 2008 and is promoted for use in breast augmentation. There are few data available on the long-term effects of this relatively new product and concerns have been raised about the implications for breast imaging, in particular breast screening. In this context we present a spectrum of imaging appearances and complications encountered to date.     

The peak player load™ of state-level netball matches

ObjectivesTo investigate the peak accelerometer-derived intensity of state-level netball matches and compare differences between positional groupings. Findings will provide guidance for sport science professionals on how to best replicate the most intense passages of play in training settings.DesignLongitudinal (one season).MethodTwenty-eight netball athletes across three teams from the same club wore an accelerometer (S5 Optimeye, Catapult sports) for all matches, in one season. Raw acceleration data were downloaded and converted into a vector magnitude (Player Load™) we then quantified the peak intensity over 30-s and one to ten-minute time periods. Positional groupings were created based on the number of thirds on a netball court that a particular position can enter, as this was deemed more appropriate for the current study than the traditional combinations based on tactical requirements. A linear mixed-model with fixed and random effects was utilised along with magnitude-based inferences to determine meaningful differences with 90 % confidence limits (CL).ResultsAcross all time periods post 30-s, only one comparison was not meaningfully different i.e. three-thirds v two-thirds at the one-minute timepoint (effect size: 0.27, CL −0.05 to 0.60).ConclusionsFindings justify that netball athletes, depending on positional group defined by this study, should train at different intensities dependent on a specified duration. Conditioning professionals and coaches should design training drills that best replicate the peak intensity of match play. This may improve an athlete’s physical performance capacity during highly exertive periods of competition, which regularly occur at critical moments in play.     

Direct electrophilic iodination of 2-thiouracil using iodo-gen™

5-Iodo-2-thiouracil (ITU) is of interest due to its ability to bind specifically to the pigment melanin during melanogenesis and is of potential value in the diagnosis and treatment of malignant melanoma. Radioiodinated ITU was prepared directly from 2-thiouracil in a two-phase reaction using Iodo-Gen™ in 0.05 M phosphate buffer pH 7.0. The identity radiochemical purity and stability of the product were checked by reversed-phase high pressure liquid chromatography (HPLC). ITU labeled with ¹²³I, ¹²⁵I or ¹³¹I has been produced in millicurie amounts and isolated on a semi-preparative reversed-phase HPLC column. Production time was 2–3 h, overall radiochemical yields averaged 80%; the radiochemical purity was greater than 98%. Specific activities on the order of 20 Ci/mmol have been obtained.     

Accuracy and repeatability of two methods of gait analysis – GaitRite™ und Mobility Lab™ – in subjects with cerebellar ataxia

Instrumental gait analysis is increasingly recognized as a useful tool for the evaluation of movement disorders. The various assessment devices available to date have mostly been evaluated in healthy populations only. We aimed to explore whether reliability and validity seen in healthy subjects can also be assumed in subjects with cerebellar ataxic gait. Gait was recorded simultaneously with two devices – a sensor-embedded walkway and an inertial sensor based system – to explore test accuracy in two groups of subjects: one with mild to moderate cerebellar ataxia due to a subtype of autosomal-dominantly inherited neurodegenerative disorder (SCA14), the other were healthy subjects matched for age and height (CTR). Test precision was assessed by retest within session for each device. In conclusion, accuracy and repeatability of gait measurements were not compromised by ataxic gait disorder. The accuracy of spatial measures was speed-dependent and a direct comparison of stride length from both devices will be most reliably made at comfortable speed. Measures of stride variability had low agreement between methods in CTR and at retest in both groups. However, the marked increase of stride variability in ataxia outweighs the observed amount of imprecision.     

Ultrasound-guided fine-needle liver biopsy:a multicentre survey of pre-procedure evaluation practices and complication rates

A survey report was conducted among 12 Italian centres experi-enced in fine-needle biopsy of the liver.The questions concerned:1.the per-formance of inpatient or outpatient fine-needle biopsy;2.the policy of routinehemostatic evaluation;3.the management of patients taking aspirin;4.thenumber of biopsies performed and the diagnoses obtained;5.the complicationsthat occurred in relation to coagulation tests values.The results were as follows:1.10 out of 12 centres performed biopsiesmainly on outpatients;2.in only 2 of the 12 centres was a history investigatingthe patient's hemostasis collected;all centres routinely performed coagulationtests;the most frequent combination included prothrombin time,partialthromboplastin time and platelet count.Among the centres a great variabilityconcerning the test values considered safe existed;3.in 10 of the 12 centresbiopsy was not deferred if the patient was taking aspirin;4.the amount ofbiopsies performed was 9156 on a total of 6261 patients,mainly in diagnosingmalignant focal liver lesions;5.in 2 out of 6261 patients(0.03%)bleedingcomplications were fatal and in 8 out of 6261(0.13%)non-fatal but significant.Besides hemostatic decompensation,factors involved in the risk of post-biopsybleeding were the type of the lesion(malignant or hemangiomatous)and the co-existence of cirrhosis.     

Genetic data for PowerPlex 21™ autosomal and PowerPlex 23 Y-STR™ loci from population of the state of Uttar Pradesh,India

International Journal of Legal Medicine - In the present study, the statistical forensic parameters were evaluated for the loci present in PowerPlex 21 autosomal and PowerPlex 23 Y-STR multiplex...     

Determination of the variables affecting mixed MiniFiler™ DNA profiles

The interpretation of mixed DNA profiles presents additional challenges for the forensic scientist. There has been a broad based call for transparency in the process of interpretation of all evidence including mixed DNA profiles. This interpretation is greatly facilitated by a sound understanding of the variability in peak heights for the two peaks of a heterozygote, in the sizes of stutter peaks and in the variability in peak heights across loci.This study examines single source and mixed DNA profiles to assess this variability. The relative variability in peak height between the two peaks of a heterozygote and in the peak heights across loci becomes greater as the peaks themselves become smaller. This is consistent with findings from other multiplexes. This variability appears larger in the MiniFiler™ system at 30 cycles than, for example, in the Identifiler™ system at 28 cycles and this difference is largely explained by the two extra cycles of amplification.Stutter peaks appear no larger in the MiniFiler™ system at 30 cycles than in the Identifiler™ system at 28 cycles.     

Stereotactic radiotherapy for choroidal melanomas by means of HybridArc™

Purpose

Stereotactic radiotherapy (SRT) is suitable to treat ocular tumours. The optimal beam geometry for SRT, however, has not been defined. Here we evaluate a combination technique with dynamic conformal arcs (DCAs) and intensity-modulated static fields (IMRT), known as HybridArc? (HA).

Methods

For the first consecutive 25 cases with choroidal melanomas with volumes of 0.02 to 1.18?cm³ treated with 50?Gy in five fractions, the results with respect to dose conformity, homogeneity, and dose distributions were summarised. To describe the dose distribution at the planning target volume (PTV) boundary, we defined a spatially averaged dose gradient (SADG) and compared it with Paddick’s gradient index (GI). We made dosimetric comparisons between HA and other irradiation techniques.

Results

The PTVs ranged from 0.42 to 3.37?cm³. The conformity index (CI) was 1.25?±?0.15, and the homogeneity index (HI) 0.08?±?0.02. The SADG was (?3.5?±?0.5) Gy/mm or (?7.0?±?1.0) %/mm between the isodose levels 95 and 20%; local minima reached ?11.5?Gy/mm or ?22.9%/mm. The coefficient of determination for a nonlinear regression of GI on SADG was 0.072. After a median follow-up time of 19.6 months, local tumour control was 100% without any case of post-therapeutic enucleation. Two patients (8%) developed liver metastases.

Conclusion

SRT of ocular tumours by HA is highly appropriate, and HA is superior to intensity-modulated arc therapy (IMAT) concerning dose reduction in organs at risk (OARs). The novel gradient measure SADG is more informative than Paddick’s GI.

     

Second-generation sequencing of forensic STRs using the Ion Torrent™ HID STR 10-plex and the Ion PGM™

Second-generation sequencing (SGS) using Roche/454 and Illumina platforms has proved capable of sequencing the majority of the key forensic genetic STR systems. Given that Roche has announced that the 454 platforms will no longer be supported from 2015, focus should now be shifted to competing SGS platforms, such as the MiSeq (Illumina) and the Ion Personal Genome Machine (Ion PGM™; Thermo Fisher). There are currently several challenges faced with amplicon-based SGS STR typing in forensic genetics, including current lengths of amplicons for CE-typing and lack of uniform data analysis between laboratories.Thermo Fisher has designed a human identification (HID) short tandem repeat (STR) 10-plex panel including amelogenin, CSF1PO, D16S539, D3S1358, D5S818, D7S820, D8S1179, TH01, TPOX and vWA, where the primers have been designed specifically for the purpose of SGS and the data analysis is supported by Ion Torrent™ software. Hence, the combination of the STR 10-plex and the Ion PGM™ represents the first fully integrated SGS STR typing solution from PCR to data analysis.In this study, four experiments were performed to evaluate the alpha-version of the STR 10-plex: (1) typing of control samples; (2) analysis of sensitivity; (3) typing of mixtures; and (4) typing of biological crime case samples. Full profiles and concordant results between replicate SGS runs and CE-typing were observed for all control samples. Full profiles were seen with DNA input down to 50 pg, with the exception of a single locus drop-out in one of the 100 pg dilutions. Mixtures were easily deconvoluted down to 20:1, although alleles from the minor contributor had to be identified manually as some signals were not called by the Ion Torrent™ software. Interestingly, full profiles were obtained for all biological samples from real crime and identification cases, in which only partial profiles were obtained with PCR-CE assays. In conclusion, the Ion Torrent™ HID STR 10-plex panel offers an all-in-one solution from amplification of STRs and amelogenin, and sequencing to data analysis.     

Next generation sequencing of SNPs using the HID-Ion AmpliSeq™ Identity Panel on the Ion Torrent PGM™ platform

The HID-Ion AmpliSeq™ Identity Panel (the HID Identity Panel) is designed to detect 124-plex single nucleotide polymorphisms (SNPs) with next generation sequencing (NGS) technology on the Ion Torrent PGM™ platform, including 90 individual identification SNPs (IISNPs) on autosomal chromosomes and 34 lineage informative SNPs (LISNPs) on Y chromosome. In this study, we evaluated performance for the HID Identity Panel to provide a reference for NGS-SNP application, focusing on locus strand balance, locus coverage balance, heterozygote balance, and background signals. Besides, several experiments were carried out to find out improvements and limitations of this panel, including studies of species specificity, repeatability and concordance, sensitivity, mixtures, case-type samples and degraded samples, population genetics and pedigrees following the Scientific Working Group on DNA Analysis Methods (SWGDAM) guidelines. In addition, Southern and Northern Chinese Han were investigated to assess applicability of this panel. Results showed this panel led to cross-reactivity with primates to some extent but rarely with non-primate animals. Repeatable and concordant genotypes could be obtained in triplicate with one exception at rs7520386. Full profiles could be obtained from 100 pg input DNA, but the optimal input DNA would be 1 ng–200 pg with 21 initial PCR cycles. A sample with ≥20% minor contributor could be considered as a mixture by the number of homozygotes, and full profiles belonging to minor contributors could be detected between 9:1 and 1:9 mixtures with known reference profiles. Also, this assay could be used for case-type samples and degraded samples. For autosomal SNPs (A-SNPs), F_ST across all 90 loci was not significantly different between Southern and Northern Chinese Han or between male and female samples. All A-SNP loci were independent in Chinese Han population. Except for 18 loci with H_e <0.4, most of the A-SNPs in the HID Identity Panel presented high polymorphisms. Forensic parameters were calculated as >99.999% for combined discrimination power (CDP), 0.999999724 for combined power of exclusion (CPE), 1.390 × 10¹¹ for combined likelihood ratio (CLR) of trios, and 2.361 × 10⁶ for CLR of motherless duos. For Y-SNPs, a total of 8 haplotypes were observed with the value of 0.684 for haplotype diversity. As a whole, the HID Identity Panel is a well-performed, robust, reliable and high informative NGS-SNP assay and it can fully meet requirements for individual identification and paternity testing in forensic science.     

Population genetic analyses of the AmpFlSTR® NGM™ in Brazil

Population data of 15 short tandem repeat loci of the AmpFlSTR? next generation multiplex (NGM)? were obtained from a sample of 835 individuals. The loci are the ten short tandem repeats (STRs) in the SGM Plus? Kit plus the EDNAP- and ENSFI-recommended STRs D10S1248, D22S1045, D2S441, D1S1656, and D12S391. Allele frequency and other forensically relevant statistics data were generated for the NGM loci into five current country macroregions of Brazil (North, Northeast, Central West, Southeast, and South). All the analyzed loci meet Hardy-Weinberg equilibrium expectations and no linkage disequilibrium in all pairs of loci. The observed and expected heterozygosity, power of discrimination, polymorphic information content, and the other population-genetic indices were calculated. The overall power of discrimination was greater than 0.99999999999999999996 and the combined power of exclusion was greater than 0.9999998 in all Brazilian populations. Comparative analysis between populations from different Brazilian macroregions as well as between Brazil and Caucasian, African Americans, and Hispanic US populations are presented.     

The roles of TGF-β3 and peroxynitrite in removal of hyper-radiosensitivity by priming irradiation

Abstract

Purpose: To investigate the mechanisms inducing and maintaining the permanent elimination of low dose hyper-radiosensitivity (HRS) in cells given a dose of 0.3 Gy at low dose-rate (LDR) (0.3 Gy/h).

Materials and methods: Two human HRS-positive cell lines (T-47D, T98G) were used. The effects of pretreatments with transforming growth factor beta (TGF-β) neutralizers, TGF-β3 or peroxynitrite scavenger on HRS were investigated using the colony assay. Cytoplasmic levels of TGF-β3 were measured using post-embedding immunogold electron microscopic analysis.

Results: TGF-β3 neutralizer inhibited the removal of HRS by LDR irradiation. Adding 0.001 ng/ml TGF-β3 to cells removed HRS in T98G cells while 0.01 ng/ml additionally induced resistance to higher doses. Cytoplasmic levels of TGF-β3 were higher in LDR-primed cells than in unirradiated cells. The presence of the peroxynitrite scavenger uric acid inhibited the effect of LDR irradiation. Furthermore, the permanent elimination of HRS in LDR-primed cells was reversed by treatment with uric acid. The removal of HRS by medium from hypoxic cells was inhibited by adding TGF-β3 neutralizer to the medium before transfer or by adding hypoxia inducible factor 1 (HIF-1) inhibitor chetomin to the cell medium during hypoxia.

Conclusions: TGF-β3 is involved in the regulation of cellular responses to small doses of acute irradiation. TGF-β3 activation seems to be induced by low dose-rate irradiation by a mechanism involving inducible nitric oxide (iNOS) and peroxynitrite, or during cycling hypoxia by a mechanism most likely involving HIF-1. The study suggests methods to turn resistance to doses in the HRS-range on (by TGF-β3) or off (by TGF-β3 neutralizer or by peroxynitrite inhibition).