Comparison of physiological motion filters for in vivo cardiac ARFI

Acoustic radiation force impulse (ARFI) imaging is being utilized to investigate mechanical properties ofcardiac tissue. The underlying physiological motion, however, presents a major challenge. This paper aims to investigate the effectiveness of various physiological motion filters using in vivo canine data with a simulated ARFI push pulse. Ideally, the motion filter will exactly model the physiological motion and, when subtracted from the total displacement, leave only the simulated ARFI displacement profile. We investigated three temporal quadratic motion filters: (1)interpolation, (2) extrapolation and (3) a weighted technique. Additionally, the various motion filters were compared when using 1-D versus 2-D autocorrelation methods to estimate motion. It was found that 2D-autocorrelation always produced better physiological motion estimates regardless of the type of filter used. The extrapolation filter gives the most accurate estimate of the physiological motion at times immediately after the ARFI push (0.1 ms) while a close-time interpolation filter using displacement estimates at times before full tissue recovery gives the most accurate estimates at later times after the ARFI push (0.7 ms). While improvements to the motion filter during atrial systole and the onset of ventricular systole are needed, the weighted, close-time interpolation and extrapolation motion filters all offer promising results for estimating cardiac physiological motion more accurately, while allowing faster ARFI frame rates than previous motion filters. This study demonstrates the ability to eliminate physiological motion in a clinically-feasible manner, opening the door for more extensive clinical experimentation.     

SPINT2 is hypermethylated in both IDH1 mutated and wild-type glioblastomas,and exerts tumor suppression via reduction of c-Met activation

Journal of Neuro-Oncology - Both IDH1-mutated and wild-type gliomas abundantly display aberrant CpG island hypermethylation. However, the potential role of hypermethylation in promoting gliomas,...     

Submental intubation in orthognathic surgery: initial experience

Submental intubation is a technique for use in maxillofacial trauma, which allows precise assessment of changes to the nasolabial complex, midlines, cants, and incisal display in patients having maxillary orthognathic surgery. We report our initial experience of it used as an adjunct in the management of orthognathic surgery in a series of 44 patients.     

Pregnancy and HIV disease progression during the era of highly active antiretroviral therapy

BACKGROUND: Before the availability of highly active antiretroviral therapy (HAART), there was no clear effect of pregnancy on human immunodeficiency virus (HIV) disease progression. This has not been assessed during the HAART era. METHODS: We conducted an observational cohort study among HIV-infected women with >or=1 outpatient clinic visit between January 1997 and December 2004. HIV disease progression was defined as the occurrence of an AIDS-defining event or death. RESULTS: Of 759 women who met the inclusion criteria, 139 (18%) had had >1 pregnancy, and 540 (71%) had received HAART. There was no difference in HAART duration by pregnancy status. Eleven pregnant (8%) and 149 nonpregnant (24%) women progressed to AIDS or death. After controlling for age, baseline CD4(+) lymphocyte count, baseline HIV-1 RNA level, and durable virologic suppression in a Cox proportional hazards model that included propensity score for pregnancy, pregnancy was associated with a decreased risk of disease progression (hazard ratio [HR], 0.40 [95% confidence interval {CI}, 0.20-0.79]; P=.009]). In a matched-pair analysis of 81 pregnant women matched to 81 nonpregnant women according to age, baseline CD4(+) lymphocyte count, receipt of HAART, and date of cohort entry, pregnant women had a lower risk of disease progression both before (HR, 0.10 [95% CI, 0.01-0.89]; P=.04) and after (HR, 0.44 [95% CI, 0.19-1.00]; P=.05) the pregnancy event. CONCLUSION: Pregnancy was associated with a lower risk of HIV disease progression in this HAART-era study. This finding could be the result of the healthier immune status of women who become pregnant or could possibly be related to a beneficial interaction between pregnancy and HAART.     

Harnessing Oncolytic Virus-mediated Antitumor Immunity in an Infected Cell Vaccine

Treatment of permissive tumors with the oncolytic virus (OV) VSV-Δ51 leads to a robust antitumor T-cell response, which contributes to efficacy; however, many tumors are not permissive to in vivo treatment with VSV-Δ51. In an attempt to channel the immune stimulatory properties of VSV-Δ51 and broaden the scope of tumors that can be treated by an OV, we have developed a potent oncolytic vaccine platform, consisting of tumor cells infected with VSV-Δ51. We demonstrate that prophylactic immunization with this infected cell vaccine (ICV) protected mice from subsequent tumor challenge, and expression of granulocyte–monocyte colony stimulating factor (GM-CSF) by the virus (VSVgm-ICV) increased efficacy. Immunization with VSVgm-ICV in the VSV-resistant B16-F10 model induced maturation of dendritic and natural killer (NK) cell populations. The challenge tumor is rapidly infiltrated by a large number of interferon γ (IFNγ)-producing T and NK cells. Finally, we demonstrate that this approach is robust enough to control the growth of established tumors. This strategy is broadly applicable because of VSV''s extremely broad tropism, allowing nearly all cell types to be infected at high multiplicities of infection in vitro, where the virus replication kinetics outpace the cellular IFN response. It is also personalized to the unique tumor antigen(s) displayed by the cancer cell.     

Future expectations for critical care nurses. Competence in immunotherapy

Immunotherapy is a promising therapy for the treatment of some forms of cancer. This research therapy uses normal immune system substances such as IL-2 to stimulate the immune system to kill tumor cells while sparing normal tissues. Many side effects of IL-2 have been identified. The most serious of these effects involves the cardiovascular, renal, and pulmonary systems. Patients who experience these IL-2-related toxicities are effectively managed in the intensive care unit. The critical care nurse has a major role in the monitoring and management of this patient population. Hospitals that participate in this research treatment for cancer are increasing. In the near future, competence in immunotherapy will be an expectation for many critical care nurses.     

Computed tomography evaluation of recurrent Merkel cell carcinoma.

Merkel cell carcinoma is a rare cutaneous neoplasm with aggressive characteristics. Local recurrence following wide local excision is common. Computed tomography (CT) findings in a case of recurrent Merkel cell carcinoma are reported, with discussion of treatment options.     

Mantle irradiation alone for clinical stage I-II Hodgkin's disease: long-term follow-up and analysis of prognostic factors in 261 patients.

PURPOSE: To evaluate mantle radiotherapy (MRT) alone as the initial therapy of patients with clinical stage (CS) I-II Hodgkin's disease (HD). PATIENTS AND METHODS: We performed a retrospective study of patients treated with MRT alone for CS I-II supradiaphragmatic HD between 1969 and 1994. Prognostic factor analysis was performed for progression-free survival (PFS) and overall survival (OS). Outcome was also assessed in favorable cohorts defined in the literature. RESULTS: There were 261 eligible patients. The median follow-up period for surviving patients was 8.4 years (range, 1.8 to 27.4 years). The 10-year OS rate was 73%. Multifactor analysis for OS showed that age was the only important prognostic factor. The 10-year PFS rate was 58%. On multifactor analysis for PFS, the most important prognostic factors were clinical stage, B symptoms, histology, number of sites, and tumor bulk. The 10-year PFS rate for lymphocyte-predominant disease was 81% for stage I and 78% for stage II. In favorable patient cohorts defined in the literature, the 10-year PFS rate ranged from 70% to 73% for the whole group and from 71% to 90% in patients with favorable stage I disease, but only from 48% to 57% in patients with favorable stage II disease. On competing-risks analysis, the cumulative 10-year incidence of first site of failure in the para-aortic/splenic region alone was 10.5%. Sixty percent of relapsed patients remain progression-free at 10 years after chemotherapy salvage. CONCLUSION: These results support the use of MRT alone in patients with favorable CS I HD and CS I-II HD with lymphocyte-predominant histology. The remainder of patients with CS I-II HD require more intensive treatment.