Hepatic Resection for Colorectal Metastasis: Impact of Tumour Size

Background Many colorectal liver metastasis patients are denied surgical resection on the basis of tumour size. The aim of this study was to explore the impact of metastasis size on modern liver resection.Methods Using a prospectively collected database, this was a retrospective analysis of 484 consecutive patients who underwent liver resection for colorectal liver metastases between 1993 and 2003. The cohort was divided into two groups: smaller metastases (<8 cm) and larger metastases (≥ 8 cm). Those with larger metastases were then further stratified into big metastases (8–12 cm) and giant metastases (>12 cm). Demographic, pathological, surgical technique and outcome data were compared between the groups.Results There were 88 (18%) patients with metastases measuring 8 cm or larger. There was an association between higher carcinoembryonic antigen (CEA) and cancer antigen (CA) 19-9 levels and larger metastases. The actuarial 5-year survival for patients with larger metastases was 38% compared with 42% for smaller metastases (not statistically significant). Patients with giant metastases had poorer overall and disease-free survival (both nonsignificant) compared with those with big metastases: 29% and 28% at 5 years, respectively.Conclusion Patients with colorectal liver metastasis greater than 8 cm and up to 12 cm in size should not be treated differently from those with smaller lesions.     

Spectral Clustering for Unsupervised Segmentation of Lower Extremity Wound Beds Using Optical Images

Chronic lower extremity wound is a complicated disease condition of localized injury to skin and its tissues which have plagued many elders worldwide. The ulcer assessment and management is expensive and is burden on health establishment. Currently accurate wound evaluation remains a tedious task as it rely on visual inspection. This paper propose a new method for wound-area detection, using images digitally captured by a hand-held, optical camera. The strategy proposed involves spectral approach for clustering, based on the affinity matrix. The spectral clustering (SC) involves construction of similarity matrix of Laplacian based on Ng-Jorden-Weiss algorithm. Starting with a quadratic method, wound photographs were pre-processed for color homogenization. The first-order statistics filter was then applied to extract spurious regions. The filter was selected based on the performance, evaluated on four quality metrics. Then, the spectral method was used on the filtered images for effective segmentation. The segmented regions were post-processed using morphological operators. The performance of spectral segmentation was confirmed by ground-truth pictures labeled by dermatologists. The SC results were additionally compared with the results of k-means and Fuzzy C-Means (FCM) clustering algorithms. The SC approach on a set of 105 images, effectively delineated targeted wound beds yielding a segmentation accuracy of 86.73 %, positive predictive values of 91.80 %, and a sensitivity of 89.54 %. This approach shows the robustness of tool for ulcer perimeter measurement and healing progression. The article elucidates its potential to be incorporated in patient facing medical systems targeting a rapid clinical assistance.     

Use of mobile telephone short message service as a reminder: the effect on patient attendance

Background: Nonattendance for hospital outpatient appointments is a major burden on healthcare systems and the estimated financial loss can be high. Various reasons for patients not attending have been reported, including the patient/carer forgetting the appointment and confusion over the date and time of the appointment. Various reminder systems have been trialled across a variety of clinical settings. More recently, short message service (SMS) text messaging has emerged as a viable approach for delivering reminders to outpatients at a relatively low cost. Aims and objectives: To evaluate the effect of appointment reminders, sent as SMS text messages to patients’ mobile telephones, on attendance at outpatient clinics at the ITS Centre for Dental Studies and Research (ITS‐CDSR), Muradnagar, Ghaziabad, Uttar Pradesh, India. Materials and methods: The study was conducted at ITS‐CDSR in the Departments of Prosthodontics, Endodontics, Orthodontics and Paedodontics. Patients attending these departments for a period of 4 months and those who had provided a contact mobile number were sent an SMS reminder. Results: In this study, 206 subjects (male, 124; female, 82) participated, 96 (male, 57; female, 39) of whom were in the test group and 110 (male, 67; female, 43) of whom were in the control group. The rate of attendance on time was found to be significantly higher in the test group (79.2%) than in the control group (35.5%). Conclusion: The study results indicate that sending appointment reminders as text messages to patients is an effective strategy to reduce nonattendance rates.     

The pattern of the maxillofacial fractures – A multicentre retrospective study

Aim of the present study was to report on the survey of fractures, frequency of presentation, sex and age distributions, aetiology, site distributions, associated injuries & modalities of treatment rendered at muticentres treated by the division of oral and maxillofacial surgery between 2000 and 2005 in Karnataka state of India. Study revealed that the common cause for the facial fractures was found to be traffic accidents (72.7%) with a male preponderance and peak incidence during 20–30 years of age. Isolated mandibular fractures were most frequent [1035 patients (41.7%)] followed by isolated mid face fractures [526 patients (21.2%)]. Among mid face fractures, zygomatic bone and arch were most frequently involved. Open reduction and internal fixation and closed method were used in almost the same frequency. Traffic accidents are the leading cause of the maxillofacial fractures from the observation made from the study. Legislations preventive measures to be enforced and abided by every citizen.     

Collagen gel contraction by ARPE-19 cells is mediated by a FAK-Src dependent pathway

Proliferative vitreoretinopathy (PVR) may result in part from de-differentiation of retinal pigment epithelium (RPE) in an aberrant wound-healing strategy. An in vitro model of PVR, collagen gel contraction by RPE, likely requires integrin engagement and activation as an important initial step. The purpose of this study was to identify the important associated integrins and signal transduction pathway. The retinal pigment epithelial cell line ARPE-19 was used in these studies. Cell surface integrin expression was assessed using flow cytometry. An in vitro contraction assay was performed and the percent contraction quantified at specific time intervals using image capture (Gel Doc) and NIH Image software. Cells were pretreated with either small molecule inhibitors of signal transduction pathways or monoclonal antibodies with specificity for specific integrin isoforms. Transient transfections with a FAK siRNA were used to decrease FAK expression. ARPE-19 cells express alpha1, alpha2, and alpha3 integrin, isoforms involved in collagen ligation. Cell surface integrin blockade using anti-integrin alpha2 (P=0.02), alpha3 (P=0.01), or a combination of alpha1, alpha2, and alpha3 (P=0.001) antibodies significantly reduced collagen gel contraction. Inhibition of the FAK-Src complex, but not MEK or PI3K, significantly decreased contraction (P=0.0001). FAK siRNA transient transfection significantly reduced FAK protein expression by 71% (P=0.02) and concordantly decreased gel contraction (P=0.0001). RPE-mediated collagen gel contraction is a multi-step process. Integrin ligation and FAK-Src activation is necessary for collagen gel contraction produced by the ARPE-19 cell line. Validation of these observations in primary RPE cells may suggest new targets for therapeutic intervention in PVR.     

Improvement of myocardial function by trifluoperazine, a calmodulin antagonist, after acute coronary artery occlusion and coronary revascularization

Activation of an intracellular calcium-calmodulin complex may play an important role in myocardial injury induced by ischemia and reperfusion. Trifluoperazine, a calmodulin antagonist, was used before ischemia to enhance myocardial preservation by preventing intracellular calcium accumulation. The experimental model used an isolated in situ pig heart (19 control animals and 15 trifluoperazine-treated animals) subjected to occlusion of the left anterior descending coronary artery for 60 minutes followed by 60 minutes of hypothermic potassium crystalloid cardioplegic arrest and 60 minutes of reperfusion. Myocardial segmental function measured by ultrasonic crystals showed that active systolic segment shortening was abolished in the distribution of the left anterior descending artery after 60 minutes of occlusion irrespective of the treatment, whereas that not in the distribution of the left anterior descending artery increased by about 15% in both groups of animals. Restoration of systolic segment shortening in the distribution of the left anterior descending artery 60 minutes after reperfusion was 12% and 42% of baseline levels in untreated and trifluoperazine-treated animals, respectively (p less than 0.01). This improvement in segmental function by trifluoperazine was reflected in significantly (p less than 0.05) better global myocardial contractility and compliance and in significantly (p less than 0.01) greater total coronary blood flow and myocardial oxygen consumption. Trifluoperazine also increased myocardial creatine phosphate content in the distribution of the left anterior descending artery (p less than 0.01) during reperfusion, and creatine kinase release was reduced (p less than 0.05). Our results suggest that trifluoperazine improved regional myocardial function after acute occlusion of the left anterior descending artery and reperfusion and that global cardiac performance was thereby improved. The beneficial effects of trifluoperazine may be exerted by prevention of myocardial injury associated with the calcium-calmodulin complex in ischemic and reperfused myocardium.     

Broad human immunodeficiency virus (HIV)-specific T cell responses to conserved HIV proteins in HIV-seronegative women highly exposed to a single HIV-infected partner

Eighteen highly exposed but persistently seronegative (HEPS) women (HW) and their human immunodeficiency virus (HIV) type 1-seropositive male partners were studied for HIV-specific T cells and other host factors. Circulating HIV-specific T cells were measured by interferon-gamma enzyme-linked immunospot assays, using recombinant vaccinia virus vectors expressing HIV proteins. Nine (50%) of the HW and all HIV-seropositive persons had HIV-specific T cell responses. Only 2 (22%) of the HEPS responders recognized Env, compared with 94% of HIV-seropositive persons. A high percentage (75%) of the HW with HIV-specific T cell responses reported recent HIV exposure. Remarkably, however, long-lived HIV-specific T cells were detected in 2 HW who had an extended period (>3.9 years) of no HIV exposure. These findings have important implications for HIV vaccine design.