Robot-assisted laparoscopic prostatectomy in a 68-year-old patient with previous heart transplantation and pelvic irradiation

We report the case of a 68-year-old man who had previously undergone heart transplantation and pelvic irradiation for Hodgkin’s lymphoma and who was under active surveillance for prostate cancer. In response to his increased prostate-specific antigen levels and elevated Gleason score, he was offered robot-assisted laparoscopic prostatectomy.     

Dietary Mustard Seeds (Sinapis alba Linn) Suppress 1,2-Dimethylhydrazine-Induced Immuno-Imbalance and Colonic Carcinogenesis in Rats

In a Wistar rat model, prolonged supplementation of mustard seed (MS) to the diet significantly ameliorates the induction of colorectal carcinomas by 1,2-dimethylhydrazine (DMH). The expression of the splenocyte major histocompatibility complex class I (MHCI) was found significantly enhanced, whereas that of the major histocompatibility complex class II (MHCII) was significantly decreased. Compared to that of control animals, the proportion of spleenic B- and dendritic cells (DC) was amplified in the MS group. The expressions of MHCI, as well as that of MHCII, were increased in DC cells; whereas in B cells, MHCI expression was augmented but that of MHCII moderately decreased. The percentages of CD8+CD28+ and CD4+CD28+ cells were increased in the MS group, while the CD4+CD25+Foxp3+ subset was depressed. Plasma analysis showed that DMH-exposure induced amplified amounts of interleukin (IL)-4, IL-5, IL-10, and transforming growth factor-beta, whereas MS feeding counteracted this effect but enhanced IL-2, IL12p70, IL21, TNF-alpha, and interferon-gamma. In the SW480 colon adenocarcinoma cell-line, the cytotoxicity of spleenic T-cells from MS-fed animals was significantly increased. In the DMH-exposed rats, the expression of perforin in the spleenic T-cells was dramatically decreased, whereas MS abolished this depression. In summary, dietary MS suppresses DMH-induced immuno-imbalance as well as colon carcinogenesis in rats.     

Economic repercussions of fisheries-induced evolution

Fish stocks experiencing high fishing mortality show a tendency to mature earlier and at a smaller size, which may have a genetic component and therefore long-lasting economic and biological effects. To date, the economic effects of such ecoevolutionary dynamics have not been empirically investigated. Using 70 y of data, we develop a bioeconomic model for Northeast Arctic cod to compare the economic yield in a model in which life-history traits can vary only through phenotypic plasticity with a model in which, in addition, genetic changes can occur. We find that evolutionary changes toward faster growth and earlier maturation occur consistently even if a stock is optimally managed. However, if a stock is managed optimally, the evolutionary changes actually increase economic yield because faster growth and earlier maturation raise the stock’s productivity. The optimal fishing mortality is almost identical for the evolutionary and nonevolutionary model and substantially lower than what it has been historically. Therefore, the costs of ignoring evolution under optimal management regimes are negligible. However, if fishing mortality is as high as it has been historically, evolutionary changes may result in economic losses, but only if the fishery is selecting for medium-sized individuals. Because evolution facilitates growth, the fish are younger and still immature when they are susceptible to getting caught, which outweighs the increase in productivity due to fish spawning at an earlier age.     

Disability and quality of life in individuals with postpolio syndrome

Purpose : The purpose of the study is to investigate disability and quality of life in individuals with the characteristic symptoms of postpolio syndrome. Method : Disability is assessed by means of the self-report activities of daily living instrument, and quality of life by means of Kaasa's questionnaire and the quality of life profile. Results : The 39 subjects have on average lived with polio sequelae for 52 years. Their main difficulties are with moving, lifting and carrying. This means restricted mobility, sedentary activities and a need to prioritize. Half of them feel that polio has lessened their possibilities in life, and a quarter have still not accepted the limitations polio has involved. Nevertheless the majority report a high level of psychosocial well-being, and almost a quarter say that living with polio has meant personal development and strength. We found a significant correlation between on the one hand disability with regard to ambulation, arm strength and finger strength on the self-report ADL, and on the other hand the number of negative problems on the quality of life profile (0.33-0.45). Conclusion : The latter instrument needs further testing before its validity can be determined with certainty.     

Intracoronary Near-Infrared Spectroscopy (NIRS) Imaging for Detection of Lipid Content of Coronary Plaques: Current Experience and Future Perspectives

Acute coronary syndromes are frequently caused by “vulnerable” coronary plaques with a lipid-rich core. In 1993 near-infrared spectroscopy (NIRS) was first used to detect the lipid (cholesterol) content of atherosclerotic plaques in an experimental animal study. NIRS was then carefully validated using human atherosclerotic plaques (ex vivo), and has subsequently been developed for intracoronary imaging in humans, for which now an FDA-approved catheter-based NIRS system is available. NIRS provides a “chemogram” of the coronary artery wall and is used to detect lipid-rich plaques. Using this technology, recent studies have shown that lipid-rich plaques are very frequent in the culprit lesion of patients with an acute coronary syndrome, and are also common in non-culprit coronary lesions in these patients as compared to patients with stable coronary disease. First studies are evaluating the impact of statin therapy on coronary NIRS-detected lipid cores. Intracoronary NIRS imaging represents a highly interesting method for coronary plaque characterization in humans and may become a valuable tool for the development of novel therapies aiming to impact on the biology of human coronary artery plaques, likely in combination with other intracoronary imaging techniques, such as optical coherence tomography.     

Physikalische Grundlagen und klinische Durchführung der interstitiellen Brachytherapie der Prostata mit Jod-125

BACKGROUND: Interstitial brachytherapy with I-125 seeds can be used for successful treatment of early stage prostate cancer. There is presented the technique of permanent transperineal implantation of I-125 seeds with intraoperative treatment planning which is suited for the treatment of prostate cancer up to the clinical stage of T2a. MATERIAL AND METHODS: Some weeks before the implantation of the seeds the prostate volume is determined using transrectal ultrasound (TRUS) so as to estimate the required number of I-125 seeds. At the outset of the treatment the prostate is stabilized by two perineally inserted needles. Subsequently there is carried out an ultrasound guided treatment planning that allows to optimize the distribution of the seeds within the prostate. In interstitial brachytherapy we use RAPID STRANDS((R)), i. e. the I-125 seeds are embedded in vicryl suture at distances of 1 cm. During implantation of the I-125 seeds the transversal placement of the applicator needles is controlled by TRUS and the cranio-caudal placement of the applicator needles is controlled using the fluoroscopic unit as well as TRUS. About 4 weeks after the implantation of the seeds there is carried out a postoperative computation of the dose distribution of the implant using CT imaging. RESULTS: The procedure possesses the advantage that ultrasound imaging, treatment planning and seed implantation are carried out with the prostate remaining in an unaltered position. During implantation the combined imaging of TRUS and fluoroscopy allows a safe placement of the seeds with in the prostate. CONCLUSION: The methods for the calculation of the actually attained dose distribution must still be optimized, because the postoperative examination of the individual results has so far been possible only with difficulties resulting from methodological inconveniences.     

Separation of no-carrier-added Cu from a proton irradiated Ni enriched nickel target

An ion exchange method has been developed to separate no-carrier-added ⁶⁴Cu from irradiated Ni target. The target is first dissolved in nitric acid and the solution is evaporated to dryness and the residue is dissolved in an ethanol–HCl solution. Cu, Co and Ni in ethanol–HCl solution are then absorbed on an anion exchange column. Co and Ni are removed from the column by eluting with 72% ethanol–0.3 mol/l HCl. Finally, the ⁶⁴Cu is eluted with water. For separating Ni from Co isotopes and recovering the ⁶⁴Ni target, the eluate of 72% ethanol–0.3 mol/l HCl is evaporated to dryness, the residue is dissolved in a concentrated HCl solution, and loaded to an another column, Ni is eluted by 9 mol/l HCl, while Co remains on the column. The procedure developed has been successfully applied for the production of no-carrier-added ⁶⁴Cu from enriched ⁶⁴Ni generated by the reaction ⁶⁴Ni(p, n)⁶⁴Cu using a cyclotron. The decontamination of Co in Cu fraction is higher than 99% and recoveries of ⁶⁴Cu and ⁶⁴Ni are higher than 95%.     

Heat stress effects for USAF anti-G suits with and without a counter-pressure vest

BACKGROUND: Aircrew have reported increased heat stress when wearing the USAF Combined Advanced Technology Enhanced Design G-Ensemble or COMBAT EDGE (CE). The perceived thermal burden has been attributed to the fact that CE includes an inflatable counter-pressure vest to ease the work of positive pressure breathing during G (PBG). This study compared the heat load of CE with that of the standard USAF anti-G system (STD) without the vest, and measured heat stress effects on G-tolerance in both suits. METHODS: This study had 12 subjects (6 of them aircrew) who participated. Simulated preflight thermal stress (20 min walking at 35 degrees C with 85% relative humidity and radiant heat) was followed by return to a cooler environment (21 degrees C). G-tolerance and subjective stress levels were determined on the human centrifuge before and after the heat stress. Body weight, rectal and skin temperatures, and blood parameters were also assessed. RESULTS: Baseline relaxed tolerance for +Gz gradual onset runs (GORs) were (mean +/- SD) 7.6 +/- 1.3 G for CE and 7.1 +/- 0.8 G for STD (p < 0.05). Maximal rectal temperature following heat stress peaked at 38.1 +/- 0.4 degrees C for both CE and STD, and mean nude weight loss was 1.10 +/- 0.24 kg for both. Relaxed GOR tolerances after heat stress were 7.1 +/- 1.3 for CE and 6.3 +/- 0.9 for STD (p < 0.01). The heat stress significantly reduced G tolerance for both CE and STD (p < 0.01). CONCLUSIONS: Simulated preflight activity in hot conditions revealed no significant difference between CE and STD with regard to maximal core and skin temperature elevations or dehydration levels. CE supported a significantly higher baseline relaxed G-tolerance than STD, an advantage that persisted after heat stress and dehydration.     

Expert for Whom? Court-Appointed Versus Party-Appointed Experts

We investigated differences in judges' attitudes between court-appointed and party-appointed forensic psychiatric expert evidence, including who commissioned the report and how this impacted on the judges' perception of the evidence presented. We also investigated the experts' views on being either a party-appointed or court-appointed expert. This survey has no explicit preconceptions. It sought to gather information empirically. The attitudes towards the experts are seen both from the legal professionals' view and from that of the experts themselves. Two groups, one of 107 forensic psychiatric experts (39 psychologists, 65 psychiatrists and three non-specialist medical doctors), and one of 157 legal professionals (44 judges, 74 attorneys and 39 prosecutors) responded to an online survey. We found that 88% of the experts had been appointed by the court and of these, 73% preferred to be court-appointed. Fifty-one per cent had also been party-appointed and the most common principal was the defence attorney (46%). Sixty-two per cent of the judges who had an opinion stated that the party-appointed experts did not assist the court. This indicates that the judges clearly preferred independent court-appointed experts.