Response of serum cytokines in patients undergoing laparoscopic cholecystectomy

The clinical observation that a laparoscopic cholecystectomy is a minimally invasive operation has not been demonstrated on a biochemical basis. Interleukin-6, a known endogenous pyrogen and hepatocyte-stimulating protein, correlates with the significance of surgical trauma. Utilizing the IL-6 immunoassay, we studied this biochemical parameter of trauma to compare its response in laparoscopic vs open cholecystectomy. Sixteen patients who underwent only laparoscopic cholecystectomy showed peak IL-6 concentrations of 51 pg/ml (22-86) vs a peak IL-6 concentration of 124 pg/ml (56-225) for open cholecystectomy. Six additional patients who underwent an ERCP followed by laparoscopic cholecystectomy showed a dramatic rise in peak IL-6 concentration to 315 pg/ml (15-634). These results biochemically confirm the true minimal invasiveness of laparoscopic cholecystectomy. The findings in the ERCP-followed-by-laparoscopic-cholecystectomy group support the theory that two invasive procedures in close proximity may prime the cytokine system in its response to surgical trauma.     

A structured modeling based methodology to design decision support systems

Many Decision Support Systems (DSS) support the decision making process through the use of mathematical models and data. DSS design involves modeling data as well as mathematical relationships in a domain. The process of model formulation and subsequent integration of model with data in a DSS is a complex and ill-structured process. This paper proposes a methodology based on Structured Modeling (SM), originally introduced by Geoffrion together with the modeling language SML, to model and design the DSS. The methodology includes rigorous and step by step procedures to design and integrate data and modelbases. The main contribution of our approach lies in the integration of research in database design, and mathematical model formulation within the structured modeling framework. The resultant procedures can be easily automated and taught to students in DSS courses. The motivation for our research stemmed from our constant frustrations in teaching DSS courses over the last five years. In the last two years, when we used our methodology, the performance of the students improved significantly. The average score in the DSS project went up to 85 from 60. Our positive experience in using our methodology in classes over the past two years suggests that the methodology imposes structure into the analysis of decision problems, and as a result students produce better DSS designs for classroom cases.     

The estrogen dilemma

There are known 3 likely mechanisms of virus conveyance into the central nervous system (CNS). These include hematogenic penetration, spread along the peripheral nerves, and the olfactory pathway which begins from the infected olfactory neuroepithelial cells. The possibility of viral spread into CNS via the olfactory pathway was shown for the representatives of togaviruses, herpesviruses, coronaviruses, rhabdoviruses, and for some others. This study suggests that the olfactory pathway of viral conveyance into CNS may be blocked by specific mucosal antibodies in the nasal mucosa. The recombinant TK- variant of WR vaccinia strain with inserted genes coding structural and nonstructural proteins of TBE virus is accumulated in the branches of the respiratory tract only while the parenteral vaccinia strain is detected in the brain regions, spleen, respiratory tract, and in blood. The protective activity of recombinant strain and inactivated TBE vaccine after mice immunization by escarification or intranasally, or subcutaneously was comparatively studied. The findings indicate that intranasal immunization by recombinant strain is the most protective against intraperitoneal challenge by TBE virus. The mucosal and humoral immune response that was induced by intranasal immunization seems to provide the highest levels of protection, which was experimentally observed.     

Medicare imposes new caps on postacute care

Prospective payment systems are replacing the methods Medicare uses to reimburse home health agencies, skilled nursing facilities, and rehabilitation hospitals, as well as imposing new limits on payments for outpatient rehabilitation services. Medicare stands to save substantial sums of money and possibly to hasten the formation of integrated delivery systems for postacute care.     

The expert identification of the remains of the imperial family by means of molecular genetic verification of genealogical relations

The paper presents the results of international complex molecular genetic expert identification of skeletal remains of 9 subjects buried near the Koptiaki road in Ekaterinburg region, presumably belonging to the Romanov Royal Family and persons in their attendance. The armory of methods based on analysis of the least permissible amounts of DNA by the polymerase chain reaction and direct fluorescent sequencing of amplified DNA fragments included the latest scientific technologies. In addition, new methods were developed and used, which have no analogs in the world expert practice. The strategy included identification of biological gender of skeletons, of familial group among exhumed individuals, and of ties of relationship of this family with two independent maternal branches of the Romanov genealogical tree using tracing kindred markers based on mitochondrial DNA (mtDNA). The study was carried out in two stages: in 1992-1993 at Aldermaston Criminology Center of Home Office of the UK with participation of British specialists and in 1995 at Military Medical Institute of Ministry of Defence of the USA in Washington with participation of American specialists. In 1993 five skeletons were identified as Emperor Nicholas II, Empress Alexandra Fedorovna, and their three daughters with 99.6% certainty. From modern criminological viewpoint, the result could not be considered as sufficiently certain for such an extraordinary case, and therefore in 1995 molecular genetic studies of presumable remains of Nicholas II and his brother Prince Georgi? Romanov were carried out again. The results showed absolute positional identity of mtDNA genetic code of these two men due to an extremely rare genetic abnormality (heteroplasmia), and thus the problem of appurtenance of the remains to the Romanov royal family was solved.     

Feasibility of cardiac cryoablation using a transvenous steerable electrode catheter

BACKGROUND AND PURPOSE: Accurate contouring of the clinical target volume (CTV) is a fundamental prerequisite for successful conformal radiotherapy of prostate cancer. The purpose of this study was to investigate intra- and inter-observer variability in contouring prostate (P) and seminal vesicles (SV) and its impact on conformal treatment planning in our working conditions. MATERIALS AND METHODS: Inter-observer variability was investigated by asking five well-trained radiotherapists of contouring on CT images the P and the SV of six supine-positioned patients previously treated with conformal techniques. Short-term intra-observer variability was assessed by asking the radiotherapists to contour the P and SV of one patient for a second time, just after the first contouring. The differences among the inserted volumes were considered for both intra- and inter-observer variability. Regarding intra-observer variability, the differences between the two inserted contours were estimated by taking the relative differences in correspondence to the CT slices on BEV plots (antero-posterior and left-right beams). Concerning inter-observer variability, the distances between the internal and external envelopes of the inserted contours (named projected diagnostic uncertainties or PDUs) and the distances from the mean inserted contours (named mean contour distances or MCDs) were measured from BEV plots (i.e. parallel to the CT slices). RESULTS: Intra-observer variability was relatively small (the average percentage variation of the volume was approximately 5%; SD of the differences measured on BEV plots within 1.8 mm). Concerning inter-observer variability, the percentage SD of the inserted volumes ranged from 10 to 18%. Differences equal to 1 cm in the cranio-caudal extension of P + SV were found in four out of six patients. The largest inter-observer variability was found when considering the anterior margin in the left-right beam of P top (MCD = 7.1 mm, 1 SD). Relatively high values for MCDs were also found for P bottom, for the posterior and lateral margins of P top (2.6 and 3.1 mm, respectively, I SD) and for the anterior margin of SV (2.8 mm, 1 SD). Relatively small values were found for P central (from 1.4 to 2.0 mm, 1 SD) and the posterior margin of SV (1.5 mm, 1 SD). CONCLUSIONS: The application of larger margins taking inter-observer variability into account should be taken into consideration for the anterior and the lateral margins of SV and P top and for the lateral margin of P. The impact of short-term intra-observer variability does not seem to be relevant.