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Context.—: Precision therapies for patients with driver mutations can offer deep and durable responses that correlate with diagnosis, metastasis prognosis, and improvement in survival. The use of such targeted therapies will continue to increase, pushing us to change our traditional approaches. We needed to search for new tools to effectively integrate technological advancements into our practices because of their capability to improve the efficiency and accuracy of our diagnostic and treatment approaches. Perhaps nothing is as relevant as identifying and implementing new workflows for processing pathologic specimens and for improving communication of critical laboratory information to and from clinicians for appropriate care of patients in an efficient and timely manner., Objectives.—: To define the gold standard in delivering the best care for patients, to identify gaps in the process, and to identify potential solutions that would improve our process, including gaps related to knowledge, skills, attitudes, and practices., Design.—: We assembled a multidisciplinary team to systematically perform a gap analysis study to clarify the discrepancy between the current reality in pathology specimen processing and the desired optimal situation to deliver the results intended for patient care., Results.—: A practical collaborative workflow for specimen management that seeks the cooperation of stakeholders in each medical discipline to provide guidelines in specimen collection, delivery, processing, and reporting of results with the ultimate goal of improving patient outcomes is provided., Conclusions.—: New tools are required to effectively integrate data-driven approaches in specimen processing to meet the new demands.

Hydroxyethylcellulose (HEC)/acrylic acid (AAc) copolymer gels with superabsorbent properties were synthesized from aqueous solutions by radiation-initiated crosslinking. The effect of the acrylic acid content on gel properties was determined at different synthesis conditions. The partial replacement of the cellulose derivative with acrylic acid improved the gelation, leading to higher gel fraction and lower water uptake even in very low concentrations (1-5%). In the presence of acrylic acid lower dose and solute concentration was required for the gel synthesis. The molecular properties of the hydroxyethylcellulose also had a major effect on the gelation: higher molecular mass resulted in better gel properties. The acrylic acid also affected the electrolyte sensitivity of the hydrogels: while pure HEC gels were unaffected by the ionic strength of the solvent, the water uptake of HEC/AAc gels decreased with the salt concentration. The sensitivity also depended on the acrylic acid ratio., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Superabsorbent hydrogels show a large potential in a wide array of applications due to their unique properties. Carboxymethylcellulose (CMC) is a commercially available water-soluble cellulose derivative of major interest in the hydrogel synthesis. High-energy irradiation allows the chemical crosslinking without the use of crosslinking agents, while the introduction of other natural or synthetic polymers offers a convenient way to modify the gels. In this study we examined the effect of the addition of starch, a low-cost renewable polysaccharide, on the properties of carboxymethylcellulose-based hydrogels., Results: Superabsorbent gels were prepared by gamma irradiation from aqueous mixtures of carboxymethylcellulose and starch. The partial replacement of CMC with starch improved the gel fraction, while a slight increase in the water uptake was also observed. However, very high starch content had a negative impact on the gelation, resulting in a decrease in gel fraction. Moreover, higher solute concentrations were preferred for the gelation of CMC/starch than for pure CMC. Hydrogels containing 30% starch showed the best properties: a water uptake of ~350 g water /g gel was achieved with ~55% gel fraction synthesized from 15 w/w% solutions at 20 kGy. Heterogeneous gel structure was observed: the starch granules and fragments were dispersed in the CMC matrix. The swelling of CMC/starch gels showed a high sensitivity to the ionic strength in water due to the CMC component. However, the mixed gels are less sensitive to the ionic strength than pure CMC gels., Conclusions: The introduction of starch to carboxymethylcellulose systems led to improved properties. Such gels showed higher water uptake, especially in an environment with high electrolyte concentration. CMC/starch hydrogels may offer a cheaper, superior alternative compared to pure cellulose derivative-based gels depending on the application.

After creation of an arteriovenous fistula or placement of an arteriovenous graft, several weeks are required for maturation prior to first cannulation. Patients need an alternative way to receive hemodialysis during this time, frequently a catheter. After multiple failed access attempts, patients can run out of options and become catheter dependent. At our institution, we place HeRO grafts in eligible patients who have otherwise been told they would be catheter dependent for life. By combining the HeRO graft system with a Flixene graft, patients are able to remove catheters sooner or avoid placement as they can undergo cannulation for hemodialysis the next day. Utilizing this novel technique, twenty-one patients over a two-year period with various forms of central venous stenosis, catheter dependence, or failing existing arteriovenous access have been successfully converted to stable long term noncatheter based upper extremity access.

Background. To compare Child Behavior Checklist (CBCL) findings for a large Brazilian general population sample with those for US children considering: (a) mean problem item ratings; (b) fit of the US-derived CBCL 8-syndrome model; (c) scale internal consistency measured by Cronbach's alphas; (d) effects of society, age, gender on CBCL problem scores; and (e) ability to discriminate referred from non-referred children. Methods. Parents of 1228 non-referred 6-to-11-year-olds from three different regions of Brazil and 247 referred 6-to-11-year-olds from one clinic rated their children's behavioural and emotional problems using the CBCL/6-18. Results. Results for mean item ratings and scale internal consistencies were very similar to those found in the US and in Uruguay. Confirmatory factor analysis indicated that Brazilian data showed the best fit to the US 8-syndrome model of all countries studied to date. Gender patterns were comparable to those reported in other societies, but mean problem scores for non-referred Brazilian children were higher than those for US children. Therefore, the CBCL discriminated less well between non-referred and referred children in Brazil than in the US. Conclusions. Overall, our findings replicated those reported in international comparisons of CBCL scores for 31 societies, thereby providing support for the multicultural robustness of the CBCL in Brazil.

Aims: In this study, we extended our previous work to determine the efficiency of antimicrobial compounds in increase of relative radiosensitivity of Salmonella Typhi in medium fat ground beef (23% fat) by testing 41 different essential oils (EOs), oleoresins and food sauces., Methods and Results: Ground beef samples inoculated with Salmonella Typhi (10(6) CFU g(-1)) were treated with each antimicrobial compound at a concentration of 0.5% (w/w). Then, the samples (25 g each) were packaged under air and irradiated in a (60)Co irradiator at doses from 0 to 1.75 kGy. Radiosensitivity was evaluated by calculating relative radiation sensitivity, defined as the ratio of radiation D(10) value in the absence/presence of antimicrobial compound., Conclusions: Depending on the compound tested, the addition of antimicrobial compound decreased the D(10) value of Salmonella Typhi, resulting in an increase of the radiation sensitivity up to more than four times. Among these antimicrobial compounds, Chinese cinnamon EO, clove EO and trans-cinnamaldehyde were most effective to increase the radiosensitivity of Salmonella Typhi in ground beef., Significance and Impact of the Study: These observations demonstrate that some active compounds can function as radiosensitizers of Salmonella Typhi.

Selected Chinese cinnamon, Spanish oregano, and mustard essential oils (EOs) were used in combination with irradiation to evaluate their ability to eliminate pathogenic bacteria and extend the shelf life of medium-fat-content ground beef (23% fat). Shelf life was defined as the time when the total bacterial count reached 10(7) CFU/g. The shelf life of ground beef was determined for 28 days at 4 degrees C after treatment with EOs. The concentrations of EOs were predetermined such that sensory properties of cooked meat were maintained: 0.025% Spanish oregano, 0.025% Chinese cinnamon, and 0.075% mustard. Ground beef samples containing EOs were then packaged under air or a modified atmosphere and irradiated at 1.5 kGy. Ground beef samples (10 g) were taken during the storage period for enumeration of total mesophilic aerobic bacteria, Escherichia coli, Salmonella, total coliforms, lactic acid bacteria, and Pseudomonas. Mustard EO was the most efficient for reducing the total mesophilic aerobic bacteria and eliminating pathogenic bacteria. Irradiation alone completely inhibited the growth of total mesophilic aerobic and pathogenic bacteria. The combination of irradiation and EOs was better for reducing lactic acid bacteria (mustard and cinnamon EOs) and Pseudomonas (oregano and mustard EOs). The best combined treatment for extending the shelf life of ground beef for up to 28 days was EO plus irradiation (1.5 kGy) and modified atmosphere packaging.

Twenty-six different essential oils were tested for their efficiency to increase the relative radiosensitivity of Escherichia coli and Salmonella Typhi in medium-fat ground beef (23% fat). Ground beef was inoculated with E. coli O157:H7 or Salmonella (10(6) CFU/g), and each essential oil or one of their main constituents was added separately at a concentration of 0.5% (wt/wt). Meat samples (10 g) were packed under air or under modified atmosphere and irradiated at doses from 0 to 1 kGy for the determination of the D10-value of E. coli O157:H7, and from 0 to 1.75 kGy for the determination of the D10-value of Salmonella Typhi. Depending on the compound tested, the relative radiation sensitivity increased from 1 to 3.57 for E. coli O157:H7 and from 1 to 3.26 for Salmonella Typhi. Addition of essential oils or their constituents before irradiation also reduced the irradiation dose needed to eliminate both pathogens. In the presence of Chinese cinnamon or Spanish oregano essential oils, the minimum doses required to eliminate the bacteria were reduced from 1.2 to 0.35 and from 1.4 to 0.5 for E. coli O157:H7 and Salmonella Typhi, respectively. Cinnamon, oregano, and mustard essential oils were the most effective radiosensitizers.

This study was undertaken to evaluate the effect of 1.0% carvacrol and 0.1% tetrasodium pyrophosphate on the radiation D10 of Escherichia coli and Salmonella Typhi added to ground beef at a concentration of 10(5) CFU/g. The ground beef was then packaged under four different atmosphere conditions: air (78.1% N2, 20.9% O2, 0.036% CO2), 100% CO2, modified atmosphere (60% O2, 30% CO2, 10% N2) and vacuum. Samples were irradiated at doses of 0.1 to 0.6 kGy for E. coli and 0.5 to 2.0 kGy for Salmonella Typhi. Radiation D10-values of 0.126 and 0.526 kGy were observed for E. coli and Salmonella Typhi, respectively, when meat was packed under air. When meat was packed under modified atmosphere conditions, the radiation D10-values for E. coli and Salmonella Typhi were 0.086 and 0.221 kGy, respectively. The addition of carvacrol and tetrasodium pyrophosphate and the use of modified atmosphere packaging reduced the radiation D10-value from 0.126 to 0.046 kGy for E. coli and from 0.526 to 0.053 kGy for Salmonella Typhi. Under vacuum and 100% CO2 conditions, the radiation D10 reduction was not as great as that for the modified atmosphere regardless of the presence or absence of carvacrol and tetrasodium pyrophosphate.

This article compares resource intensity weight costs with case costs for selected patient groups at St. Paul's Hospital, British Columbia. Analysis found that average case costs for surgical patients were 23.9% higher than their resource intensity weight costs, whereas case costs for non-surgical patients were 14.8% lower. Average case costs for patients receiving surgical implants were 32.8% higher than resource intensity weight costs. For patients receiving internal defibrillators average case costs were three times higher.

The radiosensitization of two pathogenic bacteria, Escherichia coli and Salmonella Typhi, was evaluated in the presence of thyme and its principal essential oil constituents (carvacrol and thymol) in ground beef. Ground beef was inoculated with E. coli or Salmonella Typhi (10(5) CFU/g), and each compound was added separately at various concentrations (0 to 3.5%, wt/wt). The antimicrobial potential of carvacrol, thymol, and thyme was evaluated in unirradiated meat by determining the MIC in percentage (wt/wt) after 24 h of storage at 4 +/- 1 degree C. Results showed a MIC of 0.88 +/- 0.12%, 1.14 +/- 0.05%, and 2.33 +/- 0.32% for E. coli in the presence of carvacrol, thymol, and thyme, respectively. MICs of 1.15 +/- 0.02%, 1.60 +/- 0.01%, and 2.75 +/- 0.17% were observed for Salmonella Typhi in the presence of the same compounds, respectively. The best antimicrobial compound (i.e., carvacrol) was selected and added to the sterilized ground beef along with ascorbic acid (0.5%, wt/wt) and tetrasodium pyrophosphate (0.1%, wt/wt). Meat samples (10 g) were packed in air and then irradiated in a 60Co irradiator at doses of 0 to 0.7 kGy for the determination of E. coli radiation D10 and 0 to 2.25 kGy for the determination of Salmonella Typhi radiation D10. Addition of carvacrol increased the relative sensitivity of both bacteria 2.2 times. The radiation D10 was reduced from 0.126 +/- 0.0039 to 0.057 +/- 0.0015 kGy for E. coli and from 0.519 +/- 0.0308 to 0.235 +/- 0.0158 kGy for Salmonella Typhi. The addition of tetrasodium pyrophosphate did not affect significantly (P > 0.05) the radiosensitization of either bacterium. However, the presence of ascorbic acid in the media reduced significantly (P < or = 0.05) the radiosensitivity of both bacteria. An additive effect of carvacrol addition and packaging under modified atmosphere conditions (60% O2-30% CO2-10% N2) was also observed on bacterial radiosensitization at 4 degrees C. Compared with the control packed under air, modified atmosphere packaging conditions in the presence of carvacrol and tetrasodium pyrophosphate improved the relative sensitivity of E. coli by 2.7 times and Salmonella Typhi by 9.9 times.

Most protective clothing research for workers exposed to pesticides has focused on the primary dermal exposure that results from direct contact with the pesticide and on the penetration, versus repellency, of protective materials. The role of absorption and retention in the function of traditional clothing materials to limit pesticide exposure has received less attention. This project investigates the transfer of pesticides from contaminated work clothing in the dry state to human skin with the goal of furthering our understanding of the role of absorption and retention in the function of traditional clothing materials. Our objective was to study the use of synthetic membrane to evaluate the kinetic transport of pesticide from contaminated clothing through human skin. Transport of pesticide through the test system with and without the presence of fabric was characterized by a three-parameter single exponential rise to maximum equation. The synthetic membrane system was an appropriate model for human skin in this situation. Starching applied to the fabric gave additional absorption and retention, reducing pesticide transport from the fabric to the skin, and heavier weight fabric, such as denim, provided protection through absorption and retention of the pesticide.

Purpose: Blunt aortic injury (BAI) involving the thoracic aorta is usually described as occurring at the isthmus. We hypothesized that injuries 1 cm or less from the inferior border of the left subclavian artery (LSCA) are associated with an increased mortality rate compared with injuries that are more distal., Methods: A retrospective review of patients admitted with the diagnosis of BAI was performed. Injuries were divided into two groups: group I, injuries that were 1 cm or less from the junction of the LSCA and the thoracic aorta; group II, injuries that were more than 1 cm from the LSCA. Primary outcome measures included cross-clamp time, rupture, and death., Results: In a 14-year period, 122 patients were admitted with BAI. The anatomy relative to the LSCA could be determined in 91 patients who underwent operative repair. Forty-two injuries (46%) were classified as group I, and 49 injuries were classified as group II. Group I injuries were characterized by an increased mortality rate (18/42 or 43% in group I vs 11/49 or 22% in group II, P = .04), intraoperative rupture rate (7/42 or 17% in group I vs 1/49 or 2% in group II, P = .003), and cross-clamp time (39.5 +/- 21.9 minutes in group I vs 28.4 +/- 13 minutes in group II, P = .04). Three ruptures occurred while proximal control was being obtained., Conclusion: Increased technical difficulty and risk of rupture characterize injuries that occur proximally in the descending thoracic aorta, 1 cm from the LSCA. These injuries may be better managed by instituting bypass before attempting to obtain proximal control and by routinely clamping proximal to the LSCA.

The authors describe the occurrence of type III heart block in a patient undergoing a transjugular intrahepatic portosystemic shunt recanalization with use of the AngioJet thrombectomy system.

Purpose: To evaluate whether peripherally inserted central catheters (PICCs) with a proximal valve have any advantage compared to those with a distal valve in regard to the incidence of occlusion, infection, or malfunction., Materials and Methods: One hundred patients (mean age, 46 y) were randomized to receive either a distal-valved Bard Groshong catheter (n = 48) or a proximal-valved Catheter Innovations Pressure Activated Safety Valve catheter (n = 52). All catheters were 4-F, single-lumen PICCs. Catheters were placed under fluoroscopic (n = 82) or sonographic (n = 18) guidance. Most (91%) were placed for the administration of antibiotics. The placement procedure, maintenance, and weekly follow-up were the same for both catheters., Results: Percutaneous placement with the catheter tip in the central veins was successful in all patients. Mean dwell time was 36 days. There were 12 (25%) occlusive or infectious complications in the distal valve catheter group and six (11.5%) in the proximal valve group (P = .08). There were 25 fractures in 17 distal valve catheters (35.4%) and three (5.8%) proximal valve catheter fractures (P < .01)., Conclusion: There was a marked difference in durability between the valved catheters, in favor of the catheter with a proximal valve. There was also a trend for fewer occlusive and infectious complications with the proximal valve catheter.

This article describes an initial experience with stent placement in three patients with severe pulmonary artery stenosis secondary to fibrosing mediastinitis. All three patients were severely symptomatic on admission and all three were asymptomatic after treatment and remained symptom-free approximately 1 year after treatment.

Purpose: Comparative evaluation of the biological effects of a silicone-covered stent versus a bare-metal stent, in an animal model., Methods: Twelve stent implants were placed in the iliac arteries of six adult dogs. Each animal received one 8-mm x 20-mm silicone-covered stent (Permalume; Boston Scientific Vascular, Watertown, MA, USA), in the right iliac artery and one Wallstent (Boston Scientific Vascular) of the same diameter and length in the left iliac artery, during systemic anticoagulation. Angiography was performed before and after implantations. Animals were then allowed to recover and no platelet suppression was given during a 6-week interval, after which the animals were euthanized. The stented arteries were isolated and pressure-fixed in situ with 10% buffered formalin at a pressure of approximately 100 mmHg for a period of 1 hr. Two of 12 stented specimens were opened lengthwise and the luminal surfaces were photographed. Ten of 12 stented arterial segments were encased in methacrylate, then stained with hematoxylin and eosin. Neointimal thickness was quantified on histologic cross-section, for both bare and covered stents. The mean neointimal thicknesses were compared for significant difference using a student t-test., Results: All implants were widely patent at 6-week follow-up angiography. Histologic analysis showed bare metal stents covered by a thin uniform lining of neointima composed of smooth muscle cells in a hyaline matrix (mean thickness of 189 +/- 47 microm). Silicone covered stents were devoid of neointima. There was no chronic thrombus or mature endothelium noted anywhere upon the internal silicone surfaces of any of the specimens. There was no foreign body reaction to the silicone cover., Conclusion: Short-term implantation of a silicone-lined Wallstent in canine iliac arteries is well tolerated. Silicone appears to be inert at 6 weeks in this experimental application.

The etiology of acute intraabdominal bleeding is often unclear at the time emergent arteriography is performed. During localization and embolization, the arteriogram may suggest the diagnosis of vasculitis. However, controlling the bleeding remains the priority. Connective tissue diseases such as Ehlers-Danlos syndrome (EDS) may also cause bleeding and mimic vasculitis and must be included in the differential diagnosis. We present such a case in which the initial findings were misleading.

Purpose: To determine the in vitro feasibility of abciximab absorption and elution from a polymer-coated, silicone-covered stent, and to determine the in vivo effect of local delivery of abciximab concerning endothelialization of a polymer-coated, silicone-covered stent in a canine model., Materials and Methods: Six polymer-coated, silicone-lined Wallstents were soaked in 2 mg/mL of concentrated solution of I131-labeled abciximab for a period as long as 48 hours. Quantification of abciximab absorption was determined by photon emission. Six maximally drug-loaded devices were then washed continuously with normal saline with use of a pustule pump apparatus. The quantity of residual abciximab was determined by photon emission for a period as long as 16 days. Eight similar devices (as described previously) were then implanted within the iliac arteries of four adult canines. Devices were identical except that four of eight were maximally loaded with abciximab. For each animal, one control implant was placed in the right iliac artery and one experimental implant (drug loaded) was placed in the left iliac artery, via right carotid cutdown. Animals were allowed to recover and no chronic medications were given. After an interval of 6 weeks, the animals were killed. Implants were isolated and perfused with 10% buffered formalin at a pressure of approximately 100 mm Hg for a period of 1 hour. Each implant was encased in methacrylate, sectioned into six equal segments, ground and polished, and stained with hematoxylin and eosin. Each slide was projected on a screen and the thickness of the neointima quantified. The mean neointima was determined for control and experimental groups, and compared for a potential significant difference with a Student t test., Results: Mean absorption of abciximab was 21.53 microg +/- 2.99 per device. Devices were fully saturated at 24 hours. Forty percent was absorbed at 1 hour, and 60% and 80% were absorbed at 4 hours and 12 hours, respectively. Regarding elution, 30% of abciximab was washed out after 1 hour. There was a gradual elution of the drug to 16 days, with approximately 40% remaining at the end of the term. Mean neointimal thickness was 995 microm +/- 597 for the experimental group and 1,738 microm +/- 1,042 for the control group. The difference was significant (P <.05)., Conclusions: Absorption and elution of abciximab from the surface of a covered stent is feasible. Local delivery of abciximab from the surface of this covered stent reduced the thickness of endothelial lining in the canine iliac artery compared to control.

A patient with superior vena cava (SVC) occlusion presented with severe ascites and urgent transjugular intrahepatic portosystemic shunt (TIPS) was requested. The patient had a chronically occluded SVC. An alternative to classic TIPS was employed using CT guidance to traverse the left portal vein to the inferior vena cava with a small gauge needle. Fluoroscopic guidance was then used to snare a wire placed through the needle and then work from the femoral vein to create a portocaval shunt that passed through the caudate lobe. This procedure was a technical success and improved the patient's ascites.

Purpose: To report the endovascular treatment of a relatively uncommon type of deceleration injury to the abdominal aorta., Case Report: A 21-year-old backseat passenger was wearing a single lap belt without shoulder harness when the car was involved in a collision. He sustained a transverse (Chance) fracture of the third lumbar vertebra and a circumferential dissection of the infrarenal abdominal aorta with pseudoaneurysm. As an interim measure while a stent-graft was obtained, a Wallstent was deployed to tack down the dissection and prevent distal embolization. Thirty-six hours later, an AneuRx endograft was successfully implanted inside the Wallstent to seal the pseudoaneurysm. The patient's recovery was uneventful, and the endograft remains secure and the pseudoaneurysm excluded at 10 months after the accident., Conclusions: Endovascular repair of "seat belt aorta" is a minimally invasive, straightforward method of management for this type of aortic injury. The potential for infection in a contaminated peritoneal cavity and the long-term outcome of this treatment have not been determined.

We hypothesized that the predominant factor influencing outcome of traumatic rupture of the thoracic aorta (TRA) was the degree of shock on presentation and associated injuries. We reviewed our experience with TRA over a 15-year period. Patients were classified as "unstable" if presenting systolic blood pressure was <90 mm Hg or if it decreased to <90 mm Hg after admission. We determined the presence of closed head injury, cardiac risk factors, a preoperative acute lung injury (ALI). The influence of these factors on mortality, postoperative adult respiratory distress syndrome (ARDS), and paralysis was analyzed. One hundred thirty-six patients were admitted with TRA. One hundred twenty underwent operative repair with a mortality of 31 per cent. Operative mortality was significantly higher in unstable patients (62%) versus stable patients (17%, P = 0.001), in patients with cardiac risk factors (71%) versus those without (24%, P = 0.001), and in patients with preoperative free rupture (83%) with versus those without (19%, P = 0.001). Free rupture was the cause of hypotension in only 10 of 42 unstable patients, with the remainder being due to other causes. Preoperative ALI was associated with a marked increase in postoperative ARDS (47% with vs 9% without, P = 0.001) but not operative mortality. Mechanical circulatory support (MCS) was used in 59 cases, none of whom experienced paralysis, whereas eight of 61 operated on without MCS developed paralysis (P = 0.001). When logistic regression was applied the use of MCS was not determined to be statistically significant. However, preoperative instability was found to be a significant predictor of postoperative paralysis with the risk being increased 5.5 times (confidence interval 3.3-10). The predominant factor influencing mortality, postoperative ARDS, and paralysis was preoperative instability and associated injuries. In patients who are hypotensive, other injuries should take precedence over repair of TRA. Patients who are stable but who have cardiac or pulmonary risk factors may be better managed by a period of nonoperative management until their condition improves.

Purpose: To compare patency rates of transjugular intrahepatic portosystemic shunts (TIPS) after placement of long-medium Palmaz stents or Wallstents., Methods: We performed a retrospective review of TIPS performed at our institution between December 1997 and December 1998. During this time period we placed long-medium Palmaz stents for TIPS procedures in 17 patients and Wallstents in 20 patients as the initial stent. Patency was determined on follow-up by ultrasound, angiography, or pathologic examination in the event of transplant., Results: Primary patency in the Palmaz stent group was 70.6% (12/17 patients) (follow-up 1-399 days, mean 127 days). Both primary assisted and secondary patency in the Palmaz group was 100% (17/17 patients) (follow up 1-399 days, mean 154 days). Primary patency in the Wallstent group was 50% (10/20 patients) (follow up 1-370 days, mean 65 days). Primary assisted patency in the Wallstent group was 80% (16/20 patients) (follow up 1-601 days, mean 141 days). Secondary patency in the Wallstent group was 100% (20/20 patients) (follow up 2-601 days, mean 142 days). Kaplan-Meier analysis of the two groups of patients yielded a primary patency of 266 days (standard error 45 days) for TIPS with the Palmaz stent and 139 days (standard error 45 days) for the Wallstent (p =.04). The 3, 6, and 12-month primary patency rates were .84, .63, and .42 respectively for the Palmaz stents and .36, .36, and .18 respectively for the Wallstent. There was no significant difference in primary assisted or secondary patency between the two stent groups. The mean tract curvature in the patients with Palmaz stents was 23.5 degrees (SD 18.2 degrees, range 0-69.0 degrees ) compared with 57 degrees (SD 34.5 degrees, range 7.0-144.0 degrees ) in patients with Wallstents (p =.01)., Conclusions: Our nonprospective, nonrandomized study suggests that TIPS created with the long-medium Palmaz stent have a higher primary patency than those created with the Wallstent in tracts that are relatively straight.

We report a case of successful emergency TIPS placement to control intra-abdominal bleeding after blunt abdominal trauma in a patient with severe cirrhosis and portal hypertension.

Purpose: To describe our results with primary placement of the long-medium Palmaz stent for transjugular intrahepatic portosystemic shunts (TIPS)., Materials and Methods: Between December 1997 and December 1998 primary placement of long-medium Palmaz stents was performed for TIPS procedures in 17 patients. Patency was determined with ultrasound, angiography, or pathologic examination in the event of transplant., Results: Primary patency was achieved in 13 of 17 patients (76.5%) (follow up, 1-399 days; mean, 99 days). Secondary patency was achieved in 17 of 17 patients (100%) (follow-up, 1-399 days; mean, 110 days). Among the four patients who required revision, the mean time to revision from initial shunt creation was 81 days (range, 13-125 days). Two of these four patients had symptoms of worsening ascites as well as abnormal ultrasound findings prior to their revision; the other two patients were asymptomatic and had abnormal ultrasound findings only. Revisions were performed for intimal hyperplasia within the stent in three of the patients and acute thrombus within the stent in the remaining patient. Kaplan-Meier survival analysis for primary patency yielded mean survival time of 265 days (standard error, 52 days)., Conclusion: The long-medium Palmaz stent is a viable stent for creation of TIPS shunts.

Objective: The purpose of this study was to evaluate whether a valved peripherally inserted central catheter (PICC) design would result in a lower incidence of occlusion, infection, and malfunction than a clamped catheter., Subjects and Methods: Three hundred sixty-two study patients (233 men, 129 women; mean age, 44 years) were randomized to receive a clamped (n = 182) or valved (n = 180) 5-French single-lumen PICC. Catheters were placed under fluoroscopic (n = 331) or sonographic guidance (n = 31). The valved PICC was flushed with saline solution, and the clamped PICC was flushed with a heparin-saline solution. All patients were prospectively followed up at least weekly for catheter status and complications., Results: Percutaneous placement with the catheter tip in the central veins was successful in 99% of patients. Mean dwell time was 34 days. Twenty-six occlusive or infectious complications occurred in the clamped catheter group and 12 in the valved catheter group (p = .02). The clamped and valved catheter groups had 13 and five occlusions, respectively (p = .06), and 12 and five catheter-related blood stream infections, respectively (p = .09). Most occlusions (68%) were treated successfully with urokinase, and site infection or sepsis was treated by catheter removal., Conclusion: We found a statistically significant difference in the complication rate for the valved PICC compared with the clamped PICC. With the valved PICC, occlusion and infection were reduced, and patients having these catheters did not require heparin flushes.

Purpose: To evaluate the efficacy of transcatheter arterial embolization for intractable epistaxis secondary to gunshot wounds., Materials and Methods: Seven patients with intractable epistaxis secondary to penetrating trauma (gunshot wounds) were studied with angiography and subsequently underwent embolization with particles (polyvinyl alcohol, gelatin sponge) and/or microcoils. Clinical follow-up included standard hemodynamic monitoring, serial hematocrit determinations, and clinical observation for recurrent bleeding., Results: Diagnostic angiography demonstrated evidence of acute arterial injury in all patients. All patients subsequently underwent embolization to complete angiographic stasis. Two patients had persistent bleeding following embolization. One of these patients required maintenance of his nasal packing for 7 days after embolization; no blood products were required during this time. The second patient's bleeding resolved following correction of his coagulopathy. No complications occurred in any of the patients., Conclusions: Transcatheter arterial embolization for epistaxis secondary to gunshot wounds is efficacious in the acute setting when conservative management fails.

Purpose: To evaluate the efficacy of the Wallstent endoprosthesis for treatment of stenotic or occlusive inferior vena cava (IVC) lesions refractory to balloon angioplasty in patients after orthotopic liver transplantation., Materials and Methods: Wallstent endoprostheses were implanted in six patients with IVC anastomotic stenoses or occlusions that were refractory to balloon angioplasty. Follow-up included both duplex ultrasound (US) and clinical evaluations., Results: Ten stents were successfully implanted in six patients. Five of six patients (83%) demonstrated primary patency on duplex US for a mean period of 11 months (range, 4-17 months). One patient's symptoms recurred within 3 weeks after intervention. This patient underwent repeated stent placement. Follow-up duplex US in this patient demonstrated primary assisted patency at 7 months. Mean clinical follow-up was 12 months (range, 7-18 months). Other than the previously described case, no patient developed recurrent symptoms of IVC stenosis or occlusion. Two patients who experienced hemorrhagic complications secondary to anticoagulation were treated successfully., Conclusions: The Wallstent endoprosthesis is a useful adjunct for treatment of IVC stenosis or occlusions in patients who have undergone orthotopic liver transplantation when these lesions are refractory to simple balloon angioplasty.

Franz diffusion experiments with human skin combined with work-clothing fabric have shown that skin exposure to pesticides is reduced by the presence of traditional nonbarrier textiles. This study was undertaken to obtain further information about the reduction in exposure using traditional work-clothing fabrics that had chemical finishing to increase the sorption properties. The effects of a renewable starch finish and chemical modification by carboxymethylation on cotton fabrics on the pesticide (methyl parathion) retention, transfer, and decontamination by laundering were investigated. Two weights of work clothing fabrics made of 100% cotton were used, one appropriate for shirts and the other for pants. The amount of pesticide observed on human skin was reduced by the presence of clothing fabric. Carboxymethylation of the shirt fabric reduced the amount of pesticide observed on the human skin. This treatment also resulted in less pesticide being transferred to a second fabric layer within a clothing system. No pesticide penetrated to the second fabric layer when the heavier pant fabric was used as the outer layer. The lighter weight shirt fabric did not retain as much pesticide as the pant fabric. The pesticide retained on the shirt fabric was increased by the application of a renewable starch finish and by carboxymethylation; both of these finishes were found to be effective in enhancing the decontamination of cotton fabrics by laundering.

A two-stage recovery protocol was examined for microorganisms following gamma irradiation in phosphate buffer at 0 degrees C. In the first stage, survivors were recovered on basal yeast extract agar and held at various temperatures suboptimal for their growth for 20 h (resuscitation protocol). In the second stage the survivors were incubated for an additional 24 h, but in this case at their optimum temperature for growth. Controls consisted of survivors which were not subjected to the resuscitation protocol (direct incubation at their optimum growth temperature). The ratio of survivors enumerated with and without the resuscitation protocol (control) at each specified temperature was used to formulate a recovery factor(RF). An RF was determined for each treatment dose. Results of this study indicated that the number of Escherichia coli, Salmonella serotype typhimurium and Brochothrix thermosphacta survivors increased following a resuscitation protocol (RF > 2.0). Overall, optimum resuscitation temperatures ranged from 14 to 22 degrees C. The extent of recovery also appeared dose dependent, with larger treatment doses giving rise to a higher RF. S. serotype typhimurium irradiated at 1.5 kGy exhibited the highest RF, 161, when resuscitated at 22 degrees C. Listeria monocytogenes, Yersinia enterocolitica, Staphylococcus aureus, Aeromonas hydrophila and Saccharomyces cerevisiae exhibited an RF < 2.0 regardless of resuscitation temperature. Results of this study indicated that the use of suboptimal holding temperatures as part of a recovery protocol may have advantages, especially with respect to the enumeration of E. coli and salmonellae survivors in irradiated foods such as poultry.

Purpose: To determine if three-dimensional (3D) rendered and projection images derived from magnetic resonance (MR) imaging data are advantageous for the preoperative assessment of physeal bars., Materials and Methods: Fifteen patients with suspected physeal bars were examined with MR imaging. Gradient-echo sequences were used with both two-dimensional and 3D MR imaging techniques. The 3D rendered and projection images were then derived from the MR imaging data. Patients were categorized on the basis of the effect of MR images on the decision to perform physeal bar excision., Results: MR findings had either a moderate (n = 7) or a major (n = 6) effect on the surgical treatment of 13 patients (87%). They had no effect in two patients (13%) and were misleading in none., Conclusion: MR imaging is an excellent modality for imaging physeal bars. Imaging data can be processed to yield both 3D rendered and projection physeal maps that are particularly useful in preoperative planning.

An improved disc diffusion type bioassay was developed for T-2 toxin (T-2), HT-2 toxin (HT-2), diacetoxyscirpenol (DAS), deoxynivalenol (DON), nivalenol (NIV), neosolaniol (NSL), fusarenon-X (FUS-X), trichothecin (TIN), roridin A (RDA) and verrucarin A (VCA) using the yeast, Kluyveromyces marxianus . Factors such as type of medium, agar volume per plate, preincubation time and temperature, incubation temperature, inoculum size and pH had variable, and in some cases a dramatic effect on the sensitivity of the assay. The effect of pH of the assay medium was particularly pronounced. The highest sensitivity was obtained when 6 ml per plate of a tryptic-soy-agar (TSA) medium (pH 7.5) containing 10 5 CFU inoculum per ml was incubated at 38°C for 18 h. All of the trichothecenes (TNN) were able to inhibit the growth of the yeast with the detection limit being 0.005, 0.01, 0.02, 0.02, 0.1, 0.5, 10, 10, 10 and 50 μg/disc for VCA, RDA, T-2, TTN, DAS, HT-2, DON, NSL, FUS-X and NIV, respectively. The detection limits for corn and wheat spiked with T-2 were 0.1 and 0.2 μg/g, respectively. Non-TNN mycotoxins that did not inhibit yeast at a concentration of 200 μg/disc were aflatoxin B 1 (AFB 1 ), ochratoxin A (OA), citrinin (CT), penicillic acid (PA), cyclopiazonic acid (CPA), penitrem-A (PTA) and zearalenone (ZEE). These results indicate that disc diffusion assay using K. marxianus under optimized conditions provides a sensitive method for the detection of low concentrations of several TNN.

Twelve species of bacteria and two species of yeast were tested for sensitivity against 11 different mycotoxins using a disc diffusion assay. Among the bacterial species, Bacillus brevis appeared to be the most sensitive microorganism, being sensitive to eight mycotoxins (AFB 1 , ochratoxin A [OA], citrinin [CT], patulin [PAT], penicillic acid [PA], cyclopiazonic acid [CPA], penitrem A [PT-A], and zearalenone [ZEE]). This microorganism was not affected by a high concentration (500 μg per disc) of any of the trichothecenes (T-2 toxin, HT-2 toxin, diacetoxyscirpenol, and deoxynivalenol). Kluyveromyces marxianus , a species of yeast, was the only microorganism that was inhibited by all four of the trichothecenes but was not inhibited by the other mycotoxins. The area of the inhibition zone produced by some of the mycotoxins such as OA with the B. brevis assay was dramatically influenced by the pH of the medium, while the toxicity of other mycotoxins such as AFB 1 was relatively pH independent. The sensitivity of the B. brevis assay also tended to decrease at agar volumes above 6 ml and as the number of microbes per plate increased. The lowest amounts of the different ochratoxins; OA, OB and OC (OA ethyl ester) that could be detected under optimal conditions were 0.5, 20, and 2 μg per disc, respectively. The lowest amounts of CPA, AFB 1 CT, PAT, PA, PT-A, and ZEE that were detectable were 0.5, 1, 1, 1, 1, 1, and 10 μg per disc, respectively. These results demonstrate that B. brevis can be used as a positive indicator organism to detect the presence of several common non-trichothecene mycotoxins. The results demonstrate that, used together, B. brevis and K. marxianus can be used as indicator organisms in a bioassay approach to the detection of several of the most common mycotoxins.

Effects of irradiation and fumigation on ochratoxin A production by Aspergillus alutaceus in barley were compared. Ochratoxin A production was enhanced relative to untreated controls, if the toxigenic fungus was inoculated into the grain following irradiation or fumigation with either methyl bromide or phosphine. Ochratoxin A production was diminished, if the toxigenic fungus was inoculated into the grain prior to treatment by irradiation or fumigation. The results are consistent with the interpretation that the perturbative effects of irradiation and fumigation on ochratoxin A production by A. alutaceus in this system are very similar and are mediated by a common mechanism. This mechanism involves disturbance of the competition between the toxigenic inoculum and the endogenous microflora of the grain. Reduction or elimination of the competitive microflora, by whatever treatment, allows production of greater amounts of toxin than would occur in the presence of effective competition. These findings suggest that the potential hazard associated with the possible enhancement of ochratoxin A (and probably other mycotoxin) production in treated grain is similar for irradiation or fumigation treatment. Fumigation for purposes of insect disinfestation of grain has been used for decades, with no evidence of any significant hazard vis-a-vis enhanced mycotoxin production.

The combined effects of radiation and sous-vide treatment of chicken breast meat were investigated with respect to survival and growth of Listeria monocytogenes , shelf life, thiamine content, and sensory qualities. Chicken breasts were inoculated with L. monocytogenes 81-861 (10 5 CFU/g), vacuum-packed, irradiated with electron beam (EB) up to 2.9 kGy, and cooked to an internal temperature of 65.6°C. Sous-vide treatment alone had marginal lethal effect on the L. monocytogenes ; the residual inoculum reached 10 7 CFU/g after 8 weeks at 2°C. However, after the combined treatments of sous-vide and EB at 2.9 kGy, the organism remained undetectable during the 8-week storage period. Parallel studies on uninoculated breast meat revealed that sous-vide samples had a shelf life of less than 6 weeks without EB treatment, whereas samples that were irradiated and then received sous-vide treatment had a shelf life of at least 8 weeks. There was a slight reduction in thiamine levels as a result of the EB treatment, but there was essentially no additional loss of thiamine due to the subsequent sous-vide treatment and storage at 2°C. Electron-beam treatment had very little effect on the odor and flavor of the reheated samples. It was concluded that EB treatment combined with sous-vide treatment can greatly enhance the microbial safety and shelf life of chicken breast meat.

The present studies, using Aspergillus alutaceus var. alutaceus Berkeley et Curtis (formerly A. ochraceus Wilhelm) NRRL 3174 along with three other wild-type strains, were undertaken in an attempt to understand the effects of irradiation and other treatments on mycotoxin production in grain. Bedford barley was inoculated with spores of NRRL 3174, gamma irradiated, and incubated at 28 degrees C and 25% moisture. After 10 days of incubation, two colony types, ochre (parental) and yellow (variant), were isolated from the grain. Further culturing of the yellow variant resulted in the spontaneous appearance of a white variant that exhibited greatly enhanced fluorescence under UV light. In subsequent work, we have also isolated variants producing a soluble red pigment. In addition, in model experiments involving irradiation (1 kGy) of pure cultures, induction frequencies ranging between 2 and 4% (survival basis) were observed for the yellow and red variants. Inoculation of these variants into wheat and incubation for 14 days at 28 degrees C and 32% moisture resulted in ochratoxin A production in the relative amounts of 0.09:1:4.6:9.3 for the red, ochre (parental), yellow, and white variants, respectively. Additional characteristics of these isolates are described. Confirmation that the white high-ochratoxin-A-producing variants were derived from the parental strain was demonstrated by obtaining revertant sectors in monoclonal cultures of the variants.

The radiation sensitivity and the toxigenic potential of conidiospores of the fungus Aspergillus alutaceus var. alutaceus were determined after irradiation with 60Co gamma rays and high-energy electrons. Over the pH range of 3.6 to 8.8, the doses required for a 1 log10 reduction in viability based on the exponential portion of the survival curve ranged from 0.21 to 0.22 kGy, with extrapolation numbers (extrapolation of the exponential portion of the survival curve to zero dose) of 1.01 to 1.33, for electron irradiation, and from 0.24 to 0.27 kGy, with extrapolation numbers of 2.26 to 5.13, for gamma irradiation. Nonsterile barley that was inoculated with conidia of the fungus and then irradiated with either electrons or gamma rays and incubated for prolonged periods at 28 degrees C and at a moisture content of 25% produced less ochratoxin A with increasing doses of radiation. Inoculation of barley following irradiation resulted in enhanced ochratoxin levels compared with unirradiated controls. In these experiments, inoculation with 10(2) spores per g produced greater radiation-induced enhancement than inoculation with 10(5) spores per g. There was no radiation-induced enhancement when the barley was surface sterilized by chemical means prior to irradiation. These results are consistent with the hypothesis that a reduction in the competing microbial flora by irradiation is responsible for the enhanced mycotoxin production observed when nonsterile barley is inoculated with the toxigenic fungus A. alutaceus var. alutaceus after irradiation.

Because many pesticide handlers persist in wearing and reusing conventional workclothes, a renewable functional finish that enhances the pesticide-protective qualities of fabrics would be useful. This study investigated the ability of starch to act as a pesticide trap, preventing transfer and increasing removal by laundering, and the effect of carboxymethyl cellulose on release of pesticide in laundry. The retention and distribution of methyl parathion (MeP) on 65% polyester/35% cotton fabric was studied with four finishes: starch and carboxymethyl cellulose (CMC) as nondurable finishes; durable press resin (DP) and durable press/carboxymethyl cellulose (DP/CMC) as durable finishes. Starching with an add-on of 8% (w/w) effectively reduced the area of contamination and enhanced the removal of methyl parathion from polyester/cotton fabrics. Residual pesticide values for CMC, DP, and DP/CMC finishes were similar to that of the unfinished fabric. While distribution profiles of methyl parathion throughout the yarn and fiber structures were similar for all the finishes, lower concentrations of pesticide were observed on the cotton fibers from the starched fabric. Starch reduced the pesticide transferring by rubbing from both 100% cotton and 65% polyester/cotton fabrics. These studies support the intriguing theory that starch can act as a pesticide trap on the fabric surface to decrease pesticide transfer and to enhance pesticide removal. Extensive penetration studies, field studies, and additional investigation of fiber, yarn, and fabric parameters are needed to further quantify the effects of starch.

Radiobiological studies were carried out with three strains of Listeria monocytogenes . Resistance characteristics were determined under a variety of conditions. For one strain (CFPDC), the D 10 values were 0.18, 0.21, and 0.44 kGy when subjected to gamma irradiation in phosphate buffer (pH 7.0), trypticase soy broth containing yeast extract (TSB-YE), and in poultry feed, respectively. For this strain, D 10 values in poultry feed determined by using 60 Co gamma rays or 10 MeV electrons as radiation sources were almost identical. D values for gamma irradiation of TSB-YE cultures were 0.21, 0.25, and 0.46 kGy for CFPDC, Scott A, and 81-861 strains, respectively.