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A new phosphate, sodium calcium magnesium tetrakis(phosphate), Na(8)Ca(1.5)Mg(12.5)(PO(4))(12), has been synthesized by a flux method. Its novel structure consists of MgO(x) (x = 5 and 6) polyhedra and MO(7) (M = Mg or Na) octahedra linked directly through common corners or edges to form a rigid three-dimensional skeleton, reinforced by corner-sharing between identical Mg(12)MO(48) units. The connection of these units by the PO(4) tetrahedra induces cavities and crossing tunnels where the Na(+) and Ca(2+) cations are located. This structural model was supported by a (31)P NMR spectroscopy study which confirmed the existence of 12 crystallographically independent sites for the P atoms.

Ischemic preconditioning of remote organs (RIPC) reduces liver ischemia/reperfusion (IR) injury in the rabbit and rat. Mice are the only species available with a large number of transgenic strains. This study describes development and validation of a mouse model of hindlimb RIPC that attenuates liver IR injury. Mice were allocated to 4 groups: (1) Sham surgery; (2) RIPC: 6 cycles of 4 × 4 minutes ischemia/reperfusion of hindlimb; (3) IR: 40 minutes lobar (70%) hepatic ischemia and 2 hours reperfusion; (4) RIPC+IR: RIPC followed by IR group procedures. Plasma liver aminotransferases and hepatic histopathological and transmission electron microscopy studies were performed at the end of the experiment. Hepatic microcirculatory blood flow was measured throughout the experiment. Postoperative complications and animal survival were evaluated. Hindlimb RIPC using a tourniquet resulted in limb paralysis. Hindlimb RIPC using direct clamping of the femoral vessels showed no side effects. Compared to liver IR alone, RIPC+IR reduced plasma aminotransferases (P < 0.05) and histopathological and ultrastructural features of injury. Hepatic microcirculatory blood flow was preserved in the RIPC+IR compared to IR group (P < 0.05). There was no mortality in any of the groups. By demonstrating a consistent improvement in these features of liver IR injury with antecedent hindlimb RIPC and by minimizing experimental confounding variables, we validated this mouse model. In conclusion, we describe a validated mouse model of hindlimb RIPC that reduces liver IR injury. With the availability of transgenic mice strains, this model should prove useful in unraveling the mechanisms of protection of hindlimb RIPC., (Copyright © 2011 American Association for the Study of Liver Diseases.)

During an attempt to crystallize potassium manganese diiron phosphate KMnFe(2)(PO(4))(3) by the flux method, a new phase, potassium dimanganese iron triphosphate, K(0.53)Mn(2.37)Fe(1.24)(PO(4))(3), was isolated. This phase, whose composition was confirmed by ICP analysis, is isotypic with the alluaudite-like phosphates, thus it exhibits the (A2)(A'2)(A1)(A'1)(A''1)(M1)(M2)(2)(PO(4))(3) general formula. The site occupancies led to the following cation distribution: 0.53 K on A'2 (site symmetry 2), 0.31 Mn on A''1, 1.0 Mn on M1 (site symmetry 2) and (0.62 Fe + 0.38 Mn) on M2. The structure is built up from infinite chains of edge-sharing M1O(6) and M2O(6) octa-hedra. These chains run along [10] and are connected by two different PO(4) tetrahedra, one of which exhibits 2 symmetry. The resulting three-dimensional framework delimits large tunnels parallel to [001], which are partially occupied by the K(+) and Mn(2+) cations.

The alluaudite lithiated phases Li(0.5)Na(0.5)MnFe(2)(PO(4))(3) and Li(0.75)Na(0.25)MnFe(2)(PO(4))(3) were prepared via a sol-gel synthesis, leading to powders with spongy characteristics. The Rietveld refinement of the X-ray and neutron diffraction data coupled with ab initio calculations allowed us for the first time to accurately localize the lithium ions in the alluaudite structure. Actually, the lithium ions are localized in the A(1) and A(1)' sites of the tunnel. Mössbauer measurements showed the presence of some Fe(2+) that decreased with increasing Li content. Neutron diffraction revealed the presence of a partial Mn/Fe exchange between the two transition metal sites that shows clearly that the oxidation state of the element is fixed by the type of occupied site. The electrochemical properties of the two phases were studied as positive electrodes in lithium batteries in the 4.5-1.5 V potential window, but they exhibit smaller electrochemical reversible capacity compared with the non-lithiated NaMnFe(2)(PO(4))(3). The possibility of Na(+)/Li(+) ion deintercalation from (Na,Li)MnFe(2)(PO(4))(3) was also investigated by DFT+U calculations.

Liver ischemia/reperfusion (IR) injury is typified by an inflammatory response. Understanding the cellular and molecular events underpinning this inflammation is fundamental to developing therapeutic strategies. Great strides have been made in this respect recently. Liver IR involves a complex web of interactions between the various cellular and humoral contributors to the inflammatory response. Kupffer cells, CD4+ lymphocytes, neutrophils, and hepatocytes are central cellular players. Various cytokines, chemokines, and complement proteins form the communication system between the cellular components. The contribution of the danger-associated molecular patterns and pattern recognition receptors to the pathophysiology of liver IR injury are slowly being elucidated. Our knowledge on the role of mitochondria in generating reactive oxygen and nitrogen species, in contributing to ionic disturbances, and in initiating the mitochondrial permeability transition with subsequent cellular death in liver IR injury is continuously being expanded. Here, we discuss recent findings pertaining to the aforementioned factors of liver IR, and we highlight areas with gaps in our knowledge, necessitating further research., ((c) 2010 AASLD.)

In this work, a development of polymeric inclusion membranes for the cations separation is reported. The membrane was made up of cellulose triacetate (CTA) with a tributyl phosphate (TBP) incorporated into the polymer as metal ions carrier. The transport of lead (II) and cadmium (II) ions in two membrane systems polymer inclusion membrane (PIM), PIM coupled with photo-chemical electrode using TBP as carrier and 2-nitro phenyl octyl ether (NPOE) or tris ethylhexyl phosphate (TEHP) as plasticizer have been investigated. The membranes: polymer+plasticizer+carrier were synthesized and characterized by FTIR, X-ray diffraction and scanning electron microscopy (SEM). Transports of lead and cadmium have been studied using these systems and the results were compared to commercial cation exchange membrane (CRA). The obtained results showed that for Pb(2+) ion, the concentrations of the strip phase increases using synthesized membranes. The conduction band of the delafossite CuFeO(2) (-1.25 V(SCE)) yields a thermodynamically M(2+) (=Pb(2+), Cd(2+)) photo electrodeposition and speeds up the diffusion process. In all the cases, the potential of the electrode M/M(2+) in the feed compartment increases until a maximum value, reached at approximately 100 min above which it undergoes a diminution., (Copyright 2010 Elsevier B.V. All rights reserved.)

Background: Vascular occlusion during liver resection results in ischaemia-reperfusion (IR) injury, which can lead to liver dysfunction. We performed a systematic review and meta-analysis to assess the benefits and harms of using various pharmacological agents to decrease IR injury during liver resection with vascular occlusion., Methods: Randomized clinical trials (RCTs) evaluating pharmacological agents in liver resections conducted under vascular occlusion were identified. Two independent reviewers extracted data on population characteristics and risk of bias in the trials, and on outcomes such as postoperative morbidity, hospital stay and liver function., Results: A total of 18 RCTs evaluating 17 different pharmacological interventions were identified. There was no significant difference in perioperative mortality, liver failure or postoperative morbidity between the intervention and control groups in any of the comparisons. A significant improvement in liver function was seen with methylprednisolone use. Hospital and intensive therapy unit stay were significantly shortened with trimetazidine and vitamin E use, respectively. Markers of liver parenchymal injury were significantly lower in the methylprednisolone, trimetazidine, dextrose and ulinastatin groups compared with their respective controls (placebo or no intervention)., Discussion: Methylprednisolone, trimetazidine, dextrose and ulinastatin may have protective roles against IR injury in liver resection. However, based on the current evidence, they cannot be recommended for routine use and their application should be restricted to RCTs.

Background: Vascular occlusion to reduce blood loss is used during elective liver resection but results in significant ischaemia reperfusion injury. This, in turn, might lead to significant postoperative liver dysfunction and morbidity. Various pharmacological drugs have been used with an intention to ameliorate the ischaemia reperfusion injury in liver resections., Objectives: To assess the benefits and harms of different pharmacological agents versus no pharmacological interventions to decrease ischaemia reperfusion injury during liver resections where vascular occlusion was performed during the surgery., Search Strategy: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until January 2009., Selection Criteria: We included randomised clinical trials, irrespective of language or publication status, comparing any pharmacological agent versus placebo or no pharmacological agent during elective liver resections with vascular occlusion., Data Collection and Analysis: Two authors independently identified trials for inclusion and independently extracted the data. We analysed the data with both the fixed-effect and the random-effects models using RevMan Analysis. We calculated the risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI) based on intention-to-treat analysis or available case analysis., Main Results: We identified a total of 15 randomised trials evaluating 11 different pharmacological interventions (methylprednisolone, multivitamin antioxidant infusion, vitamin E infusion, amrinone, prostaglandin E1, pentoxifylline, mannitol, trimetazidine, dextrose, allopurinol, and OKY 046 (a thromboxane A2 synthetase inhibitor)). All trials had high risk of bias. There were no significant differences between the groups in mortality, liver failure, or perioperative morbidity. The trimetazidine group had a significantly shorter hospital stay than control (MD -3.00 days; 95% CI -3.57 to -2.43). There were no significant differences in any of the clinically relevant outcomes in the remaining comparisons. Methylprednisolone improved the enzyme markers of liver function and trimetazidine, methylprednisolone, and dextrose reduced the enzyme markers of liver injury compared with controls. However, there is a high risk of type I and type II errors because of the few trials included, the small sample size in each trial, and the risk of bias., Authors' Conclusions: Trimetazidine, methylprednisolone, and dextrose may protect against ischaemia reperfusion injury in elective liver resections performed under vascular occlusion, but this is shown in trials with small sample sizes and high risk of bias. The use of these drugs should be restricted to well-designed randomised clinical trials before implementing them in clinical practice.

Background: Vascular occlusion used during elective liver resection to reduce blood loss results in significant ischaemia reperfusion (IR) injury. This in turn leads to significant postoperative liver dysfunction and morbidity. Various pharmacological drugs have been used in experimental settings to ameliorate the ischaemia reperfusion injury in liver resections., Objectives: To assess the relative benefits and harms of using one pharmacological intervention versus another pharmacological intervention to decrease ischaemia reperfusion injury during liver resections where vascular occlusion was performed during the surgery., Search Strategy: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until January 2009., Selection Criteria: We included randomised clinical trials, irrespective of language or publication status, comparing one pharmacological agent versus another pharmacological agent during elective liver resections with vascular occlusion., Data Collection and Analysis: Two authors independently identified trials for inclusion and independently extracted data. We analysed the data with both the fixed-effect and the random-effects models using RevMan Analysis. We planned to calculate the risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI) based on intention-to-treat analysis or available case analysis. However, all outcomes were only reported on by single trials, and meta-analysis could not be performed. Therefore, we performed Fisher's exact test on dichotomous outcomes., Main Results: We identified a total of five randomised trials evaluating nine different pharmacological interventions (amrinone, prostaglandin E1, pentoxifylline, dopexamine, dopamine, ulinastatin, gantaile, sevoflurane, and propofol). All trials had high risk of bias. There was no significant difference between the groups in mortality, liver failure, or perioperative morbidity. The ulinastatin group had significantly lower postoperative enzyme markers of liver injury compared with the gantaile group. None of the other comparisons showed any difference in any of the other outcomes. However, there is a high risk of type I and type II errors because of the few trials included, the small sample size in each trial, and the risk of bias., Authors' Conclusions: Ulinastatin may have a protective effect against ischaemia reperfusion injury relative to gantaile in elective liver resections performed under vascular occlusion. The absolute benefit of this drug agent remains unknown. None of the drugs can be recommended for routine clinical practice. Considering that none of the drugs have proven to be useful to decrease ischaemia reperfusion injury, such trials should include a group of patients who do not receive any active intervention whenever possible to determine the pharmacological drug's absolute effects on ischaemia reperfusion injury in liver resections.

The transport phenomena across ion exchange membrane may be enhanced by applying various strengths inside or outside the system. The electrical current, generated by n-type semiconductor, is used to catalyse the separation of metal ions. The cation exchange membrane located between the two compartments allows both the separation and concentration of M(n+) (Ag(+), Cu(2+), Pb(2+) and Ni(2+)). The flows of M(n+) from the aqueous solution to-and inside the membrane are monitored by the determination of the fluxes and the potentials. In this study, the four cations are investigated alone or in quaternary systems. From photoelectrochemical measurement, the gap of Bi(2)S(3) is found to be indirect at 1.65 eV. The shape of photocurrent potential curve and the negative flat band potential (-1.02 V(SCE)) give evidence of n-type character. The conduction band (-1.25 V(SCE)) yields thermodynamically M(2+) photoreduction and catalyzes the diffusion process. The photoelectrode Bi(2)S(3) makes the flux twofold greater than that observed in the dark. In all cases, the potential of the electrode M(2+)/M in the feed compartment increases until a maximal value, reached at approximately 100 min above which it undergoes a diminution. The membrane is more selective to Cu(2+) and this selectivity decreases in the quaternary system.

A new iron phosphate, calcium triiron(III) tris-(phosphate) oxide, CaFe(3)(PO(4))(3)O, has been isolated and shown to exhibit a three-dimensional structure built by FeO(6) octa-hedra, FeO(5) trigonal bipyramids and PO(4) tetra-hedra. The FeO(x) (x = 5, 6) polyhedra are linked through common corners and edges, forming [Fe(6)O(28)](∞) chains with branches running along [010]. Adjacent chains are connected by the phosphate groups via common corners and edges, giving rise to a three-dimensional framework analogous to those of the previously reported SrFe(3)(PO(4))(3)O and Bi(0.4)Fe(3)(PO(4))(3)O structures, in which the Ca(2+) cations occupy a single symmetry non-equivalent cavity.

Laparoscopy is an important diagnostic and therapeutic modality. It is one of the most commonly performed surgical procedures. Gaining access into the peritoneal cavity and insufflation is the first step in any laparoscopy. This should be the safest part of the procedure. We present a case in which closed induction of the pneumoperitoneum caused a near fatality that could have been avoided had an open technique been used. Endovascular therapy was used to prevent lethal complications of the patient's injuries. In the light of this case and the available literature on this topic, we question whether continued use of closed pneumoperitoneum induction for laparoscopy is still justified.

Background: Liver transplantation involves a period of ischemia and reperfusion to the graft which leads to primary non-function and dysfunction of the liver in 5-10% of cases. Remote ischemic preconditioning (RIPC) has been shown to reduce ischemia reperfusion injury (IRI) injury to the liver and increase hepatic blood flow. We hypothesized that RIPC may directly modulate hepatic microcirculation and have investigated this using intravital microscopy., Methods: A rat model of liver IRI was used with 45 min of partial hepatic ischemia (70%) followed by 3 h of reperfusion. Four groups of animals (Sham, IRI, RIPC+IRI, RIPC+Sham) were studied (n= 6, each group). Intravital microscopy was used to measure red blood cell (RBC) velocity, sinusoidal perfusion, sinusoidal flow and sinusoidal diameter. Neutrophil adhesion was assessed by rhodamine labeling of neutrophils and cell death using propidium iodide., Results: RIPC reduced the effects of IRI by significantly increasing red blood cell velocity, sinusoidal flow and sinusoidal perfusion along with decreased neutrophil adhesion and cell death., Conclusions: Using intravital microscopy, this study demonstrates that RIPC modulates hepatic microcirculation to reduce the effects of IRI. HO-1 may have a key role in the modulation of hepatic microcirculation and endothelial function.

Background: The management of gallbladder polyps is controversial. Cholecystectomy has been recommended for gallbladder polyps larger than 10 mm because of the association with gallbladder cancer. Cholecystectomy has also been suggested for gallbladder polyps smaller than 10 mm in patients with biliary type of symptoms., Objectives: The aim of this review is to compare the benefits (relief of symptoms, decreased incidence of gallbladder cancer) and harms (surgical morbidity) of cholecystectomy in patients with gallbladder polyp(s)., Search Strategy: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until July 2008 to identify the randomised trials., Selection Criteria: Only randomised clinical trials (irrespective of language, blinding, or publication status) comparing cholecystectomy and no cholecystectomy were considered for the review., Data Collection and Analysis: We planned to collect the data on the characteristics, methodological quality, mortality, number of patients in whom symptoms were improved or cured from the one identified trial. We planned to analyse the data using the fixed-effect and the random-effects models using RevMan Analysis. For each outcome we planned to calculate the risk ratio (RR) with 95% confidence intervals based on intention-to-treat analysis., Main Results: We were unable to identify any randomised clinical trials comparing cholecystectomy versus no cholecystectomy in patients with a gallbladder polyp., Authors' Conclusions: There are no randomised trials comparing cholecystectomy versus no cholecystectomy in patients with gallbladder polyps. Randomised clinical trials with low bias -risk are necessary to address the question of whether cholecystectomy is indicated in gallbladder polyps smaller than10 mm.

Background: Restoration of blood supply to an organ after a critical period of ischemia results in parenchymal injury and dysfunction of the organ referred to as reperfusion injury. Ischemia reperfusion injury is often seen in organ transplants, major organ resections and in shock. Ischemic preconditioning (IPC) is an adaptational response of briefly ischemic tissues which serves to protect against subsequent prolonged ischemic insults and reperfusion injury. Ischemic preconditioning can be mechanical or pharmacological. Direct mechanical preconditioning in which the target organ is exposed to brief ischemia prior to prolonged ischemia has the benefit of reducing ischemia-reperfusion injury (IRI) but its main disadvantage is trauma to major vessels and stress to the target organ. Remote (inter organ) preconditioning is a recent observation in which brief ischemia of one organ has been shown to confer protection on distant organs without direct stress to the organ., Aim: To discuss the evidence for remote IPC (RIPC), underlying mechanisms and possible clinical applications of RIPC. METHODS OF SEARCH: A Pubmed search with the keywords "ischemic preconditioning," "remote preconditioning," "remote ischemic preconditioning," and "ischemia reperfusion" was done. All articles on remote preconditioning up to September 2006 have been reviewed. Relevant reference articles from within these have been selected for further discussion., Results: Experimental studies have demonstrated that the heart, liver, lung, intestine, brain, kidney and limbs are capable of producing remote preconditioning when subjected to brief IR. Remote intra-organ preconditioning was first described in the heart where brief ischemia in one territory led to protection in other areas. Translation of RIPC to clinical application has been demonstrated by the use of brief forearm ischemia in preconditioning the heart prior to coronary bypass and in reducing endothelial dysfunction of the contra lateral limb. Recently protection of the heart has been demonstrated by remote hind limb preconditioning in children who underwent surgery on cardiopulmonary bypass for congenital heart disease. The RIPC stimulus presumably induces release of biochemical messengers which act either by the bloodstream or by the neurogenic pathway resulting in reduced oxidative stress and preservation of mitochondrial function. Studies have demonstrated endothelial NO, Free radicals, Kinases, Opioids, Catecholamines and K(ATP) channels as the candidate mechanism in remote preconditioning. Experiments have shown suppression of proinflammatory genes, expression of antioxidant genes and modulation of gene expression by RIPC as a novel method of IRI injury prevention., Conclusion: There is strong evidence to support RIPC. The underlying mechanisms and pathways need further clarification. The effective use of RIPC needs to be investigated in clinical settings.

A new iron phosphate, sodium barium diiron tris-(phosphate), NaBaFe(2)(PO(4))(3), has been synthesized by the flux method and shown to exhibit the well known langbeinite type structure. The Na, Ba and Fe atoms all lie on threefold axes, while the P and O atoms occupy general positions, one of the O atoms being disordered over two positions, with site occupancy factors of ca 0.7 and 0.3. The [Fe(2)(PO(4))(3)](∞) framework consists of FeO(6) octa-hedra sharing all their corners with the PO(4) tetra-hedra. The Na(+) and Ba(2+) cations are almost equally distributed over two distinct cavities, in which they occupy slightly different positions.

Dilated cardiomyopathy is the most frequent cardiomyopathy. Twenty to 35% of dilated cardiomyopathies are familial. The transmission of the disease is most frequently dominant autosomic. Dilated cardiomyopathy is genetically heterogeneous. Hence, mutations have been identified on 14 genes, and 9 loci have been associated to familial dilated cardiomyopathy. The incriminated mechanisms in the pathogeny of dilated cardiomyopathy include mutations on proteins of the sarcomere, the cytosqueletton, the nuclear membrane or involved in calcium signaling. This review indicates the genes and proteins implicated in the pathogeny of familial dilated cardiomyopathy, and their potential clinical effects.

A gene encoding a protein kinase was identified by homology-based PCR amplification in Encephalitozoon intestinalis, a microsporidian parasite pathogenic to humans, and its orthologue has been identified by database mining in the genome of the related species E. cuniculi, whose sequence has been recently published. Phylogenetic analysis revealed that the proteins encoded by these genes are homologues of the cAMP-dependent protein kinase catalytic subunits (PKAc). Southern blot analysis indicated that the EiPKAc gene is present in two copies in the E. intestinalis genome, whereas the E. cuniculi orthologue (EcPKAc) is a single copy gene. RT-PCR data showed that the EiPKAc gene is expressed in at least one of the intracellular stages during infection of the mammalian host cell by E. intestinalis.

5-Hydroxytryptamine (5-HT) and the 5-HT(1A/7) receptor agonist (+)-8-hydroxy-2-(di-n-propylamino) tetralinHBr (8-OH-DPAT), injected into the zona incerta (an area in the dorsal hypothalamus) of the female rat, inhibit the release of luteinizing hormone (LH) and the effects of both are blocked by the 5-HT(2/7) receptor antagonist, ritanserin. As both 8-OH-DPAT and ritanserin have moderate activity at the 5-HT7 receptor subtype, the possibility that this subtype might mediate their effects in the zona incerta has been investigated. Ovariectomised rats were primed with 5 microg oestradiol benzoate followed at 48 h by 0.5 mg progesterone, which induces an LH surge. 5-Carboxamidotryptamine (5-CT), a potent but non-selective agonist at 5-HT7 receptors, like 5-HT and 8-OH-DPAT, inhibited the LH surge at 5 and 1.25 nmol injected bilaterally into the zona incerta. The non-selective 5-HT(2/7) receptor antagonist ritanserin and the selective 5-HT7 receptor antagonist, (R)-3-(2-(2-(4-methyl-piperidin-1-yl)-pyrrolidine-1-sulfonyl)-phenol (SB-269970-A) at 0.5 microg/side blocked all three receptor agonists when injected concurrently into the zona incerta. However, lower (0.2 microg) and higher doses (2 and 5 microg) of SB-269970-A were less effective, indicating a bell-shaped dose-response curve. SB-269970-A was also inhibitory when administered systemically (1 mg/kg intraperitoneally (i.p.)). When LH release was suppressed by 5 microg oestradiol benzoate, SB-269970-A (0.5 and 2 microg) did not elevate levels, indicating it is unlikely that 5-HT7 receptors mediate a tonic inhibition on release but rather are involved in terminating the pre-ovulatory LH surge. These data demonstrate that 5-HT7 receptors play a role in the regulation of LH by the zona incerta in rat brain.

Purpose: To assess the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters to monitor residual tumor following non-invasive MRI-guided focused ultrasound surgery (MRIgFUS) of breast tumors., Methods: DCE-MRI data were acquired before and after the MRIgFUS treatment of small breast tumors (d < 3.5 cm) for 17 patients. The lesion was surgically resected and the presence of residual tumor was determined by histopathological analysis. The percentage of residual tumor was correlated with three DCE-MRI parameters measured at the maximally enhancing site of each tumor: increase in signal intensity (ISI), maximum difference function (MDF) and positive enhancement integral (PEI)., Results: A good correlation was found between the ISI (r = 0.897), MDF (r = 0.789) and PEI (r = 0.859) parameters and the percentage of residual viable tumor determined by histopathology. A receiver operator characteristic curve analysis yielded a cutoff value for ISI at 20% with a sensitivity of 77% and a specificity of 100%., Conclusion: These results suggest that parameters from DCE-MRI data could provide a reliable non-invasive method for assessing residual tumor following MRIgFUS treatment of breast tumors.

Purpose: To evaluate the feasibility of treating breast neoplasms with use of magnetic resonance (MR) imaging-guided focused ultrasound (US) surgery., Materials and Methods: Twenty-four female patients, each with a single biopsy-proven breast carcinoma, who were considered to be at increased surgical risk or who had refused surgery underwent MR imaging-guided focused US surgery as an adjunct to their chemotherapeutic regimen of tamoxifen. Follow-up included routine studies to rule out metastatic disease and MR studies with and without contrast material infusion in the treated breast (10 days and 1, 3, and 6 months after the treatment session). Percutaneous biopsy was performed after 6-month follow-up, and if residual tumor was present, a second MR imaging-guided focused US surgery treatment session was performed, followed by repeat biopsy 1 month later., Results: Twenty-three of 24 patients completed the protocol, with only one minor complication associated with the treatment sessions (second-degree skin burn resolved with local treatment). Follow-up MR studies demonstrated a varying hypointense treatment margin (range, 1-11 mm), which represents destruction of tissue beyond the visible tumor. Absence of enhancement may be an indicator of tumor destruction (18 of 19 patients with negative biopsy results) whereas persistent enhancement suggested tumor residue (three of five patients with residual tumor). Overall, 19 of 24 patients (79%) had negative biopsy results after one or two treatment sessions., Conclusion: MR imaging-guided focused US surgery of breast tumors is a safe, repeatable, and promising method of focal tumor destruction.

Background: Since the sensitivity of conventional diagnostic criteria for familial hypertrophic cardiomyopathy (HCM) is low, new diagnostic criteria were proposed by a European collaboration. However, their diagnostic value remains unknown. The aim of the study was to evaluate the accuracy of these new criteria, using the genetic status as the criterion of reference., Methods: We studied 109 genotyped adults (54 genetically affected, 55 unaffected) from 7 families (mutations in 3 genes). Major European echographic criteria were a maximal wall thickness >or=13 mm or >or=15 mm according to the segment involved, or the presence of SAM. Major European ECG criteria were abnormal Q waves, left ventricular hypertrophy, or marked ST-T changes. Combined major/minor European criteria were also evaluated., Results: Sensitivity and specificity of major European criteria (72 and 92%, respectively) were similar to those of major conventional criteria (70 and 94%) and were not improved by combined major/minor European criteria (72 and 90%). When all the minor European criteria were considered, sensitivity increased to 87% but specificity dramatically decreased to 51%. However, one of these minor ECG criteria, deep S V2, was of interest and when added to major European criteria, sensitivity increased to 76% and specificity remained good (90%)., Conclusions: The diagnostic value of new European criteria for HCM was evaluated for the first time. We found that it was not different from that of conventional criteria, with a good specificity but a low sensitivity. Additional criteria should be studied to improve the early identification of HCM.

We report a case of compressive optic neuropathy caused by fibrous dysplasia in a 28-year-old woman. The patient had no significant medical history. Her best-corrected visual acuity was 20/20 in the right eye and 20/400 in the left eye. There was an afferent pupillary defect in the left eye. Slit-lamp examination was unremarkable. Funduscopy showed a normal optic disc bilaterally and congenital hypertrophy of the retinal pigment epithelium in the right eye. Systemic evaluation disclosed facial asymmetry and mucocutaneous lentiginosis involving the face and the limbs. Goldmann visual field testing showed a cecocentral scotoma in the left eye. Imaging studies demonstrated extensive changes of craniofacial fibrous dysplasia involving the sphenoid bone, with compression of the left optic nerve by a cystic structure. Results of gastrointestinal fibroscopy were unremarkable. The patient was given systemic steroids. After 4 days of treatment, her visual acuity had improved to 20/40, with resolution of the afferent pupillary defect and visual field improvement. Debulking of the tumor was recommended, but the patient declined the procedure. She has remained stable over 13 months of follow-up. Compressive optic neuropathy should be considered as a leading cause of visual loss in patients with craniofacial fibrous dysplasia. Early diagnosis, close follow-up, and appropriate management are mandatory to improve or maintain the visual function in such patients.

Purpose: To evaluate the effectiveness of noninvasive magnetic resonance (MR) imaging-guided focused ultrasonographic (US) ablation of breast carcinomas., Materials and Methods: Before undergoing tumor resection, 12 patients with invasive breast carcinomas were treated with MR imaging-guided focused US ablation consisting of multiple sonications of targeted points that were monitored with temperature-sensitive MR imaging. The patients were treated with either one of two focused US systems. The effectiveness of the treatment was determined at histopathologic analysis of the resected mass that was performed to determine the volumes of necrosed and residual tumor. Complications resulting from the procedure were assessed by means of questionnaires, medical examinations, and MR image analysis., Results: US ablation was well tolerated by the patients, and with the exception of minor skin burns in two patients, no complications occurred. Histopathologic analysis of resected tumor sections enabled quantification of the amount of necrosed and residual tumor and visualization of the surrounding hemorrhage. In three patients treated with one of the US systems, a mean of 46.7% of the tumor was within the targeted zone and a mean of 43.3% of the cancer tissue was necrosed. In nine patients treated with the other US system, a mean of 95.6% of the tumor was within the targeted zone and a mean of 88.3% of the cancer tissue was necrosed. Residual tumor was identified predominantly at the periphery of the tumor mass; this indicated the need to increase the total targeted area (ie, with an increased number of sonications)., Conclusion: Thermal coagulation of small breast tumors by means of MR imaging-guided focused US appears to be a promising noninvasive ablation procedure.

Magnetic resonance diffusion-weighted imaging (DWI) of the liver was investigated to determine whether this method could be used to differentiate between the stages of fibrosis and inflammation for hepatitis C viral infection. DWI data were recorded for 18 hepatitis C patients and 10 control subjects using a modified pulse sequence allowing a 52 ms echo time delay. Acquisitions were performed with breath holding using five different b gradient factor values ranging between 50 and 250 s/mm(2) and in the three axes. Apparent diffusion coefficient (ADC) values were measured from a 5.7 cm(2) area in the central region of the liver. The inflammation and fibrosis grades were evaluated histologically on a biopsy sample. The mean ADC values were 2.30 +/- 1.28 x 10(-3) and 1.79 +/- 0.25 x 10(-3) mm(2)/s for hepatitis C patients and control subjects, respectively. Using our technique, no correlation could be found between the ADC values and the inflammation or fibrosis scores, indicating that tissue changes produced by hepatitis C do not appear to be quantifiable by DWI., (Copyright 2003 John Wiley & Sons, Ltd.)

The crystal structure of tripotassium pentairon hexaphosphate has been determined by single-crystal X-ray diffraction. The structure contains one Fe atom on a center of symmetry, one K, two Fe and two P atoms on twofold axes, and one Fe, two P and one K atom in general positions. The K(3)Fe(5)(PO(4))(6) structure consists of a complex three-dimensional framework of corner-sharing between iron polyhedra, and corner- and edge-sharing between PO(4) tetrahedra and iron polyhedra (FeO(5) and FeO(6)). This linkage between iron and phosphorus forms intersecting channels containing the K atoms.

Crystals of sodium zinc diiron(III) triphosphate, NaZnFe(2)(PO(4))(3), have been synthesized and structurally characterized by single-crystal X-ray diffraction. The compound features a new structural type built up from ZnO(6) octahedra, FeO(6) octahedra and FeO(4) tetrahedra, linked together via the corners and edges of PO(4) tetrahedra to form a three-dimensional framework, with tunnels running along [100]. Within these tunnels, Na(+) cations occupy a highly distorted cubic site.

The antiparasitic effect of a collection of compounds with antimitotic activity has been tested on a mammalian cell line infected with Encephalitozoon intestinalis, a microsporidian causing intestinal and systemic infection in immunocompromised patients. The antiparasitic effect was evaluated by counting the number of parasitophorous vacuoles detected by immunofluorescence. Out of 526 compounds tested, 2 (pancratistatin and 7-deoxynarciclasine) inhibited the infection without affecting the host cell. The 50% inhibitory concentrations (IC(50)s) of pancratistatin and 7-deoxynarciclasine for E. intestinalis were 0.18 microM and 0.2 microM, respectively, approximately eightfold lower than the IC(50)s of these same compounds against the host cells. Electron microscopy confirmed the gradual decrease in the number of parasitophorous vacuoles and showed that of the two life cycle phases, sporogony was more sensitive to the inhibitors than merogony. Furthermore, the persistence of meronts in some cells apparently devoid of sporonts and spores indicated that the inhibitors block development rather than entry of the parasite into the host cell. The occurrence of binucleate sporoblasts and spores suggests that these inhibitors blocked a specific phase of cell division.

Coronary atherosclerosis is a major cause of death in industrialized countries. Monocytes, which play a key role in atherosclerosis, migrate into the vessel wall, presumably guided by specific chemoattractant and adhesion molecules. A compelling candidate for this role is the chemokine receptor CX3CR1, which is expressed on monocytes and acts as either a chemotactic receptor or an adhesion molecule, depending on whether its ligand, fractalkine, is presented free or membrane bound. A common variant of CX3CR1 was recently identified, encoded by the alleles I249 and M280, which form a common I(249)M(280) haplotype. When CX3CR1 genotypes were analyzed in 151 patients with acute coronary syndromes and in 249 healthy controls, CX3CR1 I249 heterozygosity was associated with a markedly reduced risk of acute coronary events, independent of established acquired coronary risk factors (eg, smoking, diabetes). The adjusted odds ratio for this allele was 0.43 (95% confidence interval, 0.26-0.72; P =.001). Consistent with this, functional analysis of peripheral blood mononuclear cells showed that CX3CR1 I249 heterozygosity was associated with a significant decrease in the number of fractalkine binding sites per cell. The results show that CX3CR1 I249 is an independent genetic risk factor for coronary artery disease and that CX3CR1 may be involved in the pathogenesis of atherosclerotic disease. (Blood. 2001;97:1925-1928)

Objective: To study the clinical pattern of coeliac disease in children living in the northwest coast of Libya, to investigate the sensitivity and specificity of D-Xylose, fat load test and antigliadin antibody and their correlation to each other and changes in jejunal biopsy., Methods: A 4 year prospective study began in 1993. It includes all suspected coeliacs referred to our department for further evaluation. All have suction jejunal biopsy using Crosby capsule performed for diagnosis, screened at the same time with one hour D-Xylose, 3-5 hours urinary D-Xylose, fat load test and antigliadin antibody and followed up for 2-4 years., Results: The mean age at presentation was 8 years. There was no significant correlation between D-Xylose, fat load test and antigliadin antibody. Antigliadin antibody has 87.5% sensitivity and 50% specificity in this study. Three hours urinary D-Xylose has 93% sensitivity where as one hour D-Xylose has 82% sensitivity and only 25% specificity, whereas fat load test has 69% sensitivity., Conclusions: Blood and urinary D-Xylose and fat load tests are not useful for diagnosing coeliac disease. They have no correlation to each other or to jejunal histology. Antigliadin antibody is superior to the above tests.

Objective: Satisfaction's measurement with Mental Health Services in patients and their relatives., Design: Satisfaction scale administration to the patients who were treated in community-based psychiatric service from 1.1.1996 to 31.3.1996 and the relatives who were primarily involved in caring for the patient., Setting: The ASL Rome "C" community-based psychiatric service., Main Outcome Measures: Verona Service Satisfaction Scale-54, a multidimensional instrument which measure satisfaction with community-based psychiatric service., Results: Main results (301 scales for patients, 163 scales for relatives), pointed out for patients a higher satisfaction for the technical and interpersonal skills of psychiatrists and psychologists (score of specific items > 4). Lowest scores of satisfaction were towards the appearance, comfort level and physical layout of the facility (score 2.95) and towards the response of the service to emergencies during the night, weekend and Bank Holidays (score 2.87). Relatives were not particularly keen for the item regarding help to find open employment (score 2.76). Furthermore patients and their relatives gave a negative evaluation of the publicity and information offered by Mental Health Services. Dimension's analysis reaches the same conclusions deduced items's average score. The result of this study emphasizes the patients higher degree of satisfaction than the relatives., Conclusions: The above results point out three aspects to be improved by the Mental Health Service in order to satisfy the demands of the patients and relatives: 1. appearance, comfort level and physical layout of the facility, 2. publicity and information, 3. social activities and social skills.

A new method for orthopedic treatment, based on the ligature procedure described by Popov E. in Bulgaria, has been adapted for therapy of mandibular fractures in children.

The authors present their experience of maxillo-mandibular osteotomies performed at the Charles Nicolle Hospital in Tunis. The objective of this paper is to describe the preliminary steps (clinical, radiographic, photographic, modelling, cephalometric) in order to obtain a precise diagnosis of the dysmorphosis. They use Burstone's cephalometric analyses which allow evaluation of the relations between soft tissues which do not correspond to the relations of bony and dental displacement. They also present several clinical cases, the pre-operative steps and, most importantly, Burstone's cephalometric analyses demonstrating that, after osteotomies, the cephalometric values for soft tissues approach normal values. Complete analysis of the naso-maxillary profile may correct the motivation for consultation in some cases. The indication for Lefort I osteotomy is sometimes more appropriate than rhinoplasty. Preoperative orthodontic preparation is often required. Functional rehabilitation is necessary to adapt the orofacial muscles to the new shapes of the dental arch and to prevent recurrence.