Search

Background: Long-term data of certolizumab pegol (CZP) in Crohn's disease (CD) from pivotal registry trials are limited. We therefore aimed to evaluate the long-term efficacy of CZP in clinical practice in Switzerland., Methods: In the First Approved Certolizumab Therapeutic Experience in Switzerland-III phase IV multicenter cohort, patients receiving CZP were prospectively included all over Switzerland in (non-) academic hospitals and private practice., Results: We included 104 CD patients (52 male; only 22.1% anti-tumor necrosis factor (TNF) naïve, CZP as third anti-TNF agent in 46.2%) with follow-up time between 6 weeks up to 5 years. During treatment with CZP, we observed a significant decrease of the Harvey Bradshaw Index from a median of 7 at baseline (interquartile range 4-11) to 4, 5, 4, 3, 3, and 2 at weeks 6, 26, 52, 78, 104, and 156, respectively. While anti-TNF naïve patients showed a significantly better response at the end of induction, during CZP maintenance therapy response was similar as compared to anti-TNF experienced patients as well as between patients with a short (0-5 years) vs. long duration of disease (>5 years)., Conclusions: CZP is an effective long-term treatment option, including CD patients with long disease duration and prior treatment with 1 or 2 anti-TNF agents., (© 2017 S. Karger AG, Basel.)

The dipole configuration of the Earth's magnetic field allows for the trapping of highly energetic particles, which form the radiation belts. Although significant advances have been made in understanding the acceleration mechanisms in the radiation belts, the loss processes remain poorly understood. Unique observations on 17 January 2013 provide detailed information throughout the belts on the energy spectrum and pitch angle (angle between the velocity of a particle and the magnetic field) distribution of electrons up to ultra-relativistic energies. Here we show that although relativistic electrons are enhanced, ultra-relativistic electrons become depleted and distributions of particles show very clear telltale signatures of electromagnetic ion cyclotron wave-induced loss. Comparisons between observations and modelling of the evolution of the electron flux and pitch angle show that electromagnetic ion cyclotron waves provide the dominant loss mechanism at ultra-relativistic energies and produce a profound dropout of the ultra-relativistic radiation belt fluxes.

Background and Objectives: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) can offer long-term survival to patients with resectable peritoneal metastasis (PM) from colorectal cancer (CRC), a condition with otherwise dismal prognosis. This study describes short- and long-term outcome in a national patient cohort and aims to identify prognostic factors., Methods: All patients treated with CRS-HIPEC for non-appendiceal PM-CRC in Norway 2004-2013 were included (n = 119), and outcome and potential prognostic factors were examined using survival- and ROC-curve analysis., Results: Five-year overall survival (OS) and disease-free survival (DFS) were 36% and 14%, respectively, with 45 months median follow-up. The only factor associated with OS in multivariable analysis was peritoneal cancer index (PCI), with HR 1.05 (1.01-1.09) for every increase in PCI-score (P = 0.015). Peritoneal relapse was associated with shorter OS than distant metastasis (P = 0.002). ROC-curves identified PCI > 12 as a marker with 100% specificity for prediction of disease relapse. Severe postoperative complications (Clavien-Dindo ≥ 3) occurred in 15% of patients and there was no 100-day mortality., Conclusions: Long-term outcome was in line with published results, morbidity was acceptable and there was no 100-day mortality. The results reemphasize CRS-HIPEC as an important treatment option in PM-CRC, with particularly good results in patients with PCI < 12. J. Surg. Oncol. 2016;114:222-227. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Large-scale application of alginate-poly-L-lysine (alginate-PLL) capsules used for microencapsulation of living cells is hampered by varying degrees of success, caused by tissue responses against the capsules in the host. A major cause is proinflammatory PLL which is applied at the surface to provide semipermeable properties and immunoprotection. In this study, we investigated whether application of poly(ethylene glycol)-block-poly(L-lysine hydrochloride) diblock copolymers (PEG-b-PLL) can reduce the responses against PLL on alginate-matrices. The application of PEG-b-PLL was studied in two manners: (i) as a substitute for PLL or (ii) as an anti-biofouling layer on top of a proinflammatory, but immunoprotective, semipermeable alginate-PLL100 membrane. Transmission FTIR was applied to monitor the binding of PEG-b-PLL. When applied as a substitute for PLL, strong host responses in mice were observed. These responses were caused by insufficient binding of the PLL block of the diblock copolymers confirmed by FTIR. When PEG-b-PLL was applied as an anti-biofouling layer on top of PLL100 the responses in mice were severely reduced. Building an effective anti-biofouling layer required 50 hours as confirmed by FTIR, immunocytochemistry and XPS. Our study provides new insight in the binding requirements of polyamino acids necessary to provide an immunoprotective membrane. Furthermore, we present a relatively simple method to mask proinflammatory components on the surface of microcapsules to reduce host responses. Finally, but most importantly, our study illustrates the importance of combining physicochemical and biological methods to understand the complex interactions at the capsules' surface that determine the success or failure of microcapsules applicable for cell-encapsulation.

Islets encapsulated in immunoprotective microcapsules are being proposed as an alternative for insulin therapy for treatment of type 1 diabetes. Many materials for producing microcapsules have been proposed but only alginate does currently qualify as ready for clinical application. However, many different alginate-based capsule systems do exist. A pitfall in the field is that these systems are applied without a targeted strategy with varying degrees of success as a consequence. In the current review, the different properties of alginate-based systems are reviewed in view of future application in humans. The use of allogeneic and xenogeneic islet sources are discussed with acknowledging the different degrees of immune protection the encapsulation system should supply. Also issues such as oxygen supply and the role of danger associated molecular patterns (DAMPS) in immune activation are being reviewed. A common property of the encapsulation systems is that alginates for medical application should have an extreme high degree of purity and lack pathogen-associated molecular patterns (PAMPs) to avoid activation of the recipient's immune system. Up to now, non-inflammatory alginates are only produced on a lab-scale and are not yet commercially available. This is a major pitfall on the route to human application. Also the lack of predictive pre-clinical models is a burden. The principle differences between relevant innate and adaptive immune responses in humans and other species are reviewed. Especially, the extreme differences between the immune system of non-human primates and humans are cumbersome as non-human primates may not be predictive of the immune responses in humans, as opposed to the popular belief of regulatory agencies. Current insight is that although the technology is versatile major research efforts are required for identifying the mechanical, immunological, and physico-chemical requirements that alginate-based capsules should meet for successful human application.

Alginate-based microcapsules are being proposed for treatment of many types of diseases. A major obstacle however in the successes is that these capsules are having large lab-to-lab variations. To make the process more reproducible, we propose to cover the surface of alginate capsules with diblock polymers that can form polymer brushes. In the present study, we describe the stepwise considerations for successful application of diblock copolymer of polyethylene glycol (PEG) and poly-L-lysine (PLL) on the surface of alginate beads. Special procedures had to be designed as alginate beads are hydrophilic and most protocols are designed for hydrophobic biomaterials. The successful attachment of diblock copolymer and the presence of PEG blocks on the surface of the capsules were studied by fluorescence microscopy. Longer time periods, that is, 30-60 min, are required to achieve saturation of the surface. The block lengths influenced the strength of the capsules. Shorter PLL blocks resulted in less stable capsules. Adequate permeability of the capsules was achieved with poly(ethylene glycol)-block-poly(L-lysine hydrochloride) (PEG454-b-PLL100) diblock copolymers. The capsules were a barrier for immunoglobulin G. The PEG454-b-PLL100 capsules have similar mechanical properties as PLL capsules. Minor immune activation of nuclear factor κB in THP-1 monocytes was observed with both PLL and PEG454-b-PLL100 capsules prepared from purified alginate. Our results show that we can successfully apply block copolymers on the surface of hydrophilic alginate beads without interfering with the physicochemical properties., (Copyright © 2013 The Authors. Journal of Biomedical Materials Research Part A Published by Wiley Periodicals, Inc.)

Introduction: Pain and adhesions represent the challenge in hernia surgery., Aim: To investigate mesh fixation and adhesion prevention with a collagen-fibrin sealant., Materials and Methods: Twenty-seven male Sprague-Dawley rats were operated twice, to create and repair 2 ventral hernias. Mesh fixation was with collagen-fibrin sealant on 1 side (group I), whereas an additional peritoneal suture was added in group II. On day 60 animals were killed and mesh migration, integration and number, grade and location of adhesions noted., Results: Migration occurred in 12 (44.4%) in group 1 and 3 (11.1%) in group 2, P=0.023. Adhesions developed to 18 (33.3%) meshes. There was no difference in adhesion grade or area for mesh center or edge between the groups (P=0.735 and P=0.829, respectively). Median adhesion grade for mesh center was 1 and edge 3 (range, 0 to 4), P=0.005 and P=0.001, respectively. Granuloma formation was noted in 8 (18.6%) animals; only with suture-fixed mesh., Conclusions: Mesh fixation with fibrin sealant is not satisfactory, however, adhesion prevention seems to be; adhesions to the edge of the mesh are most severe.

We demonstrate error-free wavelength conversion of 28 GBaud 16-QAM single polarization (112 Gb/s) signals based on four-wave mixing in a dispersion engineered silicon nanowire (SNW). Wavelength conversion covering the entire C-band is achieved using a single pump. We characterize the performance of the wavelength converter subsystem through the electrical signal to noise ratio penalty as well as the bit error rate of the converted signal as a function of input signal power. Moreover, we evaluate the degradation of the optical signal to noise ratio due to wavelength conversion in the SNW.

Background: Data on lymph node distribution in the right colon D3 area are scarce, especially for nodes posterior to the superior mesenteric vessels., Objective: The aim of this study was to determine whether nodes exist posterior to the superior mesenteric vessels and if arterial crossing patterns affect node distribution., Design: This is an anatomical postmortem study., Settings: This study was conducted at the following institutions: Department of Gastrointestinal surgery/Pathology, Vestfold Hospital Trust, Norway; Institute for Pathology, University of Belgrade, Serbia; and Anatomy Sector, University of Geneva, Switzerland., Patients: Fresh human cadavers were selected to undergo autopsy., Intervention: A predefined D3 area was removed from cadavers, fixed in formaldehyde, divided into 3 vertical compartments with regard to the superior mesenteric vessels. Vertical compartments were further divided into 8 compartments. Millimeter slices were analyzed at histology., Main Outcome Measures: Lymph nodes ≥1 mm were counted in each compartment., Results: Twenty-six cadavers (14 men), median age 76 years, were included. Mean node number per cadaver was 15.9 ± 7.4. Lateral, anterior, and posterior vertical compartments contained median 5.5 (1-11), 5 (2-21), and 5 (0-11) nodes. The effect of the ileocolic artery crossing pattern on node number in the posterior vertical compartment was p = 0.020. Anterior/posterior ileocolic artery compartments contained nodes in 58% and 85% cadavers with median of 1(0-7) and 2(0-5). These compartments showed a significant difference in node numbers depending on the ileocolic artery crossing pattern, p < 0.001 (posterior crossing) and p < 0.001 (anterior crossing). The middle colic artery compartment contained nodes in all cadavers with a median of 2 (1-4). The association between volume and total number of nodes in the D3 area was statistically significant, p < 0.001., Limitations: Nodes posterior to the superior mesenteric vessels do not necessarily have clinical relevance., Conclusion: Anatomically correct D3 resection implies posterior vertical compartment removal with posterior ileocolic artery crossing. Addition of the lateral vertical compartment to routine right colectomy has an improvement potential of 5 to 6 nodes.

We describe the use of various silicon photonic device technologies to implement microwave photonic filters (MPFs). We demonstrate four-wave mixing in a silicon nanowire waveguide (SNW) to increase the number of taps for MPFs based on finite impulse response filter designs. Using a 12 mm long SNW reduces the footprint by five orders of magnitude compared to silica highly nonlinear fiber while only requiring approximately two times more input power. We also demonstrate optical delays based on serial sidewall Bragg grating arrays and step-chirped sidewall Bragg gratings in silicon waveguides. We obtain up to 63 ps delay in discrete steps from 15 ps to 32 ps over a wide bandwidth range from 33 nm to at least 62 nm. These components can be integrated with other silicon-based components such as integrated spectral shapers and modulators to realize a fully integrated MPF.

Background: The D3 right colectomy for cancer requires dissection in the vicinity of the superior mesenteric vessels, which requires preoperative 3D imaging in these patients., Case Report: We present a patient with a caecum adenocarcinoma cancer which underwent D3 resection of the right colon, preceded by pre-operative MDCT with 2D multiplanar reconstruction and 3D volume rendering., Results: The dataset analysis revealed a rare congenital aneurysm of the superior mesenteric vein below the spleno-mesenteric confluence and a co-existing anomalous irrigation in the form of an ileo-mesenteric trunk. The surgical procedure was carried out as planned and the patient presents no signs of recurrence of the disease one year after the intervention., Conclusions: The case presented - with a rare and complicated vascular situs - illustrates particularly well that multimodal post-processing of the CT dataset for volume rendering allows proper assessment of the arrangement of pertinent blood vessels, and, consequently in the planning, setup and accomplishing the delicate operation, avoiding the surgical pitfalls and iatrogenic injuries., (Celsius.)

Aim: To study and provide data on the evolution of medical procedures and outcomes of patients suffering from perforated midgut diverticulitis., Methods: Three data sources were used: the Medline and Google search engines were searched for case reports on one or more patients treated for perforated midgut diverticulitis (Meckel's diverticulitis excluded) that were published after 1995. The inclusion criterion was sufficient individual patient data in the article. Both indexed and non-indexed journals were used. Patients treated for perforated midgut diverticulitis at Vestfold Hospital were included in this group. Data on symptoms, laboratory and radiology results, treatment modalities, surgical access, procedures, complications and outcomes were collected. The Norwegian patient registry was searched to find patients operated upon for midgut diverticulitis from 1999 to 2007. The data collected were age, sex, mode of access, surgical procedure performed and number of patients per year. Historical controls were retrieved from an article published in 1995 containing pertinent individual patient data. Statistical analysis was done with SPSS software., Results: Group I: 106 patients (48 men) were found. Mean age was 72.2 ± 13.1 years (mean ± SD). Age or sex had no impact on outcomes (P = 0.057 and P = 0.771, respectively). Preoperative assessment was plain radiography in 53.3% or computed tomography (CT) in 76.1%. Correct diagnosis was made in 77.1% with CT, 5.6% without (P = 0.001). Duration of symptoms before hospitalization was 3.6 d (range: 1-35 d), but longer duration was not associated with poor outcome (P = 0.748). Eighty-six point eight percent of patients underwent surgery, 92.4% of these through open access where 90.1% had bowel resection. Complications occurred in 19.2% of patients and 16.3% underwent reoperation. Distance from perforation to Treitz ligament was 41.7 ± 28.1 cm. At surgery, no peritonitis was found in 29.7% of patients, local peritonitis in 47.5%, and diffuse peritonitis in 22.8%. Peritonitis grade correlated with the reoperation rate (r = 0.43). Conservatively treated patients had similar hospital length of stay as operated patients (10.6 ± 8.3 d vs 10.7 ± 7.9 d, respectively). Age correlated with hospital stay (r = 0.46). No difference in outcomes for operated or nonoperated patients was found (P = 0.814). Group II: 113 patients (57 men). Mean age 67.6 ± 16.4 years (range: 21-96 years). Mean age for men was 61.3 ± 16.2 years, and 74.7 ± 12.5 years for women (P = 0.001). Number of procedures per year was 11.2 ± 0.9, and bowel resection was performed in 82.3% of patients. Group III: 47 patients (21 men). Patient age was 65.4 ± 14.4 years. Mean age for men was 61.5 ± 17.3 years and 65.3 ± 14.4 years for women. Duration of symptoms before hospitalization was 6.9 d (range: 1-180 d). No patients had a preoperative diagnosis, 97.9% of patients underwent surgery, and 78.3% had multiple diverticula. Bowel resection was performed in 67.4% of patients, and suture closure in 32.6%. Mortality was 23.4%. There was no difference in length of history or its impact on survival between Groups I and III (P = 0.241 and P = 0.198, respectively). Resection was more often performed in Group I (P = 0.01). Mortality was higher in Group III (P = 0.002)., Conclusion: In cases with contained perforation, conservative treatment gives satisfactory results, laparoscopy with lavage and drainage can be attempted and continued with a conservative course.

Application of alginate-polylysine (PLL) capsules for immunoisolation of living cells are suffering from a varying degree of success and large lab-to-lab variations. In this study we show that these differences in success rates can be attributed to alginate dependent essential physicochemical changes of the properties of capsules in vivo that will render the capsules more susceptible to inflammatory responses. Capsule properties were studied before and after implantation by XPS, by immunocytochemistry, and by measuring zeta potentials. We studied a capsule type which provokes for unknown reasons a strong inflammatory response, i.e. high-guluronic (G) alginate capsules and a capsule type with near identical physicochemical properties but which evokes a minimal inflammatory response, i.e. intermediate-G alginate capsules. The cause of the difference in response was a decrease in nitrogen content on high-G capsules due to detachment of PLL in vivo and an increase of the zeta-potential. Our data illustrate an important overlooked phenomena; the physicochemical properties are not necessarily the properties after exposure to the in vivo microenvironment and might induce undesired inflammatory responses and failure of encapsulated cellular grafts., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Aim: To demonstrate the feasibility of single-port incisional hernia repair, quantify incision size, and compare results of patients operated by standard laparoscopy (SL) with those operated by the single-port technique [laparoendoscopic single-site surgery (LESS)]., Methods: Prospective data collected on patients operated from March 2008 to June 2010. Indication for surgery was incisional hernia >3 cm. There were no selection criteria for the enrollment of patients or the operative technique used., Results: Thirty-four patients were operated (18 women and 16 men): 15 with LESS and 19 with SL. There was no difference for age, body mass index, ASA scores, or number of previous surgical procedures. LESS patients had slightly larger (82 ± 54 vs. 64 ± 34 mm) and more numerous hernias: 3 (1 to 7) versus 1 (1 to 3). Adhesion grades, severity scores, and operating times (78.2 SD ± 31.2 vs. 73.5 SD ± 25.4 min, P=0.76) did not differ between the groups. The mean fascia incision size in LESS was digitally measured as 12.93 ± 2.01 mm. The hospital stay was a median of 1 day in both groups. There was 1 conversion in the SL group. The median follow-up time was 26 months (range, 25 to 31 mo) for LESS and 34 months (range, 31 to 42 mo) for SL., Complications: There were 2 seromas and 1 hematoma in the LESS group. In the SL group, there were 2 small-bowel injuries and 2 seromas. There were no recurrences in the SL group, 1 in LESS, and no port-site hernia so far., Conclusions: LESS incisional hernia repair through 1 minimal fascia incision is feasible. Early results do not indicate a longer operation time, higher complication, or higher recurrence rates.

Background: Current practice when performing right colectomy for cancer is to divide the feeding vessels for the right colon on the right side of the superior mesenteric vein., Objective: This study aims to show that arterial stumps can be visualized through an early postoperative CT and analyze their anatomical and surgical characteristics., Design: This study presents a retrospective review of prospective data., Settings: :The study was conducted at the Department of Surgery, Vestfold Hospital, Tonsberg, Norway., Patients: Patients with leakage after a right colectomy for cancer (2003-2011) were identified through a local prospective complication registry (FileMaker Pro 9.0v3 software)., Interventions: Both preoperative and postoperative CTs were retrieved, reanalyzed, and 3-dimensionally reconstructed (Osirix v.3.0.2./Mimics v.13.1.). Patients without postoperative CTs were excluded., Main Outcome Measures: The main outcomes measured were length, caliber of presumed and actual arterial stumps, and their position relative to the superior mesenteric vein., Results: Eighteen patients, median age 69 (10 men) were included. All patients had postoperative CTs, and 15 patients had preoperative CTs. Median time from operation to postoperative CT was 5 days. The ileocolic artery was found in 14 (11 CT pairs) patients, and the right colic artery was found in 5 (4 pairs) patients. Actual stump lengths were 28.0 mm (SD 9.3) and 37.3 mm (SD 14.9). A significant statistical difference between presumed and actual ileocolic artery stump lengths was found (P = .002). Posterior crossing to the superior mesenteric vein was noticed in 8 of 14 ileocolic arteries and in 3 of 5 right colic arteries. There was no statistical difference in mean caliber for the preoperative and postoperative right colic artery (P = .505) and ileocolic artery (P = .474)., Limitations: Difficulties when interpreting the postoperative images, due to intra-abdominal effusion, staples, edema, and altered syntopy of blood vessels, were overcome through comparison with preoperative CTs., Conclusion: An early postoperative CT can show arterial stumps after right colectomy for cancer. These stumps appear to be significantly longer than presumed; implying a significant improvement potential when specimen size is concerned.

Background: 3-D relations between the ileocolic (ICA), right colic artery (RCA) with the superior mesenteric vein (SMV) have been described in cadavers. However, no data exists on preoperative evaluation of these relations., Aim: To define the length of crossing and 3-D position of the ICA and RCA to the SMV in patients undergoing multidetector computerized tomography (MDCT) angiography., Methods: MDCT angiographies were analyzed with the aid of Osirix v.3.0.2. image processing application. All the datasets included arterial and venous phase, undergoing multimodal visualization: 2D multiplanar reconstruction with maximum intensity projection and 3D Volume rendering. The anatomical relations were analyzed in various planes (orthogonal and oblique), depending upon their particular course. When a clear spatial reference was achieved, the distance of the colic artery from their origin on the aorta to the right border of the SMV was measured, and its position noted., Results: 50 MDCT were analyzed (29 male). RCA occurred in 27 patients (54.0%), 25 (92.6%) passed anterior to the SMV. Length of crossing was 22.7±8.1 (8.3-41.3) mm. The ICA occurred in 48 (96%) passing under the SMV in 38 (79.2%). Length of crossing 15.4±5.8 (14.0-26.6) mm., Conclusions: RCA occurs in 54% patients, passes over the SMV in 92.6% specimens and leaves a 22.7 mm stump. ICA passes under the SMV in most cases, leaving a 15.4 mm stump. These data could be of crucial importance to the surgeon facing laparoscopic right colectomy for cancer.

Aim: To determine the effect of a single dose of bevacizumab on adhesion formation in the rat cecum abrasion model., Methods: The cecum and parietal peritoneum of 38 male Wistar rats were abraded to promote adhesion formation. The rats were randomized into 2 groups: group 1 received bevacizumab (2.5 mg/kg) intraperitoneally, and group 2 received saline. On day 30 animals were killed, adhesions scored, and histopathological samples taken., Results: There was no wound dehiscence; there were 2 incision hernias (5.3%), 1 per group. Thirty-seven animals developed adhesions (97.4%). Adhesion grade and severity scores were significantly different between groups 1 and 2 at 2.7:1.6 (P = .018) and 3.8:2.7 (P = .007), respectively. There was no difference in adhesion square area (27.7:25.0%; P = .16), location (P = 1.00), or number (2.1:1.3; P = .06). Histopathology confirmed the statistical difference between groups (P = .049), and a highly significant correlation between results was shown (r = .758; P = .0001)., Conclusion: A single dose of intraperitoneal bevacizumab significantly reduces grade and severity of abdominal adhesions in the cecum abrasion rat model., (2010 Elsevier Inc. All rights reserved.)

Background: The use of the gastrocolic trunk of Henle (GTH) as a landmark has been advocated in laparoscopic right colectomy. The aim of this study was to evaluate the GTH as a possible landmark in laparoscopic right colectomy in the context of the adjacent arteries., Methods: Corrosion casting (30 specimens) and anatomic dissection were performed on formol-fixed cadavers (12 specimens)., Results: The GTH was found in 34 specimens (81.0%). Among its closely related neighboring arterial vessels, the right colic artery was the most frequent (19 cases [55.9%]). It passed by the GTH at a mean distance of 3.6 mm. The course of the arteries in relation to the GTH was caudal and parallel in most cases (29 [85.3%]), but there was also a significant portion of crossing schemes (11.7%)., Conclusions: Although the GTH is a constant and conspicuous anatomic entity, it is not easily accessible, because of its tight relations to the right colon arteries. Instead, the authors advocate the use the superior right colic vein as an anatomic landmark leading to the GTH during laparoscopic right colectomy., (Copyright 2010 Elsevier Inc. All rights reserved.)

Cell encapsulation has been proposed for the treatment of a wide variety of diseases since it allows for transplantation of cells in the absence of undesired immunosuppression. The technology has been proposed to be a solution for the treatment of diabetes since it potentially allows a mandatory minute-to-minute regulation of glucose levels without side-effects. Encapsulation is based on the principle that transplanted tissue is protected for the host immune system by a semipermeable capsule. Many different concepts of capsules have been tested. During the past two decades three major approaches of encapsulation have been studied. These include (i) intravascular macrocapsules, which are anastomosed to the vascular system as AV shunt, (ii) extravascular macrocapsules, which are mostly diffusion chambers transplanted at different sites and (iii) extravascular microcapsules transplanted in the peritoneal cavity. The advantages and pitfalls of the three approaches are discussed and compared in view of applicability in clinical islet transplantation.

Objective: To compare peripheral pulse pressure waveforms in normal pregnancy, gestational hypertension (GH) and pre-eclampsia (PE)., Design: Comparative study., Setting: Tertiary referral teaching hospital., Sample: Women with hypertensive disease in pregnancy and matched normal pregnant controls., Methods: Women in the third trimester of pregnancy with newly developed PE (n= 27) or GH (n= 33) were studied by radial artery applanation tonometry. Values were compared with those for gestational age matched normal pregnant women (n= 39)., Main Outcome Measures: Augmentation Index., Results: Hypertension was of equal severity in PE and GH. Central augmentation pressure and augmentation index, indicating vasoconstriction, were mildly elevated in GH, but markedly elevated in PE., Conclusion: Non-invasive applanation tonometry discriminates among normal pregnancy, GH and PE, and may be useful to predict PE.

The Van Allen radiation belts are two regions encircling the Earth in which energetic charged particles are trapped inside the Earth's magnetic field. Their properties vary according to solar activity and they represent a hazard to satellites and humans in space. An important challenge has been to explain how the charged particles within these belts are accelerated to very high energies of several million electron volts. Here we show, on the basis of the analysis of a rare event where the outer radiation belt was depleted and then re-formed closer to the Earth, that the long established theory of acceleration by radial diffusion is inadequate; the electrons are accelerated more effectively by electromagnetic waves at frequencies of a few kilohertz. Wave acceleration can increase the electron flux by more than three orders of magnitude over the observed timescale of one to two days, more than sufficient to explain the new radiation belt. Wave acceleration could also be important for Jupiter, Saturn and other astrophysical objects with magnetic fields.

Data from literature suggests that a significant percentage of bakers develop occupational asthma and chronic obstructive bronchitis, the primary reason for this being the strong allergenic properties of flour. The aim of this study was to evaluate the prevalence of bronchial hyperactivity in bakers, as well as to correlate bronchial hyperactivity with positive skin tests and atopy. A group of 100 bakers (54 males and 46 females) employed in bread production for an average of 14.8 +/- 8.8 years, were examined from 1996 to 1999. Bronchial challenge tests with methacholine (cumulative dose of 4 mg) and flour were performed. It was considered positive if a FEV1 reduction of at least 20% from normal values had occurred. Additionally, skin prick tests were performed with wheat flour extracts, as well as standard environmental inhalation allergens. Total IgE were assessed using the ELISA method. Results showed that 11% of bakers demonstrated a positive methacholine test, 2% of bakers responded to the specific bronchial challenge test with wheat flour. The skin prick test with wheat flour was positive in 15% of bakers, while the same test using standard inhalation allergens was positive in 12% of bakers. Atopic status was found in 18% of bakers. The frequency of positive methacholine test was 33% in bakers with atopic status, compared to 6.1% (P < 0.01) in those without atopic status. Among the bakers who displayed a positive skin test to wheat flour, specific bronchial challenge test with flour was positive in two (13.3%) bakers, while no response to the bronchial challenge test with flour was observed in bakers with negative skin test. This is in agreement with known results.