bluuebunny/crossref_metadata_2025 huggingface dataset:
Repeated biopsy in the detection of prostate cancer: When and how many cores
Authors: Scattoni Vincenzo , Russo Andrea , Di Trapani Ettore , Capitanio Umberto , La Croce Giovanni , Montorsi Francesco
Published: February 2015

Purpose: We performed an analysis of the literature about the optimal prostate biopsy (PBX) scheme in the repeated setting Methods: We performed a clinical and critical literature review by searching Medline Database from January 2005 up to January 2014. Electronic searches were limited to the English language. The keywords were: prostate cancer, prostate biopsy, transrectal ultrasound, transperineal prostate biopsy. Results: The recommended approach in repeated setting is still the extended scheme (EPBx) (12 cores). An approach with more than 12 cores according to the clinical characteristics of the patients may optimize cancer detection. Saturation PBx (> 20 cores) clearly improves cancer detection if clinical suspicion persists after previous negative biopsy. Nevertheless international guidelines do not strongly recommended SPBx in all situations of repeated setting. EPBx or SPBX may be, in the future, substituted by multiparametric MRI-targeted biopsies. Conclusions: Since the scenario in which a PBx is changing, the issue about the number and location of the cores in PBx is still a matter of debate in repeated setting. At present, EPBx are still the gold standard even if SPBx seems to be necessary in many cases. However, random PBx does not represent the approach of the future, but rather imaging targeted biopsy.
Pathological issues in biopsy specimens of men with prostate cancer eligible for active surveillance
Authors: Mazzucchelli Roberta , Galosi Andrea Benedetto , Lopez-Beltran Antonio , Scarpelli Marina , Cheng Liang , Montironi Rodolfo
Published: February 2015

Active surveillance (AS) is an important management option for men with lowrisk, clinically localized prostate cancer. The clinical parameters for patient selection and definition of progression for AS protocols are evolving as data from several large cohorts become mature. Vital to this process is the critical role pathologic parameters play in identifying appropriate candidates for AS. These findings need to be reproducible and accurately reported by pathologists. Repeated biopsy after initial diagnosis of prostate cancer is recommended before inclusion in active surveillance for early detection of significant cancer.
Contrast enhanced ultrasound in the assessment of urogenital pathology
Authors: Barozzi Libero , Capannelli Diana , Imbriani Michele
Published: February 2015

Contrast enhanced ultrasound (CEUS) is an innovative technique that employs microbubble contrast agents to demonstrate parenchymal perfusion. Although initial clinical application was focused on the liver pathology, a wide variety of clinical conditions can be assessed now with CEUS. CEUS is a well-tolerated technique and is acquiring an increasing role in the assessment of renal pathology because contrast agents are not excreted by the kidney and do not affect the renal function. CEUS demonstrated an accuracy similar to contrast enhanced multi-detector computed tomography (CEMDCT) in detecting focal lesions, with the advantage of the real-time assessment of microvascular perfusion by using time-intensity curves. The aim of this paper is to review the main indications of CEUS in the assessment of renal and urogenital pathology. Imaging examples are presented and described. Advantages and limitations of CEUS with reference to conventional US and CE-MDCT are discussed.
Predictive value of resistive index in graft survival after kidney transplant
Authors: Forte Saverio , Martino Pasquale , Palazzo Silvano , Matera Matteo , Giangrande Floriana , Selvaggi Francesco Paolo , Ditonno Pasquale , Battaglia Michele
Published: February 2015

Introduction: The intrarenal resistance index (RI) is a calculated parameter for the assessment of the status of the graft during the follow-up ultrasound of the transplanted kidney. Currently it is still unclear the predictive value of RI, also in function of the time. Materials and Methods: We retrospectively investigated the correlation between the RI and the graft survival (GS) and the overall survival (OS) after transplantation. We evaluated 268 patients transplanted between 2003 and 2011, the mean followup was 73 months (12-136). The RI was evaluated at 8 days, 6 months, 1 year and 3 years. The ROC analysis was used to calculate the predictive value of RI and the Kaplan Mayer curves was used to evaluated the OS and PS. Results: The ROC analysis, correlated to the GS, identified a value of RI equal to 0.75 as a cut-off. All patients was stratified according to the RI at 8 days (RI ≤ 0,75: 212 vs RI > 0.75: 56), at 6 months (RI ≤ 0.75: 237 vs RI > 0.75: 31), at 1 year (RI ≤ 0.75: 229 vs RI > 0.75: 39) and at 3 years (RI ≤ 0.75: 224 vs RI > 0.75: 44). The RI showed statistically significant differences between the two groups in favor of those who had an RI ≤ 0.75 only at 8 days and at 6 moths (p = 0.0078 and p = 0.02 to 8 days to 6 months) on the GS. On the contrary, we observed that the RI estimated at 1 year and 3 years has not correlated with the GS. The same RI cut-off was correlate with PS after transplantation. We observed that there are no correlations between the RI and OS. Conclusions: The RI proved to be a good prognostic factor on survival organ when it was evaluated in the first months of follow- up after transplantation. This parameter does not appear, however, correlate with OS of the transplanted subject.
Biopsy follow-up in patients with isolated atypical small acinar proliferation (ASAP) in prostate biopsy
Authors: Leone Luca , Lacetera Vito , Montironi Rodolfo , Cantoro Ubaldo , Conti Alessandro , Sbrollini Giulia , Quaresima Luigi , Mariani Luciana , Muzzonigro Giovanni , Galosi Andrea Benedetto
Published: February 2015

The incidence of prostate cancer (PCA) was evaluated in 155 patients with isolated Atypical Small Acinar Proliferation (ASAP) found on initial prostate biopsy, after a medium-term follow-up (40 months) with at least one re-biopsy. Clinical and histological data were analysed. Cancer was detected in 81 of 155 (52.3%). The cancer detection rate was 71.6%, 91.3%, 97.5%, 100% at the 1st re-biopsy, 2nd, 3rd, and 4th rebiopsy respectively. At the uni- and multivariate analyses, prostate volume (≤ 30 cc), transition zone volume (≤ 10 cc), small core length at the initial biopsy (≤ 10 mm) and few number of cores at initial biopsy (≤ 8) are predictive of cancer. Furthermore, tumour characteristics on the whole surgical specimens was assessed in 30 men: 13 of 30 (43 %) had clinically relevant cancer (volume > 0.5 ml or/and Gleason score ≥ 7, or pT3). Most of relevant cancers were detected in the distal apex, anterior gland and midline. These anatomical sites could be under-sampled at the initial biopsy using the transrectal approach. Our data suggest that follow-up biopsy is recommended in all cases of isolated ASAP detected after biopsy using endfire transrectal probe. The re-biopsy strategy should increase the number of cores (or a saturation biopsy), focusing on area of ASAP in the initial biopsy, but also including the under-sampled areas (anterior gland, distal apex and midline) to detect clinically relevant cancers.
Accuracy of 3 Tesla pelvic phased-array multiparametric MRI in diagnosing prostate cancer at repeat biopsy
Authors: Pepe Pietro , Garufi Antonio , Priolo Giandomenico , Dibenedetto Giuseppe , Salemi Michele , Pennisi Michele , Fraggetta Filippo , Aragona Francesco , Barbera Michele
Published: February 2015

Introduction. Multiparametric pelvic magnetic resonance imaging (mpMRI) accuracy in prostate cancer (PCa) diagnosis was evaluated. Materials and Methods. From June 2011 to December 2013, 168 patients (median 65 years) with negative digital rectal examination underwent repeat transperineal saturation biopsy (SPBx; median 28 cores) for persistently high or increasing PSA values, PSA >10 ng/ml or PSA values between 4.1-10 o r 2.6-4 ng/ml with free/total PSA < 25% and < 20%, respectively. All patients underwent mpMRI using a 3.0 Tesla scanner equipped with surface 16 channels phased-array coil and lesions suspicious for PCa were submitted to additional targeted biopsies. Results. A T1c PCa was found in 66 (39%) cases; SPBx and mpMRI-suspicious targeted biopsy diagnosed 60 (91%) and 52 (78.8%) cancers missing 6 (all of the anterior zone) and 14 cancers (12 and 2 of the lateral margins and anterior zone), respectively; in detail, mpMRI missed 12 (18.1%) PCa charaterized by microfocal (1 positive core with greatest percentage of cancer and Gleason score equal to 5% and 6, respectively) disease at risk for insignificant cancer. The diameter of the suspicious mpMRI lesion was directly correlated to the diagnosis of PCa with poor Gleason score (p < 0.05); detection rate of cancer for each suspicious mpMRI core was 35.3%. Diagnostic accuracy, sensitivity, specificity, positive and negative predictive value of mpMRI in diagnosing PCa was 75.7%, 82.5%, 71.8%, 78.9%, 87.9%, respectively. Conclusion. Multiparametric pMRI improved SPBx accuracy in diagnosing significant anterior PCa; the diameter of mpMRI suspicious lesion resulted significantly predictive of aggressive cancers.
Lidocaine spray administration in transrectal ultrasound-guided prostate biopsy: Five years of experience
Authors: Dell’Atti Lucio
Published: February 2015

Objectives: We report in this singlecenter study our results of a five-year experience in the administration of lidocaine spray (LS) during ultrasound-guided prostate biopsy (TPB). Material and Methods: Between August 2008 and July 2013 a total of 1022 consecutive male patients scheduled for TPB with elevate PSA (≥ 4 ng/ml) and (or) abnormal digital rectal and (or) suspect TRUS were considered eligible for the study. Each patient was treated under local anaesthesia with LS (10 gr/100 ml), applied two minutes before the procedure. TPB was performed with the patient in the left lateral decubitus using multi-frequency convex probe “end-fire”. Two experienced urologists performed a 14-core biopsy, as first intention. After the procedure each patient was given a verbal numeric pain scale (VNS). The evaluation was differentiated in two scales VNS: VNS 1 for the insertion of the probe and the manoeuvres associated, while VNS 2 only for the pain during needle’s insertion. Results: Pain scores were not statistically significant different with regard to the values of PSA and prostate gland volume. Pain score levels during probe insertion and biopsy were significantly different: the mean pain score according to VNS was 3.3 (2-8) in the first questionnaire (VNS1) (p < 0.001) and 2.1 (1-7) in the second one (VNS2) (p < 0.125). The 8.2% of cases referred severe or unbearable pain (score ≥ 7), 74% of patients referred no pain at all. Only 21 patients would not ever repeat the biopsy or would request a different type of anaesthesia, while 82% of them would repeat it in the same way. In only eight patients we have not been able to insert TRUS probe. Conclusions: Our pain score data suggest that LS provides efficient patient comfort during TPB reducing pain both during insertion of the probe and the needle. This non-infiltrative anaesthesia is safe, easy to administer, psychologically well accepted by patients and of low cost.
Prostatic fiducial markers implantation by transrectal ultrasound for adaptive image guided radiotherapy in localized cancer: 7-years experience
Authors: Lacetera Vito , Cardinali Massimo , Mantello Giovanna , Fenu Francesco , Sbrollini Giulia , Tombolini Flavia , Conti Alessandro , Maggi Stefania , Muzzonigro Giovanni , Galosi Andrea Benedetto
Published: February 2015

Objective: we present our 7-years’ experience with fiducial gold markers inserted before Image-Guided Radiotherapy (IGRT) focusing on our echo-guided technique reporting early and late complications. Material and methods: 78 prostate cancer (PCA) patients who underwent fiducial markers placement for adaptive IGRT (period 2007-2014) were selected. Mean patient age was 75 years (range 60-81), mean PSA 7.8 ng/ml (range 3.1-10), clinical stage < T3, mean Gleason Score 6.4 (range 6-7). We recorded early and late complications. Maximum distance between the Clinical Target Volume (CTV) and Planning Target Volume (PTV) was assessed for each direction and the mean PTV reduction was estimated. Results: we describe in details our echo-guided technique of intraprostatic gold fiducial markers insertion prior to adaptative IGRT. We report rare early toxicity (5-7% grade 1-2), a mean PTV reduction of 37% and a very low late toxicity (only 3.4% bladder G3 and 8% rectal G2 side effects). Conclusion: Our technique of fiducial gold markers implantation for adaptative IGRT is safe and well-tolerated and it resulted helpful to reduce CTV-PTV margin in all cases; the effects on clinical practice seem significant in terms of late toxicity but further investigations are needed with longer follow-up.
The impact of repeated prostate biopsies on sexual function and urinary symptoms in patients with diagnosis of Atypical Small Acinar Proliferation (ASAP): Can ecoDoppler reduce side effects?
Authors: Quaresima Luigi , Lacetera Vito , Leone Luca , Montesi Lorenzo , Cantoro Ubaldo , Polito Massimo , Muzzonigro Giovanni
Published: February 2015

Objectives: To establish whether repeated trans-rectal ultrasound-guided Prostate Needle Biopsies (PNBx) performed in men with diagnosis of Small Acinar Atypical Proliferation (ASAP) predispose these subjects to Erectile Dysfunction (ED) and to evaluate if EcoColorDoppler (ECD) can help to reduce this side effect. Materials and methods: We performed a retrospective study regarding 190 men with diagnosis of ASAP detected between January 2001 and December 2011, who underwent to repeated prostate needle biopsies (PNBx). These patients were investigated about Erectile Function (EF) and Lower Urinary tract Symptoms (LUTS) using International Index of Erectile Function (IIEF-5) and International Prostate Symptom Score (IPSS) questionnaires before the first PNBx and 3 months after each other one. In particular, among the 89 men without ED before first PNBx, we compared IIEF-5 score between 64 patients who underwent to standard PNBx and 25 patients submitted to a PNBx done with in addition ECD ultrasound imaging. Results: Mean patient age was 65 years (SD 7.7); mean follow-up was 3.2 years (SD 1.8) and the mean number of re-biopsies completed was 2 (SD 1.5). Among the 143 men considered, only 89 resulted with a normal EF (IIEF-5 score > 21): in this group incidence of ED (IIEF-5 score < 21) among patients who underwent to standard PNBx was 4/64 (6.25%) while in patients submitted to a PNBx with ECD was 1/25 (4%). A greater decrease of EF was observed in patients undergone to 3 or more biopsies; no relationship between IPSS score and re-PNBx was identified. Conclusion: Repeated PNBx done in patients with diagnosis of ASAP appear to get worse EF; number of biopsies seems to increase the risk of ED. Use of ECD in transrectal ultrasound- guided PNBx may have a role to avoid neurovascular bundles (NVBs) and preserve EF; anyway further studies are highly recommended to validate this hypothesis.
Penile fracture: Retrospective analysis of our case history with long-term assessment of the erectile and sexological outcome
Authors: Pavan Nicola , Tezzot Giorgia , Liguori Giovanni , Napoli Renata , Umari Paolo , Rizzo Michele , Chiriacò Giovanni , Chiapparrone Gaetano , Vedovo Francesca , Bertolotto Michele , Trombetta Carlo
Published: February 2015

Objectives: To review the cases of patients with suspected penile fracture and asses erectile and sexological outcomes. Materials and methods: from 1987 to 2013 presented to the Urology Clinic of Trieste and at the AIED of Pordenone a total of 41 cases that were divided into two groups according to the timing of treatment: 18 patients with anamnestic diagnosis of penile fracture treated nonimmediately and 23 patients treated immediately after the trauma. For all patients we evaluated the type of treatment adopted, the occurrence of complications and reoperations and the follow-up. The erectile function was also evaluated through the IIEF, as well as the psychological impact of the trauma on social and sex life, using a psycho- sexological questionnaire. Results: Among patients treated immediately after the trauma 14 were subjected to surgery. About a year after surgery, penile curvature was reported in 1 patient, pain in 3 patients, urinary disorders in 1 patient, while none reported erectile dysfunction (ED). Out of these, only 3 patients underwent reoperation. Among those treated conservatively 1 patient reported curvature, 1 patient reported pain and none reported ED. Among patients who were admitted at a later date, 14 reported curvature and 4 reported pain whereas urinary disorders were reported in 1 and ED in 4 patients. From a psychological point of view, the trauma caused in most cases a fear of new trauma and of repercussions on erectile function and sensitivity. Conclusions: The diagnosis is mainly clinical; however, radiological investigation is essential to confirm the diagnosis, assess the site and extent of the trauma and possible urethral involvement, so as to plan the most appropriate treatment. In addition, immediate treatment leads to better long-term results, with a lower incidence of ED and penile curvature. Psychologically, penile trauma intensifies the fear of reoccurrence; it decreases, however, with the passage of time.
Perivascular epithelioid cell tumor (PEC-ome) of the prostate: Ultrasound feature in case report
Authors: Sbrollini Giulia , Conti Alessandro , Galosi Andrea Benedetto , Lacetera Vito , Montironi Rodolfo , Montesi Lorenzo , Muzzonigro Giovanni
Published: February 2015

Introduction: We describe a rare tumor arising from the prostate gland: Perivascular Epithelioid Cells tumor (PEC-ome). A 54-years old was treated for acute urinary retention with alpha-blockers at presentation due to benign prostate enlargement (65 cc) with asymmetric middle lobe and regular PSA (0.92 ng/ml). After 5 months, patient developed a second acute urinary retention episode and nodules in the left lung; he was treated with transurethral resection of the prostate and left lobectomy. Results: Histological examination of prostate and lung tissue gave the same diagnosis: leiomyosarcoma with atypical morphological features and patient was observed for 4 months. Considering the uncommon diagnosis, pathological review by the uro-pathologist at our Hospital was done. Additional immunohistochemistry was done and both tumors showed similar and typical features of metastatic PEC-ome (T1b N0 M1). Therefore a new staging showed local and distant progression with prostatic mass and small lung metastasis. Three cycles of Gemcitabine and Pazopanib were administered, but 2 months later a new urinary retention occurred, despite chemotherapy. Patient referred to our Hospital for salvage pelvic surgery with lymph node dissection. Final pathological diagnosis was PECome of the prostate stage pT4 pN0 R0 M1. Conclusions: PEC-ome is a rare but rapidly invasive mesothelial tumor with early metastatic potential. When this tumors originates from the fibromuscular stroma of the prostate it mimics benign prostatic enlargement and causes LUTS. Expert pathology aided by immunoisthochemistry is the cornerstone of diagnosis. There are no pathognomonic imaging on ultrasound or symptoms suggesting the presence of PECome in early stage. A multidisciplinary approach is necessary and radical surgery should be done to treat this aggressive cancer.
Nutrient status and crop productivity following a 14-year irrigated potato rotation study
Authors: Mohr R. , Nelson A. , Tomasiewicz D. , McLaren D. , Monreal M. , Irvine B. , Khakbazan M. , Moulin A. , Derksen D. , Volkmar K.
Published: February 2015

Mohr, R., Nelson, A., Tomasiewicz, D., McLaren, D., Monreal, M., Irvine, B., Khakbazan, M., Moulin, A., Derksen, D. and Volkmar, K. 2015. Nutrient status and crop productivity following a 14-year irrigated potato rotation study. Can. J. Plant Sci. 95: 351–360. Well-managed crop rotations contribute to high productivity and quality in subsequent crops, and neither excessively deplete nor increase soil nutrient levels. A field experiment was conducted in the year following completion of a 14-yr irrigated potato (Solanum tuberosum L.) rotation study to assess the impact of preceding rotation on soil P, K and micronutrient concentrations, and on soybean (Glycine max) productivity, yield and seed nutrient levels. Soybean was grown on six established rotations [potato with canola (PC), wheat (PW), canola–wheat (PCW), oat-wheat (POW), wheat–canola–wheat (PWCW), and canola underseeded to alfalfa–alfalfa–alfalfa (PCAA)] arranged in a randomized complete block design (RCBD) with four replicates. Soil nutrient levels fell within ranges typical of the region, as did soybean yield and quality. Lower P and K concentrations in spring soil samples, and in soybean seeds, were typically associated with PCAA, suggesting that fertilizer additions did not account for high rates of P and K removal by alfalfa hay in this rotation. While preceding rotation had minimal effects on soil Cu and Zn, soybean established after PCAA or after potato contained comparatively higher seed Cu and Zn concentrations suggesting that including mycorrhizal crops such as potato and alfalfa in rotation may have contributed to enhanced micronutrient availability. Soybean yield was 4–6% higher following potato than canola or cereals, and 6% higher following POW than PCW. Seed protein increased and oil concentration decreased where preceding rotations included alfalfa. The limited yield differences observed may have been due, in part, to the selection of soybean as an indicator crop, which likely minimized differences among rotations arising from disease, weeds and nitrogen. These findings suggest that, with careful management of irrigated potato systems over the longer term, crop productivity and nutrient availability may be maintained within acceptable levels for agricultural production.
Evaluation of a PfHRP-2 Based Rapid Diagnostic Test Versus Microscopy Method Among HIV-Positive and Unknown Serology Patients in Ouagadougou, Burkina Faso
Authors: Andreoli Arianna , Giorgetti Pier Francesco , Pietra Virginio , Melzani Alessia , Seni Wetien , Castelli Francesco , Simpore Jaques
Published: February 2015

We evaluated the performance of a malaria rapid diagnostic test (RDT; Malaria Quick Test®; Cypress Diagnostic) compared with the standard thick-smear microscopy method using blood samples from human immunodeficiency virus (HIV)-infected individuals and individuals of unknown HIV status collected in Ouagadougou, Burkina Faso. Our results show that 42.1% of 114 HIV-infected patients were concordantly RDT- and thick smear-positive, and 55.3% were concordantly negative. Sensitivity and specificity of the RDT test were 100.0% and 95.4%, respectively, with 5.9% false-positive results and a total agreement of 97.4%; 127 patients with unknown HIV serology were analyzed; of them, 40.9% were RDT- and thick smear-positive, and 46.4% concordantly negative. Sensitivity and specificity were 100.0% and 78.6%, respectively, with 23.5% false-positive results and a total agreement of 87.4%. Malaria Quick Test® is rapid and effective for the diagnosis of malaria and has a high sensitivity, confirming its use in general and HIV patients in particular.
Undifferentiated Febrile Illness in Kathmandu, Nepal
Authors: Thompson Corinne N. , Blacksell Stuart D. , Paris Daniel H. , Arjyal Amit , Karkey Abhilasha , Dongol Sabina , Giri Abhishek , Dolecek Christiane , Day Nick , Baker Stephen , Thwaites Guy , Farrar Jeremy , Basnyat Buddha
Published: February 2015

Undifferentiated febrile illnesses (UFIs) are common in low- and middle-income countries. We prospectively investigated the causes of UFIs in 627 patients presenting to a tertiary referral hospital in Kathmandu, Nepal. Patients with microbiologically confirmed enteric fever (218 of 627; 34.8%) randomized to gatifloxacin or ofloxacin treatment were previously reported. We randomly selected 125 of 627 (20%) of these UFI patients, consisting of 96 of 409 (23%) cases with sterile blood cultures and 29 of 218 (13%) cases with enteric fever, for additional diagnostic investigations. We found serological evidence of acute murine typhus in 21 of 125 (17%) patients, with 12 of 21 (57%) patients polymerase chain reaction (PCR)-positive for Rickettsia typhi. Three UFI cases were quantitative PCR-positive for Rickettsia spp., two UFI cases were seropositive for Hantavirus, and one UFI case was seropositive for Q fever. Fever clearance time (FCT) for rickettsial infection was 44.5 hours (interquartile range = 26–66 hours), and there was no difference in FCT between ofloxacin or gatifloxacin. Murine typhus represents an important cause of predominantly urban UFIs in Nepal, and fluoroquinolones seem to be an effective empirical treatment.
Home Visits to Assess the Reliability of Caregiver-Reported Use of Insecticide-Treated Bednets by Children in Machinga District, Malawi
Authors: Wong Jacklyn , Shah Monica P. , Mwandama Dyson , Gimnig John E. , Lindblade Kim A. , Mathanga Don P.
Published: February 2015

A malaria cohort study was conducted among young children in Machinga District, Malawi, following distribution of insecticide-treated bednets (ITNs) in May 2012. To assess ITN use, two independently sampled subsets of children (211 during survey 1 [December 2012–January 2013] and 325 during survey 2 [September–October 2013]) were randomly selected to compare the proportions of positive and negative agreement between caregiver verbal reports at monthly interviews with visual observation of the ITN at home visits. Caregiver-reported ITN use was consistently high during both surveys (98.1% and 96.0%, respectively; P = 0.17). Home visit-based ITN use fell significantly (P < 0.001) from survey 1 (98.6%) to survey 2 (88.6%). The proportions of positive agreement between caregiver report and home visit in the first and second surveys were 98.8% (95% confidence interval [CI] 97.6–99.8%) and 93.3% (95% CI 91.2–95.3%), respectively. The proportions of negative agreement in the first and second surveys were 28.6% (95% CI 0–75.0%) and 20.0% (95% CI 0.1–35.0%), respectively. ITN use by children was high in Machinga District, and caregiver reports and home visits with visual confirmation of the net demonstrated a high level of agreement for use of ITNs, but a low level of agreement when ITNs were not used.
Real-Time Tissue Elastography in Gynecology and Obstetrics
Authors: Ryo Eiji
Published: February 2015

Reports on the use of elastography in gynecology and obstetrics remain scare, and most have used static sonoelastography. In gynecology, most studies are related to the field of oncology. In obstetrics, the primary research object has been to estimate cervical stiffness during pregnancy. The accuracy and reliability of the quantitative evaluation of cervical stiffness using elastography has not yet been established due to the lack of comparative reference materials. More studies are needed to determine the utility of the technique in these fields.

How to cite this article

Ryo E. Real-Time Tissue Elastography in Gynecology and Obstetrics. Donald School J Ultrasound Obstet Gynecol 2014;8(4):428-436.
HDlive Image of Fetal Endocardial Cushion Defect
Authors: Mashima Masato , Kawanishi Kunihiro
Published: February 2015

We present our first experience of constructing an image of a fetal endocardial cushion defect (ECD) employing HDlive at 21 weeks and 3 days of gestation. Conventional two-dimensional (2D) echocardiography showed an atrioventricular septal defect, bilateral ventricular hypertrophy and massive pericardial effusion. Two-dimensional color Doppler ultrasound revealed atrioventricular valve regurgitation in systole. HDlive clearly demonstrated a glossy atrial septal defect, common atrioventricular valve and bilateral ventricular hypertrophy. Moreover, free, floating leaflets of the common atrioventricular valve not attached to the interventricular septum were suspected using HDlive. These findings suggested complete ECD with congestive heart failure. HDlive provided us with a new, realistic, and arguably much improved view of the complexities and interrelationships of intracardiac structures in a case of fetal ECD. HDlive may assist in the evaluation of fetal EDC, and offer potential advantages relative to conventional 2D fetal echocardiography.

How to cite this article

AboEllail MAM, Hanaoka U, Mashima M, Kawanishi K, Hata T. HDlive Image of Fetal Endocardial Cushion Defect. Donald School J Ultrasound Obstet Gynecol 2014;8(4):437-439.
Term Pregnancy following Myomectomy for Leiomyomatosis
Authors: Achar Suganya , Ramarajan Arulmozhi
Published: February 2015

Uterine fibroids are common during reproductive age. These are found in up to 77% of women. They may be asymptomatic or may present with pain, menorrhagia, infertility or recurrent pregnancy loss. Symptomatic fibroids often mandate surgical management. These situations pose a challenge when encountered in women undergoing fertility treatment. Achieving a pregnancy following myomectomy depends on the size, number and proximity to the endometrium of the fibroids.

Here is the case of a 28-year-old lady, with multiple fibroids, who presented with severe dysmenorrhea and menorrhagia for many years and inability to conceive in 3 years after marriage. She underwent extensive myomectomy. The entire endometrial surface was studded with seedling fibroids, which were scooped out along with much of the endometrium. A diagnosis of uterine leiomyomatosis was made. Three months after surgery, an ultrasound scan of the pelvis showed a bulky uterus of normal contour, endometrial thickness of 7 mm, and multiple tiny fibroids. One year later, she presented with a viable pregnancy of 7 to 8 weeks. She delivered a healthy baby at term.

How to cite this article

Achar S, Ramarajan A. Term Pregnancy following Myomectomy for Leiomyomatosis. Int J Infertil Fetal Med 2014;5(3):107-109.
Successes and challenges of measuring and modeling atmospheric mercury at the part per quadrillion level: a critical review
Authors: Sexauer Gustin M. , Amos H. M. , Huang J. , Miller M. B. , Heidecorn K.
Published: February 2015

Abstract. Measurements of atmospheric mercury (Hg) are being increasingly incorporated into monitoring networks worldwide. These data are expected to support and inform regulatory decision making aimed at protecting human and wildlife health. Here we critically review current efforts to measure Hg concentrations in the atmosphere and interpret these data with Hg models. There are three operationally defined forms of atmospheric Hg: Gaseous Elemental (GEM), Gaseous Oxidized (GOM), and Particulate Bound (PBM). While there is relative confidence in GEM measurements, GOM and PBM are less well understood. Field and laboratory investigations suggest the methods to measure GOM and PBM are impacted by analytical interferences that vary with environmental setting (e.g., ozone, relative humidity) and GOM concentrations can be biased low by a factor of 1.6–12 times depending on the chemical compound. Importantly, efforts to understand the fundamental limitations of atmospheric Hg measurement methods have provided clear evidence that the composition of GOM (e.g., HgBr2, HgCl2, HgBrOH) varies across space and time. This has significant implications for refining existing measurement methods and developing new ones, model/measurement comparisons, model development, and assessing trends. In addition, unclear features of previously published data may now be re-examined and possibly explained, which we present as a case study. Lastly, we outline recommendations for needed research directions as the Hg field moves forward. Priorities include GOM and PBM calibration systems, identification of GOM compounds in ambient air, and identification of redox mechanisms and associated rate coefficients. Determination of a quantitative correction factor for biased GOM and PBM data is also needed to facilitate model-measurement comparisons.
Climate responses to anthropogenic emissions of short-lived climate pollutants
Authors: Baker L. H. , Collins W. J. , Olivié D. J. L. , Cherian R. , Hodnebrog Ø. , Myhre G. , Quaas J. , Samset B. H.
Published: February 2015

Abstract. Policies to control air quality focus on mitigating emissions of aerosols and their precursors, and other short-lived climate pollutants (SLCPs). On a local scale, these policies will have beneficial impacts on health and crop yields, by reducing particulate matter (PM) and surface ozone concentrations; however, the climate impacts of reducing emissions of SLCPs are less straightforward to predict. In this paper we consider a set of idealised, extreme mitigation strategies, in which the total anthropogenic emissions of individual SLCP emissions species are removed. This provides an upper bound on the potential climate impacts of such air quality strategies. We focus on evaluating the climate responses to changes in anthropogenic emissions of aerosol precursor species: black carbon (BC), organic carbon (OC) and sulphur dioxide (SO2). We perform climate integrations with four fully coupled atmosphere-ocean global climate models (AOGCMs), and examine the effects on global and regional climate of removing the total land-based anthropogenic emissions of each of the three aerosol precursor species. We find that the SO2 emissions reductions lead to the strongest response, with all three models showing an increase in surface temperature focussed in the northern hemisphere high latitudes, and a corresponding increase in global mean precipitation and run-off. Changes in precipitation and run-off patterns are driven mostly by a northward shift in the ITCZ, consistent with the hemispherically asymmetric warming pattern driven by the emissions changes. The BC and OC emissions reductions give a much weaker forcing signal, and there is some disagreement between models in the sign of the climate responses to these perturbations. These differences between models are due largely to natural variability in sea-ice extent, circulation patterns and cloud changes. This large natural variability component to the signal when the ocean circulation and sea-ice are free-running means that the BC and OC mitigation measures do not necessarily lead to a discernible climate response.
On the competition among aerosol number, size and composition in predicting CCN variability: a multi-annual field study in an urbanized desert
Authors: Crosbie E. , Youn J.-S. , Balch B. , Wonaschütz A. , Shingler T. , Wang Z. , Conant W. C. , Betterton E. A. , Sorooshian A.
Published: February 2015

Abstract. A two-year dataset of measured CCN concentrations at 0.2% supersaturation is combined with aerosol size distribution and aerosol chemistry data to probe the effects of aerosol number concentrations, size distribution and composition on CCN patterns. Data have been collected over a period of two years (2012–2014) in central Tucson, Arizona: a significant urban area surrounded by a sparsely populated desert. Average CCN concentrations are typically lowest in spring (233 cm−3), highest in winter (430 cm−3) and have a secondary peak during the North American Monsoon season (July to September; 372 cm−3). There is significant variability outside of seasonal patterns with extreme concentrations (1 and 99% levels) ranging from 56 to 1945 cm−3 as measured during the winter, the season with highest variability. Modeled CCN concentrations based on fixed chemical composition achieve better closure in winter, with size and number alone able to predict 82% of the variance in CCN concentration. Changes in aerosol chemistry are typically aligned with changes in size and aerosol number, such that composition can be parameterized even though it is still variable. In summer, models based on fixed chemical composition explain at best only 41% (pre-monsoon) and 36% (monsoon) of the variance. This is attributed to the effects of secondary organic aerosol (SOA) production, the competition between new particle formation and condensational growth, and the complex interaction of meteorology, regional and local emissions, and multi-phase chemistry during the North American Monsoon. Chemical composition is found to be an important factor for improving predictability in spring and on longer timescales in winter. Regimes where parameterized models exhibit improved predictive skill are typically explained by strong relationships between CCN concentrations and the prevailing meteorology and dominant aerosol chemistry mechanisms suggesting that similar findings could be possible in other locations with comparable climates and geography.
BINARY: an optical freezing array for assessing temperature and time dependence of heterogeneous ice nucleation
Authors: Budke C. , Koop T.
Published: February 2015

Abstract. A new optical freezing array for the study of heterogeneous ice nucleation in microliter-sized droplets is introduced, tested and applied to the study of immersion freezing in aqueous Snomax® suspensions. In the Bielefeld Ice Nucleation ARraY (BINARY) ice nucleation can be studied simultaneously in 36 droplets at temperatures down to −40 °C (233 K) and at cooling rates between 0.1 and 10 K min−1. The droplets are separated from each other in individual compartments, thus preventing a Wegener–Bergeron–Findeisen type water vapor transfer between droplets as well as avoiding the seeding of neighboring droplets by formation and surface growth of frost halos. Analysis of freezing and melting occurs via an automated real-time image analysis of the optical brightness of each individual droplet. As an application ice nucleation in water droplets containing Snomax® at concentrations from 1 ng mL−1 to 1 mg mL−1 was investigated. Using different cooling rates, a small time dependence of ice nucleation induced by two different classes of ice nucleators (INs) contained in Snomax® was detected and the corresponding heterogeneous ice nucleation rate coefficient was quantified. The observed time dependence is smaller than those of other types of INs reported in the literature, suggesting that the BINARY setup is suitable for quantifying time dependence for most other INs of atmospheric interest, making it a useful tool for future investigations.
Hygroscopic growth of atmospheric aerosol particles based on active remote sensing and radiosounding measurements: selected cases in southeastern Spain
Authors: Granados-Muñoz M. J. , Navas-Guzmán F. , Bravo-Aranda J. A. , Guerrero-Rascado J. L. , Lyamani H. , Valenzuela A. , Titos G. , Fernández-Gálvez J. , Alados-Arboledas L.
Published: February 2015

Abstract. A new methodology based on combining active and passive remote sensing and simultaneous and collocated radiosounding data to study the aerosol hygroscopic growth effects on the particle optical and microphysical properties is presented. The identification of hygroscopic growth situations combines the analysis of multispectral aerosol particle backscatter coefficient and particle linear depolarization ratio with thermodynamic profiling of the atmospheric column. We analyzed the hygroscopic growth effects on aerosol properties, namely the aerosol particle backscatter coefficient and the volume concentration profiles, using data gathered at Granada EARLINET station. Two study cases, corresponding to different aerosol loads and different aerosol types, are used for illustrating the potential of this methodology. Values of the aerosol particle backscatter coefficient enhancement factors range from 2.1 ± 0.8 to 3.9 ± 1.5, in the ranges of relative humidity 60–90 and 40–83%, being similar to those previously reported in the literature. Differences in the enhancement factor are directly linked to the composition of the atmospheric aerosol. The largest value of the aerosol particle backscatter coefficient enhancement factor corresponds to the presence of sulphate and marine particles that are more affected by hygroscopic growth. On the contrary, the lowest value of the enhancement factor corresponds to an aerosol mixture containing sulphates and slight traces of mineral dust. The Hänel parameterization is applied to these case studies, obtaining results within the range of values reported in previous studies, with values of the γ exponent of 0.56 ± 0.01 (for anthropogenic particles slightly influenced by mineral dust) and 1.07 ± 0.01 (for the situation dominated by anthropogenic particles), showing the convenience of this remote sensing approach for the study of hygroscopic effects of the atmospheric aerosol under ambient unperturbed conditions. For the first time, the retrieval of the volume concentration profiles for these cases using the Lidar Radiometer Inversion Code (LIRIC) allows us to analyze the aerosol hygroscopic growth effects on aerosol volume concentration, observing a stronger increase of the fine mode volume concentration with increasing relative humidity.
In-flight control and communication architecture of the GLORIA imaging limb-sounder on atmospheric research aircraft
Authors: Kretschmer E. , Bachner M. , Blank J. , Dapp R. , Ebersoldt A. , Friedl-Vallon F. , Guggenmoser T. , Gulde T. , Hartmann V. , Lutz R. , Maucher G. , Neubert T. , Oelhaf H. , Preusse P. , Schardt G. , Schmitt C. , Schönfeld A. , Tan V.
Published: February 2015

Abstract. The Gimballed Limb Observer for Radiance Imaging of the Atmosphere (GLORIA), a Fourier transform spectrometer based limb spectral imager, operates on high-altitude research aircraft to study the transit region between the troposphere and the stratosphere. It is one of the most sophisticated systems to be flown on research aircraft in Europe, requiring constant monitoring and human intervention in addition to an automation system. To ensure proper functionality and interoperability on multiple platforms, a flexible control and communication system was laid out. The architectures of the communication system as well as the protocols used are reviewed. The integration of this architecture in the automation process as well as the scientific campaign flight application context are discussed.
Simulated anthropogenic CO2 storage and acidification of the Mediterranean Sea
Authors: Palmiéri J. , Orr J. C. , Dutay J.-C. , Béranger K. , Schneider A. , Beuvier J. , Somot S.
Published: February 2015

Abstract. Constraints on the Mediterranean Sea's storage of anthropogenic CO2 are limited, coming only from data-based approaches that disagree by more than a factor of two. Here we simulate this marginal sea's anthropogenic carbon storage by applying a perturbation approach in a high-resolution regional model. Our model simulates that, between 1800 and 2001, basin-wide CO2 storage by the Mediterranean Sea has increased by 1.0 Pg C, a lower limit based on the model's weak deep-water ventilation, as revealed by evaluation with CFC-12. Furthermore, by testing a data-based approach (transit time distribution) in our model, comparing simulated anthropogenic CO2 to values computed from simulated CFC-12 and physical variables, we conclude that the associated basin-wide storage of 1.7 Pg, published previously, must be an upper bound. Out of the total simulated storage of 1.0 Pg C, 75% comes from the air–sea flux into the Mediterranean Sea and 25% comes from net transport from the Atlantic across the Strait of Gibraltar. Sensitivity tests indicate that the Mediterranean Sea's higher total alkalinity, relative to the global-ocean mean, enhances the Mediterranean's total inventory of anthropogenic carbon by 10%. Yet the corresponding average anthropogenic change in surface pH does not differ significantly from the global-ocean average, despite higher total alkalinity. In Mediterranean deep waters, the pH change is estimated to be between −0.005 and −0.06 pH units.
Microbial respiration per unit microbial biomass depends on litter layer carbon-to-nitrogen ratio
Authors: Spohn M.
Published: February 2015

Abstract. Soil microbial respiration is a central process in the terrestrial carbon (C) cycle. In this study, I tested the effect of the carbon-to-nitrogen (C:N) ratio of soil litter layers on microbial respiration in absolute terms and per unit microbial biomass C. For this purpose, a global data set on microbial respiration per unit microbial biomass C – termed the metabolic quotient (qCO2) – was compiled from literature data. It was found that qCO2 in the soil litter layers was positively correlated with the litter C:N ratio and was negatively correlated with the litter nitrogen (N) concentration. The positive relation between qCO2 and the litter C:N ratio resulted from an increase in respiration with the C:N ratio in combination with no significant effect of the litter C:N ratio on the soil microbial biomass C concentration. The results suggest that soil microorganisms respire more C both in absolute terms and per unit microbial biomass C when decomposing N-poor substrate. The reasons for the observed relationship between qCO2 and the litter layer C:N ratio could be microbial N mining, overflow respiration or the inhibition of oxidative enzymes at high N concentrations. In conclusion, the results show that qCO2 increases with the litter layer C:N ratio. Thus, the findings indicate that atmospheric N deposition, leading to decreased litter C:N ratios, might decrease microbial respiration in soils.
Photosynthetic production in the Central Arctic during the record sea-ice minimum in 2012
Authors: Fernández-Méndez M. , Katlein C. , Rabe B. , Nicolaus M. , Peeken I. , Bakker K. , Flores H. , Boetius A.
Published: February 2015

Abstract. The ice-covered Central Arctic Ocean is characterized by low primary productivity due to light and nutrient limitations. The recent reduction in ice cover has the potential to substantially increase phytoplankton primary production, but little is yet known about the fate of the ice-associated primary production and of the nutrient supply with increasing warming. This study presents results from the Central Arctic Ocean collected during summer 2012, when sea-ice reached a minimum extent since the onset of satellite observations. Net primary productivity (NPP) was measured in the water column, sea ice and melt ponds by 14CO2 uptake at different irradiances. Photosynthesis vs. irradiance (PI) curves were established in laboratory experiments and used to upscale measured NPP to the deep Eurasian Basin (north of 78° N) using the irradiance-based Central Arctic Ocean Primary Productivity (CAOPP) model. In addition, new annual production was calculated from the seasonal nutrient drawdown in the mixed layer since last winter. Results show that ice algae can contribute up to 60% to primary production in the Central Arctic at the end of the season. The ice-covered water column has lower NPP rates than open water due to light limitation. As indicated by the nutrient ratios in the euphotic zone, nitrate was limiting primary production in the deep Eurasian Basin close to the Laptev Sea area, while silicate was the main limiting nutrient at the ice margin near the Atlantic inflow. Although sea-ice cover was substantially reduced in 2012, total annual new production in the Eurasian Basin was 17 ± 7 Tg C yr-1, which is within the range of estimates of previous years. However, when adding the contribution by sub-ice algae, the annual production for the deep Eurasian Basin (north of 78° N) could double previous estimates for that area with a surplus of 16 Tg C yr-1. Our data suggest that sub-ice algae are an important component of the ice-covered Central Arctic productivity. It remains an important question if their contribution to productivity is on the rise with thinning ice, or if it will decline due to overall sea-ice retreat and be replaced by phytoplankton.