Decreased Bioenergetic Health Index in monocytes isolated from the pericardial fluid and blood of post-operative cardiac surgery patients

Monitoring the bioenergetics of leucocytes is now emerging as an important approach in translational research to detect mitochondrial dysfunction in blood or other patient samples. Using the mitochondrial stress test, which involves the sequential addition of mitochondrial inhibitors to adherent leucocytes, we have calculated a single value, the Bioenergetic Health Index (BHI), which represents the mitochondrial function in cells isolated from patients. In the present report, we assess the BHI of monocytes isolated from the post-operative blood and post-operative pericardial fluid (PO-PCF) from patients undergoing cardiac surgery. Analysis of the bioenergetics of monocytes isolated from patients’ PO-PCF revealed a profound decrease in mitochondrial function compared with monocytes isolated from their blood or from healthy controls. Further, patient blood monocytes showed no significant difference in the individual energetic parameters from the mitochondrial stress test but, when integrated into the BHI evaluation, there was a significant decrease in BHI compared with healthy control monocytes. These data support the utility of BHI measurements in integrating the individual parameters from the mitochondrial stress test into a single value. Supporting our previous finding that the PO-PCF is pro-oxidant, we found that exposure of rat cardiomyocytes to PO-PCF caused a significant loss of mitochondrial membrane potential and increased reactive oxygen species (ROS). These findings support the hypothesis that integrated measures of bioenergetic health could have prognostic and diagnostic value in translational bioenergetics.     

A novel in vivo Cerenkov luminescence image‐guided surgery on primary and metastatic colorectal cancer

Intraoperative Cerenkov luminescence imaging (CLI) can effectively improve the performance of tumor surgery. Nevertheless, the existing approaches are still unsatisfying to the clinical demands of open surgery. This study develops a novel intraoperative in vivo CLI approach to investigate the potential and value of Cerenkov luminescence (CL) image‐guided surgery. A system characterized with high sensitivity (19.61 kBq mL^{?1 18}F‐FDG) and desirable spatial resolution (88.34 μm) is developed. CL image‐guided surgery is performed on colorectal cancer (CRC) models of mice and swine. Tumor surgery is guided by the static CL images, and the resection quality is evaluated quantitatively and contrasted with other imaging modalities exemplified by bioluminescence imaging (BLI). The in vivo results demonstrated the effectiveness of the proposed intraoperative CLI approach for removing primary and metastatic CRC. Safety of performing in vivo CL image‐guided surgery is verified as well through radiation measurements of related staffs. Overall, the developed intraoperative in vivo CLI approach can efficiently improve the cancer treatment.     

Just When You Thought the Euthanasia Debate Had Died

The death by assisted suicide in Switzerland of Australian Dr. John Elliott, in early 2007 has highlighted the inadequacy of the law pertaining to medical decisions at end-of-life, both from a legal as well as ethical perspective. Despite being illegal in most jurisdictions around the world, physician-assisted death is a reality, in part because of the flexibility, inconsistent application and, at times, invisibility, of laws surrounding it. The appropriate response to this should be greater transparency by a reform of the law.     

An integrated haptic-enabled virtual reality system for orthognathic surgery planning

Conventional Orthognathic surgery (OGS) planning involves cephalometric analyses and dental casts to be mounted on an articulator. Dental segments are subsequently identified, cut and repositioned to allow the fabrication of intraoral wafers that guide the positioning of the osteotomy bone segments. This conventional planning introduces many inaccuracies that affect the post-surgery outcomes. Although computer technologies have advanced computational tools for OGS planning, they have failed in providing a practical solution. Many focuses only on some specific stages of the planning process, and their ability to transfer preoperative planning data to the operating room is limited. This paper proposes a new integrated haptic-enabled virtual reality (VR) system for OGS planning. The system incorporates CAD tools and haptics to facilitate a complete planning process and is able to automatically generate preoperative plans. A clinical pre-diagnosis is also provided automatically by the system based on the patient’s digital data. A functional evaluation based on a real patient case study demonstrates that the proposed virtual OGS planning method is feasible and more effective than the traditional approach at increasing the intuitiveness and reducing errors and planning times.     

Tumores hipofisarios no funcionantes: actualización 2012

Non-functioning pituitary adenomas are the most common pituitary macroadenomas in adults, accounting for approximately 14%-28% of all clinically relevant pituitary tumors. They are a heterogeneous group of tumors that cause symptoms by compression and/or hormone deficiencies. The possibility of tumor growth is increased in macroadenomas and solid tumors as compared to microadenomas and cystic tumors. Diagnosis is based on imaging procedures (magnetic resonance imaging), but there are studies reporting promising potential biomarkers. Transsphenoidal surgery remains the first therapeutic option for large tumors with compressive symptoms. There is no evidence that endoscopic procedures improve outcomes, but they decrease morbidity. There is no unanimity in finding prognostic predictors of recurrence. Radiosurgery achieves tumor control and, sometimes, adenoma size reduction. Its adverse effects increase with higher doses and tumor sizes > 4 cm³. Drug treatment is of little value. In aggressive non-functioning tumors, temozolomide (TMZ) may be used with caution because no controlled studies are available. TMZ achieves tumor control in 38%-40% of aggressive non-functioning tumors. The optimal treatment regimen and duration have not been defined yet. Lack of response to TMZ after 3 cycles predicts for treatment resistance, but initial response does not ensure optimal mid or long–term results. O6-methylguanine-DNA methyltransferase expression has a limited predictive value of response to treatment with TMZ in aggressive non-functioning tumors. It should therefore not be a determinant factor in selection of patients to be treated with TMZ.