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John Longo,1 Stephen Lutz,2 Candice Johnstone1 1Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA; 2Department of Radiation Oncology, Blanchard Valley Regional Cancer Center, Findlay, OH, USA Abstract: Bone metastases are prevalent among cancer patients and frequently cause significant morbidity. Oncology providers must mitigate complications associated with bone metastases while limiting therapy-related adverse effects and their impact on quality of life. Multiple treatment modalities, including chemotherapy, surgery, external beam radiation therapy, and radioisotopes, among others, have been recommended and utilized for palliative treatment of bone metastases. Radioisotopes such as samarium-153 are commonly used in the setting of multifocal bone metastases due to their systemic distribution, affinity for osteoblastic lesions, acceptable toxicity profile, and convenience of administration. This review focuses on samarium-153, first defining its radiobiologic and pharmacokinetic properties before describing many clinical trials that support its use as a safe and effective tool in the palliation of patients with bone metastases. Keywords: bone metastases, pain, radiopharmaceuticals, pain flare

Phase-averaged organized oscillation velocities (U,V,W) and random fluctuation Reynolds stresses ([bar.uu],[bar.vv],[bar.ww],[bar.uv],[bar.uw] are presented for the nominal wake of a surface ship advancing in regular head (incident) waves, but restrained from body motions, i.e., the forward-speed diffraction problem. A 3.048 x 3.048 x 100 m towing tank, plunger wave maker, and towed, 2D particle-image velocimetry (PIV) and servo mechanism waveprobe measurement systems are used. The geometry is DTMB model 5415 (L=3.048 m, 1/46.6 scale), which is an international benchmark for ship hvdrodynamics. The conditions are Froude number Fr=0.28. wave steepness Ak=0.025, wavelength [lambda]/L= 1.5, wave frequency f=0.584 Hz, and encounter frequency [f.sub.e]=0.922 Hz. Innovative data acquisition, reduction, and uncertainty analysis procedures are developed for the phase-averaged PIV. The unsteady nominal wake is explained by interactions between the hull boundary layer and axial vortices and incident wave. There are three primary wave-induced effects: pressure gradients 4% [U.sub.c], orbital velocity transport 15% [U.sub.c], and unsteady sonar dome lifting wake. In the outer region, the uniform flow, incident wave velocities are recovered within the experimental uncertainties. In the inner, viscous-flow region, the boundary layer undergoes significant time-varying upward contraction and downward expansion in phase with the incident wave crests and troughs, respectively. The zeroth harmonic exceeds the steady-flow amplitudes by 5-20% and 70% for the velocities and Reynolds stresses, respectively. The first-harmonic amplitudes are large and in phase with the incident wave in the bulge region (axial velocity), damped by the hull and boundary layer and mostly in phase with the incident wave (vertical velocity), and small except near the free surface-hull shoulder (transverse velocity). Reynolds stress amplitudes are an order-of-magnitude smaller than for the velocity components showing large values in the thin boundary layer and bulge regions and mostly in phase with the incident wave. [DOI: 10.1115/1.2717618]

A statistical approach for estimating intervals of certification or biases of facilities or measurement systems including uncertainties is set forth based on M x N-order level testing, which is defined as M repetitions of the same N-order level experiment in M different facilities or in the same facility with M different measurement systems. In the absence of reference values, the mean facility or measurement system is used for assessing intervals of certification or biases. Certification or biases of facilities or measurement systems are defined as processes for assessing probabilistic confidence intervals for facilities or measurement systems for specific tests, data reduction equations, conditions, procedures, and uncertainty analysis. Similarly, subgroup analysis is performed for isolating and assessing levels of differences due to use of different model sizes (scale effects) or measurement systems. An example is provided for towing tank facilities for resistance tests using standard uncertainty analysis procedures based on an international collaboration between three facilities. Although the number of facilities are at a minimum, the results demonstrate the usefulness of an approach and support recommendation of future collaborations between more facilities. Knowledge of intervals of certification or biases is important for design, accrediting facilities or measurement systems, and CFD validation.

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Little is known about the mechanisms and relevance of cognitive dysfunction in systemic lupus erythematosus (SLE) patients who never displayed major neuropsychiatric manifestations (nSLE). Thirty-one nSLE female patients and 31 cognitively healthy control women were recruited. Sociodemographic, clinical, neuropsychological and SLE-related markers were collected including cerebral perfusion by single-photon emission computed tomography. Prevalences of cognitive complaints were 22.6% in nSLE versus 6.5% in the control group (p = 0.147); respective prevalences of cognitive dysfunction were 32.3 versus 6.5% (p = 0.01). Within the nSLE group, all cognitive domains appeared similarly affected, and correlations were found between cognitive dysfunction and less skilled occupation (r = –0.41, p = 0.02) and between cognitive complaints and depressive symptoms (r = 0.35, p = 0.05). Cognitive dysfunction is rather frequent in nSLE and seems to negatively impinge on social functioning. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: To examine genetic association between rheumatoid arthritis (RA) and known polymorphisms in core genes of the nuclear factor (NF)kappaB pathway, the major intracellular pathway in RA pathogenesis.Methods: Discovery and replication sample sets of Spanish patients with RA and controls were studied. A total of 181 single nucleotide polymorphisms (SNPs) uniformly spaced along the genomic sequences of 17 core genes of the NFkappaB pathway (REL, RELA, RELB, NFKB1, NFKB2, NFKBIA, NFKBIB, NFKBIE, IKBKA, IKBKB, IKBKE, IKBKAP, KBRAS1, KBRAS2, MAP3K1, MAP3K14, TAX1BP1) were studied by mass spectrometry analysis complemented with 5'-nuclease fluorescence assays in the discovery set, 458 patients with RA and 657 controls. SNPs showing nominal significant differences were further investigated in the replication set of 1189 patients with RA and 1092 controls.Results: No clear reproducible association was found, although 12 SNPs in IKBKB, IKBKE and REL genes showed significant association in the discovery set. Interestingly, two of the SNPs in the IKBKE gene, weakly associated in the discovery phase, showed a trend to significant association in the replication phase. Pooling both sample sets together, the association with these two SNPs was significant.Conclusion: We did not find any major effect among the explored members of the NFkappaB pathway in RA susceptibility. However, it is possible that variation in the IKBKE gene could have a small effect that requires replication in additional studies. [ABSTRACT FROM AUTHOR]

With growing concern about staff recruitment and retention, nurse leaders are challenged to create work cultures that promote professional empowerment, [ABSTRACT FROM AUTHOR]

The development of modern spacecrafts (launch and re-entry vehicles), either fully reusable or partly reusable needs powerful tools for the design of the aerodynamic shape with a guarantee for reliable flight and controllability along the complete ascent and descent trajectories. Experimental and numerical tools are available these days and for improving the reliability of vehicle design their capability has to be improved step by step. In the frame of the German TETRA Program very detailed technology work was carried out to reach this goal. The growth of the efficiency of these methods is demonstrated by some specific aerothermodynamic problems which are reported in this paper. [Copyright &y& Elsevier]

Purpose: To analyze the results obtained with percutaneous therapeutic procedures in patients with Budd-Chiari syndrome (BCHS).Methods: Between August 1991 and April 1993, seven patients with BCHS were treated in our hospital. Three presented with a congenital web; in another three cases the hepatic veins and/or the inferior vena cava (IVC) were compromised after major hepatic surgery; one patient presented with a severe stenosis of the intrahepatic IVC due to hepatomegaly.Results: One of the patients with congenital web has required several new dilatations due to restenosis; one patient required a transjugular intrahepatic portosystemic shunt procedure while awaiting a liver transplantation. The two postsurgical patients with stenosed hepatic veins did not require any new procedure after the placement of metallic endoprostheses. However, the patient with liver transplantation presented IVC restenosis after balloon angioplasty that required the deployment of metallic endoprostheses. In the patient with hepatomegaly a self-expandable prosthesis was placed in the intrahepatic portion of the IVC before (4 months) a liver transplantation.Conclusion: Interventional therapeutic techniques offer a wide variety of possibilities for the treatment of patients with BCHS. For IVC stenoses, the results obtained with balloon angioplasty are at least as good as those obtained with surgery. [ABSTRACT FROM AUTHOR]

Percutaneous embolization of large portosystemic collaterals was performed in three patients following placement of a transjugular intrahepatic portosystemic shunt in order to improve hepatopetal portal flow. Improved hepatic portal perfusion was achieved in these cases, thereby theoretically reducing the risk of chronic hepatic encephalopathy. [ABSTRACT FROM AUTHOR]

A case of an infected pseudocyst in the head of the pancreas is presented. Due to its small size and fistulization to the duodenum, a drainage catheter was placed through the fistulous tract from a distant transgastric approach. The fistula was balloon dilated to improve its emptying. Sixteen months later the patient remains asymptomatic with no recurrence of the pseudocyst. [ABSTRACT FROM AUTHOR]

Percutaneous transhepatic treatment of portal vein thrombosis after liver transplantation in a patient with a preexisting high volume spontaneous splenorenal shunt is presented. Local thrombolysis with urokinase and balloon angioplasty of the main portal vein stenosis were performed followed by shunt embolization to restore hepatopetal portal blood flow. [ABSTRACT FROM AUTHOR]

Posttransplant lymphoproliferative disorders are infrequent tumors related to chronic immunosuppressive therapy. We present a liver transplant recipient who developed such a tumor in the porta hepatis that provoked obstruction of the entire portal triad. Treatment consisted of systemic chemotherapy, percutaneous dilatation, and placement of Wallstent endoprostheses across both biliary and portal vein stenoses. The patient died 3 weeks later of pneumonia and sepsis. At necropsy, the tumor was completely necrosed and the prostheses in both the common bile duct and the portal vein were patent. [ABSTRACT FROM AUTHOR]

Portal vein (PV) thrombosis increases the risk of variceal bleeding in cirrhotic patients with portal hypertension. Its presence also complicates PV access during transjugular porto-caval shunt (TIPS) placement. We overcame this obstacle by using ultrasound (US) guidance for PV entry. Clot disruption by balloon catheters was then performed before placing the vascular endoprostheses for portal-venous shunting. We treated 3 cirrhotic patients in such fashion with good clinical results. Portal thrombi progressively disappeared after shunting due to both balloon disruption and the rise in portal blood flow velocity. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to assess the efficacy of transjugular intrahepatic portosystemic shunts (TIPS) in 45 patients with cirrhosis during a mean follow-up of 7 months.Methods: Forty-five consecutive patients treated by TIPS and who had been followed for at least 6 months after TIPS or until death, were included. Mean follow-up was 7.2 +/- 5.0 months. Shunt patency was assessed at 1 week and 1 month, then every 3 months after the procedure by Doppler US and angiography whenever needed.Results: Thirty-six patients had been stented for refractory bleeding from ruptured esophagogastric varices. Of these, 8 patients (22%) rebled, 7 of whom were treated by a second shunt. Nine patients were treated for refractory ascites. Three patients had recurrent ascites due to shunt obstruction. All were treated by a second shunt which occluded in 2 patients. As a whole, 14 (31.1%) patients developed shunt obstruction within a mean of 120 +/- 136 days, 4 of whom remained asymptomatic. Other complications were septicemia by Staphylococcus aureus in 1 patient, transient encephalopathy in 9 patients, and disseminated intravascular coagulation in 1 patient.Conclusions: TIPS appears to be a relatively safe and effective technique in treating complications of portal hypertension in patients with cirrhosis. Shunt obstruction in 31% of our patients probably represents the most important limitation of this technique. [ABSTRACT FROM AUTHOR]

A prototype three-axis magnetometer has been developed, intended for geophysical applications, involving high-transition temperature dc superconducting quantum interference devices (SQUIDs). Each SQUID was fabricated from a thin film of YBa[sub 2]Cu[sub 3]O[sub 7-x] deposited on a SrTiO[sub 3] bicrystal to form two Josephson junctions, and was directly coupled to a single-turn pickup loop patterned in the same film. The three orthogonally mounted sensors were immersed in liquid nitrogen in a fiberglass Dewar and operated in separate flux-locked loops. In nominally zero ambient magnetic field, the best magnetic field resolution was 170 fT Hz[sup -½] in the white noise, increasing to 225 fT Hz[sup -½] at 1 Hz. The dynamic range was ±1.6 × 10[sup 6] Hz[sup ½] in the white noise, and the highest slew rate achieved was 1.6 mT s[sup -1], at 900 Hz. The 3 dB point in the frequency response was about 90 kHz. The three channels were mutually orthogonal to about 1%. The three-axis magnetometer was also operated outside the laboratory in the presence of 60 Hz and radio-frequency noise. [ABSTRACT FROM AUTHOR]

High quality InAsSbP quaternary layers, which are lattice matched to InAs, have been grown successfully on InAs substrates by liquid phase epitaxy. Both Graded and constant composition InAsSbP layers have been grown. In addition, the graded InAsSbP layer has been used as a buffer layer for the growth of InAsSb on an InAs substrate. [ABSTRACT FROM AUTHOR]