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1.  Uniportal VATS: the first German experience 
Journal of Thoracic Disease  2014;6(Suppl 6):S650-S655.
The acceptance of uniportal video-assisted thoracic surgery (VATS) for minor and major thoracic procedures is growing in Europe. This study presents the first experience with uniportal VATS in Germany.
In a retrospective study of prospectively collected data, 56 uniportal VATS were analyzed between 06/2012 and 06/2014. The technique was used for diagnostic aims, pleurectomies, wedge resections, segmentectomies and major resections. All procedures were performed without rib spreading. Patients’ demographic data, preoperative and postoperative management as well as results were analyzed.
A total of 42 patients (75%) were males. The mean age was 59.2±15 years. The uniportal VATS procedures included one or multiple wedge resections in 30 cases (53.6%), major resections in 9 cases (16.1%), anatomical segment resections in 6 cases (10.7%) and other indications in 11 cases (19.6%). The median operation time was 252, 114, 88 and 73 minutes for major resections, anatomical segment resections, wedge resections and other indications, respectively. There were three conversions in two cases of major resections and in one anatomical segmentectomy. The mean chest tube duration was 3.4±2.1 days. The mean hospital stay was 8.3±5.3 days for the whole group.
Uniportal VATS is a feasible and safe technique for various indications in thoracic surgery. The perioperative results are promising. It can be performed by thoracic surgeons experienced in the postero-lateral thoracotomy approach.
PMCID: PMC4221335  PMID: 25379205
Video-assisted thoracic surgery (VATS); uniportal VATS; single-port thoracic surgery; minimally invasive thoracic surgery
2.  Multi-series DICOM: an Extension of DICOM That Stores a Whole Study in a Single Object 
Journal of Digital Imaging  2013;26(4):691-697.
Today, most medical images are stored as a set of single-frame composite Digital Imaging and Communications in Medicine (DICOM) objects that contain the four levels of the DICOM information model—patient, study, series, and instance. Although DICOM addresses most of the issues related to medical image archiving, it has some limitations. Replicating the header information with each DICOM object increases the study size and the parsing overhead. Multi-frame DICOM (MFD) was developed to address this, among other issues. The MFD combines all DICOM objects belonging to a series into a single DICOM object. Hence, the series-level attributes are normalized, and the amount of header data repetition is reduced. In this paper, multi-series DICOM (MSD) is introduced as a potential extension to the DICOM standard that allows faster parsing, transmission, and storage of studies. MSD extends the MFD de-duplication of series-level attributes to study-level attributes. A single DICOM object that stores the whole study is proposed. An efficient algorithm, called the one-pass de-duplication algorithm, was developed to find and eliminate the replicated data elements within the study. A group of experiments were done that evaluate MSD and the one-pass de-duplication algorithm performance. The experiments show that MSD significantly reduces the amount of data repetition and decreases the time required to read and parse DICOM studies. MSD is one possible solution that addresses the DICOM limitations regarding header information repetition.
PMCID: PMC3705029  PMID: 23404629
DICOM; Algorithms; Imaging informatics; Image data; Multi-frame DICOM; Multi-series DICOM
3.  Increased Protein-Coding Mutations in the Mitochondrial Genome of African American Women With Preeclampsia 
Reproductive Sciences  2012;19(12):1343-1351.
Preeclampsia occurs more frequently in women of African ancestry. The cause of this hypertensive complication is unclear, but placental oxidative stress may play a role. Because mitochondria are the major sites of oxidative phosphorylation, we hypothesized that placentas of preeclamptic pregnancies harbor mitochondrial DNA (mtDNA) mutations. Next-generation sequencing of placental mtDNA in African American preeclamptics (N = 30) and controls (N = 38) from Chicago revealed significant excesses in preeclamptics of nonsynonymous substitutions in protein-coding genes and mitochondrially encoded nicotinamide adenine dinucleotide dehydrogenase 5 gene and an increase in the substitution rate (P = .0001). Moreover, 88% of preeclamptics and 53% of controls carried at least one nonsynonymous substitution (P = .005; odds ratio [OR] = 6.36, 95% confidence interval [CI]: 1.5-39.1). These results were not replicated in a sample of African American preeclamptics (N = 162) and controls (N = 171) from Detroit. Differences in study design and heterogeneity may account for this lack of replication. Nonsynonymous substitutions in mtDNA may be risk factors for preeclampsia in some African American women, but additional studies are required to establish this relationship.
PMCID: PMC4046444  PMID: 22902742
preeclampsia; mtDNA; African American women; oxidative phosphorylation
4.  Response of Different Antibiotic Resistant Group of Streptococcus pyogenes to Environmental Stresses 
Indian Journal of Microbiology  2012;52(3):354-359.
Streptococcus species is considered as an important pathogen for human and animals. The antibiotic resistance mechanism in this species is continuously increased. On the other side, the tolerance of environmental stresses play an effective role in the severity of many streptococcal causative disease. In this study we assayed survey on the causative agents of pharyngitis and tonsillitis patients. The predominant causative strain was Streptococcus pyogenes with 93 % isolating ratio frequency. The other pathogenic species were S. agalactia 5.3 % and S. pneumonia 1.7 %. According to the antibiotic resistant test the S. pyogenes isolates were classified into six different groups. A selected strain from each antibiotic resistant group was tested for tolerance of a restrictive environmental factors. The variations of the environmental niches of isolates were in consistence with their antibiotic resistant variation.
PMCID: PMC3460109  PMID: 23997324
Streptococcus pyogenes; Antibiotic resistant; Environmental stresses
5.  Sleep Disturbances and Their Relationship to Glucose Tolerance in Pregnancy 
Diabetes Care  2011;34(11):2454-2457.
To explore relationships among sleep disturbances, glucose tolerance, and pregnancy outcomes.
Four validated sleep questionnaires were administered to 169 pregnant women at the time of 50-g oral glucose tolerance testing (OGTT) during the second trimester. Pregnancy outcomes were analyzed in 108 women with normal glucose tolerance (NGT).
Of the participants, 41% had excessive daytime sleepiness (Epworth Sleepiness Scale [ESS] >8); 64% had poor sleep quality; 25% snored frequently; 29% had increased risk of sleep-disordered breathing (SDB); 52% experienced short sleep (SS); 19% had both increased SDB risk and SS (SDB/SS); and 14% had daytime dysfunction. Reported sleep duration inversely correlated with glucose values from 50-g OGTT (r = −0.21, P < 0.01). Each hour of reduced sleep time was associated with a 4% increase in glucose levels. Increased likelihood of gestational diabetes mellitus (GDM) was found in subjects with increased SDB risk (odds ratio 3.0 [95% CI 1.2–7.4]), SS (2.4 [1.0–5.9]), SDB/SS (3.4 [1.3–8.7]), and frequent snoring (3.4 [1.3–8.8], after adjustment for BMI). Among NGT subjects, preterm delivery was more frequent in those with increased ESS (P = 0.02), poor sleep quality (P = 0.02), and SS (P = 0.03). Neonatal intensive care unit admissions were associated with increased ESS (P = 0.03), SDB/SS (P = 0.03), and daytime dysfunction (P < 0.01) in mothers.
Pregnant women experience significant sleep disturbances that are associated with increased risk of GDM and unfavorable pregnancy outcomes. Pregnant women with increased SDB risk, frequent snoring, and sleep duration of <7 h/night have increased risk of developing GDM.
PMCID: PMC3198297  PMID: 21926292
6.  Phylogeography and Evolutionary History of Reassortant H9N2 Viruses with Potential Human Health Implications ▿ †  
Journal of Virology  2011;85(16):8413-8421.
Avian influenza viruses of the H9N2 subtype have seriously affected the poultry industry of the Far and Middle East since the mid-1990s and are considered one of the most likely candidates to cause a new influenza pandemic in humans. To understand the genesis and epidemiology of these viruses, we investigated the spatial and evolutionary dynamics of complete genome sequences of H9N2 viruses circulating in nine Middle Eastern and Central Asian countries from 1998 to 2010. We identified four distinct and cocirculating groups (A, B, C, and D), each of which has undergone widespread inter- and intrasubtype reassortments, leading to the generation of viruses with unknown biological properties. Our analysis also suggested that eastern Asia served as the major source for H9N2 gene segments in the Middle East and Central Asia and that in this geographic region within-country evolution played a more important role in shaping viral genetic diversity than migration between countries. The genetic variability identified among the H9N2 viruses was associated with specific amino acid substitutions that are believed to result in increased transmissibility in mammals, as well as resistance to antiviral drugs. Our study highlights the need to constantly monitor the evolution of H9N2 viruses in poultry to better understand the potential risk to human health posed by these viruses.
PMCID: PMC3147996  PMID: 21680519
7.  Cardiotoxicity of Freon among refrigeration services workers: comparative cross-sectional study 
Environmental Health  2009;8:31.
Freon includes a number of gaseous, colorless chlorofluorocarbons. Although freon is generally considered to be a fluorocarbon of relatively low toxicity; significantly detrimental effects may occur upon over exposure. The purpose of the present study is to investigate whether occupational exposure to fluorocarbons can induce arterial hypertension, myocardial ischemia, cardiac arrhythmias, elevated levels of plasma lipids and renal dysfunction.
This comparative cross-sectional study was conducted at the cardiology clinic of the Suez Canal Authority Hospital (Egypt). The study included 23 apparently healthy male workers at the refrigeration services workshop who were exposed to fluorocarbons (FC 12 and FC 22) and 23 likewise apparently healthy male workers (unexposed), the control group. All the participants were interviewed using a pre-composed questionnaire and were subjected to a clinical examination and relevant laboratory investigations.
There were no significant statistical differences between the groups studied regarding symptoms suggesting arterial hypertension and renal affection, although a significantly higher percentage of the studied refrigeration services workers had symptoms of arrhythmias. None of the workers had symptoms suggesting coronary artery disease. Clinical examination revealed that the refrigeration services workers had a significantly higher mean pulse rate compared to the controls, though no significant statistical differences were found in arterial blood pressure measurements between the two study groups. Exercise stress testing of the workers studied revealed normal heart reaction to the increased need for oxygen, while sinus tachycardia was detected in all the participants. The results of Holter monitoring revealed significant differences within subject and group regarding the number of abnormal beats detected throughout the day of monitoring (p < 0.001). There were no significant differences detected in the average heart rate during the monitoring period within subject or group. Most laboratory investigations revealed absence of significant statistical differences for lipid profile markers, serum electrolyte levels and glomerular lesion markers between the groups except for cholesterol and urinary β2-microglobulin (tubular lesion markers) levels which were significantly elevated in freon exposed workers.
Unprotected occupational exposure to chlorofluorocarbons can induce cardiotoxicity in the form of cardiac arrhythmias. The role of chlorofluorocarbons in inducing arterial hypertension and coronary artery diseases is unclear, although significantly elevated serum cholesterol and urinary β2-microglobulin levels raise a concern.
PMCID: PMC2722587  PMID: 19594908
8.  Co-circulation of two sublineages of HPAI H5N1 virus in the Kingdom of Saudi Arabia with unique molecular signatures suggesting separate introductions into the commercial poultry and falconry sectors 
The Journal of General Virology  2008;89(Pt 11):2691-2697.
Since early 2007, the Kingdom of Saudi Arabia (KSA) has experienced several highly pathogenic avian influenza (HPAI) H5N1 outbreaks in the falconry and poultry sectors. The public health threat associated with peculiar husbandry systems, requiring close contact between humans and birds of prey, highlights the need of an improved understanding of the epidemiology and of the viral characteristics of H5N1 viruses circulating in the region. Here we report molecular and phylogenetic analyses of H5N1 viruses isolated in the KSA in 2007 in distinct compartments of avian husbandry. From the results of our investigation it appears that two separate introductions into the different sectors occurred. The identification of specific amino acid mutations, which are described as genetic signatures of human influenza A viruses or known to confer resistance to antiviral drugs, raises concerns for the possible human health implications of the KSA H5N1 viruses.
PMCID: PMC2886959  PMID: 18931064
9.  Blastomyces Antigen Detection for Monitoring Progression of Blastomycosis in a Pregnant Adolescent 
Although disseminated blastomycosis is a rare complication in pregnancy, delay in diagnosis and treatment can be fatal. We investigate the use of the Blastomyces urine antigen in diagnosis following disease progression in the intrapartum, postpartum, and neonatal periods. We describe a case of disseminated blastomycosis in a pregnant adolescent and review the pertinent literature regarding treatment and monitoring blastomycosis in pregnancy and the neonatal periods. This is the first reported case in which the Blastomyces urine antigen is utilized as a method of following disease activity during pregnancy confirming absence of clinically evident disease in a neonate. Urine antigen detection for blastomycosis can be useful for following progression of disease in patients with disseminated blastomycosis in both the intrapartum and postpartum periods.
PMCID: PMC1906866  PMID: 17641724
10.  Ertapenem Once a Day Versus Piperacillin–Tazobactam Every 6 Hours for Treatment of Acute Pelvic Infections: A Prospective, Multicenter, Randomized, Double-Blind Study 
Objective: To compare ertapenem therapy with piperacillin–tazobactam therapy for the management of acute pelvic infections.
Methods: In a multicenter, double-blind study, 412 women with acute pelvic infection were assigned to one of two strata, namely obstetric/postpartum infection or gynecologic/postoperative infection, and were then randomized to ertapenem, 1 g once a day, or piperacillin–tazobactam, 3.375 g every 6 hours, both administered intravenously.
Results: In total, 163 patients in the ertapenem group and 153 patients in the piperacillin–tazobactam group were clinically evaluable. The median duration of therapy was 4.0 days in both treatment groups. The most common single pathogen was Escherichia coli . At the primary efficacy endpoint 2–4 weeks post therapy, 93.9% of patients who received ertapenem and 91.5% of those who received piperacillin–tazobactam were cured (95% confidence interval for the difference, adjusting for strata, –4% to 8.8%), indicating that cure rates for both treatment groups were equivalent. Cure rates for both treatment groups were also similar when compared by stratum and severity of infection. The frequency and severity of drug-related adverse events were generally similar in both groups.
Conclusions: In this study, ertapenem was as effective as piperacillin–tazobactam for the treatment of acute pelvic infection, was generally well tolerated, and had an overall safety profile similar to that of piperacillin–tazobactam.
PMCID: PMC1852268  PMID: 12839630

Results 1-10 (10)