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This report details a method of percutaneous, transluminal retrieval of an intracardiac foreign body using fluoroscopy in combination with intracardiac echocardiography. During retrieval, intracardiac echocardiography (ICE) provided real-time anatomic localization of a constantly moving, almost radiolucent micropuncture coaxial dilator fragment with respect to the tricuspid and pulmonary valves. This method may serve as a crucial aid in retrieval of intracardiac foreign bodies that are difficult to see with fluoroscopy and which may be adjacent to cardiac valves.

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PURPOSE: Advances in medical imaging have been associated with increased utilization and increased radiation exposure, especially for patients with chronic and recurrent conditions. The authors estimated the cumulative radiation doses from medical imaging for specific cohorts with chronic and recurrent conditions. METHODS: All patients diagnosed with hydrocephalus (n = 1,711), pulmonary thromboembolic disease (n = 3,220), renal colic (n = 5,855), and cardiac disease (n = 11,072) from January 1, 2000, to December 31, 2005, were retrospectively identified. Each imaging examination that used ionizing radiation from 2000 to 2008 was incorporated into an estimate of total effective dose and organ-specific doses. Patients with high levels of radiation exposure after 3 years (total effective dose > 50 mSv; dose to the ocular lens > 150 mSv) were identified. RESULTS: The mean estimated effective doses for the surviving diagnostic cohorts after 3 years were 12.3 mSv for patients with hydrocephalus, 21.7 mSv for those with pulmonary thromboembolic disease, 18.7 mSv for those with renal colic, and 14.0 mSv for those with cardiac disease. Among patients with hydrocephalus, 26.3% (339 of 1,291) had radiation doses > 150 mSv to the ocular lens within 3 years. In all cohorts, the proportion of patients with total effective doses > 50 mSv within 3 years was significantly higher for those diagnosed in 2004 and 2005 than for those diagnosed in 2000 and 2001. CONCLUSION: Patients with hydrocephalus, pulmonary thromboembolic disease, renal colic, and cardiac disease received radiation exposures that may put them at increased risk for cancer. Moreover, the proportion who received estimated total effective doses > 50 mSv within 3 years was significantly higher for those diagnosed most recently. It is the responsibility of institutions and physicians to critically evaluate their infrastructures, diagnostic strategies, and imaging techniques for each individual patient, with an eye toward minimizing cumulative medical radiation exposure.

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Proteomics and chemical genomics face great challenges in the form of molecular libraries of ever increasing size and diversity requiring rapid screening, coupled with a growing number of target proteins for which complimentary molecular ligands are sought. Proteomics and chemical genomics are at a stage that requires techniques which can dramatically accelerate the discovery process. One technique that has shown great promise in accomplishing this is the tagged library approach. It entails the synthetic inclusion of an internal tag from the beginning of the synthesis. This tag adds another degree of functionality to the molecule, in addition to mere ligation, that eliminates the need for time-consuming steps downstream in the process. The tag's functional possibilities span a variety of uses including internal fluorophores, intrinsic binding motifs that enable compound identification, functionalities that play the major role in the synthesis of the ligand itself, and internal linkers that eliminate the need for lengthy 'tether effect' structure-activity relationship studies.

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