Background and Aims Evaluation of indeterminate biliary strictures by brush cytology and intraductal biopsies is limited by low sensitivity. The utility of SpyGlass peroral cholangioscopy for ...diagnosis of malignant biliary strictures and cholangiocarcinoma (CCA), in particular, remains unclear. Our aim was to study the utility of SpyGlass peroral cholangioscopy and targeted biopsy for diagnosis of malignant biliary strictures and CCA. Methods In this systematic review, PubMed and Embase databases were reviewed for studies published to October 2014. The main outcomes of interest were sensitivity, specificity, and diagnostic odds ratio (DOR) of SpyGlass cholangioscopy in the diagnosis of malignant biliary strictures. Results The search yielded 10 studies involving 456 patients. The pooled sensitivity and specificity of cholangioscopy-guided biopsies in the diagnosis of malignant biliary strictures was 60.1% (95% confidence interval CI, 54.9%-65.2%) and 98.0% (95% CI, 96.0%-99.0%), respectively. The pooled DOR to detect malignant biliary strictures was 66.4 (95% CI, 32.1-137.5). Four studies included patients who had previous negative imaging and brushings and/or intraductal biopsies. Among these 4 studies, the pooled sensitivity and specificity for diagnosis of malignant biliary strictures was 74.7% (95% CI, 63.3%-84.0%) and 93.3% (95% CI, 85.1%-97.8%), respectively. The pooled DOR was 46.0 (95% CI, 15.4-138.1). Only 1 study directly compared the yield of SpyBite biopsies with standard brushings and biopsies. SpyBite biopsies had a sensitivity of 76.5% compared with brushings (5.8%) and biopsies (29.4%). Six studies specifically reported the role of cholangioscopy with targeted biopsies in the diagnosis of CCA. The pooled sensitivity and specificity to detect CCA was 66.2% (95% CI, 59.7%-72.3%) and 97.0% (95% CI, 94.0%-99.0%), respectively. The pooled DOR to detect CCA was 79.7 (95% CI, 32.7-194.7). Conclusions Our study suggests that SpyGlass cholangioscopy with SpyBite biopsies has moderate sensitivity for the diagnosis of malignant biliary strictures.
Amorphous Si (a‐Si) shows potential advantages over crystalline Si (c‐Si) in lithium‐ion batteries, owing to its high lithiation potential and good tolerance to intrinsic strain/stress. Herein, ...porous a‐Si has been synthesized by a simple process, without the uses of dangerous or expensive reagents, sophisticated equipment, and strong acids that potential cause environment risks. These porous a‐Si particles exhibit excellent electrochemical performances, owing to their porous structure, amorphous nature, and surface modification. They deliver a capacity of 1025 mAh g−1 at 3 A g−1 after 700 cycles. Moreover, the reversible capacity after electrochemical activation, is quite stable throughout the cycling, resulting in a capacity retention about around 88 %. The direct comparison between a‐Si and c‐Si anodes clearly supports the advantages of a‐Si in lithium‐ion batteries.
Anode to amorphous silicon: Mesoporous amorphous Si has been synthesized by a simple process, without the use of dangerous or expensive reagents, sophisticated equipment, and strong acids that potentially cause environment risks. These porous a‐Si particles exhibit excellent electrochemical performances as an anode material in lithium‐ion batteries.
Since its inception, the Internet of Things (IoT) has witnessed mushroom growth as a breakthrough technology. In a nutshell, IoT is the integration of devices and data such that processes are ...automated and centralized to a certain extent. IoT is revolutionizing the way business is done and is transforming society as a whole. As this technology advances further, the need to exploit detection and weakness awareness increases to prevent unauthorized access to critical resources and business functions, thereby rendering the system unavailable. Denial of Service (DoS) and Distributed DoS attacks are all too common. In this paper, we propose a Protocol Based Deep Intrusion Detection (PB-DID) architecture, in which we created a data-set of packets from IoT traffic by comparing features from the UNSWNB15 and Bot-IoT data-sets based on flow and Transmission Control Protocol (TCP). We classify non-anomalous, DoS, and DDoS traffic uniquely by taking care of the problems like imbalanced and over-fitting. We have achieved a classification accuracy of 96.3% by using deep learning (DL) technique.
Mixing a small amount of magnetic beads and regents with large volume samples evenly in microcavities of a microfluidic chip is always the key step for the application of microfluidic technology in ...the field of magnetophoresis analysis. This article proposes a microfluidic chip for DNA extraction by magnetophoresis, which relies on bubble rising to generate turbulence and microvortices of various sizes to mix magnetic beads with samples uniformly. The construction and working principle of the microfluidic chip are introduced. CFD simulations are conducted when magnetic beads and samples are irritated by the generation of gas bubbles with the variation of supply pressures. The whole mixing process in the microfluidic chip is observed through a high‐speed camera and a microfluidic system when the gas bubbles are generated continuously. The influence of supply pressure on the mixing characteristics of the microfluidic chip is investigated and discussed with both simulation and experiments. Compared with magnetic mixing, bubble mixing can avoid the magnetic beads gather phenomenon caused by magnetic forces and provide a rapid and high efficient solution to realize mixing small amount of regents in large volume samples in a certain order without complex moving structures and operations in a chip. Two applications of mixing with the proposed microfluidic chip are also carried out and discussed.
Recently, a 3-plane symmetric needle with Franseen geometry and a Fork-tip biopsy needle have been developed for histologic tissue procurement. We compared 22-gauge Franseen and 22-gauge Fork-tip ...needles in patients undergoing EUS-guided sampling of pancreatic masses.
Fifty patients underwent sampling using both 22-gauge Franseen and 22-gauge Fork-tip needles, with randomization of needle order. Two dedicated passes were performed using both needles for cell block. Subsequent passes were performed for rapid onsite evaluation (ROSE) using both needles alternately until diagnosis was established. The main outcome was to evaluate for histologic core tissue by comparing area of total tissue, tumor, desmoplastic fibrosis, and rate of retained tissue architecture between cohorts. Other outcomes were rates of diagnostic cell block and diagnostic adequacy at ROSE.
Final diagnosis was pancreatic cancer in 44 patients, neuroendocrine tumor in 2, lymphoma in 1, and chronic pancreatitis in 3. There was no significant difference in area of total tissue (median 6.1 interquartie range {IQR}, 3.5-10.5 vs 8.2 mm2 IQR, 4.0-13.0, P = .50), tumor (median .9 IQR .3-2.8 vs 1.0 mm2 IQR .4-2.7, P = .33), desmoplastic fibrosis (median 4.3 IQR, 2.0-6.7 vs 5.2 mm2 IQR, 1.7-6.1, P = .71), retained architecture (100% vs 83%, P = .25), diagnostic cell block (96.0% vs 92.0%, P = .32), and diagnostic adequacy at ROSE (94.0% vs 98.0%, P = .32) between Franseen and Fork-tip needles, respectively.
There was no significant difference between Franseen and Fork-tip needles in yielding histologic tissue. Given their ability to yield diagnostic cell block in greater than 90% of patients, the new-generation fine-needle biopsy needles may obviate the need for ROSE. (Clinical trial registration number: NCT02910960.)
Background and Aims Digital cholangioscopes provide higher-resolution imaging of the pancreatobiliary tract compared with fiberoptic instruments. The role of a new, digital, single-operator ...cholangiopancreatoscopy (SOC) system for diagnosis and treatment of pancreatobiliary disorders in clinical practice is not known. Methods We performed a multicenter, observational study of 105 consecutive patients with suspected pancreatobiliary disorders. The main outcome measures were (1) sensitivity and specificity of SOC visual appearance and biopsies in the diagnosis of indeterminate biliary strictures and (2) achieving complete duct clearance in patients with biliary or pancreatic duct stones. Results A total of 98 cholangioscopy and 7 pancreatoscopy procedures were performed in 105 patients. Superior views of the ductal lumen and mucosa were obtained in all 44 patients with indeterminate biliary strictures. Among the 44 patients who underwent SOC-guided biopsies, the specimen was adequate for histologic evaluation in 43 patients (97.7%). The sensitivity and specificity of SOC visual impression for diagnosis of malignancy was 90% (95% confidence interval CI, 69.9%-97.2%) and 95.8% (95% CI, 79.8%-99.3%), respectively. The sensitivity and specificity of SOC-guided biopsies for diagnosis of malignancy was 85% (95% CI, 64.0%-94.8%) and 100% (95% CI, 86.2%-100%). In patients with biliary or pancreatic duct stones (N = 36), complete duct clearance with stone removal in 1 session was accomplished in 86.1% of patients (31/36). Three patients (2.9%) experienced SOC-related adverse events that included cholangitis in 2 patients and postprocedure pancreatitis in 1 patient. Conclusions SOC has become an integral part of the ERCP armamentarium and has high accuracy in the evaluation of indeterminate biliary strictures. Complete stone clearance was achieved in all but 1 patient with challenging biliary or pancreatic duct stones. (Clinical trial registration number: NCT01815619 .)
Although lumen-apposing metal stents (LAMS) are increasingly used for drainage of walled-off necrosis (WON), their advantage over plastic stents is unclear. We compared efficacy of LAMS and plastic ...stents for WON drainage.
Patients with WON were randomised to endoscopic ultrasound-guided drainage using LAMS or plastic stents. Primary outcome was comparing total number of procedures to achieve treatment success defined as symptom relief in conjunction with WON resolution on CT at 6 months. Secondary outcomes were treatment success, procedure duration, clinical/stent-related adverse events, readmissions, length of hospital stay (LOS) and costs.
60 patients underwent LAMS (n=31) or plastic stent (n=29) placement. There was no significant difference in total number of procedures performed (median 2 (range 2-7) LAMS vs 3 (range 2-7) plastic, p=0.192), treatment success, clinical adverse events, readmissions, LOS and overall treatment costs between cohorts. Although procedure duration was shorter (15 vs 40 min, p<0.001), stent-related adverse events (32.3% vs 6.9%, p=0.01) and procedure costs (US$12 155 vs US$6609, p<0.001) were higher with LAMS. Significant stent-related adverse events were observed ≥3 weeks postintervention in LAMS cohort. Interim audit resulted in protocol amendment where CT scan was obtained at 3 weeks postintervention followed by LAMS removal if WON had resolved. After protocol amendment, there was no significant difference in adverse events between cohorts.
Except for procedure duration, there was no significant difference in treatment outcomes between LAMS and plastic stents. To minimise adverse events with LAMS, patients should undergo follow-up imaging and stent removal at 3 weeks if WON has resolved.
NCT02685865.
Food chain contamination by cadmium (Cd) is globally a serious health concern resulting in chronic abnormalities. Rice is a major staple food of the majority world population, therefore, it is ...imperative to understand the relationship between the bioavailability of Cd in soils and its accumulation in rice grain. Objectives of this study were to establish environment quality standards for seven different textured soils based on human dietary toxicity, total Cd content in soils and bioavailable portion of Cd in soil. Cadmium concentrations in polished rice grain were best related to total Cd content in Mollisols and Udic Ferrisols with threshold levels of 0.77 and 0.32mgkg−1, respectively. Contrastingly, Mehlich-3-extractable Cd thresholds were more suitable for Calcaric Regosols, Stagnic Anthrosols, Ustic Cambosols, Typic Haplustalfs and Periudic Argosols with thresholds values of 0.36, 0.22, 0.17, 0.08 and 0.03mgkg−1, respectively. Stepwise multiple regression analysis indicated that phytoavailability of Cd to rice grain was strongly correlated with Mehlich-3-extractable Cd and soil pH. The empirical model developed in this study explains the combined effects of soil properties and extractable soil Cd content on the phytoavailability of Cd to polished rice grain. This study indicates that accumulation of Cd in rice is influenced greatly by soil type, which should be considered in assessment of soil safety for Cd contamination in rice. This investigation concluded that the selection of proper soil type for food crop production can help us to avoid the toxicity of Cd in our daily diet.
•The empirical model suggested that Cd contents in rice grain were enhanced by higher soil Mehlich-3-extractable Cd content, and lower soil pH.•Established threshold levels for food safety indicated that Cd contents in rice grain were best related to Mehlich-3-extractable Cd contents in most soils.•Dry biomass of rice decreased under Cd toxicity in all soils.
The fat mass and obesity associated protein (FTO) is a potential target for anti-obesity medicines. FTO is a 2-oxoglutarate (2OG)-dependent N-methyl nucleic acid demethylase that acts on substrates ...including 3-methylthymidine, 3-methyluracil, and 6-methyladenine. To identify FTO inhibitors, we screened a set of 2OG analogues and related compounds using differential scanning fluorometry- and liquid chromatography-based assays. The results revealed sets of both cyclic and acyclic 2OG analogues that are FTO inhibitors. Identified inhibitors include small molecules that have been used in clinical studies for the inhibition of other 2OG oxygenases. Crystallographic analyses reveal inhibition by 2OG cosubstrate or primary substrate competitors as well as compounds that bind across both cosubstrate and primary substrate binding sites. The results will aid the development of more potent and selective FTO inhibitors.
OBJECTIVE:To study the effect of disconnected pancreatic duct syndrome (DPDS) on endoscopic management of pancreatic fluid collections (PFCs).
BACKGROUND:Data on the impact of DPDS in patients ...undergoing endoscopic treatment of PFCs are limited.
METHODS:Retrospective study of patients undergoing endoscopic drainage of PFCs from 2003 to 2015. If treatment response was suboptimal following initial endoscopic or endoscopic ultrasound–guided transmural drainage, hybrid interventions (endoscopic ultrasound–guided multigate/dual modality technique, endoscopic/percutaneous sinus tract necrosectomy) were performed. Transmural stents were left permanently in situ in DPDS patients from 2008 onwards. Main outcome measures were to evaluate the effect of DPDS on need for hybrid treatment, reinterventions, rescue surgery, length of stay, and overall treatment success.
RESULTS:Of 361 patients, 34 (9.4%) were acute collections, 178 (49.3%) pseudocysts, and 149 (41.3%) walled-off necrosis (WON). DPDS was present in 167 (46.3%) patients, absent in 124 (34.3%), unknown in 70 (19.4%), and occurred more frequently in WON compared to other PFCs (68.3% vs 31.7%; P < 0.001). Although there was no difference in treatment success, more patients with DPDS required hybrid treatment (31.1% vs 4.8%, P < 0.001), reinterventions (30% vs 18.5%, P = 0.03), rescue-surgery (13.2% vs 4.8%, P = 0.02), and longer length of stay median (interquartile range) days, 3 (2–10) vs 2 (1–4), P = 0.003. PFC recurrence was lower in patients with DPDS with permanent transmural stents (17.4% vs 1.7%, P < 0.001). On multivariate logistic regression, DPDS odds ratio (OR) 2.99, WON (OR 3.37), PFC size of 100 mm or more (OR 2.66), and multiple PFCs (OR 10.6) were associated with need for hybrid treatment.
CONCLUSIONS:DPDS has a significant effect on endoscopic management of PFCs as more patients required hybrid treatment, reinterventions, and rescue surgery for achieving optimal clinical outcomes.
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