Late-medieval devotional literature embraced visualization as a means of providing the reader-devotee with the experience of being a virtual witness during a text-guided meditation. Based on a new ...reading of Cransken van minnen, a Middle Dutch prayer book from Franciscan milieus, this paper will propose a framework based on the interrelations between visualization and other key aspects pointed out in recent research as significant for understanding this type of literature: affective reactions, anamnesis and virtual witnessing. This framework entails two assumptions. The first is that visualization, especially with Mary as the compassionate “focaliser”, was instrumental in achieving the goal of devotion, which was to promote an affective reaction (contrition). The second is that this prayer book offered devotees an experience of anamnesis (“recalling”) that depended on the provision of sensory perceptions through which readers could become virtual witnesses to the events meditated upon. Using a combination of philological and literary–historical methods, the structure and content of this prayer book are scrutinized in detail to provide new insights into the strategies used by the compiler to infuse the prayer discourse with elements suggesting visual perception.
In this large study of colorectal-cancer screening, the endoscopist's rate of adenoma detection was associated with the risk of interval colorectal cancer after screening colonoscopy. Colorectal ...cancers were less likely to be diagnosed between screening examinations when colonoscopies were performed by endoscopists with an adenoma detection rate of 20% or more.
In this large study of colorectal-cancer screening, the endoscopist's rate of adenoma detection was associated with the risk of interval colorectal cancer after screening colonoscopy.
Although colonoscopy is widely used for colorectal-cancer screening,
1
–
3
its miss rate for cancers and adenomatous polyps (benign premalignant tumors or adenomas), which is low but not negligible, remains a concern.
4
–
6
It has been suggested that a high-quality examination that ensures the detection and removal of all neoplastic lesions is key for screening efficacy.
6
–
8
In response, professional societies have proposed the use of various quality-assessment indicators. Of such indicators, the rates of adenoma detection and cecal intubation are the most commonly used.
7
–
10
However, these measurements have never been validated, and it is not known whether an improvement . . .
RECOMMENDATIONS
For routine EUS-guided sampling of solid masses and lymph nodes (LNs) ESGE recommends 25G or 22G needles (high quality evidence, strong recommendation); fine needle aspiration (FNA) ...and fine needle biopsy (FNB) needles are equally recommended (high quality evidence, strong recommendation).
When the primary aim of sampling is to obtain a core tissue specimen, ESGE suggests using 19G FNA or FNB needles or 22G FNB needles (low quality evidence, weak recommendation).
ESGE recommends using 10-mL syringe suction for EUS-guided sampling of solid masses and LNs with 25G or 22G FNA needles (high quality evidence, strong recommendation) and other types of needles (low quality evidence, weak recommendation).
ESGE suggests neutralizing residual negative pressure in the needle before withdrawing the needle from the target lesion (moderate quality evidence, weak recommendation).
ESGE does not recommend for or against using the needle stylet for EUS-guided sampling of solid masses and LNs with FNA needles (high quality evidence, strong recommendation) and suggests using the needle stylet for EUS-guided sampling with FNB needles (low quality evidence, weak recommendation).
ESGE suggests fanning the needle throughout the lesion when sampling solid masses and LNs (moderate quality evidence, weak recommendation).
ESGE equally recommends EUS-guided sampling with or without on-site cytologic evaluation (moderate quality evidence, strong recommendation). When on-site cytologic evaluation is unavailable, ESGE suggests performance of three to four needle passes with an FNA needle or two to three passes with an FNB needle (low quality evidence, weak recommendation).
For diagnostic sampling of pancreatic cystic lesions without a solid component, ESGE suggests emptying the cyst with a single pass of a 22G or 19G needle (low quality evidence, weak recommendation). For pancreatic cystic lesions with a solid component, ESGE suggests sampling of the solid component using the same technique as in the case of other solid lesions (low quality evidence, weak recommendation).
ESGE does not recommend antibiotic prophylaxis for EUS-guided sampling of solid masses or LNs (low quality evidence, strong recommendation), and suggests antibiotic prophylaxis with fluoroquinolones or beta-lactam antibiotics for EUS-guided sampling of cystic lesions (low quality evidence, weak recommendation).
ESGE suggests that evaluation of tissue obtained by EUS-guided sampling should include histologic preparations (e. g., cell blocks and/or formalin-fixed and paraffin-embedded tissue fragments) and should not be limited to smear cytology (low quality evidence, weak recommendation).
MAIN RECOMMENDATIONS
For pancreatic solid lesions, ESGE recommends performing endoscopic ultrasound (EUS)-guided sampling as first-line procedure when a pathological diagnosis is required. ...Alternatively, percutaneous sampling may be considered in metastatic disease.
Strong recommendation, moderate quality evidence.
In the case of negative or inconclusive results and a high degree of suspicion of malignant disease, ESGE suggests re-evaluating the pathology slides, repeating EUS-guided sampling, or surgery.
Weak recommendation, low quality evidence.
In patients with chronic pancreatitis associated with a pancreatic mass, EUS-guided sampling results that do not confirm cancer should be interpreted with caution.
Strong recommendation, low quality evidence.
For pancreatic cystic lesions (PCLs), ESGE recommends EUS-guided sampling for biochemical analyses plus cytopathological examination if a precise diagnosis may change patient management, except for lesions ≤ 10 mm in diameter with no high risk stigmata. If the volume of PCL aspirate is small, it is recommended that carcinoembryonic antigen (CEA) level determination be done as the first analysis.
Strong recommendation, low quality evidence.
For esophageal cancer, ESGE suggests performing EUS-guided sampling for the assessment of regional lymph nodes (LNs) in T1 (and, depending on local treatment policy, T2) adenocarcinoma and of lesions suspicious for metastasis such as distant LNs, left liver lobe lesions, and suspected peritoneal carcinomatosis.
Weak recommendation, low quality evidence.
For lymphadenopathy of unknown origin, ESGE recommends performing EUS-guided (or alternatively endobronchial ultrasound EBUS-guided) sampling if the pathological result is likely to affect patient management and no superficial lymphadenopathy is easily accessible.
Strong recommendation, moderate quality evidence.
In the case of solid liver masses suspicious for metastasis, ESGE suggests performing EUS-guided sampling if the pathological result is likely to affect patient management, and (i) the lesion is poorly accessible/not detected at percutaneous imaging, or (ii) a sample obtained via the percutaneous route repeatedly yielded an inconclusive result.
Weak recommendation, low quality evidence.
This study aimed to develop and validate a model to estimate the likelihood of detecting advanced colorectal neoplasia in Caucasian patients.
We performed a cross-sectional analysis of database ...records for 40-year-old to 66-year-old patients who entered a national primary colonoscopy-based screening programme for colorectal cancer in 73 centres in Poland in the year 2007. We used multivariate logistic regression to investigate the associations between clinical variables and the presence of advanced neoplasia in a randomly selected test set, and confirmed the associations in a validation set. We used model coefficients to develop a risk score for detection of advanced colorectal neoplasia.
Advanced colorectal neoplasia was detected in 2544 of the 35,918 included participants (7.1%). In the test set, a logistic-regression model showed that independent risk factors for advanced colorectal neoplasia were: age, sex, family history of colorectal cancer, cigarette smoking (p<0.001 for these four factors), and Body Mass Index (p=0.033). In the validation set, the model was well calibrated (ratio of expected to observed risk of advanced neoplasia: 1.00 (95% CI 0.95 to 1.06)) and had moderate discriminatory power (c-statistic 0.62). We developed a score that estimated the likelihood of detecting advanced neoplasia in the validation set, from 1.32% for patients scoring 0, to 19.12% for patients scoring 7-8.
Developed and internally validated score consisting of simple clinical factors successfully estimates the likelihood of detecting advanced colorectal neoplasia in asymptomatic Caucasian patients. Once externally validated, it may be useful for counselling or designing primary prevention studies.
In a large, national program of colorectal-cancer screening in Poland, men were about twice as likely as women to have advanced neoplasia detected on colonoscopy. The yield of colonoscopy among men ...40 to 49 years of age was similar to that among women 55 to 59 years of age (in these differing age groups, one advanced neoplasia detected for every 23 men and 22 women screened).
In a large program of colorectal-cancer screening, men were about twice as likely as women to have advanced neoplasia detected on colonoscopy. The yield of colonoscopy among men 40 to 49 years of age was similar to that among women 55 to 59 years of age.
Colorectal cancer is the most frequent cancer in Europe
1
and the second leading cause of death related to cancer in the United States.
2
Screening can lead to decreased incidences of colorectal cancer and death owing to the detection of both precancerous lesions and cancers at early stages, respectively.
3
–
5
Fecal occult-blood testing and flexible sigmoidoscopy can miss a substantial fraction of important lesions.
6
Despite its risk, inconvenience, and cost, colonoscopy is a valid primary screening tool for colorectal cancer when performed every 10 years, beginning at 50 years of age in people who are at average risk.
7
,
8
Whatever method . . .
Background Endoscopic submucosal dissection (ESD) is a well-accepted method for removing superficial mucosal tumors; however, there is limited data on the use of this method for removing ...subepithelial tumors. Objective To investigate the efficacy, safety, and outcome of ESD for gastric subepithelial tumors and determine factors related to treatment success. Design Retrospective analysis of a prospectively maintained database. Setting Single tertiary academic center. Patients and Interventions From April 2007 to November 2010, 37 patients with gastric subepithelial tumors were treated with ESD. Main Outcome Measurements Macroscopically and microscopically complete en block resection rate (R0), complication rate, and endosonographic features predictive of R0 resection. Results The median tumor diameter was 25.0 mm, (range 10-60 mm, IQR 17-37). The overall rate of R0 resections was 81.1% (30/37, 95%CI: 61.8-90.2%), including 100% (15/15, 95%CI: 78.2-100.0%) of tumors from the submucosa and 68.2% (15/22, 95%CI: 45.1-86.1%) of tumors from the muscularis propria. Seventeen patients had a final diagnosis of gastrointestinal stromal tumor. The severe complication (perforation) rate was 5.4% (2/37, 95%CI: 0.0-9.5%). One patient required surgery; the other was treated conservatively. No recurrence was observed in patients with R0 resections at a median follow up of 21.0 months (IQR 11-35). Successful R0 resections were predicted by the observation of no, or only narrow, tumor connections with the underlying muscle layer during EUS (OR=35.0, 95%CI: 3.7-334.4, p=0.001). Limitations Single-center, retrospective analysis, short follow-up. Conclusions ESD is an effective and relatively safe method for removing gastric subepithelial tumors. Endoscopic ultrasonography findings can predict complete tumor resections.
Background
Pancreatic cyst fluids (PCFs) enriched in tumor-derived DNA are a potential source of new biomarkers. The study aimed to analyze germinal variants and mutational profiles of cell-free ...(cf)DNA shed into the cavity of pancreatic cysts.
Methods
The study cohort consisted of 71 patients who underwent endoscopic ultrasound fine-needle aspiration of PCF. Five malignant cysts, 19 intraductal papillary mucinous neoplasms (IPMNs), 11 mucinous cystic neoplasms (MCNs), eight serous cystic neoplasms (SCNs), and 28 pseudocysts were identified. The sequencing of 409 genes included in Comprehensive Cancer Panel was performed using Ion Proton System. The mutation rate of the
KRAS
and
GNAS
canonical loci was additionally determined using digital PCR.
Results
The number of mutations detected with NGS varied from 0 to 22 per gene, and genes with the most mutations were:
TP53
,
KRAS
,
PIK3CA
,
GNAS
,
ADGRA2
, and
APC
. The frequencies of the majority of mutations did not differ between non-malignant cystic neoplasms and pseudocysts. NGS detected
KRAS
mutations in malignant cysts (60%), IPMNs (32%), MCNs (64%), SCNs (13%), and pseudocysts (14%), with
GNAS
mutations in 20%, 26%, 27%, 13%, and 21% of samples, respectively. Digital PCR-based testing increased
KRAS
(68%) and
GNAS
(52%) mutations detection level in IPMNs, but not other cyst types.
Conclusions
We demonstrate relatively high rates of somatic mutations of cancer-related genes, including
KRAS
and
GNAS
, in cfDNA isolated from PCFs irrespectively of the pancreatic cyst type. Further studies on molecular mechanisms of pancreatic cysts malignant transformation in relation to their mutational profiles are required.
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