Evidence is limited on the comparative diagnostic performance of newer end-cutting fine-needle biopsy (FNB) needles for tissue sampling of pancreatic masses. We performed a systematic review with ...network meta-analysis to compare the diagnostic accuracy of available FNB needles for sampling of solid pancreatic lesions.
A systematic literature review (Medline and Cochrane Database) was conducted for studies evaluating the accuracy of newer FNB needles in adults undergoing EUS-guided sampling of solid pancreatic masses. The primary outcome was diagnostic accuracy. Secondary outcomes were sample adequacy, diagnostic sensitivity, specificity, and adverse event rate. We performed pairwise and network meta-analyses and appraised the quality of evidence using Grading of Recommendations Assessment, Development and Evaluation methodology.
Overall, 16 RCTs (1934 patients) were identified. On network meta-analysis, Franseen needles (Acquire; Boston Scientific, Marlborough, Mass, USA) significantly outperformed reverse-bevel needles (risk ratio RR, 1.21 95% confidence interval {CI}, 1.05-1.40 for accuracy and 1.31 95% CI, 1.05-1.22 for adequacy) and FNA needles (RR, 1.21 95% CI, 1.01-1.25 for accuracy and 1.07 95% CI, 1.02-1.13 for adequacy). Likewise, the Fork-tip needle (SharkCore; Medtronic, Dublin, Ireland) was significantly superior to the reverse-bevel needle (RR, 1.17 95% CI, 1.03-1.33 for accuracy and 1.09 95% CI, 1.02-1.16 for adequacy) and to the FNA needle (RR, 1.09 95% CI, 1.01-1.19 for accuracy and 1.03 95% CI, 1.01-1.07 for adequacy). Other comparisons did not achieve statistical significance. As a consequence, Franseen (surface under the cumulative ranking score, .89 for accuracy and .94 for adequacy) and Fork-tip needles (surface under the cumulative ranking score, .76 for accuracy and .73 for adequacy) ranked as the 2 highest-performing FNB needles. When considering different needle sizes, 25-gauge Franseen and 25-gauge Fork-tip needles were not superior to 22-gauge reverse-bevel needles (RR, 1.18 95% CI, .96-1.46 and 1.04 95% CI, .62-1.52). None of the tested needles was significantly superior to the other FNB devices or to FNA needles when rapid onsite cytologic evaluation was available.
Franseen and Fork-tip needles, particularly 22-gauge size, showed the highest performance for tissue sampling of pancreatic masses, with low confidence in estimates.
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A risk analysis framework is proposed for the optimum remediation of a contaminated aquifer under hydrogeological uncertainty. The limited information and the spatial variation of hydraulic ...conductivity in a real-world large-scale aquifer create uncertain conditions for decision-making when remediation schemes ought to be accompanied by the minimum possibility of failure. The primary concern is focused on safeguarding public health when groundwater is used for urban drinking purposes from a contaminated aquifer. The proposed framework is based on the conjunctive use of stochastic simulation–optimization modelling followed up by a risk analysis application on remediation trade-offs. The framework includes three main steps/procedures: (i) the model formulation of multiple realizations of groundwater flow and contaminant transport, (ii) the optimal positioning and operation of the clean-up wells determined by the method of stochastic optimization, and (iii) the risk analysis of the optimum remediation strategies through a proposed decision model, so as the one with the minimum cost and risk of failure is chosen as the most appropriate. The proposed framework is tested for two scenarios of nitrogen fertilizer application in the cultivated areas. The strategic target is the groundwater nitrate concentration minimization in an area where exceedances of nitrate concentrations have been observed and water supply wells have been operating for the last twenty years satisfying domestic needs. The results demonstrate that, when decision-making is under hydrogeological uncertainty, the combined use of stochastic optimization and risk-based decision analysis can commend the remediation strategy with the minimum cost and the highest possibility of success.
Agroclimatic classification identifies zones for efficient use of natural resources leading to optimal and non-optimal crop production. The aim of this paper is the development of a methodology to ...determine sustainable agricultural zones in three Mediterranean study areas, namely, “La Mancha Oriental” in Spain, “Sidi Bouzid” in Tunisia, and “Bekaa” valley in Lebanon. To achieve this, time series analysis with advanced geoinformatic techniques is applied. The agroclimatic classification methodology is based on three-stages: first, the microclimate features of the region are considered using aridity and vegetation health indices leading to water-limited growth environment (WLGE) zones based on water availability; second, landform features and soil types are associated with WLGE zones to identify non-crop-specific agroclimatic zones (NCSAZ); finally, specific restricted crop parameters are combined with NCSAZ to create the suitability zones. The results are promising as compared with the current crop production systems of the three areas under investigation. Due to climate change, the results indicate that these arid or semi-arid regions are also faced with insufficient amounts of precipitation for supporting rainfed annual crops. Finally, the proposed methodology reveals that the employment and use of remote sensing data and methods could be a significant tool for quickly creating detailed, and up to date agroclimatic zones.
Colonoscopy is the gold standard for colorectal cancer prevention; however, it is still an imperfect modality. Precancerous lesions can be lost during screening examinations, thus increasing the risk ...of interval cancer. A variety of factors either patient-, or endoscopist dependent or even the procedure itself may contribute to loss of lesions. Sophisticated modalities including advanced technology endoscopes and add-on devices have been developed in an effort to eliminate colonoscopy’s drawbacks and maximize its ability to detect potentially culprit polyps. Novel colonoscopes aim to widen the field of view. They incorporate more than one cameras enabling simultaneous image transmission. In that way the field of view can expand up to 330°. On the other hand a plethora of add-on devices attachable on the standard colonoscope promise to detect lesions in the proximal aspect of colonic folds either by offering a retrograde view of the lumen or by straightening the haustral folds during withdrawal. In this minireview we discuss how these recent advances affect colonoscopy performance by improving its quality indicators(cecal intubation rate, adenoma detection rate) and other metrics(polyp detection rate, adenomas per colonoscopy, polyp/adenoma miss rate) associated with examination’s outcomes.
This study presents an integrated modeling system for the evaluation of the quantity and quality of water resources of coastal agricultural watersheds. The modeling system consists of coupled and ...interrelated models, including (i) a surface hydrology model (UTHBAL), (ii) a groundwater hydrology model (MODFLOW), (iii) a crop growth/nitrate leaching model (REPIC, an R-ArcGIS-based EPIC model), (iv) a groundwater contaminant transport model (MT3DMS), and (v) a groundwater seawater intrusion model (SEAWAT). The efficacy of the modeling system to simulate the quantity and quality of water resources has been applied to the Almyros basin in Thessaly, Greece. It is a coastal agricultural basin with irrigated and intensified agriculture facing serious groundwater problems, such as groundwater depletion, nitrate pollution, and seawater intrusion. Irrigation demands were estimated for the main crops cultivated in the area, based on precipitation and temperature from regional weather stations. The models have been calibrated and validated against time-series of observed crop yields, groundwater table observations, and observed concentrations of nitrates and chlorides. The results indicate that the modeling system simulates the water resources quantity and quality with increased accuracy. The proposed modeling system could be used as a tool for the simulation of water resources management and climate change scenarios.
Drought is one of the most critical environmental hazards for the viability and productive development of crops, especially in a climate change environment. To this end, drought assessment is a ...process of paramount importance to make vulnerable agricultural regions more resilient. The primary aim of this paper is an integrated drought assessment through time and space in one of the most susceptible (in terms of water availability limitations) and agriculturally productive regions in Greece and the Mediterranean, namely, the Thessaly region. Supplementary objectives consist of the determination of the two most extreme years in terms of drought and wetness, so that we may reveal any potential climatological cycles/patterns from 1981 to 2020. Additionally, the methodology includes the annual and seasonal analysis using one of the most widely used drought indices, namely, the Standardized Precipitation Index (SPI), so that consistent measurements are available across a large study area, avoiding the possible scarcity/deficiency of data coming from a sparse land weather network. The innovative element of this paper is the integrated spatiotemporal drought assessment in multiple time scales through the estimation of the SPI making use of remotely sensed data, such as CHIRPS (Climate Hazards Group InfraRed Precipitation with Station data). The outcomes highlight that the study area faced two severe years of drought in 1988 and 1989, which led to moderate and extreme drought conditions, respectively. In contrast, extremely wet conditions were observed in 2002–2003, whereas 2009–2010 experienced moderately wet conditions. The central and western part of the region tends to suffer the most in terms of drought severity, especially at the most extreme years. The validity of the results has been confirmed by the adoption of R2 where the index is approaching 0.67 despite the large size of the pixels (5 × 5 km). In this context, the mapping of spatial and seasonal variability across the study area permits more targeted measures (e.g., precision farming) instead of horizontal policies.
Groundwater quantity and quality degradation by agricultural practices is recorded as one of the most critical issues worldwide. This is explained by the fact that groundwater is an important ...component of the hydrological cycle, since it is a source of natural enrichment for rivers, lakes, and wetlands and constitutes the main source of potable water. The need of aquifers simulation, taking into account water resources components at watershed level, is imperative for the choice of appropriate restoration management practices. An integrated water resources modeling approach, using hydrological modeling tools, is presented for assessing the nitrate fate and transport on an over-exploited aquifer with intensive and extensive agricultural activity under various operational strategies and future climate change scenarios. The results indicate that climate change affects nitrates concentration in groundwater, which is likely to be increased due to the depletion of the groundwater table and the decrease of groundwater enrichment in the future water balance. Application of operational agricultural management practices with the construction and use of water storage infrastructure tend to compensate the groundwater resources degradation due to climate change impacts.
Background and Aims. Inpatients’ bowel preparation before colonoscopy is frequently inadequate, and various interventions have been investigated to improve it, so far. We aimed to evaluate the ...efficacy of various interventions to improve inpatients’ colon preparation quality. Methods. We systematically reviewed the literature for publications on interventions aiming to improve the quality of inpatients’ colon preparation until June, 2018. Significant heterogeneity—measured with I2—was detected at the level of P<0.1. Adequacy rates were measured using inverse variance, and the size effect of different interventions was calculated using random effects model and expressed as odds ratio (OR). Results. Seventeen studies enrolling 2733 inpatients were included. Overall, 67% (60-75%) of the participants achieved adequate colon cleansing (I2=97%; P<0.001). In six studies assessing the impact of educational interventions to patient/physician/nurse vs. no intervention, adequate bowel preparation was achieved in 77% (62-91%) vs. 50% (32-68%) of the patients (OR 95%CI=3.49 (1.67-7.28), P=0.0009; I2=74%; P=0.002). Ten studies examined variations (qualitative and/or quantitative) in bowel preparation regimens with adequate preparation detected in 71% (60-81%) of the participants, and a single study examined the administration of preparation through an esophagogastroduodenoscope, resulting in adequate prep in 71% of the patients. Conclusions. Despite several interventions, only two-thirds of inpatients achieve adequate colon preparation before colonoscopy. Educational interventions significantly improve inpatients’ bowel preparation quality.
Gut Microbiota Dysbiosis in Functional Dyspepsia Tziatzios, Georgios; Gkolfakis, Paraskevas; Papanikolaou, Ioannis S ...
Microorganisms (Basel),
05/2020, Letnik:
8, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Functional dyspepsia (FD) is one of the most prevalent chronic functional gastrointestinal disorders. Several distinct pathophysiological mechanisms, including gastro duodenal motor disorders, ...visceral hypersensitivity, brain-gut interactions, duodenal subtle inflammation, and genetic susceptibility, have been implicated in the pathogenesis of the disease, so far. However, emerging evidence suggests that both quantitative and qualitative disturbances of the gastrointestinal microbiota may also be implicated. In this context, several studies have demonstrated differences of the commensal bacterial community between patients with FD and healthy controls, while others have shown that intestinal dysbiosis might associate with disease's symptoms severity. Elucidating these complex interactions constituting the microbiota and host crosstalk, may eventually lead to the discovery of novel, targeted therapeutic approaches that may be efficacious in treating the multiple aspects of the disorder. In this review, we summarize the data of the latest research with focus on the association between gut microbiota alterations and host regarding the pathogenesis of FD.
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