Background and Aim: We report our single‐centre experience with endoscopic ultrasound guided fine needle aspiration (EUS‐FNA) of solid pancreatic lesions with regard to clinical utility, diagnostic ...accuracy and safety.
Methods: We prospectively reviewed data on 100 consecutive EUS‐FNA procedures performed in 93 patients (54 men, mean age 60.6 ± 12.9 years) for evaluation of solid pancreatic lesions. Final diagnosis was based on a composite standard: histologic evidence at surgery, or non‐equivocal malignant cytology on FNA and follow‐up. The operating characteristics of EUS‐FNA were determined.
Results: The location of the lesions was pancreatic head in 73% of cases, the body in 20% and the tail in 7%. Mean lesion size was 35.1 ± 12.9 mm. The final diagnosis revealed malignancy in 87 cases, including adenocarcinomas (80.5%), neuroendocrine tumours (11.5%), lymphomas (3.4%) and other types (4.6%). The FNA findings were: 82% interpreted as malignant cytology, 1% as suspicious for neoplasia, 1% as atypical, 7% as benign process and 9% as non‐diagnostic. No false‐positive results were observed. There was a false‐negative rate of 5%. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 94.3%, 100%, 100%, 72.2% and 95%, respectively. In 23 (88.5%) of 26 aspirated lymph nodes malignancy was found. Minor complications occurred in two patients.
Conclusions: Our experience confirms that EUS‐FNA in patients with suspected solid pancreatic lesions is safe and has a high diagnostic accuracy. This technique should be considered the preferred test when a cytological diagnosis of a pancreatic mass lesion is required.
Antidepressants could be effective in the treatment of functional gastrointestinal disorders through their anticholinergic and pain-modulating effects. Previous studies with these drugs lacked ...sufficient power and were predominantly conducted in patients with irritable bowel syndrome. This study aimed to assess the effectiveness of the serotonin and norepinephrine reuptake inhibitor venlafaxine in patients with functional dyspepsia.
This was a multi-center, randomized, double-blind, placebo-controlled trial. Participants had persistent dyspeptic symptoms and underwent upper gastrointestinal endoscopy in a secondary care hospital to exclude organic abnormalities. They were randomly assigned to receive 8 weeks of treatment with either venlafaxine XR (2 weeks 75 mg once daily, 4 weeks 150 mg once daily, and 2 weeks 75 mg once daily) or placebo. Symptoms, health-related quality of life, anxiety, and depression were assessed before and at 4, 8, 12, and 20 weeks after inclusion.
One hundred sixty patients were randomized; 56% and 73% of participants completed treatment with venlafaxine or placebo, respectively, according to protocol. There was no difference in proportions of symptom-free patients after 8 weeks of treatment or at 20 weeks after inclusion, with venlafaxine in comparison to placebo (37% and 39%, respectively; odds ratio OR, 0.8; 95% confidence interval CI, 0.3-2.1; and 42% and 41%, respectively; OR, 3.1; 95% CI, 0.9-12.6). Per-protocol analysis did not reveal any differences between venlafaxine and placebo either (38% and 39% symptom-free, respectively; OR, 1.0; 95% CI, 0.4-2.4 at 8 weeks).
Treatment with the selective serotonin and norepinephrine reuptake inhibitor venlafaxine is not more effective than placebo in patients with functional dyspepsia.
In an earlier study we reported the apparent stabilization of a low fungal biomass in ex-arable lands during the first decades after abandonment. It was hypothesized that the lack of increase in ...fungal biomass was due to constraints on development of fungi with persistent hyphae such as lignocellulolytic basidiomycetes and ericoid mycorrhizal fungi. With respect to the former group, the slow increase of the pool of lignocellulose-rich organic matter was expected to be the major constraint for their development. To study this, we enriched soil samples of one arable land, of two recently abandoned arable lands, of one older abandoned arable land and of heathland with carbon substrates that differed in composition (glucose, cellulose and sawdust). In addition, we combined the effect of carbon addition on fungal biomass development in arable and recently abandoned lands with inoculation of 1% of soil from the older abandoned site and the heathland. All treatments induced a fast increase and a subsequent rapid decline in fungal biomass in the arable and ex-arable fields. Denaturing Gradient Gel Electrophoresis (DGGE) band patterns and enzyme activities did show differences between the carbon treatments but not between the recent and older abandoned field sites, indicating a similarly responding fungal community even after three decades of land abandonment and irrespective of soil inoculation. Identification of fungi by sequencing and culturing confirmed that decomposition processes were mostly dominated by opportunistic fungi in arable and ex-arable fields. In the heathland, only a very slow increase of microbial activity was observed after addition of carbon and sequencing of DGGE bands showed that ericoid mycorrhiza (ERM) fungi were responsible for carbon decomposition. We conclude that an increase of enduringly present fungal hyphae in ex-arable land may only be possible when a separate litter layer develops and/or when suitable host plants for ERM fungi become established.
The development of a broadly protective vaccine against meningococcal serogroup B is a well-recognized public health need. Whole-genome sequencing was used to identify meningococcal surface proteins ...that are conserved across strains. These proteins were incorporated into two investigational vaccines.
Three randomized studies were performed to evaluate a three-component recombinant meningococcal serogroup B vaccine (rMenB) and rMenB plus outer membrane vesicles from the Norwegian outbreak strain 44/76 (rMenB+OMVNW). Participants were randomized to receive 3 or 4 doses of rMenB or rMenB+OMVNW or control vaccines and provided sera for exploratory immunogenicity testing against a panel of meningococcal serogroup B strains. A booster dose was administered 12 months after the initial primary series in one of the studies. The control cohort received a licensed quadrivalent meningococcal polysaccharide vaccine against serogroups A, C, W-135 and Y as well as hepatitis B vaccine as safety comparators. Solicited reactions within 7 days of any vaccination and adverse events throughout the studies were recorded.
One hundred four participants enrolled into the clinical trials. Both rMenB and rMenB+OMVNW induced immune responses to multiple serogroup B strains in the majority of participants. Compared with rMenB, rMenB+OMVNW appeared somewhat more immunogenic and reactogenic; the study was not adequately powered for statistical assessment of these small differences. Both investigational vaccines were more reactogenic than the licensed vaccines. Few vaccinees discontinued any study due to reactogenicity to any study vaccine administered.
Based on the immunogenicity and reactogenicity results in these participants, both rMenB and rMenB+OMVNW were promising candidates for further investigation.
Chronic obstructive pulmonary disease cannot be treated effectively by corticosteroids. Thus, what are the perspectives of specific cytokine antagonists for therapy?
Chronic obstructive pulmonary ...disease (COPD) is an inflammatory lung disease associated with progressive airflow limitation. The main risk factor is tobacco smoking. Anti-inflammatory therapies (e.g. corticosteroids) are based on those developed initially for asthma. In contrast to asthma, they are rather ineffective in improving chronic symptoms and reducing inflammation and lung function decline. Specific drugs need to be developed directed against this chronic inflammation, thereby preventing lung tissue damage. Cytokine antagonists for tumour necrosis factor α, interleukin 8 receptor, interleukin 1, and specific signal transduction inhibitors have proven to be effective for other inflammatory diseases. Their efficacy for COPD therapy has yet to be demonstrated.
A beat-to-beat model of the cardiovascular system is developed to study the spontaneous short-term variability in arterial blood pressure (BP) and heart rate (HR) data from humans at rest. The model ...consists of a set of difference equations representing the following mechanisms: 1) control of HR and peripheral resistance by the baroreflex, 2) Windkessel properties of the systemic arterial tree, 3) contractile properties of the myocardium (Starling's law and restitution), and 4) mechanical effects of respiration on BP. The model is tested by comparing power spectra and cross spectra of simulated data from the model with spectra of actual data from resting subjects. To make spectra from simulated data and from actual data tally, it must be assumed that respiratory sinus arrhythmia at rest is caused by the conversion of respiratory BP variability into HR variability by the fast, vagally mediated baroreflex. The so-called 10-s rhythm in HR and BP appears as a resonance phenomenon due to the delay in the sympathetic control loop of the baroreflex. The simulated response of the model to an imposed increase of BP is shown to correspond with the BP and HR response in patients after administration of a BP-increasing drug, such as phenylephrine. It is concluded that the model correctly describes a number of important features of the cardiovascular system. Mathematical properties of the difference-equation model are discussed.
A laboratory investigation was conducted to measure wetted radii and drop sizes and to estimate the energy characteristics of a rotating spray-plate sprinkler. Maximum wetted radii were positively ...related to increasing sprinkler elevation above an irrigated surface and increasing nozzle pressure. Nozzle diameter had a minimal effect on drop size, but nozzle pressure had a significant inverse influence. Energy parameters were calculated for sprinkler operational scenarios. Average kinetic energies over sprinkler-wetted areas were inversely related to nozzle pressure and the square of nozzle pressure. Rapidly and slowly rotating spray plate sprinklers had similar time-averaged specific power distributions. However, the rapidly rotating sprinklers had continuous rotational distribution patterns in space with relatively low peak specific power values that corresponded to natural rainfall intensities of about 20 mm/h. Slowly rotating sprinklers had discontinuous spatial distribution patterns with very high peak values that corresponded to natural rainfall intensities of about 200 mm/h.
Polycrystalline diamonds produced with the chemical vapor deposition technique (PC CVD diamonds) are regularly used as beam loss monitors in accelerators by measuring the ionization of the lost ...particles. In the past, these beam loss monitors showed sudden increase in the dark leakage current without beam loss and these erratic leakage currents were found to decrease, if magnetic fields were present. Here, we report on a systematic study of leakage currents inside a magnetic field. The decrease of erratic currents in a magnetic field was confirmed. On the contrary, diamonds without erratic currents showed an increase of the leakage current in a magnetic field perpendicular to the electric field for fields up to 0.6 T, for higher fields it decreases. A preliminary model is introduced to explain the observations.
Pyruvate protects myocardium from ischemic and anoxic injury, effects that have been attributed to beneficial metabolic alterations. Pyruvate also reacts with hydrogen peroxide in vitro, and pyruvate ...prevents free radical injury in other organs. Hearts supplied with 2 mM of pyruvate with glucose during reperfusion recovered significantly more mechanical function (81%) than those provided with 2 mM of acetate (which does not react with free radicals) and glucose (49%) or glucose alone (27%). Pyruvate significantly reduced free radical generation during reperfusion as measured with electron spin resonance using the spin-trap 5,5-dimethyl-1-pyrroline-1-oxide. In a model of direct oxidant stress, hearts were perfused with 0.28 mM of hydrogen peroxide. In this model, loss of function was almost entirely prevented by addition of 2 mM of pyruvate. From these results we conclude an important mechanism of protection when pyruvate is supplied during reperfusion is limitation of oxygen-derived free radical damage.
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