Pancreatic nodule positive for 68-Ga-DOTAPEPTIDE-PET: NET or ectopic spleen? The importance of a good differential diagnosis

Abstract Background Accessory spleen is a congenital defect in which splenic tissue is present outside the spleen. In 20% of cases, accessory spleen is localized within the pancreatic tail, a condition known as IPAS. The identification of this benign anomaly, which affects about 2% of general population, is not easy because it is often mistaken for a pNET which is more common, at around 5%. A 68-Ga-DOTAPEPTIDE-PET normally identifies pNETs with high rate of sensitivity and specificity, but in some conditions, it produces false positives, including IPAS. Materials and tools A clinical case we recently encountered, prompted us to review the available medical literature on the topic. Typing "intrapancreatic accessory spleen" into PubMed database and limiting research to the last 10 years yielded 121 results from which we selected the most relevant articles for decision-making, with a brief explanation of the reasons for selecting those. Our analysis focused on the most critical and least descriptive articles, those which clearly indicated the importance of differential diagnosis by promoting the use of advanced investigations in case of pancreatic nodule suspected for IPAS. Ultimately, our objective was to update the available guidelines recommendations. Discussion and conclusions Despite concern in the medical literature, a differential IPAS diagnosis is still subordinate to other clinical, radiological, nuclear medicine, and cytological criteria. After reviewing the literature, we recommend that IPAS should always be considered as a possibility before diagnosis of pNET is made. IPAS should be suspected in the presence of the following findings: asymptomatic pancreatic nodule found incidentally, absence of laboratory findings of NETs, localization in the pancreatic tail, between 1 and 3 cm in size with well-defined margins, homogeneous enhancement, and similar attenuation to the spleen on CT and MRI. In these cases, the use of advanced investigations beyond 68-Ga-DOTAPEPTIDE-PET must be systematic. The recognition of IPAS is not only a diagnostic refinement, but it also avoids unnecessary surgery for the patient

Application of average volume assured pressure support (AVAPS) and ultrasound assessment in COVID-19 infection: real-life observation.

BACKGROUND: ARDS in COVID-19 patients admitted to Emergency Departments (ED) is characterized by reduced diaphragm motility and increased work of breathing (WOB) by accessory respiratory muscles. Reduced perfusion of compliant lungs as consequence of vascular abnormalities has been highlighted as possible explanation of typical hypoxemia. Non-invasive mechanical ventilation (NIMV) has been proposed to treat ARDS. AVAPS is a hybrid modality of NIMV combining features of pressure and volume ventilation. METHODS: we enrolled 38 patients with COVID-19 ARDS to whom we applied NIMV with AVAPS modality. We assessed Tidal Volume (TV), diaphragm excursion (DE) and PaO2/FiO2 before starting NIMV and after three (T3) and six hours (T6) of ventilation. RESULTS: Admissions to ICU were avoided in 68% of our patients. TV (627±147.6 vs. 747.1±226 mL, P<0.00005) and DE (21.8±5.4 vs. 17.9±6.1 mm, P<0.00005) already improved after three hours of AVAPS. TV (521.5±120 mL, P<0.00005), DE (25.8±6.9 mm, P<0.00005) and PaO2/FiO2 (197.3±75.3 vs. 158±67.7, P<0.005) significantly improved in our cohort of patients after six hours. CONCLUSIONS: NIMV with AVAPS modality can be confidently used in the clinical management of COVID-19 patients with ARDS, since AVAPS has positive effects on ventilation-perfusion matching and WOB. We recommend low PEEP value and ultrasound assessment of diaphragm motility and lung characteristics, although further studies are needed to individuate clinical features of NIMV best-responder patients

Performance of the new amplifier-shaper-discriminator chip for the ATLAS MDT chambers at the HL-LHC

The Phase-II Upgrade of the ATLAS Muon Detector requires new electronics for the readout of the MDT drift tubes. The first processing stage, the Amplifier-Shaper-Discriminator (ASD), determines the performance of the readout for crucial parameters like time resolution, gain uniformity, efficiency and noise rejection. An 8-channel ASD chip, using the IBM 130 nm CMOS 8RF-DM technology, has been designed, produced and tested. The area of the chip is 2.2 x 2.9 square mm size. We present results of detailed measurements as well as a comparision with simulation results of the chip behaviour at three different levels of detail

Occupational exposure to organic dust and risk of lymphoma subtypes in the EPILYMPH case-control study

Objectives: This study aimed to estimate the risk of lymphoma and its major subtypes in relation to occupational exposure to specific organic dusts. Methods: We explored the association in 1853 cases and 1997 controls who participated in the EpiLymph case–control study, conducted in six European countries in 1998–2004. Based on expert assessment of lifetime occupational exposures, we calculated the risk of the major lymphoma subtypes associated with exposure to six specific organic dusts, namely, flour, hardwood, softwood, natural textile, synthetic textile, and leather, and two generic (any types) groups: wood and textile dusts. Risk was predicted with unconditional regression modeling, adjusted by age, gender, study center, and education. Results: We observed a 2.1-fold increase in risk of follicular lymphoma associated with ever exposure to leather dust [95% confidence interval (CI) 1.01–4.20]. After excluding subjects who ever worked in a farm or had ever been exposed to solvents, risk of B-cell lymphoma was elevated in relation to ever exposure to leather dust [odd ratio (OR) 2.2, 95% CI 1.00–4.78], but it was not supported by increasing trends with the exposure metrics. Risk of Hodgkin lymphoma was elevated (OR 2.0, 95% CI 0.95–4.30) for exposure to textile dust, with consistent upward trends by cumulative exposure and three independent exposure metrics combined (P=0.023, and P=0.0068, respectively). Conclusions: Future, larger studies might provide further insights into the nature of the association we observed between exposure to textile dust and risk of Hodgkin lymphoma

Diagnóstico de la producción de plantas forestales en los viveros de la Municipalidad de Guatemala; evaluación del enraizamiento de matilisguate (Tabebuia rosea bertol) y servicios realizados en el Vivero Municipal Acatán, Zona 16, Ciudad De Guatemala, Guatemala, C.A.

El presente trabajo de investigación se orientó hacia la producción de plantas forestales de los viveros de la Municipalidad de Guatemala, referente a distintos criterios de selección del material al momento de plantarse en campo, así como principales modos de propagación que se utilizan en los viveros para abastecer a los distintos proyectos de jardinización y arborización urbana. Mediante el diagnóstico se puedo conoce la situación actual de los sistemas de producción de plantas forestales en los viveros, se determinaron las principales características de las especies forestales que se utilizan para arborización urbana, jardinización, criterios de selección y modos de propagación, encontrándose como principal medio de propagación la semilla y no otras alternativas que agilicen la obtención masal de plántulas de mayor tamaño en el menor tiempo posible. La investigación se dirigió a establecer el un método alternativo para la propagación vegetativa de una especie ampliamente utilizada para arborización urbana: Tabebuia rosea bertol. Se evaluó la respuesta al enraizamiento en vástago, en función de tres concentraciones del ácido Indol3Butírico y tres diámetros de estaca, en plantas en fase de vivero con material juvenil para propagar. La investigación tuvo una duración de 4 meses. El estudio se realizó en el Huerto y Vivero Urbano Municipal Acatán zona 16, ciudad de Guatemala. El resultado de la investigación, demostró que existe respuesta a la propagación vegetativa por la especie bajo estudio, la respuesta fue mayor para el caso de propagación por vástago de 2.5cm. de diámetro y 2500ppm del regulador. Los resultados se midieron en presencia de callo, de raíces, y de brotes; además, peso seco de raíces, altura de la planta. Este resultado es de importancia ya que permite obtener plantas de matilisguate de mayor tamaño en menos tiempo y esto se vería reflejado en el arbolado urbano

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

A 28 nm CMOS 100 MHz 67 dB-Dynamic-Range 968 µW Flipped-Source-Follower Analog Filter

This paper presents a fourth-order continuous-time analog filter based on the cascade of two flipped-source-follower (FSF) biquadratic (biquad) cells. The FSF biquad adopts two interacting loops (the first due to the classic source-follower, and the second to the additional gain path) which lower the impedances of all circuit nodes with relevant benefits in terms of noise power reduction and linearity enhancement. The presented device was integrated in 28 nm CMOS and featured 100 MHz −3 dB bandwidth with 67 dB Dynamic-Range. Input IP3 was 12 dBm at 10 and 11 MHz input tone frequencies. Total power consumption was 0.968 mW (0.484 mW per cell). Hence, the filter performed one of the highest figures-of-merit (160.7 dBJ-1) compared with analog state-of-the-art filters