Anatomical pancreatic variants in intraductal papillary mucinous neoplasm patients : a cross-sectional study

Background No previous studies have examined the possible relationship between intraductal papillary mucinous neoplasm (IPMN) and the developmental ductal variations of the pancreas, such as an ansa pancreatica and a meandering main pancreatic duct (MMPD). Methods This retrospective cross-sectional study enrolled 214 patients, 108 with IPMN disease and 106 subjects from a community at the tertiary care unit. The main pancreatic duct (MPD) was evaluated in the head of the pancreas by its course, which were non-MMPD: descending, vertical, and sigmoid, or MMPD including loop types, reverse-Z subtypes, and an N-shape, which was identified for the first time in this study. IPMN patients were also evaluated for worrisome features (WF) or high-risk stigmata (HRS), and the extent of IPMN cysts. Results Among IPMN patients, 18.4% had MMPD, which we observed in only 3.0% of the control group (P < 0.001). Patients with MMPD were more likely to belong to the IPMN group compared with non-MMPD patients [odds ratio (OR) 6.4, 95% confidence interval (CI) 2.2-24.9]. Compared with a descending shape MPD, IPMN patients with an N-shaped MPD were more likely to have a cystic mural nodule (OR 5.9, 95% CI 1.02-36.0). The presence of ansa pancreatica associated with more extent IPMN disease (OR 12.8, 95% CI 2.6-127.7). Conclusions IPMN patients exhibited an MMPD more often than control patients. Ansa pancreatica associated with multiple cysts. Furthermore, an N-shape in IPMN patients associated with cystic mural nodules, suggesting that this shape serves as a risk factor for more severe IPMN.Peer reviewe

Kapillarielektroforeesi rikostekniikassa

Tiivistelmä. Kapillaarielektroforeesi on erotusmenetelmä, jonka avulla voidaan erottaa hiukkaset toisistaan. Erotus perustuu hiukkasten erilaisiin liikkuvuuksiin nesteessä, mihin on luotu sähkökenttä. Laitteen selkeimpiä etuja on sen monipuolisuus sekä erittäin hyvä selektiivisyys. Rikosteknisissä tutkimuksissa laite onkin antanut uusia mahdollisuuksia esimerkiksi enatiomeerien selvittämiseksi. Rikostekniset tutkimukset ovat haastavia, sillä monet muuttujat vaikuttavat mittaustuloksiin. Näytteet koostuvat usean komponentin yhdistelmistä ja erilaiset kontaminaatiot näytteenotossa tuovat lisähaastetta analyyseihin. Tämän vuoksi näytteen analysoitavat spesiekset tulee erottaa toisistaan, jonka jälkeen saadaan virhemarginaalien sisällä olevia mittaustuloksia. Kapillaarielektroforeesia voidaan hyödyntää, kun analysoidaan esimerkiksi musteiden koostumuksia, dna-näytteitä ja huumausaineiden enatiomeerejä. Musteanalyysit kapillaarielektroforeesilla ovat osoittautuneet hyödylliseksi väärennöstutkimuksissa. Musteista on saatu analysoitua pääkomponentit ja tämän jälkeen on voitu karakterisoida eri valmistajien musteet. Karakterisoinnin avulla voidaan kertoa virallisista dokumenteista mitkä ovat väärennettyjä ja mitkä alkuperäisiä. Tulevaisuudessa kapillaarielektroforeesia tullaan kehittämään ja hyödyntämään rikostekniikassa. Laite on monipuolinen, jonka vuoksi sitä voidaan soveltaa yhä useampaan tutkimuksen kohteeseen. Laitteen mahdollisuudet ovat tämän takia suuret, jonka vuoksi uusia ja erilaisia tutkimuksia voidaan olettaa erilaisilta aloilta

Risk of donor-site lymphatic vessel dysfunction after microvascular lymph node transfer

BACKGROUND: Microvascular lymph node transfer has been used to improve lymphatic function in patients with lymphoedema. We previously reported changes in the lymphatic function of the donor limb after lymph node transfer. For this reason, we modified our surgical method to be more conservative. SUBJECTS AND METHODS: Microvascular lymph node transfer was performed in 13 patients using the previously reported original method. Sixteen patients were operated upon using the more conservative modified method. Lymphatic function in the donor limb was evaluated using volumetry, lymphoscintigraphy and tissue water percentage. RESULTS: In the original method group, the donor-limb volume was on average greater (199 ± 540 ml) than in the non-operated control limb. The volume difference between the limbs was smaller (151 ± 463 ml) in the modified method group. Two patients in the original method group had abnormal transport index (Ti) values in lymphoscintigraphy indicating decreased lymphatic function of the donor limb. In the modified method group, the Ti-values remained normal. The tissue water percentage of the donor limb was on average 40% ± 4% in the original method group and 40% ± 3% in the modified method group. Importantly, none of the patients in either group developed clinical lymphoedema in the donor limb during the 11-84-month follow-up. CONCLUSIONS: Even with the more conservative lymph node transfer method, we can observe slight, subclinical signs of lymphatic dysfunction in the donor limb. These results highlight the importance of minimizing the surgical exploration in the inguinal area and avoiding damage to the lymphatic vessels or sentinel nodes draining the lower limb.</p

On dimension reduction in Gaussian filters

A priori dimension reduction is a widely adopted technique for reducing the computational complexity of stationary inverse problems. In this setting, the solution of an inverse problem is parameterized by a low-dimensional basis that is often obtained from the truncated Karhunen-Loeve expansion of the prior distribution. For high-dimensional inverse problems equipped with smoothing priors, this technique can lead to drastic reductions in parameter dimension and significant computational savings. In this paper, we extend the concept of a priori dimension reduction to non-stationary inverse problems, in which the goal is to sequentially infer the state of a dynamical system. Our approach proceeds in an offline-online fashion. We first identify a low-dimensional subspace in the state space before solving the inverse problem (the offline phase), using either the method of "snapshots" or regularized covariance estimation. Then this subspace is used to reduce the computational complexity of various filtering algorithms - including the Kalman filter, extended Kalman filter, and ensemble Kalman filter - within a novel subspace-constrained Bayesian prediction-and-update procedure (the online phase). We demonstrate the performance of our new dimension reduction approach on various numerical examples. In some test cases, our approach reduces the dimensionality of the original problem by orders of magnitude and yields up to two orders of magnitude in computational savings

Aerosol formation and growth rates from chamber experiments using Kalman smoothing

Bayesian state estimation in the form of Kalman smoothing was applied to differential mobility analyser train (DMA-train) measurements of aerosol size distribution dynamics. Four experiments were analysed in order to estimate the aerosol size distribution, formation rate, and size-dependent growth rate, as functions of time. The first analysed case was a synthetic one, generated by a detailed aerosol dynamics model and the other three chamber experiments performed at the CERN CLOUD facility. The estimated formation and growth rates were compared with other methods used earlier for the CLOUD data and with the true values for the computer-generated synthetic experiment. The agreement in the growth rates was very good for all studied cases: estimations with an earlier method fell within the uncertainty limits of the Kalman smoother results. The formation rates also matched well, within roughly a factor of 2.5 in all cases, which can be considered very good considering the fact that they were estimated from data given by two different instruments, the other being the particle size magnifier (PSM), which is known to have large uncertainties close to its detection limit. The presented fixed interval Kalman smoother (FIKS) method has clear advantages compared with earlier methods that have been applied to this kind of data. First, FIKS can reconstruct the size distribution between possible size gaps in the measurement in such a way that it is consistent with aerosol size distribution dynamics theory, and second, the method gives rise to direct and reliable estimation of size distribution and process rate uncertainties if the uncertainties in the kernel functions and numerical models are known.Bayesian state estimation in the form of Kalman smoothing was applied to differential mobility analyser train (DMA-train) measurements of aerosol size distribution dynamics. Four experiments were analysed in order to estimate the aerosol size distribution, formation rate, and size-dependent growth rate, as functions of time. The first analysed case was a synthetic one, generated by a detailed aerosol dynamics model and the other three chamber experiments performed at the CERN CLOUD facility. The estimated formation and growth rates were compared with other methods used earlier for the CLOUD data and with the true values for the computer-generated synthetic experiment. The agreement in the growth rates was very good for all studied cases: estimations with an earlier method fell within the uncertainty limits of the Kalman smoother results. The formation rates also matched well, within roughly a factor of 2.5 in all cases, which can be considered very good considering the fact that they were estimated from data given by two different instruments, the other being the particle size magnifier (PSM), which is known to have large uncertainties close to its detection limit. The presented fixed interval Kalman smoother (FIKS) method has clear advantages compared with earlier methods that have been applied to this kind of data. First, FIKS can reconstruct the size distribution between possible size gaps in the measurement in such a way that it is consistent with aerosol size distribution dynamics theory, and second, the method gives rise to direct and reliable estimation of size distribution and process rate uncertainties if the un-certainties in the kernel functions and numerical models are known.Peer reviewe

MRI follow-up for pancreatic intraductal papillary mucinous neoplasm : an ultrashort versus long protocol

Purpose To evaluate whether an ultrashort-protocol (USP) MRI including only T2-weighted HASTE axial and 3D MRCP SPACE sequences adequately measures the largest diameter of the largest cyst and the main pancreatic duct (MPD) and identifies worrisome features (WF) and high-risk stigmata (HRS) when compared to longer protocols (LP, long protocol; SP, short protocol; S-LP, short or long protocol). We also calculated reductions in costs associated with USP. Methods This retrospective study included 183 IPMN patients. Two radiologists compared two imaging sets (USP versus S-LP) per patient, comparing the mean values of the largest cyst and MPD and agreement regarding the presence or absence of cystic or MPD mural nodules and solid pancreatic tumors. The interobserver agreement for cystic mural nodules and WF/HRS was evaluated, using the Bland-Altman plot and Cohen's Kappa. Results A total of 112 IPMN patients were evaluated. For detecting cysts or MPD nodules, WF/HRS, and solid pancreatic tumors, USP and S-LP coincided in 94.9%, 99.1%, 92.4%, and 99.1% of cases, respectively. Both USP and S-LP identified all true cystic mural nodules. The mean size of the largest cyst and MPD was 19.48/19.67 mm and 3.24/3.33 mm using USP versus S-LP, while the mean differences for USP versus S-LP were 0.19 mm and 0.08 mm. The USP cost was 39% of LP cost and 77% of SP. Interobserver agreement was moderate to strong. Conclusions For IPMN surveillance, an ultrashort-protocol MRI provides nearly identical information to the more expensive longer protocols.Peer reviewe

Inhibition of rubella virus replication by the broad-spectrum drug nitazoxanide in cell culture and in a patient with a primary immune deficiency

Persistent rubella virus (RV) infection has been associated with various pathologies such as congenital rubella syndrome, Fuchs's uveitis, and cutaneous granulomas in patients with primary immune deficiencies (PID). Currently there are no drugs to treat RV infections. Nitazoxanide (NTZ) is an FDA-approved drug for parasitic infections, and has been recently shown to have broad-spectrum antiviral activities. Here we found that empiric 2-month therapy with oral NTZ was associated in the decline/elimination of RV antigen from lesions in a PID patient with RV positive granulomas, while peginterferon treatment had no effect. In addition, we characterized the effects of NTZ on cell culture models of persistent RV infection. NTZ significantly inhibited RV replication in a primary culture of human umbilical vein endothelial cells (HUVEC) and Vero and A549 epithelial cell lines in a dose dependent manner with an average 50% inhibitory concentration of 0.35 mu g/ml (1.1 mu M). RV strains representing currently circulating genotypes were inhibited to a similar extent. NTZ affected early and late stages of infection by inhibiting synthesis of cellular and RV RNA and interfering with intracellular trafficking of the RV surface glycoproteins, E1 and E2. These results suggest a potential application of NTZ for the treatment of persistent rubella infections, but more studies are required.Peer reviewe

A retrospective study of intraductal papillary neoplasia of the pancreas (IPMN) under surveillance

Background and objective: The growing number of identified intraductal papillary mucinous neoplasm (IPMN) patients places greater pressure on healthcare systems. Only a minority of patients have IPMN-related symptoms. Thus, more precise surveillance is required. Methods: In this retrospective single-center cross-sectional study, patients with an active diagnosis of branch duct IPMN (BD-IPMN) and >6 months of surveillance were classified as follows: presence/absence of worrisome features (WF) or high-risk stigmata (HRS), newly developed WF/HRS, under/over 15 mm cyst, growing/not growingPeer reviewe

Adolescent Verbal Memory as a Psychosis Endophenotype: A Genome-Wide Association Study in an Ancestrally Diverse Sample

Verbal memory impairment is one of the most prominent cognitive deficits in psychosis. However, few studies have investigated the genetic basis of verbal memory in a neurodevelopmental context, and most genome-wide association studies (GWASs) have been conducted in European-ancestry populations. We conducted a GWAS on verbal memory in a maximum of 11,017 participants aged 8.9 to 11.1 years in the Adolescent Brain Cognitive Development Study®, recruited from a diverse population in the United States. Verbal memory was assessed by the Rey Auditory Verbal Learning Test, which included three measures of verbal memory: immediate recall, short-delay recall, and long-delay recall. We adopted a mixed-model approach to perform a joint GWAS of all participants, adjusting for ancestral background and familial relatedness. The inclusion of participants from all ancestries increased the power of the GWAS. Two novel genome-wide significant associations were found for short-delay and long-delay recall verbal memory. In particular, one locus (rs9896243) associated with long-delay recall was mapped to the NSF (N-Ethylmaleimide Sensitive Factor, Vesicle Fusing ATPase) gene, indicating the role of membrane fusion in adolescent verbal memory. Based on the GWAS in the European subset, we estimated the SNP-heritability to be 15% to 29% for the three verbal memory traits. We found that verbal memory was genetically correlated with schizophrenia, providing further evidence supporting verbal memory as an endophenotype for psychosis