EUS-guided portal pressure gradient measurement with a simple novel device: a human pilot study.

Background and aimsPortal hypertension is a serious adverse event of liver cirrhosis. Recently, we developed a simple novel technique for EUS-guided portal pressure gradient (PPG) measurement (PPGM). Our animal studies showed excellent correlation between EUS-PPGM and interventional radiology-acquired PPGM. In this video we demonstrate the results of the first human pilot study of EUS-PPGM in patients with liver disease.MethodsEUS-PPGM was performed by experienced endosonographers using a linear echoendoscope, a 25-gauge FNA needle, and a novel compact manometer. The portal vein and hepatic vein (or inferior vena cava) were targeted by use of a transgastric or transduodenal approach. Feasibility was defined as successful PPGM in each patient. Safety was based on adverse events captured in a postprocedural interview.ResultsTwenty-eight patients underwent EUS-PPGM with 100% technical success and no adverse events. PPG ranged from 1.5 to 19 mm Hg and had excellent correlation with clinical parameters of portal hypertension, including the presence of varices (P = .0002), PH gastropathy (P = .007), and thrombocytopenia (P = .036).ConclusionThis novel technique of EUS-PPGM using a 25-gauge needle and compact manometer is feasible and appears safe. Given the availability of EUS and the simplicity of the manometry setup, EUS-guided PPG may represent a promising breakthrough for procuring indispensable information in the management of patients with liver disease

Management of an Accessory Bile Duct Leak Following Pancreaticoduodenectomy: A Novel Approach Utilizing a Percutaneous and Endoscopic Rendezvous.

Biliary leaks are uncommon but morbid complications of pancreaticoduodenectomies, which have historically been managed with percutaneous drainage, reoperation, or a combination of both. We report a de novo percutaneous-endoscopic hepaticojejunostomy from an anomalous right hepatic duct injured during pancreaticoduodenectomy to the afferent bowel limb. The percutaneous-endoscopic hepaticojejunostomy was stented to allow for tract formation with successful stent removal after 5.5 months. One year after the creation of the percutaneous-endoscopic hepaticojejunostomy, the patient remains clinically well without evidence of biliary leak or obstruction

Surgical Treatment of Benign Spinal Cord Tumors

Benign spinal cord tumors (SCTs) are uncommon neoplasms that can arise within or adjacent to the spinal cord. Depending on their anatomical location, benign SCTs can be categorized as intramedullary, intradural-extramedullary, and extradural. The three most common benign SCTs are meningioma, nerve sheath tumors, and ependymoma. Both meningioma and nerve sheath tumors develop in the intradural-extramedullary compartment, while ependymoma occurs in the intramedullary space. Spinal meningiomas derive from arachnoidal cells and most commonly occur within the thoracic segment of the spine. Nerve sheath tumors, including schwannomas and neurofibromas, are closely associated with spinal nerves. Half of the spinal cord ependymomas arise in the lumbosacral segment or the filum terminale. Surgical treatment of large or symptomatic benign SCTs concentrates on total or subtotal resection of the tumors, which should be cautiously individualized based on the tumor location and histopathology. A curable complete resection should be achieved if possible while preserving the nervous function of the spinal cord and minimizing potential complications. Thoracic spinal roots may be sacrificed to acquire a total resection, yet cervical and lumbar nerve roots should be preserved prudently. Due to the vulnerable and complex anatomic nature of the spinal cord, maximal resection of the tumors can be achieved with the aid of appropriate intraoperative neural monitoring and meanwhile preserve nervous function

Immunotherapy for Glioblastomas

Glioblastoma (GBM), a WHO grade IV brain tumor, is an aggressive tumor with poor prognosis; even with current standard care of triple therapy, consisting of surgical resection, chemo and radiation therapy, the patients’ median survival time is only approximately 15 months. Recent practice shows that immunotherapy made some progress in some other solid tumors, like melanoma or non-small cell lung cancer. This chapter is going to review some advances in immunotherapy for GBM

An interleaved sampling scheme for the characterization of single qubit dynamics

In this paper, we demonstrate that interleaved sampling techniques can be used to characterize the Hamiltonian of a qubit and its environmental decoherence rate. The technique offers a significant advantage in terms of the number of measurements that are required to characterize a qubit. When compared to the standard Nyquist-Shannon sampling rate, the saving in the total measurement time for the interleaved method is approximately proportional to the ratio of the sample rates.Comment: 9 pages, 4 figure

Frequency Tracking and Parameter Estimation for Robust Quantum State-Estimation

In this paper we consider the problem of tracking the state of a quantum system via a continuous measurement. If the system Hamiltonian is known precisely, this merely requires integrating the appropriate stochastic master equation. However, even a small error in the assumed Hamiltonian can render this approach useless. The natural answer to this problem is to include the parameters of the Hamiltonian as part of the estimation problem, and the full Bayesian solution to this task provides a state-estimate that is robust against uncertainties. However, this approach requires considerable computational overhead. Here we consider a single qubit in which the Hamiltonian contains a single unknown parameter. We show that classical frequency estimation techniques greatly reduce the computational overhead associated with Bayesian estimation and provide accurate estimates for the qubit frequencyComment: 6 figures, 13 page

Molecular Diagnostics and Pathology of Major Brain Tumors

Tumors of central nervous system (CNS) account for a small portion of tumors of human body, which include tumors occurring in the parenchyma of brain and spinal cord as well as their coverings. The following chapter covers some new development in some major brain tumors in both pediatric and adult populations, as well as some uncommon but diagnostic and management challenging tumors

The association between distal findings and proximal colorectal neoplasia: a systematic review and meta-analysis

Objectives: Whether screening participants with distal hyperplastic polyps (HPs) detected by flexible sigmoidoscopy (FS) should be followed by subsequent colonoscopy is controversial. We evaluated the association between distal HPs and proximal neoplasia (PN)/advanced proximal neoplasia (APN) in asymptomatic, average-risk patients. Methods: We searched Ovid Medline, EMBASE, and the Cochrane Library from inception to 30 June 2016 and included all screening studies that examined the relationship between different distal findings and PN/APN. Data were independently extracted by two reviewers with disagreements resolved by a third reviewer. We pooled absolute risks and odds ratios (ORs) with a random effects meta-analysis. Seven subgroup analyses were performed according to study characteristics. Heterogeneity was characterized with theI2 statistics. Results: We analyzed 28 studies (104,961 subjects). When compared with normal distal findings, distal HP was not associated with PN (OR=1.16, 95% confidence interval (CI)=0.89–1.51,P=0.14,I2=40%) or APN (OR=1.09, 95% CI=0.87–1.36,P=0.39,I2=5%), while subjects with distal non-advanced or advanced adenoma had higher odds of PN/APN. Higher odds of PN/APN were observed for more severe distal lesions. Weaker association between distal and proximal findings was noticed in studies with higher quality, larger sample size, population-based design, and more stringent endoscopy quality-control measures. The Egger’s regression tests showed allP>0.05. Conclusions: Distal HP is not associated with PN/APN in asymptomatic screening population when compared with normal distal findings. Hence, the presence of distal HP alone detected by FS does not automatically indicate colonoscopy referral for all screening participants, as other risk factors of PN/APN should be considered