Airway inflammatory markers in chronic obstructive pulmonary disease patients and healthy smokers

Background: Cigarette smoke with its toxic ingredients leads to chronic inflammations in the airways.Objectives: In this study, the effect of cigarette smoke on the levels of inflammatory markers, interleukin.6 (IL.6), interleukin.8 (IL.8), and tumor necrosis factor.alpha (TNF.ƒ¿) in induced sputum was investigated.Materials and Methods: Twenty patients with chronic obstructive pulmonary disease (COPD) (group I), 20 healthy smokers (group II), and 20 healthy nonsmokers (group III) were included in the study. The levels of IL.6, IL.8, and TNF.ƒ¿ in induced sputum were measured in these groups, and comparison analysis between the groups and correlation analysis for smoking load (pack.years) and spirometric parameters were performed.Results: Mean age of the patients in groups I, II, and III were 61.2 } 1.7, 58.2 } 1.6, and 59.1 } 5.4 years, respectively (P > 0.05). Smoking loads of group I and group II were 38.6 } 2.1 and 29.5 } 2.3 pack.years, respectively (P < 0.05). All cytokine levels were significantly higher in group I than groups II and III (P < 0.05). In addition to this, mean cytokineslevels were significantly higher in group II than group III (P < 0.05). Smoking load of group II subjects was positively correlated with IL.6, IL.8, and TNF.ƒ¿ in induced sputum (P < 0.05).Conclusions: We found that inflammatory marker levels in induced sputum were significantly higher in COPD patients and smokers than nonsmokers. Moreover, there was a moderate positive correlation between IL.6, IL.8, and TNF.ƒ¿ levels and smoking load in the healthy smokers. We think that further studies are needed to determine whether higher levels of cytokine levels in sputum might be helpful in predicting the healthy smokers who will develop COPD in future.Key words: Chronic obstructive pulmonary disease, inflammatory markers, induced sputum, IL.6, IL.8, TNF.ƒ

Endoscopic Unroofing of a Choledochocele

A 42-year-old man with previous laparoscopic cholecystectomy was referred for further evaluation of recurrent acute pancreatitis. Secretin-enhanced magnetic resonance cholangiopancreatography showed a 16 mm × 11 mm T2 hyperintense cystic lesion at the major papilla (Figure 1). Upper endoscopic ultrasound (EUS) showed a 15 mm × 10 mm oval, intramural, subepithelial lesion at the major papilla (Figure 2). Endoscopic retrograde cholangiopancreatography (ERCP) showed an 18-mm bulging lesion at the major papilla with normal overlying mucosa (Figure 3); injected contrast collected into a 16-mm cystic cavity (Figure 4). Findings were suggestive of type A choledochocele. A 10–12-mm freehand precut papillotomy was made with a monofilament needle-knife (Huibregtse Single-Lumen Needle Knife, Cook Medical, Bloomington, IN) using an ERBE VIO electrocautery system (ERBE USA; Marietta, GA). The incision was made as long as safely possible in an attempt to open the choledochocele completely and thus expose its walls and contents. We used a standard pull sphincterotome and ERBE electrocautery to perform the pancreatic sphincterotomy, followed by placement of a pancreatic stent. Biliary sphincterotomy was performed using the same technique (settings for needle-knife and pull sphincterotomies: Endocut I, blend current, effect 2/duration 2/interval 3). Biopsies of the inverted choledochocele showed biliary mucosa and duodenal columnar epithelium with inflammation and fibrosis, and no dysplasia. Follow-up ERCP at 4 weeks showed adequate unroofing of the choledochocele (Figure 5); the pancreatic stent was subsequently removed. The patient reported no recurrence of acute pancreatitis at 6-, 12-, and 18-month follow-up intervals

Nano-oxidation of silicon surfaces: Comparison of noncontact and contact atomic-force microscopy methods

3 pages, 4 figures.Local oxidation lithography by atomic-force microscopy is emerging as a powerful method for nanometer-scale patterning of surfaces. Here, we perform a comparative study of contact and noncontact atomic-force microscopy (AFM) oxidation experiments. The comparison of height and width dependencies on voltage and pulse duration allows establishing noncontact AFM as the optimum local oxidation method. For the same electrical conditions, noncontact AFM oxides exhibit higher aspect ratios (0.04 vs 0.02). The smallness of the liquid meniscus in noncontact AFM oxidation produces smaller oxide widths. We also report a slower oxidation rate in contact AFM oxidation. We explain this result by introducing an effective energy barrier (~0.14 eV) that includes the mechanical work done by the growing oxide against the cantilever (~0.01 eV).This work was financially supported by the Dirección General de Enseñanza Superior e Investigación (PB98-0471) and the European Commission (GR5D-CT- 2000-00349).Peer reviewe

Metachronous gastric metastasis from lung primary, with synchronous pancreatic neuroendocrine carcinoma

The finding of gastric metachronous metastasis, several years after the diagnosis of primary lung large cell carcinoma is rare and incidental. Even more extremely rare is the finding of a synchronous primary pancreas cancer. EUS-FNA with immunohistochemistry is useful for diagnosing metastatic lesions and differentiating those from synchronous primary lesions

Annular pancreas: endoscopic and pancreatographic findings from a tertiary referral ERCP center

Background and Aims Annular pancreas is a congenital anomaly whereby pancreatic tissue encircles the duodenum. Current knowledge of endoscopic findings of annular pancreas is limited to small case series. The aim of this study was to describe the endoscopic and pancreatographic findings of patients with annular pancreas at a large tertiary care ERCP center. Methods This is a retrospective observational study. Our Institutional Review Board–approved, prospectively collected ERCP database was queried for cases of annular pancreas. The electronic medical records were searched for patient and procedure-related data. Results From January 1, 1994, to December 31, 2016, 46 patients with annular pancreas underwent ERCP at our institution. Index ERCP was technically successful in 42 patients (91.3%), and technical success was achieved in all 46 patients (100%) after 2 attempts, when required. A duodenal narrowing or ring was found in most patients (n = 39, 84.8%), yet only 2 (4.3%) had retained gastric contents. Pancreas divisum was found in 21 patients (45.7%), 18 of which were complete divisum. Pancreatobiliary neoplasia was the indication for ERCP in 7 patients (15.2%). Pancreatographic findings consistent with chronic pancreatitis were noted in 15 patients (32.6%) at the index ERCP. Conclusion This is the largest series describing the endoscopic and pancreatographic findings of patients with annular pancreas. We found that 45.7% of patients had concurrent pancreas divisum. Endoscopic therapy was successful in most patients at our institution after 1 ERCP, and in all patients after a second ERCP. Nearly one-third of patients had findings consistent with chronic pancreatitis at the time of index ERCP. It is unclear whether this may be a feature of the natural history of annular pancreas

Geochemistry of fluid inclusions in travertines from Western and Northern Turkey: inferences on the role of active faults in fluids circulation

The understanding of the relationship between the geochemistry of fluids circulating during travertine deposition and the presence of active faults is crucial for evaluating the seismogenetic potential of an area. Here we investigate travertines from Pamukkale and Reşadiye (Turkey), sited in seismic regions and next to thermal springs. These travertines formed ~24,500–50,000 (Pamukkale) and ~240–14,600 years (Reşadiye) BP. We characterize fluid inclusions (FIs) and studied concentration of H2O, CO2, O2 + N2, and 3He, 4He, 20Ne, and 40Ar, and bulk composition (trace elements and δ13C‐δ18O). FIs from both localities are mainly primary with low salinity and homogenization temperature around 136–140 °C. H2O is the major component followed by CO2, with the highest gas content measured in Pamukkale travertines. Concentrations of Ne‐Ar together with O2 + N2 indicate that travertines from both areas precipitated from atmosphere‐derived fluids. The 3He/4He is 0.5–1.3 Ra in Pamukkale and 0.9–4.4 Ra in Reşadiye. Samples with R/Ra > 1 are modified by cosmogenic 3He addition during exposure to cosmic rays. Excluding these data, FIs of Reşadiye are mostly atmosphere‐derived. This implies a shallow formation where the circulation was dominated by meteoric waters, which is consistent with their young age. Instead, FIs of Pamukkale show mixing of mantle‐, crustal‐, and atmosphere‐derived He, indicating that these travertines formed in lithospheric fractures. Based on the δ13CCO2 and δ18O of bulk rocks, we infer that travertines formed involving crustal‐ (mechanochemical rather than organic) and mantle‐derived CO2. Trace elements of Pamukkale and Reşadiye show comparable rare earth element patterns. We conclude that travertines formed in response of seismogenetic activity.Published5473-54982T. Deformazione crostale attiva7T. Variazioni delle caratteristiche crostali e precursori sismici6A. Geochimica per l'ambiente e geologia medicaJCR Journa

Strength in numbers : patient experiences of group exercise within hospice palliative care

Background: Exercise is increasingly recognized as a core component of palliative rehabilitation. The group exercise model is often adopted as a means of reaching more patients with limited resource. Despite the growth of quantitative research examining this area of practice, few qualitative studies have looked at the patient experience of participating in group exercise in a palliative setting, and most exclude patients with a non-cancer diagnosis. Methods: The aim of this study was to explore patients’ experiences of participating in group exercise classes in a hospice setting. In this qualitative, phenomenological study, nine patients participating in a group exercise programme at a South London hospice completed semi-structured interviews. Participants were purposively sampled by gender, age, ethnicity and diagnosis; to include diagnoses across cancer, respiratory and neurological conditions. Transcripts were interpreted using thematic analysis. Results: All patients reported positive experiences of participating in group exercise classes. Improvements reported in physical function had a positive effect on ability to complete activities of daily living and enhanced patient mood. Other reported psychosocial benefits included: promotion of self-management; space and opportunity for reflection; supportive relationships; sharing of information; and a deeper appreciation of patients’ own abilities. Conclusion: This study highlights the positive experiences and value of group exercise classes to groups of people with diverse cancer and non-cancer conditions. The physical, emotional and psychosocial benefits suggest hospices and other palliative services should explore similar programmes as part of their rehabilitation services. The recognition that exercise groups can be mixed and need not be bespoke to one condition has positive cost and staff resource ramifications

Subthalamic nucleus stimulation affects orbitofrontal cortex in facial emotion recognition: a pet study

Deep brain stimulation (DBS) of the bilateral subthalamic nucleus (STN) in Parkinson's disease is thought to produce adverse events such as emotional disorders, and in a recent study, we found fear recognition to be impaired as a result. These changes have been attributed to disturbance of the STN's limbic territory and would appear to confirm that the negative emotion recognition network passes through the STN. In addition, it is now widely acknowledged that damage to the orbitofrontal cortex (OFC), especially the right side, can result in impaired recognition of facial emotions (RFE). In this context, we hypothesized that this reduced recognition of fear is correlated with modifications in the cerebral glucose metabolism of the right OFC. The objective of the present study was first, to reinforce our previous results by demonstrating reduced fear recognition in our Parkinson's disease patient group following STN DBS and, second, to correlate these emotional performances with glucose metabolism using 18FDG-PET. The 18FDG-PET and RFE tasks were both performed by a cohort of 13 Parkinson's disease patients 3 months before and 3 months after surgery for STN DBS. As predicted, we observed a significant reduction in fear recognition following surgery and obtained a positive correlation between these neuropsychological results and changes in glucose metabolism, especially in the right OFC. These results confirm the role of the STN as a key basal ganglia structure in limbic circuits