Somatic molecular analysis augments cytologic evaluation of pancreatic cyst fluids as a diagnostic tool

Objective: Better tools are needed for early diagnosis and classification of pancreatic cystic lesions (PCL) to trigger intervention before neoplastic precursor lesions progress to adenocarcinoma. We evaluated the capacity of molecular analysis to improve the accuracy of cytologic diagnosis for PCL with an emphasis on non-diagnostic/negative specimens. Design: In a span of 7 years, at a tertiary care hospital, 318 PCL endoscopic ultrasound-guided fine needle aspirations (EUS-FNA) were evaluated by cytologic examination and molecular analysis. Mucinous PCL were identified based on a clinical algorithm and 46 surgical resections were used to verify this approach. The mutation allele frequency (MAF) of commonly altered genes (BRAF, CDKN2A, CTNNB1, GNAS, RAS, PIK3CA, PTEN, SMAD4, TP53 and VHL) was evaluated for their ability to identify and grade mucinous PCL. Results: Cytology showed a diagnostic sensitivity of 43.5% for mucinous PCL due in part to the impact of non-diagnostic (28.8%) and negative (50.5%) specimens. Incorporating an algorithmic approach or molecular analysis markedly increased the accuracy of cytologic evaluation. Detection of mucinous PCL by molecular analysis was 93.3% based on the detection of KRAS and/or GNAS gene mutations (p = 0.0001). Additional genes provided a marginal improvement in sensitivity but were associated with cyst type (e.g. VHL) and grade (e.g. SMAD4). In the surgical cohort, molecular analysis and the proposed algorithm showed comparable sensitivity (88.9% vs. 100%). Conclusions: Incorporating somatic molecular analysis in the cytologic evaluation of EUS-FNA increases diagnostic accuracy for detection, classification and grading of PCL. This approach has the potential to improve patient management

COMPARISON BETWEEN ABSORBED DOSES IN TARGET ORGANS IN PANORAMIC RADIOGRAPHY, USING SINGLE EMULSION AND DOUBLE EMULSION FILMS

"nThe use of panoramic radiography, due to its numerous advantages, is increasing. Radiographic films used in this technique are of double emulsion (DE) type which are used with intensifying screens. Single emulsion (SE) films can also be used. The purpose of this study was to determine the exposure parameters to achieve an appropriate optical density in these two types of films, and to estimate under such parameters, radiation doses to mandibular bone marrow (MBM), thyroid gland and parotid gland. This study was performed through a tissue equivalent phantom. First, with various tube voltage and tube current, 128 radiographs were taken of phantom with these two types of films. After examining the optical densities, the exposure parameters under which both films have the same density, were determined. Then, phantom again was exposed and MBM, thyroid gland and parotid gland absorbed doses were measured, using TLDs. It was demonstrated that: 1) SE films, in order to provide appropriate optical density, require two times radiation in comparison with double emulsion film; 2) using SE films increases MBM dose, up to 2-2.5 times, thyroid gland dose up to 1.7-2 times and parotid gland dose up to 1.3 times, in comparison with DE films; 3) in DE films, under lower exposure parameters and desirable processing, MBM dose up to 3.5 times, thyroid gland dose up to 1.5 times and parotid gland dose up to 2.5 times will increase. Considering that the risk of radiation induced cancers increases with repeated radiation doses, using SE films is not recommended

Prevalence of Obesity and Its Association with Socioeconomic Factors in Elderly Iranians from Razavi-Khorasan Province

There are few data regarding the prevalence of obesity and its socioeconomic determinants among elderly individuals, particularly in Iran. We wished to determine the prevalence of overweight and obesity in free-living elderly people and the relationship to nutritional and socioeconomic factors in the Razavi-Khorasan province of Iran. Free-living elderly persons (917 males/1045 females), aged ?60 years, were recruited using cluster sampling. Overweight and obesity were evaluated using body mass index (BMI) and subjects were categorized as thin (BMI <18.5 kg/m2), normal (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), and obese (?30 kg/m2). The association between the prevalence of overweight or obesity with socioeconomic and demographic factors, including gender, place of residence, literacy, type of living, source of income, use of supplements during the past 3 months, and employment status, was examined using regression analysis. The distribution of BMI values indicated that 13, 46.5, 28.9, and 11.7% of the total population were thin, normal, overweight, and obese, respectively. The prevalence of central obesity was higher among Iranian women than men (63.1 vs. 18.6%, respectively). Regression analysis results indicated that gender (p < 0.001), place of residence (p < 0.001), literacy (p = 0.01), and source of income (p < 0.001) were significantly associated with the incidence of overweight or obesity. This study showed that 40.6% of elderly subjects were overweight or obese. Results reinforce the need to plan strategies for primary prevention of this fast-growing public health problem