Carcinoma involving the gallbladder: a retrospective review of 23 cases - pitfalls in diagnosis of gallbladder carcinoma

<p>Abstract</p> <p>Background</p> <p>Carcinoma of the gallbladder (GBC) clinically mimics benign gallbladder diseases and often escapes detection until advanced stage. Despite the frequency of cholecystectomy, diagnosis of GBC remains problematic in many situations. We sought to identify pathologic features that contribute to the difficulty in recognition of GBC.</p> <p>Methods</p> <p>We identified 23 patients (ranged from 45 to 86 years, male to female ratio 1:4.5) with carcinoma involving the gallbladder referred to an academic medical center over a period of 10 years for study. This includes 10 cases of primary GBC, 6 cases of metastatic tumor to gallbladder, 6 cases of directly invasive adenocarcinoma arising elsewhere in the biliary tree, and one case of unidentified origin adenocarcinoma. Primary tumors include adenocarcinoma not otherwise specified (NOS) in 6 cases, papillary adenocarcinoma in 2 cases, and single cases of undifferentiated carcinoma and combined adenocarcinoma and neuroendocrine carcinoma (NEC). Metastatic tumors to gallbladder were from a wide range of primary sites, predominantly the gastrointestinal tract.</p> <p>Results</p> <p>These cases illustrate seven potential pitfalls which can be encountered. These include: 1) mistakenly making a diagnosis of adenocarcinoma of gallbladder when only benign lesions such as deeply penetrating Rokitansky-Aschoff sinuses are present (overdiagnosis), 2) misdiagnosing well-differentiated invasive carcinoma with minimal disease as benign disease (underdiagnosis), 3) differentiating between primary NEC of gallbladder and metastasis, 4) confusing primary mucinous adenocarcinoma of gallbladder with pseudomyxoma peritonei from a low grade appendiceal neoplasm disseminated to gallbladder, 5) confusing gangrenous necrosis related to cholecystitis with geographic tumoral necrosis, 6) undersampling early, grossly occult disease, and 7) misinterpreting extracellular mucin pools.</p> <p>Conclusions</p> <p>Clinical history and a high index of suspicion are prerequisite to detecting GBC. Detection of GBC at an early stage is difficult because the symptoms mimic benign gallbladder diseases. Misinterpretation of subtle microscopic abnormalities contributes diagnostic failures in early cases. Careful attention to any evidence of mural thickening, thorough sampling, particularly in older patients, and close examination of any deeply situated glandular structures are critical. Correlations with radiographic and clinical findings are important helps to avoid misdiagnosis in this commonly resected organ.</p

Teachers’ Beliefs and Practices Regarding Assessment in English as a Foreign Language Classrooms in Vietnam

Task-based language teaching (TBLT) has generated worldwide popularity as a curriculum innovation, and extensive research has investigated various aspects of the approach. However, little is known about the implementation of classroom assessment in TBLT curricula. This study investigated high school English as a foreign language teachers’ beliefs and practices regarding assessment in a curriculum innovation context in Vietnam. Data comprised in-depth interviews with six teachers, as well as testing documents. The findings revealed a strong impact of the high-stakes exams on teachers’ testing beliefs in that they focused explicitly on linguistic items in the assessed content and forms of assessment. These beliefs were accurately reflected in their testing practices. However, both the teachers’ beliefs and practices were contradictory to teaching principles and the expectations of the intended curriculum. These findings suggest that in-service teacher professional development programs are necessary for innovations like TBLT to have a real change in the classroom

Ranking load in microgrid based on fuzzy analytic hierarchy process and technique for order of preference by similarity to ideal solution algorithm for load shedding problem

This paper proposes a method to rank the loads in the microgrid by means of a weight that combines the criteria together in terms of both technical and economic aspects. The fuzzy analytic hierarchy process technique for order of preference by similarity to ideal solution (fuzzy AHP TOPSIS) algorithm is used to calculate this combined weight. The criteria to be considered are load importance factor (LIF), voltage electrical distance (VED) and voltage sensitivity index (VSI). The fuzzy algorithm helps to fuzzy the judgment matrix of the analytic hierarchy process (AHP) method, making it easier to compare objects with each other and remove the uncertainty of the AHP method. The technique for order of preference by similarity to ideal solution (TOPSIS) algorithm is used to normalize the decision matrix, determine the positive and negative ideal solutions to calculate the index of proximity to the ideal solution, and finally rank all the alternatives. The combination of fuzzy AHP and TOPSIS algorithms is the optimal combination for decision making and ranking problems in a multi-criteria environment. The 19-bus microgrid system is applied to calculate and demonstrate the effectiveness of the proposed method

Evaluation Of Allelopathic Potential Of Cissus sicyoides Against the Growth Of Echinochloa Crus-Galli And Some Tested Plants

Many plant species in nature exert significant allelopathic potential as part of the defense mechanism system, many among their secondary metabolites (allelochemicals), including mineral constituents, which are responsible for the suppression of weeds and enhancing crop yield when directly incorporated into paddy fields. Cissus sicyoides is considered a high-potential allelopathic plant because of its invasion in nature and detected allelochemicals from the plant parts in some studies. The objective of this research was to exploit the allelopathic properties of C.sicyoides against paddy weeds and some indicator plants under laboratory bioassays and greenhouse conditions. The results demonstrated that C. sicyoides had significant inhibition on E. crus-galli, tested plants, and other paddy weeds. In the laboratory conditions, the extracts from C.sicyoides leaves inhibited the growth of Echinochloa crus-galli by 54.3%. The powders from C.sicyoides leaves inhibited the emergence of paddy weeds by approximately 100.0%. In the greenhouse conditions, the powders from C.sicyoides leaves by adding after 3 and 13 days inhibited the growth of E. crus-galli and the emergence of paddy weeds by 64.4%. Remarkably, negligible harmful effects on rice growth were observed. The findings of the study may provide useful information for the exploitation of this plant species to effectively control weeds in the rice fields for sustainable agriculture production

Taxonomic assignment for large-scale metagenomic data on high-perfomance systems

Metagenomics is a powerful approach to study environment samples which do not require the isolation and cultivation of individual organisms. One of the essential tasks in a metagenomic project is to identify the origin of reads, referred to as taxonomic assignment. Due to the fact that each metagenomic project has to analyze large-scale datasets, the metatenomic assignment is very much computation intensive. This study proposes a parallel algorithm for the taxonomic assignment problem, called SeMetaPL, which aims to deal with the computational challenge. The proposed algorithm is evaluated with both simulated and real datasets on a high performance computing system. Experimental results demonstrate that the algorithm is able to achieve good performance and utilize resources of the system efficiently. The software implementing the algorithm and all test datasets can be downloaded at http://it.hcmute.edu.vn/bioinfo/metapro/SeMetaPL.html

Effects of protein levels of commercial diets on the growth performance and survival rate of rabbitfish (Siganus guttatus) at the nursing stage

This study aimed to determine the effect of a commercial diet's protein level on the fry-to-fingerling stage. Thirty days-old fries having the initial length and weight of 18.25 ± 0.15 mm fish-1 and 0.036 ± 0.50 g fish-1 respectively have been used in this study. Diet having three protein levels i.e. 30% (trial 1 as control), 35% (trial 2), 40% (trial 3), and 45% (trial 4), respectively, have been used to evaluate the effect of protein, and each trial has been repeated three times. During the study, stocking density was allocated to 1000 fish per composite tank with a volume of 1 m3. After 30 days of rearing, the weight of fingerlings in trial 1 reached up to 1.50 ± 0.02 g fish-1 and it was recorded as 1.52 ± 0.01g for trial 2, these two were lower than that of trials 3 and 4, where fingerling weight was reported 1.69 ± 0.01 and 1.58g fish-1 respectively and obtained the best weight compared to others. The length of fingerlings at the end of the experimental period was also changed in different trials and it was recorded 47.12; 46.92; 50.97; and 48.89 mm fish-1 for trail 1, 2, 3, and 4 respectively, among the tested combinations lower fingerlings length was recorded for trial 2 (35% CP), but it is not significantly different for trial 1 and 2 and a significant difference (P &lt; 0.05) was reported for trail 2, 3, and 4. The survival rate of fingerlings ranged from 67.27 to 72.33%. Meanwhile, the herd distribution coefficient variation (CVW) in the treatment using 40% protein (trial 3) was the highest at 72.33% (p &lt; 0.05). The results of the study can be concluded that the level of protein has a significant effect on the various growth parameters of fingerlings

Prevalence of Opisthorchis viverrini-like fluke infection in ducks in Binh Dinh Province, Central Vietnam

Following the first report of Opisthorchis viverrini infection in a domestic duck in Phu My District of Binh Dinh Province, Central Vietnam, many other cases were observed in the province. We determined the infection rate and intensity of O. viverrini infection in ducks in 4 districts of the province. A total of 178 ducks were randomly selected from 34 farms for examination of flukes in the liver and gall bladder. An infection rate of 34.3% (range 20.7-40.4% among districts) was found; the intensity of infection was 13.8 worms per infected duck (range 1-100). These findings show the role of ducks as a host for O. viverrini, duck genotype, which is sympatric with the human O. viverrini genotype in this province. It also stresses the need for investigations on the zoonotic potential and the life cycle of this parasite

Nanomaterial for Adjuvants Vaccine: Practical Applications and Prospects

Vaccines contain adjuvants to strengthen the immune responses of the receiver against pathogen infection or malignancy. A new generation of adjuvants is being developed to give more robust antigen-specific responses, specific types of immune responses, and a high margin of safety. By changing the physical and chemical properties of nanomaterials, it is possible to make antigen-delivery systems with high bioavailability, controlled and sustained release patterns, and the ability to target and image. Nanomaterials can modulate the immune system so that cellular and humoral immune responses more closely resemble those desired. The use of nanoparticles as adjuvants is believed to significantly improve the immunological outcomes of vaccination because of the combination of their immunomodulatory and delivery effects. In this review, we discuss the recent developments in new adjuvants using nanomaterials. Based on three main vaccines, the subunit, DNA, and RNA vaccines, the possible ways that nanomaterials change the immune responses caused by vaccines, such as a charge on the surface or a change to the surface, and how they affect the immunological results have been studied. This study aims to provide succinct information on the use of nanomaterials for COVID-19 vaccines and possible new applications

Simultaneously induced mutations in eIF4E genes by CRISPR/Cas9 enhance PVY resistance in tobacco

Tobacco is an important commercial crop and a rich source of alkaloids for pharmaceutical and agricultural applications. However, its yield can be reduced by up to 70% due to virus infections, especially by a potyvirus Potato virus Y (PVY). The replication of PVY relies on host factors, and eukaryotic translation initiation factor 4Es (eIF4Es) have already been identified as recessive resistance genes against potyviruses in many plant species. To investigate the molecular basis of PVY resistance in the widely cultivated allotetraploid tobacco variety K326, we developed a dual guide RNA CRISPR/Cas9 system for combinatorial gene editing of two clades, eIF4E1 (eIF4E1-S and eIF4E1-T) and eIF4E2 (eIF4E2-S and eIF4E2-T) in the eIF4E gene family comprising six members in tobacco. We screened for CRISPR/Cas9-induced mutations by heteroduplex analysis and Sanger sequencing, and monitored PVY(O) accumulation in virus challenged regenerated plants by DAS-ELISA both in T0 and T1 generations. We found that all T0 lines carrying targeted mutations in the eIF4E1-S gene displayed enhanced resistance to PVY(O) confirming previous reports. More importantly, our combinatorial approach revealed that eIF4E1-S is necessary but not sufficient for complete PVY resistance. Only the quadruple mutants harboring loss-of-function mutations in eIF4E1-S, eIF4E1-T, eIF4E2-S and eIF4E2-T showed heritable high-level resistance to PVY(O) in tobacco. Our work highlights the importance of understanding host factor redundancy in virus replication and provides a roadmap to generate virus resistance by combinatorial CRISPR/Cas9-mediated editing in non-model crop plants with complex genomes