Diagnostic accuracy of laparoscopy following computed tomography (CT) scanning for assessing the resectability with curative intent in pancreatic and periampullary cancer

BACKGROUND: Surgical resection is the only potentially curative treatment for pancreatic and periampullary cancer. A considerable proportion of patients undergo unnecessary laparotomy because of underestimation of the extent of the cancer on computed tomography (CT) scanning. Laparoscopy can detect metastases not visualised on CT scanning, enabling better assessment of the spread of cancer (staging of cancer). This is an update to a previous Cochrane Review published in 2013 evaluating the role of diagnostic laparoscopy in assessing the resectability with curative intent in people with pancreatic and periampullary cancer. OBJECTIVES: To determine the diagnostic accuracy of diagnostic laparoscopy performed as an add-on test to CT scanning in the assessment of curative resectability in pancreatic and periampullary cancer. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via PubMed, EMBASE via OvidSP (from inception to 15 May 2016), and Science Citation Index Expanded (from 1980 to 15 May 2016). SELECTION CRITERIA: We included diagnostic accuracy studies of diagnostic laparoscopy in people with potentially resectable pancreatic and periampullary cancer on CT scan, where confirmation of liver or peritoneal involvement was by histopathological examination of suspicious (liver or peritoneal) lesions obtained at diagnostic laparoscopy or laparotomy. We accepted any criteria of resectability used in the studies. We included studies irrespective of language, publication status, or study design (prospective or retrospective). We excluded case-control studies. DATA COLLECTION AND ANALYSIS: Two review authors independently performed data extraction and quality assessment using the QUADAS-2 tool. The specificity of diagnostic laparoscopy in all studies was 1 because there were no false positives since laparoscopy and the reference standard are one and the same if histological examination after diagnostic laparoscopy is positive. The sensitivities were therefore meta-analysed using a univariate random-effects logistic regression model. The probability of unresectability in people who had a negative laparoscopy (post-test probability for people with a negative test result) was calculated using the median probability of unresectability (pre-test probability) from the included studies, and the negative likelihood ratio derived from the model (specificity of 1 assumed). The difference between the pre-test and post-test probabilities gave the overall added value of diagnostic laparoscopy compared to the standard practice of CT scan staging alone. MAIN RESULTS: We included 16 studies with a total of 1146 participants in the meta-analysis. Only one study including 52 participants had a low risk of bias and low applicability concern in the patient selection domain. The median pre-test probability of unresectable disease after CT scanning across studies was 41.4% (that is 41 out of 100 participants who had resectable cancer after CT scan were found to have unresectable disease on laparotomy). The summary sensitivity of diagnostic laparoscopy was 64.4% (95% confidence interval (CI) 50.1% to 76.6%). Assuming a pre-test probability of 41.4%, the post-test probability of unresectable disease for participants with a negative test result was 0.20 (95% CI 0.15 to 0.27). This indicates that if a person is said to have resectable disease after diagnostic laparoscopy and CT scan, there is a 20% probability that their cancer will be unresectable compared to a 41% probability for those receiving CT alone.A subgroup analysis of people with pancreatic cancer gave a summary sensitivity of 67.9% (95% CI 41.1% to 86.5%). The post-test probability of unresectable disease after being considered resectable on both CT and diagnostic laparoscopy was 18% compared to 40.0% for those receiving CT alone. AUTHORS' CONCLUSIONS: Diagnostic laparoscopy may decrease the rate of unnecessary laparotomy in people with pancreatic and periampullary cancer found to have resectable disease on CT scan. On average, using diagnostic laparoscopy with biopsy and histopathological confirmation of suspicious lesions prior to laparotomy would avoid 21 unnecessary laparotomies in 100 people in whom resection of cancer with curative intent is planned

The Need for Visits to Social and Vocational Programs for the Mentally Ill as Part of General Psychiatry Residency Training

Background. Comprehensive treatment planning for psychiatric illnesses should be based on a biopsychosocial model of treatment to address the acuity and chronicity of these disorders. To achieve this goal, knowledge about pharmacological, psychological, and social aspects of the treatment plan should be presented as an integral part of general psychiatry residency training. This survey study was conducted to examine how many programs provide training where residents have scheduled visits to social and vocational mental health service organizations in the community and to identify potential obstacles to including this rotation in general psychiatry residency training. Methods. A voluntary, anonymous survey was sent via SurveyMonkey® to the program directors of all general psychiatry residency programs in the United States. The survey consisted of five questions designed to assess if their programs had a rotation where residents visit social and vocational programs in the community designed for mentally ill patients to provide knowledge of the community mental health resources to their residents. Results. Of the 168 survey invitations issued, 73 (44%) responded. Fifty-six responders acknowledged that their residents were required to visit a community mental health organization, but their programs did not offer visits to community social and vocational programs. Seventeen program directors reported that their program did not provide this experience to their residents and indicated a desire to include such a rotation. Conclusions. Community mental health service organization visits should enhance knowledge of psychiatry residents about community mental health resources and indirectly promote better patient care. Information obtained from this survey should create discussion to work toward better psychiatric resident training

Transdermal Delivery of Cytochrome C—A 12.4kDa Protein—Across Intact Skin by Constant-Current Iontophoresis

Purpose: To demonstrate the transdermal iontophoretic delivery of a small (12.4kDa) protein across intact skin. Materials and Methods: The iontophoretic transport of Cytochrome c (Cyt c) across porcine ear skin in vitro was investigated and quantified by HPLC. The effect of protein concentration (0.35 and 0.7mM), current density (0.15, 0.3 or 0.5mA.cm−2 applied for 8h) and competing ions was evaluated. Co-iontophoresis of acetaminophen was employed to quantify the respective contributions of electromigration (EM) and electroosmosis (EO). Results: The data confirmed the transdermal iontophoretic delivery of intact Cyt c. Electromigration was the principal transport mechanism, accounting for ∼90% of delivery; correlation between EM flux and electrophoretic mobility was consistent with earlier results using small molecules. Modest EO inhibition was observed at 0.5mA.cm−2. Cumulative permeation at 0.3 and 0.5mA.cm−2 was significantly greater than that at 0.15mA.cm−2; fluxes using 0.35 and 0.7mM Cyt c in the absence of competing ions (J tot  = 182.8 ± 56.8 and 265.2 ± 149.1μg.cm−2.h−1, respectively) were statistically equivalent. Formulation in PBS (pH8.2) confirmed the impact of competing charge carriers; inclusion of ∼170mM Na+ resulted in a 3.9-fold decrease in total flux. Conclusions: Significant amounts (∼0.9mg.cm−2 over 8h) of Cyt c were delivered non-invasively across intact skin by transdermal electrotranspor

Pretest Predictions for Ventilation Tests

The objective of this calculation is to predict the temperatures of the ventilating air, waste package surface, concrete pipe walls, and insulation that will be developed during the ventilation tests involving various test conditions. The results will be used as input to the following three areas: (1) Decisions regarding testing set-up and performance. (2) Assessing how best to scale the test phenomena measured. (3) Validating numerical approach for modeling continuous ventilation. The scope of the calculation is to identify the physical mechanisms and parameters related to thermal response in the ventilation tests, and develop and describe numerical methods that can be used to calculate the effects of continuous ventilation. Sensitivity studies to assess the impact of variation of linear power densities (linear heat loads) and ventilation air flow rates are included. The calculation is limited to thermal effect only

Restoring Vision through “Project Prakash”: The Opportunities for Merging Science and Service

“So how does this help society?” is a question we are often asked as scientists. The lack of immediate and tangible results cannot be held against a scientific project but statements of future promise in broad and inchoate terms can sometimes pass the benefit-buck indefinitely. There is no incentive against over-stating the benefits, especially when they are hypothetical and lie in the distant future. Few scientists will say their science is not designed to serve society. Yet the proliferation of “potential benefits” in grant proposals and the Discussion sections of research papers, in the absence of tangible translations, can make the service element of science seem like a cliched ritual. Its repetition hollows out its meaning, breeding cynicism about the idea that basic science can be of service

Eine neue Sensortechnik zur Messung von elektrischen Potentialprofilen der menschlichen Haut anAkupunkturpunkten

Introduction: From an electro-physiological point of view human skin shows an inhomogeneous pattern regarding its electrical resistance: in certain areas a decreased electrical resistance can be observed. It has been postulated that these areas correspond to acupuncture points. Subsequently, devices have been developed as detectors for acupuncture points which are used for diagnosis and treatment in acupuncture. However, most of these devices are inconsistent: they show a remarkable inaccuracy in their measurements and are poorly evaluated. Further analyses have shown that the measuring pens often used are subject to various disturbances such as pressure, angle of measurement, humidity of the skin, different thickness of stratum corneum of the skin and external disturbances such as temperature and humidity in the measuring room. Material and Methods: We present a new device for standardized measuring of electrical skin resistance. It consists of a field of 64 electrodes (measuring array) on a surface of 60 x 60 mm(2) and a distance of 8 mm between electrodes. For a more precise spatial resolution a field of 32 electrodes on a surface of 3.5 x 3.5 mm(2) with a distance of 0.65 mm is available. A high, precise, temporal resolution of electric potentials in human skin is realized by fast scanning of the electrodes. Technical details are described. Conclusions: First analyses of collected data show that reliable and valid measurements are possible. Using this device in a controlled and blinded study design will help elucidate the issue of altered skin resistance at acupuncture points and clarify if this phenomenon is unique at acupuncture points

Thermodynamics of Dipolar Chain Systems

The thermodynamics of a quantum system of layers containing perpendicularly oriented dipolar molecules is studied within an oscillator approximation for both bosonic and fermionic species. The system is assumed to be built from chains with one molecule in each layer. We consider the effects of the intralayer repulsion and quantum statistical requirements in systems with more than one chain. Specifically, we consider the case of two chains and solve the problem analytically within the harmonic Hamiltonian approach which is accurate for large dipole moments. The case of three chains is calculated numerically. Our findings indicate that thermodynamic observables, such as the heat capacity, can be used to probe the signatures of the intralayer interaction between chains. This should be relevant for near future experiments on polar molecules with strong dipole moments.Comment: 15 pages, 5 figures, final versio

Condensed Matter Theory of Dipolar Quantum Gases

Recent experimental breakthroughs in trapping, cooling and controlling ultracold gases of polar molecules, magnetic and Rydberg atoms have paved the way toward the investigation of highly tunable quantum systems, where anisotropic, long-range dipolar interactions play a prominent role at the many-body level. In this article we review recent theoretical studies concerning the physics of such systems. Starting from a general discussion on interaction design techniques and microscopic Hamiltonians, we provide a summary of recent work focused on many-body properties of dipolar systems, including: weakly interacting Bose gases, weakly interacting Fermi gases, multilayer systems, strongly interacting dipolar gases and dipolar gases in 1D and quasi-1D geometries. Within each of these topics, purely dipolar effects and connections with experimental realizations are emphasized.Comment: Review article; submitted 09/06/2011. 158 pages, 52 figures. This document is the unedited author's version of a Submitted Work that was subsequently accepted for publication in Chemical Reviews, copyright American Chemical Society after peer review. To access the final edited and published work, a link will be provided soo

emm gene diversity, superantigen gene profiles and presence of SlaA among clinical isolates of group A, C and G streptococci from western Norway

In order to investigate molecular characteristics of beta-hemolytic streptococcal isolates from western Norway, we analysed the entire emm gene sequences, obtained superantigen gene profiles and determined the prevalence of the gene encoding streptococcal phospholipase A2 (SlaA) of 165 non-invasive and 34 contemporary invasive group A, C and G streptococci (GAS, GCS and GGS). Among the 25 GAS and 26 GCS/GGS emm subtypes identified, only emm3.1 was significantly associated with invasive disease. M protein size variation within GAS and GCS/GGS emm types was frequently identified. Two non-invasive and one invasive GGS possessed emm genes that translated to truncated M proteins as a result of frameshift mutations. Results suggestive of recombinations between emm or emm-like gene segments were found in isolates of emm4 and stG485 types. One non-invasive GGS possessed speC, speG, speH, speI and smeZ, and another non-invasive GGS harboured SlaA. speA and SlaA were over-represented among invasive GAS, probably because they were associated with emm3. speGdys was identified in 83% of invasive and 63% of non-invasive GCS/GGS and correlated with certain emm subtypes. Our results indicate the invasive potential of isolates belonging to emm3, and show substantial emm gene diversity and possible lateral gene transfers in our streptococcal population