Efficacy and the safety of endoscopic ultrasound guided radiofrequency ablation of pancreatic tumors : a systematic review and meta-analysis

Radiofrequency ablation (RFA) is well-established therapy for the treatment of solid organ tumor. We aimed to determine the efficacy of endoscopic ultrasound guided RFA (EUS-RFA) in management of pancreatic tumors

Cholangiocarcinoma in a Resected Biliary Cyst: Importance of Follow-up

Biliary cysts are rare cystic dilatations of the biliary tree. Biliary cysts are positively associated with several significant complications, amongst them, cholangiocarcinoma befalls the most dreadful one. The elevated incidence is 20-30% in the unresected cyst and 0.7% in resected cysts. Magnetic resonance imaging (MRI) scan, magnetic resonance cholangiopancreatography (MRCP) or a contrast-enhanced computed tomography (CECT) is applied for the initial diagnostic study but the ultimate diagnosis ordinarily requires the tissue biopsy. Currently, the sole curative option involves the complete surgical resection of the lesion, with standard chemotherapy and active radiation applied as an alternative for the unresectable tumors. Despite the curative surgery the percentage of eternal recurrence of the tumor indefinitely persists, and effective post-surgical surveillance is reasonably demanded. We report a case of 29-year-old female with local recurrence of cholangiocarcinoma in a previously resected biliary cyst type I. The curative resection of the choledochal cyst only minimizes the considerable risk of the possible development of future cholangiocarcinoma but it does not completely prevent it. The appropriate follow-up for potential patients who have been typically treated for a biliary cyst is unclear. The lethal course of cholangiocarcinoma is believed due to its slow asymptomatic growing phase. Therefore, to adequately screen for malignancy, periodic imaging along with annual liver tests represents a reasonable approach to prevent the possible development of this appalling complication.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Clinical and Dosimetric Implications of Air Gaps between Bolus and Skin Surface during Radiation Therapy

Purpose: The main objective of the study was to evaluate the effect of air gaps of 0 - 5.0 cm between bolus and skin for 1.0 cm Superflab bolus on surface dose (DSurf) and depth of maximum dose (dmax) in solid water and Rando® phantoms. Methods: In this work, the effects of bolus to surface distance on DSurf and variation in dmax were analyzed in a solid water phantom and in an anthropomorphic Rando® phantom for different field sizes, using Gafchromic® EBT films and farmer chamber. Results: For field sizes of 5 × 5 cm2 the DSurf is significantly affected by increasing air gaps greater than 5 mm. For field sizes larger than 10 × 10 cm2, DSurf is nearly the same for air gaps of 0 - 5.0 cm. For small fields and 6 MV photon beam, dmax increases with increasing air gap, while for 10 MV beam and smaller field sizes (i.e. 5 × 5 and 10 × 10 cm2) the dmax first decreases and then increases with the air gaps. For both 3DCRT and IMRT plans on Rando®, DSurf reduction is more prominent with increasing air gaps. Conclusion: For field sizes larger than 10 × 10 cm2 DSurf is largely unaffected by air gaps. However, smaller air gap results in shallower dmax for both 6 MV and 10 MV photon beams at all fields sizes. Special consideration should be taken to reduce air gaps between bolus and skin for field sizes smaller than 10 × 10 cm2 or when surface contour variations are greater or when the bolus covers small area and at the border of the field

Remote Control of Tissue Interactions via Engineered Photo-switchable Cell Surfaces

We report a general cell surface molecular engineering strategy via liposome fusion delivery to create a dual photo-active and bio-orthogonal cell surface for remote controlled spatial and temporal manipulation of microtissue assembly and disassembly. Cell surface tailoring of chemoselective functional groups was achieved by a liposome fusion delivery method and quantified by flow cytometry and characterized by a new cell surface lipid pull down mass spectrometry strategy. Dynamic co-culture spheroid tissue assembly in solution and co-culture tissue multilayer assembly on materials was demonstrated by an intercellular photo-oxime ligation that could be remotely cleaved and disassembled on demand. Spatial and temporal control of microtissue structures containing multiple cell types was demonstrated by the generation of patterned multilayers for controlling stem cell differentiation. Remote control of cell interactions via cell surface engineering that allows for real-time manipulation of tissue dynamics may provide tools with the scope to answer fundamental questions of cell communication and initiate new biotechnologies ranging from imaging probes to drug delivery vehicles to regenerative medicine, inexpensive bioreactor technology and tissue engineering therapies

Combustion and explosion characteristics of pulverised wood, valorized with mild pyrolysis in pilot scale installation, using the modified ISO 1 m(3) dust explosion vessel

Featured Application Design of explosion safety measures for torrefaction installations and design of pulverized-fired burners for biocoal. Biomass is a renewable energy source with great potential worldwide and in the European Union. However, valorization is necessary to turn many types of waste biomass into a tradable commodity that has the potential to replace coal in power plants without significant modifications to firing systems. Mild pyrolysis, also known as torrefaction, is a thermal valorization process of low-quality biomass that could be suitable for such a purpose. In this work, typical Spruce-Pine-Fir residues from a sawmill were tested in terms of the explosion and flame propagation properties. The ISO 1 m(3) dust explosion vessel was used, with a modified and calibrated dust dispersion system that could cope with very coarse particles. The deflagration index, K-st, was higher for the torrefied sample, with a peak at 36 bar m/s compared with 27 for the raw biomass. The peak flame speeds were similar for both samples, reaching 1 m/s. The peak P-max/P-i was between 7.3 and 7.4 bar for both untreated and torrefied biomass. The mechanism for coarse particle combustion is considered to be influenced by the explosion-induced wind blowing the finer fractions ahead of the flame, which burns first, subsequently devolatilizing the coarser fractions.Web of Science1224art. no. 1292

New flavonoids from the Saudi Arabian plant:Retama raetam which stimulates secretion of insulin and inhibits α-glucosidase

Retama raetam is a bush which is a member of the family Fabaceae. It is used traditionally in North Africa and Saudi Arabia for the treatment of diabetes. Several flavonoids and alkaloids are already known from this plant. Chromatographic fractionation and purification led to the isolation of three new derivatives of prenylated flavones, retamasin C-E, and four new derivatives of prenylated isoflavones, retamasin F-I, in addition to two isoflavones which have not been previously reported in this plant. Particularly interesting structures included isoflavones containing 3,5-dihydro-2H-2,5-methanobenzo[e][1,4]dioxepine and 3a,8b-dihydro-7-hydroxyfuro[3,2-b]benzo[2,1-d]furan units, both of which are new amongst natural product flavonoids. Five new examples (two flavones and three isoflavones) strongly enhanced the glucose-triggered release of insulin by murine pancreatic islets and one isoflavone was a potent inhibitor of α-glucosidase. This study may rationalise the traditional medicinal use of R. raetam and provide new leads for drug design in the treatment of diabetes.</p

International external validation of a stratification tool to identify branch-duct intraductal papillary mucinous neoplasms at lowest risk of progression

BACKGROUND: Identifying branch‐duct intraductal papillary mucinous neoplasms (BD‐IPMNs) at lowest risk of progression may allow for a reduced intensity of surveillance. OBJECTIVE: We aimed to externally validate the previously developed Dutch‐American Risk stratification Tool (DART‐1; https://rtools.mayo.edu/DART/), which identifies cysts at low risk of developing worrisome features (WFs) or high‐risk stigmata (HRS). METHODS: Three prospective cohorts of individuals under surveillance for BD‐IPMNs were combined, independent from the original development cohort. We assessed the performance (discrimination and calibration) of DART‐1, a multivariable Cox‐proportional logistic regression model with five predictors for the development of WFs or HRS. RESULTS: Of 832 individuals (mean age 77 years, SD 11.5) under surveillance for a median of 40 months (IQR 44), 163 (20%) developed WFs or HRS. DART‐1's discriminative ability (C‐statistic 0.68) was similar to that in the development cohort (0.64–0.72) and showed moderate calibration. DART‐1 adequately estimated the risk for patients in the middle risk quintile, and slightly underestimated it in the lowest quintiles. Their range of predicted versus observed 3‐year risk was 0%–0% versus 0%–3.7% for Q1; 0.3%–0.4% versus 3%–11% for Q2; and 2.6%–3% versus 2.4%–9.8% for Q3. The development of WFs or HRS was associated with pancreatic cancer (p < 0.001). Vice versa, in absence of WFs or HRS, the risk of malignancy was low (0.3%). CONCLUSIONS: The performance of DART‐1 to predict the development of WFs or HRS in BD‐IPMN was validated in an external international cohort, with a discriminative ability equal as in the development cohort. Risk estimations were most accurate for patients with BD‐IPMNs in the middle risk quintile and slightly underestimated in the lowest quintiles

Expression of core antigen of HCV genotype 3a and its evaluation as screening agent for HCV infection in Pakistan

<p>Abstract</p> <p>Background</p> <p>Pakistan is facing a threat from hepatitis C infection which is increasing at an alarming rate throughout the country. More specific and sensitive screening assays are needed to timely and correctly diagnose this infection.</p> <p>Methods</p> <p>After RNA extraction from specimen (HCV-3a), cDNA was synthesized that was used to amplify full length core gene of HCV 3a. After verification through PCR, DNA sequencing and BLAST, a properly oriented positive recombinant plasmid for core gene was digested with proper restriction enzymes to release the target gene which was then inserted downstream of GST encoding DNA in the same open reading frame at proper restriction sites in multiple cloning site of pGEX4t2 expression vector. Recombinant expression vector for each gene was transformed in <it>E. coli </it>BL21 (DE3) and induced with IPTG for recombinant fusion protein production that was then purified through affinity chromatography. Western blot and Enzyme Linked Immunosorbant Assay (ELISA) were used to detect immuno-reactivity of the recombinant protein.</p> <p>Results</p> <p>The HCV core antigen produced in prokaryotic expression system was reactive and used to develop a screening assay. After validating the positivity (100%) and negativity (100%) of in-house anti-HCV screening assay through a standardized panel of 200 HCV positive and 200 HCV negative sera, a group of 120 serum specimens of suspected HCV infection were subjected to comparative analysis of our method with commercially available assay. The comparison confirmed that our method is more specific than the commercially available assays for HCV strains circulating in this specific geographical region of the world and could thus be used for HCV screening in Pakistan.</p> <p>Conclusion</p> <p>In this study, we devised a screening assay after successful PCR amplification, isolation, sequencing, expression and purification of core antigen of HCV genotype 3a. Our developed screening assay is more sensitive, specific and reproducible than the commercially available screening assays in Pakistan.</p

Time to endoscopy for acute upper gastrointestinal bleeding: results from a prospective multicentre trainee-led audit

Background: Endoscopy within 24 hours of admission (early endoscopy) is a quality standard in acute upper gastrointestinal bleeding (AUGIB). We aimed to audit time to endoscopy outcomes and identify factors affecting delayed endoscopy (>24h of admission).Methods: This prospective multicentre audit enrolled patients admitted with AUGIB who underwent inpatient endoscopy between Nov-Dec 2017. Analyses were performed to identify factorsassociated with delayed endoscopy, and to compare patient outcomes, including length of stay and mortality rates, between early and delayed endoscopy groups.Results: Across 348 patients from 20 centres, the median time to endoscopy was 21.2h (IQR 12.0- 35.7), comprising median admission to referral and referral to endoscopy times of 8.1h (IQR 3.7- 18.1) and 6.7h (IQR 3.0-23.1) respectively. Early endoscopy was achieved in 58.9%, although this varied by centre (range: 31.0% - 87.5%, p=0.002). On multivariable analysis, lower Glasgow-Blatchford score, delayed referral, admissions between 7am-7pm or via the Emergency Department were independent predictors of delayed endoscopy. Early endoscopy was associated with reduced length of stay (median difference 1d; p= 0.004), but not 30-day mortality (p=0.344).Conclusions: The majority of centres did not meet national standards for time to endoscopy. Strategic initiatives involving acute care services may be necessary to improve this outcome