Predicting residual neoplasia after a non-curative gastric ESD: validation and modification of the eCura system in the Western setting: the W-eCura score

OBJECTIVE

To evaluate the risk factors for lymph node metastasis (LNM) after a non-curative (NC) gastric endoscopic submucosal dissection (ESD) and to validate and eventually refine the eCura scoring system in the Western setting. Also, to assess the rate and risk factors for parietal residual disease.

DESIGN

Retrospective multicentre multinational study of prospectively collected registries from 19 Western centres. Patients who had been submitted to surgery or had at least one follow-up endoscopy were included. The eCura system was applied to assess its accuracy in the Western setting, and a modified version was created according to the results (W-eCura score). The discriminative capacities of the eCura and W-eCura scores to predict LNM were assessed and compared.

RESULTS

A total of 314 NC gastric ESDs were analysed (72% high-risk resection (HRR); 28% local-risk resection). Among HRR patients submitted to surgery, 25% had parietal disease and 15% had LNM in the surgical specimen. The risk of LNM was significantly different across the eCura groups (areas under the receiver operating characteristic curve (AUC-ROC) of 0.900 (95% CI 0.852 to 0.949)). The AUC-ROC of the W-eCura for LNM (0.916, 95% CI 0.870 to 0.961; p=0.012) was significantly higher compared with the original eCura. Positive vertical margin, lymphatic invasion and younger age were associated with a higher risk of parietal residual lesion in the surgical specimen.

CONCLUSION

The eCura scoring system may be applied in Western countries to stratify the risk of LNM after a gastric HRR. A new score is proposed that may further decrease the number of unnecessary surgeries.

Endoscopic submucosal dissection of appendicular lesions is feasible and safe: a retrospective multicenter study (with video)

BACKGROUND AND AIMS

Endoscopic submucosal dissection (ESD) is challenging for appendicular lesions. We report the outcomes of ESD in this context.

METHODS

We collected data of ESD procedures for appendiceal neoplasia in a multicenter prospective registry. Main study endpoints were R0, en-bloc, and curative resection rates and adverse event rate.

RESULTS

One hundred twelve patients were included, 47 (42%) with previous appendectomy. Fifty-six (50%) were Toyonaga type 3 lesions (15 [13.4%] postappendectomy). En-bloc and R0 resection rates were 86.6% and 80.4%, respectively, with no significant difference associated with different grades of appendiceal invasion (P = .9 and P = .4, respectively) or previous appendectomy (P = .3 for both). The curative resection rate was 78.6%. Additional surgery was performed in 16 cases (14.3%), including 10 (62.5%) Toyonaga type 3 lesions (P = .04). This included the treatment of 5 cases (4.5%) of delayed perforation and 1 acute appendicitis.

CONCLUSIONS

ESD for appendicular lesions is a potentially safer and effective alternative to surgery for a significant proportion of patients.

Short-term outcomes in patients with non-ST-segment elevation myocardial infarction

Funding Acknowledgements

Type of funding sources: None.

Introduction

The proportion of non-ST-segment elevation myocardial infarction (NSTEMI) is increasing among the acute coronary syndromes (ACS). Reinfarction (RI) is a potential complication in high-risk patients with NSTEMI and it will cause an impact on these patients’ prognosis.

Purpose

Identify high-risk patients with RI and their prognosis in the setting of NSTEMI.

Methods

Based on a multicenter retrospective study, data collected from admissions between January 2013 and January 2020. Patients without data on previous cardiovascular history or uncompleted clinical data were excluded. Patients were divided in 2 groups (G): G1 – patients without RI; G2 - patients with RI during hospitalization. Logistic regression and survival analysis were performed.

Results

7180 patients were admitted with NSTEMI, RI occurred in 71 pts (0.99%). Regarding epidemiological and past history G2 was older (71±12 vs 66±12, p=0.001), had higher rates of previous stroke (15.9% vs 7.0%, p 0.003) and peripheric arterial disease (6.3% vs 6.1%, p=0.004). The groups were similar regarding arterial hypertension (p=0.74), diabetes type 2 (p=0.11) and dyslipidaemia (p=0.48).

G2 had higher levels of brain natriuretic peptide (45.5% vs 24.5%, p<0.001) and lower levels of haemoglobin (20.3% vs 7.9%, p<0.001). Patients taking prasugrel (2% vs 0.3%, p=0.002) or ticagrelor (6.1% vs 2.2%, p<0.001) previously to the admission were more susceptible to have RI. Patients with severe left ventricular systolic dysfunction (3.4% vs 2.6%, p<0.001), need of invasive (2.8% vs 0.8%, p<0.001) or non-invasive (4.2% vs 1.3%, p<0.001) ventilation and percutaneous coronary intervention (PCI) (80.3% vs 64.7%, p0.006) had higher rates of RI.

Logist regression confirmed that PCI (p=0.03, OR 2.22, CI 1.08-4.53), previous stroke (p=0.02, OR 0.58, CI 0.37-0.92) and pts previously taking prasugrel (p=0.02, OR 1.85, CI 1.11-3.10) were predictors of RI in the setting of NSTEMI.

Conclusion

RI in the setting of NSTEMI was associated with PCI, previous stroke and pts previously taking prasugrel. One year prognosis was poorer for patients who suffered RI.

Can we prevent the occurrence of stroke in patients admitted with non-ST-segment elevation myocardial infarction?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardio-cerebral vascular diseases are a leading cause of deaths worldwide.

Stroke is a potential complication in high-risk patients who had non-ST-segment elevation myocardial infarction (NSTEMI).

Purpose

Identify high-risk patients with stroke and their prognosis in the setting of NSTEMI.

Methods

Based on a multicenter retrospective study, data collected from admissions between January 2013 and January 2020. Patients without data on previous cardiovascular history or uncompleted clinical data were excluded. Patients were divided in 2 groups (G): G1 – patients who suffered stroke; G2 - patients without stroke. Logistic regression and survival analysis were performed.

Results

7180 patients were admitted with NSTEMI, stroke occurred in 35 patients (0.49%). Regarding epidemiological and past history G1 was older (72±9 vs 66±12, p= 0.004), had more females (54.3% vs 45.75, p<0.001), had higher rates of type 2 diabetes mellitus (51.3% vs 35.2%, p=0.05), previous strokes / transient ischemic attack (24.2% vs 7.0%, p=0.007) and dementia (3.3% vs 0.8%, p<0.001). Arterial hypertension (77.1 vs 72.8%, p=0.56), dyslipidaemia (61.8% vs 63.0%, p=0.88) and smoking (17.6% vs 26.0%, p=0.27) were similar between groups. Patients who presented with chest pain (72.7% vs 92.0%, p<0.001) and patients who were not revascularized were more likely to suffer a stroke (43.3% vs 17.5%, p<0.001).

Logist regression only confirmed that females were more likely to have a stroke (p<0.001, OR 4.13, CI 1.87-9.15) and patients who presented with chest pain (p=0.001, OR 0.23, CI 0.10-0.54). One year event-free survival was higher in patients who did not have stroke (95.3% vs 80.0%, p=0.005, OR 4.50, CI 1.43-14.15)

Conclusion

Since sex gender and form of presentation of NSTEMI are not modifiable factors we cannot prevent strokes from happening in the context of NSTEMI.

Effects of short-term exposure to genistein and overfeeding diet on the neural and retinal progenitor competence of adult zebrafish (Danio rerio)

Neurogenesis is a process that occurs throughout the life of a vertebrate. Among the different factors that may affect the natural occurrence of neurogenesis, obesity seems to decrease the proliferation capacity of progenitor neuronal cells. Conversely, the phytoestrogen genistein is known to attenuate some obesity effects beyond its neuroprotective action. Aiming to improve the understanding of how obesity and genistein trigger an impact on the neural and retinal progenitor competence of adult zebrafish, fish were exposed to genistein (GEN - 2 μg L^-1) alone or combined with two dietary groups (control and overfeed - OFD) for up to 9 weeks. Zebrafish were fed once per day with Artemia sp. in the control and GEN (2% of BW, control diet), and three times per day in the OFD and OFD + GEN groups (12% BW, overfeeding diet). To assess obesity induction, BMI, biometric parameters, and PPAR-γ protein were quantified. Afterwards, qRT-PCR and immunohistochemistry were performed to determine the cell proliferation and the presence of stem cells through PCNA and Sox-2. Our findings proved that overfeeding adult zebrafish increased the general growth and induced the development of fatty liver. However, for OFD + GEN, this effect was assuaged through the anti-adipogenic effect of GEN. This finding suggests that phytoestrogens could be beneficial to reduce the negative effects of obesity. Moreover, OF induced negative effects on retinal and brain homeostasis, decreasing the proliferation capacity of progenitor neuronal cells. With regard to retinal progenitor competence, genistein seems to mitigate the negative impacts of obesity, whereas the effects of obesity on the brain were exacerbated by this phytoestrogen which negatively influenced the homeostasis of zebrafish neural progenitor competence. This study highlighted the fact that the effects of phytoestrogens in adult neural progenitor competence are complex and could exhibit dissimilar effects depending on the tissue.

Endocardial left ventricular pacing Where are we a systematic review

Funding Acknowledgements

Type of funding sources: None.

Background

Endocardial left ventricular pacing is a technique used in cardiac resynchronization therapy (CRT), when a coronary sinus implant is not possible, conventional CRT was an unsuccess and in CRT nonresponders. We performed a systemic review to evaluate its risks and benefits.

Objective

Review the evidence regarding the efficacy and safety of endocardial left ventricular pacing.

Methods

A systemic research on MEDLINE and PUBMED with the term "endocardial left ventricular pacing", "biventricular pacing" or "endocardial left pacing". 1038 results were identified, however, just publish papers (excluding abstract) with more than 16 patients was admitted in these analyses. Comparisons pre and post CRT regard New York Heart Association (NYHA) functional classification, left ventricular ejection fraction (LVEF) and QRS width was performed. Mean differences (MD) and confidence interval (CI) was used as a measurement of treatment.

Results

Eleven studies were selected, including a total of 560 patients. The studies were performed with different techniques, trans-atrial septal technique, trans-ventricular septal technique and transapical technique. Mean age 66.93 years old, 90.54% male, median ejection fraction of 28.86%, NYHA class of 3.03, QRS width 167,50 mseg. Ischemic etiologic in 43.88%, atrial fibrillation in 45.35% and left bundle branch block in 55.20%. Was reported several complications after the procedure, 8 pocket infection (7 studies), 17 transient ischemic attacks (10 papers), 17 ischemic stroke (all), 35 tromboembolic events (all) and 115 deaths, nevertheless, follow up in the different studies was diverse and heterogeneous. Significant improvement was registered in NYHA class (MD 0.64, CI 0.56-0.72, p < 0.00001, I2 = 89%) (reported in 7 studies), LVEF (MD 6.20, CI 5.09-7.32, p = 0.002, I2 = 69%) %) (reported in 8 studies) and QRS width (MD 31.35, CI 26.11-36.60, p < 0.00001, I2 = 89%) %) (reported in 5 studies), (all p < 0.00001).

Conclusions

Left ventricular endocardial pacing is a feasible alternative to conventional CRT, when the last one is not possible. With clinical, electrocardiogram and echocardiogram improvement in several series. First data regarding this procedure were associated with higher stroke incidence, something contrary to the last study’s results. Nevertheless, at the moment just small series present this technique with heterogenous results and different approaches, being important further investigation.

Septal vs apical defibrillator electrode placement a systematic review

Funding Acknowledgements

Type of funding sources: None.

Background

The optimal right ventricular defibrillator lead placement is still a debatable matter. We attempt to performed a systemic review to evaluate whether septal and apical placement had significant differences in the follow-up with an indication for implantation of these devices.

Objective

Review the evidence regarding the efficacy and safety of right ventricular apical and septal defibrillator lead placement.

Methods

A systemic research on MEDLINE and PUBMED with the term "septal pacing", "apical pacing" "septal defibrillation" or "apical defibrillation". 309 results were identified, however, after a serious analysis, several articles were excluded. Comparisons between apical and septal placement were performed regarding R wave amplitude, pacing threshold at 0.5 ms, lead impedance, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD) and lead complication that produced lead re-placement. Mean differences (MD) and confidence interval (CI) was used as a measurement of treatment.

Results

Six studies were selected, including a total of 2180 patients. The studies were performed with different techniques, analyses and goals. The studies presented heterogeneous and diverse results, with a varied follow-up period, that resulted in the exclusion of one of the studies. Mean age 64.51 years old, 76.86% male, a median ejection fraction of 27.84%, NYHA class of 2.65, ischemic etiologic in 51.10% and a follow-up period of 26.49 months. Septal defibrillator lead placement was established in 772 patients, while the apical defibrillator lead placement was performed in 1399 patients. No differences regarding the lead performance on apical and septal placement were detected regarding the R-wave (MD -0.36, CI -0.75 - +0.03, p = 0.68, I2 = 0%) (reported in 3 studies) and lead impedance (MD -23.83, CI -51.36 - +3.69, p = 0.003, I2 = 82%) (reported in 3 studies). Pacing threshold seems to be favor a septal defibrillator lead implantation (MD -0.05, CI -0.09 - -0.02, p = 0.12, I2 = 53%) (reported in 3 studies). Concerning echocardiography parameters during the follow up period, LVEF (MD -0.83, CI -3.05 - +1.38, p = 0.10, I2 = 57%) (reported in 3 studies) and LVEDD (MD -0.51, CI -2.13 - +1.10, p = 0.20, I2 = 38%) (reported in 3 studies) were not significant influenced for the defibrillator lead placement. Lead complications that provoke a lead replacement was not significant between the lead placement (MD 1.25, CI 0.53 – 2.94, p = 0.71, I2 = 0%) (reported in 3 studies).

Conclusions

Just pacing threshold proved to improve the septal defibrillator lead placement. Neither the other lead parameters or the echocardiography results during the follow-up were influenced by the lead placement. For a definitive conclusion is important to further investigation.

EUS-guided placement of fiducial markers for stereotactic body radiation therapy in pancreatic cancer: feasibility, security and a new quality score

Background and study aims  In borderline resectable/locally advanced pancreatic ductal adenocarcinoma (PDAC), stereotactic body radiation therapy (SBRT) is an emerging neoadjuvant treatment option. Endoscopic ultrasound (EUS)-guided insertion of fiducial markers being a prerequisite, our aim was to assess its feasibility and safety and also to evaluate its success, from both the endoscopist's and radiotherapist's perspectives. Patients and methods  We prospectively collected data concerning PDAC patients submitted to EUS-guided fiducial placement, from February 2018 to November 2019. Technical success was defined as at least one marker presumed inside the tumor. Quality success was assessed at pre-SBRT computed tomography, accordingly to the number of markers inside or < 1 cm from the tumor, number of markers at the tumor extremity, their location in different planes, the distance between them, and their distance from the biliary stent (if present). A new quality score was then proposed and high-quality success defined as at least six of 12 points. Results  Thirty-seven patients were enrolled. A total of 97 fiducials were implanted, with a median of three fiducials per patient (0-4). The technical success rate was 92 %, with failure of fiducial placement in three patients. Three patients (8 %) had adverse events (fever, mild acute pancreatitis, and biliary stent migration). At pre-SBRT evaluation, two patients' markers had migrated. The high-quality success rate was 62.5 %. Conclusions  Our results contribute to demonstrating the feasibility and safety of EUS-guided fiducial placement for SBRT treatment in PDAC. It is hoped that the newly proposed quality score will pave the way for improving fiducial positioning and SBRT delivery.

Effects of Mechanical Insufflation-Exsufflation on Airway Mucus Clearance Among Mechanically Ventilated ICU Subjects

BACKGROUND

Few studies have evaluated the effects of mechanical insufflation-exsufflation (MI-E) in subjects on mechanical ventilation. Therefore, this study aimed to evaluate the effectiveness of MI-E on airway mucus clearance among mechanically ventilated ICU subjects.

METHODS

A randomized, parallel-group, open-label trial was conducted between June and November 2017 in a single, mixed ICU. Adult ICU subjects receiving mechanical ventilation for > 24 h with stable ventilatory and hemodynamic status were randomized to receive either standard respiratory physiotherapy alone (control group) or respiratory physiotherapy by using an MI-E device (intervention group). The primary outcome was the weight of aspirated airway mucus after study interventions. Secondary outcomes included variation in static lung compliance (ΔC_L), airway resistance (ΔR_aw), work of breathing (ΔWOB) in relation to the pre-intervention period, and hemodynamic and ventilator complications during the procedures.

RESULTS

There were 90 subjects in each group. The mean ± SD weight of the aspirated airway mucus was higher in the intervention group than in the control group (2.42 ± 2.32 g vs 1.35 ± 1.56 g, P < .001). The ΔC_L values in the intervention group were higher than those in the control group (1.76 ± 4.90 mL/cm H₂O vs -0.57 ± 4.85 mL/cm H₂O, P = .001). The ΔR_aw and ΔWOB values were similar between the groups. No hemodynamic or ventilatory complications were observed.

CONCLUSIONS

Among the general ICU subjects receiving mechanical ventilation, use of an MI-E device during respiratory physiotherapy resulted in a larger amount of airway mucus clearance than respiratory physiotherapy alone. (ClinicalTrials.gov registration NCT03178565.).

Sparse-coding denoising applied to reversible conformational switching of a porphyrin self-assembled monolayer induced by scanning tunnelling microscopy

Scanning tunnelling microscopy (STM) was used to induce conformational molecular switching on a self-assembled monolayer of zinc-octaethylporphyrin on a graphite/tetradecane interface at room temperature. A reversible conformational change controlled by applying a tip voltage was observed. Consecutive STM images acquired at alternating tip voltages showed that at 0.4 V the porphyrin monolayer presents a molecular arrangement formed by alternate rows with two different types of structural conformations and when the potential is increased to 0.7 V the monolayer presents only one type of conformation. In this paper, we characterize these porphyrin conformational dynamics by analyzing the STM images, which were improved for better quality and interpretation by means of a denoising algorithm, adapted to process STM images from state of the art image processing and analysis methods. STM remains the best technique to 'see' and to manipulate the matter at atomic scale. A very sharp tip a few angstroms of the surface can provide images of molecules and atoms with a powerful resolution. However, these images are strongly affected by noise which is necessary to correct and eliminate. This paper is about new computational tools specifically developed to denoise the images acquired with STM. The new algorithms were tested in STM images, obtained at room temperature, of porphyrin monolayer which presents reversible conformational change in function of the tip bias voltage. Images with high resolution, acquired in real time, show that the porphyrins have different molecular arrangements whether the tip voltage is 0.4 V or 0.7 V.

Guide for adults in the children's therapeutic tale: “I conquered my fears”

The book “I conquered my fears” was created as a result of the clinical experience of the author. It is a therapeutic tale, which is valid as a resource to be used by health workers and parents so as to help children overcome their fears at bedtime.

Because experience is important for an adult so as to better reflect on the theme, the book also includes an appendix to help accordingly.

The adult is invited to express what he/she likes to hear the most and the least, when waking from a sleepless night, and is also invited to dynamically interact with the book, give answers and create hypothesis, with no fear of making mistakes.

The parents, after reading the book, refer a better stress management capacity at critical moments experienced with the children at bedtime.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Nodular Regenerative Hyperplasia in HIV-positive patients : a case series and review of the literature

Nodular regenerative hyperplasia (NRH) is a well-described condition that leads to non-cirrhotic portal hypertension and is histologically characterised by a nodular transformation of the liver without fibrosis. It seems to be a consequence of obliterative portal venopathy of small hepatic veins. Its precise aetiology remains to be clearly determined. NRH was reported to occur in HIV-positive patients ten years ago. In this article, three consecutive clinical cases of HIV-related NRH were identified in a high volume reference centre of HIV positive patients and are presented. Clinical, diagnostic aspects and strategies for management of this under-diagnosed medical condition in the HIV population are also developed.

Tailoring the properties of gelatin films for drug delivery applications: influence of the chemical cross-linking method

Two types of chemically cross-linked gelatin films were prepared and characterized. The first type of films was cross-linked with 1-ethyl-3-(3-dimethyl aminopropyl)carbodiimide hydrochloride (EDC) under heterogeneous conditions and are named Gel-E. In the second type of films, gelatin was previously functionalized with methacrylamide side groups by the reaction with methacrylic anhydride and for that is named Gel-MA. The modified gelatin was subsequently cross-linked by a photoinitiated radical polymerization. These films were characterized relatively to their degree of cross-linking, buffer uptake capacity, resistance to hydrolytic and proteolytic degradation, and mechanical and thermal properties. Results show that the employed cross-linking method, together with the degree cross-linking, dictate the final properties of the films. Gel-E films have significant lower buffer uptake capacities and higher resistance to collagenase digestion when compared to Gel-MA films. Additionally, Gel-E films exhibit higher values of stress at break and lower strains at break. Moreover, the films properties could be modified by varying the extent of the chemical cross-linking, which in turn could be controlled by varying the concentration of EDC, for the first type of films (Gel-E), or by using gelatins with different degrees of functionalization, in the case of the second type of films (Gel-MA).

Characterization of patients with suicidal behaviors

Objectives

To characterize the population with suicidal behaviour that uses the ER of the Hospital Infante D. Pedro. Elaborate a plan for prevention.

Methods

Observational descriptive study of a single sample, transversal, including 102 individuals. All patients were assessed concerning socio-demographic, clinical and psychological items - IACLIDE (Depression Scale), 23QVS (Stress Vulnerability Scale) and Mini-Mult (Personality Scale).

Results

90.6% of women use pills as suicide method. 63.2% of men use drugs, 10.5% phlebotomy and 26.8% resorts to violent methods.

Individuals with moderate or severe depression have a higher probability (91x) of suicidal risk compared with individuals with no depression or mild depression. Individuals vulnerable to stress have a higher probability (5.7X) of attempting suicide. Individuals with external influence suicidal behaviour have a higher likelihood of suicide risk (4x), compared to individuals without external influence. Individuals with personality disorder (particularly cluster B) have a higher probability (25x) for suicide risk in people without personality disorder.

Conclusion

The para-suicidal prototype seems to be a 36 year old woman, low level of literacy, married, with previous para-suicidal gestures, from ingestion of drugs, at home, following an emotional conflict. The suicidal will probably be a 40 year old man, divorced, low financial resources, unemployed, having prepared a previous plan that consummated suicide by violent methods.

The elaboration of a para-suicidal and suicidal profile, is an essential contribution to the determination of relative risk and to structure a prevention plan tailored to the perceived reality research.

Factors associated with uncontrolled asthma in Porto Alegre, Brazil

The prevalence of uncontrolled and controlled asthma, and the factors associated with uncontrolled asthma were investigated in a cross-sectional study. Patients aged 11 years with confirmed asthma diagnosis were recruited from the outpatient asthma clinic of Hospital de Clínicas de Porto Alegre, Brazil. Patients were excluded if they had other chronic pulmonary disease. They underwent an evaluation by a general questionnaire, an asthma control questionnaire (based on the 2006 Global Initiative for Asthma guidelines), assessment of inhaled device technique and pulmonary function tests. Asthma was controlled in 48 of 275 patients (17.5%), partly controlled in 74 (26.9%) and uncontrolled in 153 (55.6%). In the univariate analysis, asthma severity was associated with asthma control (P < 0.001). Availability of asthma medications was associated with asthma control (P = 0.01), so that most patients who could purchase medications had controlled asthma, while patients who depend on the public health system for access to medications had lower rates of controlled asthma. The use of inhaled corticosteroid was lower in the uncontrolled group (P < 0.001). Logistic regression analysis identified three factors associated with uncontrolled asthma: severity of asthma (OR = 5.33, P < 0.0001), access to medications (OR = 1.97, P = 0.025) and use of inhaled corticosteroids (OR = 0.17, P = 0.030). This study showed a high rate of uncontrolled asthma in patients who attended an outpatient asthma clinic. Severity of asthma, access to medications and adequate use of inhaled corticosteroids were associated with the degree of asthma control.

Ultrahigh resolution optical coherence tomography of Barrett's esophagus: preliminary descriptive clinical study correlating images with histology

BACKGROUND AND STUDY AIMS

Endoscopic ultrahigh resolution optical coherence tomography (UHR OCT) achieves an axial image resolution of approximately 5 microm, which is 2 - 3 times finer than standard endoscopic OCT imaging. This study investigated the capability of endoscopic UHR OCT for imaging patients with Barrett's esophagus.

PATIENTS AND METHODS

Fivty volunteers previously diagnosed with Barrett's esophagus underwent UHR OCT. Imaging was performed at 1.3 microm wavelengths with approximately 5 microm axial and approximately 15 microm transverse resolutions using a 1.8 mm/diameter linear-scanning catheter introduced through the accessory channel of a standard endoscope. OCT images were compared with endoscopic diagnosis and pinch biopsy histological appearances.

RESULTS

UHR OCT images of normal esophagus, Barrett's esophagus, high grade dysplasia and esophageal adenocarcinoma were evaluated. UHR OCT images of the normal esophagus exhibited characteristic layered architecture with uniform epithelium, while images of Barrett's esophagus corresponded to crypt-like glandular structures. High grade dysplasia and esophageal adenocarcinoma images exhibited more heterogeneous structures corresponding to irregular, heterogeneous tissue morphology from distorted and cribriform or villiform glandular architecture. Fine features can be discerned more clearly with endoscopic UHR OCT.

CONCLUSIONS

This study evaluated new endoscopic OCT technology and demonstrated the feasibility of carrying out UHR OCT imaging in conjunction with standard endoscopy for in vivo real-time imaging of Barrett's esophagus, dysplasia, and esophageal adenocarcinoma. A survey of normal and abnormal upper gastrointestinal tissues was performed using a research prototype OCT system with the highest axial resolution to date, and can serve as a baseline for future investigation.

Antibody screening in 37 degrees C saline. Is it safe to omit it using the indirect antiglobulin (gel) test?

Pretransfusion tests must detect antibodies that can shorten the life of red blood cells (RBCs). Some studies have demonstrated the existence of clinically significant antibodies detected at 37 degrees C in saline that are not detected by the indirect antiglobulin test (IAT) when the conventional tube test is used. Our aim was to determine whether these antibodies, detected with a 37 degrees C saline tube test, are also detected when a sensitive column gel agglutination method is used. The 2373 pretransfusion samples were tested as they were received (from May 1998 to December 1999), in 37 degrees C saline and by IAT using the DiaMed gel system. The screening tests were performed using 50 microL of 0.8% low-ionic-strength saline suspended RBCs and 50 microL of plasma. The tests were examined for agglutination and hemolysis. Two hundred and thirty three samples (9.81%) were reactive by IAT and 88 (3.70%) by 37 degrees C saline. All 88 samples reactive by 37 degrees C saline also reacted by IAT. These data indicate that 37 degrees C saline is not an essential pretransfusion procedure when the DiaMed gel test is used.

Development and reproducibility of a brief food frequency questionnaire for assessing the fat, fiber, and fruit and vegetable intakes of rural adolescents

OBJECTIVE

To describe the systematic development and reproducibility of a food frequency questionnaire (FFQ) designed to meet the specific research requirements of the Goals for Health cancer prevention intervention program for rural middle school children.

DESIGN

A 4-step process was used to develop a brief FFQ for scoring intakes of total fat, fiber, and fruits and vegetables. The resulting questionnaire consisted of 25 food frequency items and 10 supplemental questions. Reproducibility of the questionnaire was determined by comparing responses at the beginning and end of a 4-month interval.

SUBJECTS

Study subjects were sixth- and seventh-grade students attending middle schools in rural areas of Virginia and upstate New York. Seventh-grade students participated in the pilot study, and sixth-grade students participated in the reproducibility study. The final version of the FFQ was completed twice by 539 sixth graders. After exclusions for missing and unreliable data, the usable sample size was 415. Boys were somewhat more likely than girls to be excluded for missing data. African-American students comprised 32% of the population.

STATISTICAL ANALYSES PERFORMED

Each food frequency item was associated with 3 scores--a fat score, a fiber score, and a combined score for the number of servings of fruits and vegetables. Means and standard deviations were determined for nutrient variables, differences between repeat administrations were tested for significance by paired t test, and Pearson correlation coefficients were calculated for nutrients and for individual food items.

RESULTS

Correlation coefficients for nutrient scores were 0.58 for fat, 0.49 for fiber, and 0.51 for fruits and vegetables. For individual food items, correlations ranged from 0.24 to 0.59 (mean=0.41).

APPLICATIONS/CONCLUSIONS

Using a systematic approach to developing a study-specific FFQ for rural adolescents is feasible. Further, the reproducibility of the Goals for Health questionnaire was demonstrated for the 3 nutrient scores it was designed to measure. This developmental approach may be readily adapted to other populations, study designs, and nutrients of interest. The validity of the questionnaire remains to be tested.

Study of the elastic fibres' framework of the rat lung

A combination of intravascular resin injection and formic acid incubation was used to study the three-dimensional organization of the elastic fibres of the adult rat lung by scanning electron microscopy (SEM). After SEM observations, the same samples were further processed for transmission electron microscopy (TEM) in order to confirm the presence of the elastic fibres and to complement some aspects of its surface morphology observed under the SEM. Complementary studies by light microscopy (LM) and TEM using specific histochemical methods for the elastic fibres were also performed. The SEM study clearly demonstrated that the cast of the microvasculature acted as a scaffold to preserve the in vivo arrangement of the easily collapsible elastic tissue. The methodology used allowed the observation of a fine framework of elastic fibres representing remnants of the alveolar walls in close association with the capillaries interwoven with the network of elastin. Each thick elastic fibre was composed of a bundle of thin fibres. Some of these thin fibres separated from the main fibre, join other fibres, giving the appearance of an anastomosing net. The interwoven network of elastin and its proximity with the capillaries suggests that the distensibility of the alveolar wall should contribute to the subtle rhythmical change of the alveolar microcirculation at each respiratory movement. On the sub-pleural region of the lung, the elastic fibres were observed forming a continuous and fine mesh network. The elastic fibres linking the walls of the intrapulmonary conducting airways, the vessels wall and the alveolar and sub-pleural elastic network establish an interrelated and interlaced continuous framework, certainly with great physiological implications to the overall process of the mechanics of the lung respiratory function. The methodology applied was a useful tool in order to study the spatial organization of the pulmonary elastic fibres, its branching and close relation with the other lung structures.

Cancer prevention in rural youth: teaching goals for health: the pilot

BACKGROUND

The Goals for Health project is designed to change the cancer-related behaviors of tobacco use and dietary fat and fiber consumption. The intervention teaches health and life skills to rural, minority sixth and seventh graders in rural Virginia and New York. This article presents the results of the pilot.

METHODS

Participants were 129 sixth graders at one rural middle school who were surveyed prior to and following delivery of the pilot sixth-grade intervention.

RESULTS

Results include significant changes from pre- to post-intervention in several diet and smoking attitude and self-efficacy variables, dietary fat and fiber knowledge, high-fat snack consumption, and dietary fat scores. Multivariate analyses reveal important contributions of personal control over food choices and family and friend influence on change in dietary fat score from pre- to post-intervention.

CONCLUSIONS

These pilot program results suggest avenues for dietary and cancer prevention interventions in high-risk, rural adolescents.

Biocompatibility of poly (DL-lactide-co-glycolide) microspheres implanted into the brain

The delivery of therapeutic molecules to the brain has been limited in part due to the presence of the blood-brain barrier. One potential solution is the implantation of biodegradable polymers with sustained release of drugs. Poly (DL-lactide-co-glycolide) (PLG) is a bioerodible polymer with a long and successful history of use as a suture material. More recently, PLG has been investigated for localized and sustained delivery of molecules into both peripheral sites and the brain. Despite its well-defined safety profile for parenteral applications, little information exists concerning the safety of PLG when implanted into the brain. To further characterize the biocompatibility of PLG in the brain, we examined the gliotic response following implants of PLG into the brains of rats. As a control, each animal received an injection of the suspension medium into the contralateral hemisphere. Following implantation, PLG was well tolerated. GFAP-positive astrocytes were observed throughout the cerebral cortex and striatum on both the implanted and control sides, with the reaction being greatest within the heavily myelinated fiber tracts of the corpus callosum. Quantitative analyses revealed that this reaction occurred within 1 h postsurgery, reached its peak at 1 week following surgery, and then decreased markedly by 1 month postsurgery. A minimal gliotic reaction was still present 1 year postsurgery but was localized to the needle tract. No differences in GFAP reactivity were seen between the polymer-implanted and control sides at any time point. Histological analysis determined that the majority of the PLG disappeared between 1 and 4 weeks. A set of parallel studies in which PLG samples were retrieved from the brain at various time points corroborated these findings and determined that the majority of PLG degraded within 2 weeks following implantation. Together, these results demonstrate that PLG is well tolerated following implantation into the CNS and that the astrocytic response to PLG is largely a consequence of the mechanical trauma that occurs during surgery. The biocompatibility of PLG implanted into the CNS provides further support for its use in a wide range of new therapeutic applications for sustained and localized drug delivery to the brain.