Level of polychlorinated biphenyls in tumor and blood serum of breast cancer patients and control subjects from Punjab, Pakistan

The current study examined the level of Polychlorinated biphenyls (PCBs) in tumor and blood serum of female breast cancer patients and control individuals recruited from Punjab, Pakistan. Breast tumor and blood serum from 40 patients and only blood serum from ten control subjects were obtained and concentration of 32 PCB congeners was analyzed through Gas chromatography coupled with Mass spectrophotometry. Sociodemographic variables of the patients along with essential clinical and haematological parameters were taken as covariates. Tumor reflects the highest median (min-max) concentration (ng g-1 lw) of ƩPCBs at 115.94 (0.05-17.75) followed by 16.53 (0.09-2.94) and 5.24 (0.01-0.59) in blood serum of cancer patients and control group respectively. Median concentrations (ng g-1 lw) of non-dioxine like ƩPCBs were considerably higher at 83.04, 32.89 and 4.27 compared to 13.03 and 3.50 and 0.97 for dioxin like ƩPCBs in tumor, serum of breast cancer patients and control subjects respectively. PCB-87 was most dominant congeners in tumor followed by PCB-170 and -82 whereas PCB-28 and -52 reflected greatest contribution in serum of breast cancer patients. Blood haemoglobin, potassium and chloride ions showed significant positive whereas body mass index reflect inverse relationship when regressed with ƩPCBs in tumor. This pioneer study depicts elevated concentrations of PCBs in patients compared to control, reflecting potential positive association of PCBs with breast cancer which need further confirmation. We concluded that chronic exposure to PCBs might be associated with an increasing number of breast cancer incidences in developing countries like Pakistan, which should be further elucidated through detail in vitro and in vivo studies.

Fabricating a 3D floating porous PDMS - Ag/AgBr decorated g-C3N4 nanocomposite sponge as a re-usable visible light photocatalyst

In this study, polymeric graphitic carbon nitride (g-C3N4) semiconductors was synthesized via a thermal condensation method. Subsequently, Ag/AgBr nanoparticles with varying ratios were decorated onto the g-C3N4 surface using the water/oil emulsion method. The resulting nanocomposites were characterized using XRD for phase identification and structural analysis, HR-TEM and SEM&EDAX for morphological structure, particle size, and elemental composition analysis, and XPS for investigating the chemical state and electronic structure. The impact of Ag/AgBr content on the optical properties of g-C3N4 were also studied such as (optical bandgap (Eg), refractive index (n), extinction coefficient (k), optical conductivity (σopt) and dielectric function (ε*)), Electrochemical impedance spectroscopy (EIS), PL spectroscopy and Chrono-amperometric investigations were conducted to assess the charge transfer capabilities and long-term durability of the prepared nanocomposites. The results revealed a reduction in Ag/AgBr particle size with an increase in g-C3N4 content, accompanied by a decrease in the optical bandgap from 2.444 eV to 2.393 eV. Furthermore, the nanocomposites exhibited enhanced degradation efficiencies of RhB dye, with the highest tested content of Ag/AgBr achieving 100% degradation after 120 min of irradiation. However, the challenge of catalyst separation after the degradation process remained. To address this issue, we developed a novel approach by impregnating Ag/AgBr@g-C3N4 photocatalyst onto a floating porous sponge using a simple sugar-template technique, offering potential as a reusable photocatalyst material. Furthermore, the 3D PDMS - Ag/AgBr@g-C3N4 photocatalyst was evaluated and found to maintain nearly the same photocatalytic efficiency for up to 5 consecutive cycles.

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

BACKGROUND

Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation.

METHODS

WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109.

FINDINGS

Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital.

INTERPRETATION

In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates.

FUNDING

European Society of Intensive Care Medicine, European Respiratory Society.

Growth, hemato-biochemical, immune-antioxidant response, and gene expression in Nile tilapia (Oreochromis niloticus) received nano iron oxide-incorporated diets

Nanotechnology has recently played a key role in tackling many aquacultures issues. Hence, the present study targets the evaluation of dietary inclusion of nano iron oxide (nFe₂O₃) on growth performance, hematology, immune-antioxidant responses, ionic regulation and expression of related genes in Nile tilapia (Oreochromis niloticus). Fish were fed supplementary nFe₂O₃ at rates of zero (control), 0.5, and 1 g/kg diet for 30 days. Obtained data demonstrated that nFe₂O₃ significantly (P < 0.05) augmented growth performance (final weight and length, body mass gain, specific growth rate, feed conversion ratio, and length gain rate). Hematological picture {RBCs, Hb, MCV, MCH and MCHC, and leukocytes interpretations (WBCs and monocytes)}; and biochemical indexes including (AST and ALT; total protein; and glucose, and cortisol) were significantly (P < 0.05) improved in nFe₂O₃ supplemented groups. Plasma ionic concentration was also altered with nFe₂O₃ supplementation, and 1g nFe₂O₃ revealed the most marked increase in plasma (Na⁺) potassium (K⁺) levels. Similarly, IgM, nitrous oxide (NO), and lysozyme activity, plus superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activities showed a remarkable improvement in 1g nFe₂O₃ group compared to the control. Expression of Insulin-Like Growth Factor-1 (IGF-1) and interleukin 1-β (IL-1β) genes were significantly up-regulated in nFe₂O₃ supplemented groups. Briefly, dietary nFe₂O₃ inclusion had enhanced properties on growth; hemato-biochemical; immune, antioxidative profiles; and related genes expression of O. niloticus, with a recommended concentration of 1g nFe₂O₃.

Evaluation of serum procalcitonin level as a biomarker for disease severity in COVID-19 patients

The pandemic of coronavirus disease 2019 (COVID-19) has infected millions of individuals around the globe. Forecasting the COVID-19 severity is essential, and various biomarkers could be used to evaluate it. The current study was therefore aimed to evaluate the serum pro-calcitonin (PCT) level as a biomarker for bacterial co-infection and disease severity in COVID-19 patients. A total of 430 COVID-19 positive individuals were examined, in which 332 (77.2%) were male individuals while 98 (22.8%) were female individuals. Among the examined samples, 281 were classified as moderate (PCT value 0.07 ± 0.06 ng/mL), 95 were severe (PCT value 0.5 ± 0.4 ng/mL), and 54 were classified as critical (PCT value > 1 ng/mL) individuals. The increase in the total serum level of PCT was observed with the severity of the disease (p < 0.05). The statistical analysis represented no association of PCT value with gender (p 0.9650) while revealed a significant association (p < 0.001) with the age and PCT value in COVID-19 patients. It can be concluded that the serial PCT measurement could determine the prognosis of the disease and the presence of bacterial co-infection in COVID-19 patients. Further exploration of the topic is needed to evaluate the effect of different therapies on the PCT level and to prescribe specific treatment options for coinfection.

To Push or To Pull? In a Post-COVID World, Supporting and Incentivizing Antimicrobial Drug Development Must Become a Governmental Priority

The COVID-19 pandemic has refocused attention worldwide on the dangers of infectious diseases, in terms of both global health and the effects on the world economy. Even in high income countries, health systems have been found wanting in dealing with the new infectious agent. However, the even greater long-term danger of antimicrobial resistance in pathogenic bacteria and fungi is still under-appreciated, especially among the general public. Although antimicrobial drug development faces significant scientific challenges, the gravest challenge at the moment appears to be economic, where the lack of a viable market has led to a collapse in drug development pipelines. There is therefore a critical need for governments across the world to further incentivize the development of antimicrobials. Most incentive strategies over the past decade have focused on so-called "push" incentives that bridge the costs of antimicrobial research and development, but these have been insufficient for reviving the pipeline. In this Perspective, we analyze the current incentive strategies in place for antimicrobial drug development, and focus on "pull" incentives, which instead aim to improve revenue generation and thereby resolve the antimicrobial market failure challenge. We further analyze these incentives in a broader "One Health" context and stress the importance of developing and enforcing strict protocols to ensure appropriate manufacturing practices and responsible use. Our analysis reiterates the importance of international cooperation, coordination across antimicrobial research, and sustained funding in tackling this significant global challenge. A failure to invest wisely and continuously to incentivize antimicrobial pipelines will have catastrophic consequences for global health and wellbeing in the years to come.

BONE DEVELOPMENT AND FRACTURE HEALING IS NORMAL IN MICE THAT HAVE A DEFECT IN THE DEVELOPMENT OF THE LYMPHATIC SYSTEM

Ectopic lymphatics form in bone and promote bone destruction in diseases such as Gorham-Stout disease, generalized lymphatic anomaly, and kaposiform lymphangiomatosis. However, the role lymphatics serve in normal bone development and repair is poorly understood. The objective of this study was to characterize bone development and fracture healing in mice that have a defect in the development of the lymphatic vasculature. We found that bones in wild-type adult mice and mouse embryos did not have lymphatics. We also found that bone development was normal in Vegfr3Chy/Chy embryos. These mice do not have lymphatics and die shortly after birth. To determine whether lymphatics serve a role in postnatal bone development and fracture healing, we analyzed bones from Vegfr3wt/Chy mice. These mice are viable and have fewer lymphatics than wild-type mice. We found that postnatal bone development and fracture healing was normal in Vegfr3wt/Chy mice. Taken together, our results suggest that lymphatics do not play a major role in normal bone development or repair.

15 Structured Geriatric Liaison Services in Mental Health Inpatient Facilities

Introduction

Older people admitted to mental health facilities may be at increased risk of deterioration in the physical co-morbidities and increased rates of mortality when admitted in acute medical settings. Our model of care focuses on intervening in the physical aspect of patients admitted in the mental health unit addressing their comorbidities and polypharmacy and offering staff support during the admission process. Our Older Mental Health Unit is based in the district hospital with a total of 22 beds for people over 65 years old distributed in two areas: dementia with behavioral and psychological symptoms (BPS) and functional disorders.

Methods

Allocated geriatrician once a week to attend MDT and medical ward rounds. 5 working days telephone consultations for advice and supporting trainees in teaching and research. We measure the impact of our intervention comparing the data predating our intervention comparing 20 patients in each period 2016 and 2018.

Results

Mean age increased from 74.3 to 77.8 in a two year period with an average of 3.5 medical co-morbidities. Reduction in polypharmacy from 7.15 to 5.5 number of medication, 58% reduction in the number of hospital transfers and 90% reduction in specialty referrals.

Conclusions

Structured Geriatric Liaison Services in Mental Health in inpatient facilities are shown to be effective in reducing acute hospital and outpatient clinic attendances minimising the challenges of management of these patients in non-mental health facilities.

Application of leaching tests on phosphogypsum by infiltration-percolation

The phosphoric acid production obtained by attacking phosphate rock by sulphuric acid cogenerates considerable quantities of phosphogypsum. The world cogeneration is estimated about 100-280 Mt per year. In another context of sustainable development, the phosphate chemical industry develops different ways of phosphogypsum valorization, which makes its storage stack in a suitable way for its potential use as an industrial by-product. Although, this storage can cause an environmental impact largely due to the transfer of trace elements (TEs) to groundwater by leaching. It is therefore important to evaluate the impact linked to the storage in order to limit this transfer. The evaluation is usually performed through leaching tests in columns or reactor. In this work, leaching tests were performed in columns by infiltration-percolation on two filter mediums: phosphogypsum and synthetic sandy soils. The results showed that the phosphogypsum is acting as a filter, which retains and releases the TEs. Most of these TEs (Pb, Se, Ag, Zn and Cu) were highly retained in the synthetic soils surfaces and their contents in waters were considerably lower than the maximum contaminant levels (MCLs). Although As, Cd, Cr and Ni were strongly transferred to groundwater, their respective contents were higher than the MCLs.

Early Pregnancy Ultrasound and Management: Effect of a Multifaceted Training on Physician Knowledge

Vaginal bleeding is a common event in early pregnancy, with 20-40% of pregnancies affected. Prompt diagnosis and management of bleeding is important, both to reduce morbidity and to avoid excessive emotional distress. This was a prospective study of an educational programme aimed at Obstetrics and Gynaecology BST trainees in the National Maternity Hospital, Dublin. The educational programme consisted of didactic lectures, and simulation and practical sessions. A questionnaire reviewing early pregnancy complications was used to assess participant knowledge. Six trainees participated in the programme, with five (83%) answering the questionnaire. The pre-education questionnaire showed a generally poor level of knowledge of early pregnancy complications with 8/50 (16%) questions answered correctly. Following the educational intervention there was a statistically significant increase in participant knowledge with 45/50 (90%) questions answered correctly. A significant increase in participant knowledge of early pregnancy complications followed our multifaceted educational programme. Study limitations exist, however we have shown the potential value of our educational programme.

Intrinsic fluorescence of selenium nanoparticles for cellular imaging applications

Nanoparticles hold great potential in contributing to high-resolution bioimaging as well as for biomedical applications. Although, selenium (Se) nanoparticles (NPs) have been investigated owing to their potential roles in therapeutics, the imaging capability of these NPs has never been explored. This manuscript identifies the intrinsic fluorescence of Se NPs, which is highly beneficial for nanoscale imaging of biological structures. The emission of individual NPs and its evolution with time is explored. The photoluminescence spectra has revealed visible to near infrared emission for Se NPs. The work finally reflects on the role of this intrinsic fluorescence for in vitro imaging and tracking in fibroblast cells, without the need of any additional tags. This technique would overcome the limitations of the conventionally used methods of imaging with tagged fluorescent proteins and dyes, preventing possible adverse cellular effects or phototoxicity caused by the added fluorescent moieties.

Crystal phase engineered quantum wells in ZnO nanowires

We report the fabrication of quantum wells in ZnO nanowires (NWs) by a crystal phase engineering approach. Basal plane stacking faults (BSFs) in the wurtzite structure can be considered as a minimal segment of zinc blende. Due to the existing band offsets at the wurtzite (WZ)/zinc blende (ZB) material interface, incorporation of a high density of BSFs into ZnO NWs results in type II band alignment. Thus, the BSF structure acts as a quantum well for electrons and a potential barrier for holes in the valence band. We have studied the photoluminescence properties of ZnO NWs containing high concentrations of BSFs in comparison to high-quality ZnO NWs of pure wurtzite structure. It is revealed that BSFs form quantum wells in WZ ZnO nanowires, providing an additional luminescence peak at 3.329 eV at 4 K. The luminescence mechanism is explained as an indirect exciton transition due to the recombination of electrons in the QW conduction band with holes localized near the BSF. The binding energy of electrons is found to be around 100 meV, while the excitons are localized with the binding energy of holes of ∼5 meV, due to the coupling of BSFs, which form QW-like structures.

Method for vector characterization of polar liquids using frequency-domain spectroscopy

A device for performing vector transmission spectroscopy on aqueous and polar solvent specimens at terahertz frequencies is presented. The device enables the direct measurement of the complex dielectric function across the terahertz band using a Fourier transform IR spectrometer for lossy solutions. Using microfluidic sampling, specimen handling is straightforward and direct measurements on polar specimens are made possible. The method is scalable to longer or shorter wavelengths.

Polarization insensitive terahertz metamaterial absorber

We present the simulation, implementation, and measurement of a polarization insensitive resonant metamaterial absorber in the terahertz region. The device consists of a metal/dielectric-spacer/metal structure allowing us to maximize absorption by varying the dielectric material and thickness and, hence, the effective electrical permittivity and magnetic permeability. Experimental absorption of 77% and 65% at 2.12 THz (in the operating frequency range of terahertz quantum cascade lasers) is observed for a spacer of polyimide or silicon dioxide respectively. These metamaterials are promising candidates as absorbing elements for thermally based terahertz imaging.

A terahertz polarization insensitive dual band metamaterial absorber

Metamaterial absorbers have attracted considerable attention for applications in the terahertz range. In this Letter, we report the design, fabrication, and characterization of a terahertz dual band metamaterial absorber that shows two distinct absorption peaks with high absorption. By manipulating the periodic patterned structures as well as the dielectric layer thickness of the metal-dielectric-metal structure, significantly high absorption can be obtained at specific resonance frequencies. Finite-difference time-domain modeling is used to design the structure of the absorber. The fabricated devices have been characterized using a Fourier transform IR spectrometer. The experimental results show two distinct absorption peaks at 2.7 and 5.2 THz, which are in good agreement with the simulation. The absorption magnitudes at 2.7 and 5.2 THz are 0.68 and 0.74, respectively.

Sensitivity pattern of methicillin resistant Staphylococcus aureus isolated from patients admitted in a tertiary care hospital of Pakistan

BACKGROUND AND OBJECTIVES

Methicillin resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen causing significant morbidity and mortality. The aim of this study was to evaluate in vitro activities of different antibiotics against methicillin resistant Staphylococcus aureus.

MATERIALS AND METHOD

The study was conducted over a period of one year (January 2009 - December 2009) in the Department of Microbiology, Army Medical College, the National University of Sciences and Technology, Pakistan. One hundred and thirty-nine Methicillin resistant Staphylococcus aureus isolated from the clinical specimens at Rawalpindi Military Hospital were subjected to in vitro susceptibility against various antimicrobials using Kirby Bauer disc diffusion technique.

RESULTS

All the isolated MRSA organisms were uniformly susceptible to vancomycin, linezolid and tigecycline. Other drugs which were found to be effective were chloramphenicol, and rifampacin. Most of the MRSA were isolated from pus samples.

CONCLUSION

Vancomycin, tigecycline and linezolid were effective against methicillin resistant strains of S.aureus. This study suggests that chloramphenicol and rifampacin also have good in vitro efficacy for methicillin resistant S. aureus infections. Oral dosing option for linezolid, chloramphenicol and rifampacin can allow earlier discharge of hospitalized patients and thus reduce health care expenses as well as help reduce the chances of vancomycin resistant strains emergence.

Imprinted terahertz artificial dielectric quarter wave plates

We have developed low-loss polymer artificial dielectric quarter wave plates (QWP) operating at 2.6, 3.2 and 3.8 THz. The QWPs are imprinted on high density polyethylene (HDPE) using silicon masters. The grating period for the quarter wave plates is 60 microm. 330 microm, 280 microm and 230 microm deep gratings are used to obtain a pi/2 phase retardance between TE and TM polarization propagating through the QWPs. High frequency structure simulator (HFSS) was used to optimize the grating depth. Since the required grating depth is high, two plates, fixed in a back-to-back configuration were used for each QWP. A maximum aspect ratio (grating height/grating width) of 6.6 was used.

Terahertz dual-band resonator on silicon

We have designed and fabricated a dual-band resonator in the terahertz frequency range on high-resistivity silicon. The device is designed to show resonances at 2.6 and 4.3 THz using the finite-difference time-domain modeling method. The characteristics of the fabricated device have been examined by using a Fourier-transform IR spectrometer. Measured results are in excellent agreement with the simulated data, showing two polarization-independent resonant peaks observed at 2.60 and 4.37 THz, respectively. The first resonance has a bandwidth of 0.56 THz, while the second one has a bandwidth of 0.70 THz. These dual-band resonant devices can be used for various applications such as dual-band spectral imaging and multiband biosensors.

Current trends in management of ectopic pregnancy in the United Kingdom

The potential advantages of laparoscopic management of ectopic pregnancy include lower morbidity, faster return to work, and less impact on reproductive health. This study aimed to investigate the current management of ectopic pregnancy in the United Kingdom. Thirty-five per cent of ectopic pregnancies are currently managed laparoscopically. Units that tended to operate laparoscopically were more likely to attempt to preserve the fallopian tube at surgery. Ninety per cent of units in the UK feel that they potentially could manage ectopic pregnancies laparoscopically but in practice only 60% managed any of the last three ectopic pregnancies by this technique.

Intraductal papillary mucinous tumor of the pancreas (IPMT): follow-up of twelve cases

INTRODUCTION

Intraductal papillary mucinous tumours (IPMT) were described as a distinct entity in I982. The extent of surgical resection for this disease remains controversial.

METHODS

Twelve patients with a diagnosis of IPMT were included in the present retrospective study.

RESULTS

Ten out of twelve patients had symptoms suggesting chronic pancreatitis. Two patients were not operated on due to biopsy-verified metastases in the liver. Nine patients were treated with a total pancreatectomy and one with a pancreaticoduodenectomy. In the ten patients operated on for IPMT, histological examination showed eight non-invasive- and two invasive carcinomas. In six cases, multifocal extensive intraductal changes were found, affecting either most of or the whole pancreas. There was no perioperative mortality. Six patients were alive at follow-up without recurrence and four patients were dead, two of them with recurrence.

CONCLUSION

IPMTs represent a subgroup of pancreatic neoplasms with a favourable prognosis, and the resection should aim at removing all dysplastic foci. In cases with diffuse dilatation of the main pancreatic duct, widespread tumour involvement of the duct system can be expected and total pancreatectomy should be the operation of choice.

Direct fabrication of terahertz optical devices on low-absorption polymer substrates

We have fabricated terahertz wire grid polarizer and terahertz bandpass filter devices on high-density polyethylene substrates using simple photolithographic fabrication techniques. The performance of the fabricated devices was measured using a Fourier transform IR spectrometer. Both devices showed good performance in the terahertz frequency range up to 5 THz, in agreement with rigorous coupled-wave analysis (polarizer) and finite-difference time-domain (filter) simulations. Our results successfully demonstrate the use of standard fabrication techniques to produce large-aperture free-standing terahertz optical devices on low-absorption polymer materials with the advantage of low cost using a simple fabrication process. The fabricated polarizer had better than 30 dB extinction ratio at 3 THz. Bandpass filters were demonstrated at three different center frequencies (1.5, 1.8, 2.9 THz) with a 3 dB insertion loss and 2<or=Q<or=7.

A simple method to screen for azo-dye-degrading bacteria

A stab-culture method was adapted to screen for azo dyes-decolorizing bacteria from soil and water samples. Decolorized azo dye in the lower portion of the solid media indicates the presence of anaerobic azo dyes-decolorizing bacteria, while aerobic decolorizing bacteria decolorizes the surface portion of the solid media. Of twenty soil samples tested, one soil sample shows positive results for the decolourisation of two azo dyes; Biebrich scarlet (BS) and Direct blue 71 (DB) under anaerobic conditions. A gram negative and oxidase negative bacterial isolate was found to be the principal azo dyes degrader The isolate was identified by using the Biolog identification system as Serratia marcescens.

Endoscopic ultrasound-guided fine-needle aspiration for diagnosis of solid pseudopapillary tumors of the pancreas: a multicenter experience

BACKGROUND AND STUDY AIMS

Solid pseudopapillary tumors of the pancreas are rare, low-grade, epithelial neoplasms that are usually discovered incidentally in young women. Distinguishing solid pseudopapillary tumors from other pancreatic tumors, especially pancreatic endocrine tumors, can be challenging. The role of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in this context remains unclear. The purpose of this study was to describe the endoscopic ultrasound features of solid pseudopapillary tumors and the role of EUS-FNA in the preoperative diagnosis of these tumors.

PATIENTS AND METHODS

Patients from five tertiary referral centers with surgically confirmed solid pseudopapillary tumors who had undergone preoperative EUS-FNA were included. The endoscopic ultrasound findings, cytologic descriptions, immunostaining results, operative records, surgical pathology, and results of the most recent clinical follow-up were reviewed.

RESULTS

A total of 28 patients were identified (four men [14 %], 24 women [86 %], mean age +/- standard deviation [SD] 35 +/- 10 years). Solid pseudopapillary tumors had been found as incidental findings on cross-sectional imaging in 50 % of cases. The mean tumor size +/- SD was 42 +/- 19.5 mm and the majority were located in the pancreatic body and tail. The endoscopic ultrasound report described a well-defined, echo-poor mass in 86 %; the tumors were solid in 14 patients (50 %), mixed solid and cystic in 11 patients (39 %), and cystic in three patients (11 %). A preoperative diagnosis of solid pseudopapillary tumor was made in 21 patients (75 %) on the basis of EUS-FNA cytology. Surgical resection was performed in all cases. Laparoscopic resection was performed in eight of these patients (29 %).

CONCLUSIONS

A solid pseudopapillary tumor should be included in the differential diagnosis of any well-demarcated, echo-poor, solid or mixed solid/cystic pancreatic lesion seen during endoscopic ultrasound, particularly in young women. The diagnostic accuracy of EUS-FNA for solid pseudopapillary tumors was 75 % in this study. A definitive preoperative diagnosis can guide the surgical approach in selected cases.

Rosiglitazone treatment improves cardiac efficiency in hearts from diabetic mice

Isolated perfused hearts from type 2 diabetic (db/db) mice show impaired ventricular function, as well as altered cardiac metabolism. Assessment of the relationship between myocardial oxygen consumption (MVO(2)) and ventricular pressure-volume area (PVA) has also demonstrated reduced cardiac efficiency in db/db hearts. We hypothesized that lowering the plasma fatty acid supply and subsequent normalization of altered cardiac metabolism by chronic treatment with a peroxisome proliferator-activated receptor-gamma (PPARgamma) agonist will improve cardiac efficiency in db/db hearts. Rosiglitazone (23 mg/kg body weight/day) was administered as a food admixture to db/db mice for five weeks. Ventricular function and PVA were assessed using a miniaturized (1.4 Fr) pressure-volume catheter; MVO(2) was measured using a fibre-optic oxygen sensor. Chronic rosiglitazone treatment of db/db mice normalized plasma glucose and lipid concentrations, restored rates of cardiac glucose and fatty acid oxidation, and improved cardiac efficiency. The improved cardiac efficiency was due to a significant decrease in unloaded MVO(2), while contractile efficiency was unchanged. Rosiglitazone treatment also improved functional recovery after low-flow ischemia. In conclusion, the present study demonstrates that in vivo PPARgamma-treatment restores cardiac efficiency and improves ventricular function in perfused hearts from type 2 diabetic mice.

Impact of the availability of sonography in the acute gynecology unit

OBJECTIVE

The initial assessment of acute gynecology patients is usually based on history and clinical examination and does not involve ultrasound. The aim of this study was to investigate the impact of the availability of transvaginal sonography at the time of initial assessment of the emergency gynecology patient.

METHODS

This was a prospective observational study carried out over a 5-month period in the acute gynecology unit of an inner London teaching hospital. Women were assessed in the routine manner by history-taking and clinical examination and questionnaires were completed by the doctors, including details of the intention to treat. Transvaginal ultrasound examinations were then performed and a second diagnosis and management plan were made utilizing the extra information from the scan. The plans for clinical management before and after the ultrasound examination were compared.

RESULTS

We originally recruited 1000 consecutive women to the study. The mean age was 31.1 (SD, 9.81) years. Complete data were available for 920 (92%). 84 (9.1%) women did not require a scan. Of the 521 women with a positive pregnancy test, 75.6% were reassured immediately that their pregnancy was intrauterine. 143 women (27.4%) were given the diagnosis of a suspected ectopic pregnancy before sonography, compared with 29 (5.6%) after. Following the ultrasound examination there was a change in clinical management in 54.1% of the women with a positive pregnancy test and a reduction in admissions (including inpatient theater admissions) (from 40.3% to 17.1%) and outpatient follow-up examinations (from 41.1% to 35.5%). In 90 (23.8%) non-pregnant women a significant ovarian cyst (> 5 cm) was suspected clinically; 28/90 (31.1%) were confirmed on sonography. Following the ultrasound examination there was a change in clinical management for 38.1% of non-pregnant women and a reduction in admissions (from 37.1% to 19.4%) and outpatient follow-up examinations (from 25.7% to 18.1%).

CONCLUSION

It appears that the availability of transvaginal sonography at the time of initial assessment of emergency gynecology patients improves diagnostic accuracy and reduces unnecessary admissions and follow-up examinations.

A 93 year old man with the PRSS1 R122H mutation, low SPINK1 expression, and no pancreatitis: insights into phenotypic non-penetrance

BACKGROUND

The cationic trypsinogen (PRSS1) R122H mutation causes autosomal dominant hereditary pancreatitis (HP) with multiple attacks of acute pancreatitis, but the penetrance, frequency, and severity of attacks are highly variable. HP twins study suggests that modifier genes influence severity but not penetrance.

AIM

To investigate potential trypsin associated factors in subjects with the PRSS1 R122H mutation and phenotypic non-penetrance.

METHODS

Two subjects from HP families (including a 93 year old subject with PRSS1 R122H without pancreatitis), one with chronic pancreatitis and one with a normal pancreas, were studied. Relative expression of: (a) the PRSS1 R122 and H122 alleles; and (b) the PRSS1 and SPINK1 genes in pancreatitis were determined using complementary methods.

RESULTS

PRSS1 wild-type (R122) and mutant (H122) allele expression was equivalent in multiple (> 3) samples from the phenotypically affected and non-penetrant subjects with R122H genotypes using allele specific quantitative reverse transcription-polymerase chain reaction (RT-PCR) and intron spanning nested RT-PCR followed by cDNA sequencing. Compared with PRSS1 mRNA levels, SPINK1 mRNA levels were low in normal appearing tissue but markedly increased in samples with chronic inflammation, independent of PRSS1 genotype.

CONCLUSION

Attacks of acute pancreatitis in HP subjects appear to be independent of the relative expression of the mutant PRSS1 H122 allele or SPINK1 gene expression. The marked increase in SPINK1 gene expression with inflammation is consistent with its regulation as an acute phase protein.

The use of ultrasound-based 'soft markers' for the prediction of pelvic pathology in women with chronic pelvic pain-can we reduce the need for laparoscopy?

OBJECTIVE

To assess the accuracy of new transvaginal ultrasound-scan-based markers and to compare them to conventional ultrasound methods used in the detection of common pelvic pathology in women with chronic pelvic pain (CPP).

DESIGN

A prospective observational study.

SETTING

Teaching hospital.

POPULATION

A total of 120 consecutive women with CPP undergoing transvaginal ultrasonography before either diagnostic or operative laparoscopy.

METHODS

Anatomical abnormalities, e.g. endometrioma or hydrosalpinx (hard markers), were documented. The woman was then assessed for the presence or absence of 'soft markers' (reduced ovarian mobility and site-specific pelvic tenderness).

MAIN OUTCOME MEASURE

Presence or absence of pelvic pathology noted during laparoscopy.

RESULTS

Seventy women had pelvic pathology, of whom 51 had endometriosis alone, 7 both endometriosis and pelvic adhesions, 6 pelvic adhesions, 1 hydrosalpinx with endometriosis and 5 hydrosalpinx and pelvic adhesions. The likelihood ratio for the hard markers was infinity (specificity was 100%), for the soft makers 1.9 (95% CI 1.2-3.1) and for a 'normal' ultrasound 0.18 (0.09-0.34). The pre-test probability of pelvic disease in our population of women with CPP was 58%, and this probability of disease was raised to 100% with the presence of hard markers and to 73% with the presence of soft markers. The pre-test probability of 58% fell to 20% when ultrasound finding was found to be normal.

CONCLUSION

This new approach improves the detection and exclusion of significant pathology in women with CPP and may lead to a reduction in the number of unnecessary laparoscopies carried out on women with CPP.