Fine-needle aspiration technique under endoscopic ultrasound guidance:A technical approach for RNA profiling of pancreatic neoplasms

BACKGROUND Early diagnosis of pancreatic ductal adenocarcinoma(PDAC)has been a longstanding challenge.The prognosis of patients with PDAC depends on the stage at diagnosis.It is necessary to identify biomarkers for the detection and differentiation of pancreatic tumors and optimize PDAC sample preparation procedures for DNA and RNA analysis.Most molecular studies are done using paraffin-embedded blocks;however,the integrity of DNA and RNA is often compromised in this format.Moreover,RNA isolated from human pancreatic tissue samples is generally of low quality,in part,because of the high concentration of endogenous pancreatic RNAse activity present.AIM To assess the potential of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)to obtain specimens from pancreatic neoplasms for subsequent RNA molecular profiling,including next-generation sequencing(NGS).METHODS Thirty-four EUS-FNA samples were included in this study:PDAC(n=15),chronic pancreatitis(n=5),pancreatic cysts(n=14),mucinous cysts(mucinous cystic neoplasia/intraductal papillary mucinous neoplasia)n=7,serous cystic neoplasms n=5,and pseudocysts n=2.Cyst material consisted of cyst fluid and cyst wall samples obtained by through-the-needle biopsy(TTNB).Samples were stored at -80℃ until analysis.RNA purity(A260/230,A260/280 ratios),concentration,and integrity(RIN)were assessed.Real-time polymerase chain reaction was conducted on all samples,and small RNA libraries were prepared from solid mass samples.RESULTS RNA was successfully extracted from 29/34(85%)EUS-FNA samples:100% pancreatic adenocarcinoma samples,100% chronic pancreatitis samples,70% pancreatic fluid cyst samples,and 50%TTNB samples.The relative expression of GAPDH and HPRT were obtained for all successfully extracted RNA samples(n=29)including lowquality RNA specimens.Low concentration and nonoptimal RIN values(no less than 3)of RNA extracted from EUS-FNA samples did not prevent NGS library preparation.The suitability of cyst fluid samples for RNA profiling varied.The quality of RNA extracted from mucinous cyst fluid had a median RIN of 7.7(5.0-8.2),which was compatible with that from solid neoplasms[6.2(0-7.8)],whereas the quality of the RNA extracted from all fluids of serous cystic neoplasms and TTNB samples had a RIN of 0.CONCLUSION The results demonstrate the high potential of EUS-FNA material for RNA profiling of various pancreatic lesions,including low-quality RNA specimens.

Copper Ions Removal from Wastewater by Electrocoagulation Using Cement-based Cathode Plates

The present work uses PEO solution to well disperse carbon fiber and identifies percolation thresholds of carbon fiber and carbon black which are used as conductive fillers.The resultant cathode plates have an average compressive strength of 27.3 MPa and flexural strength of 29.09 MPa,which demonstrate excellent mechanical properties.The Cu^(2+)removal efficiency was measured at different current densities in EC process with cement-based cathode plate,while the voltage changes were recorded.The results showed that the cement-based cathode plate operated stably and achieved 99.7%removal of 1 L of simulated wastewater with a Cu^(2+)concentration of 200 ppm at a current density of 8 m A/cm^(2)for 1 h.Characterization of floc and tested cathode plates,SEM and EDS analyses,and repeatability testing of the tested plates demonstrate the reusability of the plates,proving that cement-based plates can effectively replace metal cathode plates,reduce the cost of EC and improve the applicability of EC devices.

The efficacy and safety of endoscopic ultrasound-guided fine-needle biopsy in gallbladder masses

Background: Endoscopic ultrasound-guided fine-needle biopsy(EUS-FNB) is a widely used modality for acquiring various target samples, but its efficacy in gallbladder masses is unknown. The aim of this retrospective study was to evaluate the efficacy and safety of EUS-FNB in patients with gallbladder masses. Methods: The study samples were composed of patients from March 2015 to July 2019 who needed to identify the nature of gallbladder masses through EUS-FNB. The outcomes of this study were the adequacy of specimens, diagnostic yields, technical feasibility, and adverse events of the EUS-FNB in gallbladder masses. Results: A total of 27 consecutive patients with a median age of 58 years were included in this study. The 22-gauge FNB needle was feasible in all lesions. The median follow-up period of the patients was 294 days. The specimens sufficient for diagnosis account for 89%(24/27) and 93%(25/27) in cytology and histology, respectively. The overall diagnostic yields for malignancy showed the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 95.45% [95% confidence interval(CI): 75.12%-99.76%], 100%(95% CI: 46.29%-10 0%), 10 0%(95% CI: 80.76%-100%), 83.33%(95% CI: 36.48%-99.12%), and 96.30%(95% CI: 80.20%-99.99%), respectively. The subgroup analysis revealed that FNB could obtain sufficient specimens and high diagnostic yields in both gallbladder mass < 20.5 mm group and ≥20.5 mm group. One patient experienced mild abdominal pain after the procedure and recovered within one day. Conclusions: EUS-FNB is a reasonable diagnostic tool for the pretreatment diagnosis of patients with gallbladder masses, especially for patients who may miss the opportunity of surgery and need sufficient specimens to identify the pathological type so as to determine chemotherapy regimens. Further largescale studies are needed to confirm our conclusion.

Mass-producible low-cost flexible electronic fabrics for azo dye wastewater treatment by electrocoagulation

Electrocoagulation is progressively becoming an ecologically friendly water treatment method owing to its lack of secondary pollution,high active ingredient concentration,high treatment effectiveness,simple equipment,and simplicity of automated control implementation.Herein,electrocoagulation is offered as a method for treating wastewater containing azo dyes using a revolutionary flexible electronic fabric that can be mass-producible at a reasonable price.A computer-controlled machine embroiders 316L stainless steel fiber(316L SSF)onto an insulating fabric to manufacture a flexible electronic device of cathode and anode with a monopolar arrangement on the fabric surface.Using methyl orange(MO)solution to simulate azo dye wastewater,the decolorization rate of 500 ml MO reached 99.25% under the conditions of 50 mg·L^(-1)initial mass concentration,120 min electrolysis time,15 mA·g^(-1)current density,1 cm electrode spacing,0.1 mol·L^(-1)NaCl,pH 7.6,200 r·min^(-1)rotational speed of the stirrer,and 22-25℃ room temperature.In addition,it is feasible to embroider flexible electronic fabrics with varied sizes and numbers of electrodes based on the amount of treated sewage to increase the degradation rate,which has significant practical application value.

Cheesy material on macroscopic on-site evaluation after endoscopic ultrasound-guided fine-needle biopsy:Don't miss the tuberculosis

Endoscopic ultrasound-guided fine-needle biopsy(EUS-FNB)is an excellent investigation to diagnose pancreatic lesions and has shown high accuracy for its use in pathologic diagnosis.Recently,macroscopic on-site evaluation(MOSE)performed by an endoscopist was introduced as an alternative to rapid on-site cytologic evaluation to increase the diagnostic yield of EUS-FNB.The MOSE of the biopsy can estimate the adequacy of the sample directly by the macroscopic evaluation of the core tissue obtained from EUS-FNB.Isolated pancreatic tuberculosis is extremely rare and difficult to diagnose because of its non-specific signs and symptoms.Therefore,this challenging diagnosis is based on endoscopy,imaging,and the bacteriological and histological examination of tissue biopsies.This uncommon presentation of tuberculosis can be revealed as pancreatic mass mimicking cancer.EUS-FNB can be very useful in providing a valuable histopathological diagnosis.A calcified lesion with a cheesy core in MOSE must be suggestive of tuberculosis,leading to the request of the GeneXpert,which can detect Mycobacterium tuberculosis deoxyribonucleic acid and resistance to rifampicin.A decent diagnostic strategy is crucial to prevent unnecessary surgical resection and to supply conservative management with antitubercular therapy.

New treatment for gastric duplication cyst:Endoscopic ultrasonography-guided fine-needle aspiration combined with lauromacrogol sclerotherapy:A case report

BACKGROUND Gastric duplication cysts are very rare disease that are mainly diagnosed by endoscopic ultrasonographic fine-needle aspiration biopsy.In the past,this disease was usually treated with traditional surgery and rarely with minimally invasive endoscopic surgery.However,minimally invasive endoscopic therapy has many advantages,such as no skin wound,organ preservation,postoperative pain reduction,early food intake,fewer postoperative complications,and shorter post-procedure hospitalization.CASE SUMMARY We report a case of endoscopic ultrasonography-guided fine-needle aspiration(EUS-FNA)combined with lauromacrogol sclerotherapy for pyloric obstruction due to gastric duplication cysts.CONCLUSION EUS-FNA combined with lauromacrogol sclerotherapy provides a new option for the treatment of gastrointestinal duplication cysts.

Optimizing electrocoagulation process for the treatment of biodiesel wastewater using response surface methodology

The production of biodiesel through a transesterification method produces a large amount of wastewater that contains high levels of chemical oxygen demand （COD） and oil and grease （O＆G）. Currently, flotation is the conventional primary treatment for O＆G removal prior to biological treatments. In this study, electrocoagulation （EC） was adopted to treat the biodiesel wastewater. The effects of initial pH, applied voltage, and reaction time on the EC process for the removal of COD, O＆G, and suspended solids （SS） were investigated using one factor at a time experiment. Furthermore, the Box-Behnken design, an experimental design for response surface methodology （RSM）, was used to create a set of 15 experimental runs needed for optimizing of the operating conditions. Quadratic regression models with estimated coefficients were developed to describe the pollutant removals. The experimental results show that EC could effectively reduce COD, O＆G, and SS by 55.43%, 98.42%, and 96.59%, respectively, at the optimum conditions of pH 6.06, applied voltage 18.2 V, and reaction time 23.5 min. The experimental observations were in reasonable agreement with the modeled values.

Treatment of tannery wastewater by electrocoagulation

Treatment of tannery wastewater by electrocoagulation with low cell current （≤ 1A） and soluble electrodes （mild steel electrodes and aluminum electrodes） was studied. Compared with aluminum electrodes, mild steel electrodes were more effective for the removal of sulfide, with a removal efficiency of over 90%. But during the treatment process, black color precipitate typical to iron（Ⅱ） sulfides was produced. While aluminum electrodes were effective to eliminate the colority of the effluent, the removal efficiency of sulfide was lower than 12%. The mechanisms of the removal of chemical oxygen demand, ammonia, total organic carbon, sulfide and colority with the two soluble electrodes （mild steel and aluminum electrodes） were discussed in detail. In order to exert the predominance of diffenent types of electrodes, the tannery wastewater was treated using mild steel electrodes first followed by the filter and finally by the aluminum electrodes, the elimination rates of chemical oxygen demand, ammonia, total organic carbon, sulfide and colority were 68.0%, 43.1%, 55.1%, 96.7% and 84.3%, respectively, with the initial concentrations 2413.1 mg/L, 223.4 mg/L, 1000.4 mg/L, 112.3 mg/L and 256 dilution times, respectively. The absorbance spectra and energy consumption during electrocoagulation process were also discussed.

An alternative treatment process for upgrade of petroleum refinery wastewater using electrocoagulation

An electrocoagulation treatment process was developed for treatment and upgrade of petroleum refinery effluent （wastewater）, instead of the conventional methods, which can consume higher amounts of chemicals and produce larger amounts of sludge. The effect of the operation parameters, such as current density, initial pH, anode material, anode dissolution, energy consumption and electrolysis time, on treatment efficiency was investigated. The experimental results showed that the effluent can be effectively treated under optimal conditions. Fourier transform infrared （FTIR） analysis of the effluent, and scanning electron microscopy （SEM） coupled with energy dispersive analysis of X-rays （EDAX） of the sludge produced, revealed that the unwanted pollutants can be eliminated. The electrocoagulation treatment process was assessed by using the removal efficiency of chemical oxygen demand （COD）, total suspended solids （TSS）, and the general physicochemical characteristics of wastewater, and the results showed that the electrocoagulation is an efficient process for recycling of petroleum wastewater; it is faster and provides better quality of treated water than the conventional methods.

Rapid on-site evaluation of endoscopic-ultrasound-guided fine-needle aspiration diagnosis of pancreatic masses

Endoscopic ultrasound(EUS)has become an essential tool for the study of pancreatic diseases.Specifically,EUS plays a pivotal role evaluating patients with a known or suspected pancreatic mass.In this setting,differential diagnosis remains a clinical challenge.EUSguided fine-needle aspiration(FNA)and fine-needle biopsy(FNB)have been proven to be safe and useful tools in this setting.EUS-guided FNA and FNB,by obtaining cytological and/or histological samples,are able to diagnose pancreatic lesions with high sensitivity and specificity.In this context,several methodological features,trying to increase the diagnostic yield of EUS-guided FNA and FNB,have been evaluated.In this review,we focus on the role of rapid on-site evaluation(ROSE).From data reported in the literature,ROSE may increase diagnostic yield of EUS-FNA specimens by10%-30%,and thus,diagnostic accuracy.However,we should point out that many recent studies have reported adequacy rates of>90%without ROSE,indicating that,perhaps,at high-volume centers,ROSE may not be indispensable to achieve excellent results.The use of ROSE can be considered important during the learning curve of EUS-FNA,and also in hospital with diagnostic accuracy rates<90%.

Risk factors of electrocoagulation syndrome after esophageal endoscopic submucosal dissection

AIM To investigate post endoscopic submucosal dissection electrocoagulation syndrome(PEECS) of the esophagus.METHODS We analyzed 55 consecutive cases with esophageal endoscopic submucosal dissection for superficial esophageal squamous neoplasms at a tertiary referral hospital in South Korea. Esophageal PEECS was defined as "mild" meeting one of the following criteria without any obvious perforation: fever(≥ 37.8 ℃), leukocytosis(> 10800 cells/μl), or regional chest pain more than 5/10 points as rated on a numeric pain intensity scale. The grade of PEECS was determined as "severe" when meet two or more of above criteria.RESULTS We included 51 cases without obvious complications in the analysis. The incidence of mild and severe esophageal PEECS was 47.1% and 17.6%, respectively. Risk factor analysis revealed that resected area, procedure time, and muscle layer exposure were significantly associated with PEECS. In multivariate analysis, a resected area larger than 6.0 cm^2(OR = 4.995, 95%CI: 1.110-22.489, P = 0.036) and muscle layer exposure(OR = 5.661, 95%CI: 1.422-22.534, P = 0.014) were independent predictors of esophageal PEECS. All patients with PEECS had favorable outcomes with conservative management approaches, such as intravenous hydration or antibiotics.CONCLUSION Clinicians should consider the possibility of esophageal PEECS when the resected area exceeds 6.0 cm^2 or when the muscle layer exposure is noted.

High performance electrocoagulation process in treating palm oil mill effluent using high current intensity application

Electrocoagulation process using high current intensity to treat palm oil mill effluent(POME) was investigated in this study.Various operating parameters such as electrolysis time, inter-electrode distance and initial pH were carried out to determine the efficient process condition on the removal of chemical oxygen demand(COD),biological oxygen demand(BOD) and suspended solids(SS).The highest treatment was achieved at 50 min with the removal efficiencies for COD, BOD and SS obtained as 85%, 83%, and 84%, respectively.More than 50 min treatment showed the fluctuated trends of removal efficiencies which can be considered insignificant.The application of higher current resulted in higher removals of organics while the gas bubbles also assisted in removing the pollutant particles by floatation.In an inter-electrode distance study, the removal efficiency decreased when inter-electrode distance was either higher or lower than 10 mm due to the increase of solution resistance and the decrease of anode active surface area.In initial pH study, it was found that high removal efficiencies were achieved in slightly acidic POME sample rather than in neutral or basic condition.An electrocoagulation process by using the optimum operating parameters was able to remove COD, BOD and SS up to 95%, 94% and 96% respectively.The experimental results confirm that application of high current intensity in electrocoagulation provided high treatment efficiency at a reduced reaction time.

Phenol Removal from Aqueous Solutions by Electrocoagulation Technology Using Iron Electrodes:Effect of Some Variables

The aim of this study was to determine the effect of electrocoagulation technology using iron electrodes on phenol removal in aqueous solutions. The removal of phenol was investigated in terms of various parameters, namely, current density, phenol and NaCl concentration, pH, and alginic acid concentration. The results showed that the removal efficiency of phenol increased with increasing the current density, pH and NaCl concentration, whereas it was inversely associated with initial concentration of phenol and alginic acid concentration. According to the results, electrocoagulation is a promising process for treatment of wastewater containing high concentration of phenol.

Endoscopic ultrasound-guided fine-needle aspiration cytology in pancreaticobiliary carcinomas:diagnostic efficacy of cell-block immunocyto-chemistry

BACKGROUND： Endoscopic ultrasound-guided fine-needle aspiration cytology was demonstrated to be a useful tool for the diagnosis and staging of pancreaticobiliary neoplastic le- sions. Nonetheless, the diagnostic value of this procedure may be limited by low cellularity of the specimen, contamination of intestinal cells and unfeasibility of ancillary immunocy- tochemical procedures. The present study was to evaluate its usefulness in the diagnosis of neoplastic lesions.

Optimization and mechanisms analysis of indigo dye removal using continuous electrocoagulation

Electrocoagulation(EC) is among the most effective techniques that remove color and decontaminate effluent.Coagulants are delivered in situ by anode corrosion.In this research,indigo dye removal using iron electrodes in continuous electrocoagulation process and the responsible species for decolorization were investigated.The Response Surface Methodology(RSM) was used to optimize the process parameters.The finding in this study shows that at fixed conductivity at 15,000 μS·cm^(-1) the neutral conditions(pH from 6 to 8),the low absorbance,the low flow rate and the high voltage level enhance the color removal efficiency.The high R~2 value of 97.8% and ANOVA analyses show a good correlation between the experimental and predicted results.Under the optimum conditions,which are pH of 7.5, solution concentration of 60 mg·L^(-1), inlet flow rate of 2 L·min^(-1) and voltage of 47 V, the predicted decolorization of 94.083% was achieved at 93.972% with a total cost of 0.0927 USD·m^(-3) of treated effluent.At the optimum pH(7.5),the zeta potential value(-4 mV) of the effluent during EC match with the one of iron Ⅲ hydroxide.The dye removal is ensured thanks to physical adsorption and flocculation.The results exposed in this work prove that the continuous electrocoagulation process could be successfully used for indigo dye removal at industrial scale.

High total Joule heat increases the risk of post-endoscopic submucosal dissection electrocoagulation syndrome after colorectal endoscopic submucosal dissection

BACKGROUND We hypothesized that thermal damage accumulation during endoscopic submucosal dissection(ESD)causes the pathogenesis of post-ESD electrocoagulation syndrome(PECS).AIM To determine the association between Joule heat and the onset of PECS.METHODS We performed a retrospective cohort study in patients who underwent colorectal ESD from May 2013 to March 2021 in Japan.We developed a novel device that measures swift coagulation time with a sensor adjacent to the electrosurgical coagulation unit foot switch,which enabled us to calculate total Joule heat.PECS was defined as localized abdominal pain(visual analogue scale≥30 mm during hospitalization or increased by≥20 mm from the baseline)and fever(temperature≥37.5 degrees or white blood cell count≥10000μ/L).Patients exposed to more or less than the median Joule heat value were assigned to the high and low Joule heat groups,respectively.Statistical analyses included Mann-Whitney U and chisquare tests and logistic regression and receiver operating characteristic curve(ROC)analyses.RESULTS We evaluated 151 patients.The PECS incidence was 10.6%(16/151 cases),and all patients were followed conservatively and discharged without severe complications.In multivariate analysis,high Joule heat was an independent PECS risk factor.The area under the ROC curve showing the correlation between PECS and total Joule heat was high[0.788(95%confidence interval:0.666-0.909)].CONCLUSION Joule heat accumulation in the gastrointestinal wall is involved in the onset of PECS.ESD-related thermal damage to the peeled mucosal surface is probably a major component of the mechanism underlying PECS.

Remediation of Pulp and Paper Industry Effluent Using Electrocoagulation Process

Electrocoagulation of pulp and paper industry effluent with SS-304 electrode has been carried out under varying process variable such as pH, current density, time and dose of electrolyte to find out the optimum conditions. Maximum reduction efficiency of Chemical Oxygen Demand (COD) 82% and color more than 99% from pulp and paper industry wastewater at the following conditions pH = 7, current density = 24.80 mA/cm2 time = 40 min and dose of electrolytes = 1.0 g/L. Moreover, effects of electrolytes dosage on electricity consumption were observed and found to be that NaCl is better in comparison of Na2SO4 in respect of lower down the electricity consumption. But application of NaCl causes the formation of hazardous compounds as secondary pollutants within treated water. Therefore, Na2SO4 could be a potent replacement of NaCl to enhance the conductivity of paper industry effluent treated by EC process. The treated water has been compared with standard of Central Pollution control board (CPCB) and World Health organization, and found to be suitable for the reuse in irrigation.

Ecofriendly Remediation of Pulp and Paper Industry Wastewater by Electrocoagulation and Its Application in Agriculture

In the present study pulp and paper industry effluent was treated with the help of aluminum electrode using electrocoagulation (EC) process with feasible sludge management. The influences of pH, time, current density and electrolytes dose were investigated and optimum conditions were established to reduce the maximum amount of Chemical Oxygen Demand (COD) and color. At optimum conditions 70% of COD and 98% of color were removed. Additionally, the behavior of electrolytes (NaCl and Na2SO4) was determined;it has shown that Na2SO4 results in the generation of less secondary pollutants than that NaCl and thereby could be used as better replacement in paper industries for electrocoagulation mediated treatment of wastewater. The residual amount of operational parameters in EC treated water was compared to the World Health Organization (WHO) and Central Pollution Control Board (CPCB) of India. It was found to be safe for utilization in irrigation. Furthermore, sludge produced during the EC process has been analyzed for physicochemical characteristics. To understand the physical and elemental phases of sludge, the analytical technique such as field emission electron microscope coupled with energy dispersive spectroscopy has been used to find out the possible management alternative.

Role of preoperative endoscopic ultrasound-guided fine-needle tattooing of a pancreatic head insulinoma

Although insulinomas are rare, they are the most com-mon pancreatic neuroendocrine tumor, with an inci-dence of four cases per million population. Insulinomas are generally benign indolent intrapancreatic tumors. Surgical resection remains the main option for treat-ment. However, up to 67% of a pancreatic head insu-linomas are nonpalpable, thus surgical resection of the nonplapable insulinoma in this area could become prob-lematic resulting in prolonged surgical time, increased risk of pancreatic duct injury and need for pancreati-coduodenectomy. Endoscopic ultrasound-guided fine- needle tattooing(EUS-FNT), has been shown to have a crucial role for localization of pancreatic body and tail lesions, facilitating laparoscopic distal pancreatectomyand helping surgeons identify the location of the tumor. EUS-FNT might have a role for preoperative localiza-tion of pancreatic head insulinomas which are likely to be nonpalpable. We report a case of preoperative EUS-FNT for localization of a nonplapable pancreatic head insulinoma. This report demonstrates that EUS-FNT of pancreatic head insulinomas may facilitate surgical resection, reduce operative time and decrease surgical complications.

Application of Electrocoagulation and Electrolysis on the Precipitation of Heavy Metals and Particulate Solids in Washwater from the Soil Washing

Soil washing, ex situ mechanical technique, is one of the few permanent treatment alternatives to remove metal contaminants from soils by employing physical separation based on mineral processing technologies to remove discrete particles or metal-bearing particles and/or chemical extraction based on leaching or dissolving process to extract the metals from the soils into an aqueous solution. However, washwater remained from soil washing process contains discrete particulate particles along with heavy metals as solution phase to be treated separately, as well as this process can produce large amount of sludge that requires further treatment, slow metal precipitation, poor settling, the aggregation of metal precipitates. Electrical treatments including electrocoagulation and electrolysis can be effective in removing these substances from washwater. This paper reviews the theoretical models in applying electrocoagulation and electrolysis to remove heavy metals and discrete particulate particles in washwater by examining and comparing the status of washwater treatment technologies which have been undertaken, mostly in the US and EU for the period 1990-2012.