Contrast-enhanced guided endoscopic ultrasound procedures

Contrast-enhanced endoscopic ultrasound(CH-EUS)can overcome the limi-tations of endoscopic ultrasound-guided acquisition by identifying microvessels inside inhomogeneous tumours and improving the characterization of these tumours.Despite the initial enthusiasm that oriented needle sampling under CH-EUS guidance could provide better diagnostic yield in pancreatic solid lesions,further studies did not confirm the supplementary values in cases of tissue acquisition guided by CH-EUS.This review details the knowledge based on the available data on contrast-guided procedures.The indications for CH-EUS tissue acquisition include isoechoic EUS lesions with poor visible delineation where CH-EUS can differentiate the lesion vascularisation from the surrounding parenchyma and also the mural nodules within biliopancreatic cystic lesions,which occur in select cases.Additionally,the roles of CH-EUS-guided therapy in patients whose pancreatic fluid collections or bile ducts that have an echogenic content have indications for drainage,and patients who have nonvisualized vessels that need to be highlighted via Doppler EUS are presented.Another indication is represented if there is a need for an immediate assessment of the post-radiofrequency ablation of pancreatic neuroendocrine tumours,in which case CH-EUS can be used to reveal the incomplete tumour destruction.

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.

Tumor necrosis factor-alpha, transforming growth factor-beta, degree of lower urinary tract symptoms as predictors of erectile dysfunction in benign prostatic hyperplasia patients

Objective: Erectile dysfunction (ED) is a condition of insufficient penile erection, consistently or recurrently, for sexual activity. Tumor necrosis factor-alpha (TNF-α) induces transforming growth factor-beta (TGF-β), which causes the transition of epithelial cells into mesenchymal cells that affect ED. This study aimed to evaluate the roles of TNF-α, TGF-β, degree of lower urinary tract symptoms, and prostatic volume for the presence of ED in benign prostatic hyperplasia (BPH) patients.Methods: Our study performed an analytic observational retrospective cohort study using secondary data from four hospitals in Bali, Indonesia, including medical records and other administrative data. The sample was BPH patients with several history qualifications.Results: Our sample was 83 respondents, ranging from 50 years to 80 years, 61 respondents with ED and 22 with non-ED. The International Prostate Symptom Score showed a significant result, which indicates that ED is more common in patients with higher International Prostate Symptom Score (p=0.002). Moreover, the TNF-α of ≥43.9 pg/mg and TGF-β of ≥175.8 pg/mL were significantly associated with the presence of ED in BPH patients (p<0.0001). Despite these results, prostate volume is not significant with ED (p=0.947).Conclusion: TNF-α, TGF-β, and lower urinary tract symptoms severity can predict the occurrence of ED in BPH, while prostatic volume was not significant.

Ferritin and mortality in hemodialysis patients with COVID-19:A systematic review and meta-analysis

Objective:To investigate the difference in serum ferritin levels between deceased and surviving regular hemodialysis patients with COVID-19.Methods:We conducted a systematic search across four databases following the PRISMA statement guidelines.Studies reporting ferritin levels and mortality of regular hemodialysis patients with COVID-19 were included.Employing the random-effects model,we performed a meta-analysis to determine the mean difference in serum ferritin levels between the studied groups,along with their corresponding 95%confidence intervals.The meta-analysis was carried out using Review Manager 5.4 and Stata 16.Results:A total of 1013 patients from seven studies were included in this study.Our meta-analysis showed higher mean serum ferritin in the deceased compared to surviving regular hemodialysis patients with COVID-19,with a mean difference of 449.43 ng/mL[95%CI(244.07,654.80),P<0.0001;I2=58%,P=0.003].Conclusions:Our study found a higher mean of serum ferritin levels in the deceased compared to surviving regular hemodialysis patients with COVID-19.

Solar-driven CO_(2) conversion to methane and methanol using different nanostructured Cu_(2)O-based catalysts modified with Au nanoparticles

This work describes the use of TiO_(2)nanotubes-based electrodes(TNT)modified with Cu_(2)O nanostructures and gold nanoparticles for the photoelectroreduction of CO_(2)to produce value-added compounds.A thin layer of polydopamine was used as both an adherent agent and an electron transfer mediator,due to itsπ-conjugated electron system.The highest production yield was achieved using a TNT@PDA/Nc/Au40%electrode,with Faradaic efficiencies of 47.4%(110.5μM cm^(-2))and 27.8%(50.4μM cm^(-2))for methanol and methane,respectively.The performance of the photoelectrodes was shown to be Cu_(2)O facet-dependent,with cubic structures leading to greater conversion of CO_(2)to methanol(43%)and methane(27%),compared to the octahedral morphology,while a higher percentage of metallic gold on the nanostructured Cu_(2)O surface was mainly important for CH4production.Density functional theory(DFT)calculations supported these findings,attributing the superior photoelectrocatalytic performance of the TNT@PDA/Nc/Au40%electrode for CH4generation to the formation of an OCH3intermediate bonded to Au atoms.Studies using isotope-labeling and analysis by gas chromatograph-mass(GC-MS)demonstrated that13CO_(2)was the source for photoelectrocatalytic generation of13CH3OH and13CH313CH2OH.

Key changes across valley floors in mountain areas affected by different levels of human impact: a case study of the Ochotnica river catchment in the Polish Carpathians

The goal of this paper was to present knowledge on changes in the morphodynamic structure of the Ochotnica River(Polish Carpathians)and transformations within its active river zone since the end of the 19th century.The study used a set of archival and contemporary cartographic materials and the results of three-fold field mapping of the morphodynamic structure of the riverbed.Direct and indirect human interference with the natural environment of the catchment and the fluvial system was taken into account in the analysis.Analysis of changes in the morphodynamic structure of the Ochotnica and its active river zone since the end of the 19th century indicated significant changes in the development trend of the riverbed.The contemporary structure of the Ochotnica is more complex than in the 1980s.There has been a fragmentation of the riverbed into sections with different morphodynamic sections.The proportion of erosive sections has increased,which explains the reduced in the width of the active river zone of the Ochotnica.The average width of the active river zone of the river between 1861 and 2022 has changed from 80 m to 18 m.Human impact has been identified as the main reason for the changes in the morphodynamic structure of the riverbed and its active river zone.Currently,only the unregulated sect ion is characterised by free lateral migration of the riverbed and the widest active river zone(~28 m).

Techniques for otosclerosis surgery: Ear surgery from the microscope to the endoscope - A literature review

Stapes surgery is the gold standard for managing otosclerosis.It has become increasingly appreciated to perform endoscopic ear surgery worldwide as the field of endoscopy expands.In basic terms,a stapes surgery intends to restore ossicular mobility and therefore improve sound energy transduction into the inner ear,thereby improving communication and sound amplification and bringing hearing levels back to acceptable levels.The aim of the study is to analyze surgical techniques comparing microscopic and endoscopic approaches for stapes surgery.The perspectives of Surgical Pioneers in Early Stapes Surgery and the contemporary development of surgical technology will be explored as well.Specifically,this study compiles well-documented,reliable information concerning the surgical outcomes for the endoscopic approach to stapes surgery and the results of recent studies.

Arterial Duct Stenting Versus Modified Blalock-Taussig Shunt in Patient with Ductal-Dependent Pulmonary Circulation: Systematic Review & Meta-Analysis

Objective:Patients with ductal-dependent pulmonary circulation require alternative bloodflow to provide and maintain adequate oxygenation.Modified Blalock-Taussig Shunt(MBTS)has been the standard for providing such a result.Currently,less invasive methods such as Arterial Duct(AD)stenting have been performed as alter-natives.This study aims to compare the outcome of AD stenting and MBTS.Method:Systematic research was performed in online databases using the PRISMA protocol.The outcomes measured were 30-day mortality,com-plication,unplanned intervention,oxygen saturation,duration of hospital,and ICU length of stay.Any compara-tive study provided with full text is included.The outcome of each study was analyzed using a trandom effects model with relative risk and mean difference as the effect size.Bias risk assessment was conducted using the New-castle-Ottawa Scale.All analyses were performed using Review Manager 5.4.1.Result:A total of 11 studies with 3154 samples included in this study.There is no significant difference in 30-day mortality between the two groups(p-value=0.10).However,there is significantly less complication(RR 0.53[0.35,0.82];p-value=0.004)and unplanned intervention(RR 0.59[0.38,0.92];p-value=0.02)in the AD stent group.Comparison of the Nakata index showed no significant difference(p-value=0.88).Post-operative oxygen saturation was measured signifi-cantly higher in the AD stenting(MD 1.80[0.85,2.74];p-value=0.0002).However,AD stent group shows sig-nificantly lower long-term oxygen saturation(MD-8.43[-14.38,-2.48];p-value=0.005).Both hospital and ICU length of stay was significantly shorter in the AD stent group(MD-8.30[-11.13,-5.48];p-value<0.00001;MD-5.09[-7.79,-2.38];p-value=0.0002).Conclusion:AD stenting provides comparable outcomes relative to MBTS as it provides less complication and unplanned intervention and higher post-procedural O2 saturation.However,MBTS proved its superiority in maintaining higher long-term oxygen saturation and still became the preferred option to manage complex cases where stenting is either challenging or unsuccessful.

促进糖尿病患者足溃疡愈合的干预措施指南(2023年更新版)——《国际糖尿病足工作组:糖尿病相关的足病预防与管理指南(2023)》的一部分

创面处理的原则,包括清创、创面准备和使用涉及改变创面生理以促进愈合的新技术,在试图治愈慢性糖尿病相关的足溃疡时是至关重要的。此外,糖尿病相关的足溃疡的发病率和治疗成本不断上升,这就需要结合作为金标准的多学科治疗已有共识,运用高质量的疗效和成本效益证据来支持和加强慢性糖尿病相关的足溃疡创面愈合的干预措施。本指南是2023年国际糖尿病足工作组(IWGDF)针对促进糖尿病患者足溃疡愈合的干预措施的循证指南。它是对2019年IWGDF指南的更新。我们遵循推荐、评估、发展、评价分级(GRADE)方法,以患者-干预-对照-结果(PICO)形式设计临床问题从而得出重要结果,进行系统综述,制定评判表汇总,并为每个问题撰写推荐和理由。每条推荐的形式都是基于系统综述中发现的证据,并使用GRADE评判汇总项目,包括理想和不理想的效果、证据的可信度、对患者的价值、所需的资源、成本效益、公平性、可行性和可接受性;我们制定的推荐由作者同意并由独立专家和利益相关者审查。根据系统综述和从证据到决策过程的结果,我们提出29条推荐。我们对使用干预措施改善糖尿病患者足溃疡的愈合提出了一些有条件的支持性推荐。这些推荐包括蔗糖八硫酸盐敷料的使用,对手术后的创面使用负压疗法,使用胎盘衍生产品,使用自体白细胞、血小板、纤维蛋白贴剂,使用局部氧疗,以及使用高压氧,但我们强调在任何情况下这些推荐应在单独应用最佳标准治疗无法治愈伤口且有资源可用于干预的情况下使用。这些关于创面愈合的推荐应该有助于提高糖尿病伴足溃疡患者的疗效,我们希望这些推荐能得到广泛的实施。然而,尽管作为推荐基础的许多证据的准确性正在提高,但总体上仍然很差,我们鼓励在这一领域进行更多、质量更好的试验,包括那些有关卫生经济学分析的试验。

Endoscopic ultrasound-guided tissue acquisition for the diagnosis of focal liver lesion

In patients with liver tumors,the histopathology examination can assist in diagnosis,staging,prognosis,and therapeutic management strategy.Endoscopic ultrasound(EUS)-guided tissue acquisition using fine needle aspiration(FNA)or more newly fine needle biopsy(FNB)is a well-developed technique in order to evaluate and differentiate the liver masses.The goal of the EUS-FNA or EUS-FNB is to provide an accurate sample for a histopathology examination.Therefore,malignant tumors such as hepatocarcinoma,cholangiocarcinoma and liver metastasis or benign tumors such as liver adenoma,focal hyperplastic nodular tumors and cystic lesions can be accurately diagnosed using EUS-guided tissue acquisition.EUS-FNB using 19 or 22 Ga needle provide longer samples and a higher diagnostic accuracy in patients with liver masses when compared with EUS-FNA.Few data are available on the diagnostic accuracy of EUS-FNB when compared with percutaneously,ultrasound,computer tomography or transjugulary-guided liver biopsies.This review will discuss the EUS-guided tissue acquisition options in patients with liver tumors and its efficacy and safety in providing accurate samples.The results of the last studies comparing EUS-guided liver biopsy with other conventional techniques are presented.The EUS-guided tissue acquisition using FNB can be a suitable technique in suspected liver lesions in order to provide an accurate histopathology diagnosis,especially for those who require endoscopy.

A Qualitative Assessment of Medical Diagnosis Capabilities of Three Artificial Intelligence Models: ChatGPT-4o, CodyMD, and Dr. Gupta

Background: Artificial intelligence (AI) has the potential to transform medical diagnostics by enhancing the accuracy and efficiency of diagnostic processes. Its application in clinical practice can greatly support medical professionals by offering improved tools for faster and more precise diagnoses. Understanding AI’s capabilities is essential for its successful integration into medical diagnostics. In this context, evaluating the performance of different AI models in the diagnostic process becomes particularly important. The objective of this study is to qualitatively evaluate the diagnostic performance of three AI models—ChatGPT-4o, CodyMD, and Dr. Gupta—based on patient-reported symptoms. Objectives: The aim of the study is to compare the three AI models in terms of diagnostic accuracy, the level of detail in the provided information, the interaction between the models and patients, and the number of differential diagnoses offered. Results: ChatGPT-4o achieved the highest accuracy, correctly diagnosing 90% of the cases. The model provides basic information and focuses on a single most likely diagnosis. CodyMD and Dr. Gupta achieved 50% accuracy, with CodyMD using an interactive approach and offering differential diagnoses with probability percentages for each. Dr. Gupta provided educational medical information and differential diagnoses without probability estimates. Conclusions: The AI models assessed can assist medical professionals in the diagnostic process, but they require further refinement and optimization. ChatGPT-4o stands out for its high accuracy, though increased patient interaction is needed. CodyMD excels in offering an interactive approach and more detailed responses, but requires improved accuracy. Dr. Gupta provided differential diagnoses, but the information provided is suitable for educational purposes. While these models show potential for clinical use, further research is needed to optimize and validate them in real-world settings.

Method“Monte Carlo”in healthcare

In public health,simulation modeling stands as an invaluable asset,enabling the evaluation of new systems without their physical implementation,experimentation with existing systems without operational adjustments,and testing system limits without real-world repercussions.In simulation modeling,the Monte Carlo method emerges as a powerful yet underutilized tool.Although the Monte Carlo method has not yet gained widespread prominence in healthcare,its technological capabilities hold promise for substantial cost reduction and risk mitigation.In this review article,we aimed to explore the transformative potential of the Monte Carlo method in healthcare contexts.We underscore the significance of experiential insights derived from simulated experimentation,especially in resource-constrained scenarios where time,financial constraints,and limited resources necessitate innovative and efficient approaches.As public health faces increasing challenges,incorporating the Monte Carlo method presents an opportunity for enhanced system construction,analysis,and evaluation.

Assessing the Influence of Dykes on the Drainage Network of the Shivan River in North Maharashtra

The prominent linear dyke ridges outcropped in the Narmada-Tapi dykes’ swarm represent an intrusion in the Deccan Traps. Understanding the relationship among the underlying geological structures, the strike of the dykes, and the channel patterns is essential. Dykes act as obstructions to stream flow, causing diversions, and their geometry and patterns significantly impact the rivers and streams that drain and cross the dyke swarm zone. For this study, Google Earth images, LISS III images, and Cartosat DEM were used to delineate the Shivan basin and extract dyke features. The Shivan River basin is a sixth-order drainage system that reflects superimposed drainage systems within the Tapi dyke swarm zone. About 65% (169 km2) of its area is controlled by dyke orientation. The dyke ridges align predominantly in an East-West (E-W) direction, a pattern mainly followed by lower-order streams, which have developed an insequent, transverse drainage network within the dyke swarm zone. In the lower parts of the Shivan basin, where the number of dykes decreases, the drainage network follows the general slope and is oriented in a North-South direction. The Shivan River and its tributaries have partially adjusted to the dyke orientation, resulting in a transverse drainage pattern in areas characterized by parallel dyke ridges.

Adipose-derived stem cells and knee osteoarthritis:New perspectives,old concerns

In this editorial,we comment on the paper by Muthu et al published in the recent issue of the journal.This editorial review focusses on the use of adipose-derived stem cells(ADSCs)in knee osteoarthritis treatment.We discuss the differences between the stromal vascular fraction and microfragmented adipose tissue and highlight the results of clinical studies comparing both treatments and the use of hyaluronic acid,platelet-rich plasma,and bone marrow aspirate concentrate.The use of expanded ADSCs is also discussed;moreover,concerns regarding treatment with ADSCs,particularly the heterogeneity of published studies and the need to standardize protocols to explore clinical potential is explored.

Autoantibodies related to ataxia and other central nervous system manifestations of gluten enteropathy

Gluten ataxia and other central nervous system disorders could be linked to gluten enteropathy and related autoantibodies.In this narrative review,we focus on the various neuro-logical manifestations in patients with gluten sensitivity/celiac disease,immunological and autoimmune mechanisms of ataxia in connection to gluten sensitivity and the autoantibodies that could be used as a biomarker for diagnosing and following.We focused on the anti-gliadin antibodies,antibodies to different isoforms of tissue transglutaminase(TG)(anti-TG2,3,and 6 antibodies),anti-glycine receptor antibodies,anti-glutamine acid decarboxylase antibodies,anti-deamidated gliadin peptides antibodies,etc.Most studies found a higher prevalence of these antibodies in patients with gluten sensitivity and neurological dysfunction,presented as different neurological disorders.We also discuss the role of a gluten-free diet on the clinical improvement of patients and also on imaging of these disorders.

Changes in calcium accumulation and utilization efficiency and their impact on recycling,immobilization,and export across the oil palm cycle

Effective calcium(Ca)management is crucial for optimizing oil palm cultivation and enhancing crop yield.This study aimed to gain insights into the dynamics of Ca concentration,accumulation,exportation,immobilization,and recycling in various oil palm organs relative to plant age.The experiment was conducted at the Agropalma enterprise site in the northeastern region of Para State,Brazil,evaluating seven plant age treatments:2,3,4,5,6,7,and 8 years old.Employing a completely randomized design with four replications.The results demonstrated an age-related increase in Ca concentration in petioles,rachis,arrows,male inflorescences,peduncles,and fruits.Furthermore,Ca accumulation exhibited an upward trend in all organs with progressing plant age.Notably,the study revealed an enhanced Ca use efficiency across all plant organs in correlation with the age of oil palm cultivation.These findings underscore the dynamic nutritional demands of oil palm,influencing Ca immobilization,cycling,and export throughout its developmental stages.

Sternocleidomastoid flap for reconstruction of tongue small cell carcinoma: A case report

BACKGROUND The management of tongue carcinoma is excision and radical neck dissection followed with reconstruction.This is a case report of a patient with tongue squamous cell carcinoma(SCC)who underwent the procedure with sternocleidomastoid(SCM)flap reconstruction.CASE SUMMARY A 52-year-old woman without smoking history complained tongue ulcer since 3 years ago.Based on the histopathological examination,the patient was diagnosed with T2N2M0 right tongue SCC and underwent wide excision of tumor;right mandibular;neck dissection and were reconstructed with SCM flap.CONCLUSION SCC of the tongue requires wide excision and dissection of the neck and mandible if infiltration into the surrounding lymph nodes has been found.The SCM flap reconstruction could be used post-surgery.

垃圾填埋场的保护目标与安全

在相当长的时间内 ,人们尽管对所产生的垃圾和废物采取尽可能的循环再利用技术和避免措施 ,但仍然还有一定量的废物要在填埋场里得到最终处理。位于生物圈上的这个废物仓库—填埋场则要依它的严密的选址技术和技术结构确保其周围环境的安全 ,并要达到对生物圈上的人、动植物、水域和土壤等的保护目标的安全。

腺苷的热解过程及其热分解非等温动力学(英文)

目的 :研究了腺苷的热解过程及非等温动力学 .方法 :采用了 TG- DTG热重仪与红外技术测定腺苷的热解曲线 ,用Ozawa多升温速率法以及 Achar微分法和 Coats- Redfern积分法确定热分解函数 .结果 :由 TG及 IR解析了热解过程并得到动力学参数活化能 E、指前因子 A.结论 :腺苷的热解产物为腺嘌呤 ,第 1步热分解动力学表达式为 :dα/ dt=Ae- E/RT2 (1-α)[- ln(1-α) ]1

基于视点变化的徒手作图输入变形

提出了一种直观、高效地用于概念设计作图的徒手输入、进行几何变形的方法 .采用此方法可以徒手输入两笔曲线 (参考曲线和目标曲线 ) ,并据此二曲线来移动多边形模型的顶点 ,从而达到变形三维模型的目的 .解决了大曲率变形时产生的自相交问题 .另外 ,还可用来定义变形影响区域 .