ABSTRACT
Background/Aims@#In stereomicroscopic sample isolation processing, the cutoff value (≥4 mm) of stereomicroscopically visible white cores indicates high diagnostic sensitivity. We aimed to evaluate endoscopic ultrasound-guided tissue acquisition (EUS-TA) using a simplified stereomicroscopic on-site evaluation of upper gastrointestinal subepithelial lesions (SELs). @*Methods@#In this multicenter prospective trial, we performed EUS-TA using a 22-gauge Franseen needle in 34 participants with SELs derived from the upper gastrointestinal muscularis propria, requiring pathological diagnosis. The presence of stereomicroscopically visible white core (SVWC) in each specimen was assessed using stereomicroscopic on-site evaluation. The primary outcome was EUS-TA’s diagnostic sensitivity with stereomicroscopic on-site evaluation based on the SVWC cutoff value (≥4 mm) for malignant upper gastrointestinal SELs. @*Results@#The total number of punctures was 68; 61 specimens (89.7%) contained stereomicroscopically visible white cores ≥4 mm in size. The final diagnoses were gastrointestinal stromal tumor, leiomyoma, and schwannoma in 76.5%, 14.7%, and 8.8% of the cases, respectively. The sensitivity of EUS-TA with stereomicroscopic on-site evaluation based on the SVWC cutoff value for malignant SELs was 100%. The per-lesion accuracy of histological diagnosis reached the highest level (100%) at the second puncture. @*Conclusions@#Stereomicroscopic on-site evaluation showed high diagnostic sensitivity and could be a new method for diagnosing upper gastrointestinal SELs using EUS-TA.
ABSTRACT
Tropical natives (TROP) are capable of tolerating tropical heat because of their long-term adaptation to tropical environments. When exposed to heat stress, these natives tend to respond with lower sweat output, which is generally thought to be the result of heat acclimatization. The main objective of this study was to clarify central mechanisms inherent to suppressed thermal sweating in tropical natives (Malaysians) by comparing their sweating responses to those of temperate native (TEMP) (Koreans). This experiment was conducted in a thermoneutral climatic chamber (24+/-0.5 degrees C, 40+/-3% relative humidity). Heat loads were applied to each subject by the immersion of their lower legs in a hot water bath (43 degrees C for 30 min). Sweat onset-time and sweat volume were compared between TROP and TEMP. The sweat onset-times on four selected points on the body ranged from 10.25 to 13.47 min in TEMP subjects, and from 16.24 to 17.83 min in TROP subjects (p<0.001). The local sweat volumes at the same sites ranged from 4.30 to 9.74 mg/cm2 in TEMP subjects, and from between 1.80 to 4.40 mg/cm2 in TROP subjects (p<0.001). These results demonstrated a significant difference between TROP and TEMP subjects with regard to the manner in which they regulate their body temperatures when exposed to heat loads, and verified that long-term thermal adaptation blunts sweating sensitivities.
Subject(s)
Humans , Male , Acclimatization , Baths , Body Temperature , Hot Temperature , Immersion , Internship and Residency , Leg , Population Groups , Sweat , Sweating , WaterABSTRACT
People in tropics have the ability to tolerate heat by residential permanence in the tropics. Previously, we have shown that African and Thai subjects who lived for whole their lives in only their respective countries sweat less under hot conditions than South Koreans who also lived whole their lives in Korea. The difference in sweating responses was attributed to the dissimilar central and peripheral sweating mechanisms operating in people from both groups. In the present study, acetylcholine (ACh), the primary transmitter for the sudomotor functions, was iontophoretically administered to South Koreans and Africans to determine the characteristic sudorific responses of their acclimatized biologic make-up to their respective environments. Using quantitative sudomotor axon reflex test (QSART), direct (DIR) and axon reflex (AXR) responses were evaluated. The findings revealed that the sweat onset-time among South Koreans was 0.91 min earlier than among Africans (P< 0.01). The axon reflex sweat volume of nicotine receptor activity AXR (1) and sweat volume of muscarinic receptor activity DIR (2) among South Koreans were 79% and 53% greater (P< 0.01), respectively. These results indicate that the reduced thermal sweating among Africans is at least in part attributed to the diminished sensitivity of sweat glands to ACh.