A prospective, comparative trial to optimize sampling techniques in EUS-guided FNA of solid pancreatic masses.

BACKGROUND: There is no standardization of the use of suction during puncturing of a target in pancreatic EUS-guided FNA (EUS-FNA). It is also debatable whether expressing aspirates from the needle by the traditional method of reinserting the stylet is more effective than by air flushing, which is easier and safer. OBJECTIVE: To optimize sampling techniques in pancreatic EUS-FNA. DESIGN: Prospective, comparative trial. SETTING: Tertiary-care referral center. PATIENTS: Eighty-one consecutive patients with solid pancreatic masses. INTERVENTION: Four punctures were performed for each mass in random order by a 2 × 2 factorial design. Sample quality and diagnostic yield were compared between samples with suction (S+) versus no suction (S-) and expressed by reinserting the stylet (RS) versus air flushing (AF). MAIN OUTCOME MEASUREMENTS: Sample quality by the number of diagnostic samples, cellularity, bloodiness, and air-drying artifact; diagnostic yield by accuracy, sensitivity, and specificity. RESULTS: The number of diagnostic samples (72.8% vs 58.6%; P = .001), cellularity (odds ratio [OR] 2.12; 95% confidence interval [CI], 1.37-3.30; P < .001), bloodiness (OR 1.46; CI, 1.28-1.68; P < .001), accuracy (85.2% vs 75.9%; P = .004), and sensitivity (82.4% vs 72.1%; P = .005) were higher in S+ than in S-. Bloodiness was lower in AF than in RS (OR 1.16; CI, 1.03-1.30; P = .017). LIMITATIONS: Single-center trial, 2 kinds of needle gauges, and no immediate cytopathology evaluation. CONCLUSION: Puncturing with suction and expressing by air flushing may be used preferentially in pancreatic EUS-FNA because they were more effective and convenient techniques. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT01354795.).

Treatment outcomes according to endoscopic treatment modalities for rectal carcinoid tumors.

BACKGROUND: Despite a growing understanding of the clinical effectiveness of endoscopic treatment for small rectal carcinoid tumors, there is still controversy concerning the best endoscopic treatment for resecting rectal carcinoid tumors easily and effectively. OBJECTIVES: The objective of the present study was to compare the therapeutic efficacy and safety of endoscopic submucosal resection with a ligation device (ESMR-L) with endoscopic submucosal dissection (ESD) for rectal carcinoid tumors. In addition, a conventional snare-based endoscopic mucosal resection (EMR) was included in the study and compared with both ESMR-L and ESD. METHODS: A retrospective analysis was performed in 115 patients who underwent endoscopic resection of a rectal carcinoid tumor between January 2005 and June 2011. These patients were classified into three groups according to the type of endoscopic procedure: EMR group (n=33), ESMR-L group (n=40) and ESD group (n=44). RESULTS: The complete resection rate of the EMR group was significantly lower than those of the ESMR-L and ESD groups (77.4 vs. 100 and 97.7%, P=0.002 and P=0.007). Tumor-free vertical margins were significantly greater in the ESMR-L and ESD groups than in the EMR group (ESMR-L and ESD vs. EMR group, P=0.013 and P=0.041). The curative resection rate of rectal carcinoid tumors in the EMR group was 77.4%, which was significantly lower than that of the ESMR-L (95%, 38/40) and EDS groups (97.7%, 43/44) (77.4% vs. 95%, P=0.036 and 77.4% vs. 97.7%, P=0.007). CONCLUSIONS: Our results show that ESMR-L and ESD might be superior to conventional EMR for the treatment of small rectal carcinoid tumors.

Intraductal thermal injury using a heat probe and radiofrequency ablation electrode in a swine model of biliary stenosis.

BACKGROUND AND OBJECTIVE: An animal model for bile duct stenosis using intraductal thermal injury has not yet been established. The aims of the current study were to develop biliary stenosis in a swine model by inducing intraductal thermal injury using a heat probe or radiofrequency ablation electrode and to investigate an effective and safe energy dose. METHODS: Intraluminal thermal injury was applied to the common bile duct with a heat probe in three swines and a radiofrequency ablation electrode in the other three swines by either endoscopic retrograde cholangiography or open laparotomy. Cholangiography and histologic evaluation of common bile duct were taken 2 weeks after thermal injury. RESULTS: Thermal injury with a heat probe at 25 J for 40 seconds produced a stricture in all three animals. Application of a radiofrequency ablation electrode produced a stricture in two of three animals. An energy dose of 40 W at 80°C for 30 seconds produced biliary stenosis without any complications initially and 2 weeks after thermal injury. CONCLUSIONS: The application of a heat probe and a radiofrequency ablation electrode for intraductal thermal injury resulted in a reproducible animal model of biliary stenosis.

The feasibility and safety of the endoscopic submucosal dissection of superficial gastric neoplastic lesions in patients with compensated liver cirrhosis: a retrospective study.

BACKGROUND/AIMS: When undergoing endoscopic submucosal dissection (ESD), patients with liver cirrhosis (LC) may suffer from a high risk of bleeding, bacteremia and tissue vulnerability. There have been few reports evaluating the efficacy and safety of ESD in patients with LC. METHODS: From January 2004 to March 2010, 23 patients with LC (cirrhosis group) underwent ESD for superficial gastric neoplastic lesions. The number of patients with a liver function in the Child-Pugh classes A and B were 20 and 3, respectively. The clinical outcomes and complications were compared with 69 patients without LC (control group) that were matched for age and sex. RESULTS: The en bloc resection, R0 resection and en bloc plus R0 resection rates of the cirrhosis group were 82.6%, 91.3%, and 82.6%, respectively, and did not show significant differences from the rates of the control group. No local recurrence was found in either group during the follow-up period. The procedure length of time (41.0 vs 39.0 minutes), rate of bleeding (4.3% vs 7.2%) and rate of perforation (0.0% vs 1.4%) in the cirrhosis group were also comparable to the results from the control group. CONCLUSIONS: ESD was safely performed in patients with LC, and satisfactory outcomes were achieved with high en bloc and R0 resection rates for superficial gastric neoplastic lesions.

The characteristics of dental X-ray fluoroscopic equipment 'DreamRay 60F'.

This study examined the characteristics of the dental X-ray fluoroscopic equipment, 'DreamRay 60F', which was recently developed in Korea. The output linearity, output reproducibility, half-value layer (HVL), leakage radiation and scattered radiation were measured using an ionisation chamber. The surface dose equivalent rate and estimated dose equivalent of the operator were also calculated. The output linearity was 0.0015-0.0175 and the coefficient of variation for the output reproducibility was 0.0013-0.0074. The experimental HVL was 2.1 mm Al, and the leakage dose rate at 100 cm from the X-ray focus ranged from 2.70 to 19.66 microGy h (-1) depending on the direction. The scattered radiation doses differed significantly (1.7-16.8 times) depending on the distance and direction. If an operator is exposed for 10 min per procedure, 5 procedures a day at 5 days a week, he/she sitting at a 90 degrees direction will receive an annual dose equivalent of 13.0 mSv (at 30 cm) and 63.7 mSv (at 50 cm) in the trunk and face surface, respectively.

Suppressed production of pro-inflammatory cytokines by LPS-activated macrophages after treatment with Toxoplasma gondii lysate.

During Toxoplasma gondii infection, macrophages, dendritic cells, and neutrophils are important sources of pro-inflammatory cytokines from the host. To counteract the pro-inflammatory activities, T. gondii is known to have several mechanisms inducing down-regulation of the host immunity. In the present study, we analyzed the production of proand anti-inflammatory cytokines from a human myelomonocytic cell line, THP-1 cells, in response to treatment with T. gondii lysate or lipopolysaccharide (LPS). Treatment of THP-1 cells with LPS induced production of IL-12, TNF-alpha, IL-8, and IL-10. Co-treatment of THP-1 cells with T. gondii lysate inhibited the LPS-induced IL-12, IL-8 and TNF-alpha expression, but increased the level of IL-10 synergistically. IL-12 and IL-10 production was down-regulated by anti-human toll-like receptor (TLR)-2 and TLR4 antibodies. T. gondii lysate triggered nuclear factor (NF)-kappaB-dependent IL-8 expression in HEK293 cells transfected with TLR2. It is suggested that immunosuppression induced by T. gondii lysate treatment might occur via TLR2-mediated NF-kappaB activation.

Improved imaging of the cervico-thoracic junction in computed tomography.

PURPOSE: To reduce beam hardening artifacts caused by the shoulder joint, we explored new and unique methods to improve the quality of images, such as varying the injection site and changing the position of patients (swimmers position). MATERIALS AND METHODS: Fifth-four patients underwent neck CT examinations performed in routine and swimmers position and with a 64-slice MDCT scanner in spiral scanning. To examine the difference due to the injection sites of contrast material, subjects were divided into right- and left-side groups. For the evaluation of images, we carried out a subjective and objective assessment based on radiologists' ratings and noise measurement. RESULTS: Images of the lower neck in the swimmers position exhibited less hardening and streak artifacts. The subjective and objective evaluations showed that the swimmers position received higher rating by radiologists and had lower noise level than that of routine position. The swimmers position was the most effective for the diagnosis of the cervico-thoracic junction area. As for the injection site, we obtained better images by an injection of contrast material in the right arm than in the left. CONCLUSION: CT examination of the lower neck in the swimmers position may improve the quality of image and the effectiveness of diagnosis. The injection of a contrast material to the right side rather than the left side reduced foreign body artifacts.

Patient dose measurements in diagnostic radiology procedures in Korea.

This study is the first nationwide investigation aimed at estimating the patient dose for radiographic examinations in Korea including gastrointestinal studies, computed tomography and mammography. The survey data from 161 hospitals and the dose data from 32 hospitals were analysed. The third quartile entrance surface dose, dose area product (DAP), weighted CT dose index (CTDIw) and mean glandular dose (MGD) were reported. All the estimated doses were less than the stated International Atomic Energy Agency (IAEA) reference levels for radiographic examinations. However, DAPs for the fluoroscopic examinations had higher dose values than the IAEA reference levels. In addition, the CTDIw and MGD were lower than the IAEA reference levels.

Involvement of MAPK activation in chemokine or COX-2 productions by Toxoplasma gondii.

This experiment focused on MAPK activation in host cell invasion and replication of T. gondii, as well as the expression of CC chemokines, MCP-1 and MIP-1 alpha , and enzyme, COX-2/prostaglandin E2 (PGE2) in infected cells via western blot, [3H]-uracil incorporation assay, ELISA and RT-PCR. The phosphorylation of ERK1/2 and p38 in infected HeLa cells was detected at 1 hr and/or 6 hr postinfection (PI). Tachyzoite proliferation was reduced by p38 or JNK MAPK inhibitors. MCP-1 secretion was enhanced in infected peritoneal macrophages at 6 hr PI. MIP-1 alpha mRNA was increased in macrophages at 18 hr PI. MCP-1 and MIP-1 alpha were reduced after treatment with inhibitors of ERK1/2 and JNK MAPKs. COX-2 mRNA gradually increased in infected RAW 264.7 cells and the secretion of COX-2 peaked at 6 hr PI. The inhibitor of JNK suppressed COX-2 expression. PGE2 from infected RAW 264.7 cells was increased and synthesis was suppressed by PD98059, SB203580, and SP600125. In this study, the activation of p38, JNK and/or ERK1/2 MAPKs occurred during the invasion and proliferation of T. gondii tachyzoites in HeLa cells. Also, increased secretion and expression of MCP-1, MIP-1 alpha , COX-2 and PGE2 were detected in infected macrophages, and appeared to occur via MAPK signaling pathways.

Expression of cspH upon nutrient up-shift in Salmonella enterica serovar Typhimurium.

The gene cspH, which encodes one of the cold-shock proteins in Salmonella enterica serovar Typhimurium, has previously been reported to be induced during early exponential phase at 37 degrees C. In the present study, the expression of cspH upon nutrient up-shift at 37 degrees C was investigated and found to be affected by DNA gyrase and DNA-binding protein Fis. When cells at stationary phase were subcultured into a rich medium, the mRNA level of cspH increased dramatically prior to the first cell division. However, when the cells were treated with DNA gyrase inhibitors, cspH mRNA was not induced upon nutrient up-shift. The low level of DNA superhelical density at the cspH promoter in part affected the expression of cspH mRNA in vitro. In addition, a fis-deficient strain had a lower level of cspH mRNA than the wild-type upon nutrient up-shift. Finally, a cspH-lacZ construct, in which the putative binding region for Fis was deleted in the cspH promoter, expressed a low level of LacZ, in contrast to the native cspH-lacZ construct.