Discrepancy between endoscopic forceps biopsy and endoscopic resection in gastric epithelial neoplasia

BACKGROUND

Endoscopic forceps biopsy (EFB) is a major diagnostic procedure for gastric epithelial neoplasia (GEN). However, discrepancy between the result of EFB and endoscopic resection (ER) is not uncommon. Thus, there is controversy over whether specimens obtained by EFB are optimal for diagnosis of GEN. We investigated the discrepancy between EFB and ER in the diagnosis of GEN.

METHODS

A total of 1,850 GEN cases were histologically diagnosed with EFB, including 954 low-grade dysplasias (LGDs), 315 high-grade dysplasias (HGDs), and 581 carcinomas. Following diagnosis with EFB, all patients were treated with ER. We retrospectively reviewed the pathologic findings and patient characteristics and analyzed predictors for the discrepancy between the two procedures (largest diameter, number of biopsy fragments, number of biopsy fragments/largest diameter, location, macroscopic type, color, surface unevenness, and erosion).

RESULTS

The overall discrepancy rate between EFB and ER was 31.7 % (587/1,850). Among the discordant group, 440 (23.9 %) cases showed a higher grade of disease after ER; 229 of the 954 LGDs (24.0 %) were diagnosed as HGD or carcinoma, 166 of the 315 HGDs (52.7 %) as carcinoma, and 45 of the 581 differentiated carcinomas (7.7 %) as undifferentiated carcinoma. In the LGD group with EFB, the largest diameter (≥1.8 cm; P < 0.001), surface unevenness (P = 0.014), and depressed macroscopic type (P < 0.001) were factors associated with discrepancy. In the carcinoma group with EFB, flat macroscopic type (P = 0.043) was the only significant factor. In the HGD group with EFB, there were no significant factors for discrepancy.

CONCLUSIONS

EFB can be insufficient for diagnosing GENs, and ER can be considered not only as treatment but also as a diagnostic modality in GEN. It is especially pertinent to all cases of HGD regardless of their endoscopic features and to cases of LGDs with the largest lesion diameter ≥1.8 cm, surface unevenness, or a depressed macroscopic type.

The Rhizomes of Acorus gramineus and the Constituents Inhibit Allergic Response In vitro and In vivo

The rhizomes of Acorus gramineus have frequently been used in traditional medicine mainly for sedation as well as enhancing brain function. In this study, the anti-allergic activity of A. gramineus was investigated. The 70% ethanol extract of the rhizomes of A. gramineus was found to inhibit the allergic response against 5-lipoxygenase (5-LOX)-catalyzed leukotriene (LT) production from rat basophilic leukemia (RBL)-1 cells and β-hexosaminidase release from RBL-2H3 cells with IC₅₀’s of 48.9 and >200 μg/ml, respectively. Among the 9 major constituents isolated, β-asarone, (2R,3R,4S,5S)-2,4-dimethyl-1,3-bis (2',4',5'-trimethoxyphenyl)tetrahydrofuran (AF) and 2,3-dihydro-4,5,7-trimethoxy-1-ethyl-2-methyl-3-(2,4,5-trimethoxyphenyl)indene (AI) strongly inhibited 5-LOX-catalyzed LT production in A23187-treated RBL-1 cells, AI being the most potent (IC₅₀=6.7 μM). Against β-hexosaminidase release by antigen-stimulated RBL-2H3 cells, only AI exhibited strong inhibition (IC₅₀=7.3 μM) while β-asarone and AF showed 26.0% and 39.9% inhibition at 50 μM, respectively. In addition, the ethanol extract of A. gramineus showed significant inhibitory action against the hapten-induced delayed hypersensitivity reaction in mice by oral administration at 200 mg/kg. Therefore, it is suggested that A. gramineus possesses anti-allergic activity and the constituents including β-asarone and AI certainly contribute to the anti-allergic activity of the rhizomes of A. gramineus.

A prospective clinical utility and pharmacoeconomic study of the impact of the 21-gene Recurrence Score® assay in oestrogen receptor positive node negative breast cancer

PURPOSE

The primary purpose of this study was to measure the impact of the 21-gene Recurrence Score® result on systemic treatment recommendations and to perform a prospective health economic analysis in stage I-II, node-negative, oestrogen receptor positive (ER+) breast cancer.

METHODS

Consenting patients with ER+ node negative invasive breast cancer and their treating medial oncologists were asked to complete questionnaires about treatment preferences, level of confidence in those preferences and a decisional conflict scale (patients only) after a discussion of their diagnosis and risk without knowledge of the Recurrence Score. At a subsequent visit, the assay result and final treatment recommendations were discussed prior to both parties completing a second set of questionnaires. A Markov health state transition model was constructed, simulating the costs and outcomes experienced by a hypothetical 'assay naïve' population and an 'assay informed' population.

RESULTS

One hundred and fifty-six patients across two cancer centres were enrolled. Of the 150 for whom successful assay results were obtained, physicians changed their chemotherapy recommendations in 45 cases (30%; 95% confidence interval (CI) 22.8-38.0%); either to add (10%; 95% CI 5.7-16.0%) or omit (20%; 95% CI 13.9-27.3%) adjuvant chemotherapy. There was an overall significant improvement in physician confidence post-assay (p<0.001). Patient decisional conflict also significantly decreased following the assay (p<0.001). The simulation model found an incremental cost-effectiveness ratio of Canadian Dollars (CAD) $6630/quality-adjusted life years (QALY).

CONCLUSION

Within the context of a publicly funded health care system, the Recurrence Score assay significantly affects adjuvant treatment recommendations and is cost effective in ER+ node negative breast cancer.

Official language minority communities in Canada: is linguistic minority status a determinant of mental health?

OBJECTIVES

Language has been identified as a determinant of mental health. Within Canada, individuals may speak an official language and still belong within the linguistic minority (Francophones outside Quebec and Anglophones within Quebec). The objectives of this study were to compare mental health problems between minority and majority official language communities, and examine the association between official language minority and mental health problems.

METHODS

Data from the Canadian Community Health Survey, Cycle 1.2 were used to make two comparisons: Francophones to Anglophones within Quebec, and Francophones to Anglophones outside Quebec. Twelve-month and lifetime prevalences of mental disorders (major depressive episode, anxiety disorders, and alcohol/substance abuse/dependence) and mental health indices were compared. Logistic regression analysis examined whether official language minority status was a determinant of mental health.

RESULTS

Mental health between minority and majority language groups was similar. Official language minority status was not a significant determinant of mental health. Self-rated mental health indices varied between groups. In some cases, minority language groups reported lower levels of life satisfaction (minority Anglophones versus majority Francophones), while in other cases more majority Anglophones reported poor life satisfaction and mental health (majority Anglophones versus minority Francophones).

CONCLUSIONS

Overall, few differences were found between language groups, though variations in self-rated mental health indices were observed. In order to better understand the role of context in determining health outcomes, future research should examine mental health problems among official language minority groups provincially to help stakeholders in directing resources and programs to populations in most need.

Impact of nutritional status and dietary quality on stroke: do we need specific recommendations?

Stroke, one of the most prevalent geriatric diseases, is a leading cause of death worldwide that often results in permanent physical disability and decreased quality of life, and can have a negative impact on families both financially and emotionally. Although many previous studies have shown relationships between the risk of stroke and nutritional factors, clear dietary recommendations for the prevention and reduction of stroke recurrence have not been established. Several factors should be considered to control and manage stroke. For example, a considerable number of patients with stroke are poorly nourished, have several comorbidities and undesirable health-related behaviors may be present. Stroke patients are less likely to consume beneficial foods, have poorer eating habits and have impoverished dietary quality. In addition, psychological factors such as depression must also be considered in stroke management. Given these factors, dietary recommendations for stroke patients should be established. In this article, we summarized the nutritional status and dietary quality of stroke patients. We also suggested some nutritional guidelines for stroke patients and for those who are at risk for stroke.

Slewing Mirror Telescope optics for the early observation of UV/optical photons from Gamma-Ray Bursts

We report on design, manufacture, and testing of a Slewing Mirror Telescope (SMT), the first of its kind and a part of Ultra-Fast Flash Observatory-pathfinder (UFFO-p) for space-based prompt measurement of early UV/optical light curves from Gamma-Ray Bursts (GRBs). Using a fast slewing mirror of 150 mm diameter mounted on a 2 axis gimbal stage, SMT can deliver the images of GRB optical counterparts to the intensified CCD detector within 1.5~1.8 s over ± 35 degrees in the slewing field of view. Its Ritchey-Chrétien telescope of 100 mm diameter provides a 17 × 17 arcmin² instantaneous field of view. Technical details of design, construction, the laboratory performance tests in space environments for this unique SMT are described in conjunction with the plan for in-orbit operation onboard the Lomonosov satellite in 2013.

Bard PowerPICC Solo2 vs Cook Turbo-Ject: A Tale of Two PICCs

Purpose

To compare the complications experienced for 2 different brands of peripherally inserted central venous catheters (PICC), Cook Turbo-Ject and the Bard PowerPICC Solo2. The rationale for this project revolved around concern that one of the PICCS in question had high rates of complications.

Methods

A prospective clinical trial was conducted after obtaining approval from the University of Saskatchewan Human Research Ethics Committee. All PICCs were implanted at the Royal University Hospital Medical Imaging Department by an interventional radiologist. Patient randomization was achieved by alternating the brand of PICC implanted in sequential patients. All the subjects were inpatients from a single surgical ward. Patients were excluded from the study if they had a known uncorrected coagulopathy, or if they were being treated for venous thrombosis. This project was financially supported by the Summer Student Research Fund, College of Medicine, University of Saskatchewan.

Results

A total of 53 PICCs (25 Bard and 28 Cook) were inserted over the study period. The mean PICC dwell time was 23.3 days for both the Bard and Cook PICCs, respectively. No statistically significant differences were detected in study group demographics, technical placement of the PICCs, or in the complications encountered.

Discussion

Both the Cook Turbo-Ject and the Bard PowerPicc Solo2 PICCs provided acceptable venous access for a wide variety of clinical indications.

Measurement of direct photons in Au+Au collisions at √(s(NN))=200 GeV

We report the measurement of direct photons at midrapidity in Au+Au collisions at √(s(NN))=200 GeV. The direct photon signal was extracted for the transverse momentum range of 4 GeV/c<p(T)<22 GeV/c, using a statistical method to subtract decay photons from the inclusive photon sample. The direct photon nuclear modification factor R(AA) was calculated as a function of p(T) for different Au+Au collision centralities using the measured p+p direct photon spectrum and compared to theoretical predictions. R(AA) was found to be consistent with unity for all centralities over the entire measured p(T) range. Theoretical models that account for modifications of initial direct photon production due to modified parton distribution functions in Au and the different isospin composition of the nuclei predict a modest change of R(AA) from unity. They are consistent with the data. Models with compensating effects of the quark-gluon plasma on high-energy photons, such as suppression of jet-fragmentation photons and induced-photon bremsstrahlung from partons traversing the medium, are also consistent with this measurement.

Hepatic embolotherapy in interventional oncology: technology, techniques, and applications

Embolotherapy continues to play a growing role in the management of primary and secondary hepatic malignancies. In this review article, we examine the basis of therapy with a focus on neovascularization, which makes treatments via the hepatic artery possible. An overview of the three generations of embolic and therapeutic agents follows. The techniques, technologies, and complications of bland embolization, transarterial chemoembolization, drug-eluting beads, and selective internal radiotherapy are covered to give the reader an overview of this exciting field in interventional radiology.

Lenalidomide enhancement of human T cell functions in human immunodeficiency virus (HIV)-infected and HIV-negative CD4 T lymphocytopenic patients

Suppressed T cell functions in human immunodeficiency virus (HIV) infection were identified and corrected by lenalidomide in middle-aged HIV-infected patients. Chemotaxis of T cells from HIV-infected men (n = 6, mean 43 years) to sphingosine 1-phosphate (S1P) and CCL21 was significantly lower than that of HIV-negative men (n = 6, mean 41 years), and was enhanced significantly up to control levels by 100 and 1000 nM lenalidomide. Generation of interleukin (IL)-2, but not interferon (IFN)-γ, by T cells of middle-aged HIV-infected men was significantly lower than that for controls and was increased significantly by 10-1000 nM lenalidomide up to a maximum of more than 300%. CD4 and CD8 T cells isolated from healthy middle-aged men and reconstituted in vitro at a low CD4 : CD8 ratio typical of HIV infection had depressed chemotaxis to S1P, but not CCL21, and generation of IL-2, but not IFN-γ. Significant enhancement of chemotaxis to S1P and CCL21 was induced by 100-1000 nM lenalidomide only for normal T cells at a low CD4 : CD8 ratio. T cells from HIV-negative middle-aged CD4 T lymphocytopenic patients (n = 3), with a CD4 : CD8 ratio as low as that of HIV-infected patients, had similarly diminished chemotaxis to S1P and CCL21, and depressed generation of IL-2, but not IFN-γ. Lenalidomide at 30-1000 nM significantly enhanced chemotaxis to S1P and IL-2 generation for T cells from HIV-negative CD4 T lymphocytopenic patients as from HIV-infected patients, with less effect on CCL21-elicited chemotaxis and none for IFN-γ generation. Defects in functions of T cells from middle-aged HIV-infected men are partially attributable to CD4 T lymphocytopenia and are corrected by lenalidomide.

A practical method for ultrasonographically monitoring the day-to-day growth of individual ovarian follicles in women undergoing assisted reproduction

The objective of this study was to validate the use of the nonidentity (NonID) method compared with the identity (ID) method for tracking the day-to-day growth of individual follicles in women undergoing ovarian stimulation for assisted reproduction. A retrospective observational study was conducted in 20 women during ovarian stimulation. Conventional 2-D transvaginal ultrasonography was used to monitor follicle growth every 2-3 days throughout stimulation. Video clips of both ovaries were obtained in sagittal and coronal planes at each visit. Standardized diameter measurements of all follicles ≥4 mm were made retrospectively from video clips. The growth profiles of all follicles that developed to ≥10 mm were determined using the ID and NonID methods. Using Lin's concordance statistics, we documented that agreement between methods was 91% for follicles <10 mm, 96% for follicles 10-15 mm and 99% for follicles >15 mm. Lin's concordance correlation coefficient between the two methods was 0.96 (standard error = 0.003). We concluded that the NonID method is a practical, effective tool for monitoring the day-to-day growth of individual ovarian follicles in women undergoing assisted reproduction.

Fruit drink consumption is associated with overweight and obesity in Canadian women

OBJECTIVE

Overweight and obesity in Canada have significantly increased during the last three decades, paralleled by increased intake of fat and sugar, particularly sugary beverages. The Canadian Community Health Survey, Cycle 2.2, conducted in 2004 (CCHS 2.2), provides the opportunity to evaluate beverage intakes in relation to overweight and obesity using body mass index (BMI). Our objective was to examine the association between sugar-sweetened beverages and BMI in Canadian adults.

METHODS

CCHS 2.2 data were used (n=14,304, aged >18 years and < or =65 years) and dietary intake was assessed on the basis of single 24-hour recall. Using cluster analysis (K-means method), males and females were classified into distinct clusters based on the dominant pattern of beverage intakes. Logistic regression models were used to determine associations between dominant beverage consumption patterns and BMI, controlling for age and other confounding factors.

RESULTS

BMI in women with predominant "fruit drink" pattern (28.3 +/- 1.0 kg/m2) was higher than in those with no dominant pattern (26.8 +/- 0.3 kg/m2), p < 0.001. Adjusting for energy intake and other potential confounders, high intake of fruit drinks was a significant predictor of overweight (OR=1.84, 95% CI: 1.06-3.20), obesity (OR = 2.55, 95% CI: 1.46-4.47) and overweight/obesity (OR = 2.05, 95% CI: 1.29-3.25) in women. In men, mean BMI was not different among beverage consumption clusters and none of the beverage intake patterns was a predictor for overweight and obesity.

CONCLUSION

Using a nationally representative dataset, there was an association between sugar-sweetened beverages and overweight and obesity in Canadian women.