Accuracy of preoperative workup in a prospective series of surgically resected cystic pancreatic lesions

Abstract Background. Magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) are considered useful techniques in the evaluation of pancreatic cysts. Aim of this study was to prospectively compare the diagnostic value of these techniques. Methods. This study included consecutive patients who underwent MRI, EUS, and EUS-FNA for a pancreatic cyst that was eventually resected surgically. Observers scored for cyst characteristics, a distinction between mucinous and non-mucinous cysts and a suspicion of malignancy. The interobserver agreement between MRI and EUS was calculated. Results. A total of 32 patients were included. Sensitivity for diagnosing a mucinous cyst was 78% for EUS versus 91% for MRI. Sensitivity for detecting malignancy was 25% (1/4) and 50% (2/4) for EUS and MRI respectively. Sensitivity of EUS-FNA for diagnosing a mucinous cyst (positive cytology and/or CEA >192 ng/ml) was 61%. Sensitivity for detecting malignancy (positive cytology) was 1/4 (25%). Interobserver agreement between MRI and EUS for the features was poor to fair. Conclusion. MRI and EUS are comparable techniques for the morphological characterization of pancreatic cysts. Combined sensitivity of EUS and MRI was higher than the sensitivity of one of the techniques alone. For diagnosing a mucinous cyst, FNA findings showed a low sensitivity, but a high specificity.     

Unbiased plasma proteomics for novel diagnostic biomarkers in cardiovascular disease: identification of quiescin Q6 as a candidate biomarker of acutely decompensated heart failure

Aims Biochemical marker testing has improved the evaluation and management of patients with cardiovascular diseases over the past decade. Natriuretic peptides (NPs), used in clinical practice to assess cardiac dysfunction, exhibit many limitations, however. We used an unbiased proteomics approach for the discovery of novel diagnostic plasma biomarkers of heart failure (HF). Methods and results A proteomics pipeline adapted for very low-abundant plasma proteins was applied to clinical samples from patients admitted with acute decompensated HF (ADHF). Quiescin Q6 (QSOX1), a protein involved in the formation of disulfide bridges, emerged as the best performing marker for ADHF (with an area under the receiver operator characteristic curve of 0.86, 95% confidence interval: 0.79-0.92), and novel isoforms of NPs were also identified. Diagnostic performance of QSOX1 for ADHF was confirmed in 267 prospectively collected subjects of whom 76 had ADHF. Combining QSOX1 to B-type NP (BNP) significantly improved diagnostic accuracy for ADHF by particularly improving specificity. Using thoracic aortic constriction in rats, QSOX1 was specifically induced within both left atria and ventricles at the time of HF onset. Conclusion The novel biomarker QSOX1 accurately identifies ADHF, particularly when combined with BNP. Through both clinical and experimental studies we provide lines of evidence for a link between ADHF and cardiovascular production of QSOX1.     

Stimulation of the intra-cardiac vagal nerves innervating the AV-node to control ventricular rate during AF: specificity, parameter optimization and chronic use up to 3?months

Background  

Stimulation of the intra-cardiac vagal nerves innervating the AV-node (AVNS) is a promising approach to slow down ventricular rate (VR) during atrial fibrillation (AF). Our purpose was to demonstrate that effects on R-R-interval during stable AF can be maintained for several months once optimized and that AVNS affects specifically the nerves innervating the AV-node.     

Selective recovery of zinc from goethite residue in the zinc industry using deep-eutectic solvents

Several deep-eutectic solvents (DESs) were tested for the valorisation of goethite residue produced by the zinc industry. The objective of the work was to selectively recover zinc from the iron-rich matrix using deep-eutectic solvents as lixiviants. The effect of the type of hydrogen bond donor and hydrogen bond acceptor of the deep-eutectic solvent on the leaching efficiency was studied. Levulinic acid–choline chloride (x_ChCl = 0.33) (LevA–ChCl) could selectively leach zinc from the iron-rich matrix, and it was selected as the best-performing system to be used in further study. The leaching process was optimised in terms of temperature, contact time, liquid-to-solid ratio and water content of the deep-eutectic solvent. The role of the choline cation on the leaching process was investigated by considering the leaching properties of a LevA–CaCl₂ mixture. The goethite residue was also leached with pure levulinic acid. The results were compared to a purely hydrometallurgical approach using sulphuric acid leaching. Leaching with LevA–ChCl resulted in higher selectivity compared to the conventional “hot leaching” with 80 g L⁻¹ sulphuric acid. Furthermore, a slightly higher zinc recovery and comparable selectivity for zinc over iron were achieved with LevA–ChCl compared to conventional “neutral leaching” with 10 g L⁻¹ sulphuric acid.

A mixture of levulinic acid and choline chloride can be used to selectively leach zinc from industrial residues with iron-rich matrices.