Foamy gland pancreatic ductal adenocarcinoma diagnosed on EUS‐FNA: A histochemical,immunohistochemical, and molecular report

The foamy gland pattern (FGP) may impart to pancreatic ductal adenocarcinoma (PDA) a deceptively benign appearance. Thus, its diagnosis on FNA is challenging. A case of PDA with FGP, that was suspected on Diff Quik smears, diagnosed on cell‐block preparation and confirmed by ancillary stains and molecular techniques, is here reported. The diagnostic interpretation of foamy atypical cells on direct smears may benefit from cell block preparation and from ancillary techniques. Diagn. Cytopathol. 2013. © 2012 Wiley Periodicals, Inc.     

Task failure during standing heel raises is associated with increased power from 13 to 50 Hz in the activation of triceps surae

The goal of this paper was to investigate the amplitude and sub-100 Hz frequency content of surface electromyography (EMG) signals obtained from agonist, antagonist and synergist muscles during a heel-raise task sustained to failure. Twenty-two healthy adults, 14 men and 8 women participated in the study. Surface EMG data from the raising and lowering phases of the movement were studied in the time (EMG amplitude) and frequency (wavelet transform) domains. For the raising phase, we found a significant increase in the EMG amplitude of all muscles studied throughout the task (P < 0.02); however, for the lowering phase, we found a decrease in overall muscle activation for the medial gastrocnemius and tibialis anterior. Additionally, we found higher 13–30 and 30–50 Hz normalized power during the raising phase for the triceps surae prior to task failure and at task failure compared with the beginning and midway of the task (P < 0.05); during the lowering phase, however, we found higher normalized power from 30 to 50 Hz for the triceps surae (P < 0.01) and higher 13–30 Hz normalized power for the tibialis anterior (P < 0.01) at task failure compared with the beginning and midway of the task. Finally, we showed that a dynamic task performed until failure can induce different activation strategies for agonist, antagonist and synergist muscles, and that the frequency content below 100 Hz contains useful information about the neural activation of these muscles in relation to task failure that is not evident from the EMG amplitude.     

Evidence of a disturbance of the hypothalamic-pltuitary-adrenal axis in polycystic ovary syndrome: effect of naloxone

OBJECTIVE  A recent report has demonstrated a stronger association between the HLA-DQA1*0501 allele and Graves' disease in Caucasian men than in women. Our aim was to confirm this association in a larger series of male Caucasian patients.
DESIGN  Polymerase chain reaction/sequence specific oligonucleotide probing (PCR/SSOP).
PATIENTS  Fifty men and 70 women with Graves' disease were studied as well as a control group consisting of 57 healthy, unrelated men and women.
METHODS  Genomic DNA was derived from venous blood samples. Appropriately primed DNA was amplified by PCR and the products were subjected to SSOP. The presence of the allele was demonstrated by enhanced chemiluminescence.
RESULTS  A significant association between HLA-DQA1* 0501 and Graves' disease was demonstrated among both the men and women as well as in the combined disease cohort, with HLA-DQA1*0501 conferring a greater relative risk than HLA-DR3 in all three groups. This association persisted when the results from the DR3-negative Graves' patients were analysed in isolation. HLA-DQA1*0501 was heterogeneously distributed between the sexes with significantly more female Graves' patients carrying this allele.
CONCLUSIONS  There is a significant association between HLA-DQA1*0501 and Graves' disease which may be unrelated to the inheritance of this allele on an extended haplotype with HLA-DR3. In contrast to a recent report, HLA-DQA1*0501 was significantly more prevalent among women with Graves' disease than men.     

Comparison of two flow generators with a noninvasive ventilator to deliver continuous positive airway pressure: a test lung study

Objective To compare the performance of two continuous flow generators with a ventilator designed for noninvasive positive pressure ventilation (NPPV) to deliver continuous positive airway pressure (CPAP). The performance of flow generators using different oxygen pressure supplies was also compared.Design and setting Experimental study using a mechanical lung model in a university research laboratory.Measurements Two flow generators supplied at 100, 200, and 300 kPa and an NPPV ventilator were compared at CPAP of 5, 10, and 15 cmH₂O in: (a) area under the adjusted CPAP level during inspiration, (b) capacity to attain the preset CPAP, and (c) tidal volume.Results The NPPV ventilator attained the preset CPAP better than flow generators, but its area under adjusted CPAP was similar to or higher than that of flow generators when these were adjusted to their better pressure supply. Both flow generators had better performance with an output flow around 100 l/min, which was achieved at 100 kPa with one flow generator and 300 with the other. Flow generators and the NPPV ventilator generated similar tidal volumes.Conclusions Flow generators performance showed large variations among different devices and oxygen pressure supplies. Adjusted to their better pressure supply, flow generators had a similar or better capacity to maintain the CPAP level, but the NPPV ventilator was more reliable to attain the preset CPAP. Flow generators could be an alternative to provide CPAP in low-income areas, usually with scarce medical equipment availability.     

Noninvasive ventilation immediately after extubation improves weaning outcome after acute respiratory failure: a randomized controlled trial

Introduction

Noninvasive ventilation (NIV), as a weaning-facilitating strategy in predominantly chronic obstructive pulmonary disease (COPD) mechanically ventilated patients, is associated with reduced ventilator-associated pneumonia, total duration of mechanical ventilation, length of intensive care unit (ICU) and hospital stay, and mortality. However, this benefit after planned extubation in patients with acute respiratory failure of various etiologies remains to be elucidated. The aim of this study was to determine the efficacy of NIV applied immediately after planned extubation in contrast to oxygen mask (OM) in patients with acute respiratory failure (ARF).

Methods

A randomized, prospective, controlled, unblinded clinical study in a single center of a 24-bed adult general ICU in a university hospital was carried out in a 12-month period. Included patients met extubation criteria with at least 72 hours of mechanical ventilation due to acute respiratory failure, after following the ICU weaning protocol. Patients were randomized immediately before elective extubation, being randomly allocated to one of the study groups: NIV or OM. We compared both groups regarding gas exchange 15 minutes, 2 hours, and 24 hours after extubation, reintubation rate after 48 hours, duration of mechanical ventilation, ICU length of stay, and hospital mortality.

Results

Forty patients were randomized to receive NIV (20 patients) or OM (20 patients) after the following extubation criteria were met: pressure support (PSV) of 7 cm H₂O, positive end-expiratory pressure (PEEP) of 5 cm H₂O, oxygen inspiratory fraction (FiO₂) ≤ 40%, arterial oxygen saturation (SaO₂) ≥ 90%, and ratio of respiratory rate and tidal volume in liters (f/TV) < 105. Comparing the 20 patients (NIV) with the 18 patients (OM) that finished the study 48 hours after extubation, the rate of reintubation in NIV group was 5% and 39% in OM group (P = 0.016). Relative risk for reintubation was 0.13 (CI = 0.017 to 0.946). Absolute risk reduction for reintubation showed a decrease of 33.9%, and analysis of the number needed to treat was three. No difference was found in the length of ICU stay (P = 0.681). Hospital mortality was zero in NIV group and 22.2% in OM group (P = 0.041).

Conclusions

In this study population, NIV prevented 48 hours reintubation if applied immediately after elective extubation in patients with more than 3 days of ARF when compared with the OM group.

Trial Registration number

ISRCTN: 41524441.     

Brain dynamics of upstream perceptual processes leading to visual object recognition: a high density ERP topographic mapping study

Recent studies suggest that visual object recognition is a proactive process through which perceptual evidence accumulates over time before a decision can be made about the object. However, the exact electrophysiological correlates and time-course of this complex process remain unclear. In addition, the potential influence of emotion on this process has not been investigated yet. We recorded high density EEG in healthy adult participants performing a novel perceptual recognition task. For each trial, an initial blurred visual scene was first shown, before the actual content of the stimulus was gradually revealed by progressively adding diagnostic high spatial frequency information. Participants were asked to stop this stimulus sequence as soon as they could correctly perform an animacy judgment task. Behavioral results showed that participants reliably gathered perceptual evidence before recognition. Furthermore, prolonged exploration times were observed for pleasant, relative to either neutral or unpleasant scenes. ERP results showed distinct effects starting at 280 ms post-stimulus onset in distant brain regions during stimulus processing, mainly characterized by: (i) a monotonic accumulation of evidence, involving regions of the posterior cingulate cortex/parahippocampal gyrus, and (ii) true categorical recognition effects in medial frontal regions, including the dorsal anterior cingulate cortex. These findings provide evidence for the early involvement, following stimulus onset, of non-overlapping brain networks during proactive processes eventually leading to visual object recognition.     

The role of antiangiogenetic agents in the treatment of breast cancer

Angiogenesis is known to be essential for the development and progression of cancer. Vascular endothelial growth factor (VEGF) is a critical mediator in tumor angiogenesis for many solid malignancies, including breast cancer. Increased levels of VEGF have been associated with poor clinical outcomes, including reduced survival. VEGF has become an attractive target for cancer therapy in view of its pivotal role in angiogenesis. The primary approaches for inhibiting angiogenesis have focused on inhibiting the activity of VEGF, either by targeting the VEGF ligand itself with monoclonal antibodies (mAbs) or by interfering with the signaling events downstream of VEGF through the use of tyrosine kinase inhibitors (TKIs). Bevacizumab is a recombinant, humanized monoclonal IgG1, anti-VEGF antibody that has demonstrated significant clinical benefit in several solid tumors. Bevacizumab has been approved for use in combination with paclitaxel for the first line treatment of patients with metastatic breast cancer (MBC) based on the results of the randomized phase III E2100 trial in which it improves response rate and time to progress when administered with weekly paclitaxel until disease progression. Several trials to define the role of bevacizumab in different setting of disease and in combination with different chemotherapy regimens and targeted therapy in breast cancer patients are ongoing. Other small molecule inhibitors of VEGF tyrosine kinase activity (TKIs) such as sunitinib, vandetanib and sorafenib are being tested in MBC. This review will focus on bevacizumab and on the developements of the main antiangiogenic agents in the treatment of breast cancer.