Molecular characterization of Aeromonas hydrophila isolates from diseased fishes in district Kasur, Punjab, Pakistan

Abstract Pakistan is an agricultural country and fisheries play a very important role in the economic development of the country. Different diseases are prevalent in Pakistani fish but information related to the causative agents is not well-known. Keeping in view the significance of bacterial pathogens as the causative agents of multiple fish diseases, the present study was conducted for identification, characterization and analysis of virulence genes of Aeromonas spp. isolated from diseased fishes. A total of fifty fish samples having multiple clinical indications were collected from different fish farms of district Kasur, Punjab Pakistan. For isolation of Aeromonas spp. samples were enriched and inoculated on Aeromonas isolation medium. Isolates were identified and characterized by different biochemical tests, Analytical Profile Index (API) 20E kit and Polymerase Chain Reaction (PCR) assays. All isolates were screened for three putative virulence genes including aerolysin (aer), haemolysin (hyl) and heat labile cytotonic enterotoxin (alt). Seven isolates of Aeromonas (A.) hydrophila were retrieved and identified based on API 20E. These isolates were further confirmed as A. hydrophila on the basis of PCR assays. Three isolates were detected positive for the presence of virulence genes (alt and hyl). Whereas aerolysin (aer) gene was not present in any of A. hydrophila isolates. The present study confirmed A. hydrophila as the causative agent of epizootic ulcerative syndrome and motile Aeromonas septicemia in fish farms of district Kasur, Punjab Pakistan. Moreover, detection of two virulence genes (alt and hyl) in A. hydrophila isolates is a threat for fish consumers of study area.

Resumo O Paquistão é um país agrícola, onde a pesca desempenha um papel muito importante para o desenvolvimento econômico. Diferentes doenças são prevalentes em peixes do Paquistão, mas as informações relacionadas aos agentes causadores não são bem conhecidas. Tendo em vista a importância dos patógenos bacterianos como agentes causadores de múltiplas doenças em peixes, o presente estudo foi conduzido para identificação, caracterização e análise de genes de virulência de isolados de Aeromonas spp. de peixes doentes. Foram coletadas 50 amostras de peixes com múltiplas indicações clínicas em diferentes fazendas do distrito de Kasur, Punjab, Paquistão. Para isolar Aeromonas spp., as amostras foram enriquecidas e inoculadas em meio de isolamento. Os isolados foram identificados e caracterizados por diferentes testes bioquímicos, kit Analytical Profile Index (API) 20E, e ensaios de reação em cadeia da polimerase (PCR). Todos os isolados foram selecionados para três genes de virulência putativos, incluindo aerolisina (aer), hemolisina (hyl) e enterotoxina citotônica termolábil (alt). Sete isolados de Aeromonas hydrophila foram recuperados e identificados com base no API 20E. Esses isolados foram posteriormente confirmados como A. hydrophila de acordo com ensaios de PCR. Três isolados indicaram a presença de genes de virulência (alt e hyl), enquanto o gene aerolisina (aer) não esteve presente em nenhum dos isolados de A. hydrophila. O presente estudo confirmou A. hydrophila como o agente causador da síndrome ulcerativa epizoótica e septicemia móvel por Aeromonas em fazendas de peixes, no distrito de Kasur, Punjab, Paquistão. Além disso, a detecção de dois genes de virulência (alt e hyl) em isolados de A. hydrophila é uma ameaça para os consumidores de peixes da área de estudo.

Molecular characterization of Aeromonas hydrophila isolates from diseased fishes in district Kasur, Punjab, Pakistan / Caracterização molecular de isolados de Aeromonas hydrophila de peixes doentes no distrito de Kasur, Punjab, Paquistão

Abstract Pakistan is an agricultural country and fisheries play a very important role in the economic development of the country. Different diseases are prevalent in Pakistani fish but information related to the causative agents is not well-known. Keeping in view the significance of bacterial pathogens as the causative agents of multiple fish diseases, the present study was conducted for identification, characterization and analysis of virulence genes of Aeromonas spp. isolated from diseased fishes. A total of fifty fish samples having multiple clinical indications were collected from different fish farms of district Kasur, Punjab Pakistan. For isolation of Aeromonas spp. samples were enriched and inoculated on Aeromonas isolation medium. Isolates were identified and characterized by different biochemical tests, Analytical Profile Index (API) 20E kit and Polymerase Chain Reaction (PCR) assays. All isolates were screened for three putative virulence genes including aerolysin (aer), haemolysin (hyl) and heat labile cytotonic enterotoxin (alt). Seven isolates of Aeromonas (A.) hydrophila were retrieved and identified based on API 20E. These isolates were further confirmed as A. hydrophila on the basis of PCR assays. Three isolates were detected positive for the presence of virulence genes (alt and hyl). Whereas aerolysin (aer) gene was not present in any of A. hydrophila isolates. The present study confirmed A. hydrophila as the causative agent of epizootic ulcerative syndrome and motile Aeromonas septicemia in fish farms of district Kasur, Punjab Pakistan. Moreover, detection of two virulence genes (alt and hyl) in A. hydrophila isolates is a threat for fish consumers of study area.

Resumo O Paquistão é um país agrícola, onde a pesca desempenha um papel muito importante para o desenvolvimento econômico. Diferentes doenças são prevalentes em peixes do Paquistão, mas as informações relacionadas aos agentes causadores não são bem conhecidas. Tendo em vista a importância dos patógenos bacterianos como agentes causadores de múltiplas doenças em peixes, o presente estudo foi conduzido para identificação, caracterização e análise de genes de virulência de isolados de Aeromonas spp. de peixes doentes. Foram coletadas 50 amostras de peixes com múltiplas indicações clínicas em diferentes fazendas do distrito de Kasur, Punjab, Paquistão. Para isolar Aeromonas spp., as amostras foram enriquecidas e inoculadas em meio de isolamento. Os isolados foram identificados e caracterizados por diferentes testes bioquímicos, kit Analytical Profile Index (API) 20E, e ensaios de reação em cadeia da polimerase (PCR). Todos os isolados foram selecionados para três genes de virulência putativos, incluindo aerolisina (aer), hemolisina (hyl) e enterotoxina citotônica termolábil (alt). Sete isolados de Aeromonas hydrophila foram recuperados e identificados com base no API 20E. Esses isolados foram posteriormente confirmados como A. hydrophila de acordo com ensaios de PCR. Três isolados indicaram a presença de genes de virulência (alt e hyl), enquanto o gene aerolisina (aer) não esteve presente em nenhum dos isolados de A. hydrophila. O presente estudo confirmou A. hydrophila como o agente causador da síndrome ulcerativa epizoótica e septicemia móvel por Aeromonas em fazendas de peixes, no distrito de Kasur, Punjab, Paquistão. Além disso, a detecção de dois genes de virulência (alt e hyl) em isolados de A. hydrophila é uma ameaça para os consumidores de peixes da área de estudo.

Anaplastic (undifferentiated) carcinoma of pancreas, an uncommon variant: Diagnosed on endoscopic-guided fine needle aspiration

Anaplastic carcinoma of pancreas (ACP) are rare pancreatic neoplasms. They are well known to be associated with more aggressive tumor behavior and less favorable prognosis than usual pancreatic ductal adenocarcinoma. Endoscopic-guided fine needle aspiration (EUS-FNA) is now a widely accepted modality in diagnosis of pancreatic lesions. However, only a few reports are available describing cytological features of anaplastic carcinoma. Here, we report two cases of ACP diagnosed on EUS-FNA.

Gall Bladder Polyps : A Paradigm Shift – Need for Reappraisal of Guidelines

Background : Gall Bladder Polyps are mucosal lesions that project from the Gall Bladder wall into the Gallbladder lumen. They form morphologically distinct lesion/s with internal characteristics different than that of neighboring structures as verified by microscopic examination. About 4-6% are picked up clinically, 2-12% in Cholecystectomy specimens and 4% on Ultrasound. Materias and Methods : A three calendar year retrospective single surgical unit study compromised of 1442 cholecystectomies performed for benign Gall Bladder Disease. The patient were subjected to Ultrasound of abdomen for diagnosis and routine clinic work up. The Gall Bladders Harboring Polyps were examined grossly for site ,number, and microscopy for histological details. Results : In a total number of 40 cases of Gall Bladder Polyp, females outnumbered males. This series spreads over age groups of 3rd decade - 9th decade, most of the patients were seen in 6th decade of life. Youngest patients were 27 years old and oldest one was 85 years old. Incidentally, none of the old patients had evidence of malignancy on histopathology in their Gall Badder Polyp, only 2% were necessitated for a pre-operative diagnosis of Gall Bladder Polyps alone. Rest required it for presence of Gallstones with or without Polyp. None of >10mm size showed any malignant change on histopathological examination. On the Contrary, among the polypoid lesions <10mm size, one polypid lesion (7mm) showed a malignant change (Carcinoma in situ) Conclusion : A predictive model for neoplastic potential of Gall Bladder Polyp may support clinical decision to achieve an ideal therapeutic outcome. Hence a need for reappraisal of management guidelines.

Os estados de ego pela experiência psicodramática bipessoal: a externalização de papéis internos (partes) / Estados del ego a través de la experiencia psicodramática bipersonal: la exteriorización de roles internos (partes) / Ego states through bipersonal psychodramatic experience: the externalization of internal roles (parts)

RESUMO Este artigo tem como objetivo apresentar o manejo clínico para externalização dos papéis internos ou partes, através da experiência psicodramática, tendo por base as técnicas de Moreno e de Rojas-Bermúdez, a exemplo da construção de imagens tridimensionais e bidimensionais por meio de pessoas, objetos, bonecos, tecidos e o psicodrama interno desenvolvido por outros autores. A gênese das partes, em geral, está relacionada à dissociação decorrente de traumas ou ao introjeto de figuras parentais significativas, principalmente quando o apego é inseguro. Traumas complexos, relacionados a bullying, abuso sexual, violência doméstica de várias naturezas ao longo do desenvolvimento da criança vai trazer à tona essas partes internas que precisam ser bem compreendidas porque afetam vários papéis sociais. Papéis internos, partes, eu parcial, divisão interna, personagens, estados de ego, criança ferida, subpersonalidades são denominações de um mesmo fenômeno, que se manifesta pela multiplicidade de eus. Esse fenômeno é também constatado no campo da neurose e em normóticos.

RESUMEN Este artículo tiene como objetivo presentar el manejo clínico para la externalización de roles o partes internas, a través de la experiencia psicodramática, basada en las técnicas de Moreno y Rojas-Bermúdez, como la construcción de imágenes tridimensionales y bidimensionales a través de personas, objetos, marionetas, tejidos y el psicodrama interno desarrollado por otros autores. La génesis de las partes, en general, está relacionada con la disociación resultante del trauma o la introyección de figuras parentales significativas, especialmente cuando el apego es inseguro. Los traumas complejos relacionados con el bullying, el abuso sexual, la violencia doméstica de diversa índole a lo largo del desarrollo del niño sacarán a la luz estas partes internas, que deben entenderse bien porque afectan a varios roles sociales. Roles internos, partes, yo parcial, división interna, personajes, los estados del ego, los niños heridos, las subpersonalidades son denominaciones del mismo fenómeno, que se manifiesta por la multiplicidad de Yoes. Este fenómeno también se observa en el campo de la neurosis y en la normótica.

ABSTRACT This article aims to present the clinical management for externalization of internal roles or parts, through psychodramatic experience, based on the techniques of Moreno and Rojas-Bermúdez, such as the construction of three-dimensional and two-dimensional images through people, objects, puppets, tissues and the internal psychodrama developed by other authors. The genesis of the parts, in general, is related to dissociation resulting from trauma or the introjection of significant parental figures, especially when the attachment is insecure. Complex traumas related to bullying, sexual abuse, domestic violence of various natures throughout the child's development will bring to light these internal parts, which need to be well understood because they affect various social roles. Internal roles, parts, partial self, internal division, characters, ego states, wounded children, subpersonalities are denominations of the same phenomenon, which is manifested by the multiplicity of selves. This phenomenon is also observed in the field of neurosis and in normotics.

Masculinidades e psicodrama: contribuições da técnica do desdobramento do eu / Masculinities and psychodrama: contributions of the self unfolding technique / Masculinidades y psicodrama: contribuciones de la técnica de desdoblamiento del yo

RESUMO Este artigo tem como objetivo compreender os benefícios da utilização da técnica do desdobramento do eu em demandas psicológicas relacionadas às masculinidades em um processo de psicodrama bipessoal. Por meio de uma pesquisa-ação com um homem adulto, foi possível identificar conservas culturais vinculadas ao papel de gênero. Observou-se uma suposta obrigatoriedade de vigor físico e psicológico, de não demonstração de sentimentos, vulnerabilidades e sensibilidade, bem como uma exigência constantede trabalho e produtividade. Ao se fazer os eus internos do protagonista contracenarem por meio da técnica do desdobramento do eu, possibilitou-se o encontro com caminhos efetivos de busca da saúde biopsicossocial, por vezes integrando e/ou acionando outros eus para atuarem diante dos desafios cotidianos.

ABSTRACT This article aims to understand the benefits of using the self unfolding technique in psychological demands related to masculinities in a bipersonal psychodrama process. Through action research with an adult man, it was possible to identify cultural conserves linked to gender role. There is an assumption that masculinity requires physical and psychological vigor, not showing feelings, vulnerabilities and sensitivity, as well as a constant demand for work and productivity. By making the protagonist's internal selves act together through the self unfolding technique, it was possible to encounter effective paths in search of biopsychosocial health, sometimes integrating and/or triggering other selves to act in the face of daily challenges.

RESUMEN Este artículo tiene como objetivo comprender los beneficios de utilizar la técnica de desdoblamiento del yo en demandas psicológicas relacionadas con las masculinidades en un proceso de Psicodrama Bipersonal. A través de una investigación con un hombre adulto, fue posible identificar las acciones culturales vinculadas al rol de género. Se observa una supuesta exigencia de vigor físico y psicológico, de no manifestar sentimientos, vulnerabilidades y sensibilidad, así como una constante demanda de trabajo y productividad. Al hacer que mis yo internos actuaran como protagonistas a través de la técnica de desdoblamiento del yo, fue posible encontrar caminos efectivos para la búsqueda de la salud biopsicosocial, integrando en ocasiones y / o desencadenando otros yo para actuar ante los desafíos cotidianos.

Value of immunohistochemical IMP3 expression with endoscopic ultrasound-guided-fine needle aspiration (EUS-FNA) in diagnosing pancreatic lesions: Review Article

Pancreatic cancer (PC), a lethal condition with a poor prognosis, ranks fourth among the most common causes of cancer-related mortality as early diagnosis of PC is so tricky. Consequently, most cases at the time of initial diagnosis already harbor metastasis. PC cases' early detection and survival depend mainly on improving diagnostic approaches. This review sheds light on the role of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) as a minimally invasive method in early PC diagnosis and differentiation between different pancreatic lesions. The discovery of new diagnostic and prognostic markers for PC will raise the accuracy of proper diagnosis, and in turn, patients will gain better survival and prognosis. Insulin-like growth factor II mRNA binding protein3 (IMP3) is overexpressed in several malignant tumors, including pancreatic cancer, which may raise its role in diagnosis and prognosis as well as its therapeutic benefit for PC.

Derivación biliodigestiva guiada por ultrasonografía endoscópica en el paciente con adenocarcinoma de páncreas y obstrucción de la vía biliar estadio IV: reporte de caso / Biliodigestive shunt guided by endoscopic ultrasonography in patient with stage IV pancreatic adenocarcinoma and obstruction of the bile duct. A case report

Resumen La endosonografía endoscópica es una alternativa que sirve como guía para la realización de derivaciones biliodigestivas en los casos en los que la colangiopancreatografía retrógrada endoscópica (CPRE) ha fallado. Se han descrito técnicas como la coledocoduodenostomía o coledocoantrostomía guiadas por ultrasonografía endoscópica (USE). Se describe el caso de una paciente de 72 años con adenocarcinoma de páncreas, compromiso portal y de paredes duodenales, en quien se usó la CPRE para intentar una derivación paliativa y fue fallida, por lo cual se realizó la colocación de un stent metálico guiado por endosonografía endoscópica, con adecuada respuesta clínica al tratamiento. En conclusión, el procedimiento es seguro y la endosonografía es una vía alterna efectiva en los casos de CPRE fallidas para lograr derivaciones biliares en casos de obstrucción de la vía biliar de origen maligno.

Abstract Endoscopic endosonography is an alternative to guide biliodigestive shunting in cases where endoscopic retrograde cholangiopancreatography (ERCP) has failed. Techniques such as choledoduodenostomy or choledochoantrostomy guided by endoscopic ultrasonography have been described. This is the case of a 72-year-old patient with pancreatic adenocarcinoma, portal vein and duodenal wall involvement, in whom ERCP to try a palliative shunt failed. Therefore, a metal stent was placed using endoscopic endosonography, with adequate clinical response to the procedure and treatment. It is concluded that the procedure is safe and that endosonography is an effective alternative in cases of ERCP failure to achieve biliary bypass in cases of malignant biliary obstruction.

Eficacia y seguridad del drenaje ecoendoscópico de colecciones líquidas peripancreáticas en un hospital de referencia / Efficacy and safety of echoendoscopy drainage of liquid peripancreatic collections in a reference hospital

RESUMEN Introducción: El drenaje guiado por ecoendoscopía es considerado como la mejor opción para el drenaje de las colecciones liquidas peripancreáticas. No hay reportes en nuestro medio de la experiencia en esta terapia endoscópica. Objetivos: detallar las características, eficacia y seguridad de los drenajes ecoendoscópicos de las colecciones liquidas peripancreáticas en el Hospital Nacional Edgardo Rebagliati Martins. Material y métodos: se realizó un estudio transversal retrospectivo de todos los pacientes con colecciones liquidas peripancreáticas sintomáticas sometidos a drenaje ecoguiado. Se analizaron variables demográficas, características ecoendoscópicas asociadas al procedimiento terapéutico y dispositivos empleados. La eficacia se evaluó con la tasa de éxito técnico y de éxito clínico. La seguridad se evaluó en base a las principales complicaciones inmediatas y posteriores. Se empleó estadística descriptiva básica. Resultados: Se realizaron 17 drenajes ecoguiadas de colecciones peripancreáticas (10 pseudoquistes y 7 necrosis pancreáticas encapsuladas o WON) en 17 pacientes: 9 mujeres (52,9%) y 8 hombres (47,1%). El rango de edad de los pacientes fue de 26-72 años, con una mediana de 59 años. El tamaño promedio de las colecciones liquidas fue 14,8 cm con un rango de 8-24 cm. El acceso transgástrico se empleó en 16 casos (94,1%) y el acceso transduodenal en 1 caso (5,9%). Se empleó prótesis plástica (6 casos), prótesis metálica autoexpandibles (SEMS) biliar (4 casos) y prótesis de aposición luminal (LAMS) en 7 casos. El éxito técnico fue del 100% (17 pacientes), mientras que el éxito clínico fue de 70,6% (12 pacientes). Las complicaciones ocurrieron en 41,2%: infección de colección (2 casos), perforación, sangrado en zona de drenaje, obstrucción de prótesis plástica, migración de prótesis al interior de colección y al lumen gástrico (1 caso cada uno). El manejo quirúrgico de éstas complicaciones fue necesaria en 3 casos, mientras que en los otros 4 casos solo requirió manejo médico - endoscópico. Conclusiones: los drenajes guiados por ecoendoscopía de las colecciones liquidas peripancreáticas tienen alta tasa de éxito técnico y clínico con reducido porcentaje de complicaciones.

ABSTRACT Introduction: Endoscopic ultrasound (EUS) guided drainage is considered the best option for peripancreatic fluid collections drainage. There are no previous reports in our country of this type of endoscopic therapy. Objectives: To detail the characteristics, efficacy and safety of EUS-guided drainage of peripancreatic fluid collections at Edgardo Rebagliati Martins National Hospital. Materials and methods: We carried out a retrospective cross-sectional study of all patients who underwent EUS-guided drainage of symptomatic peripancreatic fluid collections. Demographics, procedure-related endosonographic features and devices used were analyzed. We assessed the effectiveness with technical and clinical success rate. Clinical safety was assessed based on major immediate and delayed adverse events. Basic descriptive statistics was used. Results: A total of 17 patients (9 women, 52.9% and 8 men, 47.1%) with peripancreatic fluid collections (10 pseudocysts and 7 walled-off necrosis) underwent EUS-guided drainage. The median age of the patients was 59 years (range 26 - 72 years). The mean diameter of the fluid collections was 14.8 cm (range 8-24 cm). Transgastric route was used in 16 cases (94.1%) and transduodenal route in 1 case (5.9%). Plastic stent (6 cases), biliary self expanding metal stent (4 cases) and lumen apposing stent (7 cases) were used. The technical success rate was 100% (17 patients), while clinical success rate was 70.6% (12 patients). Adverse events occurred in 41.2%: infection (2 cases), perforation, bleeding, plastic stent occlusion, stent migration into the collection cavity and out of the collection cavity (1 case each one). Surgical management of adverse events was necessary in 3 cases, while the 4 other cases only required medical - endoscopic management. Conclusions: EUS-guided drainage of peripancreatic fluid collections have a high technical and clinical success rate with a low percentage of adverse events.

Endobronchial ultrasound-guided transbronchial needle aspiration combined with either endoscopic ultrasound-guided fine-needle aspiration or endoscopic ultrasound using the EBUS scope-guided fine-needle aspiration for diagnosing and staging mediastinal diseases: a systematic review and meta-analysis

The present systematic review and meta-analysis aimed to evaluate the available evidence base on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) combined with either endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or endoscopic ultrasound using the EBUS scope-guided fine-needle aspiration (EUS-B-FNA) for diagnosing and staging mediastinal diseases. PubMed, Web of Science, and Embase were searched to identify suitable studies up to June 30, 2019. Two investigators independently reviewed articles and extracted relevant data. Data were pooled using random effect models to calculate diagnostic indices that included sensitivity and specificity. Summary receiver operating characteristic (SROC) curves were used to summarize the overall test performance. Data pooled from up to 16 eligible studies (including 10 studies of 963 patients about EBUS-TBNA with EUS-FNA and six studies of 815 patients with EUS-B-FNA) indicated that combining EBUS-TBNA with EUS-FNA was associated with slightly better diagnostic accuracy than combining it with EUS-B-FNA, in terms of sensitivity (0.87, 95%CI 0.83 to 0.90 vs. 0.84, 95%CI 0.80 to 0.88), specificity (1.00, 95%CI 0.99 to 1.00 vs. 0.96, 95%CI 0.93 to 0.97), diagnostic odds ratio (413.39, 95%CI 179.99 to 949.48 vs. 256.38, 95%CI 45.48 to 1445.32), and area under the SROC curve (0.99, 95%CI 0.97 to 1.00 vs. 0.97, 95%CI 0.92 to 1.00). The current evidence suggests that the combination of EBUS-TBNA with either EUS-FNA or EUS-B-FNA provides relatively high accuracy for diagnosing mediastinal diseases. The combination with EUS-FNA may be slightly better.

EUS-guided biliary drainage using a fully covered self-expandable metal stent for malignant obstructive jaundice / 中华肝胆外科杂志

Objective To study the therapeutic effects of EUS-guided biliary drainage (EUS-BD) using a nitinol fully covered self-expandable metal stents in patients with malignant obstructive jaundice after failed ERCP.Methods From January 2016 to January 2018,all patients with malignant obstructive jaundice who failed ERCP underwent EUS-guided biliary drainage using nitinol fully covered self-expandable metal stent at Affiliated Hangzhou First People' s Hospital,Zhejiang University School of Medicine.The operation success rate,liver functional recovery time,complication rate,length of hospital stay and survival time were observed.Results Of 36 patients who underwent EUS-guided biliary drainage,34 were successfully performed,with 19 through the stomach,and 15 through the duodenum.The operation success rate was 94.4％ (34/36).The liver functional recovery time of the 34 patients were 25.8 ±.6.5 days.One patient developed hemobilia and one cholangitis,both improved after conservative treatment.The total complication rate was 5.6％ (2/36).The hospital stay and survival time were 21.5 ± 4.7 days and 220.5 ± 54.8 days,respectively.Conclusion EUS-BD using nitinol fully covered self-expandable metal stents was a feasible and effective treatment in patients with malignant biliary obstruction after failed ERCP.

Research advances in preoperative staging of gastric cancer / 中国肿瘤临床

Accurate preoperative staging of gastric cancer is of great significance for choosing an optimal therapeutic schedule and for evaluating the prognosis. Accurate preoperative preparation can avoid unnecessary treatment and help with selecting optimal treat-ment modalities. In recent years, the preoperative staging of gastric cancer has been greatly improved owing to the use of diagnostic methods such as endoscopic ultrasonography, multi-slice spiral computed tomography, positron emission computed tomography, and staging laparoscopy, among other such modalities. However, all diagnostic methods are associated with advantages and limitations. Thus, a combination of various diagnostic modalities is essential for accurate preoperative staging. This paper reviews the research progress in the aforementioned diagnostic methods for preoperative staging.

Progress in Research on Endoscopic Ultrasonography-guided Gallbladder Drainage / 胃肠病学

Laparoscopic cholecystectomy is the gold standard for treatment of gallstones with clinical symptoms, however, various complications may occur. Endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD) has the advantages of minimal invasion, keeping the gallbladder and safe in operation, which is suitable for the conservative treatment under endoscopy of patients who are intolerant to laparoscopic cholecystectomy and having strong will to keep gallbladder, and for advanced malignant tumor patients with distal bile duct obstruction. This article reviewed the progress in research on EUS-GBD.

Future Perspectives on Endoscopic Ultrasonography-Guided Therapy for Pancreatic Neoplasm

Endoscopic ultrasonography (EUS)-guided therapy with ethanol injection or catheter-based radiofrequency ablation for pancreatic neoplasm has been conducted as a potential alternate treatment modality for patients who are not eligible for surgery. On the basis of the limited number of studies available, EUS-guided ablation therapy with the aforementioned methods for small pancreatic neoplasms has demonstrated promising technical feasibility and safety profiles. To be considered as a legitimate alternative option to surgery, however, EUS-guided ablation therapy must provide a long-term efficacy profile along with the consensus among experts regarding its treatment parameter. This review focuses on the clinical issues and future perspectives of EUS-guided therapy for pancreatic neoplasm.

Safety and Complications of Interventional Endoscopic Ultrasound

Endoscopic ultrasound (EUS) has become an essential tool for the diagnostic and therapeutic intervention of gastrointestinal diseases. Beyond the drainage of fluid collections, it enables decompression of inaccessible bile and pancreatic ducts, the gallbladder, and the creation of anastomosis within the gastrointestinal tract using fully lumen-apposing stents. This review explored the safety and efficacy of these novel procedures and discussed the training pathway that is necessary to perform them efficiently and safely.

Clinical Value of Contrast-Enhanced Harmonic Endoscopic Ultrasonography in the Differential Diagnosis of Pancreatic and Gallbladder Masses

BACKGROUND/AIMS: Recent studies have revealed that contrast-enhanced harmonic endoscopic ultrasonography (CEH-EUS) is beneficial in the differential diagnosis of malignant neoplasms of the pancreas and gallbladder from benign masses, in terms of the evaluation of microvasculature and real-time perfusion. In this study, we aimed to prove the clinical value of CEH-EUS in the differential diagnosis of pancreatic and gallbladder masses by direct comparison with that of conventional EUS. METHODS: We reviewed the sonographic images and medical information of 471 patients who underwent conventional EUS and CEH-EUS for the diagnosis of pancreatic and gallbladder masses at a single medical center (Severance Hospital, Seoul, Korea) between March 2010 and March 2016. RESULTS: The enhancement pattern of CEH-EUS of the pancreatic solid masses showed higher sensitivity and specificity in differentiating pancreatic adenocarcinoma and neuroendocrine tumors (82.0% and 87.9% for pancreatic adenocarcinoma and 81.1% and 90.9% for neuroendocrine tumors, respectively), and the area under the receiver operating characteristic curves was higher than that of conventional EUS. The enhancement texture of CEH-EUS of the gallbladder masses showed a higher sensitivity in differentiating malignant masses than that of conventional EUS; however, the difference between the areas under the receiver operating characteristic curves was not statistically significant. CONCLUSIONS: CEH-EUS can complement conventional EUS in the diagnosis of pancreatic and gallbladder masses, in terms of the limitations of the latter.

Endoscopic ultrasonography (EUS) in diagnosis of colorectal submucosal lesions / 中国内镜杂志

Objective To investigate the role of endoscopic ultrasonography (EUS) in diagnosis and treatment of colorectal submucosal lesions. Methods EUS were applied in 74 patients with suspected colorectal submucosal lesions. According to the origin of submucosal lesion, the patients had received biopsy, endoscopic ultrasonography-fine needle aspiration (EUS-FNA) and endoscopic treatment or surgery. The correlation between EUS and clinical pathology is analyzed retrospectively. Results In the diagnosis based on EUS, there were 28 cases of neuroendocrine tumors (occurred in the rectum), 15 lipomas (4 cases occurred in ileocecal, 1 in transverse colon, 8 in ascending colon, 2 in sigmoid colon), 2 rectal gastrointestinal stromal tumor (1 in muscularis propria and the other in muscularis mucosa), 14 external pressure changes (9 ovarian tumor, 2 lymph nodes, 3 pelvic tumor), 5 cyst (4 in transverse colon, 1 in ascending colon), 1 gas cyst, 3 sigmoid colon endometriosis, 4 rectum malignant tumor invasion, 2 intestinal lymphoma. All the patients had received biopsy, EUS-FNA, endoscopic treatment or surgery. Compared with pathology, a total coincidence rate of 91.9% (68/74) was achieved by EUS, and 2 cases were pathologically diagnosed as leiomyoma, which is considered as rectal carcinoma by EUS at first, 1 case of intestinal lymphoma instead of lipoma, 2 inflammatory mass instead of malignant tumor around the rectum, and 1 rectal carcinoma instead of endometriosis. Conclusion The digestive tract structure could be showed clearly with EUS, and the size of the colon and rectal submucosal lesions, the layer of origin and the structural relationship of adjacent tissues could also be detected. Then, the appropriate treatment against the colon and rectal submucosal lesions would be adopted after the accurate judgment of lesions with EUS.

EUS-guided rendezvous for malignant obstructive jaundice after failured ERCP / 中国内镜杂志

Objective To study the therapeutic effect of EUS-guided rendezvous (EUS-RV) when ERCP failed in patients with malignant obstructive jaundice. Methods 12 cases of malignant obstructive jaundice patients were underwent EUS-RV after unsuccessful ERCP. The operation success rate, liver function recovery 1 week and 1 month after operation, complication rates, hospital stay and patient survival were observed. Results All 12 patients were successfully operated and placed stents by endoscopic ultrasound puncture following by ERCP: 8 patients by the stomach, 4 patients by duodenum, the operation success rate was 100.00%; There were significant difference between the liver function recovery of preoperative and postoperative one week or postoperative one week and postoperative one month (P < 0.05). 1 bleeding occurred and were improved after conservative treatment, the complications rate was 8.33%; the hospital stay was (20.68 ± 5.76) d; the average survival time of patients was 224 d. Conclusion EUS-guided rendezvous may be the alternative treatment due to the diminutive trauma and good effect when ERCP failed in patients with malignant obstructive jaundice.

Endoscopic Ultrasound (EUS)-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography or EUS: Mid-Term Analysis of an Emerging Procedure

BACKGROUND/AIMS: Performing endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone Rouxen-Y gastric bypass (RYGB) is challenging. Standard ERCP and enteroscopy-assisted ERCP are associated with limited success rates. Laparoscopy- or laparotomy-assisted ERCP yields improved efficacy rates, but with higher complication rates and costs. We present the first multicenter experience regarding the efficacy and safety of endoscopic ultrasound (EUS)-directed transgastric ERCP (EDGE) or EUS. METHODS: All patients who underwent EDGE at two academic centers were included. Clinical success was defined as successful ERCP and/or EUS through the use of lumen-apposing metal stents (LAMS). Adverse events related to EDGE were separated from ERCP- or EUS-related complications and were defined as bleeding, stent migration, perforation, and infection. RESULTS: Sixteen patients were included in the study. Technical success was 100%. Clinical success was 90% (n=10); five patients were awaiting maturation of the fistula tract prior to ERCP or EUS, and one patient had an aborted ERCP due to perforation. One perforation occurred, which was managed endoscopically. Three patients experienced stent dislodgement; all stents were successfully repositioned or bridged with a second stent. Ten patients (62.5%) had their LAMS removed. The average weight change from LAMS insertion to removal was negative 2.85 kg. CONCLUSIONS: EDGE is an effective, minimally invasive, single-team solution to the difficulties associated with ERCP in patients with RYGB.

Diagnostic value of endoscopic ultrasound guided fine needle aspiration combined with the new category of papanicolaou society of cytopathology in solid pancreatic lesions / 中华消化杂志

Objective To study the diagnostic value of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) combined with the new category of papanicolaou society of cytopathology in solid pancreatic lesions (SPL) rapid on-site evaluation (ROSE).Methods From February 2011 to October 2014,225 patients with SPL who underwent EUS-FNA and obtained the cytological diagnosis were enrolled.The lesions were finally diagnosed according to pathological results,imaging and follow-up data,and then the sensitivity,specificity,and accuracy of EUS-FNA in the diagnosis of SPL were calculated based on the new papanicolaou society of cytopathology terminology.Logistic stepwise regression analysis was performed to analyze the risk factors.Results Among 225 patients with SPL,96 cases (42.7％)had uncertain cytological diagnosis,17.3％ (39/225) could not be diagnosed,8.0％ (18/225) were atypical lesions,and 17.3％ (39/225) were suspicious malignant carcinomas.Among 129 cases (57.3％)with certain cytological diagnosis,15.1％ (34/225) were benign lesions,14.7％ (33/225) were tumors (benign or others) and 27.6％ (62/225) were malignant tumors.When atypical lesions were added into non-tumor lesions or tumor lesions,the sensitivity,specificity and accuracy of diagnosis were 87.3 ％,91.7％,88.2％,and 94.7％,72.2％,90.3％,respectively.Serum CA125≥14 kU/L (odds ratio (OR) =7.13,95％ confidence interval (CI) 2.02 to 25.22,P=0.002) and history of biliary disease (OR=3.85,95％CI 1.22 to 12.51,P=0.022) were two independent risk factors of pancreatic tumors.Conclusions Despite of a high percentage of uncertain cytological diagnosis,EUS-FNA still has high diagnostic value in SPL when combined with the new papanicolaou society of cytopathology terminology.Furthermore,serum CA125≥14 kU/L and history of biliary disease may help to diagnose pancreatic tumors.