Withdrawal Notice: Analysing the Quality of Food using Convolution Neural Network and Fuzzy Classifier in Hyperspectral Imagery

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Evaluation of performance of EUS-FNA in preoperative lymph node staging of cancers of esophagus, lung, and pancreas.

We reviewed the cytologic and histologic diagnoses and EUS report of 77 consecutive patients who had undergone EUS-FNA preoperative staging for esophageal, lung, and pancreatic cancers at our institution. A total of 122 EUS-FNA lymph nodes were identified. Thirty of 77 cases had histologic follow-up. Using surgical node staging and/or surgical resection as the reference standard, the sensitivity, specificity, accuracy, and positive and negative predictive values were 75%, 95%, 89%, 86%, and 90%, respectively, for EUS-FNA node staging. We compared cytologically malignant and benign lymph node groups with eight EUS parameters including the total number of lymph nodes found by EUS, the shape, margin, long axis, short axis, echogenicity, location of the lymph node, and EUS tumor staging. We found that the short axis is the best EUS feature to predict malignancy. Lymph nodes found in an abdominal location in esophageal and lung cancer are likely malignant.

Effects of self-assessment on retention in rule-based learning.

The main purpose of most educational and training programs isthat the person will acquire some specified knowledge, retain it until a later time when it will be retrieved and employed to make decisions, select and execute actions, etc. Previous research has indicated that there might be a positive relation between an individual's certainty about the correctness of learned responses and how well the material is retained over shorter time-periods. In the present study, 39 men and 38 women learned the names of eight different hand pliers; they were also assessing their certainty about the names of the pliers. After the learning session, the participants returned after either 1, 6, or 12 wk. for a retention and relearning session. Analysis showed that higher certainty was associated positively with retention. The men were more prone than the women to rate themselves as being "Extremely sure" of being correct, even when they, in fact, were wrong. Also, men and women learned the material equally fast, but the men required significantly fewer trials than the women to relearn material. Inclusion of ratings of certainty offers a convenient way of assessing when training has been sufficient and facilitates detection of misinformation (sure-but-wrong answers).

Unsedated esophagoscopy for the diagnosis of esophageal varices in patients with cirrhosis.

BACKGROUND AND STUDY AIMS: Unsedated endoscopy with ultrathin endoscopes has been shown to be an alternative to conventional endoscopy. This technique would appear to be an ideal way to screen for varices, but there is scant data for unsedated endoscopy in patients with cirrhosis. The aims of this pilot study were to evaluate whether unsedated endoscopy can be used to screen for varices and to determine how well it is tolerated in patients with hepatic dysfunction. PATIENTS AND METHODS: We prospectively evaluated unsedated esophagoscopy in 15 patients with cirrhosis who were candidates for beta-adrenergic-antagonist therapy. Patients with cirrhosis without gastrointestinal bleeding or contraindications to beta-adrenergic-antagonist therapy gave consent to the procedure. The presence and size of varices and the procedure time were recorded. After the procedure, patient tolerance, as gauged by questionnaire and willingness to repeat, was assessed. RESULTS: All patients tolerated the procedure without significant discomfort. The mean time of the procedure was 2 minutes. Esophageal varices were found in nine of 15 patients. Of these, one patient with Child-Pugh class C cirrhosis had large varices and was started on propranolol. CONCLUSIONS: Unsedated esophagoscopy in patients with cirrhosis appears to be well tolerated. Given both potential safety and cost benefits over conventional endoscopy, this could be a useful method for screening for varices. A randomized trial comparing this method with standard endoscopy is warranted.

Postoperative endoscopic retrograde high dose-rate brachytherapy for cholangiocarcinoma.

Cholangiocarcinoma typically presents with disease unlikely to be completely resected, and prognosis remains poor. Improvements in imaging, endoscopy, and stenting have given rise to renewed interest in brachytherapy. Several recent retrospective series suggest a benefit to intraluminal brachytherapy, most commonly delivered by the transhepatic route. We describe a case in which brachytherapy was delivered via the nasobiliary route to address positive margins at the common bile duct stump. A custom catheter was manufactured to make the procedure feasible. Pertinent literature is reviewed, which supports the view that these malignancies benefit from high doses of radiation, if this can be achieved respecting normal tissue tolerance.

Treatment of severe esophageal Crohn's disease with infliximab.

Esophageal ulceration with fistula is an uncommon manifestation of Crohn's disease. Typical presentation of symptomatic esophageal Crohn's disease may include dysphagia, odynophagia, weight loss, and chest discomfort. We present a patient with severe esophageal and skin involvement of Crohn's disease that was progressive despite conventional therapy including prednisone and 6-mercaptopurine. The diagnosis of Crohn's was based on the presence of typical clinical, endoscopic, and pathologic findings, including granulomas in the skin ulcer and the absence of infectious etiologies. The patient had a nearly complete resolution of her esophageal disease with a single infusion of infliximab.

Torulopsis glabrata fungemia as a complication of a clotted transjugular intrahepatic portosystemic shunt.

Torulopsis glabrata fungemia developed in a patient with a clotted transjugular intrahepatic portosystemic shunt (TIPS) 11 months after placement. Fungemia persisted despite treatment with amphotericin B. On autopsy, T. glabrata was found in the thrombus occluding the TIPS and extending into the splenic and portal vein. TIPS infections may be considered in patients with fungemia.

Mixed infection with cagA-positive and cagA-negative strains of Helicobacter pylori.

BACKGROUND: Helicobacter pylori infection has been implicated strongly in the pathogenesis of gastritis, peptic ulcer disease, gastric adenocarcinoma, and gastric lymphoma, but the reasons for these widely different clinical outcomes are unknown. The aim of this study was to determine whether these differences could be due in part to mixed infection in the same individual, with bacteria having differences in pathogenic factors associated with ulcers. MATERIALS AND METHODS: The cagA gene of H. pylori was used to test for mixed infection because it is present in only some strains, and its presence has been associated with ulcers. Polymerase chain reaction (PCR) assays for the cagA gene were applied to H. pylori culture isolates and endoscopic gastric aspirates. Individual bacterial clones were tested for genetic similarity by random primer amplification and restriction endonuclease digestion of urease gene PCR products. RESULTS: The majority of H. pylori-positive patients had strongly cagA-positive culture isolates and endoscopic samples (62.5% and 69.6%, respectively). However, many of these patients had evidence of mixed infection with cagA negative and cagA positive strains in cultures isolates and endoscopic samples (25% and 17.4%, respectively). Mixed infection was found to be due to genetically unrelated strains in two patients in whom genetic analysis was performed. CONCLUSION: Mixed infection with differences in substrain pathogenic factors might occur in H. pylori infection and might contribute to differences in clinical outcome.

Immune evasion by Helicobacter pylori: gastric spiral bacteria lack surface immunoglobulin deposition and reactivity with homologous antibodies.

BACKGROUND: Helicobacter pylori infection persists in the presence of potent serum and gastric mucosal antibody responses against bacterial antigens. The aim of this article is to report on a study determine whether there is antibody deposition on H. pylori in vivo in the stomach of infected patients and whether gastric and cultured forms of H. pylori differ in their antibody reactivity. MATERIALS AND METHODS: Serum, gastric biopsies, and antral brushings were obtained from 10 patients having endoscopy. H. pylori was cultured from gastric biopsies. Bacterial samples were stained directly for immunoglobulin deposition and indirectly using rabbit antiurease serum or patient serum. Samples were examined by immunofluorescence microscopy and flow cytometry. RESULTS: Although spiral bacteria could be identified easily by acridine orange staining and antiurease staining of gastric brushings from H. pylori infected patients, gastric bacteria did not have detectable IgG or IgA present, and only one of five samples could be stained for IgG and IgA indirectly using patient serum. In contrast, cultured bacteria could be stained readily with homologous serum for IgG and IgA in the majority of cases. Low pH inhibited immunoglobulin reactivity with cultured H. pylori. CONCLUSIONS: Gastric H. pylori may evade humoral defense owing to poor deposition of immunoglobulin in the gastric environment or failure to express surface antigens that are present on cultured forms of H. pylori.

Efeitos da desnutriçäo protéica sobre a resposta metabólica ao trauma / Effects of protein malnutrition on the metabolic response to trauma

Com o objetivo de estudar as alteraçöes metabólicas pós-traumáticas frente, à desnutriçäo protéica, ratos alimentados com dietas de teor proteíco variado foram submetidos a um trauma osteo muscular padronizado e tiveram analisados aspectos metabólicos de balanço nitrogenado e composiçäo corpórea. Após 21 dias de alimentaçäo com dieta apropriada para cada grupo de estudo (normoprotéica e hipoprotéica), praticou-se ferida cutânea dorsal (subgrupos NJ (6) e DJ (6) e, em parte dos animais, traumatismo osteomuscular em ambas as patas traseiras (subgrupos NF(6) e DF (6). Após 14 dias da realizaçäo do trauma (35§ dia do experimento), os animais foram sacrificados e as carcaças foram preparadas para a determinaçäo dos compartimentos de composiçäo corpórea. Peso corpóreo, ingesta alimentar, excreçäo urinária e fecal de nitrogênio foram observados diariamente. Verificou-se que, nos animais alimentados com dieta normoprotéica, o trauma osteomuscular provocou reduçäo da ingestäo alimentar, do ganho de peso, do balanço nitrogenado e perda de gordura total. Nos animais com restriçäo protéica, a resposta ao trauma osteomuscular foi caracterizada por aumento na excreçäo de nitrogênio urinário e reduçäo no balanço nitrogenado, näo se verificando reduçäo na ingestäo alimentar, peso corporal e nos compartimentos de composiçäo corpórea