Optimal Techniques for EUS-Guided Fine-Needle Aspiration of Pancreatic Solid Masses at Facilities without On-Site Cytopathology: Results from Two Prospective Randomised Trials

Background: EUS-guided fine-needle aspiration (EUS-FNA) has emerged as the primary modality for the cytologic diagnosis of pancreatic solid masses. The aim of this study is to determine whether technical factors including suction (S), non-suction (NS), capillary sampling with stylet slow-pull (CSSS), and the number of needle actuations (to-and-fro needle movements) may affect the accuracy of EUS-FNA for pancreatic solid masses at facilities without on-site cytopathology. Methods: The diagnostic yield of malignancy, blood contamination and cellularity at each sample acquired from EUS-FNA with or without S and different numbers of actuation (10, 15 and 20) were measured (study I). The optimal actuation number was determined and a head-to-head comparison trial between S and CSSS was performed (study II). Results: In study I, significant blood contamination was seen using S with 20 compared with 15 actuations (p = 0.002). Diagnostic yield of malignancy was not significantly different between 10, 15, and 20 actuations with S, whereas it was statistically higher for 15 actuations compared with 10 actuations with NS (p = 0.001). In study II, no difference was noted in diagnostic yield with 15 actuations between S and CSSS (88% vs. 90%, p = 0.74). Conclusions: Increasing actuation in NS resulted in a better diagnostic yield for EUS-FNA without significant blood contamination, whereas increasing actuation in S did not change the diagnostic yield of EUS-FNA while causing significant blood contamination. With 15 actuations, the diagnostic yield was comparable between S and CSSS.

Ultrasound-Guided Fine-Needle Aspiration Versus Fine-Needle Capillary Sampling in Evaluation of Lymph Node Metastasis of Thyroid Cancer

BackgroundTo compare the sampling adequacy and diagnostic efficiency of ultrasound-guided fine-needle aspiration with 22-, 25-gauge needles and capillary sampling with 22-gauge needle in the biopsy of cervical lymph node.MethodsA total of 130 cervical lymph nodes from 103 patients were consecutively included in the prospective study. Each suspected lymph node was aspirated with a 22-gauge needle, capillary sampled with a 22-gauge needle and aspirated with a 25-gauge needle. The adequacy rates and nondiagnostic rates of obtained specimen were calculated.ResultsOf the 130 suspected lymph nodes, there were 77 lymph nodes<6.0 mm and 53 lymph nodes≥6.0mm in the smallest dimension. Both FNA22G and FNC22G got significantly higher sampling adequacy than FNA25G for the total lymph nodes. For lymph nodes<6.0 mm, the sampling adequacy was significantly higher with FNA22G than with FNA25G for each parameter and the cumulative score (all P<0.05), while no difference were seen between FNA22G and FNC22G, and between FNC22G and FNA25G. There were higher nondiagnostic rates for FNA25G compared with FNA22G and FNC22G in all lymph nodes and in each size subgroups. FNA25G yielded more diagnostically inadequate specimens than FNA22G and FNC22G did in the total lymph nodes (P=0.002), in lymph nodes<6.0 mm (P=0.014), and in those ≥ 6.0 mm (P=0.000).ConclusionsFNA22G and FNC22G obtained more diagnostically adequate specimens than FNA25G in cervical lymph nodes. FNA22G and FNC22G may be more suitable than FNA25G in diagnosing cervical lymph nodes. FNA22G and FNC22G may yield specimens with similar quality.

Evaluation of Mathematical Arterialization of Venous Blood in Intensive Care and Pulmonary Ward Patients

<b><i>Background:</i></b> Arterial blood gases are important when assessing acute or critically ill patients. Capillary blood and mathematical arterialization of venous blood have been proposed as alternative methods, eliminating pain and complications of arterial puncture. <b><i>Objectives:</i></b> This study compares the arterial samples, arterialized venous samples, and capillary samples in ICU and pulmonary ward patients. <b><i>Method:</i></b> Ninety-one adult patients with respiratory failure were included in the analysis. Arterial, peripheral venous, and mathematically arterialized venous samples were compared in all patients using Bland-Altman analysis, with capillary samples included in 36 patients. <b><i>Results:</i></b> Overall for pH and PCO₂, arterialized venous values, and in the subset of 36 patients, capillary values, compared well to arterial values and were within the pre-defined clinically acceptable differences (pH ± 0.05 and PCO₂ ± 0.88 kPa). For PO₂, arterialized or capillary values describe arterial with similar precision (PO₂ arterialized −0.03, LoA −1.48 to 1.42 kPa and PO₂ capillary 0.82, LoA −1.36 to 3 kPa), with capillary values underestimating arterial. <b><i>Conclusions:</i></b> Mathematical arterialization functions well in a range of patients in an ICU and ward outside the country of development of the method. Furthermore, accuracy and precision are similar to capillary blood samples. When considering a replacement for arterial sampling in ward patients, using capillary sampling or mathematical arterialization should depend on logistic ease of implementation and use rather than improved measurements of using either technique.

Comparison of Venous and Capillary Sampling in Oral Glucose Testing for the Diagnosis of Gestational Diabetes Mellitus: A Diagnostic Accuracy Cross-Sectional Study Using Accu-Chek Inform II

Gestational diabetes mellitus (GDM) is a common complication with negative impacts on mother and child. The primary aim of this study was to examine whether plasma glucose cutoffs for GDM diagnosis based on venous sampling can be replaced by cutoffs based on capillary sampling. A prospective cross-sectional study was performed at an antenatal care clinic including 175 pregnant women undergoing an oral glucose tolerance test (OGTT). Duplicate samples were collected by capillary and venous puncture while fasting and 1 h and 2 h after an OGTT. Both samples were analyzed on Accu-Chek Inform II. The cutoffs for a GDM diagnosis using capillary samples were corrected from 5.1 to 5.3 mmol/L for the fasting sample, from 10.0 to 11.1 mmol/L for the 1 h sample, and from 8.5 to 9.4 mmol/L for the 2-h sample using half of the dataset. Applying these cutoffs to the remaining dataset resulted in a sensitivity, specificity, and accuracy of 85.0%, 95.0%, and 90.3%, respectively, with a positive predictive value (PPV) of 83%, an negative predictive value (NPV) of 96%, and a positive negative likelihood ratio (LHR) of 16.4 using capillary sampling for the GDM diagnosis at fasting and 2-h after. Corrected cutoffs and capillary samples can be used for the diagnosis of GDM with maintained diagnostic accuracy using Accu-Chek Inform II.

The fetus

An understanding of the assessment of fetal well-being in labour and basic interpretation of the cardio-tocograph is important for any obstetric anaesthetist, in order to anticipate transfer to theatre for operative delivery as early as possible. Illustrated normal and abnormal CTG patterns, fetal ST analysis, fetal scalp capillary sampling, and interpretation of umbilical cord blood gases are discussed in detail. Methods of assessment of fetal well-being during pregnancy are discussed: ultrasound biometry, amniotic fluid volume, and umbilical artery Doppler, followed by the management of intra-uterine growth restriction. Finally, the effects of analgesia in labour, regional and general anaesthesia, and other drugs e.g. magnesium sulphate and terbutaline on the fetus are reviewed.

Glycemic response of Emblica officinalis powder-incorporated Indian recipes

Purpose Glycemic index (GI) is a physiological basis for ranking carbohydrate foods based on the blood glucose responses they produce after ingestion. Emblica officinalis (E. officinalis) is a medicinal plant that purportedly has hypoglycaemic and hypolipidemic properties. This study aims to determine the glycemic and lipemic responses of freeze-dried E. officinalis powder-incorporated recipes. Design/methodology/approach Two sets of four equicarbohydrate (50 g) recipes (vegetable cutlet, handvo, muthiya and methi thepla) were developed, one without E. officinalis powder incorporation (standard) and one with E. officinalis powder incorporation at the 2 g level (test). After overnight fasting, 50 g glucose, standard and test recipes were administered to healthy adult volunteers at different instances (each 3–4 days apart) and blood glucose levels were measured using capillary sampling every 15 min for 2 h. The glycemic response and GI values were then calculated. Findings Among the standard recipes, lowest glycemic response was obtained by methi thepla (60.90 ± 15.54) and highest glycemic response by handvo (90.57 ± 33.88). Incorporation of E. officinalis powder brought about a non-significant reduction in the GI of methi thepla (p = 0.94), vegetable cutlet (p = 0.54), muthiya (p = 0.69) and handvo (p = 0.09). Maximum per cent reduction was for handvo, which shifted from the high to medium GI category. The lipemic response was lowest with muthiya, showing a fall in triacylglycerol (TG) levels (3.9%). E. officinalis powder incorporation in muthiya led to a further fall (7.8%) in TG levels. Originality/value Incorporation of freeze-dried E. officinalis powder in Indian recipes can bring about a reduction in the postprandial glycemic and lipemic responses.

ЭКСПЕРИМЕНТАЛЬНОЕ ПОДТВЕРЖДЕНИЕ РАБОТОСПОСОБНОСТИ КАПИЛЛЯРНОГО ЗАБОРНОГО УСТРОЙСТВА (СЕТЧАТОГО РАЗДЕЛИТЕЛЯ) ПРИ ПРОГРАММНОМ РАЗВОРОТЕ

One of the problems of providing a group launch of spacecraft is to ensure the re-launch of the propulsion engine for the transition to another orbit, after the separation of the first vehicle. When the spacecraft is separated into a stage, an acceleration is applied directed toward the bottom of the tank and leading to an outflow of the fuel component from the mesh separator. This, in turn, leads to the denudation of the mesh separator and the penetration of gas under it, which can lead to a breakdown of the launch of the engine. In viewof the complexity of the hydrodynamic processes taking place in the tanks, experimental confirmation of the mesh separators chosen during the design is required.In this paper, we describe the methods for determining the model conditions (the choice of the scale of the experimental design, the type of the model fluid, the magnitude of the accelerations, etc.), a description of the stand designed specifically for the test data, and the results of the experimental confirmation of the capillary sampling device performance in the separation of the spacecraft. The results of the performed works confirm the correctness of the decisions made in the development of capillary sampling devices.