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World Journal of Gastroenterology Oct 2014The role of endoscopic ultrasound (EUS) in evaluating pancreatic pathology has been well documented from the beginning of its clinical use. High spatial resolution and... (Review)
Review
The role of endoscopic ultrasound (EUS) in evaluating pancreatic pathology has been well documented from the beginning of its clinical use. High spatial resolution and the close proximity to the evaluated organs within the mediastinum and abdominal cavity allow detection of small focal lesions and precise tissue acquisition from suspected lesions within the reach of this method. Fine needle aspiration (FNA) is considered of additional value to EUS and is performed to obtain tissue diagnosis. Tissue acquisition from suspected lesions for cytological or histological analysis allows, not only the differentiation between malignant and non-malignant lesions, but, in most cases, also the accurate distinction between the various types of malignant lesions. It is well documented that the best results are achieved only if an adequate sample is obtained for further analysis, if the material is processed in an appropriate way, and if adequate ancillary methods are performed. This is a multi-step process and could be quite a challenge in some cases. In this article, we discuss the technical aspects of tissue acquisition by EUS-guided-FNA (EUS-FNA), as well as the role of an on-site cytopathologist, various means of specimen processing, and the selection of the appropriate ancillary method for providing an accurate tissue diagnosis and maximizing the yield of this method. The main goal of this review is to alert endosonographers, not only to the different possibilities of tissue acquisition, namely EUS-FNA, but also to bring to their attention the importance of proper sample processing in the evaluation of various lesions in the gastrointestinal tract and other accessible organs. All aspects of tissue acquisition (needles, suction, use of stylet, complications, etc.) have been well discussed lately. Adequate tissue samples enable comprehensive diagnoses, which answer the main clinical questions, thus enabling targeted therapy.
Topics: Biomarkers; Cytogenetic Analysis; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Flow Cytometry; Humans; Immunohistochemistry; Immunophenotyping; Molecular Diagnostic Techniques; Predictive Value of Tests; Reproducibility of Results
PubMed: 25339816
DOI: 10.3748/wjg.v20.i39.14292 -
Journal of Pharmacy Practice Dec 2023Chemotherapeutic and immunomodulatory medications can pose a serious risk to patient and healthcare provider safety because of complex processes, cytotoxicity, and... (Observational Study)
Observational Study
Deviations From Best Practice: Findings From a Certified Patient Safety Organization Remote-Verification Observational Study of Intravenous Compounding of Chemotherapeutic and Ancillary Drugs.
Chemotherapeutic and immunomodulatory medications can pose a serious risk to patient and healthcare provider safety because of complex processes, cytotoxicity, and prevalent medication use. To evaluate chemotherapeutic and ancillary medication compounding in hospital pharmacies using a remote verification system, focusing on pharmaceutical deviations from best practice, compounding time, medication waste, and cost. This retrospective, blinded observational study used a remote intravenous (IV) workflow verification system to examine IV chemotherapeutic compounding errors in large hospital systems. A Patient Safety Organization securely obtained >5000 compounding records and photos from the IV workflow system. Blinded pharmacists evaluated IV chemotherapy preparations using picture slide viewers to assess any deviations from best practice. Time variables, medication waste, STAT vs non-STAT orders, and cost were also evaluated. The most frequently reported deviations from best practice included medications exceeding the >10% additive volume guideline (35.9%) and inaccurate dose labels (28.3%). Time flow analyses demonstrated a substantial increase in total compounding time per vial for 1 vs 2 vials. Most medications in this analysis had an average waste ranging from 0-.36 vials. STAT orders, accounting for 38.4% of all orders, wasted more medication than non-STAT orders. Gemcitabine cost analyses showed an association for number of vials and compounding time with overall cost per dose. Substantial inconsistencies between workflow stations were observed-highlighting the lack of standardization across chemotherapeutics, volume of medication waste during preparation, and the need to establish improved quality controls to safeguard patient and health care provider safety.
Topics: Humans; Patient Safety; Retrospective Studies; Drug Compounding; Administration, Intravenous; Medication Errors
PubMed: 36271614
DOI: 10.1177/08971900221134836 -
Cancer Cytopathology Aug 2018Ancillary testing is absolutely integral to the correct recognition and classification of lymphoid neoplasms as procured with the fine-needle aspiration (FNA) biopsy... (Review)
Review
Ancillary testing is absolutely integral to the correct recognition and classification of lymphoid neoplasms as procured with the fine-needle aspiration (FNA) biopsy technique. In patients with a newly diagnosed lymphoid neoplasm, immunophenotyping with flow cytometry, immunohistochemistry, or both is a standard that is currently expected by oncologists before any form of therapy is initiated. This is often the case also for patients with recurrent/relapsed disease. The cellular material obtained with FNA is perfectly suited to meet this demand. That said, the exceptional complexity of modern-day lymphoma classification often precludes definitive subclassification in a subset of lymphomas for a variety of reasons with the FNA biopsy technique, even with the application of ancillary tests. These include a requirement for definitive knowledge of the nodal architecture (eg, Hodgkin lymphoma), of the histologic grade via the counting of cells per microscopic field (follicular lymphoma), and of molecular findings (often unobtainable because of limitations of cellularity). The application of molecular tests to lymph node aspirates continues to evolve but is still largely confined to specialized medical centers. The intent of this article is to briefly review the diagnostic approach and algorithm for handling lymph node aspirates at the authors' own laboratory. This article highlights what the authors and others consider to be essential ancillary tests and discusses their respective advantages and shortcomings. It lists limited and extended antibody panels and molecular tests that the authors have found helpful not only for correctly recognizing lymphoma with FNA cytopathology but also for subtyping lymphomas whenever possible.
Topics: Biopsy, Fine-Needle; Cytodiagnosis; Humans; Immunophenotyping; Lymph Nodes; Lymphoproliferative Disorders
PubMed: 30156771
DOI: 10.1002/cncy.22013 -
Frontiers in Public Health 2022The Survey of the Health of Wisconsin (SHOW) was established in 2008 by the University of Wisconsin (UW) School of Medicine and Public Health (SMPH) with the goals of...
INTRODUCTION
The Survey of the Health of Wisconsin (SHOW) was established in 2008 by the University of Wisconsin (UW) School of Medicine and Public Health (SMPH) with the goals of (1) providing a timely and accurate picture of the health of the state residents; and (2) serving as an agile resource infrastructure for ancillary studies. Today, the SHOW program continues to serve as a unique and vital population health research infrastructure for advancing public health.
METHODS
SHOW currently includes 5,846 adult and 980 minor participants recruited between 2008 and 2019 in four primary waves. WAVE I (2008-2013) includes annual statewide representative samples of 3,380 adults ages 21 to 74 years. WAVE II (2014-2016) is a triannual statewide sample of 1,957 adults (age ≥18 years) and 645 children (age 0-17). WAVE III (2017) consists of follow-up of 725 adults from the WAVE I and baseline surveys of 222 children in selected households. WAVEs II and III include stool samples collected as part of an ancillary study in a subset of 784 individuals. WAVE IV consists of 517 adults and 113 children recruited from traditionally under-represented populations in biomedical research including African Americans and Hispanics in Milwaukee, Wisconsin.
FINDINGS TO DATE
The SHOW resource provides unique spatially granular and timely data to examine the intersectionality of multiple social determinants and population health. SHOW includes a large biorepository and extensive health data collected in a geographically diverse urban and rural population. Over 60 studies have been published covering a broad range of topics including, urban and rural disparities in cardio-metabolic disease and cancer, objective physical activity, sleep, green-space and mental health, transcriptomics, the gut microbiome, antibiotic resistance, air pollution, concentrated animal feeding operations and heavy metal exposures.
DISCUSSION
The SHOW cohort and resource is available for continued follow-up and ancillary studies including longitudinal public health monitoring, translational biomedical research, environmental health, aging, microbiome and COVID-19 research.
Topics: COVID-19; Gastrointestinal Microbiome; Humans; Microbiota; Population Health; Wisconsin
PubMed: 35433595
DOI: 10.3389/fpubh.2022.818777 -
Journal of Latina/o Psychology Nov 2019Familism is a central Hispanic/Latino cultural value that emphasizes close, supportive family relationships and prioritizing family over the self. One of its best-known...
Familism is a central Hispanic/Latino cultural value that emphasizes close, supportive family relationships and prioritizing family over the self. One of its best-known measures is Sabogal's Familism Scale (Sabogal, Marin, Otero-Sabogal, VanOss Marin, & Perez-Stable, 1987). Although widely used, this scale's measurement properties are not well understood. This study addressed that gap by examining the factor structure, factorial invariance, convergent and discriminant validity, and internal consistency of Sabogal's Familism Scale using data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. A diverse population-based sample of Hispanics/Latinos ( = 5,313) completed measures that were administered via interview in English or Spanish. Confirmatory factor analyses ( = 5,310) revealed that a three-factor model (, , ; Sabogal's original three factors) fit the data well and did not vary across English and Spanish language groups (i.e., factorial invariance). Convergent and discriminant validities were also established; familism correlated positively with other Hispanic/Latino cultural values (simpatía, fatalism) and correlated negatively with U.S. acculturation. Internal consistency was acceptable. Sabogal's Familism Scale is recommended for continued use in the study of familism in U.S. Hispanics/Latinos.
PubMed: 31853517
DOI: 10.1037/lat0000126 -
Korean Journal of Radiology Oct 2021Based on the Liver Imaging Reporting and Data System version 2018 (LI-RADS, v2018), this study aimed to analyze LR-5 diagnostic performance for hepatocellular carcinoma...
OBJECTIVE
Based on the Liver Imaging Reporting and Data System version 2018 (LI-RADS, v2018), this study aimed to analyze LR-5 diagnostic performance for hepatocellular carcinoma (HCC) when threshold growth as a major feature is replaced by a more HCC-specific ancillary feature, as well as the frequency of threshold growth in HCC and non-HCC malignancies and its association with tumor size.
MATERIALS AND METHODS
This retrospective study included treatment-naive patients who underwent gadoxetate disodium-enhanced MRIs for focal hepatic lesions and surgery between January 2009 and December 2016. The frequency of major and ancillary features was evaluated for HCC and non-HCC malignancies, and the LR-category was assessed. Ancillary features that were significantly more prevalent in HCC were then used to either replace threshold growth or were added as additional major features, and the diagnostic performance of the readjusted LR category was compared to the LI-RADS v2018.
RESULTS
A total of 1013 observations were analyzed. Unlike arterial phase hyperenhancement, washout, or enhancing capsule which were more prevalent in HCCs than in non-HCC malignancies (521/616 vs. 18/58, 489/616 vs. 19/58, and 181/616 vs. 5/58, respectively; < 0.001), threshold growth was more prevalent in non-HCC malignancies than in HCCs (11/23 vs. 17/119; < 0.001). The mean size of non-HCC malignancies showing threshold growth was significantly smaller than that of non-HCC malignancies without threshold growth (22.2 mm vs. 42.9 mm, = 0.040). Similar results were found for HCCs; however, the difference was not significant (26.8 mm vs. 33.1 mm, = 0.184). Additionally, Fat-in-nodule was more frequent in HCCs than in non-HCC malignancies (99/616 vs. 2/58, = 0.010). When threshold growth and fat-in-nodule were considered as ancillary and major features, respectively, LR-5 sensitivity (73.2% vs. 73.9%, = 0.289) and specificity (98.2% vs. 98.5%, > 0.999) were comparable to the LI-RADS v2018.
CONCLUSION
Threshold growth is not a significant diagnostic indicator of HCC and is more common in non-HCC malignancies. The diagnostic performance of LR-5 was comparable when threshold growth was recategorized as an ancillary feature and replaced by a more HCC-specific ancillary feature.
Topics: Carcinoma, Hepatocellular; Contrast Media; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity
PubMed: 34269533
DOI: 10.3348/kjr.2020.1341 -
BMJ Global Health Oct 2021About 96.3 million children and adolescents aged 0-19 years reside in Nigeria, comprising 54% of the population. Without adequate access to surgery for commonly...
BACKGROUND
About 96.3 million children and adolescents aged 0-19 years reside in Nigeria, comprising 54% of the population. Without adequate access to surgery for commonly treatable diseases, many face disability and increased risk of mortality. Due to this population's unique perioperative needs, increasing access to paediatric surgical care requires a situational evaluation of the distribution of paediatric surgeons and anaesthesiologists. This study's aim is to identify the percentage of Nigerian youth who reside within 2 hours of paediatric surgical care at the state and national level.
METHODS
The Association of Paediatric Surgeons of Nigeria and the Nigeria Society of Anaesthetists provided surgical and anaesthesia workforce data by state. Health facilities with paediatric surgeons were converted to point locations and integrated with ancillary geospatial layers and population estimates from 2016 and 2017. Catchment areas of 2 hours of travel time around a facility were deployed as the benchmark indicator to establish timely access.
RESULTS
Across Nigeria's 36 states and Federal Capital Territory, the percentage of Nigeria's 0-19 population residing within 2 hours of a health facility with a paediatric surgical and anaesthesia workforce ranges from less than 2% to 22.7%-30.5%. In 3 states, only 2.1%-4.8% of the population can access a facility within 2 hours, 12 have 4.9%-13.8%, and 8 have 13.9%-22.6%.
CONCLUSION
There is significant variation across Nigerian states regarding access to surgical care, with 69.5%-98% of Nigeria's 0-19 population lacking access. Developing paediatric surgical services in underserved Nigerian states and investing in the training of paediatric surgical and anaesthesia workforce for those states are key components in improving the health of Nigeria's 0-19 population and reducing Nigeria's burden of surgical disease, in line with Nigeria's National Surgical, Obstetrics, Anaesthesia and Nursing Plan.
Topics: Adolescent; Child; Female; Geography; Humans; Nigeria; Pregnancy
PubMed: 34697085
DOI: 10.1136/bmjgh-2021-006025 -
Cancer Cytopathology Jun 2012The routine use of ancillary studies is reshaping the practice of cytopathology. Currently, most cytopathologists recognize the importance of immunocytochemistry and... (Comparative Study)
Comparative Study Review
The routine use of ancillary studies is reshaping the practice of cytopathology. Currently, most cytopathologists recognize the importance of immunocytochemistry and molecular techniques as adjuncts to morphology to achieve a precise diagnosis. Cytopathologists also are expected to include specific prognostic and predictive information in their reports. The objective of this review was to address the use of immunocytochemistry and molecular techniques to refine the preoperative diagnosis and classification of lung cancer, thyroid cancer, kidney cancer, gastrointestinal cancer, and soft tissue tumors. Fine-needle aspiration also offers a suitable alternative to biopsy in a variety of clinical settings, in particular, when it may be useful to obtain material to study prognostic and predictive markers. This is particularly relevant to obtain material from metastatic sites. The study of KRAS in colon cancer, CKIT in gastrointestinal stromal tumors, and epidermal growth factor receptor mutational status in lung cancer also are addressed particularly in this report.
Topics: Ancillary Services, Hospital; Biomarkers, Tumor; Biopsy, Fine-Needle; Cytodiagnosis; Female; Gastrointestinal Neoplasms; Humans; Immunohistochemistry; Kidney Neoplasms; Lung Neoplasms; Male; Molecular Biology; Molecular Targeted Therapy; Neoplasms; Portugal; Sensitivity and Specificity; Soft Tissue Neoplasms; Thyroid Neoplasms
PubMed: 22045615
DOI: 10.1002/cncy.20197 -
Journal of Diabetes and Metabolic... Dec 2022Type 1 diabetes is an autoimmune disease that often develops during childhood. Complications such as retinopathy often occur during the course of the disease. Studies to...
PURPOSE
Type 1 diabetes is an autoimmune disease that often develops during childhood. Complications such as retinopathy often occur during the course of the disease. Studies to identify possible predictors of complications in type 1 diabetes are needed; in particular markers able to identify risk of complications long before they occur. The first aim of this study was to investigate plasma levels of sCD163, sST2 and Gal-3 at diagnosis of type 1 diabetes in children and adolescents. The second aim was to study their correlation to HbA1c in this study cohort.
METHODS
Patients (n = 242, 0-18 years) with type 1 diabetes, at Helsingborg's Hospital were included in this study and circulating levels of sCD163, sST2 and Gal-3 were investigated in plasma using commercially available DuoSet ELISA and supplementary ancillary kit.
RESULTS
Circulating sCD163 was significantly higher at diagnosis compared to after diagnosis (666 ± 318ng/ml and 505 ± 223ng/ml respectively; p < 0.001). Also sST2 was significantly higher (18.2 [12.7-25.6] ng/ml respectively 9.1 [6.3-13.5] ng/ml (p < 0.001), but Gal-3 levels did not differ from onset of diabetes to after diagnosis. HbA1c was shown to correlate to sCD163 (r=0.36; p < 0.001), sST2 (r=0.22; p = 0.016) and Gal-3 (r=0.2; p = 0.020) in patients with a diabetes duration < 5 years.
CONCLUSIONS
sCD163 levels increased in patients with recent-onset type 1 diabetes and the levels increased with higher HbA1c. Patients included in this study will be followed annually until the eventual development of diabetic complications, while continuously studying circulating levels of inflammatory proteins such as sCD163.
PubMed: 36404844
DOI: 10.1007/s40200-022-01075-3 -
Respiration; International Review of... 2019The European observational, prospective PASSPORT study evaluated the long-term safety of pirfenidone under real-world conditions in idiopathic pulmonary fibrosis (IPF),... (Observational Study)
Observational Study
BACKGROUND
The European observational, prospective PASSPORT study evaluated the long-term safety of pirfenidone under real-world conditions in idiopathic pulmonary fibrosis (IPF), over up to 2 years following its initiation.
OBJECTIVES
The FAS (French Ancillary Study) assessed the clinical outcomes of IPF patients participating in PASSPORT (n = 192).
METHODS
Efficacy data were collected retrospectively and prospectively. The primary efficacy endpoints were: change in percent predicted forced vital capacity (FVC) and change in the distance travelled during the 6-min walk test (6MWD).
RESULTS
The mean baseline FVC was 71.7% of predicted value. The mean absolute change in the percentage of predicted FVC was -2.4% and -3.8% at months 12 and 24. The mean change in 6MWD was 8.6 and 3.1 m at months 12 and 24, with a range of 23.4-51.7 m. Acute IPF exacerbation and pulmonary hypertension occurred in 20.0 and 8.4% of patients, respectively. The most common reasons for prematurely discontinuing PASSPORT were adverse drug reactions (ADRs) related to pirfenidone (31.3%), death (11.5%), and disease progression (10.9%). The median progression-free survival was 18.4 months (95% CI 12.9, not estimable). The median exposure was 16.3 months (0.5-28.5). The most frequently reported ADRs leading to pirfenidone discontinuation were decreased weight (4.2%), rash (4.2%), and photosensitivity reactions (3.1%).
CONCLUSIONS
The efficacy data of FAS are consistent with the efficacy results of published phase III clinical trials in IPF. Approximately one third of IPF patients treated with pirfenidone in real-life settings were still under treatment 2 years after initiation. Safety data are consistent with the known safety profile of pirfenidone.
Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Female; France; Humans; Idiopathic Pulmonary Fibrosis; Male; Middle Aged; Prospective Studies; Pyridones; Time Factors; Treatment Outcome; Vital Capacity
PubMed: 30965332
DOI: 10.1159/000496735