Primary gastric synovial sarcoma resected by laparoscopic endoscopic cooperative surgery of the stomach: a case report

Background Primary gastric synovial sarcoma is extremely rare, only 44 cases have been reported so far, and there have been no reports of laparoscopic endoscopic cooperative surgery for this condition. Case presentation A 45-year-old male patient presented with gastric pain. Esophagogastroduodenoscopy was performed that led to the identification of an 8-mm submucosal tumor in the anterior wall of the antrum, and a kit-negative gastrointestinal stromal tumor was suspected following biopsy. On endoscopic ultrasonography, the boundary of the tumor, mainly composed of the second layer, was depicted as a slightly unclear low-echo region, and a pointless no echo region was scattered inside. A boring biopsy revealed synovial sarcoma. Positron emission tomography did not reveal fluorodeoxyglucose (18F-FDG) accumulation in the stomach or other organs. Thus, the patient was diagnosed with a primary gastric synovial sarcoma, and laparoscopic endoscopic cooperative surgery was performed. The tumor of the antrum could not be confirmed laparoscopically from the serosa, and under intraoperative endoscopy, it had delle on the mucosal surface, which was removed by a method that does not involve releasing the gastric wall. Immunohistochemistry showed that the spindle cells were positive for EMA, BCL-2 protein, TLE-1, and SS18-SSX fusion-specific antibodies but negative for KIT and DOG-1. The final pathological diagnosis was synovial sarcoma of the stomach. The postoperative course was good, and the patient was discharged from the hospital on the 11th postoperative day. Conclusion Resection with laparoscopic endoscopic cooperative surgery (LECS), which has not been reported before, was effective for small synovial sarcomas that could not be confirmed laparoscopically. With the combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique (CLEAN-NET) procedure, it was possible to excise the tumor with the minimum excision range of the gastric serosa without opening the stomach.

X-Rays through the Looking Glass: Mobile Imaging Dosimetry and Image Quality of Suspected COVID-19 Patients

Background: This paper aims to evaluate the clinical utility and radiation dosimetry, for the mobile X-ray imaging of patients with known or suspected infectious diseases, through the window of an isolation room. The suitability of this technique for imaging coronavirus disease 2019 (COVID-19) patients is of particular focus here, although it is expected to have equal relevance to many infectious respiratory disease outbreaks.Materials and Methods: Two exposure levels were examined, a “typical” mobile exposure of 100 kVp/1.6 mAs and a “high” exposure of 120 kVp/5 mAs. Exposures of an anthropomorphic phantom were made, with and without a glass window present in the beam. The resultant phantom images were provided to experienced radiographers for image quality evaluation, using a Likert scale to rate the anatomical structure visibility.Results and Discussion: The incident air kerma doubled using the high exposure technique, from 29.47 μGy to 67.82 μGy and scattered radiation inside and outside the room increased. Despite an increase in beam energy, high exposure technique images received higher image quality scores than images acquired using lower exposure settings.Conclusion: Increased scattered radiation was very low and can be further mitigated by ensuring surrounding staff are appropriately distanced from both the patient and X-ray tube. Although an increase in incident air kerma was observed, practical advantages in infection control and personal protective equipment conservation were identified. Sites are encouraged to consider the use of this technique where appropriate, following the completion of standard justification practices.

Effect of Socioeconomic and Demographic Factors on Crash Occurrence

The number of crashes and fatalities rate in the Commonwealth of Kentucky, U.S., have been higher than the national average for the past decades. It has been hypothesized that the distinct socioeconomic conditions of the state could be contributing to and explaining these trends. This study investigated the influence of socioeconomic characteristics on highway safety in Kentucky and attempted to identify the high-risk driver groups, based on crash data and the socioeconomic and demographic features of their residence zip codes. The quasi-induced exposure technique and binary logistic regression were employed to develop a predictive modeling approach for determining the probability of being the at-fault driver in a single- and two-unit crashes, based on socioeconomic characteristics of the driver residence zip code. The study identified that socioeconomic features such as income, poverty level, employment, age, gender, rurality, and number of traffic-related convictions of a driver’s zip code influence their likelihood to be at fault in a two-unit crash, while for single-unit crashes, in addition to these variables, educational attainment had also an impact. Younger and older drivers living in zip codes with low socioeconomic conditions have a higher probability to be the at-fault driver in both single- and two-unit crashes. The conclusions of the study can be used to determine the regions (zip codes) and driver groups with higher likelihood to be the at-fault driver in a crash and develop effective safety programs for the target groups.

Can a different pasta making process preserve the starch’s ultrastructure, increasing its digestibility?

BACKGROUND: Pasta plays an important role in human nutrition, nevertheless its organoleptic, structural and bromatologic properties have not been completely studied. OBJECTIVE: The study aims to compare the ultrastructure pasta cross-sections produced with reduced mechanic stress and low heat exposure technique (Pietro Massi Technology ™) to common samples obtained with traditional technology in order to assess if a different process can alter the ultrastructure of starch and then, its digestibility. METHODS: A comparative study was performed on the ultrastructure of pasta using scanning electron microscopy (S.E.M). 55 were pasta cross-sections made with Pietro Massi technology, 33 were samples from different pasta factory produced using traditional process, for a total of 88 samples analysed. RESULTS: According to an Index based on what it was observed at one slide at S.E.M we classified samples and compared the number of grains, caves and canals visible, their dimensions in μm and average size of grains. The number of grains in group 1 (9.06±5.01) in group 2 (5.71±5.77), in group 3 (5.93±7.65) resulted significative more elevated compared to group 4 (0.73±2.58); in group 1 and group 2 the number of caves observed was higher than group 4. The size in μm of canals resulted significantly more elevated in group 1 than group 3 (p = 0.008), group 2(p = 0.013), and group 4 (p = 0.02). CONCLUSION: The analysis of average size of caves and canals in μm, the number of caves and grains demonstrated in samples obtained with Massi technology elevated values compared to samples obtained with traditional technique. The number of caves, grains and canals visible in the starch surface demonstrate the high quality of this pasta because they likely ensure penetration of water during cooking, facilitating at the same time the penetration of pancreatic amylases during digestion, suggesting a better digestibility in pasta produced according to this methodology.

Characteristics and antibiogram of airborne bacterial communities

Composition and concentration of the bacterial communities in air of using a culture-dependent plate exposure technique and air sampling with filter were analysed. An average value of 2.8 x 103 bacterial CFU/m3 was found in different seasons. A total of 8 bacterial genera were identified among 58 species. The most predominant bacteria were Bacillus (73%), Planococcus (9%), Staphylococcus (6%), Micrococcus (4%), Deinococcus (2%), Arthrobacter (2%), Microbacterium (2%), and Exiguobacterium (2%). The distribution of predominant airborne bacteria varied greatly between different sampling sites and seasons and was limited by environmental parameters, as well as human activities.

Management of maxillary impacted canines: A prospective study of practitioners’ preferences (Preprint)

UNSTRUCTURED Objective: To investigate orthodontists’ approach concerning managing maxillary impacted canines (MIC). Methods: A cross-sectional study comprising a comprehensive survey with 22 questions was sent to practicing orthodontists. This study explored the preferred diagnostic measures, surgical techniques, materials, and mechanics utilized to manage MIC;104 responses were returned. Results: Palatal impaction was reported to be encountered more often by 60% of the respondents. In 62% of the respondents, an oral and maxillofacial surgeon was the specialist preferred to perform the surgical exposure. In 66%, the choice of required surgical techniques was reported as a joint decision between orthodontists and other specialists who perform the surgery. Cone-beam computed tomography (CBCT) was reported to be the diagnostic X-ray of choice. The gold button with a chain was the preferred bonded attachment in 86% of cases. Less than half of the respondents bonded the attachments themselves during surgical exposure. A clear plastic retainer was the preferred retainer in 61% of the respondents, and 43% of the respondents tended to use a closed exposure technique. Coe-pakTM was the preferred surgical pack for orthodontists who prefer an open exposure technique. Piggyback (double wire) was the preferable mechanic to move a palatally impacted canine. Conclusions: Our findings indicate that there are variations among orthodontists on how to manage MICs concerning diagnostic methods, surgical management, materials, and mechanics.