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BackgroundSpread hepatic tumours are not suitable for treatment either by surgery or conventional ablation methods. The aim of this study was to evaluate feasibility and safety of selectively increasing the healthy hepatic conductivity by the hypersaline infusion (HI) through the portal vein. We hypothesize this will allow simultaneous safe treatment of all nodules by irreversible electroporation (IRE) when applied in a transhepatic fashion.Material and methodsSprague Dawley (Group A, n = 10) and Athymic rats with implanted hepatic tumour (Group B, n = 8) were employed. HI was performed (NaCl 20%, 3.8 mL/Kg) by trans-splenic puncture. Deionized serum (40 mL/Kg) and furosemide (2 mL/Kg) were simultaneously infused through the jugular vein to compensate hypernatremia. Changes in conductivity were monitored in the hepatic and tumour tissue. The period in which hepatic conductivity was higher than tumour conductivity was defined as the therapeutic window (TW). Animals were monitored during 1-month follow-up. The animals were sacrificed and selective samples were used for histological analysis.ResultsThe overall survival rate was 82.4% after the HI protocol. The mean maximum hepatic conductivity after HI was 2.7 and 3.5 times higher than the baseline value, in group A and B, respectively. The mean maximum hepatic conductivity after HI was 1.4 times higher than tumour tissue in group B creating a TW to implement selective IRE.ConclusionsHI through the portal vein is safe when the hypersaline overload is compensated with deionized serum and it may provide a TW for focused IRE treatment on tumour nodules.

Background: It is unknown whether narrow-band imaging (NBI) could be more effective than high-definition white-light endoscopy (HD-WLE) in detecting serrated lesions in patients with prior serrated lesions > 5 mm not completely fulfilling serrated polyposis syndrome (SPS) criteria. Methods: We conducted a randomized, cross-over trial in consecutive patients with prior detection of at least one serrated polyp ≥10 mm or ≥ 3 serrated polyps larger than 5 mm, both proximal to the sigmoid colon. Five experienced endoscopists performed same-day tandem colonoscopies, with the order being randomized 1:1 to NBI-HD-WLE or HD-WLE-NBI. All tandem colonoscopies were performed by the same endoscopist. Results: We included 41 patients. Baseline characteristics were similar in the two cohorts: NBI-HD-WLE (n = 21) and HD-WLE-NBI (n = 20). No differences were observed in the serrated lesion detection rate of NBI versus HD-WLE: 47.4% versus 51.9% (OR 0.84, 95% CI: 0.37-1.91) for the first and second withdrawal, respectively. Equally, no differences were found in the polyp miss rate of NBI versus HD-WLE: 21.3% versus 26.1% (OR 0.77, 95% CI: 0.43-1.38). Follow-up colonoscopy in nine patients (22%) allowed them to be reclassified as having SPS. Conclusions: In patients with previous serrated lesions, the serrated lesion detection rate was similar with NBI and HD-WLE. A shorter surveillance colonoscopy interval increases the detection of missed serrated polyps and could change the diagnosis of SPS in approximately one in every five patients.

Workflow efficiency is important in every laboratory. Manual assessment of white blood cell counts and differentials that have been rejected by an automated analyzer is one of the most time-consuming tasks in the routine hematology laboratory. In this study, receiver operating characteristics (ROC) curve analysis was used for the first time when anomalous distribution and suspect flag alarms appeared in hemograms carried out with the new Beckman Coulter LH 750 analyzer. This article is our second about the LH 750 analyzer published in this journal; we increased the number of cases and describe the novel application of statistical analysis of ROC curves. In processing of specimens from patients with 3% to 6% immature granulocytes (myelocytes + metamyelocytes + bands ), the suspect flag Imm Ne 1 (immature granulocytes) showed 77% diagnostic efficiency with a maximum area under curve (AUC) of 0.71 and a 95% confidence interval (CI) of 0.597 to 0.831 without significant differences between the 3 available levels of alarms in the analyzer (L1, L2, L2). In processing of specimens from patients with >6% immature granulocytes, the Imm Ne 1 flag showed superior diagnostic efficiency of 98% with a maximum AUC of 0.80 and a CI of 0.713 to 0.879. The suspect flag Imm Ne 2 in processing of specimens from patients with >6% of immature granulocytes showed diagnostic efficiency of 92% with a maximum AUC of 0.77 and a CI of 0.665 to 0.871, finding a significant positive difference in level L3 regarding sensitivity in comparison with the other 2 levels of the analyzer (L1, L2). For specimens from patients with >2% blasts, the suspect Blasts alarm showed a diagnostic efficiency of 94%, an AUC of 0.91, and a CI of 0.775 to 1.043; positive differences were observed between the levels L2/L3 and L1. In processing of specimens with variant lymphocytes (large, granular, prolymphocytes, cleaved, chronic lymphocytic leukemia type, and so forth) >10% (x = 14%), the suspect alarm Var Lym (variant lymphocytes) showed a low diagnostic sensitivity of 20% with a maximum AUC of 0.59 and a CI of 0.300 to 0.870 without significant differences between the 3 available levels (L1, L2, L3). However, in processing of specimens presenting values >10% reactive or activated lymphocytes (x = 23%), typical for patients with infectious mononucleosis, the Var Lym flag showed a superior sensitivity of 75% with a diagnostic efficiency of 92% and an AUC of 0.84 with a CI of 0.587 to 1.089. Finally, the laboratory can easily program definitive abnormal morphological flags of distribution (granulocytosis, eosinophilia, monocytosis, and so forth) on the basis of its patient population. In this study we were able to carry out comparisons of AUC and to choose the values for the automated counts in percentage, absolute value, or both. Therefore we were able to define the reliability and impact on the alarm routine to optimize the performance of the user-adjustable definitive alarms for anomalous distribution.

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