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Background and aims Limited data are available regarding fully covered metal stents in the management of malignant distal biliary strictures. The aim of this study was to evaluate the safety of a fully covered self-expanding metal stent (FCSEMS) with flared ends, in treating malignant biliary strictures. We report our long-term retrospective analysis from 6 centers. Methods A total of 260 patients (142 males, median age 68 y) underwent endoscopic retrograde cholangiopancreatography with placement of FCSEMS (WallFlex; Boston Scientific, Natick, MA) for the palliation of obstructive jaundice in the setting of pancreatic adenocarcinoma (169), metastatic disease (36), cholangiocarcinoma (23), ampullary cancer (19), or other (13). Patients were evaluated clinically in follow-up and biochemical tests of liver function were obtained. Data were recorded for the following variables: patient survival, duration of stent patency, the need for subsequent biliary intervention, and complications. Results A total of 266 FCSEMS were placed in 260 patients. There was a median survival of 100 days (range, 7 to 531 d). There was a mean follow-up of 134±118 days (range, 4 to 519 d). Biliary decompression was successful in 252 patients (97%). At the end of the study period, 121 were alive with a patent stent, 65 patients died with a patent stent, 40 patients were successfully bridged to surgery, 8 patients had their patent stent removed and had no need for further stenting, and 18 patients were lost to follow-up. Five patients who had a successfully placed FCSEMS were considered a failure due to the following reason: migration (2), cholangitis (1), stent occlusion (1), and removal for management of proximal biliary obstruction (1). Two additional patients experienced migration that did not require FCSEMS removal or replacement. Stent replacement was required in 10 patients, of whom 6 had a second FCSEMS placed. The remaining 4 were in the failure group and underwent replacement with either uncovered stents or plastic stents. Other complications, managed conservatively, included pain (2), postendoscopic retrograde cholangiopancreatography pancreatitis (4), fever (1), retroperitoneal perforation (1), and postsphincterotomy bleeding (1). The mean patency duration was 328 days (SE 19.04). The patency percentage was 83% at 3 months, 63% at 6 months, and 48.5% at 12 months. Conclusions In the management of malignant distal biliary strictures, the fully covered WallFlex stent has acceptable patency and complication rates. Further long-term prospective data are required to confirm this observation.

This paper presents the results of extensive experience in the development and promotion of tobacco-based insecticides for the control of field crop pests in Igalaland, Nigeria. A non-governmental organization (NGO), the Diocesan Development Services (DDS), became involved in the development of tobacco-based insecticides in the early 1990s, and facilitated a series of ‘on-farm’ trials between 1997 and 2000 designed to test the effectiveness of such insecticides for two crops that are particularly vulnerable to pest attack in Igalaland: cowpea (Vigna unguiculata) and maize (Zea mays). The results suggest that even crude tobacco formulations had a significant benefit on cowpea and maize yields relative to the absence of pest control, although commercial insecticides were more effective. However, while having advantages of cost and availability over commercial insecticides, tobacco-based products appear to have serious internal and external disadvantages that limit their widespread use, and some of these are discussed. It is concluded that while technical efficacy of botanicals is an important element, there are others such as the logistics of production and preparation that need to be considered. A better understanding of the balance between these factors and how context-specific they may be is required in order to maximize their adoption by farmers under ‘resource-poor’ conditions.

Yam rots caused by fungal pathogens (mostly Fusarium spp.) are a major cause of storage losses, and previous work has shown that fungal lesions were only found if there was pre-existing physical damage to the tuber. The general perception is that damage inflicted in the field prior to storage is far more important in this regard than damage caused during storage, and this has led to much research directed at the minimisation of field damage with relatively little work on the amelioration of insect damage during storage. This study examined whether insect damage inflicted on yam tubers during storage in specialised barns is an important agent in the incidence of fungal disease. It was found that treatment of tubers with insecticide dust (Actellic 2% Dust; ai=pirimiphos-methyl) significantly reduced fungal infections resulting from insect attack during storage. In addition, physical damage acquired during harvest appeared to be ameliorated by the insecticide, resulting in significantly fewer fungal lesions. The results suggest that insecticide treatment of yam tubers prior to storage could provide a relatively cheap and effective means of preservation.

UNSCEAR has estimated that 14 C discharges from the nuclear fuel reprocessing plant at Sellafield are responsible for about a quarter of the total global release of this radiologically important radionuclide. Reported discharges from the site have been based on direct monitoring of the effluent since 1978. Prior to that date, however, discharges have been estimated from the measurement of 14 C levels in the annual growth rings of a locally grown tree. In the present study, discharges prior to 1978 have been re-calculated based on new measurements of 14 C levels in tree rings. The results indicate that 14 C discharges from Sellafield prior to 1978 were significantly lower than previously thought, 124 TBq as opposed to 207 TBq. The total release of 14 C to the atmosphere from this site from the start of operations up to 1995 is now estimated to have been 244 TBq.

Background: Covered self-expanding metal stents are being used more frequently in benign biliary strictures (BBS). We report the results of a multicenter study with fully covered self-expanding metal stent (FCSEMS) placement for the management of BBS. Aim: To prospectively evaluate the efficacy and safety of FCSEMS in the management of BBS. Patients and Methods: Patients with BBS from 6 tertiary care centers who received FCSEMS with flared ends between April 2009 and October 2010 were included in this retrospective study. Patients and Methods: Efficacy was measured after removal of FCSEMS by evaluating stricture resolution on the basis of symptom resolution, imaging, laboratory studies, and/or choledochoscopy at removal. Safety profile was evaluated by assessing postprocedural complications. Results: A total of 133 patients (78, 58.6% males) with a mean age of 59.2±14.8 years with BBS received stents. Of the 133 stents placed, 97 (72.9%) were removed after a mean stent duration of 95.5±48.7 days. Stricture resolution after FCSEMS removal was as follows: postsurgical, 11/12 (91.6%); gallstone-related disease, 16/19 (84.2%); chronic pancreatitis, 26/31 (80.7%); other etiology, 4/5 (80.0%); and anastomotic strictures, 19/31(61.2%). Ninety-four patients were included in the logistic regression analyses. Patients who had indwelling stents for >90 days were 4.3 times more likely to have resolved strictures [odds ratio, 4.3 (95% confidence interval, 1.24-15.09)] and patients with nonmigrated stents were 5.4 times more likely to have resolved strictures [odds ratio, 5.4 (95% confidence interval, 1.001-29.29)]. Conclusions: FCSEMS for BBS had an acceptable rate of stricture resolution for postsurgical strictures, gallstone-related strictures, and those due to chronic pancreatitis. Predictors for stricture resolution include longer indwell time and absence of migration. Further study is warranted to assess long-term efficacy in a prospective manner with longer than 3-month time of stent indwelling time.

Obtaining venous access continues to be one of the most difficult problems faced by a physician caring for the pediatric patient in cardiac arrest. Our study examined the use of the intraosseous route (through the bone) to obtain venous access for sodium bicarbonate administration in a cardiac arrest model. Ventricular fibrillation was induced in 23 domestic swine. Cardiopulmonary resuscitation was performed for five minutes and sodium bicarbonate (1 mEq/kg) was administered through a peripheral IV line (n = 6), a central IV line (n = 5), or intraosseously (n = 6). Controls (n = 6) did not receive bicarbonate. Blood pH was sampled every two minutes for 30 minutes from the right ventricle, left ventricle, and femoral artery. An analysis of variance revealed that the central and intraosseous routes were significantly different (P less than .05) from the peripheral group, and that all three groups were significantly different (P less than .05) from the control. Pathology studies revealed only minor damage to bone when sodium bicarbonate was administered intraosseously. These data demonstrate that the intraosseous route is a rapid and effective alternative for venous access in a cardiac arrest model.