Search

Background Most endosonographers use an EUS needle with an internal stylet during EUS-guided FNA (EUS-FNA). Reinserting the stylet into the needle after every pass is tedious and time-consuming, and there are no data to suggest that it improves the quality of the cytology specimen. Objective To compare the samples obtained by EUS-FNA with and without a stylet for (1) the degree of cellularity, adequacy, contamination, and amount of blood and (2) the diagnostic yield of malignancy. Design Prospective,single-blind, randomized, controlled trial. Setting Two tertiary care referral centers. Patients Patients referred for EUS-FNA of solid lesions. Intervention Patients underwent EUS-FNA of the solid lesions, and 2 passes each were made with a stylet and without a stylet in the needle. The order of the passes was randomized, and the cytopathologists reviewing the slides were blinded to the stylet status of passes. Main Outcome Measurements Degree of cellularity, adequacy, contamination, amount of blood, and the diagnostic yield of malignancy in the specimens. Results A total of 101 patients with 118 lesions were included in final analysis; 236 FNA passes were made, each with and without a stylet. No significant differences were seen in the cellularity ( P = .98), adequacy of the specimen ( P = .26), contamination ( P = .92), or significant amount of blood ( P = .61) between specimens obtained with and without a stylet. The diagnostic yield of malignancy was 55 of 236 specimens (23%) in the with-stylet group compared with 66 of 236 specimens (28%) in the without-stylet group ( P = .29). Limitations Endosonographers were not blinded to the stylet status of the passes. Conclusions Using a stylet during EUS-FNA does not confer any significant advantage with regard to the quality of the specimen obtained or the diagnostic yield of malignancy. (Clinical trial registration number: NCT 01213290).

Rifamixin is an orally administrated, nonabsorbed antibiotic whose utility in eradication of small intestinal bacterial overgrowth (SIBO) is currently being evaluated.The aim of this study was to investigate efficacy and safety of rifaximin in relieving symptoms and normalizing the glucose breath test (GBT) in patients with SIBO.Symptom score assessment, consisting of frequency and severity of bloating, gas, abdominal pain, and bowel movements and the GBT were performed before and after treatment with rifaximin 800 mg/d for 4 weeks.Twenty consecutive symptomatic patients (16 women and 4 men; mean age, 47.8 years; range, 19 to 85 years) who had a positive GBT were prospectively studied in an open-labeled fashion. Fourteen patients (70.0%) presented with diarrhea, 3 (15.0%) with bloating and gas, and 3 (15.0%) with constipation as the dominant symptom.: Eleven patients were hydrogen producers, 8 exclusively methane, and 1 patient produced both gases by the GBT. Among patients with diarrhea, 12 of 14 (85.7%) reported improvement in symptom scores of more than 50%; 1 between 25% and 50%, 1 had no response after 4 weeks of rifamixin. Among patients with bloating and gas or constipation as the main symptom: 2 of 6 (33.3%) had improvement between 50% and 75%; 3 (50%) had 25% to 50% improvement, and 1 (16.7%) had no response. Repeat GBT at the end of the 4 weeks showed that 54.5% of hydrogen formers and 50.0% of methane producers were eradicated, and there was a significant reduction (P0.05) in the area under the concentration-time curve and peak values. No adverse effects were observed.Rifaximin in a dose of 800 mg per day for 4 weeks: 1) was safe and effective treatment in reducing symptoms in patients with SIBO of multiple etiologies, especially when diarrhea was the dominant symptom; and 2) normalized the GBT in approximately 50% of patients. Data support a future therapeutic role for rifaximin in SIBO.

Dermatomycoses due to Trichophyton violaceum are described in Mediterranean Countries, North Africa and in the Horn of Africa where T. soudanense is present too, but it was rare until few years ago in Italy. Aim of the present study was to evaluate an Italian multicenter 9 year (2005-2013) experience concerning these re-emerging pathogens. Fifty three fungal strains were sent from clinical laboratories to the Medical Mycology Committee (CoSM)--Italian Association of Clinical Microbiology (AMCLI) for mycological confirmation. Strains were identified as T. violaceum (23) and T. soudanense (30) by phenotypic and genotypic methods. These dermatophytes present epidemiological (high rate of inter-human transmission, high risk among adopted children coming from countries of either the Horn of Africa or Sub-Saharan Africa also in outbreaks of tinea capitis) and clinical peculiarities (reduced alopecia, presence of exudative lesions) confirming the originality of these "imported" dermatophyte infections.

Whole-cell patch-clamp recordings were made from substantia nigra pars reticulata (SNR) neurones in rat midbrain slices to investigate the electrophysiological effects of cannabinoids. The cannabinoid receptor agonist WIN 55212-2 (10 microM) significantly reduced intranigrally evoked and spontaneous inhibitory post-synaptic currents (IPSCs) which were mediated by GABA(A) receptors. The postsynaptic current induced by bath application of GABA was not affected by the presence of WIN 55212-2. The actions of WIN 55212-2 were not mimicked by the inactive enantiomer WIN 55212-3. WIN 55212-2 also hyperpolarized the membrane of SNR neurones in a tetrodotoxin/0-Ca2+-insensitive manner. These data suggest that cannabinoids modulate the activity of SNR neurones by presynaptic inhibition of GABA inputs. They may also exert a direct post-synaptic inhibition on these neurones.

In this study, the feasibility of creating one dielectric layer system acting simultaneously as antireflection coating, phosphorous doping source, masking against metal plating, and surface passivation is presented. Moreover, a similar layer stack is described, which behaves as rear-side surface passivation, boron dopant source, and internal reflection mirror. The optical characteristics of these layers are especially investigated and optimized for a solar cell's front- and rear-side coating. By consequent use of the multifunctional layers, a totally diffused solar cell with rear-side passivation and local rear contacts can be produced using only one wet chemical bath sequence, one multilayer vacuum step, and one high-temperature process. We present the first proof of concept for such a solar cell production using multifunctional plasma-enhanced chemical vapor deposition layers resulting already in a conversion efficiency of 18.3%.

27th European Photovoltaic Solar Energy Conference and Exhibition; 1751-1754, To adopt a galvanic based Nickel seed layer front side metallization on an industrial manufacturing cell concept several process steps had to be optimized related to plating. In this work relevant process steps have been investigated with regard to their potential impact for galvanic based front side metallization. Starting with an industrial standard process scheme for solar cells the not feasible processes are determined and alternatives will be presented. The investigated impacts are the emitter formation the plasma enhanced chemical vapor deposition SiNx anti-reflection coating (ARC) opening and the thermal contact formation [1]. A revised process scheme, involving an adopt emitter profile based on a inline furnace emitter [2] and an SiNx ARC laser ablation, is introduced and first solar cell results with 18.4% efficiencies are achieved with a fully plated, nickel based, front side metallization.

Purpose of the study To compare the accuracy of endoscopic ultrasonography (EUS) imaging with histopathology in the diagnosis of upper gastrointestinal subepithelial lesions. Methods Thirty-seven patients (21 female; mean age: 55 y) underwent endoscopic submucosal resection (ESMR) of upper gastro intestinal subepithelial lesions at a tertiary care facility. All patients underwent EUS before ESMR of the lesion. Information regarding location, size, echogenecity, layer of origin, presumptive diagnosis based on EUS imaging, and histopathology diagnosis after ESMR of the subepithelial lesion was recorded. Results Twenty-seven subepithelial lesions were resected from the stomach, 5 from the esophagus, and 5 from the duodenum. The mean size of the lesions was 9 mm (range, 6-18 mm). Thirty-six lesions originated from the submucosa, and 1 from the muscularis propria. Using histopathology as the gold standard, the overall diagnostic accuracy of EUS imaging was 49% (18 out of 37). The accuracy of EUS imaging for the diagnosis of esophageal, gastric, and duodenal subepithelial lesions was 20%, 56%, and 40%, respectively. One patient developed a microperforation, and 1 developed bleeding during the ESMR procedure. No complications were reported with the EUS procedure. Conclusions The diagnostic accuracy of EUS imaging is inferior to histopathology in the diagnosis of small upper gastrointestinal subepithelial lesions. Endoluminal resection is a relatively safe and noninvasive modality that not only provides tissue sample for accurate diagnostic interpretation, but also aids in the complete removal of small subepithelial lesions of the upper gastrointestinal tract.

26th European Photovoltaic Solar Energy Conference and Exhibition; 1089-1093, Most high-efficiency concepts for silicon solar cells utilise passivated surfaces and/or novel metallisation approaches. For these devices an anneal step, preferential in forming gas ambient, is beneficial or even crucial. Annealing is known to activate or improve surface passivation, facilitate metal-silicide formation, improve adhesion of metal contacts and cure potential crystal damage. Challenges for industrial solutions of anneal processes are a precise control of the process atmosphere and temperature, as well as a high throughput and easy integration into production lines. We present a high capacity inline annealing system that addresses these tasks with a throughput of over 1000 wafers per hour. The gas locks, located at the entrance and exit of the furnace, allow for an effective separation of laboratory and forming gas process ambient, which results in a residual oxygen concentration of a few ppm. Inline annealed silicon solar cells with a thermal oxide passivated rear surface show the same conversion efficiency as reference cells, which are annealed in a single wafer reactor. The specific cost of inline annealing in forming gas is calculated to be below 1.1 €ct/Wp.

26th European Photovoltaic Solar Energy Conference and Exhibition; 2063-2068, Automated wafer handling is inevitable during the production of crystalline silicon solar cells. Additional to the risk of wafer breakage, the influence of wafer handling devices on the optical and electrical properties of the solar cell proofs to be of great importance. This work investigates the influence of different wafer grippers on the optical properties of grown random pyramids as well as their impact on the quality of hydrogenated amorphous silicon (a-Si) passivation layers. The homogeneity of the random pyramids is characterized by examination of scanning electron microscopy (SEM) images and reflectance measurements. The influence of the wafer grippers on the electrical properties is investigated by calibrating quasi-steady-state photoconductance (QSSPC) measurements to photoluminescence (PL) images. We find that using grippers which distribute their exerted force on a larger area of the wafer surface provides better optical and electrical properties than using grippers with smaller, locally defined contact areas.

There is some degree of overlap in the symptomatic spectrum of patients with gastroparesis and small intestinal bacterial overgrowth (SIBO) and some of the etiologies for gastroparesis, such as diabetes mellitus and vagotomy are known to predispose to SIBO. The aims of our study were to measure the prevalence of SIBO in a cohort of gastroparetic patients with prominence of abdominal pain and bloating and try to identify predictors with regard to demographics, concurrent use of medications such as prokinetics, proton pump inhibitors, and opiate analgesics, and predominant bowel movement abnormality.Glucose breath testing (GBT) for SIBO was performed in 50 patients (41 females) with gastroparesis. Demographic data, medication profiles, baseline and peak measurements of hydrogen or methane gas on the GBT, and results of the most recent gastric emptying scintigraphy test were recorded.Thirty of fifty (60%) patients had a positive GBT for SIBO on the basis of hydrogen (63%), methane (27%), or both criteria (10%). SIBO was more likely (P=0.001) in patients with gastroparetic symptoms of greater duration (mean 5 y; 95% CI: 4-6 y). No significant differences were noted in both groups with regard to age, sex, or etiology of gastroparesis. Gastric emptying was similar in the SIBO and non-SIBO group (P0.05). After adjusting for tegaserod and opiate analgesic use, 14/23 (61%) had a positive GBT.SIBO is very common in gastroparetics with predominance of abdominal pain and bloating, especially those with a longer duration of gastroparesis. Awareness of SIBO in the setting of gastroparesis will facilitate separation of the 2 entities and allow appropriate therapies to be instituted.

Background Fecal incontinence (FI) is a common clinical condition with a negative impact on the quality of life. Commonly performed tests to evaluate FI include anorectal manometry (ARM) and endoanal ultrasonography (EAU). Objective of our study was to compare the results of these 2 tests in a cohort of patients with FI. Methods Retrospective study of 27 patients (20 women) referred to the gastrointestinal motility clinic for FI. EAU and ARM were performed in all patients. Demographic data and information regarding etiology of FI was also recorded. Results Mean age of the patients was 56 years (range 26-87 years). Etiology of FI was obstetric trauma in 4, pelvic surgery in 9, pelvic trauma in 3, pelvic radiation in 1, and idiopathic in 8. Based on the ARM data, 14 of 27 had a weak external sphincter squeeze pressure and 3 had impaired rectal sensation, whereas with the EAU there was thinning of the external anal sphincter in 3 and complete disruption in 1, and abnormalities of the internal anal sphincter (IAS) in 7 of 27 with thinning, and defects. Overall, only 2 of 27 had normal findings by combined ARM and EAU. Conclusions Although the yield of finding major sphincter defects was low, only a small percentage of patients had a normal ARM or EAU. When there are degrees of external anal sphincter thinning or partial or complete disruption of the sphincters, a good correlation with ARM is achieved. EAU and ARM are complimentary investigations for the thorough assessment of the anal sphincter apparatus.

Gastroparesis is a relatively common and often disabling condition that is characterized by a broad range of clinical presentation ranging from dyspeptic symptoms to nausea, vomiting, abdominal pain, malnutrition, frequent hospitalizations and incapacitation. The treatment of gastroparetic symptoms can be challenging to the gastroenterologist and the intensity of therapy varies with the physician's knowledge. Hence the determination that a patient is refractory to 'standard medical therapy' is an assessment that is subspeciality-based and could differ around the world depending on medications available. In this article, we review the use of available prokinetics, antiemetic agents, the approach for analgesia in the context of gastroparesis, and also discuss potential and evolving pharmacotherapies. The progress has been relatively limited as far as availability of new medications for gastroparesis is concerned; however, active research in developing newer prokinetics holds great promise for the future of management of this challenging entity.

Objectives To evaluate the efficacy of botulinum toxin-A in the treatment of postvagotomy gastroparesis. Methods This open-labeled trial identified and recruited 11 subjects who developed symptomatic gastroparesis after a vagotomy (9 fundoplication, 1 trauma, and 1 exploratory laparotomy). Gastroparesis was defined as an abnormal solid-phase gastric emptying test using the standardized 4-hour radionuclide eggbeater meal method and vagotomy was confirmed with a sham meal challenge test. To complete the study, subjects should have completed the 6-month follow-up visit after their pylorus was injected with botulinum toxin-A injection in a 4-quadrant manner. Patients either received 100 (n = 2) or 200 (n = 9) units of botulinum toxin. Questionnaires recorded symptom severity of gastroparesis at baseline and at monthly intervals for 6 months after the therapy was completed by the patients. Results Of the 11 subjects initially recruited, 10 finished the 6-month follow-up visit (7 women). Mean age was 51 years (range, 31–84 years). Mean symptom score at baseline was 16 (95% CI 13–19) and showed a numerical decline to 9 ( P > 0.05) over the 6-month period after the procedure (95% CI 5–13). Seven (70%) patients observed >30% improvement in the total symptom score. No complications were recorded. Conclusions In conclusion, this open-label study in patients with postvagotomy gastroparesis patients reveals a reduction of gastroparetic symptoms at 1 and 3 months after treatment with pyloric injection of botulinum toxin-A, with return of symptoms by 6 months. Thus, botulinum toxin treatment does not produce a sustained reduction in gastroparetic symptoms in this clinical setting.

24th European Photovoltaic Solar Energy Conference, 21-25 September 2009, Hamburg, Germany; 1469-1474, Advanced metallization techniques for crystalline silicon solar cells have the potential to increase the cell efficiency importantly with only slight alterations of the production process. Compared to the standard process (screen-printing of silver pastes), different two-step processes (seed and plate, as described in [1]) offer both flexibility and reduced shadowing loss at comparable or improved series resistance. Typically, the seed layer applied in a first step is optimized only to make a contact to the solar cell and does not give sufficient lateral conductivity. This is remedied in the second step (plating), which is in many cases realized by light-induced plating. Most of the investigations dealing with this process so far have been carried out on screen-printed seed layers. However, the most improvement is achieved in combination with new seeding technologies, such as aerosol jetting [2] or nickel plating [3], which are used to produce ever narrower seed layers. The plating conditions are very different on such seed layers, e.g. in terms of current density and surface morphology, which both have an important influence on the deposited metal layer. In order to get satisfactory plating results, it is necessary to investigate the deposition onto such substrates.

One-step screen-printing processes are still the most widely-used technique for the front-side metallization of crystalline silicon solar cells in the PV industry. This is because of the knowledge, stability and speed of the process, and despite some big disadvantages exhibited by the resulting contacts. Therefore, the metal contacts of high-efficiency laboratory cells are usually produced via advanced two-step metallization processes, which allow the application of optimized contact structures. In a first step, a narrow metal layer is applied to form the contact to the silicon wafer. Several different techniques have been developed for this first stage. In the second step, the seed layer is reinforced electrochemically with a dense layer of a metal of high conductivity, usually by light-induced plating. The transfer of such techniques into industrial scale has been pursued intensively, and may enter solar cell production lines in the near future. However, the process can still be improved based on a better process understanding, in order to benefit from the full potential of the technology.

The introduction of flexible fiberoptic endoscopy in the 1960s was a major step forward in the diagnosis and management of various esophageal disorders. Since then, there has been steady progress in the development of novel gastrointestinal endoscopy techniques. Magnification and high-resolution endoscopy, chromoendoscopy, narrow-band imaging, autofluorescence imaging, and confocal laser endomicroscopy are some of the recent advances that have shown promise in the diagnosis of squamous cell carcinoma, gastroesophageal reflux disease, Barrett's esophagus, and adenocarcinoma of the esophagus. The purpose of this review is to summarize the recent advances in endoscopic imaging of the esophagus and their practical application for the gastroenterologist.

Domperidone is a dopamine-2 receptor antagonist. It acts as an antiemetic and a prokinetic agent through its effects on the chemoreceptor trigger zone and motor function of the stomach and small intestine. Unlike metoclopramide, it does not cause any adverse neurological symptoms as it has minimal penetration through the blood-brain barrier. It thus provides an excellent safety profile for long-term administration orally in the recommended doses. Domperidone is widely used in many countries and can now be officially prescribed to patients in the United States by an investigational new drug application for the treatment of gastroparesis and any condition causing chronic nausea and vomiting. In view of this additional clinical exposure of domperidone to a new generation of gastroenterologists and other specialists, the purpose of this timely review is to revisit the pharmacology, clinical application, and safety profile of this beneficial medication.

Background Gastroparesis has a number of etiologies. The main ones are secondary to a complication from diabetes mellitus, related to post vagotomy or post gastric surgical resections, or idiopathic when the etiology is unclear. Gastroparesis secondary to a demyelinating disease of the brain is unusual. Case presentation A 22-year-old woman was referred for acute onset of intractable nausea and vomiting. She also had cerebellar deficits, dysphagia and paresthesias. Magnetic resonance imaging (MRI) of the brain revealed an isolated area of demyelination in the medullary region. Another 24-year-old woman had a similar presentation with right hemiplegia and MRI of the brain revealed a distal medullary region. Both these patients had an abnormal gastric emptying test. Gastroparesis and neurological deficits improved with intravenous corticosteroids. While the former patient has had no further recurrences, the latter patient developed multiple sclerosis within three months of presentation. Conclusion A demyelinating disease is a rare cause gastropareis, but should be suspected when symptoms of gastroparesis are associated with neurological deficits. MRI might help in the diagnosis and intravenous coriticosteroids can address the underlying disease process and improve gastric emptying, especially when used early during the course of the disease.