The LOD and LOQ values for the standard solution were respectivel

The LOD and LOQ values for the standard solution were respectively 0.09 and 0.31 mg L−1. For the honey samples, the LOD and LOQ values were 3.37 and 11.24 mg kg−1, respectively. In order to show the CE–UV reliability of the HMF analysis in a real sample,

a comparison was performed using the LC/MS/MS methodology analysis. Thus, a paired-samples t test was carried out, taking into account the HMF present in the honey sample. The statistical results (for n = 7) were p-value equal to 0.12 for the paired-samples t test. The Pearson correlation was 0.98, and this data, from the pairing (or matching), appears to be effective Galunisertib chemical structure with a p-value equalling 0.21 for Kolmogorov–Smirnov distance (normality test). As the p-value was higher than 0.05, no significant difference within the 95% confidence interval between

CE–UV and DNA Methyltransferas inhibitor LC/MS/MS methodologies was observed. The proposed method, after being optimised and evaluated in terms of the parameters described above, was successfully applied to determine 5-HMF in several commercially available honey samples (n = 7) which were prepared as indicated above. The honey samples were prepared in duplicate and injected in triplicate. The concentrations of 5-HMF determined for the samples are shown in Table 5. All samples, with the exception of D and Methocarbamol F, were below the concentration limit specified for this compound by Brazilian regulations (Brasil, 2000).The electropherogram of sample F is shown in Fig. 2. A MECK–UV method was developed with the aid of an experimental design to rapidly optimise the analysis time and resolution for 5-HMF separation and determination of this compound in honey samples.

Satisfactory results in relation to linearity, selectivity, precision and accuracy were obtained, which confirmed that the proposed method was suitable for this purpose. The analytical performance of the method, particularly the very short analysis time, low cost and simple sample pretreatment, verifies its potential applicability for routine and automated analysis of 5-HMF in the quality control of honeys. Overall, the results demonstrated that CE can be applied as an alternative (or complementary) technique to the recommended spectrophotometric method for application in food analysis. The authors wish to acknowledge the government agencies Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Empresa de Pesquisa Agropecuária e Extensão Rural de Santa Catarina (EPAGRI), Instituto Nacional de Ciência e Tecnologia de Catálise em Sistemas Moleculares e Nanoestruturados (INCT Catálise) and Fundação de Apoio a Pesquisa Científica do Estado de Santa Catarina (FAPESC) for financial support and fellowships.

DDT and its metabolites were analysed from 2002 to 2011 using the

DDT and its metabolites were analysed from 2002 to 2011 using the same method as

described for PCB6. From 2006 several other organochlorine pesticides were also analysed using GC/MS as described by Berntssen et al. (2011b). For quality control, an in-house control sample was analysed with each run, and the CRM SRM-1946 from the National Institute of Standards and Technology (Gaithersburg, USA) was analysed at least once a year. The pesticides check details analysed were: aldrin, dieldrin, alpha-endosulfan, beta-endosulfan, endosulfan-sulphate, alpha-hexachlorocyclohexane, beta-hexachlorocyclohexane, gamma- hexachlorocyclohexane, cis-chlordane, trans-chlordane, oxy-chlordane, cis-nonachlor, trans-nonachlor heptachlor A, hexachlorocyclobenzene, isodrin, mirex and toxaphene (40 + 41, 26, 32, 42a, 50, 62). Not all pesticides were measured in each sample; the number of replicates for each pesticide is given in Appendix 1. This method was accredited in 2005, and remained accredited to and including 2011. The median was chosen as the descriptor of the population mean due to the lack of normality of the data, and a large number of measurements below the LOQ. Median is presented with interquartile ranges to illustrate variability. When more than 50% of the results were below the LOQ the median was not calculated. Since the uncertainty

increases when one approaches the LOQ, regression analyses were excluded when more than 50% of the analyses were below 1.5× LOQ. Regression was used for evaluating time trends for the different contaminants. Differences between years were also determined using the non-parametric Kruskal–Wallis with post hoc paired comparisons. Differences were regarded GSK2118436 as significant when p < 0.05. Statistical Sclareol analyses were performed using

Statistica 9 (StatSoft Inc., Tulsa, USA), and Graphpad Prism 5.04 (Graphpad software Inc., San Diego, CA, USA). A total of 1025 samples from 2005 to 2011 were analysed for elemental mass fraction of Hg, As, Pb and Cd. For Cd, the measured levels in 933 of the total 1025 samples were < LOQ (0.01 mg kg− 1 w.w.), whilst 994 measurements of Pb were < LOQ (0.04 mg kg− 1 w.w.). In contrast, the measured levels of Hg were < LOQ (0.03 mg kg− 1) in only seven samples, and As was detectable > LOQ in all samples. Since most of Cd and Pb data were < LOQ, statistical analyses of time trends were not feasible. A linear regression showed a decline during the 6 years of sampling for As and Hg mass fraction in fillet (Fig. 1). This time trend was verified using the non-parametric Kruskal–Wallis test. The median elemental mass fractions of As and Hg in fillets for the time period were 1.07 and 0.029 mg kg− 1 w.w. respectively. A total of 432 samples were analysed for dioxins and dl-PCBs from 1999 to 2011. For data from 2005 and earlier, only 1998 WHO TEQ was available. Thus a conversion regression described by Bhavsar et al. (2008) was used to convert data to WHO-TEQ 2005. The regression analyses performed by Bhavsar et al.

It should be noted that these methods are largely atheoretical an

It should be noted that these methods are largely atheoretical and group membership is merely based on empirical similarities within a cluster and differences across clusters. In order to examine possible subgroups in the three component processes, factor composites for capacity, AC,

and SM were formed (see Unsworth, 2009 Z-VAD-FMK order for a similar approach). Next, the three factor composites were entered into a two-step cluster analysis. In this analysis, cases were first grouped into pre-clusters at the first step by constructing a cluster feature tree (see Zhang, Ramakrishnan, & Livny, 1996). For each case the algorithm determined if the case should be included with a previously formed pre-cluster or a new pre-cluster should be created based on the cluster feature tree. In the second stage an agglomerative hierarchical clustering method was used on the pre-clusters and allowed for an exploration of different numbers

of clusters. In this stage clusters were recursively merged until the desired number of clusters was determined by the algorithm. In these analyses, distance between clusters was based on a log-likelihood measure whereby distance was related to the decrease in log-likelihood as the clusters were formed into a single cluster. The algorithm automatically determines the number of clusters by taking into account the lowest information criterion (here AIC) and the highest ratio of distance measures (indicating Osimertinib solubility dmso the best separation of the clusters). The cluster analysis suggested the presence of five groups consisting of 34, 30, 40, 35, and 32 participants each. Shown in Table 4 are the resulting groups’ scores on each respective factor. Specifically, as shown in Table 4 looking at capacity suggested that Groups 1 and 4 were weak in capacity whereas Group 5 was strong in capacity and Groups 2 and 3 were more average in capacity. A one-way ANOVA on the capacity scores confirmed these impressions, F(4, 166) = 63.98, MSE = .34, p < .01, partial η2 = .61. Bonferroni post hoc comparisons suggested that there were significant differences

(all ps < .01) between all of the groups in Dichloromethane dehalogenase capacity (except for Groups 2 and 3, which did not differ [p > .50]). 3 As shown in Table 4, examining AC suggested that Group 1 was weak in AC, while Groups 2 and 5 were strong in AC abilities and Groups 3 and 4 were more average in AC. These impressions were confirmed with a one-way ANOVA on AC scores, F(4, 166) = 83.38, MSE = .19, p < .01, partial η2 = .67. Bonferroni post hoc comparisons suggested that there were significant differences (all ps < .01) between all of the groups in AC (except for Groups 2 and 5, which did not differ [p > .90] and Groups 3 and 4, which did not differ [p > .90]). Finally, as shown in Table 4, examining SM scores suggested that Group 1 was weak in SM, whereas Groups 4 and 5 were strong in SM and Groups 2 and 3 were average to weak in SM.

, 2013) Monitoring at least two reference conditions and focusin

, 2013). Monitoring at least two reference conditions and focusing on at least two variables Tofacitinib within each of three ecosystem attributes (diversity, vegetation [e.g., cover, structure, biomass], ecological processes [e.g., nutrient pools and cycling, soil organic matter, mycorrhizae]) has been recommended (Ruiz-Jaén and Aide, 2005b) as a way to improve post-restoration strategies (Herrick et al., 2006). Ecological process monitoring

is seldom attempted, partly because most processes are difficult to monitor, may be slow to change, and the monitoring phase for restoration projects seldom lasts more than 5 years (Ruiz-Jaén and Aide, 2005a and Ruiz-Jaén and Aide, 2005b). Short-term success, however, may not predict long-term sustainability (Herrick et al., 2006) and incorporating an understanding of ecosystem

development patterns in the monitoring design may enable identifying deviation from objectives and the need for corrective intervention (Dey and Schweitzer, 2014). Spatial disaggregation of monitoring effort based on fundamental attributes, such as soil and site stability, hydrological functions, and biotic integrity, facilitates process monitoring (Palik et al., 2000, Herrick et al., 2006 and Doren et al., 2009). Selecting which indicators to monitor is daunting. The goal is to use the smallest set of indicators that can be simply and easily measured (Burton, 2014) to sufficiently monitor change, support science-based decision-making, and effectively communicate results to the public (Doren et al., 2009 and Dey and Schweitzer, cAMP inhibitor 2014). Criteria for choosing indicators can be found in Dey and Schweitzer, 2014 and Doren et al., 2009. Indicators may also span multiple scales, Tryptophan synthase including specific landscape metrics (Lausch and Herzog, 2002, Sayer et al., 2007 and Cushman et al., 2008), resources

such as wildlife (Block et al., 2001 and McCoy and Mushinsky, 2002), and social expectations (Hallett et al., 2013). Conversely, Stanturf et al. (2014) used sustainability attributes of forests to display indicators of degradation that could be reversed and used as indicators of restoration. Indicators are what gets monitored and should be easy to measure, reliable, and have predictive as well as monitoring capability (Burton, 2014 and Crow, 2014). Ground-based monitoring is time consuming, and therefore expensive, but resolution of species diversity and structure on a small scale is high, and this is the only method for examining most ecological processes. When resources are limited, focusing on indicator or keystone species may be a valid compromise (González et al., 2013 and Mouquet et al., 2013). Remote sensing has advantages, especially as the size of the project area becomes larger, but a technique such as aerial photography is less robust in differentiating species (Shuman and Ambrose, 2003).

Session 4 is used to plan this meeting if events have not require

Session 4 is used to plan this meeting if events have not required an earlier appointment (e.g., school is requiring prompt action by parents).

At a minimum, the therapist, the parent(s), and one school official should be present. This school official (e.g., school counselor, school social worker/psychologist, academic teacher, or administrator) serves as the point-person for the case. Ideally, a school representative who knows the youth best (e.g., an academic teacher or counselor) is also included. The goals for the school meeting LGK-974 cell line are to (a) establish a working relationship/collaboration with the school, (b) exchange information about the youth’s in-school and out-of-school patterns and efforts, (c) agree on goals for school re-integration, (d) identify school resources (staff availability,

study periods, counselor visits) and limits (maximum absences before severe consequences set in and nature of consequences), (e) incentives to use both in- and out-of-school, (f) to brainstorm ways to practice skills inside and outside of school, and (g) identify ways to track progress and find more provide feedback. Realistic expectations for school re-entry should be individualized and negotiated with parents and schools. Treatment seekers at our clinic tend to be chronic refusers who have missed over 20 school days or a substantial portion of days for several months or longer. Creating expectations for 100% attendance after two weeks may be unrealistic, especially when refusal behavior has recurred over several years. We tend to target 75%-80% attendance within 6-8 weeks. More acute, recent episodes of SR can be addressed more quickly. Such expectations need to be negotiated within the realities of school rules, but we have found that most schools welcome realistic goals, particularly when the only other option is to transfer the student to alternative schooling at great expense to the district. After the first four sessions, the manual takes a principles-based approach, wherein problem behaviors are functionally assessed and each DBT-A skill (mindfulness, emotion regulation, distress tolerance interpersonal effectiveness, walking

the middle path) can be used flexibly to address the most Meloxicam current concerns. The manual provides examples to help place each skill in the context of SR. The DBT target hierarchy guides therapists in structuring each session, such that life-threatening behaviors take precedence over therapy-interfering and quality-of-life interfering behaviors (Linehan, 1993a). Web-based Coaching (WBC) In standard DBT and DBT-A, the individual therapist is available to the client outside of therapy sessions via phone (or other methods, like texting or email) to provide coaching in DBT skills in “real world” situations. For DBT-SR, we extended this mode of treatment in two important ways: the medium (web-based) and the timing (early morning when SR behaviors are most prominent).

, 1993 and Sharshar et al ,

, 1993 and Sharshar et al., click here 2005). Moreover, surface electrodes have previously been validated against diaphragm needle EMG (Demoule et al., 2003a) and we were anyway reluctant to use the latter technique because of the risk of pneumothorax during inspiratory effort and in the context of positive pressure

ventilation. A related issue is the possibility that changes in the position of the diaphragm relative to the electrodes during NIV could have influenced the response to TMS although the difference between esophageal pressures was not large. TMS responses were therefore normalized to the response to phrenic nerve stimulation to minimize the impact of any peripheral changes. Ideally we would have performed paired stimulations at a range of interstimulus intervals to produce an interstimulus response curve as described previously (Demoule et al., 2003b, Sharshar et al., 2004a and Sharshar et al., 2004b). However, this would have considerably increased both the number of stimulations and the duration of the study, so we chose to use only the two interstimulus intervals shown previously to produce the greatest inhibition and facilitation (Hopkinson et al., 2004). Again, to reduce the number of stimulations administered we did not formally assess the motor threshold for the rectus abdominis. However, we have found previously that rectus abdominis threshold in response to stimulation at the vertex

is similar to that of the diaphragm both in COPD patients and controls (Hopkinson

et al., 2004). A further consideration is that in contrast to the diaphragm, it is Y-27632 order not possible to perform peripheral supramaximal stimulation of the abdominal muscles in a manner that is likely to be acceptable to patients (Hopkinson et al., 2010 and Suzuki et al., 1999) so it was not possible to normalize the MEP response to allow for any changes in peripheral conduction that might have occurred. In summary we conclude that a requirement for long-term home NIV in COPD is not associated with changes in the excitability Epothilone B (EPO906, Patupilone) of corticospinal pathways to the respiratory muscles. However we did find, taking the group as a whole, that the facilitatory and inhibitory properties of the intracortical circuits of the diaphragm motor cortex were strongly correlated with inspiratory muscle strength and hypercapnia respectively. While we are cautious in over interpreting the former result we speculate that prolonged exposure to hypercapnia results in greater intracortical inhibition: this could contribute to the pathogenesis of respiratory failure in COPD. Finally, the acute application of NIV did not, in contrast to our previous findings in healthy subjects, alter the facilitatory and inhibitory properties of the diaphragm motor cortex as judged by the response to paired TMS, indicating likely long-term reorganisation of the cortex as a consequence of COPD. The authors have no conflict of interest.

White pine and hemlock were harvested for lumber and bark for use

White pine and hemlock were harvested for lumber and bark for use in the tanning of hides, with the small town of Lehigh Tannery boasting the 2nd largest tannery in the United States (Pennsylvania DCNR, 2010). In 1875 AD a fire swept through the Lehigh Gorge destroying remaining timber, lumber stockpiles, and sawmills (Pennsylvania DCNR, 2010). These observations combined with flood histories and the history of coal mining in the area suggests that the coal sand/silt deposit dates >1820 AD. The Oberly Island Site (36Nm140) is located 68 km downstream from the Nesquehoning Creek Site along the lower

Lehigh River valley. Oberly is a man-made island resulting from CFTR modulator artificial Lehigh Canal construction during the 1820s (Fig. 2B). The Oberly Island archeological site on the island was recorded on an alluvial terrace composed of a >3.5 m-thick sequence

of vertical-accretion deposits that have accumulated since the early Holocene, possibly as early as the late Pleistocene (Basalik and Lewis, 1989, Siegel et al., 1999 and Wagner, 1996) (Fig. 4). Prehistoric artifacts occur within the lower strata, which are commonly weathered INCB024360 clinical trial into Bt horizons. The upper Bt horizon contains Late to Terminal Archaic artifacts, placing the age of these deposits somewhere between 3000 and 1000 BC. Overlying the moderately developed buried alluvial soils are historic alluvial deposits, including a 1- to 1.2-m-thick coal sand layer and the upper of two plowzone (Ap) horizons. The thick, >1 m, succession of coal sand and silt toward the surface conforms to the NRCS survey classification of Oberly Island Grape seed extract surface soils as Fluvaquents (Soil Survey Staff, 2012a and Soil Survey Staff, 2012b). This thick succession of coal alluvium likely occurs across much of the island. Proximal to the island, Gibraltar series (Gb) soils (Mollic Udifluvents) are forming along many of the floodplain and alluvial terrace landforms (Fig. 2B). The Mollic characteristics of the Gb are attributed

to the black coal deposits that comprise the topsoil. Siegel et al. (1999) documents two potential coal depositional events that occurred around 1841 AD at the archeological site. Because we have no evidence of prehistoric Americans plowing, the consistent presence of a plowed buried A horizon (Apb) suggests historic disturbance prior to the deposition of any coal sand. The lack of time diagnostic artifacts recovered from the “coalwash” and buried plowzone at Oberly Island prevents precise dating of the coalwash deposits. It is presumed to have occurred after the 1820s and the completion of the portion of the Lehigh Canal that created Oberly Island, and tentatively is linked to a major historic flood dating to 1841 AD (e.g., Siegel et al., 1999:38). Barbadoes Island is located along the lower Schuylkill River, 35 km upstream from the confluence with the Delaware River at Philadelphia, PA.

Drowning of paleo-sand ridge sets and their transformation into b

Drowning of paleo-sand ridge sets and their transformation into barrier systems can provide additional though temporary protection to the remaining inland delta plain. Our long running project in the Danube delta is supported by multiple sources in the US (including NSF and WHOI) and Romania and supplemented by our pocket money. We thank all friends who helped us in the field (special thanks to Dan Urcan and Jenica Hanganu), shared ideas and inspired us (Jeff Donnelly, James Syvitski, John Day, Rudy Slingerland, Chris

Paola and Andrew Ashton), and scientists from selleck screening library the National Ocean Sciences Accelerator Mass Spectrometry Facility for radiocarbon dating. The paper benefited from the editorial advice of Jon Harbor and the constructive comments of two anonymous reviewers. “
“In a landmark paper published in the journal Science near the turn of the 21st century, Luminespib research buy “Human Domination of Earth’s Ecosystems,” Vitousek et al. (1997) conducted a meta-analysis and found that humans had reached a historical watershed in transforming our planet—atmospherically, hydrologically, pedologically, geochemically, biologically, ecologically, and more (

Fig. 1). A few 4 years later, Jackson et al. (2001) argued that the recent collapse of marine fisheries and ecosystems had deeper roots in a gradual intensification of coastal fisheries and the development of sophisticated maritime technologies by Homo sapiens sapiens (anatomically modern humans, a.k.a. AMH). Ecological and cultural changes intensified with the development of European colonialism and a globalized economy, beginning in the late 15th Dimethyl sulfoxide century AD with Christopher Columbus’

‘discovery’ of the Americas and the mapping of remote continents and islands that ensued in the decades or centuries that followed. These and other studies proposed that humans have had significant impacts on earth’s ecosystems for centuries or even millennia (e.g., Alroy, 2001, Erlandson and Rick, 2010, Foley et al., 2013, Goudie, 2000, Kirch, 2005, Kirch and Hunt, 1997, Martin, 1973, Martin and Steadman, 1999 and Redman, 1999; Redman et al., 2004; Rick and Erlandson, 2008 and Steadman, 2006). At the turn of the millennium, not coincidentally, another idea proposed earlier gained significant traction. This was the idea that humans had reached a level of domination of the Earth that was both measurable and of comparable scale to those of previous transitions between geological epochs. This proposed new epoch, known as the Anthropocene (human era), recognizes the widespread effects humans have had on Earth’s climate, atmosphere, oceans, rivers, estuaries, terrestrial landscapes, and the biodiversity of floral and faunal communities. The concept of an Anthropocene epoch has generated considerable debate, some about the value of the idea itself, and some about where the temporal boundary between the Holocene and the Anthropocene should be drawn.

The lack of Ang-(1–7) action through Mas receptor increased level

The lack of Ang-(1–7) action through Mas receptor increased levels of serum NEFA and decreased the response of adipocytes

to the antilipolytic effect of insulin. In fat cells, insulin inhibits the mobilization of NEFA by decreasing the rate of lipolysis and/or increasing the lipogenic rate and lipid storage. Insulin resistance in adipose tissue is characterized see more by decreased suppression of adipose tissue lipolysis by insulin, resulting in elevated circulating NEFA levels [19]. Increased NEFA concentrations leads to serine/threonine phosphorylation of insulin receptor substrate (IRS-1 and IRS-2), subsequently reducing the ability of the IRS to activate phosphatidylinositol (PI) 3-kinase and glucose transport [28]. Recently Giani et al. [14] demonstrated that infusion of Ang-(1–7) in rats resulted in a reversal of fructose-induced insulin resistance through the IR/IRS/PI3 K/Akt pathway in the main target of insulin: skeletal muscle, liver and adipose tissue. These findings are in accordance with the observation that transgenic rats, with chronic elevation of plasma Ang-(1–7), improved

responsiveness to insulin stimulation and increased total and phosphorylated Akt in adipose tissue [24]. In addition, previous work from our group have shown that Mas-knockout mice presented glucose intolerance and reduced insulin sensitivity as well as a decrease in insulin-stimulated glucose uptake by adipocytes and decreased GLUT4 in adipose tissue [25]. click here Previous studies have shown that Mas-deficient mice present lack of several Ang-(1–7) actions, mainly concerning to behavior and cardiovascular regulation [1]. Mas receptor deletion abolished the vasodialator effect of Ang-(1–7) in vitro and also induced a hypertensive state in FVB/N mice. All these data are followed by dysbalance between nitric oxide Rho and reactive oxygen species in the vessel wall of Mas-KO. Recently studies have shown that Mas knockout mice presented a prothrombotic profile [12], altered calcium signaling on cardiomyocytes [10] and renal dysfunction

[21]. In conclusion, the absence of Ang-(1–7)/Mas axis induces important alterations in adipose tissue, evidenciated by decreased insulin sensibility in adipocytes, which might be consequent to: (1) decreased mRNA expression of PPARγ; (2) exacerbation of Ang-II action as a consequence of the missing contraregulation by Ang-(1–7), via receptor Mas. EGM – conducted the animal experiments, generation and collection of data, and helped draft and revision of the manuscript. SHSS – participated in the generation and collection of RT-PCR data and helped the revision of the manuscript. AVMF – participated in the generation and collection of RT-PCR data. MB – generated mice lacking the Mas protooncogene. RASS – helped draft and revision of the manuscript, approval of the final version of the manuscript.

Por sua vez, a administração de contraste endovenoso (hexafluoret

Por sua vez, a administração de contraste endovenoso (hexafluoreto de enxofre,

Sonovue®) ( fig. 1) permite analisar o padrão de microvascularização das lesões. O ADC tem uma aparência hipovascular, contrariamente aos TNE e às lesões de pancreatite crónica e autoimune, que têm aparência hiper ou isovascular 33. O achado de uma massa hipocaptante exibe uma sensibilidade de 94% e especificidade de 89% no diagnóstico de ADC do pâncreas 34. A análise quantitativa da captação de contraste pode vir a aumentar a acuidade da técnica, particularmente no diagnóstico diferencial entre ADC e pancreatite crónica 34. Outras aplicações possíveis dos agentes de contraste incluem a avaliação das estruturas vasculares perilesionais, permitindo melhorar AZD5363 in vivo a acuidade da EE no estadiamento T, e a deteção de lesões de pequenas dimensões não identificadas por EE em modo B, particularmente nos doentes com pancreatite crónica

ou com próteses biliares. Embora não possam substituir a PAAF-EE, estas 2 modalidades podem contribuir para a tomada de decisões 5-Fluoracil mouse clínicas na abordagem de casos com cito-histologia negativa para malignidade e podem ser utilizadas para guiar e potenciar os resultados da PAAF–EE de lesões pancreáticas e de gânglios linfáticos, permitindo selecionar as áreas suspeitas a puncionar 35 and 36. O ADC compreende 90% das neoplasias sólidas do pâncreas. Localiza-se mais frequentemente na região cefálica. O aspeto ecomorfológico mais representativo deste tumor é o de uma massa heterogénea, hipoecóica e com margens irregulares (fig. 2), tendo como achados preditivos a dilatação do ducto pancreático principal e a presença de um halo hipoecóico periductal (sinal hipoecóico periductal)37. Dada a elevada sensibilidade da angio–TC na avaliação da invasão arterial, a EE deve ter o papel de confirmar o grau de envolvimento vascular já determinado por este método de imagem, após exclusão de metastização à distância38. Os tumores irressecáveis ou borderline ressectable podem ser incluídos em protocolos de terapêutica

Aldehyde dehydrogenase neoadjuvante em validação e com diferentes finalidades 39. Nestes casos é mandatório o diagnóstico cito-histopatológico prévio obtido por PAAF-EE. Igualmente, a presença de linfadenopatias malignas pode justificar a realização de terapêutica neoadjuvante. As características ecomorfológicas dos gânglios linfáticos associadas a malignidade são a forma arredondada, dimensão superior a 5 mm, ecotextura hipoecóica e margens bem definidas. Quando presentes em conjunto, apresentam uma acuidade diagnóstica de 80%, o que ocorre em apenas 25% dos gânglios malignos, podendo ser necessário recorrer à PAAF para confirmação cito-histológica 37. A EE possibilita, também, a identificação e punção de bolsas de efusões peritoneais e pleurais, lesões nodulares hepáticas e adenopatias à distância.