Outcomes of Single-Operator Cholangioscopy-Guided Lithotripsy in Patients with Difficult Biliary and Pancreatic Stones

BACKGROUND AND AIMS: Endoscopic retrograde cholangiopancreatography is the preferred strategy for the management of biliary and pancreatic duct stones. However, difficult stones occur, and electrohydraulic (EHL) and laser lithotripsy (LL) have emerged as treatment modalities for ductal clearance. Recently, single-operator cholangioscopy was introduced, permitting the routine use of these techniques. We aimed to evaluate the clinical effectiveness of cholangioscopy-guided lithotripsy using LL or EHL in patients with difficult biliary or pancreatic stones. METHODS: This is a prospective clinical study - conducted at two affiliated university hospitals - of 17 consecutive patients with difficult biliary and pancreatic stones who underwent single-operator cholangioscopy-guided lithotripsy using two techniques: holmium laser lithotripsy (HL) or bipolar EHL. We analyzed complete ductal clearance as well as the impact of the location and number of stones on clinical success and evaluated the efficacy of the two techniques used for cholangioscopy-guided lithotripsy and procedural complications. RESULTS: Twelve patients (70.6%) had stones in the common bile duct/common hepatic duct, 2 patients (17.6%) had a stone in the cystic stump, and 3 patients (17.6%) had stones in the pancreas. Sixteen patients (94.1%) were successfully managed in 1 session, and 1 patient (5.9%) achieved ductal clearance after 3 sessions including EHL, LL, and mechanical lithotripsy. Eleven patients were successfully submitted to HL in 1 session using a single laser fiber. Six patients were treated with EHL: 4 patients achieved ductal clearance in 1 session with a single fiber, 1 patient obtained successful fragmentation in 1 session using two fibers, and 1 patient did not achieve ductal clearance after using two fibers and was successfully treated with a single laser fiber in a subsequent session. Complications were mild and were encountered in 6/17 patients (35.2%), including fever (n = 3), pain (n = 1), and mild pancreatitis (n = 1). Conclusions: Cholangioscopy-guided lithotripsy using LL or EHL in patients with difficult biliary or pancreatic stones is highly effective with transient and minimal complications. There is a clear need to further compare EHL and HL in order to assess their role in the success of cholangioscopy-guided lithotripsy.info:eu-repo/semantics/publishedVersio

PENGEMBANGAN SUMBER DAYA MANUSIA DALAM LEMBAGA PENDIDIKAN ISLAM

Investasi pengembangan SDM merupakan program jangka panjang yang di dalamnya terdapat program jangka menengahyang harus sedini mungkin diformulasikan perencanaanya dan diimplementasikan. Investasi ini harus menunjang perkembangan ekonomi dengan visi membangun suatu masyarakat madani yang makmur dan berkeadilan. Dalam hal ini ada tiga hal yang perlu dilakukan yaitu sumber daya sejarah dan budaya, kualitas sumber daya manusia, pemberdayaan rakyat.Madrasah dalam tujuannya berupaya mengintegrasikan ilmu agama dan umum. Menyeimbangkan keduanya untuk menggapai kebahagiaan dunia dan akhirat. Ada beberapa aspek yang perlu dikembangkan dalam lingkup lembaga pendidikan Islam pada umumnya, dan Madrasah pada khususnya untuk menumbuhkan kualitas SDM yang berwawasan global paling tidak harus asanya pengelolaan yang baik dari aspek pendidikan (pedagogis), aspek Moral-Spiritual, aspek sosio-kultural, aspek Sistem pendidikan, aspek sarana dan prasaran

Intrathyroidal Ectopic Thymus: A Case Series

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Metastatic small bowel occlusion as initial presentation of squamous cell carcinoma of the lung

info:eu-repo/semantics/publishedVersio

The influence of V addition on the structure, mechanical properties, and oxidation behaviour of TiAlSiN coatings deposited by DC magnetron sputtering

The influence of V content on the morphology, structure, hardness (H) and reduced Young's modulus (E), adhesion, and oxidation resistance of TiAlSiN coatings is investigated. The coatings were produced by DC reactive magnetron sputtering, with increasing V contents from 0, 4.8 and 11.0 at.%. All coatings exhibit a fcc type structure. The coating with 4.8 at.% of V shows the highest values of H and E, whereas the values are similar for the reference coating and the coating with 11.0 at.% of V. The coatings adhere well to the substrates and show a dense and compact columnar growth extending from the adhesive interlayer to the top surface of the coatings. The dynamic thermal gravimetric oxidation curves reveal that V additions decreases the onset point of oxidation significantly and degrades the oxidation resistance of the coatings. A dual oxide layer is formed on the top surface of the reference coating: an outer porous Ti–Al–O rich layer with plate-like features on the top, which classified to TiO2 (rutile and anatase) and Al2O3 phases, and an inner Ti–Si–O rich layer with Al depletion that identified as mixture of amorphous Si–O and Ti–Si–O protective oxides. The diffusion of V to the top surface governs the oxidation process of the V-containing coatings, i.e. increasing V concentration leads to disrupt the formation of the protective continuous oxide layers easily.This research is sponsored by national funds through FCT e Fundação para a Ciência e a Tecnologia, under the projects: UIDB/00285/2020, SMARTLUBdref. “POCI-01-0145-FEDER-031-807”. MCTool21 project “Manufacturing of cutting tools for the 21st century: from nano-scale material design to numerical process simulation” (reference: POCI-01-0247-FEDER-045940), co-financed by the European Regional Development Fund, through Portugal 2020 (PT2020), and by the Competitiveness and Internationalization Operational Programme (COMPETE 2020).info:eu-repo/semantics/publishedVersio

Human Papillomaviruses and Epstein-Barr Virus Interactions in Colorectal Cancer: A Brief Review.

Human papillomaviruses (HPVs) and the Epstein-Barr virus (EBV) are the most common oncoviruses, contributing to approximately 10%-15% of all malignancies. Oncoproteins of high-risk HPVs (E5 and E6/E7), as well as EBV (LMP1, LMP2A and EBNA1), play a principal role in the onset and progression of several human carcinomas, including head and neck, cervical and colorectal. Oncoproteins of high-risk HPVs and EBV can cooperate to initiate and/or enhance epithelial-mesenchymal transition (EMT) events, which represents one of the hallmarks of cancer progression and metastasis. Although the role of these oncoviruses in several cancers is well established, their role in the pathogenesis of colorectal cancer is still nascent. This review presents an overview of the most recent advances related to the presence and role of high-risk HPVs and EBV in colorectal cancer, with an emphasis on their cooperation in colorectal carcinogenesis

Approach to attributed feature modeling for requirements elicitation in Scrum agile development

Requirements elicitation is a core activity of requirements engineering for the product to be developed. The knowledge that has been gained during requirements engineering about the product to be developed forms the basis for requirement elicitation. The agile approach is becoming known day by day as the most widely used innovative process in the domain of requirements engineering. Requirements elicitation in agile development faces several challenges. Requirements must be gathered sufficiently to reflect stakeholders' needs. Furthermore, because of the development process, requirements evolve, and they must be adequately treated to keep up with the changing demands of the market and the passage of time. Another challenge with agile implementation is handling non-functional requirements in software development. Addressing non- functional requirements is still a critical factor in the success of any product. Requirements prioritization is also one of the most challenging tasks, and it is uncommon for requirement engineers to be able to specify and document all the requirements at once. This paper presents an approach for requirements elicitation in scrum-based agile development. The approach operates with the feature modeling technique, which is originally used in the Software Product Line (SPL). One of the most important proposed extensions to Feature Models (FMs) is the introduction of feature attributes. Our method uses attributed FMs to consider both functional and non-functional requirements as well as requirement prioritization. For the evaluation purposes, we have demonstrated our approach through two case studies in different domains of software product development. The first case study is in the domain of education, and the second one is in the domain of health care. The results reveal that our approach fits the requirements elicitation process in scrum agile development.Bourns College of Engineering, University of California, Riverside(undefined

Hepatite Sifilítica: uma Complicação Rara da Sífilis Secundária. O Reporte de um Caso

Syphilis is a sexually transmitted disease caused by Treponema pallidum, progressing through active and latent stages if left untreated. Hepatic involvement can occur in secondary syphilis, but this is an uncommon complication, with few published case reports. A 34-year-old man without significant medical history was admitted to the gastroenterology department with a 2-week history of unexplained jaundice and acute cholestatic hepatitis. He also presented with erythematous papules and plaques in the genital area, suggestive of secondary syphilis. T. pallidum hemaglutination assay and venereal disease research laboratory test were both positive, the latter with a 1:16 titer. The diagnosis of secondary syphilis with hepatic involvement was considered. The improvement of cutaneous and laboratory findings after intramuscular benzathine penicillin injection supported this hypothesis. Symptomatic cholestatic hepatitis is a rare feature of the systemic spectrum of secondary syphilis. The clinical and laboratorial response after penicillin treatment is a strong clue for this diagnosis.info:eu-repo/semantics/publishedVersio

Xanthogranuloma of the lacrimal sac as a manifestation of Wegener's granulomatosis

McGill Univ, Ctr Hlth, Dept Ophthalmol & Pathol, Montreal, PQ H3A 2B4, CanadaHenry C Witelson Ocular Pathol Lab, Montreal, PQ, CanadaUniversidade Federal de São Paulo, Dept Ophthalmol, UNIFESP, EPM, São Paulo, BrazilMcGill Univ, Ctr Hlth, Dept Ophthalmol, Montreal, PQ H3A 2B4, CanadaUniversidade Federal de São Paulo, Dept Ophthalmol, UNIFESP, EPM, São Paulo, BrazilWeb of Scienc