Covered self-expandable metal stents for pancreatic duct stricture: a systematic review and meta-analysis

Background and study aims Placement of a covered (C)-self-expandable metal stent (SEMS) has been recently investigated as an alternative endoscopic treatment for main pancreatic duct stricture (MPDS) in chronic pancreatitis. Our aim was to carry out a systematic review and meta-analysis of studies quantifying efficacy and safety of C-SEMSs in the management of MPDS.Methods A multiple database search was performed, including MEDLINE, Embase and Cochrane Library, from January 2000 to September 2020, to identify studies reporting the efficacy and safety of C-SEMSs in patients with MPDS. Stricture and pain resolution were investigated. Other outcomes included technical success, stent migration, stricture recurrence and need for repeated stent placement. Pancreatitis, severe abdominal pain requiring stent removal and de-novo stricture were recorded as complications.Results Nineteen studies were identified, which included a total of 300 patients. C-SEMSs showed a pooled stricture resolution rate of 91 % [95 % confidence interval (CI), 85 %-96 %] and a pooled pain resolution rate of 92 % (95 % CI, 85 %-98 %). The pooled proportion for stricture recurrence was equal to 6 % (95 % CI, 1 %-14 %), while stent migration occurred in 33 of 300 patients, the pooled proportion being 7 % (95 % CI 1 %-15 %). The pooled mean stent duration was 133 days (95 % CI, 100-166 days). The most common complication was pancreatitis (3 %, 95 % CI 0 %-8 %), while de-novo stricture pooled proportion was 2 % (95 % CI, 0 %-5 %).Conclusions C-SEMSs are effective and safe in the treatment of MPDS. However, there is a significant need for further high-quality, well-designed studies to produce evidence-based data on short and long-term efficacy, safety, costs of C-SEMSs, and also optimal stent duration

Assessing the level of spatial homogeneity of the agronomic Indian monsoon onset

Over monsoon regions, such as the Indian subcontinent, the local onset of persistent rainfall is a crucial event in the annual climate for agricultural planning. Recent work suggested that local onset dates are spatially coherent to a practical level over West Africa; a similar assessment is undertaken here for the Indian subcontinent. Areas of coherent onset, defined as local onset regions or LORs, exist over the studied region. These LORs are significant up to the 95% confidence interval and are primarily clustered around the Arabian Sea (adjacent to and extending over the Western Ghats), the Monsoon Trough (north central India), and the Bay of Bengal. These LORs capture regions where synoptic scale controls of onset may be present and identifiable. In other regions, the absence of LORs is indicative of regions where local and stochastic factors may dominate onset. A potential link between sea surface temperature anomalies and LOR variability is presented. Finally, Kerala, which is often used as a representative onset location, is not contained within an LOR suggesting that variability here may not be representative of wider onset variability

Safety and Efficacy of Combined Antegrade and Retrograde Endoscopic Dilation for Complete Esophageal Obstruction: A Systematic Review and Meta-Analysis

Background Complete esophageal obstruction (CEO) due to occlusive proximal stricture occurs after chemoradiation for head and neck cancers. A combined antegrade and retrograde endoscopic technique with controlled recanalization and dilation (CARD) has been shown to be an effective and safe method for regaining and maintaining esophageal luminal patency in the short term. Methods We conducted a comprehensive search of multiple electronic databases and conference proceedings, including PubMed, EMBASE, and Web of Science databases (from inception through November 2018), to identify studies that reported the outcomes of CARD. The primary outcomes were the pooled rates of technical and clinical success, specifically improvement in dysphagia and independence from percutaneous endoscopic gastrostomy (PEG)-tube feeds. The secondary outcomes were the need for repeat dilations and the risks of complications, such as pneumomediastinum, perforation, and death. Results From a total of 19 studies (229 cases and 251 procedures) the calculated technical success rate was 88.9% (95% confidence interval [CI] 83.9-92.5, I2 =0). The rates of improvement in dysphagia and being PEG-tube free were 58.4% (95%CI 50-66.3, I2 =12.6) and 43.5% (95%CI 34.1-53.4, I2 =30.6), respectively. The pooled rate of repeat dilatations was 78.9% (95%CI 69.7- 85.8, I2 =15.2). The risks of pneumomediastinum, perforation and death were 9.9% (95%CI 6.2- 15.6, I2 =0), 8% (95%CI 4.8-13, I2 =0), and 6.8% (95%CI 3.4-13.1, I2 =0), respectively. Minimal heterogeneity was noted in the analysis. Conclusions The CARD procedure for CEO has a high technical success rate, but also a high rate of repeat dilations. Given its complexity and associated adverse events, this procedure should be restricted to centers with a high level of expertise

Phosphorylated α‐synuclein in the retina is a biomarker of Parkinson's disease pathology severity

Background: PD patients often have visual alterations, for example, loss of visual acuity, contrast sensitivity or motion perception, and diminished electroretinogram responses. PD pathology is mainly characterized by the accumulation of pathological α‐synuclein deposits in the brain, but little is known about how synucleinopathy affects the retina. Objective: To study the correlation between α‐synuclein deposits in the retina and brain of autopsied subjects with PD and incidental Lewy body disease. Methods: We evaluated the presence of phosphorylated α‐synuclein in the retina of autopsied subjects with PD (9 subjects), incidental Lewy body disease (4 subjects), and controls (6 subjects) by immunohistochemistry and compared the retinal synucleinopathy with brain disease severity indicators. Results: Whereas controls did not show any phosphorylated α‐synuclein immunoreactivity in their retina, all PD subjects and 3 of 4 incidental Lewy body disease subjects had phosphorylated α‐synuclein deposits in ganglion cell perikarya, dendrites, and axons, some of them resembling brain Lewy bodies and Lewy neurites. The Lewy‐type synucleinopathy density in the retina significantly correlated with Lewy‐type synucleinopathy density in the brain, with the Unified Parkinson's disease pathology stage and with the motor UPDRS. Conclusion: These data suggest that phosphorylated α‐synuclein accumulates in the retina in parallel with that in the brain, including in early stages preceding development of clinical signs of parkinsonism or dementia. Therefore, the retina may provide an in vivo indicator of brain pathology severity, and its detection could help in the diagnosis and monitoring of disease progression.This work was supported by the Michael J. Fox Foundation for Parkinson's Research. I.O.L. acknowledges financial support from the Ministerio de Educación, Spain (FPU 14/03166). N.C. acknowledges financial support from the Ministerio de Economía y Competitividad, Spain (MINECO‐FEDER‐BFU2015‐67139‐R), Generalitat Valenciana (Prometeo 2016/158), and Instituto Carlos III (ISCIII RETICS‐FEDER RD12/0034/0010). The Brain and Body Donation Program has been supported by the National Institute of Neurological Disorders and Stroke (U24 NS072026), the National Institute on Aging (P30 AG19610), the Arizona Department of Health Services, the Arizona Biomedical Research Commission, and the Michael J. Fox Foundation for Parkinson's Research

Large N expansion of the 2-matrix model

We present a method, based on loop equations, to compute recursively all the terms in the large $N$ topological expansion of the free energy for the 2-hermitian matrix model. We illustrate the method by computing the first subleading term, i.e. the free energy of a statistical physics model on a discretized torus.Comment: 41 pages, 9 figures eps

Noncommutative Sp(2,R) Gauge Theories - A Field Theory Approach to Two-Time Physics

Phase-space and its relativistic extension is a natural space for realizing Sp(2,R) symmetry through canonical transformations. On a Dx2 dimensional covariant phase-space, we formulate noncommutative field theories, where Sp(2,R) plays a role as either a global or a gauge symmetry group. In both cases these field theories have potential applications, including certain aspects of string theories, M-theory, as well as quantum field theories. If interpreted as living in lower dimensions, these theories realize Poincare' symmetry linearly in a way consistent with causality and unitarity. In case Sp(2,R) is a gauge symmetry, we show that the spacetime signature is determined dynamically as (D-2,2). The resulting noncommutative Sp(2,R) gauge theory is proposed as a field theoretical formulation of two-time physics: classical field dynamics contains all known results of `two-time physics', including the reduction of physical spacetime from D to (D-2) dimensions, with the associated `holography' and `duality' properties. In particular, we show that the solution space of classical noncommutative field equations put all massless scalar, gauge, gravitational, and higher-spin fields in (D-2) dimensions on equal-footing, reminiscent of string excitations at zero and infinite tension limits.Comment: 32 pages, LaTe

Competition of lattice and basis for alignment of nematic liquid crystals

Due to elastic anisotropy, two-dimensional patterning of substrates can promote weak azimuthal alignment of adjacent nematic liquid crystals. Here we consider how such alignment can be achieved using a periodic square lattice of circular or elliptical motifs. In particular, we examine ways in which the lattice and motif can combine to favor differing orientations. Using Monte Carlo simulation and continuum elasticity we find, for circular motifs, that the coverage fraction controls both the polar anchoring angle and a transition in the azimuthal orientation. If the circles are generalized to ellipses, arbitrary control of the effective easy axis and effective anchoring potential becomes achievable by appropriate tuning of the ellipse motif relative to the periodic lattice patterning. This has possible applications in both monostable and bistable liquid crystal device contexts

Noncommutative geometry inspired black holes in higher dimensions at the LHC

When embedding models of noncommutative geometry inspired black holes into the peridium of large extra dimensions, it is natural to relate the noncommutativity scale to the higher-dimensional Planck scale. If the Planck scale is of the order of a TeV, noncommutative geometry inspired black holes could become accessible to experiments. In this paper, we present a detailed phenomenological study of the production and decay of these black holes at the Large Hadron Collider (LHC). Noncommutative inspired black holes are relatively cold and can be well described by the microcanonical ensemble during their entire decay. One of the main consequences of the model is the existence of a black hole remnant. The mass of the black hole remnant increases with decreasing mass scale associated with noncommutative and decreasing number of dimensions. The experimental signatures could be quite different from previous studies of black holes and remnants at the LHC since the mass of the remnant could be well above the Planck scale. Although the black hole remnant can be very heavy, and perhaps even charged, it could result in very little activity in the central detectors of the LHC experiments, when compared to the usual anticipated black hole signatures. If this type of noncommutative inspired black hole can be produced and detected, it would result in an additional mass threshold above the Planck scale at which new physics occurs.Comment: 21 pages, 7 figure

Cultural differences affecting decision-making style: a comparative study between four countries

The aim of this paper was to identify the impact of national culture on decision-making styles in selected countries: Croatia, Slovenia, Bosnia and Herzegovina and Hungary. The estimation of Hofstede’s dimensions of national cultures and comparative analyses was carried out by using a narrow-sample strategy. The estimated positions on each dimension confirmed the Hofstede’s original research ranking. The result with significant value was the confirmation of the global trend of decreasing power distance and significant movement towards the individualism. Besides the standardization procedure of comparative cross-cultural analyses, variance analyses were used to identify cultural differences in decision-making styles related to complex decisions (Janis and Mann’s typology). The proposition is that complex decisions are, above and beyond all others, the consequence of social and cultural values installed in every individual. Statistically significant dependency was identified for hyper-vigilant and vigilant decision-making style and national culture’s dimensions. A beneficial goal was to identify the differences and the similarities in value orientation and those in the decision-making style which should not be mistreated as they may influence future business cooperation and political and economic integrations within the CEE context

No Exit? Withdrawal Rights and the Law of Corporate Reorganizations

Bankruptcy scholarship is largely a debate about the comparative merits of a mandatory regime on one hand and bankruptcy by free design on the other. By the standard account, the current law of corporate reorganization is mandatory. Various rules that cannot be avoided ensure that investors’ actions are limited and they do not exercise their rights against specialized assets in a way that destroys the value of a business as a whole. These rules solve collective action problems and reduce the risk of bargaining failure. But there are costs to a mandatory regime. In particular, investors cannot design their rights to achieve optimal monitoring as they could in a system of bankruptcy by free design. This Article suggests that the academic debate has missed a fundamental feature of the law. Bankruptcy operates on legal entities, not on firms in the economic sense. For this reason, sophisticated investors do not face a mandatory regime at all. The ability of investors to place assets in separate entities gives them the ability to create specific withdrawal rights in the event the firm encounters financial distress. There is nothing mandatory about rules like the automatic stay when assets can be partitioned off into legal entities that are beyond the reach of the bankruptcy judge. Thus, by partitioning assets of one economic enterprise into different legal entities, investors can create a tailored bankruptcy regime. In this way, legal entities serve as building blocks that can be combined to create specific and varied but transparent investor withdrawal rights. This regime of tailored bankruptcy has been unrecognized and underappreciated and may be preferable to both mandatory and free design regimes. By allowing a limited number of investors to opt out of bankruptcy in a particular, discrete, and visible way, investors as a group may be able to both limit the risk of bargaining failure and at the same time enjoy the disciplining effect that a withdrawal right brings with it