The White Nipple Sign: Please Do Not Disturb

Blood spurting or oozing from a varix confirms the diagnosis of variceal hemorrhage. In most cases of variceal hemorrhage, however, the bleeding has ceased by the time endoscopy is performed. Endoscopists rely on identification of stigmata of recent hemorrhage to determine whether varices are the cause of bleeding and to predict the likelihood of rebleeding. Most of the attention has focused on red color signs, such as red wale markings, described by Beppu et al. [Gastrointest Endosc 1981;27:213-218] and well known to endoscopists. Here we describe our experience with a less recognized stigma of variceal hemorrhage known as the ‘white nipple sign’, which resulted in active hemorrhage when manipulated

"Acute pseudo-pericardial tamponade": the compression of the thoracal inferior vena cava – a case report

We describe a case of 68-year-old woman which was admitted to our hospital for mitral valve replacement (MVR), in whom acute compresion of the vena cava inferior developed after repair of lacerated atrio-caval junction with hemostatic tissue sealant, biologic glue (BioGlue, Cryolife, ınc, Kennesaw, Ga). Removal of the BioGlue relieved the unexpected problem

The impact of molecular profile on the lymphatic spread pattern in stage III colon cancer

The anatomical spread of lymph node (LN) metastasis is of practical importance in the surgical management of colon cancer (CC). We examined the effect of KRAS, BRAF, and microsatellite instability (MSI) on LN count and anatomical spread pattern in stage III CC. We determined KRAS, BRAF, and MSI status from stage III CC patients. Biomarker status was correlated with LN count and anatomical spread pattern, which was classified as sequential or skipped. Relapse-free survival (RFS) was estimated using Kaplan-Meier method, and correlations were assessed using log-rank and Cox regression analyses. We analyzed 369 stage III CC patients. The proportion of KRAS mutant (mt), BRAF mt, and MSI-high (H) were 44.2% (163/344), 6.8% (25/344), and 6.8% (25/344), respectively. The mean number of metastatic LN was higher in microsatellite-stable (MSS) compared with MSI patients (3.5 vs. 2.7, P = .0406), although no differences were observed in accordance with KRAS or BRAF status. Interestingly, patients with BRAF mt and MSI-H were less likely to harbor skipped metastatic LN (9.3% vs 20% and 4% vs 10.5% compared with BRAF wild-type (wt) and MSS, respectively), but KRAS status did not predict anatomical spread pattern. Patients with KRAS wt and MSI-H showed superior RFS compared with KRAS mt and MSS patients, respectively, whereas BRAF status did not affect RFS. Differences exist in the anatomical pattern of invaded LN in accordance with the molecular status of stage III CC. Patients with MSI-H CC have less invaded and skipped LN, suggesting that a tailored surgical approach is possible

Gauge links for transverse momentum dependent correlators at tree-level

In this paper we discuss the incorporation of gauge links in hadronic matrix elements that describe the soft hadronic physics in high energy scattering processes. In this description the matrix elements appear in soft correlators and they contain non-local combinations of quark and gluon fields. In our description we go beyond the collinear approach in which case also the dependence on transverse momenta of partons is taken into consideration. The non-locality in the transverse direction leads to a complex gauge link structure for the full process, in which color is entangled, even at tree-level. We show that at tree-level in a 1-parton unintegrated (1PU) situation, in which only the transverse momentum of one of the initial state hadrons is relevant, one can get a factorized expression involving transverse momentum dependent (TMD) distribution functions. We point out problems at the level of two initial state hadrons, even for relatively simple processes such as Drell-Yan scattering.Comment: 25 pages, corrected typos and updated reference

MicroRNAs in pulmonary arterial remodeling

Pulmonary arterial remodeling is a presently irreversible pathologic hallmark of pulmonary arterial hypertension (PAH). This complex disease involves pathogenic dysregulation of all cell types within the small pulmonary arteries contributing to vascular remodeling leading to intimal lesions, resulting in elevated pulmonary vascular resistance and right heart dysfunction. Mutations within the bone morphogenetic protein receptor 2 gene, leading to dysregulated proliferation of pulmonary artery smooth muscle cells, have been identified as being responsible for heritable PAH. Indeed, the disease is characterized by excessive cellular proliferation and resistance to apoptosis of smooth muscle and endothelial cells. Significant gene dysregulation at the transcriptional and signaling level has been identified. MicroRNAs are small non-coding RNA molecules that negatively regulate gene expression and have the ability to target numerous genes, therefore potentially controlling a host of gene regulatory and signaling pathways. The major role of miRNAs in pulmonary arterial remodeling is still relatively unknown although research data is emerging apace. Modulation of miRNAs represents a possible therapeutic target for altering the remodeling phenotype in the pulmonary vasculature. This review will focus on the role of miRNAs in regulating smooth muscle and endothelial cell phenotypes and their influence on pulmonary remodeling in the setting of PAH

Hygroscopic behavior of lyophilized bovine pericardium

Hygroscopic behavior of lyophilized products can be visualized starting from the construction of Moisture Sorption Isotherms (MSI). Such curves show the relationship between the maximum amount of absorbed water for a substance, with the equilibrium vapor pressure or water activity, at a given constant temperature. Aimed to study later the reconstitution and use of biological materials of lyophilized bovine pericardium, it was plot adsorption and desorption curves, at temperatures of 15, 25 and 35°C, on HydrosorbTM 1000 - water vapor sorption analyzer. The results showed MSI type II, according BET classification, typical reaction of hydrophilic surfaces with monolayer and multilayer formation. Histerese phenomenon was observed during the whole MSI interval. The mathematical models of BET and GAB fitted well the experimental data and allowed the water monolayer calculation, estimate the critical level of residual moisture that assures more stability to the product.O comportamento higroscópico de produtos desidratados pode ser visualizado a partir da construção de curvas denominadas Isotermas de Sorção de Umidade (ISU). Esse tipo de curva relaciona a quantidade máxima de água absorvida por uma substância, com a pressão de vapor de equilíbrio ou a atividade de água, numa dada temperatura mantida constante. Com o objetivo de estudar posteriormente a reconstituição, material de embalagem e utilização de implantes feitos a partir de pericárdio bovino liofilizado, foram traçadas curvas de adsorção e dessorção de umidade em um analisador de sorção de vapor de água, HydrosorbTM 1000, nas temperaturas de 15, 25 e 35°C. Os resultados obtidos mostraram ISU tendendo ao tipo II, segundo a classificação de BET, reação típica de superfícies hidrofílicas com formação de monocamada e multicamadas. O fenômeno da histerese foi observado durante todo o intervalo da ISU. Os modelos matemáticos de Brunauer-Emmett-Teller (BET) e Guggenheim-Anderson-de Boer (GAB) ajustaram bem os dados experimentais permitindo o cálculo do valor monomolecular, importante para a estimativa do nível crítico de umidade residual que confere maior estabilidade de armazenamento ao produto.31332