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

“Enriching Lives within Sedimentary Geology”: Actionable Recommendations for Making SEPM a Diverse, Equitable and Inclusive Society for All Sedimentary Geologists

Innovative science benefits from diversity of thought and influence at all waypoints along the scientific journey, from early education to career-length contributions in research and mentorship. Scientific societies, like the Society for Sedimentary Geology (SEPM), steward their innovators and the direction of the science, thereby defining the societal impact and evolution of a discipline. They are uniquely positioned to promote the representation and success of all scientists, including those from minoritized populations, through proactive advocacy, and inclusive mentorship, awards, and leadership. We introspectively review available records of SEPM membership, leadership, awardees, and editorial boards to identify areas for growth and begin a dialogue about how the society and its members can work together to better reflect our community. In the last decade, SEPM has seen a decline in membership, while representation and recognition of scientists from minoritized groups has remained low. Awards and honors have overwhelmingly gone to men, even in the last ten years, and very few women or people of color are in leadership roles. SEPM has recently taken positive steps towards becoming more inclusive (e.g., the Code of Professional Conduct); however, much more work is needed. We provide recommendations for swift actions that SEPM and its members should undertake for the society to become a diverse, inclusive, and equitable environment where all scientists thrive. The systemic changes needed will take continuous effort, which must be shared by all of us, to build an enduring legacy that we can be proud of

Measuring the Seeds of Ion Outflow: Auroral Sounding Rocket Observations of Low-Altitude Ion Heating and Circulation

We present an analysis of in situ measurements from the MICA (Magnetosphere-Ionosphere Coupling in the Alfvén Resonator) nightside auroral sounding rocket with comparisons to a multifluid ionospheric model. MICA made observations at altitudes below 325 km of the thermal ion kinetic particle distributions that are the origins of ion outflow. Late flight, in the vicinity of an auroral arc, we observe frictional processes controlling the ion temperature. Upflow of these cold ions is attributed to either the ambipolar field resulting from the heated electrons or possibly to ion-neutral collisions. We measure convection away from the arc (poleward) and downflows of hundreds of m s−1 poleward of this arc, indicating small-scale low-altitude plasma circulation. In the early flight we observe DC electromagnetic Poynting flux and associated ELF wave activity influencing the thermal ion temperature in regions of Alfvénic aurora. We observe enhanced, anisotropic ion temperatures which we conjecture are caused by transverse heating by wave-particle interactions (WPI) even at these low altitudes. Throughout this region we observe several hundred m s−1 upflow of the bulk thermal ions colocated with WPI; however, the mirror force is negligible at these low energies; thus, the upflow is attributed to ambipolar fields (or possibly neutral upwelling drivers). The low-altitude MICA observations serve to inform future ionospheric modeling and simulations of (a) the need to consider the effects of heating by WPI at altitudes lower than previously considered viable and (b) the occurrence of structured and localized upflows/downflows below where higher-altitude heating rocesses are expected

The Portuguese Severe Asthma Registry: Development, Features, and Data Sharing Policies

The Portuguese Severe Asthma Registry (Registo de Asma Grave Portugal, RAG) was developed by an open collaborative network of asthma specialists. RAG collects data from adults and pediatric severe asthma patients that despite treatment optimization and adequate management of comorbidities require step 4/5 treatment according to GINA recommendations. In this paper, we describe the development and implementation of RAG, its features, and data sharing policies. The contents and structure of RAG were defined in a multistep consensus process. A pilot version was pretested and iteratively improved. The selection of data elements for RAG considered other severe asthma registries, aiming at characterizing the patient's clinical status whilst avoiding overloading the standard workflow of the clinical appointment. Features of RAG include automatic assessment of eligibility, easy data input, and exportable data in natural language that can be pasted directly in patients' electronic health record and security features to enable data sharing (among researchers and with other international databases) without compromising patients' confidentiality. RAG is a national web-based disease registry of severe asthma patients, available at asmagrave.pt. It allows prospective clinical data collection, promotes standardized care and collaborative clinical research, and may contribute to inform evidence-based healthcare policies for severe asthma.info:eu-repo/semantics/publishedVersio

Stimulation of endothelial progenitor cells: a new putative effect of several cardiovascular drugs

The role of vascular endothelium in cardiovascular disorders is well recognized. Mature endothelial cells contribute to the repair of endothelial injury, but they only have a limited capacity to do so. This has led to growing interest and further investigation into circulating endothelial progenitor cells (EPCs) and their role in vascular healing, repair, and postnatal neovascularization. The current perception of vascular health is that of a balance between ongoing injury and resultant vascular repair, mediated at least in part by circulating EPCs. Circulating EPCs play an important role in accelerating endothelialization at areas of vascular damage, and EPC enumeration is a viable strategy for assessing reparative capacity. Recent studies have shown that EPCs are affected both in number and function by several cardiovascular risk factors as well as various cardiovascular disease states, such as hypertension, hypercholesterolemia, and coronary artery disease. The present review summarizes the most relevant studies on the effects of cardiovascular drugs on vascular function and EPCs, focusing on their mechanisms of action