EUS-guided portal pressure gradient measurement with a simple novel device: a human pilot study.

Background and aimsPortal hypertension is a serious adverse event of liver cirrhosis. Recently, we developed a simple novel technique for EUS-guided portal pressure gradient (PPG) measurement (PPGM). Our animal studies showed excellent correlation between EUS-PPGM and interventional radiology-acquired PPGM. In this video we demonstrate the results of the first human pilot study of EUS-PPGM in patients with liver disease.MethodsEUS-PPGM was performed by experienced endosonographers using a linear echoendoscope, a 25-gauge FNA needle, and a novel compact manometer. The portal vein and hepatic vein (or inferior vena cava) were targeted by use of a transgastric or transduodenal approach. Feasibility was defined as successful PPGM in each patient. Safety was based on adverse events captured in a postprocedural interview.ResultsTwenty-eight patients underwent EUS-PPGM with 100% technical success and no adverse events. PPG ranged from 1.5 to 19 mm Hg and had excellent correlation with clinical parameters of portal hypertension, including the presence of varices (P = .0002), PH gastropathy (P = .007), and thrombocytopenia (P = .036).ConclusionThis novel technique of EUS-PPGM using a 25-gauge needle and compact manometer is feasible and appears safe. Given the availability of EUS and the simplicity of the manometry setup, EUS-guided PPG may represent a promising breakthrough for procuring indispensable information in the management of patients with liver disease

The Perfect Marriage: Community Based and Online Learning

Community based projects are an integral part of most student’s higher education experience. It has become a popular pedagogical method that moves teaching and learning out of the traditional classroom and into the community where learning outcomes can be integrated into a particular context. Online learning has also emerged as a popular pedagogical practice in education and is continuing to gain popularity in higher education. Each has distinct benefits for teaching and learning and both provide instructors ways in which they can differentiate learning. To consider merging these two practices may seem challenging and ultimately, to some, impossible. Some may discredit the instructor’s ability to appropriately monitor community based learning activities while teaching a course from a distance and that the assessment of a student’s work will be too challenging. This presentation will provide examples and support for conducting community based learning projects into an online course and demonstrate ways in which assessment can be very authentic and meaningful. The examples used in this presentation are in the area of sport management but community based learning projects across other disciplines could also considered for these types of projects. Keywords Online Learning, Distance Learning, Community Based Learning, Service Learning, Assessmen

A prospective observational study of mycophenolate mofetil treatment in progressive diffuse cutaneous systemic sclerosis of recent onset.

OBJECTIVE: A prospective observational study of mycophenolate mofetil (MMF) treatment in patients with diffuse progressive cutaneous systemic sclerosis (SSc) of recent onset. METHODS: Twenty-five previously untreated consecutive patients with recent-onset (\u3c 24 mo) diffuse progressive cutaneous SSc received MMF as the only disease-modifying therapy. Modified Rodnan skin score (mRSS) and affected body surface area (BSA) were compared from initiation of MMF to study end. Pulmonary function tests performed at the same institution before therapy and at study end were available in 15 patients. Histopathology and real-time PCR assessment of fibrosis-related gene expression were performed before and after treatment in skin biopsies from 3 patients. RESULTS: At 18.2 ± 8.73 months of MMF therapy (median 2000 mg/day) the mRSS decreased from 24.56 ± 8.62 to 14.52 ± 10.9 (p = 0.0004) and the affected BSA from 36% ± 16% to 14% ± 13.3% (p = 0.00001). Pulmonary function tests remained stable from initiation of MMF to the end of the study. Skin histopathology showed a remarkable reduction in accumulation of fibrotic tissue. Real-time PCR of skin biopsies demonstrated a marked decrease in expression of fibrosis-related genes. CONCLUSION: Patients with diffuse progressive cutaneous SSc of recent onset treated with MMF experienced marked improvement in skin involvement and stabilization of pulmonary function. Skin biopsies from 3 patients demonstrated histopathological improvement and decreased expression of fibrosis-related genes

Management of an Accessory Bile Duct Leak Following Pancreaticoduodenectomy: A Novel Approach Utilizing a Percutaneous and Endoscopic Rendezvous.

Biliary leaks are uncommon but morbid complications of pancreaticoduodenectomies, which have historically been managed with percutaneous drainage, reoperation, or a combination of both. We report a de novo percutaneous-endoscopic hepaticojejunostomy from an anomalous right hepatic duct injured during pancreaticoduodenectomy to the afferent bowel limb. The percutaneous-endoscopic hepaticojejunostomy was stented to allow for tract formation with successful stent removal after 5.5 months. One year after the creation of the percutaneous-endoscopic hepaticojejunostomy, the patient remains clinically well without evidence of biliary leak or obstruction

The Gemini Planet Imager Exoplanet Survey: Giant Planet and Brown Dwarf Demographics from 10 to 100 au

We present a statistical analysis of the first 300 stars observed by the Gemini Planet Imager Exoplanet Survey. This subsample includes six detected planets and three brown dwarfs; from these detections and our contrast curves we infer the underlying distributions of substellar companions with respect to their mass, semimajor axis, and host stellar mass. We uncover a strong correlation between planet occurrence rate and host star mass, with stars M* > 1.5 M⊙ more likely to host planets with masses between 2 and 13 M_(Jup) and semimajor axes of 3–100 au at 99.92% confidence. We fit a double power-law model in planet mass (m) and semimajor axis (a) for planet populations around high-mass stars (M* > 1.5 M⊙) of the form d^2N/dmda ∝ m^αa^β, finding α = −2.4 ± 0.8 and β = −2.0 ± 0.5, and an integrated occurrence rate of 9^(+5)_(−4)% between 5–13 M_(Jup) and 10–100 au. A significantly lower occurrence rate is obtained for brown dwarfs around all stars, with 0.8^(+0.8)_(−0.5)% of stars hosting a brown dwarf companion between 13–80 M_(Jup) and 10–100 au. Brown dwarfs also appear to be distributed differently in mass and semimajor axis compared to giant planets; whereas giant planets follow a bottom-heavy mass distribution and favor smaller semimajor axes, brown dwarfs exhibit just the opposite behaviors. Comparing to studies of short-period giant planets from the radial velocity method, our results are consistent with a peak in occurrence of giant planets between ~1 and 10 au. We discuss how these trends, including the preference of giant planets for high-mass host stars, point to formation of giant planets by core/pebble accretion, and formation of brown dwarfs by gravitational instability

Knowledge-based vision and simple visual machines

The vast majority of work in machine vision emphasizes the representation of perceived objects and events: it is these internal representations that incorporate the 'knowledge' in knowledge-based vision or form the 'models' in model-based vision. In this paper, we discuss simple machine vision systems developed by artificial evolution rather than traditional engineering design techniques, and note that the task of identifying internal representations within such systems is made difficult by the lack of an operational definition of representation at the causal mechanistic level. Consequently, we question the nature and indeed the existence of representations posited to be used within natural vision systems (i.e. animals). We conclude that representations argued for on a priori grounds by external observers of a particular vision system may well be illusory, and are at best place-holders for yet-to-be-identified causal mechanistic interactions. That is, applying the knowledge-based vision approach in the understanding of evolved systems (machines or animals) may well lead to theories and models that are internally consistent, computationally plausible, and entirely wrong

Systematic diagonal and vertical errors in antisaccades and memory-guided saccades

Studies of memory-guided saccades in monkeys show an upward bias, while studies of antisaccades in humans show a diagonal effect, a deviation of endpoints toward the 45° diagonal. To determine if these two different spatial biases are specific to different types of saccades, we studied prosaccades, antisaccades and memory-guided saccades in humans. The diagonal effect occurred not with prosaccades but with antisaccades and memory-guided saccades with long intervals, consistent with hypotheses that it originates in computations of goal location under conditions of uncertainty. There was a small upward bias for memory-guided saccades but not prosaccades or antisaccades. Thus this bias is not a general effect of target uncertainty but a property specific to memory-guided saccades