Influence of reheating on the trispectrum and its scale dependence

We study the evolution of the non-linear curvature perturbation during perturbative reheating, and hence how observables evolve to their final values which we may compare against observations. Our study includes the evolution of the two trispectrum parameters, \gnl and \taunl, as well as the scale dependence of both \fnl and \taunl. In general the evolution is significant and must be taken into account, which means that models of multifield inflation cannot be compared to observations without specifying how the subsequent reheating takes place. If the trispectrum is large at the end of inflation, it normally remains large at the end of reheating. In the classes of models we study, it is very hard to generate \taunl\gg\fnl^2, regardless of the decay rates of the fields. Similarly, for the classes of models in which \gnl\simeq\taunl during slow--roll inflation, we find the relation typically remains valid during reheating. Therefore it is possible to observationally test such classes of models without specifying the parameters of reheating, even though the individual observables are sensitive to the details of reheating. It is hard to generate an observably large \gnl however. The runnings, \nfnl and \ntaunl, tend to satisfy a consistency relation \ntaunl=(3/2)\nfnl, but are in general too small to be observed for the class of models considered regardless of reheating timescale

Malignant colo-duodenal fistula; case report and review of the literature

BACKGROUND: Colo-duodenal fistula is a rare complication of malignant and inflammatory bowel disease. Cases with malignant colo-duodenal fistulae can present with symptoms from the primary, from the fistula or from metastatic disease. The fistula often results in diarrhoea and vomiting with dramatic weight loss. Upper abdominal pain is usually present as is general malaise both from the presence of the disease and from the metabolic sequelae it causes. The diarrhoea relates to colonic bacterial contamination of the upper intestines rather than to a pure mechanical effect. Vomiting may be faeculant or truly faecal and eructation foul smelling but in the case reports this 'classic' symptomatology was often absent despite a fistula being present and patent enough to allow barium through it. Occasionally patients will present with a gastro-intestinal bleed. CASE PRESENTATION: We present an unusual case of colorectal carcinoma, where a 65 year old male patient presented with diarrhoea and vomiting secondary to a malignant colo-duodenal fistula near the hepatic flexure. Adenocarcinoma was confirmed on histology from a biopsy obtained during the patient's oesophageogastroduodenoscopy, and the fistula was demonstrated in his barium enema. Staging computed tomography showed a locally advanced carcinoma of the proximal transverse colon, with a fistula to the duodenum and regional lymphadenopathy. The patient was also found to have subcutaneous metastasis. Following discussions at the multidisciplinary meeting, this patient was referred for palliation, and died within 4 months after discharge from hospital. CONCLUSION: We present the case, discuss the management and review the literature. Colo-duodenal fistulae from colonic primaries are rare but early diagnosis may allow curative surgery. This case emphasises the importance of accurate staging and repeated clinical examination

The Characterisation of Jesus the Davidic Shepherd in Mark’s Gospel: a narrative analysis through the lens of Metalepsis

While commentators widely acknowledge the importance of the role of the shepherd image in portraying the God of Israel, the earthly leadership and Jesus in the Hebrew Bible (HB) and the New Testament (NT), the two appearances of the images in Mark’s Gospel (6:34; 14:27) may appear to be of limited significance in portraying Jesus and his ministry, compared with the use of the Son of Man. While Mark’s use of the shepherd images has been the subject of scholarly debate, there is not yet a thorough analysis fully acknowledging the literary qualities of these images, which are intertextual references to the HB and figures of speech for narrative characterisation. Previous intertextual studies of the shepherd images selectively reduce the original literary backgrounds of the references to static themes without clarifying the selection process. Other examinations explore how the images portray Mark’s Jesus. However, those analyses inadequately consider the connections between the portrayal of Jesus as the Davidic shepherd and the other portraits of Jesus and the relevance between the two shepherd images along the plotline. By adopting a narrative-critical approach using Genette’s conception of narrative metalepsis, this thesis offers insights into the significance of Mark’s use of the shepherd images. It illuminates how the original literary background of the shepherd images functions to characterise Jesus and other characters along the plotline and create rhetorical impacts on Mark’s implied readers, persuading them to acknowledge the shepherding work of Jesus and the nature of being his disciples. Chapter 1 surveys the issues related to Mark’s shepherd image and reviews the secondary literature on the topic. Chapter 2 establishes a narrative-critical method for the thesis. By defining a specific implied reader, the methodology offers a theoretical framework for approaching the two shepherd images in Mark’s narrative as intertextual references and 2 figures of speech. Chapter 3 conducts an exegetical examination of the events surrounding the shepherd images in Ezekiel 34 and in Zech 13:7–9. This examination demonstrates how these events are relevant to the shepherd images and their significance in their original literary contexts. Chapter 4 studies the plot development of Mark 1:1–6:6 and explores how Mark’s narrator portrays Jesus and other characters, preparing the implied readers to receive the shepherd images. Before the concluding chapter summarises the present research, chapters 5 and 6 investigate the stories of Jesus feeding the five thousand (6:30–44) and Jesus’ prediction of Peter’s denial (14:26–31), which contain the two shepherd images in Mark’s narrative. Through the lens of narrative metalepsis, the analysis explains how the images characterise Jesus and other characters in the immediate context. These chapters also demonstrate how the portrayal of Jesus the Davidic shepherd connects to other portraits in the broader context of Mark’s narrative, creating rhetorical impacts on the implied readers. The metaleptic understanding of the shepherd images in Mark’s narrative highlights their profound significance in contrast to previous studies in several ways. First, Jesus is characterised as the Davidic shepherd appointed to fulfil God’s radical restoration with his death. The renewed community will enjoy the abundance of God and live a life of purity under Jesus’ shepherding ministry. Second, the Jewish religious leaders are portrayed as incorrigibly corrupted and deserving of God’s punishment. Lastly, the disciples appear to be both the insiders and outsiders in God’s kingdom. Their desertion of Jesus after he is arrested is to be understood as part of God’s refining and testing of them, demanding a response. Will they decide to follow Jesus the Davidic shepherd who will radically restore the covenantal relationship, or will they become outsiders in the kingdom of God

Association of maternal levothyroxine use during pregnancy with offspring birth and neurodevelopmental outcomes: a population-based cohort study

BACKGROUND: The influence of maternal levothyroxine treatment during pregnancy remains unclear. This study aimed to evaluate the associations of maternal levothyroxine treatment during pregnancy with the birth and neurodevelopmental outcomes in offspring. METHODS: This population-based cohort study was conducted among pregnant women using the Hong Kong Clinical Data Analysis and Reporting System. Mother-child pairs in Hong Kong from 2001 to 2015 were included and children were followed up till 2020. We defined the exposure group as mothers who were exposed to levothyroxine during pregnancy. Preterm birth and small for gestational age (SGA) were included as birth outcomes. Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) were included as neurodevelopmental outcomes. Odds ratios (OR) or hazard ratios (HRs) with a 95% confidence interval (CI) were evaluated to assess the association of gestational levothyroxine use with offspring birth and neurodevelopmental outcomes respectively, using propensity score fine-stratification weighting and a Cox proportional hazards regression model. RESULTS: Among 422,156 mother-child pairs, 2125 children were born from mothers exposed to levothyroxine during pregnancy. A significantly increased risk of preterm birth was observed in children with maternal levothyroxine exposure during pregnancy, when compared to mothers who had no history of thyroid-related diagnoses or prescriptions (weighted OR [wOR]: 1.22, 95% CI: 1.07, 1.39). Similarly, an increased risk of preterm birth was found among children of gestational levothyroxine users, when compared to children of mothers who had used levothyroxine before but stopped during pregnancy (wOR: 2.16, 95% CI: 1.09, 4.25). Sensitivity analysis, by excluding mothers exposed to psychotropic or antiepileptic medications before or during pregnancy, also indicated a similar increased risk of preterm birth regarding the gestational use of levothyroxine (wOR: 1.26, 95% CI: 1.10, 1.45). No significant association was observed for the risk of SGA, ADHD, and ASD. CONCLUSIONS: There is no evidence that gestational use of levothyroxine is associated with SGA, ADHD, or ASD in offspring. Gestational levothyroxine treatment is associated with a higher risk of preterm birth. Such risk might be confounded by the underlying maternal thyroid disease itself, however, we cannot completely exclude the possible effect of gestational L-T4 treatment on offspring preterm birth. Our findings provided support to the current guidelines on the cautious use of levothyroxine treatment during pregnancy. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12916-022-02586-9

Predictors of functional deterioration in Chinese patients with Psoriatic arthritis: A longitudinal study.

10.1186/1471-2474-15-284BMC Musculoskeletal Disorders15128

Decomposition, Reformulation, and Diving in University Course Timetabling

In many real-life optimisation problems, there are multiple interacting components in a solution. For example, different components might specify assignments to different kinds of resource. Often, each component is associated with different sets of soft constraints, and so with different measures of soft constraint violation. The goal is then to minimise a linear combination of such measures. This paper studies an approach to such problems, which can be thought of as multiphase exploitation of multiple objective-/value-restricted submodels. In this approach, only one computationally difficult component of a problem and the associated subset of objectives is considered at first. This produces partial solutions, which define interesting neighbourhoods in the search space of the complete problem. Often, it is possible to pick the initial component so that variable aggregation can be performed at the first stage, and the neighbourhoods to be explored next are guaranteed to contain feasible solutions. Using integer programming, it is then easy to implement heuristics producing solutions with bounds on their quality. Our study is performed on a university course timetabling problem used in the 2007 International Timetabling Competition, also known as the Udine Course Timetabling Problem. In the proposed heuristic, an objective-restricted neighbourhood generator produces assignments of periods to events, with decreasing numbers of violations of two period-related soft constraints. Those are relaxed into assignments of events to days, which define neighbourhoods that are easier to search with respect to all four soft constraints. Integer programming formulations for all subproblems are given and evaluated using ILOG CPLEX 11. The wider applicability of this approach is analysed and discussed.Comment: 45 pages, 7 figures. Improved typesetting of figures and table

Bezoar in gastro-jejunostomy presenting with symptoms of gastric outlet obstruction: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Gastric outlet obstruction usually presents with non-bilious vomiting, colicky epigastric pain, loss of appetite and occasionally, upper gastrointestinal bleeding. Causes can be classified as benign or malignant, or as extra- or intraluminal. Gastrojejunostomy is a well-recognised surgical procedure performed to bypass gastric outlet obstruction. A bezoar occurs most commonly in patients with impaired gastrointestinal motility or with a history of gastric surgery. It is an intestinal concretion, which fails to pass along the alimentary canal.</p> <p>Case presentation</p> <p>A 62-year-old Asian woman with a history of gastrojejunostomy for peptic ulcer disease was admitted to hospital with epigastric pain, vomiting and dehydration. All investigations concluded gastric outlet obstruction secondary to a "stricture" at the site of gastrojejunostomy. Subsequent laparotomy revealed that the cause of the obstruction was a bezoar.</p> <p>Conclusion</p> <p>Many bezoars can be removed endoscopically, but some will require operative intervention. Once removed, emphasis must be placed upon prevention of recurrence. Surgeons must learn to recognise and classify bezoars in order to provide the most effective therapy.</p

Acupuncture in the treatment of rheumatoid arthritis: a double-blind controlled pilot study

<p>Abstract</p> <p>Background</p> <p>In planning a randomized controlled trial of acupuncture, we conducted a pilot study using validated outcome measures to assess the feasibility of the protocol, and to obtain preliminary data on efficacy and tolerability of 3 different forms of acupuncture treatment as an adjunct for the treatment of chronic pain in patients with Rheumatoid arthritis (RA).</p> <p>Methods</p> <p>The study employs a randomized, prospective, double-blind, placebo-controlled trial to evaluate the effect of electroacupuncture (EA), traditional Chinese acupuncture (TCA) and sham acupuncture (Sham) in patients with RA. All patients received 20 sessions over a period of 10 weeks. Six acupuncture points were chosen. Primary outcome is the changes in the pain score. Secondary outcomes included the changes in the ACR core disease measures, DAS 28 score and the number of patients who achieved ACR 20 at week 10.</p> <p>Results</p> <p>From 80 eligible patients, 36 patients with mean age of 58 ± 10 years and disease duration of 9.3 ± 6.4 years were recruited. Twelve patients were randomized to each group. Twelve, 10 and 7 patients from the EA, TCA and Sham group respectively completed the study at 20 weeks (p < 0.03); all except one of the premature dropouts were due to lack of efficacy. At week 10, the pain score remained unchanged in all 3 groups. The number of tender joints was significantly reduced for the EA and TCA groups. Physician's global score was significantly reduced for the EA group and patient's global score was significantly reduced for the TCA group. All the outcomes except patient's global score remained unchanged in the Sham group.</p> <p>Conclusion</p> <p>This pilot study has allowed a number of recommendations to be made to facilitate the design of a large-scale trial, which in turn will help to clarify the existing evidence base on acupuncture for RA.</p> <p>Trial registration</p> <p>ClinicalTrials.gov NCT00404443</p

Deleted in Liver Cancer 2 (DLC2) Was Dispensable for Development and Its Deficiency Did Not Aggravate Hepatocarcinogenesis

DLC2 (deleted in liver cancer 2), a Rho GTPase-activating protein, was previously shown to be underexpressed in human hepatocellular carcinoma and has tumor suppressor functions in cell culture models. We generated DLC2-deficient mice to investigate the tumor suppressor role of DLC2 in hepatocarcinogenesis and the function of DLC2 in vivo. In this study, we found that, unlike homologous DLC1, which is essential for embryonic development, DLC2 was dispensable for embryonic development and DLC2-deficient mice could survive to adulthood. We also did not observe a higher incidence of liver tumor formation or diethylnitrosamine (DEN)-induced hepatocarcinogenesis in DLC2-deficient mice. However, we observed that DLC2-deficient mice were smaller and had less adipose tissue than the wild type mice. These phenotypes were not due to reduction of cell size or defect in adipogenesis, as observed in the 190B RhoGAP-deficient mouse model. Together, these results suggest that deficiency in DLC2 alone does not enhance hepatocarcinogenesis