Pancreatico-gastric fistula arising from IPMN associated with ductal adenocarcinoma of the pancreas: a case report and a literature review

IntroductionAn intraductal papillary mucinous neoplasm (IPMN) is a potentially malignant cystic tumor that is characterized by an excessive papillary proliferation of mucin-producing epithelial cells. The IPMN usually exhibits different degrees of dysplasia and is accompanied by cystic dilation of the main pancreatic duct (MPD) or side branch. We report a case of an IPMN that has penetrated the stomach and has differentiated into an adenocarcinoma.Case presentationA 69-year-old female, suffering from chronic pancreatitis of unknown etiology, visited our outpatient clinic with complaints of sudden weight loss, diarrhea, and abdominal pain. She underwent several examinations to evaluate the reasons for her sudden onset of symptoms. A gastroscopy showed an ulcerated lesion covered with mucus. CT and magnetic resonance cholangiopancreatography images revealed that the MPD was dilated to 1.3 cm with a fistula formation between the MPD and the stomach. After a multidisciplinary discussion of this case, a total pancreatectomy was proposed. An en bloc total pancreatectomy with gastric wedge resection including the fistula together with splenectomy was carried out. A Roux-en-Y choledochojejunostomy and gastrojejunostomy were performed. Histology results revealed the association of IPMN with invasive carcinoma.DiscussionMany reports on IPMN of the pancreas have been published recently. Fistula formation between IPMN and adjacent organs is possible. Given the CT and endoscopic ultrasonography findings, it shows that in our case a main duct IPMN (MD-IPMN) formed a pancreatico-gastric fistula. We point out that the adherence of invasive cancer cells contributed to the fistula formation between the pancreas and the stomach.ConclusionThis case report provides evidence for the possibility of IPMN becoming complicated with pancreatico-gastric fistula. Thus, we suggest that surgical resection should be considered in the case of MD-IPMN because of its high propensity for malignant transformation

Dental Hygiene, Dental, and Medical Students’ OMFS/Hospital Dentistry‐Related Knowledge/Skills, Attitudes, and Behavior: An Exploration

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153557/1/jddj002203372017812tb06260x.pd

Comparing carriers as a support media of white-rot fungi in natural tannins removal

In the last decades, White-rot Fungi bioremediation potential has been widely investigated, providing remarkable results toward several recalcitrant molecules. However, full-scale applications based on fungi are not employed yet and little is known about their optimal operating conditions, such as (i) their ability to grow without sterile conditions, (ii) co-substrate requirements and (iii) the accurate carrier design for fungal growth. In this study, several batch tests were performed as preliminary steps to evaluate the possible design of a pilot-scale reactor based on fungal biomass to be operated under not-sterile conditions in the removal of Quebracho natural tannin. The tests were performed to verify fungal affinity, including Basidiomycetes and Ascomycetes for innovative cellulose-containing carriers compared to commonly employed PolyUrethane Foam Cubes. In particular, four fungi, including three Basidiomycetes White-rot Fungi, Bjerkandera adusta, Phanerochaete chrysosporium and Tyromyces chioneus and the Ascomycota strain Aspergillus tubingensis, were employed. As a first step, fungi were tested to evaluate their ability to attach and grow onto 12 types of innovative carriers made by High-Density PolyEthylene and containing cellulose in different percentages. Other tests were performed without sterile conditions. In particular, fungal abilities (i) to attach and grow onto two different types of support, including cellulose-containing carrier and polyurethane foam cubes and (ii) to biotransform recalcitrant molecules (Quebracho natural tannin) (iii) to grow and operate synergistically in a consortium of two fungi, were evaluated. The main parameters evaluated were soluble Chemical Oxygen Demand (sCOD) reduction and dry weight increase. Basidiomycetes showed high affinity for cellulose-containing carrierswith the highest cellulose percentage (7%) achieving full colonization and 60% coverage, in sterile conditions and not- sterile conditions, respectively. These results were associated with a Quebracho sCOD removal of 25 ± 4%, without sterility. When combined, the two selected strains, Bjerkandera adusta and Aspergillus tubingensis were able to grow on carriers and to remove up to 15 ± 4% of tannins recalcitrant sCOD. This study provides evidence of (i) Basidiomycetes high affinity for cellulose-containing carriers that could favour fungi attachment in sterile and not-sterile conditions and (ii) the feasibility of a combined use of Ascomycetes and Basidiomycetes in bioremediation

Tribological properties of unbalanced magnetron sputtered nano-scale multilayer coatings TiAlN/VN and TiAlCrYN deposited on plasma nitrided steels

Unbalanced magnetron sputtered multilayer coatings TiAlN/VN and TiAlCrYN grown on pulse plasma nitriding pre-treated low alloy steel P20 have been characterised by using X-ray diffraction (XRD), scanning electron microscope (SEM), micro-indentation, scratch and pin-on-dise wear tests. A 160-mu m-thick nitrided case was formed on the steel surface containing a pure Fe3N and Fe4N compound layer and showing hardness up to 8.5 GPa, which led to improved load bearing ability and adhesion behaviour of the coating-substrate system. The coatings deposited on non-nitrided P20 showed poor adhesion and severe cracking and spalling wear. In contrast, the TiAlN/VN and TiAlCrYN deposited on nitrided substrates showed only mild polishing and oxidation wear mechanisms and extremely low wear coefficients in the scales of 10(-17) and 10(-16) m(3) N-1 m(-1), respectively. In drilling solution treated 304 austenite stainless steel, the TiAlN/VN-coated drills showed a lifetime 50% longer than TiAlN-coated drills. Plasma nitriding pre-treatment led to further increases of lifetime by 33%. (c) 2004 Elsevier B.V. All rights reserved

"Dark" GRB 080325 in a Dusty Massive Galaxy at z ~ 2

We present optical and near infrared observations of GRB 080325 classified as a "Dark GRB". Near-infrared observations with Subaru/MOIRCS provided a clear detection of afterglow in Ks band, although no optical counterpart was reported. The flux ratio of rest-wavelength optical to X-ray bands of the afterglow indicates that the dust extinction along the line of sight to the afterglow is Av = 2.7 - 10 mag. This large extinction is probably the major reason for optical faintness of GRB 080325. The J - Ks color of the host galaxy, (J - Ks = 1.3 in AB magnitude), is significantly redder than those for typical GRB hosts previously identified. In addition to J and Ks bands, optical images in B, Rc, i', and z' bands with Subaru/Suprime-Cam were obtained at about one year after the burst, and a photometric redshift of the host is estimated to be z_{photo} = 1.9. The host luminosity is comparable to L^{*} at z \sim 2 in contrast to the sub-L^{*} property of typical GRB hosts at lower redshifts. The best-fit stellar population synthesis model for the host shows that a large dust extinction (Av = 0.8 mag) attributes to the red nature of the host and that the host galaxy is massive (M_{*} = 7.0 \times 10^{10} Msun) which is one of the most massive GRB hosts previously identified. By assuming that the mass-metallicity relation for star-forming galaxies at z \sim 2 is applicable for the GRB host, this large stellar mass suggests the high metallicity environment around GRB 080325, consistent with inferred large extinction.Comment: 22 pages, 10 figures, accepted for publication in The Astrophysical Journa

Case Report The Case for Improved Interprofessional Care: Fatal Analgesic Overdose Secondary to Acute Dental Pain during Pregnancy

Prenatal oral health extends beyond the oral cavity, impacting the general well-being of the pregnant patient and her fetus. This case report follows a 19-year-old pregnant female presenting with acute liver failure secondary to acetaminophen overdose for management of dental pain following extensive dental procedures. Through the course of her illness, the patient suffered adverse outcomes including fetal demise, acute kidney injury, spontaneous bacterial peritonitis, and septic shock before eventual death from multiple organ failure. In managing the pregnant patient, healthcare providers, including physicians and dentists, must recognize and optimize the interconnected relationships shared by the health disciplines. An interdisciplinary approach of collaborative and coordinated care, the timing, sequence, and treatment for the pregnant patient can be improved and thereby maximize overall quality of health. Continued efforts toward integrating oral health into general healthcare education through interprofessional education and practice are necessary to enhance the quality of care that will benefit all patients

Spectrum and Variability of Mrk501 as observed by the CAT Imaging Telescope

The CAT Imaging Telescope has observed the BL Lac object Markarian 501 between March and August 1997. We report here on the variability over this time including several large flares. We present also preliminary spectra for all these data, for the low emission state, and for the largest flare.Comment: 4 pages, 4 figures, Late

Observation of the Crab Nebula Gamma-Ray Emission Above 220 Gev by the Cat Cherenkov Imaging Telescope

The CAT imaging telescope, recently built on the site of the former solar plant Themis (French Pyrenees), observed gamma-rays from the Crab nebula from October 1996 to March 1997. This steady source, often considered as the standard candle of very-high-energy gamma-ray astronomy, is used as a test-beam to probe the performances of the new telescope, particularly its energy threshold (220 GeV at 20 degrees zenith angle) and the stability of its response. Due to the fine-grain camera, an accurate analysis of the longitudinal profiles of shower images is performed, yielding the source position in two dimensions for each individual shower.Comment: 5 pages, 3 figures, Tex, contribution to 25th ICRC Durba

Detection of Vhe Gamma-Rays from MRK 501 with the Cat Imaging Telescope

The CAT imaging telescope on the site on the former solar plant Themis has been observing gamma-rays from Mrk501 above 220 GeV in March and April 1997. This source is shown to be highly variable and the light curve is presented. The detected gamma-ray rate for the most intense flare is in excess of 10 per minute.Comment: 5 pages, 4 figures, Tex, contribution to 25th ICRC Durba

CD8(+) T cells retain protective functions despite sustained inhibitory receptor expression during Epstein-Barr virus infection in vivo

Epstein Barr virus (EBV) is one of the most ubiquitous human pathogens in the world, persistently infecting more than 90% of the adult human population. It drives some of the strongest human CD8+ T cell responses, which can be observed during symptomatic primary infection known as infectious mononucleosis (IM). Despite high viral loads and prolonged CD8+ T cell stimulation during IM, EBV enters latency and is under lifelong immune control in most individuals that experience this disease. We investigated whether changes in T cell function, as frequently characterized by PD-1 up-regulation, occur during IM due to the prolonged exposure to high antigen levels. We readily detected the expansion of PD-1 positive CD8+ T cells together with high frequencies of Tim-3, 2B4, and KLRG1 expression during IM and in mice with reconstituted human immune system components (huNSG mice) that had been infected with a high dose of EBV. These PD-1 positive CD8+ T cells, however, retained proliferation, cytokine production, and cytotoxic abilities. Multiple subsets of CD8+ T cells expanded during EBV infection, including PD-1+ Tim-3+ KLRG1+ cells that express CXCR5 and TCF-1 germinal center homing and memory markers, and may also contain BATF3. Moreover, blocking the PD-1 axis compromised EBV specific immune control and resulted in virus-associated lymphomagenesis. Finally, PD-1+ , Tim-3+ , and KLRG1+ CD8+ T cell expansion coincided with declining viral loads during low dose EBV infection. These findings suggest that EBV infection primes PD-1 positive CD8+ T cell populations that rely on this receptor axis for the efficient immune control of this ubiquitous human tumor virus