Annular pancreas: endoscopic and pancreatographic findings from a tertiary referral ERCP center

Background and Aims Annular pancreas is a congenital anomaly whereby pancreatic tissue encircles the duodenum. Current knowledge of endoscopic findings of annular pancreas is limited to small case series. The aim of this study was to describe the endoscopic and pancreatographic findings of patients with annular pancreas at a large tertiary care ERCP center. Methods This is a retrospective observational study. Our Institutional Review Board–approved, prospectively collected ERCP database was queried for cases of annular pancreas. The electronic medical records were searched for patient and procedure-related data. Results From January 1, 1994, to December 31, 2016, 46 patients with annular pancreas underwent ERCP at our institution. Index ERCP was technically successful in 42 patients (91.3%), and technical success was achieved in all 46 patients (100%) after 2 attempts, when required. A duodenal narrowing or ring was found in most patients (n = 39, 84.8%), yet only 2 (4.3%) had retained gastric contents. Pancreas divisum was found in 21 patients (45.7%), 18 of which were complete divisum. Pancreatobiliary neoplasia was the indication for ERCP in 7 patients (15.2%). Pancreatographic findings consistent with chronic pancreatitis were noted in 15 patients (32.6%) at the index ERCP. Conclusion This is the largest series describing the endoscopic and pancreatographic findings of patients with annular pancreas. We found that 45.7% of patients had concurrent pancreas divisum. Endoscopic therapy was successful in most patients at our institution after 1 ERCP, and in all patients after a second ERCP. Nearly one-third of patients had findings consistent with chronic pancreatitis at the time of index ERCP. It is unclear whether this may be a feature of the natural history of annular pancreas

Avaliação das diferenças de gênero nas estratégias de enfrentamento da dor lombar

El dolor lumbar puede ser visto como un gran problema de salud pública. Las diferencias de género son importantes factores que influyen en los síntomas y en las respuestas del comportamiento. El objetivo de este estudio fue investigar las diferencias de género en los comportamientos de dolor y en el manejo del dolor lumbar crónico. La muestra estuvo conformada por 158 participantes (66,5% mujeres), con edades entre los 30 y 88 años que fueron diagnosticados con artrosis lumbar. Los instrumentos utilizados fueron: la Escala Visual Analógica, el Cuestionario de Calidad de Vida y un cuestionario para evaluar las actividades de ocio y distracción del dolor. Los resultados del MANOVA demostraron que las mujeres presentaron mayor percepción del dolor que los hombres. También fue posible observar frecuencias más altas de actividades sociales en las mujeres, así como correlaciones significativas entre las actividades sociales y los dominios psicológicos, sociales y medio ambientales. En conclusión, las mujeres presentan un mayor número de estrategias de afrontamiento para el dolor, lo cual puede influir positivamente en su calidad de vida.A dor lombar pode ser vista como um grande problema de saúde pública. As diferenças de gênero são importantes fatores que influenciam nos sintomas e nas respostas do comportamento. O objetivo deste estudo foi pesquisar as diferenças de gênero nos comportamentos de dor e na gestão da dor lombar crônica. A amostra foi conformada por 158 participantes (66,5% mulheres), com idade entre 30 e 88 anos, que foram diagnosticadas com artrose lombar. Os instrumentos utilizados foram: a Escala Visual Analógica, o Questionário de Qualidade de Vida e um questionário para avaliar as atividades de lazer e distração da dor. Os resultados do MANOVA demonstraram que as mulheres apresentaram maior percepção da dor do que os homens. Também foi possível observar frequências mais altas de atividades sociais nas mulheres, bem como correlações significativas entre as atividades sociais e os domínios psicológicos, sociais e meio ambientais. Em conclusão, as mulheres apresentaram um maior número de estratégias de enfrentamento para a dor, o que pode influenciar positivamente em sua qualidade de vida.Low-back pain is considered a serious public health problem. Gender differences are important factors that influence symptoms and behavioral responses. This research aimed to investigate gender differences in pain behaviors and pain management of chronic low back pain. The sample consisted of 158 participants (66.5% female), aged 30-88 who were diagnosed with Lumbar Osteoarthritis. The instruments used were the Visual Analogue Scale, the Quality of Life Questionnaire and a questionnaire to assess leisure and distraction activities from pain. Results of MANOVA showed that women have significant greater pain perception than men. Higher frequencies of social activities were also observed for women as well as significant correlations between social activities and psychological, social and environmental domains. In conclusion, women presented a greater number of coping strategies for pain than men, which probably tend to have a positive influence in their life quality

Dual function filtration and catalytic breakdown of organic pollutants in wastewater using ozonation with titania and alumina membranes

Water recycling via treatment from industrial and/or municipal waste sources is one of the key strategies for resolving water shortages worldwide. Polymer membranes are effective at improving the water quality essential for recycling, but depend on regular cleaning and replacement. Pure ceramic membranes can reduce the cleaning need and last significantly longer in the same applications while possessing the possibility of operating in more aggressive environments not suitable for polymers. In the current work, filtration using a tubular ceramic membrane (�-Al2O3 or TiO2) was combined with ozonation to remove organic compounds present in a secondary effluent to enhance key quality features of the water (colour and total organic carbon, TOC) for its potential reuse. ‘Bare’ commercial �-Al2O3 filters (pore size ∼0.58 �m) were tested as a microfiltration membrane and compared with the more advanced catalytically active TiO2 layer that was formed by the sol–gel method. The presence of anatase with a 4 nm pore size at the membrane surface was confirmed by X-ray diffraction (XRD) and N2 adsorption. Filtration of the effluent over a 2 h period led to a reduction in flux to 45% and 60% of the initial values for the �-alumina and TiO2 membrane, respectively. However, a brief dose (2 min) of ozone at the start of the run resulted in reductions to only 70% of the initial flux for both membranes. It is likely that the oxide’s functional property facilitated the formation of hydroxyl (OH•) or other radicals on the membrane surface from ozone decomposition which targeted the breakdown of organic foulants thus inhibiting their deposition. Interestingly, the porous structure therefore acted in a synergistic, dual function mode to physically separate the particulates while also catalytically breaking down organic matter. The system also greatly improved the efficiency of membrane filtration for the reduction of colour, A254 (organics absorption at the wavelength of 254 nm) and TOC. The best performance came from combined ozonation (2 min ozonation time with an estimated applied ozone dose of 8 mg L−1) with the TiO2 membrane, which was able to reduce colour by 88%, A254 by 75% and TOC by 43%. It is clearly evident that a synergistic effect occurs with the process combination of ozonation and ceramic membrane filtration demonstrating the practical benefit of combining ceramic membrane filtration with conventional water ozonation

Research priorities in advanced heart failure: James Lind alliance priority setting partnership.

OBJECTIVE: To determine research priorities in advanced heart failure (HF) for patients, carers and healthcare professionals. METHODS: Priority setting partnership using the systematic James Lind Alliance method for ranking and setting research priorities. An initial open survey of patients, carers and healthcare professionals identified respondents' questions, which were categorised to produce a list of summary research questions; questions already answered in existing literature were removed. In a second survey of patients, carers and healthcare professionals, respondents ranked the summary research questions in order of priority. The top 25 unanswered research priorities were then considered at a face-to-face workshop using nominal group technique to agree on a 'top 10'. RESULTS: 192 respondents submitted 489 responses each containing one or more research uncertainty. Out-of-scope questions (35) were removed, and collating the responses produced 80 summary questions. Questions already answered in the literature (15) were removed. In the second survey, 65 questions were ranked by 128 respondents. The top 10 priorities were developed at a consensus meeting of stakeholders and included a focus on quality of life, psychological support, the impact on carers, role of the charity sector and managing prognostic uncertainty. Ranked priorities by physicians and patients were remarkably divergent. CONCLUSIONS: Engaging stakeholders in setting research priorities led to a novel set of research questions that might not have otherwise been considered. These priorities can be used by researchers and funders to direct future research towards the areas which matter most to people living with advanced HF

Стилистический эффект разговорной речи и его составляющие

В обучении русскому языку как иностранному на современном этапе большое внимание уделяется особенностям русской разговорной речи. Это обусловлено целым рядом причин, среди которых, на наш взгляд, можно выделить следующие: во-первых, разговорная речь всегда отличается активностью проникновения во все сферы жизнедеятельности людей и функционирует как в повседневном общении, так и в различных сферах (литературе, кино, политике и т.д.). Во-вторых, разговорная речь носит многожанровый характер, что зачастую затрудняет ее понимание иностранными студентами. В-третьих, в разговорную речь помимо слов нейтрального стиля все активнее стала проникать арготическая лексика. Именно в связи с этим особый интерес у нас вызывает разговорный стиль речи в преломлении на инофонную аудиторию

Multidecadal ocean variability and NW European ice sheet surges during the last deglaciation

A multiproxy paleoceanographic record from the Atlantic margin off the British Isles reveals in unprecedented detail discharges of icebergs and meltwater in response to sea surface temperature increases across the last deglaciation. We observe the earliest signal of deglaciation as a moderate elevation of sea surface temperatures that commenced with a weakly developed thermocline and the presence of highly ventilated intermediate waters in the Rockall Trough. This warming pulse triggered a series of multidecadal ice-rafted debris peaks that culminated with a major meltwater discharge at 17,500 years before present related to ice sheet disintegration across the NW European region. The impact of meltwater caused a progressive reduction in deep water ventilation and a sea surface cooling phase that preceded the collapse of the Laurentide Ice Sheet during Heinrich event 1 by 500-1000 years. A similar sequence of rapid ocean-ice sheet interaction across the European continental margin is identified during the Bølling-Allerød to Younger Dryas transition. The strategic location of our sediment core suggests a sensitive and rapid response of ice sheets in NW Europe to transient increases in thermohaline heat transport

Reflections

The American Society of International Law Committee recommended that the Manley 0. Hudson Medal be awarded to Professor Eric Stein for his lifetime of significant contributions to international and comparative law. Stein, the Hessel E. Yntema Professor of Law, Emeritus, at the University of Michigan Law School, had been an active supporter of ASIL as Honorary Vice President, Counsellor, and Honorary Editor of, and frequent contributor to, the American Journal of International Law. His many books and articles established him as a leading thinker and writer on European Community law and on what he described in a famous article as the Uses, Misuses, and Nonuses of Comparative Law

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts