123 research outputs found

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

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    <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

    The outlook of building information modeling for sustainable development

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    As human needs evolve, information technologies and natural environments require a wider perspective of sustainable development, especially when examining the built environment that impacts the central of social-ecological systems. The objectives of the paper are (a) to review the status and development of building information modeling (BIM) in regards to the sustainable development in the built environment, and (b) to develop a future outlook framework that promotes BIM in sustainable development. Seven areas of sustainability were classified to analyze forty-four BIM guidelines and standards. This review examines the use of BIM in sustainable development, focusing primarily on certain areas of sustainability, such as project development, design, and construction. The developed framework describes the need for collaboration with the multiple disciplines for the future adoption and use of BIM for the sustainable development. It also considers the integration between “BIM and green assessment criteria”; and “BIM and renewable energy” to address the shortcomings of the standards and guidelines

    IBMPFD disease-causing mutant VCP/p97 proteins are targets of autophagic-lysosomal degradation

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    The ubiquitin-proteasome system (UPS) degrades soluble proteins and small aggregates, whereas macroautophagy (autophagy herein) eliminates larger protein aggregates, tangles and even whole organelles in a lysosome-dependent manner. VCP/p97 was implicated in both pathways. VCP/p97 mutations cause a rare multisystem disease called IBMPFD (Inclusion Body Myopathy with Paget's Disease and Frontotemporal Dementia). Here, we studied the role IBMPFD-related mutants of VCP/p97 in autophagy. In contrast with the wild-type VCP/p97 protein or R155C or R191Q mutants, the P137L mutant was aggregate-prone. We showed that, unlike commonly studied R155C or R191Q mutants, the P137L mutant protein stimulated both autophagosome and autolysosome formation. Moreover, P137L mutant protein itself was a substrate of autophagy. Starvation- and mTOR inhibition-induced autophagy led to the degradation of the P137L mutant protein, while preserving the wild-type and functional VCP/p97. Strikingly, similar to the P137L mutant, other IBMPFD-related VCP/p97 mutants, namely R93C and G157R mutants induced autophagosome and autolysosome formation; and G157R mutant formed aggregates that could be cleared by autophagy. Therefore, cellular phenotypes caused by P137L mutant expression were not isolated observations, and some other IBMPFD disease-related VCP/p97 mutations could lead to similar outcomes. Our results indicate that cellular mechanisms leading to IBMPFD disease may be various, and underline the importance of studying different disease-associated mutations in order to better understand human pathologies and tailor mutation-specific treatment strategies

    Green process innovation: Where we are and where we are going

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    Environmental pollution has worsened in the past few decades, and increasing pressure is being put on firms by different regulatory bodies, customer groups, NGOs and other media outlets to adopt green process innovations (GPcIs), which include clean technologies and end-of-pipe solutions. Although considerable studies have been published on GPcI, the literature is disjointed, and as such, a comprehensive understanding of the issues, challenges and gaps is lacking. A systematic literature review (SLR) involving 80 relevant studies was conducted to extract seven themes: strategic response, organisational learning, institutional pressures, structural issues, outcomes, barriers and methodological choices. The review thus highlights the various gaps in the GPcI literature and illuminates the pathways for future research by proposing a series of potential research questions. This study is of vital importance to business strategy as it provides a comprehensive framework to help firms understand the various contours of GPcI. Likewise, policymakers can use the findings of this study to fill in the loopholes in the existing regulations that firms are exploiting to circumvent taxes and other penalties by locating their operations to emerging economies with less stringent environmental regulations.publishedVersio

    What can whiskers tell us about mammalian evolution, behaviour, and ecology?

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    Most mammals have whiskers; however, nearly everything we know about whiskers derives from just a handful of species, including laboratory rats Rattus norvegicus and mice Mus musculus, as well as some species of pinniped and marsupial. We explore the extent to which the knowledge of the whisker system from a handful of species applies to mammals generally. This will help us understand whisker evolution and function, in order to gain more insights into mammalian behaviour and ecology. This review is structured around Tinbergen’s four questions, since this method is an established, comprehensive, and logical approach to studying behaviour. We ask: how do whiskers work, develop, and evolve? And what are they for? While whiskers are all slender, curved, tapered, keratinised hairs that transmit vibrotactile information, we show that there are marked differences between species with respect to whisker arrangement, numbers, length, musculature, development, and growth cycles. The conservation of form and a common muscle architecture in mammals suggests that early mammals had whiskers. Whiskers may have been functional even in therapsids. However, certain extant mammalian species are equipped with especially long and sensitive whiskers, in particular nocturnal, arboreal species, and aquatic species, which live in complex environments and hunt moving prey. Knowledge of whiskers and whisker use can guide us in developing conservation protocols and designing enriched enclosures for captive mammals. We suggest that further comparative studies, embracing a wider variety of mammalian species, are required before one can make large-scale predictions relating to evolution and function of whiskers. More research is needed to develop robust techniques to enhance the welfare and conservation of mammals

    A case report on a nasolabial cyst presenting with a nasolacrimal sac cyst

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    Nasolabial cysts are rare, nonodontogenic soft tissue developmental cysts that occur in the maxillary lip and nasal alar regions. Patients with this type of cyst generally presents with an asymptomatic soft swelling that may obliterate the nasolabial fold, elevate the nasal ala or the floor of the nose and fill the labial vestibule intraorally. The exact origin of nasolabial cysts is uncertain. The seed theory suggests that these cysts develop from a misplaced epithelium of the nasolacrimal duct because of their similar location and histologic appearance. This report aimed to present a case of nasolabial cyst presenting with a nasolacrimal sac cyst.Key words: Nasolabial cyst, nasolacrimal sac cyst, nonodontogenic cys

    Sequential Product Development and Introduction by Cash-Constrained Start-Ups

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    Firms developing novel and innovative products regularly face a canonical product development and introduction problem: introduce a proven and immediately available product, or delay product introduction until the successful development of an advanced version. Limited access to resources for the development of an advanced version adds another wrinkle to this problem, particularly for cash-constrained startups. For such startups, introduction of an on-hand product can generate additional funds to support the development of an advanced product. However, the lower performance of the on-hand product can negatively impact the perception of the firm’s future products — i.e., cannibalize the payoffs of the advanced product — and lower future profitability. In this paper, we study this trade-off between revenues that an on-hand product generates for R&D funding and the cannibalization effect it has on future products. We characterize the optimal introduction timing of the on-hand product as a function of the financial resource constraints, the interdependence between these sequential products and the cost of development. Comparison of these results with that of an established firm (with no such cash constraints) show important differences between the optimal product introduction strategies of a startup and an established firm. Specifically, while it is always optimal for an established firm to accelerate the launch of a better quality on-hand product, a startup might find it optimal to delay its launch. We translate our analytical findings into a managerial framework and illustrate these results using examples from the pharmaceutical and medical devices industries
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