Acute bleeding obstruction pancreatitis after Roux-en-Y anastomosis in total gastrectomy: a single center experience

Anastomotic intraluminal bleeding is a well-known complication after total gastrectomy. Nevertheless, few data are published on acute bleeding obstruction pancreatitis (BOP) due to a bleeding from the jejunojejunostomy (JJ). In this paper we describe our experience. A total of 140 gastrectomies for EGJ cancer were performed in our Institute from January 2012 to January 2017. All reconstructions were performed with a Roux-en-Y anastomosis: a mechanical end-to-side esophago-jejunostomy and a mechanical end-to-side JJ. Three patients suffered from a bleeding at the JJ with a consequent BOP. We analyzed the time of diagnosis, the treatment and the outcomes. The three patients presented anemia at the laboratory findings on postoperative day (POD) 1. In patient I laboratory findings of acute pancreatitis were found in POD 2. CT scan was performed and showed signs of BOP. Endoscopic treatment was tried without success. Therefore, patient underwent surgery: JJ take down, bleeding control and anastomosis rebuild were performed. In spite of this the patient died of MOF in POD 4. Patient II had a persistent anemia treated with blood transfusions until POD 3, when laboratory tests showed increased lipase and bilirubin levels. Patient was successfully treated with endoscopy but several blood transfusions and a prolonged recovery were necessary. Patient III had laboratory findings of acute pancreatitis on POD 1. Immediate surgery was performed and patient was discharged on POD 9 without sequelae. BOP is a rare but deadly complication after Roux-en-Y anastomosis. An early diagnosis and an aggressive treatment seem to improve the outcome

Hybrid rescue technique after failure of a standard multibranched stent graft

A 78-year-old woman presented with type IIIC and IIID endoleaks after endovascular treatment for a thoracoabdominal aortic aneurysm. Mating between the ruptured segments of superior mesenteric artery stent graft was performed. After failed attempts at relining the right renal artery stent graft, a hybrid approach was used to connect the side branch to the target vessel: a stent graft was deployed into the side branch of the main graft and it was temporarily occluded with a balloon. After opening the sac, a stent graft was deployed into the right renal artery and the two stent grafts were connected with a running suture. Follow-up examination performed 1 month postoperatively by computed tomography imaging confirmed the effectiveness of this treatment

Timing performance of a Micro-Channel-Plate Photomultiplier Tube

The spatial dependence of the timing performance of the R3809U-50 Micro-Channel-Plate PMT (MCP-PMT) by Hamamatsu was studied in high energy muon beams. Particle position information is provided by a GEM tracker telescope, while timing is measured relative to a second MCP-PMT, identical in construction. In the inner part of the circular active area (radius r5.5 mm) the time resolution of the two MCP-PMTs combined is better than 10 ps. The signal amplitude decreases in the outer region due to less light reaching the photocathode, resulting in a worse time resolution. The observed radial dependence is in quantitative agreement with a dedicated simulation. With this characterization, the suitability of MCP-PMTs as t0 reference detectors has been validated.Peer reviewe

Precise timing with the PICOSEC-Micromegas detector

This work presents the concept of the PICOSEC-Micromegas de-tector to achieve a time resolution below 30 ps. PICOSEC consists of a two-stageMicromegas detector coupled to a Cherenkov radiator and equipped with a photo-cathode. The results from single-channel prototypes as well as the understanding ofthe detector in terms of detailed simulations and preliminary results from a multi-channel prototype are presented.Peer reviewe

FICD acts bifunctionally to AMPylate and de-AMPylate the endoplasmic reticulum chaperone BiP

Protein folding homeostasis in the endoplasmic reticulum (ER) is defended by an unfolded protein response that matches ER chaperone capacity to the burden of unfolded proteins. As levels of unfolded proteins decline, a metazoan-specific FIC-domain-containing ER-localized enzyme (FICD) rapidly inactivates the major ER chaperone BiP by AMPylating T518. Here we show that the single catalytic domain of FICD can also release the attached AMP, restoring functionality to BiP. Consistent with a role for endogenous FICD in de-AMPylating BiP, FICD$_{-/-}$ hamster cells are hypersensitive to introduction of a constitutively AMPylating, de-AMPylation-defective mutant FICD. These opposing activities hinge on a regulatory residue, E234, whose default state renders FICD a constitutive de-AMPylase $\textit{in vitro}$. The location of E234 on a conserved regulatory helix and the mutually antagonistic activities of FICD $\textit{in vivo}$, suggest a mechanism whereby fluctuating unfolded protein load actively switches FICD from a de-AMPylase to an AMPylase.Supported by Wellcome Trust Principal Research Fellowship to D.R. (Wellcome 200848/Z/16/Z), a UK Medical Research Council PhD studentship to L.A.P. and a Wellcome Trust Strategic Award to the Cambridge Institute for Medical Research (Wellcome 100140)

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Local Governments’ Financial Vulnerability: Analysing the Impact of the Covid-19 Pandemic

Local Governments’ Financial Vulnerability presents a conceptual framework developed to examine how vulnerable local finances were before and in the immediate aftermath of the COVID-19 pandemic crisis by mapping and systematising its dimensions and sources. The model is then applied to eight countries with different administrative models and traditions: Australia, Austria, Bosnia and Herzegovina, Germany, Italy, Portugal, Spain, and the United States. Comparative results reveal not only that COVID-19 impacts and policy tools had a lot of similarities across countries, but also that financial vulnerability has an inherently contingent nature intime and space and can lead to paradoxical outcomes. The book shows that the impact of the crisis on local governments’ finances hasbeen postponed and that financial vulnerability is expected to increase dramatically for a few years following the pandemic, especially in larger and richer municipalities which are traditionally more autonomous and less financially vulnerable. The authors providetimely insights and analytical tools that can be useful for both academic and public policy purposes, to further appreciate local governments’ financial vulnerability, especially during crises. This book is a valuable resource for practitioners and academics, as well as students of public policy, public management, financial management, and public accounting. Local governments can use the framework to better appreciate and manage their financial vulnerability, while oversight authorities can use it to help local governments become less financially vulnerable or, at least, more aware of their financial vulnerability. Financial institutions, advisors, and rating agencies may use this publication to refine or revise their models of credit risk assessment