Percutaneous cholecystostomy:Single centre experience in 111 patients with an acute cholecystitis

'Purpose: 'To evaluate the safety and long-term outcome of percutaneous cholecystostomy (PC) under radiologic guidance for acute calculous cholecystitis (ACC) and acute acalculous cholecystitis (AAC) in all patients undergoing that procedure at our institution. 'Materials and methods: 'We performed a retrospective analysis of 111 patients who underwent PC from 2004 to 2012. Patients were divided into two groups: AAC and ACC. For all patients, comorbidity and American Society of Anesthesiologists (ASA) classification were determined. The indications, complications, recurrence rate and long-term outcome for both groups were analysed. The mean follow-up was 55 months. 'Results: 'Twenty-four patients with AAC and 87 patients with ACC underwent PC. The most common sonographic findings of ACC and AAC were gallbladder wall thickening (90,9%) and hydrops (72,9%). Twelve of 24 patients with AAC (50%) were hospitalized at the Intensive Care Unit (ICU). Overall, the procedure failed in 2 (1,8%) patients. There were 4 (3,6%) abscesses and 2 (1,8%) fistulas post PC. Drain dislodgment was found without sequelae in 8 (7,2%) patients. Elective cholecystectomy was performed in 35/111 (31,5%). Fifty-one of 87 (58,6%) patients with gallstones underwent cholecystectomy; 36/87 (41,3%) did not undergo surgery due to a too short follow-up or death of nonbiliary disease. In the AAC group, there was no recurrent cholecystitis in 17/24 (70,8%) patients; 3/24 (12,5%) underwent surgery and 4/24 (16,6%) patients died in the ICU. 'Conclusion: 'PC is a minimally invasive treatment with low complication rate for patients with acute cholecystitis whom considered being at high-risk for urgent cholecystectomy. Good selection (ASA III and IV) and indication is needed in patients with ACC before PC because the majority will be operated later on. AAC can be managed nonoperatively and further treatment might not be needed

The SPAN cookbook: A practical guide to accessing SPAN

This is a manual for remote users who wish to send electronic mail messages from the Space Physics Analysis Network (SPAN) to scientific colleagues on other computer networks and vice versa. In several instances more than one gateway has been included for the same network. Users are provided with an introduction to each network listed with helpful details about accessing the system and mail syntax examples. Also included is information on file transfers, remote logins, and help telephone numbers

A placebo-controlled trial of folic acid and betaine in identical twins with Angelman syndrome.

BackgroundAngelman syndrome (AS) is a neurodevelopmental disorder that is caused by maternal genetic deficiency of a gene that encodes E6-AP ubiquitin-protein ligase (gene symbol UBE3A) mapping to chromosome 15q11-q13. AS leads to stiff and jerky gait, excess laughter, seizures, and severe intellectual disability. In some parts of the brain, the paternally inherited UBE3A gene is subject to genomic imprinting by the action of the UBE3A-antisense transcript (UBE3A-ATS) on the paternally inherited allele. Consequently, only the maternally inherited UBE3A gene is expressed in mature neurons. AS occurs due to deletions of the maternal 15q11 - 13 region, paternal uniparental disomy (UPD), imprinting center defects, mutations in the maternal UBE3A gene, or other unknown genetic malfunctions that result in a silenced maternal UBE3A gene in the specific imprinted regions of the brain.ResultsA potential treatment strategy for AS is to increase methylation of UBE3A-ATS to promote expression of the paternal UBE3A gene and thus ameliorate the clinical phenotypes of AS. We treated two sets of male identical twins with class I deletions with a 1 year treatment trial of either betaine and folic acid versus placebo. We found no statistically significant changes in the clinical parameters tested at the end of the 1 year trial, nor did we find any significant adverse events.ConclusionsThis study tested the hypothesis that by increasing the methylation of the UBE3A-antisense transcript in Angelman syndrome to promote expression of the silenced paternal UBE3A gene we may ameliorate the clinical phenotypes of AS. We treated two sets of identical twins with placebo versus betaine and folic acid. Although this study represented a novel approach to treating Angelman syndrome, the differences in the developmental testing results was not significant. This paper also discusses the value of monozygotic twin studies in minimizing confounding variables and its utility in conducting small treatment studies.Trial registrationNCT00348933 . Registered 6 July 2006

The association between psychological factors and breastfeeding behaviour in women with a body mass index (BMI) ≥30 kg m-2: a systematic review

Breastfeeding can play a key role in the reduction of obesity, but initiation and maintenance rates in women with a body mass index (BMI) of ≥30 kg m−2 are low. Psychological factors influence breastfeeding behaviours in the general population, but their role is not yet understood in women with a BMI ≥30 kg m−2. Therefore, this review aimed to systematically search and synthesize the literature, which has investigated the association between any psychological factor and breastfeeding behaviour in women with a BMI ≥30 kg m−2. The search identified 20 eligible papers, reporting 16 psychological factors. Five psychological factors were associated with breastfeeding behaviours: intentions to breastfeed, belief in breast milk's nutritional adequacy and sufficiency, belief about other's infant feeding preferences, body image and social knowledge. It is therefore recommended that current care should encourage women to plan to breastfeed, provide corrective information for particular beliefs and address their body image and social knowledge. Recommendations for future research include further exploration of several psychological factors (i.e. expecting that breastfeeding will enhance weight loss, depression, anxiety and stress) and evidence and theory‐based intervention development

World without cash – changes in conventional banking and payment systems

Cash remains the dominant means of payment in most countries around the world – with its importance being highest in Africa and lowest in Oceania. With approximately 60 % of transactions being made in cash, Germany ranged in the upper midfeld in Europe in 2020. However, compared to 74 % in 2017, the decline in cash use was massive – probably also due to the COVID-19 pandemic. The main winners of this development in Germany are the providers of debit and credit cards. Tese are used as plastic cards in bricks-and-mortar trade and as virtual cards for processing mobile payments and Internet payment methods. New players such as BigTechs and FinTechs are becoming increasingly active with regard to payment transactions and ofer products and services for more convenient payments with various additional functions

The Perceptions And Experiences Of Women With A Body Mass Index ≥ 30 kg m2 Who Breastfeed: A Meta-synthesis

Breastfeeding has copious health benefits for both mother and child, but rates of initiation and maintenance amongst women with a BMI ≥30kg/m2 are low. Few interventions aiming to increase these rates have been successful, suggesting that breastfeeding behaviour in this group is not fully understood. Therefore, this review aimed to systematically identify and synthesise the qualitative literature which explored the perceptions and experiences of women with a BMI ≥30kg/m2 who breastfed. The search identified five eligible papers, and a meta-ethnographic approach was taken to synthesise the findings. One theme was identified: ‘weight amplifies breastfeeding difficulties’, revealing that women with a BMI ≥30kg/m2 experience common breastfeeding difficulties to a greater degree. In particular, women with a BMI ≥30kg/m2 struggle with the impact of medical intervention, doubt their ability to breastfeed, and need additional support. These findings can inform understanding of breastfeeding models, future research directions, intervention development and antenatal and postnatal care for women with a BMI ≥30kg/m2

Narrowing the Digital Divide: The Young Women Leaders Program HerStory Project

Research suggests that girls are at especial disadvantage in the field of informational technology and are less likely than boys to take courses or seek out careers in this area. The Young Women Leaders Program (YWLP), a mentoring program at the University of Virginia that pairs at-risk middle school girls with college women for a year of mentoring, developed the YWLP HerStory project to engage middle school girls in informational technology through their development of technology projects focused on psychosocial issues of importance to them. This study reviewed an early version of the YWLP HerStory’s technology curriculum and training for mentors, the revisions made to both, and evaluated the effectiveness of the revisions with a sample of 27 eighth grade girls and their mentors. Findings indicated that participating in the revised curriculum improved girls’ engagement in technology projects, including an 83% completion rate, and modifications to mentor training improved mentor’s grasp of relevant technology and confidence in teaching it to their mentees. Notably, participating eighth grade girls reported that the technology curriculum was fun and expressed an interest in further engagement in using technology platforms to tell their stories

Changes in waist circumference independent of weight: Implications for population level monitoring of obesity

Population monitoring of obesity is most commonly conducted using body mass index (BMI). We test the hypothesis that because of increases in waist circumference (WC) independent of increases in weight, BMI alone detects an increasingly smaller proportion of the population with obesity. Methods: Australian adults with measured height, weight, and WC were selected from three nationally representative cross-sectional surveys (1989, 1999–2000, 2011–12; n = 8313, 5903 & 3904). Participants were defined as having obesity using classifications for an obese BMI (≥ 30 kg·m− 2) and substantially-increased-risk WC (≥ 88 cm [women], ≥ 102 cm [men]). Age-standardised prevalence of obesity according to BMI and/or WC, and the proportion of these detected by BMI and by WC were compared across surveys. Findings: Between 1989 and 2011–12, weight and WC increased by 5.4 kg and 10.7 cm (women), and by 7.0 kg and 7.3 cm (men). For women and men, 63% and 38% of increases in WC were independent of increases in weight. Over this period, the prevalence of obesity according to BMI and/or WC increased by 25.3 percentage-points for women (18.9% to 44.3%) and 21.1 percentage-points for men (17.1% to 38.2%). The proportion of these detected by BMI decreased for women by 20 percentage-points (77% to 57%) with no change for men. The proportion of these detected by WC increased for women and men by 10 percentage-points (87% to 97%) and 6 percentage-points (85% to 91%) respectively. Conclusion: BMI alone is detecting a decreasing proportion of those considered obese by BMI and/or WC. Renewed discussion regarding how we monitor obesity at the population level is required