Distal subgaleal-peritoneal shunt migration into the abdominal wall with subsequent formation of a pre-peritoneal pseudocyst: a rare complication.

Distal ventriculo-peritoneal shunt migration and extra-peritoneal CSF pseudocyst formation are unusual complications of shunt placement. We present a 65-year-old-female who received a subgaleal-peritoneal shunt to decompress a post-surgical subgaleal fluid collection. Eight weeks later, shunt series showed tight coiling of the distal catheter, and operative exploration found the distal shunt tip to have migrated superficial to the rectus sheath, where it had become encapsulated in a pre-peritoneal CSF pseudocyst. Migration of the distal catheter into the abdominal wall was likely due to local inflammation of the inner surface of the abdomen, with pressure from intestinal peristaltic movements and intra-abdominal pressure, and continued inflammation at the distal catheter tip may have caused formation of a pre-peritoneal CSF pseudocystic dilatation. To date, this is the first reported case of distal shunt migration into the abdominal wall with subsequent formation of an extra-peritoneal pseudocyst and represents a rare event in the surgical management of peritoneal shunts

Patients with stricturing or penetrating Crohn\u27s disease phenotypes report high disease burden and treatment needs

BACKGROUND: Crohn\u27s disease (CD) is a chronic autoimmune disease in which inflammation can progress to complications of stricturing and/or penetrating disease. Real-world data on burden of complicated CD phenotypes are limited. METHODS: We analyzed cross-sectional data from the SPARC IBD (Study of a Prospective Adult Research Cohort with Inflammatory Bowel Disease) registry from 2016 to 2020. Four mutually exclusive phenotype cohorts were created: inflammatory CD (CD-I), complicated CD (stricturing CD, penetrating CD, and stricturing and penetrating CD [CD-SP]). Statistical analyses were performed using CD-I as the reference. RESULTS: A total of 1557 patients were identified: CD-I (n = 674, 43.3%), stricturing CD (n = 457, 29.4%), penetrating CD (n = 166, 10.7%), and CD-SP (n = 260, 16.7%). Patients with complicated phenotypes reported significantly greater use of tumor necrosis factor inhibitors (84.2%-86.7% vs 66.0%; P \u3c .001) and corticosteroids (75.3%-82.7% vs 68.0%; P \u3c .001). Patients with CD-SP reported significantly more aphthous ulcer (15.4% vs 10.5%; P \u3c .05), erythema nodosum (6.5% vs 3.6%; P \u3c .05), inflammatory bowel disease-related arthropathy (25.8% vs 17.2%; P \u3c .01), liquid stools (24.2% vs 9.3%; P \u3c .001), nocturnal fecal incontinence (10.8% vs 2.5%; P \u3c .001), and CD-related surgery (77.7% vs 12.2%; P \u3c .001). CONCLUSIONS: Patients with complicated CD phenotypes reported higher rates of active CD-related luminal and extraintestinal manifestations, and underwent more surgeries, despite being more likely to have received biologics than those with CD-I. The potential for early recognition and management of CD-I to prevent progression to complicated phenotypes should be explored in longitudinal studies

Biological Pretreatment of Oil Palm Frond Fiber Using White-Rot Fungi for Enzymatic Saccharification

Oil palm frond is one type of lignocellulosic biomass abundantly and daily available in Indonesia. It contains cellulose which can be converted to glucose, and further processed to produce different kinds of value –added products. The aim of this research is to study the effects of biological pretreatment of oil palm frond (OPF) fiber using Phanerochaete chrysosporium and Trametes versicolor on the enzymatic saccharification of the biomass. The OPF fiber (40-60 mesh sizes) was inoculated with cultures of the two fungi and incubated at 27 °C for 4 weeks. The samples were taken after 1, 2, 3, and 4 weeks of incubation. Chemical components of the biomass after pretreatment were analyzed. The saccharification of the pretreated samples using cellulase and β-glucosidase was performed in a water bath shaker at 50 °C for 48 hours. The concentration of reducing sugar increased with increasing of incubation time, either in those pretreated with culture of P. chrysosporium or with T. versicolor. Pretreatment of OPF fiber using single culture of T. versicolor for 4 weeks gave the highest reducing sugar yield (12.61% of dry biomass)

Equity in community health insurance schemes: evidence and lessons from Armenia

Introduction Community health insurance (CHI) schemes are growing in importance in low-income settings, where health systems based on user fees have resulted in significant barriers to care for the poorest members of communities. They increase revenue, access and financial protection, but concerns have been expressed about the equity of such schemes and their ability to reach the poorest. Few programmes routinely evaluate equity impacts, even though this is usually a key objective. This lack of evidence is related to the difficulties in collecting reliable data on utilization and socio-economic status. This paper describes the findings of an evaluation of the equity of Oxfam's CHI schemes in rural Armenia

Point Primitives Based Virtual Surgery System

In order to achieve a high degree of visual realism in surgery simulation, we present a virtual surgery system framework, which is based on point primitives for the virtual surgery scene rendering and the biomechanical calculation of the soft tissue. To embody the superiority of this framework, two virtual surgery systems based on point primitives we developed are exhibited in this paper. Six critical functional modules were selected as representative of basic and advanced virtual surgery skill. These modules were: 1) point-based texture mapping; 2) deformation simulation; 3) cutting simulation; 4) tearing simulation; 5) dynamic texture mapping; and 6) 3-D display. These modules were elaborated by including working principle, execution process, and the performance of the algorithm. The experimental results have shown that point primitives-based virtual surgery systems obtained higher performance in terms of computational efficiency and rendering effect than traditional meshes-based virtual surgery system

Designing an automated clinical decision support system to match clinical practice guidelines for opioid therapy for chronic pain

Abstract Background Opioid prescribing for chronic pain is common and controversial, but recommended clinical practices are followed inconsistently in many clinical settings. Strategies for increasing adherence to clinical practice guideline recommendations are needed to increase effectiveness and reduce negative consequences of opioid prescribing in chronic pain patients. Methods Here we describe the process and outcomes of a project to operationalize the 2003 VA/DOD Clinical Practice Guideline for Opioid Therapy for Chronic Non-Cancer Pain into a computerized decision support system (DSS) to encourage good opioid prescribing practices during primary care visits. We based the DSS on the existing ATHENA-DSS. We used an iterative process of design, testing, and revision of the DSS by a diverse team including guideline authors, medical informatics experts, clinical content experts, and end-users to convert the written clinical practice guideline into a computable algorithm to generate patient-specific recommendations for care based upon existing information in the electronic medical record (EMR), and a set of clinical tools. Results The iterative revision process identified numerous and varied problems with the initially designed system despite diverse expert participation in the design process. The process of operationalizing the guideline identified areas in which the guideline was vague, left decisions to clinical judgment, or required clarification of detail to insure safe clinical implementation. The revisions led to workable solutions to problems, defined the limits of the DSS and its utility in clinical practice, improved integration into clinical workflow, and improved the clarity and accuracy of system recommendations and tools. Conclusions Use of this iterative process led to development of a multifunctional DSS that met the approval of the clinical practice guideline authors, content experts, and clinicians involved in testing. The process and experiences described provide a model for development of other DSSs that translate written guidelines into actionable, real-time clinical recommendations.http://deepblue.lib.umich.edu/bitstream/2027.42/78267/1/1748-5908-5-26.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/2/1748-5908-5-26.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/3/1748-5908-5-26-S3.TIFFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/4/1748-5908-5-26-S2.TIFFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/5/1748-5908-5-26-S1.TIFFPeer Reviewe

Reporting of ethical considerations in clinical trials in Chinese nursing journals

Background: It is acknowledged that publishers now require all primary research papers to demonstrate that they have obtained ethical approval for their research. Objectives: To assess the rate of reporting of ethical approval in clinical trials in core nursing journals in mainland China. Research design: A retrospective observational study. Participants: All clinical trials published in all of the 12 core nursing periodicals from 2016 edition China Science and Technology Journal Citation Report (core version) between 2013 and 2016 were retrieved by hand to explicate rate of reporting ethical approval and informed consent. Ethical considerations: The study did not require approval from the research ethics committee as it did not involve human subjects or records. Results: In total, 40,278 papers were published in 12 nursing periodicals between 2013 and 2016. Out of these, 9488 (23.6%) focused on clinical trials. Informed consent obtained from patients or the legally authorized representative was reported in 51.8% of clinical trials. Notably, only 27.4% of clinical trials reported that they had obtained written consent. Furthermore, 25.9% of clinical trials described ethical approval; however, the rate of reporting informed consent and ethical approval in these 12 nursing journals in China during 4 years from 2013 to 2016 improved markedly, with 38.1%, 44.0%, 59.0% and 66.6%, respectively (p<0.001), and 17.6%, 21.9%, 28.6% and 35.8%, respectively (p<0.001). In addition, both reporting informed consent and reporting written informed consent had a positive significant correlation with the reporting ethical approval (p<0.05 or p<0.01). Conclusion: Chinese scientific nursing journals have improved the rate of reporting informed consent and ethical approval in clinical trials during the last 4 years. However, it should be noted that nearly half of clinical trials still did not report either ethical approval or whether informed consent was obtained. Efforts from editors, researchers, sponsors and authors are needed to ensure the transparency of ethical scrutiny and adherence to ethical guidelines in publishing clinical trials in Chinese nursing journals