Colonoscopy: Advanced and Emerging Techniques-A Review of Colonoscopic Approaches to Colorectal Conditions.

A complete colonoscopy is key in the diagnostic and therapeutic approaches to a variety of colorectal diseases. Major challenges are incomplete polyp removal and missed polyps, particularly in the setting of a difficult colonoscopy. There are a variety of both well-established and newer techniques that have been developed to optimize polyp detection, perform complete polypectomy, and endoscopically treat various complications and conditions such as strictures and perforations. The objective of this article is to familiarize the colorectal surgeon with techniques utilized by advanced endoscopists

Source signatures from combined isotopic analyses of PM2.5 carbonaceous and nitrogen aerosols at the peri-urban Taehwa Research Forest, South Korea in summer and fall.

Isotopes are essential tools to apportion major sources of aerosols. We measured the radiocarbon, stable carbon, and stable nitrogen isotopic composition of PM2.5 at Taehwa Research Forest (TRF) near Seoul Metropolitan Area (SMA) during August-October 2014. PM2.5, TC, and TN concentrations were 19.4 ± 10.1 μg m-3, 2.6 ± 0.8 μg C m-3, and 1.4 ± 1.4 μg N m-3, respectively. The δ13C of TC and the δ15N of TN were - 25.4 ± 0.7‰ and 14.6 ± 3.8‰, respectively. EC was dominated by fossil-fuel sources with Fff (EC) of 78 ± 7%. In contrast, contemporary sources were dominant for TC with Fc (TC) of 76 ± 7%, revealing the significant contribution of contemporary sources to OC during the growing season. The isotopic signature carries more detailed information on sources depending on air mass trajectories. The urban influence was dominant under stagnant condition, which was in reasonable agreement with the estimated δ15N of NH4+. The low δ15N (7.0 ± 0.2‰) with high TN concentration was apparent in air masses from Shandong province, indicating fossil fuel combustion as major emission source. In contrast, the high δ15N (16.1 ± 3.2‰) with enhanced TC/TN ratio reveals the impact of biomass burning in the air transported from the far eastern border region of China and Russia. Our findings highlight that the multi-isotopic composition is a useful tool to identify emission sources and to trace regional sources of carbonaceous and nitrogen aerosols

Metformin as a Therapeutic Target in Endometrial Cancers.

Endometrial cancer is the most common gynecologic malignancy in developed countries. Its increasing incidence is thought to be related in part to the rise of metabolic syndrome, which has been shown to be a risk factor for the development of hyperestrogenic and hyperinsulinemic states. This has consequently lead to an increase in other hormone-responsive cancers as well e.g., breast and ovarian cancer. The correlation between obesity, hyperglycemia, and endometrial cancer has highlighted the important role of metabolism in cancer establishment and persistence. Tumor-mediated reprogramming of the microenvironment and macroenvironment can range from induction of cytokines and growth factors to stimulation of surrounding stromal cells to produce energy-rich catabolites, fueling the growth, and survival of cancer cells. Such mechanisms raise the prospect of the metabolic microenvironment itself as a viable target for treatment of malignancies. Metformin is a biguanide drug that is a first-line treatment for type 2 diabetes that has beneficial effects on various markers of the metabolic syndrome. Many studies suggest that metformin shows potential as an adjuvant treatment for uterine and other cancers. Here, we review the evidence for metformin as a treatment for cancers of the endometrium. We discuss the available clinical data and the molecular mechanisms by which it may exert its effects, with a focus on how it may alter the tumor microenvironment. The pleiotropic effects of metformin on cellular energy production and usage as well as intercellular and hormone-based interactions make it a promising candidate for reprogramming of the cancer ecosystem. This, along with other treatments aimed at targeting tumor metabolic pathways, may lead to novel treatment strategies for endometrial cancer

KMT-2016-BLG-1107: A New Hollywood-Planet Close/Wide Degeneracy

We show that microlensing event KMT-2016-BLG-1107 displays a new type of degeneracy between wide-binary and close-binary Hollywood events in which a giant-star source envelops the planetary caustic. The planetary anomaly takes the form of a smooth, two-day "bump" far out on the falling wing of the light curve, which can be interpreted either as the source completely enveloping a minor-image caustic due to a close companion with mass ratio $q=0.036$, or partially enveloping a major-image caustic due to a wide companion with $q=0.004$. The best estimates of the companion masses are both in the planetary regime ($3.3^{+3.5}_{-1.8}\,M_{\rm jup}$ and $0.090^{+0.096}_{-0.037}\,M_{\rm jup}$) but differ by an even larger factor than the mass ratios due to different inferred host masses. We show that the two solutions can be distinguished by high-resolution imaging at first light on next-generation ("30m") telescopes. We provide analytic guidance to understand the conditions under which this new type of degeneracy can appear.Comment: 23 pages, 7 figures, accepted for publication in A

KMT-2018-BLG-1990Lb: A Nearby Jovian Planet From A Low-Cadence Microlensing Field

We report the discovery and characterization of KMT-2018-BLG-1990Lb, a Jovian planet $(m_p=0.57_{-0.25}^{+0.79}\,M_J)$ orbiting a late M dwarf $(M=0.14_{-0.06}^{+0.20}\,M_\odot)$, at a distance (D_L=1.23_{-0.43}^{+1.06}\,\kpc), and projected at $2.6\pm 0.6$ times the snow line distance, i.e., a_{\rm snow}\equiv 2.7\,\au (M/M_\odot), This is the second Jovian planet discovered by KMTNet in its low cadence ($0.4\,{\rm hr}^{-1}$) fields, demonstrating that this population will be well characterized based on survey-only microlensing data.Comment: 24 pages, 7 figures, 4 table

Serum creatinine as a predictor of functional and anatomical success in diabetic tractional retinal detachment

Pacientes con Desprendimiento de retina traccional diabéticoObjectives: The aim of the study was to evaluate pre-operative, intraoperative, and post-operative factors associated with functional and anatomical success in patients with diabetic tractional retinal detachment (TRD) treated with pars plana vitrectomy (PPV). Material and Methods: We retrospectively reviewed the medical records of patients with diabetic TRD surgically repaired with PPV between March 2014 and February 2015 at the Instituto de Oftalmología Fundación de Asistencia Privada Conde de Valenciana, IAP in Mexico City. A total of 250 records were reviewed and 85 met the inclusion criteria. Pre-operative, intraoperative, and post-operative variables were obtained from all records. Statistical analysis included Fisher’s exact test, Kruskal–Wallis test, and Mann–Whitney U test. Results: A total of 88 eyes of 85 patients were included in the study. The average patient age at the time of the surgery was 51.53 years (SD ± 11.99). At post-operative month (POM) 1, a greater pre-operative serum creatinine value and a greater surgical duration were associated with a worse anatomical success (P = 0.032; P = 0.014). At POM 1, 31% of the eyes with macula-involved TRD and 57.5% of the eyes without macula-involved TRD achieved visual success (P = 0.013, Fisher’s exact test). Conclusion: A greater pre-operative serum creatinine value was associated with a worse visual and anatomical outcome at POM 1. A macula-involved TRD was associated with a worse visual outcome at POM 3. Post-operative complications were associated with a worse functional and/or anatomical success at the final follow-up visit (P < 0.05).https://orcid.org/0000-0002-1310-9852Revista Internacional - No indexadaN

The relationship between school type and academic performance at medical school:A national, multi-cohort study

Acknowledgements We thank UKMED for releasing the data for this project via a competitive bid process. We are grateful to the following for their support of the application to UKMED for this and other research projects: Dr Sally Curtis (University of Southampton, UK), Dr Sandra Nicholson (Barts and The London School of Medicine and Dentistry, UK), Professor Peter Johnston (NHS Education for Scotland, UK) and Dr Rhoda MacKenzie (University of Aberdeen, UK). We thank Daniel Smith and Andy Knapton of the General Medical Council of the UK for their support for the application and throughout the project, particularly regarding data linkage and troubleshooting. We thank Dr Gordon Prescott (University of Aberdeen, UK) for the statistical support. Funding This study is part of Ben Kumwenda’s doctoral programme of research funded by the UKCAT Research Panel, of which JC and RG are members.Peer reviewedPublisher PD

Whole-Body MRI and Ethnic Differences in Adipose Tissue and Skeletal Muscle Distribution in Overweight Black and White Adolescent Boys

It is unclear whether ethnic differences exist in adipose tissue (AT) and skeletal muscle (SM) distribution in black and white youth. Investigation into the pattern of AT and SM distribution in black versus white youth may provide insight into the previously reported health disparities between these ethnicities. Therefore, we examined total and regional AT and SM in overweight black and white boys. The study sample included overweight black (n = 19) and white (n = 21) boys (11–18 yr, BMI ≥ 85th) whose body composition was evaluated using whole-body MRI. Despite similar age, Tanner stage, and BMI, black boys had significantly (P < .05) less visceral AT than white boys and more (P < .05) total and lower-body subcutaneous AT (SAT) in both absolute (kg) and relative (%) terms. There was a main effect (P < .05) of ethnicity on the relationship between total and regional AT, such that for a given amount of total body AT (kg), black boys had a greater (P < .05) lower-body SAT and less visceral AT than their white peers. For a given amount of total SM, black boys had more (P < .05) SM in the thigh. Compared with overweight white boys, overweight black boys have less visceral fat, more subcutaneous fat, and more thigh skeletal muscle