Cholangioscopy-guided holmium laser lithotripsy of a stone trapped in a mechanical lithotripter

Large common bile duct (CBD) stones can be removed with mechanical lithotripsy, although over-the-basket techniques such as electrohydraulic or pulsed dye laser lithotripsy can be necessary in cases of stone impaction.1 We report the case of a 42-year-old woman with a 30-mm stone in the CBD in whom mechanical lithotripsy was attempted after wide sphincterotomy. However, during the procedure, a rupture occurred in the traction wire of the basket, next to the handle. Emergency lithotripsy (EL) with use of an external-type system was immediately attempted, but wire fracture occurred again (2 times), turning its length shorter than the metallic sheath of the EL and rendering EL impossible(undefined)info:eu-repo/semantics/publishedVersio

Estriturotomia de anastomose esofágica: Incisão com needle knife

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Precut fistulotomy - widening its limits

info:eu-repo/semantics/publishedVersio

Endoscopic Ultrasound-Guided Biliary Drainage in Two Patients with Difficult Biliary Access

Endoscopic retrograde cholangiopancreatography is the method of choice for biliary drainage, although in some cases standard biliary access is difficult or even impossible. Endoscopic ultrasound (EUS)-guided endoluminal procedures are an alternative in these cases, although experience with these techniques is still limited.Introduction: Endoscopic retrograde cholangiopancreatography is the method of choice for biliary drainage, although in some cases standard biliary access is difficult or even impossible. Endoscopic ultrasound (EUS)-guided endoluminal procedures are an alternative in these cases, although experience with these techniques is still limited. Clinical Case: We present two cases of successful EUS-guided biliary drainage. In the first case, a hepaticogastrostomy was performed in a patient with stage IV gastric adenocarcinoma with obstructive jaundice due to compression of the hilum, where malignant gastric stenosis and previous palliative gastrojejunostomy precluded access to the second part of the duodenum. In the second case, a patient with a pancreatic head adenocarcinoma with duodenal invasion that precluded major papillae identification was submitted to a choledochoduodenostomy. Both procedures occurred without immediate or delayed adverse events, with technical and clinical success. Discussion: Although experience with EUS-guided biliary drainage is still limited, its efficacy and safety is favorable when compared with percutaneous and surgical drainage, and should be considered an alternative to these techniques where sufficient expertise existsIntrodução: A colangiopancreatografia retrógrada endoscópica é o procedimento de escolha para a drenagem biliar, embora em alguns casos o acesso biliar convencional é difícil ou até impossível. As técnicas de drenagem guiadas por ecoendoscopia são uma alternativa nestes casos, embora a experiência seja ainda limitada. Caso: Apresentamos dois casos de drenagem biliar eficaz guiada por ecoendoscopia. No primeiro caso foi realizada hepaticogastrostomia numa doente com adenocarcinoma gástrico estadio IV, com icterícia obstrutiva devido a compressão hilar pela neoplasia, na qual o acesso à segunda porção duodenal se revelou impossível devido à neoplasia gástrica estenosante e a antecedentes de gastrojejunostomia paliativa. No segundo caso, uma doente com adenocarcinoma cefalo-pancreático com invasão duodenal que impedia a identificação da papila foi submetida a coledocoduodenostomia. Em ambos os procedimentos foi conseguida drenagem biliar eficaz e não ocorreram eventos adversos imediatos ou tardios. Discussão: Apesar de a experiência com técnicas de drenagem biliar guiadas por ecoendoscopia ser limitada, o seu perfil de eficácia e segurança parece ser favorável quando comparada com as alternativas (drenagem percutânea ou cirúrgica), pelo que devem ser consideradas quando exista equipamento e experiência necessária(undefined)info:eu-repo/semantics/publishedVersio

Mechanical properties of dense cordierite discs sintered by solar radiation heating

Consolidation of cordierite disc specimens was undertaken under concentrated solar beam in a solar furnace at PSA (Plataforma Solar de Almerıá). Satisfactory extent of densification was achieved by the present solar-sintering experiment. The mechanical properties measured for the solar-sintered cordierite test pieces were; density ¼ 2:45 0:02 g/cm3, Vickers microhardness HV ¼ 7:31 0:29 GPa, Young’s modulus E ¼ 97 5 GPa, shear modulus G ¼ 38 2 GPa, Poisson ratio ¼ 0:27 0:01, fracture toughness KIC ¼ 1:50 0:15 MPa m1=2 and modulus of rupture evaluated by ring-on-ring test MORROR ¼ 57:8 13:7 MPa which were comparable to those of the counterparts sintered by conventional industrial gas furnace

Intelligent systems in healthcare: an architecture proposal

Multi-Agent Systems has existed for decades and has focused on principles such as loose coupling, distribution, reactivity, and local state. Despite substantial tool and programming language research and development, industry adoption of these systems has been restricted, particularly in the healthcare arena. Artificial intelligence, on the other hand, entails developing computer systems that can execute tasks that normally require human intelligence, such as decision-making, problem-solving, and learning. The goal of this article is to develop and implement an architecture that includes multi-agent systems with microservices, leveraging the capabilities of both methodologies in order to harness the power of Artificial Intelligence in the healthcare industry. It assesses the proposed architecture’s merits and downsides, as well as its relevance to various healthcare use cases and the influence on system scalability, adaptability, and maintainability. Indeed, the proposed architecture is capable of meeting the objectives while maintaining scalability, flexibility, and adaptability.This work has been supported by FCT (Fundação para a Ciência e Tecnologia) within the R&D Units Project Scope: UIDB/00319/2020

Heterogeneity along the Height in Disc Specimens of Graphite/Tungsten Powder Mixtures with Sub-Stoichiometric Carbon Atom Ratios Heated by Concentrated Solar Beam to 1600 C

Compositional heterogeneity along the thickness of compacted disc specimens of graphite/tungsten powder mixtures with substoichiometric carbon atom ratios (0.35, 0.50 and 1.00) heated by concentrated solar beam to 1600 C was characterised by X-ray diffraction. Top surface of any examined test piece was consisted purely of mono-carbide WC while the bottom surface showed different constitution depending on the net initial C/W ratio of the test piece; almost pure metallicWfor the C/W ¼ 0:35 specimen, dominant metallicWassociated with small proportion ofW2C for the C/W ¼ 0:50 and dominantW2C with trivial proportion of WC for the C/W ¼ 1:0. In the intermediate zone between the top and the bottom layers, the constitution held virtually constant depending on the nominal C/W ratio of the starting material: co-existing metallicWandW2C for the C/W ¼ 0:35, pureW2C for the C/W ¼ 0:50 and predominant WC with traceW2C for the C/W ¼ 1:00. Unlike for the top surface of the C/W ¼ 0:35 test piece heated in a solar furnace to 1900 C reported earlier, no evidence of formation of nano-meter scale WC whisker was detected for the top surface in any sample heated to 1600 C in the present work

ACUMULAÇÃO DE METAIS PESADOS E ALTERAÇÃO DAS PROPRIEDADES FÍSICAS E QUÍMICAS DE AREIAS DE DUNAS LITORÂNEAS

Nos dois últimos séculos, na orla costeira de Portugal, generalizou-se a prática agrícola em areias de duna com a aplicação de agroquímicos, sem controlo técnico, de onde resultaram alterações da composição físico-química e acumulação de metais pesados nas areias. Com o objetivo de avaliar os efeitos do manejo agrícola foram coletadas e caracterizadas, do ponto de vista físico e químico, amostras das dunas, entre os 0,0 cm e os 20 cm de profundidade, com e sem prática agrícola. Foi determinada, por ensaio de peneiramento, a fração fina (partículas com diâmetro inferior a 0,074 mm) e pelo método MAB – Peróxido a composição em matéria orgânica. Foi estimada a umidade das amostras e determinado, pelo método eletroquímico, o pH, a condutividade elétrica e o potencial de oxirredução. A composição química foi analisada por fluorescência de raios-x. Verificou-se que o manejo agrícola das dunas resultou no aumento da fração fina, da matéria orgânica, da umidade, da condutividade elétrica e do potencial de oxirredução das areias. O pH diminuiu, de básico para valores próximos de neutro, aumentando o risco de acumulação e mobilização de Fe, Mn, Cu, Zn, Pb, As, Zr, Th, Rb, Cr, V, Ni, Hg, Co e U

Remdesivir in Very Old Patients (≥80 Years) Hospitalized with COVID-19: Real World Data from the SEMI-COVID-19 Registry

Background: Large cohort studies of patients with COVID-19 treated with remdesivir have reported improved clinical outcomes, but data on older patients are scarce. Objective: This work aims to assess the potential benefit of remdesivir in unvaccinated very old patients hospitalized with COVID-19; (2) Methods: This is a retrospective analysis of patients >= 80 years hospitalized in Spain between 15 July and 31 December 2020 (SEMI-COVID-19 Registry). Differences in 30-day all-cause mortality were adjusted using a multivariable regression analysis. (3) Results: Of the 4331 patients admitted, 1312 (30.3%) were >= 80 years. Very old patients treated with remdesivir (n: 140, 10.7%) had a lower mortality rate than those not treated with remdesivir (OR (95% CI): 0.45 (0.29-0.69)). After multivariable adjustment by age, sex, and variables associated with lower mortality (place of COVID-19 acquisition; degree of dependence; comorbidities; dementia; duration of symptoms; admission qSOFA; chest X-ray; D-dimer; and treatment with corticosteroids, tocilizumab, beta-lactams, macrolides, and high-flow nasal canula oxygen), the use of remdesivir remained associated with a lower 30-day all-cause mortality rate (adjusted OR (95% CI): 0.40 (0.22-0.61) (p < 0.001)). (4) Conclusions: Remdesivir may reduce mortality in very old patients hospitalized with COVID-19