235 research outputs found
The feasibility of wireless capsule endoscopy in detecting small intestinal pathology in children under the age of 8 years: a multicentre European study.
Objective: To systematically evaluate the feasibility and methodology to carry out wireless capsule endoscopy (WCE) in children <8 years to define small intestinal pathology.
Design: Prospective European multicentre study with negative prior investigation.
Patients and interventions: 83 children aged 1.5â7.9 years were recruited. Initially, all were offered âswallowingâ (Group 1) for capsule introduction. If this failed endoscopic placement (Group 2) was used and the Roth net, Advance or custom-made introducers were compared.
Outcome measures: Primary endpoint: to determine pathology; secondary endpoint: comparison of capsule introduction methods.
Results: Capsule introduction: 20 (24%) children aged 4.0â7.9 years (mean, 6.9 years; 14 male) comprising Group 1 were older (p<0.025) than 63 (76%) aged 1.5â7.9 years (mean, 5.25 years; 30 male) forming Group 2. Complications: Roth net mucosal trauma in 50%; no others occurred. The available recording apparatus was inappropriate for those <3 years. Indications: gastrointestinal bleeding: nâ=â30 (16 positive findings: four ulcerative jejunitis, four polyps, two angiodysplasia, two blue rubber blebs, two Meckelâs diverticula, one anastomotic ulcer, one reduplication); suspected Crohnâs disease: nâ=â20 (11 had Crohnâs disease); abdominal pain: nâ=â12 (six positive findings: three Crohnâs disease, two lymphonodular hyperplasia, one blue rubber bleb); protein loss: nâ=â9 (four lymphangectasia); malabsorption: nâ=â12 (seven positive findings: six enteropathy, one ascaris). No abnormalities overall: 45%.
Conclusion: WCE is feasible and safe down to the age of 1.5 years. 20 children >4 years swallowed the capsule. The Advance introducer proved superior for endoscopic placement. The pathologies encountered showed age specificity and, unlike in adolescents, obscure gastrointestinal bleeding was the commonest indication
Long-term outcomes of biliary atresia patients surviving with their native livers
Publisher Copyright: © 2021 The Author(s)Portoenterostomy (PE) has remained as the generally accepted first line surgical treatment for biliary atresia (BA) for over 50 years. Currently, close to half of BA patients survive beyond 10 years with their native livers, and most of them reach adulthood without liver transplantation (LT). Despite normalization of serum bilirubin by PE, ductular reaction and portal fibrosis persist in the native liver. The chronic cholangiopathy progresses to cirrhosis, complications of portal hypertension, recurrent cholangitis or hepatobiliary tumors necessitating LT later in life. Other common related health problems include impaired bone health, neuromotor development and quality of life. Only few high-quality trials are available for evidence-based guidance of post-PE adjuvant medical therapy or management of the disease complications. Better understanding of the pathophysiological mechanisms connecting native liver injury to clinical outcomes is critical for development of accurate follow-up tools and novel therapies designed to improve native liver function and survival.Peer reviewe
The feasibility of wireless capsule endoscopy in detecting small intestinal pathology in children under the age of 8 years: a multicentre European study
Growth of children with biliary atresia living with native livers : impact of corticoid therapy after portoenterostomy
We addressed growth of biliary atresia (BA) patients living with native livers between ages 0-6 and effects of post-surgical corticosteroid treatment on growth. Growth charts of 28 BA patients born in Finland between 1987 and 2017 were retrospectively evaluated. Dosage and length of corticosteroid treatment and hydrocortisone substitution were reviewed. At birth, BA patients were shorter (median height -0.6 (interquartile range (IQR) -1.3 to -0.1) SDS, n=28, PPeer reviewe
Solving ill-posed bilevel programs
This paper deals with ill-posed bilevel programs, i.e., problems admitting multiple lower-level solutions for some upper-level parameters. Many publications have been devoted to the standard optimistic case of this problem, where the difficulty is essentially moved from the objective function to the feasible set. This new problem is simpler but there is no guaranty to obtain local optimal solutions for the original optimistic problem by this process. Considering the intrinsic non-convexity of bilevel programs, computing local optimal solutions is the best one can hope to get in most cases. To achieve this goal, we start by establishing an equivalence between the original optimistic problem an a certain set-valued optimization problem. Next, we develop optimality conditions for the latter problem and show that they generalize all the results currently known in the literature on optimistic bilevel optimization. Our approach is then extended to multiobjective bilevel optimization, and completely new results are derived for problems with vector-valued upper- and lower-level objective functions. Numerical implementations of the results of this paper are provided on some examples, in order to demonstrate how the original optimistic problem can be solved in practice, by means of a special set-valued optimization problem
The interlayer cohesive energy of graphite from thermal desorption of polyaromatic hydrocarbons
We have studied the interaction of polyaromatic hydrocarbons (PAHs) with the
basal plane of graphite using thermal desorption spectroscopy. Desorption
kinetics of benzene, naphthalene, coronene and ovalene at sub-monolayer
coverages yield activation energies of 0.50 eV, 0.85 eV, 1.40 eV and 2.1 eV,
respectively. Benzene and naphthalene follow simple first order desorption
kinetics while coronene and ovalene exhibit fractional order kinetics owing to
the stability of 2-D adsorbate islands up to the desorption temperature.
Pre-exponential frequency factors are found to be in the range
- as obtained from both Falconer--Madix (isothermal
desorption) analysis and Antoine's fit to vapour pressure data. The resulting
binding energy per carbon atom of the PAH is 5 meV and can be identified
with the interlayer cohesive energy of graphite. The resulting cleavage energy
of graphite is ~meV/atom which is considerably larger than previously
reported experimental values.Comment: 8 pages, 4 figures, 2 table
Spacelike Singularities and Hidden Symmetries of Gravity
We review the intimate connection between (super-)gravity close to a
spacelike singularity (the "BKL-limit") and the theory of Lorentzian Kac-Moody
algebras. We show that in this limit the gravitational theory can be
reformulated in terms of billiard motion in a region of hyperbolic space,
revealing that the dynamics is completely determined by a (possibly infinite)
sequence of reflections, which are elements of a Lorentzian Coxeter group. Such
Coxeter groups are the Weyl groups of infinite-dimensional Kac-Moody algebras,
suggesting that these algebras yield symmetries of gravitational theories. Our
presentation is aimed to be a self-contained and comprehensive treatment of the
subject, with all the relevant mathematical background material introduced and
explained in detail. We also review attempts at making the infinite-dimensional
symmetries manifest, through the construction of a geodesic sigma model based
on a Lorentzian Kac-Moody algebra. An explicit example is provided for the case
of the hyperbolic algebra E10, which is conjectured to be an underlying
symmetry of M-theory. Illustrations of this conjecture are also discussed in
the context of cosmological solutions to eleven-dimensional supergravity.Comment: 228 pages. Typos corrected. References added. Subject index added.
Published versio
Efficacy of the pentavalent rotavirus vaccine, RotaTeqÂź, in Finnish infants up to 3Â years of age: the Finnish Extension Study
Rotavirus Efficacy and Safety Trial (REST) enrolled nearly 70,000 infants, of whom more than 23,000 were from Finland. REST determined the efficacy of the pentavalent rotavirus vaccine (RV5) against rotavirus-related hospitalisations and emergency department (ED) visits in the first year after vaccination. Finnish infants initially in REST transitioned into the Finnish Extension Study (FES), where they were followed for rotavirus-related hospitalisations and ED visits through their second year of life and beyond. FES identified 150 (31%) additional rotavirus gastroenteritis (RVGE) cases beyond those identified in REST in the Finnish participants. Overall, RV5 reduced RVGE hospitalisations and ED visits, regardless of the rotavirus serotype, by 93.8% (95% confidence interval [CI]: 90.8â95.9%) for up to 3.1Â years following the last vaccine dose. Vaccine efficacy against combined hospitalisations and ED visits between ages 4Â months to 11Â months, 12Â months to 23Â months, and 24Â months to 35Â months was 93.9% (95% CI: 89.1â96.9%), 94.4% (95% CI: 90.2â97.0%), and 85.9% (95% CI: 51.6â97.2%), respectively. The reduction of hospitalisations and ED visits due to any acute gastroenteritis, rotavirus or not, was 62.4% (95% CI: 57.6â66.6%) over the entire follow-up period. The results from FES confirm that RV5 induces high and sustained protection against rotavirus-related hospitalisations and ED visits, and has a very substantial impact on all gastroenteritis-related hospitalisations and ED visits into the third year of life in Finnish children
Overexpression of the Rieske FeS protein of the Cytochrome b 6 f complex increases C4 photosynthesis in Setaria viridis.
C4 photosynthesis is characterised by a CO2 concentrating mechanism that operates between mesophyll and bundle sheath cells increasing CO2 partial pressure at the site of Rubisco and photosynthetic efficiency. Electron transport chains in both cell types supply ATP and NADPH for C4 photosynthesis. Cytochrome b 6 f is a key control point of electron transport in C3 plants. To study whether C4 photosynthesis is limited by electron transport we constitutively overexpressed the Rieske FeS subunit in Setaria viridis. This resulted in a higher Cytochrome b 6 f content in mesophyll and bundle sheath cells without marked changes in the abundances of other photosynthetic proteins. Rieske overexpression plants showed better light conversion efficiency in both Photosystems and could generate higher proton-motive force across the thylakoid membrane underpinning an increase in CO2 assimilation rate at ambient and saturating CO2 and high light. Our results demonstrate that removing electron transport limitations can increase C4 photosynthesis
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