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Rectal free perforation after stapled hemorrhoidopexy: A case report of laparoscopic peritoneal lavage and repair without stoma
No full textAbstractIntroductionStapled hemorrhoidopexy is widely performed for treatment of prolapsed hemorrhoids because of advantages, including shorter hospital stay and less discomfort, compared with conventional hemorrhoidectomy. However, it can have severe adverse effects, such as rectal bleeding, perforation, and sepsis.Presentation of caseWe report the case of a healthy 28-year-old man who presented to the emergency department with sudden-onset diffuse abdominal pain and hematochezia. He had undergone stapled hemorrhoidopexy 5days earlier and was discharged after an uneventful postoperative course. For the present condition, after immediate evaluation, we successfully performed emergency laparoscopic repair of the rectal perforation without any stoma. His postoperative course was uneventful, and he was discharged on postoperative day 16.DiscussionThis is a rare case of rectal perforation after stapled hemorrhoidopexy in which the perforation was treated successfully by laparoscopic repair. In most cases of rectal perforation following stapled hemorrhoidopexy, surgeons perform open laparotomy and create diverting stoma. However, our patient underwent totally laparoscopic lavage and primary closure without diverting stoma. Multiple investigators have reported that laparoscopic lavage for perforated diverticulitis may be an appropriate treatment option. Factors favoring this approach include early surgery, young age, sufficient irrigation, and meticulous primary closure.ConclusionStapled hemorrhoidopexy can have severe adverse effects, such as rectal bleeding, pelvic sepsis, and rectal perforation, which are potentially life-threatening. Laparoscopic lavage and primary repair without stoma can be performed successfully in select patients with rectal perforation following stapled hemorrhoidopexy
Confronting lepton flavor universality violation in B decays with high-pT tau lepton searches at LHC
No full textAbstractWe confront the indications of lepton flavor universality (LFU) violation observed in semi-tauonic B meson decays with new physics (NP) searches using high pT tau leptons at the LHC. Using effective field theory arguments we correlate possible non-standard contributions to semi-tauonic charged currents with the τ+τ− signature at high energy hadron colliders. Several representative standard model extensions put forward to explain the anomaly are examined in detail: (i) weak triplet of color-neutral vector resonances, (ii) second Higgs doublet and (iii) scalar or (iv) vector leptoquark. We find that, in general, τ+τ− searches pose a serious challenge to NP explanations of the LFU anomaly. Recasting existing 8 TeV and 13 TeV LHC analyses, stringent limits are set on all considered simplified models. Future projections of the τ+τ− constraints as well as caveats in interpreting them within more elaborate models are also discussed
Yokukansan enhances the proliferation of B65 neuroblastoma
No full textAbstractYokukansan, a traditional Japanese herbal medicine, has been considered to be a novel alternative treatment for several neurological diseases such as neurodegenerative disorders, as well as neurosis, insomnia, and behavioral and psychological symptoms in Alzheimer's disease. Moreover, it has been shown that yokukansan has antidepressant-like and pain-relieving effects in animal models. Recently, several studies have shown that yokukansan has a neuroprotective effect. In this study, we focused on whether or no yokukansan influences cell proliferation related to cell-cycle progression by using B65 neuroblastoma cells derived from monoaminergic neurons. Under treatment with yokukansan, the proliferation rate of B65 neuroblastoma cells significantly increased in a dose-dependent manner. In particular, a proliferative effect was observed after treatment with yokukansan for 48 h and 72 h. Moreover, among seven medicinal herbs that comprise yokukansan, both Bupleuri Radix and Glycyrrhize Radix also enhanced the proliferation of B65 neuroblastoma cells. We assessed the effect of yokukansan on p44/42 mitogen-activated protein kinase (MAPK) phosphorylation in B65 neuroblastoma cells, and found that yokukansan increased p44/42 MAPK phosphorylation after treatment for 48 h. In contrast, neither Bupleuri Radix nor Glycyrrhize Radix altered the level of p44/42 MAPK phosphorylation, although they did increase cell proliferation. Our findings suggest that yokukansan has a cell-proliferative due to both Bupleuri Radix and Glycyrrhize Radix, and this is unrelated to the p44/42 MAPK signaling cascade
Full disclosure: Unraveling the mystery of a wide complex tachycardia
No full textAbstractWide complex tachycardia is not uncommon in patients with underlying structural heart disease and reduced ejection fraction. It is important to make the correct diagnosis as it carries prognostic and clinical implications. We present a case of a challenging wide complex rhythm detected on remote telemetry monitoring. This case outlines the differential diagnosis of a wide complex tachycardia and the clues to making a diagnosis of artifact. It highlights the importance of correct diagnosis as an incorrect diagnosis may lead to inappropriate treatments and unnecessary investigations
Multiple comorbid neuropathologies in the setting of Alzheimer's disease neuropathology and implications for drug development
No full textAbstractDementia is often characterized as being caused by one of several major diseases, such as Alzheimer's disease (AD), cerebrovascular disease, Lewy body disease, or a frontotemporal degeneration. Failure to acknowledge that more than one entity may be present precludes attempts to understand interactive relationships. The clinicopathological studies of dementia demonstrate that multiple pathologic processes often coexist.How overlapping pathologic findings affect the diagnosis and treatment of clinical AD and other dementia phenotypes was the topic taken up by the Alzheimer's Association's Research Roundtable in October 2014. This review will cover the neuropathologic basis of dementia, provide clinical perspectives on multiple pathologies, and discuss therapeutics and biomarkers targeting overlapping pathologies and how these issues impact clinical trials.High prevalence of multiple pathologic findings among individuals with clinical diagnosis of AD suggests that new treatment strategies may be needed to effectively treat AD and other dementing illnesses
Catchment metabolism: Integrating natural capital in the asset management portfolio of the water sector
No full textAbstractThe policy of the water sector demands integrated and resilient asset management. The majority of current research focuses on urban or community asset systems. To provide a fully integrated approach, one needs to delineate the focus of asset management at a catchment scale, to include the natural capital. The research described in this paper introduces such an approach, with the Environmental Regional Input-Output (E-RIO) analysis at its core.The novelty of the work is the conceptualisation of a catchment as a complex asset system, comprising of multiple subsystems. This expands the application of Industrial Ecology and functional modelling techniques in Integrated Catchment Management and Water Accounting. The Catchment Metabolism modelling schema created in this paper serves asset, water resources and catchment management purposes. The schema forms the grounds for structured collaboration among experts for integrated water resources planning and decision-making. In this paper the process of creating the modelling schema along with the techniques used are presented. A ‘live’ industrial example from the UK water sector (Poole Harbour Catchment) is used to demonstrate its application
Intercropping leek (Allium porrum L.) with dyer’s woad (Isatis tinctoria L.) increases rooted zone and agro-ecosystem retention of nitrogen
No full textAbstractNitrate leaching can be high in organic vegetable production. Late-harvested crops like leek limit the use of autumn catch crops. The aim of this study was to investigate the growing of a combination of a deep-rooted catch crop and a shallow-rooted vegetable to reduce the risk of nitrate leaching. We compared a leek sole crop (S) with two intercropped systems of leek and early-sown dyer’s woad (five weeks after leek planting) (IE) or late-sown dyer’s woad (eight weeks after leek planting) (IL) in two seasons: 2012 and 2013. To reveal root and resource competition, leek with dyer’s woad rows left empty (Semp), and early and late-sown dyer’s woad with leek rows left empty (DEemp, DLemp) were included. Yield, dry above-ground biomass, aboveground N accumulation and soil inorganic N (Ninorg) were measured as well as root growth by use of minirhizotrons to 2.3m soil depth. Results showed that the marketable yield of leek in IE and IL systems was comparable with the yield in the S system when calculated per length of leek row. The Relative Competition Index (RCI) revealed that interspecific competition facilitated the growth of leek but hampered that of dyer’s woad. The rooted zone increased from 0.5m in the S system to more than 2m depth in those of the intercropped systems. Dyer’s woad ceased growing above ground but kept growing below ground after crop harvest and extended roots under the leek root system in 2012. Intercropping increased the root intensity of late-sown dyer’s woad after leek harvest in the 0.75–1.75m soil layer compared to dyer’s woad growing alone (DLemp), while the root depth was not affected. The intercropped system with early-sown dyer’s woad reduced soil Ninorg by 52kgha−1 relative to the sole-cropped system, and dyer’s woad accumulated 48kgNha−1 in aboveground biomass at harvest in 2013. Late-sown dyer’s woad had fewer roots, left higher soil Ninorg and had lower aboveground N accumulation than early-sown dyer’s woad until the following spring. Therefore, early-sown dyer’s woad is applicable in an organic intercropped system with high yields of leek to decrease the risk of nitrate leaching
Dimensional hyper-reduction of nonlinear finite element models via empirical cubature
No full textAbstractWe present a general framework for the dimensional reduction, in terms of number of degrees of freedom as well as number of integration points (“hyper-reduction”), of nonlinear parameterized finite element (FE) models. The reduction process is divided into two sequential stages. The first stage consists in a common Galerkin projection onto a reduced-order space, as well as in the condensation of boundary conditions and external forces. For the second stage (reduction in number of integration points), we present a novel cubature scheme that efficiently determines optimal points and associated positive weights so that the error in integrating reduced internal forces is minimized. The distinguishing features of the proposed method are: (1) The minimization problem is posed in terms of orthogonal basis vector (obtained via a partitioned Singular Value Decomposition) rather that in terms of snapshots of the integrand. (2) The volume of the domain is exactly integrated. (3) The selection algorithm need not solve in all iterations a nonnegative least-squares problem to force the positiveness of the weights. Furthermore, we show that the proposed method converges to the absolute minimum (zero integration error) when the number of selected points is equal to the number of internal force modes included in the objective function. We illustrate this model reduction methodology by two nonlinear, structural examples (quasi-static bending and resonant vibration of elastoplastic composite plates). In both examples, the number of integration points is reduced three order of magnitudes (with respect to FE analyses) without significantly sacrificing accuracy
Approaches to Middle Stone Age landscape archaeology in tropical Africa
No full textAbstractThe Southern Montane Forest-Grassland mosaic ecosystem in the humid subtropics southern Rift Valley of Africa comprised the environmental context for a large area in which modern human evolution and dispersal occurred. Variable climatic conditions during the Late Pleistocene have ranged between humid and hyperarid, changing the character of the ecosystem and transforming it at different points in time into a barrier, a refuge, and a corridor between southern and eastern African populations. Alluvial fans presently blanket the areas adjacent to major river systems, which were key areas of prehistoric human habitation. These sets of variables have created conditions that are both challenging and advantageous to conduct archaeological research. Lateritic soil development has resulted in poor organic preservation and facilitated insect bioturbation, which has demanded an integrated micro-macro scale approach to building a reliable geochronology. An integrated field and analytical methodology has also been employed to identify the nature and degree of post-depositional movement in alluvial deposits, which preserve a wide range of spatial integrity levels in buried stone artifact assemblages between 47 and 30 ka in Karonga, northern Malawi. This paper describes the methodological advances taken toward understanding open-air Middle Stone Age archaeology in sub-tropical Africa, and explores the inferential potential for understanding Pleistocene human ecology in the important southern Rift Valley region
Genome sequence of Bradyrhizobium embrapense strain CNPSo 2833T, isolated from a root nodule of Desmodium heterocarpon
No full textAbstractBradyrhizobium embrapense CNPSo 2833T is a nitrogen-fixing symbiont of the legume pasture Desmodium. Its draft genome contains 8,267,832bp and 7876 CDSs. The symbiotic island includes nodulation and nitrogen fixation genes resembling the operon organization of B. japonicum. Several CDSs related to secretion proteins and stress tolerance were also identified