Notes

Magnetic resonance cholangiopancreatography: problems inside interpretation.
BACKGROUND  Gastric outlet obstruction (GOO) with peritoneal carcinomatosis presents a technical challenge. Surgical gastrojejunostomy (SGJ) or enteral stenting have been the standard of care; however, endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has emerged as a favorable alternative. Few data exist that compare these techniques in the setting of peritoneal carcinomatosis. METHODS  This single-center retrospective cohort study included 25 EUS-GE and 27 SGJ consecutive patients. Baseline demographics, cancer diagnosis and stage, clinical and technical success, adverse events, and obstruction recurrence data were collected. The primary outcome was the technical success comparison; secondary outcome was the adverse event rate comparison. Rates were compared with standard statistical tests. RESULTS  Mean age, obstruction location, and symptoms were similar between the groups. The EUS-GE group had more advanced disease (clinical stage 4, 100 % vs. 67 %; P = 0.006) and higher American Society of Anesthesiologists classification (class 3-4, 92 % vs. THZ1 50 %; P = 0.004). The technical success rate was 100 % in both groups (P > 0.99) and the adverse event rate was lower for EUS-GE (8 % vs. 41 %; P = 0.01). Clinical success was 88 % for EUS-GE and 85 % for SGJ (P > 0.99) and recurrent obstruction was lower with EUS-GE (28 % vs. 41 %; P = 0.13). The EUS-GE group had shorter procedure duration, length of stay, and time to chemotherapy resumption than the SGJ group. CONCLUSIONS  Although the EUS-GE group was older, with more comorbidity and advanced stages, the technical success rate was similar to SGJ and it had significantly fewer adverse events. EUS-GE is a safe and effective option for the management of malignant GOO with peritoneal carcinomatosis.The practice of reaching an audience through social media to promote nonsurgical treatments of the face is in its infancy. Young adults, arguably the most health-literate generation to date, comprise both the majority of users targeted by social media and the fastest growing demographic seeking cosmetic consultation. We know that this age group is also at an increased risk of depression and body dysmorphia in an era where nonsurgical cosmetic options are typically thought to be gateways to surgical treatments. In light of these facts, it seems the ethics of medicine might be lagging behind the amorphous, rapidly evolving nature of social media and, specifically, its use as a platform for business promotion and health information. As cosmetic treatments become a normalized facet of society's health care routine, in large part due to its ubiquity on social media platforms, its promotion by providers requires reexamination so that its pro-social potential can be realized. This is ensured by fostering a social media presence and in-office attitude that treatments should be an agreement between patient and provider on realistic expectations and how best to meet them.
This study investigated combined prescriptions of drugs for mood disorders and physical comorbidities that need special attention in the light of frequent physical comorbidities in patients with mood disorders.

We used the claims sampling data of 581,990 outpatients in January 2015 from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Fisher's exact test was performed to compare the prescription rates of non-steroidal anti-inflammatory drugs (NSAIDs), loop/thiazide diuretics, angiotensin-converting enzyme inhibitors, and/or angiotensin II receptor blockers between lithium users and age- and sex-matched non-lithium users; NSAIDs, antiplatelet drugs, and/or anticoagulants between selective serotonin reuptake inhibitor (SSRI)/serotonin-noradrenaline reuptake inhibitor (SNRI) users and non-users; warfarin between mirtazapine users and non-users; and the proportions of patients in the two groups with a diagnosis of somatic conditions for which these medications were indicated and actually received them. A Bonferroni corrected p-value of<0.05/3 was considered statistically significant.

Prescriptions of the above-mentioned medications were less frequent in lithium and mirtazapine users and comparable in SSRI/SNRI users, compared to non-users (18.3 vs. 31.9%, p=7.6×10
; 0.78 vs. 1.65%, p=0.01; 23.1 vs. 24.1%, p=0.044). In a subgroup of patients with somatic diseases for which these medications were indicated, the prescription rates were comparable in lithium and mirtazapine users and higher in SSRI/SNRI users compared to non-users (28.0 vs. 29.4%, p=0.73; 4.7 vs. 7.4%, p=0.28; 35.6 vs. 33.4%, p=0.0026).

Pharmacotherapy with drugs for mood disorders and physical comorbidities that require attention was commonly observed in clinical practice.
Pharmacotherapy with drugs for mood disorders and physical comorbidities that require attention was commonly observed in clinical practice.As blood flows from the portal triad to the central vein, cell-mediated depletion establishes gradients of soluble factors such as oxygen, nutrients, and hormones, which act through molecular pathways (e.g., Wnt/β-catenin, hedgehog) to spatially regulate hepatocyte functions along the sinusoid. Such "zonation" can lead to the compartmentalized initiation of several liver diseases, including alcoholic/non-alcoholic fatty liver diseases, chemical/drug-induced toxicity, and hepatocellular carcinoma, and can also modulate liver regeneration. Transgenic rodent models provide valuable information on the key molecular regulators of zonation, while in vitro models allow for subjecting cells to precisely controlled factor gradients and elucidating species-specific differences in zonation. Here, we discuss the latest advances in both in vivo and in vitro models of liver zonation and pending questions to be addressed moving forward. Ultimately, obtaining a deeper understanding of zonation can lead to the development of more effective therapeutics for liver diseases, microphysiological systems, and scalable cell-based therapies.
Congenital microphthalmos can either occur alone (simple microphthalmos) or be associated with other ocular malformations, such as sclerocornea or cataract (complex microphthalmos). As this is a rare condition, there are no uniform recommendations for treatment.

Retrospective case series of 103 patients or a total of 114 eyes with congenital microphthalmos, with reporting of age, sex, visual acuity, pupil reaction, axial length, horizontal width of the palpebral fissure, type of therapy performed and complications.

All patients would have been able to be fitted with a prosthesis primarily. The size of the palpebral fissure depended on the underlying findings "bilateral microphthalmos" < "microphthalmos and healthy fellow eye" < "microphthalmos and fellow anophthalmos". In order to assess visual (residual) function in an infant in the first weeks or months of life, the pupillary response is of the upmost importance in deciding on therapy, especially in unilateral disease, and as assessed with the ian be started early in the first year of life without fear of resulting complications.
In the case of visual function of the microphthalmos, surgical measures should not be indicated or only with extreme caution, since the preservation of the existing visual acuity must be regarded as having priority over the cosmetic findings. In cases of asymmetry or underdeveloped palpebral fissure, therapy can be started early in the first year of life without fear of resulting complications.
Report of clinical findings relating to the lacrimal system in congenital clinical anophthalmos and severe blind microphthalmos (MAC-complex patients).

A retrospective study of the notes of 207 consecutive patients treated surgically at least once with highly hydrophilic self-inflating expanders for MAC between 1998 and 2021. The lacrimal drainage system was always probed and irrigated under general anaesthesia before any other procedure was started.

64 patients were excluded due to possible misdiagnosis because of previous lid or orbit surgery elsewhere or due to missing data. The analysis therefore included 67 girls and 76 boys aged between 1 and 126 months (median age 5 months). 72 patients presented with unilateral and 42 with bilateral anophthalmos, and 24 had unilateral and 5 bilateral microphthalmos; consequently, 286 orbits (of which, 190with probable pathology) were available for assessment. In unilateral cases the lacrimal system on the normal side was never affected. On the anophthalmic or mi evidence of an embryological connection, this association is certainly not a random finding.Congenital dacryostenosis is the most common reason for ophthalmic consultation in childhood. It is most often caused by persisting of Hasner's membrane. However, congenital malformations of the lacrimal drainage system can also occur in rare cases. In the area of the proximal lacrimal drainage system, supernumerary lacrimal puncta and canaliculi can arise as well as diverticula, fistula, and atresia. The distal lacrimal drainage system can be affected by fistulas, amniotoceles, and cysts. Association of lacrimal malformations with congenital systemic diseases is reported in about 10% of cases. Depending on the severity of the symptoms, surgical rehabilitation can be performed, and endoscopic procedures and modern lacrimal drainage intubation systems may be employed.The embryological and fetal morphogenesis of the eyelids and lacrimal drainage system is multifactorial and complex. This protracted process begins in the 5th week of prenatal life and involves a successive series of subtle and tightly regulated morphogenetic events. Major milestones of the embryological and fetal development of the eyelids include the beginning of eyelid formation during the 6th week, eyelid fusion by the 8th week, and the development of eyelid structures beginning in the 9th week (immediately following eyelid fusion), with progression until eyelid separation by the 24th week. After eyelid separation, the eyelids begin to assume their newly developed shape. Around the 32nd week, eyelids are almost fully developed and fully separated but still visibly closed. Key development steps of the lacrimal drainage system include formation of the lacrimal lamina (the primordium of the future lacrimal system) and the lacrimal cord (the primordium of the lacrimal canaliculi) in the 7th week, with canalization starting from the 10th week. During the 10th week, the excretory lacrimal system displays a lumen with a true lacrimal duct that can be distinguished. The epithelium of the lacrimal canaliculi is in contact with the palpebral conjunctival epithelium. The two epithelia form a continuous epithelial lamina. The caudal extreme of the lacrimal duct and the inferior meatal lamina join and the latter begins to cavitate. Understanding this multidimensional process of development in prenatal life, as well as identifying and linking signaling cascades and regulatory genes to existing diseases, may pave the way for developing minimally invasive interventions and scar reducing surgical methods, controlling the spread of malignancies, and the use of progenitor/stem cell and even regenerative therapy.
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