Notes

Adjuvant regarding vaccine immunotherapy involving cancer--focusing about Toll-like receptor Two and three agonists regarding correctly boosting antitumor defense.
Background and study aims  The utility of digital single- operator cholangiopancreatoscopy (D-SOCP) in surgically altered anatomy (SAA) is limited. We aimed to evaluate the technical success and safety of D-SOCP in patients SAA. Patients and methods  Patients with SAA who underwent D-SOCP between February 2015 and June 2020 were retrospectively evaluated. selleck chemical Technical success was defined as completing the intended procedure with the use of D-SOCP. Results  Thirty-five patients underwent D-SOCP (34 D-SOC, 1 D-SOP). Bilroth II was the most common type of SAA (45.7 %), followed by Whipple reconstruction (31.4 %). Twenty-three patients (65.7 %) patients had prior failed ERCP due to the presence of complex biliary stone (52.2 %). A therapeutic duodenoscope was utilized in the majority of the cases (68.6 %), while a therapeutic gastroscope (22.7 %) or adult colonoscope (8.5 %) were used in the remaining procedures. Choledocholithiasis (61.2 %) and pancreatic duct calculi (3.2 %) were the most common indications for D-SOCP. Technical success was achieved in all 35 patients (100 %) and majority (91.4 %) requiring a single session. Complex interventions included electrohydraulic or laser lithotripsy, biliary or pancreatic stent placement, stricture dilation, and target tissue biopsies. Two mild adverse events occurred (pancreatitis and transient bacteremia). Conclusions  In SAA, D-SOCP is a safe and effective modality to diagnose and treat complex pancreatobiliary disorders, especially in cases where standard ERCP attempts may fail.Background and study aims  The endoscopic pressure study integrated system (EPSIS), a novel diagnostic tool for gastroesophageal reflux disease (GERD), allows evaluation of the anti-reflux barrier using endoscopy by monitoring the intragastric pressure (IGP) during insufflation. In this study, we evaluated the association between EPSIS results and lower esophageal sphincter (LES) function measured by high-resolution manometry (HRM) to elucidate whether EPSIS can evaluate the LES function. Patients and methods  A retrospective, single-center study of patients with GERD symptoms who underwent endoscopy, pH-impedance monitoring, EPSIS, and HRM was conducted. The primary outcome was basal LES pressure and the secondary outcomes were end-respiratory LES pressure and integrated relaxation pressure (IRP). As EPSIS parameters, the following were measured 1) pressure difference (mmHg), the difference between maximum and basal IGP; and 2) pressure gradient (mmHg/s), calculated by dividing pressure difference by the insufflating time. Pressure difference  less then  4.7 mmHg or pressure gradient less then  0.07 mmHg/s was defined as an EPSIS GERD pattern. Results  Forty-seven patients (median age 53 years, 37 female) were analyzed. Pressure difference and pressure gradient significantly correlated with basal LES pressure (ρ = 0.29; P =  0.04 and ρ = 0.29; P =  0.04). Patients with EPSIS GERD pattern showed significantly lower basal LES pressure [13.2 (4.8-26.6) vs 25.3 (10.4-66.7) mmHg, P =  0.002], lower end-respiratory LES pressure [8.5 (1.1-15.9) vs 15.5 (1.9-43.9) mmHg, P =  0.019] and lower IRP [5.9 (1.0-12.0) vs 9.8 (1.3-17.8) mmHg, P =  0.020]. Conclusions  This study showed a close association between EPSIS results and LES pressures measured by HRM. This indicates that EPSIS can evaluate the LES function during endoscopy and endorse the role of EPSIS as a diagnostic tool for GERD.Background and study aims  Gastroparesis post-lung transplant (LTx) can lead to increased risk of gastroesophageal reflux (GER) and accelerated graft dysfunction. We aimed to evaluate the efficacy and safety of gastric per-oral endoscopic myotomy (G-POEM), a promising tool in patients with refractory gastroparesis, for managing refractory gastroparesis and GER in post-LTx patients. Patents and methods  This was a multicenter retrospective study on post-LTx patients who underwent G-POEM for management of gastroparesis and GER that were refractory to standard medical therapy. The primary outcome was clinical success post-G-POEM. Secondary outcomes included the rate of post-G-POEM objective esophageal pH exam normalization, rate of gastric emptying scintigraphy (GES) normalization, technical success, and adverse events. Results  A total of 20 patients (mean age 54.7 ± 14.1 years, Female 50 %) underwent G-POEM at a median time of 13 months (interquartile range 6.5-13.5) post-LTx. All G-POEM procedures were technically successful. Clinical success was achieved in 17 (85 %) patients during a median follow-up time of 8.9 (IQR 3-17) months post-G-POEM. Overall GCSI and two of its subscales (bloating and postprandial fullness/early satiety) improved significantly following G-POEM. Two patients (10 %) developed post-procedural AEs (delayed bleeding 1, pyloric stenosis 1, both moderate in severity). Post-G-POEM GES improvement was achieved in 12 of 16 patients (75 %). All 20 patients were on proton pump inhibitors pre-G-POEM, as opposed to five post-G-POEM. Post-G-POEM PH study normalization was noted in nine of 10 patients (90 %) who underwent both pre- and post-G-poem pH testing. Conclusions  G-POEM is a promising noninvasive therapeutic tool for management of refractory gastroparesis and GER post-LTx.Background and study aims  In pancreatic cancer, the antitumor effect can only be assessed by means of a computed tomography (CT) scan using RECIST (Response Evaluation Criteria in Solid Tumours) criteria. The aim of this study was to assess the intra-observer and interobserver agreement of endoscopic ultrasound (EUS) imaging in assessing tumor volume in primary pancreatic cancer. Patients and methods  During a Phase 1 gene therapy trial, 21 patients had EUS before the first and second EUS-guided in situ gene therapy injections. All anonymized EUS files were then randomly distributed to three gastroenterologists/endosonographers and three radiologists (blind status). The largest tumor diameter was measured and the intraclass correlation coefficient (ICC) was determined. Results  Intra-observer and interobserver agreements were good to excellent, regardless of operator experience (junior versus senior member of staff) (ICC 0.65 to 0.84). A comparison of pretreatment and post-treatment measurements by the investigators highlighted a significant antitumor effect (-11 %; P  = 0.0098), similar to that obtained during the generic protocol (-10 %; P  = 0.0045). Conclusions  Interobserver agreement regarding primary pancreatic adenocarcinoma measurements appears good to excellent, thus paving the way for the future inclusion of EUS assessments, particularly in trials assessing local therapies for pancreatic tumors.Important adolescents' career-related decisions might be influenced by their beliefs about malleability of intelligence and learning (mindset). We combined quantitative and qualitative data to provide in-depth insights in the beliefs that 13-14-year-olds hold about learning and intelligence, the factors influencing these beliefs, and the consequences of these beliefs in relation to classroom behaviour and study choices. To establish students' mindsets quantitatively, we categorised theory of intelligence questionnaire (TOI; Dweck, 1999) averaged scores into three levels entity, intermediate or incremental mindsets, to provide insight into the distribution of the different mindset types in our sample (N = 492). The results of this quantitative study show that more than half of the students believed intelligence is "fixed" (entity mindset), these data showed no effect of gender. To gain more in-depth insight in the views of these students, focus groups about mindset and its influences and consequences were held in a subsample (n = 176). The qualitative data provide more nuanced insights, for example they reveal subtle gender differences regarding effort beliefs and motivation. Integrated discussion of the quantitative and qualitative results demonstrates that this multi-method approach reflects the complexity of the concept mindset better than only the widely used TOI questionnaire.Organisms living in seasonal environments often adjust physiological capacities and sensitivities in response to (or in anticipation of) environment shifts. Such physiological and morphological adjustments ("acclimation" and related terms) inspire opportunities to explore the mechanistic bases underlying these adjustments, to detect cues inducing adjustments, and to elucidate their ecological and evolutionary consequences. Seasonal adjustments ("seasonal acclimation") can be detected either by measuring physiological capacities and sensitivities of organisms retrieved directly from nature (or outdoor enclosures) in different seasons or less directly by rearing and measuring organisms maintained in the laboratory under conditions that attempt to mimic or track natural ones. But mimicking natural conditions in the laboratory is challenging-doing so requires prior natural-history knowledge of ecologically relevant body temperature cycles, photoperiods, food rations, social environments, among other variables. We argue that traditional laboratory-based conditions usually fail to approximate natural seasonal conditions (temperature, photoperiod, food, "lockdown"). Consequently, whether the resulting acclimation shifts correctly approximate those in nature is uncertain, and sometimes is dubious. We argue that background natural history information provides opportunities to design acclimation protocols that are not only more ecologically relevant, but also serve as templates for testing the validity of traditional protocols. Finally, we suggest several best practices to help enhance ecological realism.The number of shoulder replacements performed each year continues to increase, and the need for revision replacements has grown accordingly. The outcome of a revision replacement may influence which primary implant is selected and the timing of primary surgery, particularly in younger patients. The aim of this study was to establish the expected improvement in shoulder function and implant survival following revision of a hemiarthroplasty and revision of an anatomical total shoulder arthroplasty (TSA). A systematic review and meta-analysis were performed of all studies reporting shoulder scores or implant survival following revision hemiarthroplasty or revision TSA. MEDLINE, EMBASE, CENTRAL, The Cochrane Database of Systematic Reviews and National Joint Registry reports were searched. 15 studies were included, reporting on 593 revision anatomical shoulder replacements. There was large variation in the magnitude of improvement in shoulder scores following revision surgery. Over 80% of revision replacements last 5 years and over 70% last 10 years. There was no significant difference in shoulder scores or implant survival according to the type of primary implant. The belief that revision of a shoulder hemiarthroplasty may lead to improved outcomes compared to revision of a TSA is not supported by the current literature.The spread of respiratory diseases via aerosol particles in indoor settings is of significant concern. The SARS-CoV-2 virus has been found to spread widely in confined enclosures like hotels, hospitals, cruise ships, prisons, and churches. Particles exhaled from a person indoors can remain suspended long enough for increasing the opportunity for particles to spread spatially. Careful consideration of the ventilation system is essential to minimise the spread of particles containing infectious pathogens. Previous studies have shown that indoor airflow induced by opened windows would minimise the spread of particles. However, how outdoor airflow through an open window influences the indoor airflow has not been considered. The aim of this study is to provide a clear understanding of the indoor particle spread across multiple rooms, in a situation similar to what is found in quarantine hotels and cruise ships, using a combination of HVAC (Heating, Ventilation and Air-Conditioning) ventilation and an opening window.
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