Papilla of Vater morphology as an influencing factor in successful cannulation during resident training in advanced endoscopy. A prospective clinical study.

INTRODUCTION AND AIM: Endoscopic retrograde cholangiopancreatography (ERCP) is a complex procedure. Clinical guidelines assess competence in ERCP through a defined number of procedures, but multiple factors are involved. Our aim was to analyze the morphology of the papilla of Vater as an independent factor in selective common bile duct cannulation during resident training. MATERIAL AND METHODS: Patients that underwent ERCP were studied consecutively. All ERCPs were begun by a resident in training. The type of papilla was classified according to Haraldsson, including those with previous sphincterotomy. Cannulation difficulty and success and their relation to the type of papilla were documented. The analysis was divided into three 4-month periods. RESULTS: Of the 429 patients, cannulation was difficult in 101 (23.5%). The residents achieved selective cannulation of the common bile duct in 276 (64.3%) and the cannulation success rate at the end of their training was 81.7%. Cannulation was performed with the least difficulty in papillae with previous sphincterotomy (2.8%), unlike the type 4 papilla, which was difficult to cannulate in 50% of the cases. The lowest overall cannulation success was in the type 2 papilla (81.8%). CONCLUSION: Papilla type can influence cannulation success, but it is not the only related factor. Patients that underwent previous sphincterotomy appear to be the cases in whom ERCP training can be started.

Use of audiovisual devices in transnasal endoscopy without sedation to improve tolerance. A prospective clinical trial.

INTRODUCTION AND AIM: Transnasal endoscopy (TNE) has proven its diagnostic utility, but it has not been widely accepted given that it is performed without sedation. There are no previous studies on the use of methods to improve its tolerability. Our aim was to evaluate the tolerability of TNE, when simultaneously performed with an audiovisual device as a distractor. METHODS: We evaluated 50 patients, 10 of whom did not agree to participate. The performance of the procedure was explained, using an audiovisual device. Before randomization, we applied anxiety and depression scores. Patients were divided into 2 groups: Group I (using an audiovisual device during the procedure) and Group II (without a device). Anxiety and numeric pain rating scales were used, and vital signs were monitored and recorded before, during, and after the endoscopy. An overall procedure satisfaction score was applied at the end of the study and 24 h later. RESULTS: Mean age was 41.6 years and 35 of the patients were women (87.5%). The most frequent indication for TNE was refractory gastroesophageal reflux disease. There were no severe comorbidities, and none of the patients had a significant anxiety or depression score. One patient in Group II did not tolerate TNE due to nasal pain. There was no statistically significant difference between groups, regarding anxiety, pain, vital signs, and satisfaction scale. CONCLUSION: Our study showed that TNE was well tolerated and had a high acceptance rate in our patients. The use of distracting audiovisual devices did not increase tolerance to the endoscopic procedure.

The increment of the temperature of maximum density of water by addition of small amounts of tert-butanol: Experimental data and microscopic description revisited.

The temperature of maximum density, TMD, of aqueous solutions of tert-butanol has been experimentally determined in the pressure range of 0-300 bars and up to 0.025 tert-butanol mole fraction. At atmospheric pressure, this quantity increases for low alcohol mole fractions, reaches a maximum at intermediate concentrations, and then quickly falls. The new experimental results are basically in agreement with previous data in the literature by Wada and Umeda [G. Wada and S. Umeda, Bull. Chem. Soc. Jpn. 35, 646 (1962)], except at very low mole fractions, where these authors reported a stronger density anomaly. Our measurements also confirm the known effect of pressure, p, on the variation in the temperature of maximum density with respect to that of pure water, ΔTMD: this quantity increases with p over the whole composition range. In addition, molecular dynamics simulations were performed between 0 and 2000 bars and from 238 to 328 K using a recently proposed model for the tert-butanol/water system. It has been found that our model reproduces qualitatively the experimental behavior of the ΔTMD, but for pressures above 1000 bars. A detailed structural analysis showed that the addition of tert-butanol promotes the low density water structure, and this promotion is somewhat hampered as the temperature increases at high pressure (ΔTMD > 0) and mostly independent of temperature at low pressures (ΔTMD < 0). Our analysis shows that the ultimate factor determining changes in the TMD is the temperature dependence of the low density water structure enhancement. We have also carried out a local structure analysis in which in addition to solid-like structures, low density liquid water ones have also been considered.

Esophagogastric junction outflow obstruction in the differential diagnosis of post-fundoplication dysphagia in children.

INTRODUCTION AND AIMS: Post-fundoplication dysphagia is resolved with no therapeutic intervention in the majority of cases but it can persist in 5.3% of children that undergo the procedure. Among the differential diagnoses, esophagogastric junction outflow obstruction (EGJOO) is a disorder that should be suspected if there is a persistence of dysphagia. The aim of our study was to describe the clinical characteristics, treatment, and follow-up in a case series of patients diagnosed with post-fundoplication EGJOO. MATERIALS AND METHODS: The clinical records of patients diagnosed with EGJOO at a tertiary care hospital within the time frame of September 2015 to September 2019 were reviewed, with respect to manometry, etiology, treatment, and clinical course of the disease. RESULTS: Of the 213 high-resolution esophageal manometries performed, 4 patients met the criteria for post-fundoplication EGJOO. The primary symptom was dysphagia, presenting 15 days after the procedure. Esophageal dilations were carried out on all the patients but with no improvement. Symptoms related to the condition resolved spontaneously in three of the four patients. CONCLUSION: The management of children with post-fundoplication EGJOO continues to be a challenge. Even though more than half of the cases resolve with no intervention, optimum management of the motility disorder is still limited, given the scant experience with the condition in the pediatric population.

Cystlike Lesions as a Late Sequela of Radiotherapy in Pediatric Patients.

BACKGROUND AND PURPOSE: The developing nervous system is particularly vulnerable to late adverse effects of cranial radiation therapy, such as leukoencephalopathy, microbleeds, and cavernomas. Cystlike lesions have been rarely described and characterized in the literature. We aimed to characterize cystlike lesions, their risk factors, and association with other late adverse effects. MATERIALS AND METHODS: Children treated for brain tumors during a 30-year period (n = 139) were included. We documented imaging findings, focusing on cystlike lesion development and its relationship with clinical history and other imaging findings. Multivariable analysis was performed using logistic regression and negative binomial regression models. RESULTS: Cystlike lesions developed in 16.5% of patients treated with radiotherapy, with a median of 2 years until the development of the first lesion. For every 4-year age increase, there were 50% decreased odds of developing lesions and a 50% decrease in the average count of lesions. Females demonstrated a 4.00 rate ratio of developing a higher number of lesions. Patients who underwent chemoradiotherapy had 3.20 increased odds of developing cystlike lesions compared with patients with radiation therapy alone. A larger proportion of patients treated with methotrexate (25%) developed cystlike lesions, but this was not statistically significant. Cystlike lesions tended to develop in cerebral locations where leukoencephalopathy was worse. A strong relationship was found between the development of cystlike lesions and leukoencephalopathy severity. CONCLUSIONS: Cystlike lesions are frequent and under-reported late adverse effects of cranial radiation therapy in children. Younger age, chemoradiotherapy, and the severity of leukoencephalopathy represent risk factors for the development of cystlike lesions.

Serrated polyps of the colon and rectum: a concise review.

"Serrated polyps" is the term used for epithelial lesions of the colon and rectum that have a "sawtooth" pattern on the polyp's surface and crypt epithelium. The so-called serrated pathway describes the progression of sessile serrated adenomas and traditional serrated adenomas to colorectal cancer. Said pathway is well recognized as an alternative mechanism of carcinogenesis and accounts for 15-30% of the cases of colorectal cancer. It also explains a large number of the cases of interval colorectal cancer. Thus, due to their usually aggressive and uncertain behavior, serrated polyps are of the utmost importance in colorectal cancer screening. Our aim was to review the history, current nomenclature, pathophysiology, morphology, treatment, and surveillance of serrated polyps.

Ergonomic assessment of a new hand tool design for laparoscopic surgery based on surgeons' muscular activity.

Laparoscopic surgery techniques are customarily used in non-invasive procedures. That said traditional surgical instruments and devices used by surgeons suffer from certain ergonomic deficiencies that may lead to physical complaints in upper limbs and back and general discomfort that may, in turn, affect the surgeon's skills during surgery. A novel design of the laparoscopic gripper handle is presented and compared with one of the most used instruments in this field in an attempt to overcome this problem. The assessment of the ergonomic feature of the novel design was performed by using time-frequency analysis of the surface electromyography (sEMG) signal during dynamic activities. Singular Spectrum Analysis (SSA) was used to decompose the sEMG signal and extract the median frequency of each muscle to assess muscle fatigue. The results reveal that using the proposed ergonomic grip reduces the mean values of the muscle activity during each of the proposed tasks. The novel design also improves the ease of use in laparoscopic surgery as it minimises high-pressure contact areas, reduces large amplitude movements and promotes a neutral position of the hand, wrist and forearm. Furthermore, the SSA method for time-frequency analysis provides a powerful tool to analyse a prescribed activity in ergonomic terms. The proposed methodology to assess muscle activity during surgery activities may be useful in the selection of surgical instruments when programming extended procedures, as it provides an additional selection criterion based on the surgeon's biomechanics and the proposed activity.

Inducción de organogénesis in vitro con 6-bencilaminopurina en Cattleya trianae Linden & Rchb.f / Induction of organogenesis in vitro with 6-benzylaminopurine in Cattleya trianae Linden & Rchb.f

RESUMEN La orquídea Cattleya trianae Linden & Rchb.f. es reconocida como flor nacional de Colombia y se encuentra en peligro crítico, al presentar una reducción estimada mayor al 80% en los últimos 100 años, debido a la disminución en la calidad del hábitat y niveles altos de explotación o recolección. La familia Orchidaceae es una de las que mayor número de especies posee en el reino Plantae, con aproximadamente 900 géneros, de los cuales, el 38% es endémico de Colombia, concentrado en la región Andina, con 87,2%. Esta investigación buscó profundizar en el tema de la propagación como mecanismo de conservación, para lo cual, se determinó el efecto de la 6-Bencilaminopurina (6-BAP), sobre el desarrollo in vitro, en Fusagasugá (Cundinamarca), en un diseño de bloques completamente al azar, con 3 repeticiones. Cuerpos protocórmicos provenientes de semillas recolectadas en Pacho (Cundinamarca) fueron sembrados en medio básico Murashige & Skoog, enriquecido con 4 concentraciones de 6-BAP. Los resultados mostraron respuestas diferenciales a la adición de la citoquinina, ya que, con la concentración más alta, se obtuvo el mayor porcentaje de callos, con la de 0,05mg.L-1, el mayor porcentaje de brotes y sin la aplicación del regulador de crecimiento, el mayor porcentaje de raíz.

ABSTRACT The orchid Cattleya trianae Linden & Rchb.f. is recognized as the national flower of Colombia, the species is in a critical danger, presenting an estimated reduction of more than 80% in the last 100 years due to the decrease in habitat quality and high levels of exploitation or harvesting. The Orchidaceae family is one of the largest number of species in the Plant Kingdom, with approximately 900 genera, of which 38% are endemic in Colombia, concentrated in the Andean region with 87.2%. This research sought to deepen in the topic of the propagation as mechanism of protection for their conservation, for which the effect of cytokinin 6-benzylaminopurine (6-BAP) on development was determined in vitro in Fusagasugá (Cundinamarca), in a completely randomized block design with 3 replicates. The protocorm-like bodies from seeds collected in Pacho (Cundinamarca) were sown in a basic medium Murashige and Skoog enriched with 4 concentrations of 6-BAP. The results showed differential responses to the addition of cytokinin, as the highest concentration was obtained the highest percentage of callus, with the 0.05mg. L-1, the highest percentage of shoots and without the application of the growth regulator, the highest root percentage.

Design of Semirigid Wearable Devices Based on Skin Strain Analysis.

Nowadays, both usability and comfort play a key role in the development of medical and wearable products. When designing any device that is in contact with the human body, the mechanical behavior of the embraced soft tissue must be known. The unavoidable displacement of the soft tissue during motion may lead to discomfort and, thus, the removal of the wearable product. This paper presents a new methodology to design and test a wearable device based on the measurement of the dynamic skin strain field. Furthermore, from this field, the anatomical lines with minimum strain (lines of nonextension (LoNEs)) are calculated to design the structural parts of the wearable device. With this new criterion, the resulting product is not only optimized to reduce the friction in skin-device interface, but fully personalized to the patient's morphology and motion. The methodology is applied to the design of an ankle-foot wearable orthosis for subjects with ankle dorsiflexors muscles weakness due to nervous system disorders. The results confirm that the use of LoNEs may benefit the design of products with a high interaction with the skin.

A new intermolecular potential for simulations of methanol: The OPLS/2016 model.

In this work, a new rigid-nonpolarizable model of methanol is proposed. The model has three sites, located at the same positions as those used in the OPLS model previously proposed by Jorgensen [J. Phys. Chem. 90, 1276 (1986)]. However, partial charges and the values of the Lennard-Jones parameters were modified by fitting to an adequately selected set of target properties including solid-fluid experimental data. The new model was denoted as OPLS/2016. The overall performance of this model was evaluated and compared to that obtained with other popular models of methanol using a similar test to that recently proposed for water models. In the test, a certain numerical score is given to each model. It was found that the OPLS/2016 obtained the highest score (7.4 of a maximum of 10) followed by L1 (6.6), L2 (6.4), OPLS (5.8), and H1 (3.5) models. The improvement of OPLS/2016 with respect to L1 and L2 is mainly due to an improvement in the description of fluid-solid equilibria (the melting point is only 14 K higher than the experimental value). In addition, it was found that no methanol model was able to reproduce the static dielectric constant and the isobaric heat capacity, whereas the better global performance was found for models that reproduce the vaporization enthalpy once the so-called polarization term is included. Similar conclusions were suggested previously in the analysis of water models and are confirmed here for methanol.

A Quantitative Analysis of Cold Water for Human Consumption in Hospitals in Spain.

An estimation of the water used for human consumption in hospitals is essential to determine possible savings and to fix criteria to improve the design of new water consumption models. The present work reports on cold water for human consumption (CWHC) in hospitals in Spain and determines the possible savings. In the period of 2005-2012, 80 Eco-Management and Audit Schemes (EMAS) from 20 hospitals were analysed. The results conclude that the average annual consumption of CWHC is 1.59 m(3)/m(2) (with a standard deviation of 0.48 m(3)/m(2)), 195.85 m(3)/bed (standard deviation 70.07 m(3)/bed), or 53.69 m(3)/worker (standard deviation 16.64 m(3)/worker). The results demonstrate the possibility of saving 5,600,000 m(3) of water per year. Assuming the cost of water as approximately 1.22 €/m(3), annual savings are estimated as 6,832,000 €. Furthermore, 2,912 MWh of energy could be saved, and the emission of 22,400 annual tonnes of CO2 into the atmosphere could be avoided.

Temperature of maximum density and excess thermodynamics of aqueous mixtures of methanol.

In this work, we present a study of representative excess thermodynamic properties of aqueous mixtures of methanol over the complete concentration range, based on extensive computer simulation calculations. In addition to test various existing united atom model potentials, we have developed a new force-field which accurately reproduces the excess thermodynamics of this system. Moreover, we have paid particular attention to the behavior of the temperature of maximum density (TMD) in dilute methanol mixtures. The presence of a temperature of maximum density is one of the essential anomalies exhibited by water. This anomalous behavior is modified in a non-monotonous fashion by the presence of fully miscible solutes that partly disrupt the hydrogen bond network of water, such as methanol (and other short chain alcohols). In order to obtain a better insight into the phenomenology of the changes in the TMD of water induced by small amounts of methanol, we have performed a new series of experimental measurements and computer simulations using various force fields. We observe that none of the force-fields tested capture the non-monotonous concentration dependence of the TMD for highly diluted methanol solutions.

Utilidad de la resonancia magnética en el diagnóstico de lesiones musculares de localización atípica / Usefulness of magnetic resonance imaging in the diagnosis of atypical location muscle lesions

En el presente los desgarros musculares son una causa muy frecuente de lesión en la práctica deportiva. Según los estudios actuales, un 30% de las lesiones en atletas afecta los músculos, siendo particularmente comunes a nivel de los isquiotibiales, el recto anterior de los cuádriceps, los gemelos y los aductores. El diagnóstico se realiza en forma sencilla mediante un estudio ecográfico. Sin embargo, existe un número importante de lesiones musculares de localización profunda e infrecuente, que pueden pasar inadvertidas en la ecografía y que causan largos períodos de inactividad para el deportista. La resonancia magnética (RM), por su resolución anatómica y capacidad multiplanar, es el método de elección para el estudio de este tipo de afecciones, ya que permite descartar otras patologías de similar presentación clínica y realizar un diagnóstico específico. En este artículo describimos los desgarros musculares de localización inusual, particularmente los de localización pelviana, evaluando también la pared torácica, abdominal y miembros superiores e inferiores. En todos los casos, se usaron equipos de alto campo 1.5 y 3 Tesla.

Muscle injuries are currently particularly frequent among people who participate in sports. Current studies show that 30% of injuries in athletes affect muscles, with hamstrings, quadriceps, gastrocnemius, and adductors being particularly prevalent. The diagnosis is easily made with an ultrasound study. However, there are a significant number of muscle injuries, considered uncommon, that may be not be detected by ultrasound, mainly because of their depth, and could be responsible for long periods of inactivity for the sportsman. Magnetic resonance imaging (MRI), with a better anatomical resolution and multiplanar capability, is the method of choice for detecting the precise location and severity of the injury and can establish their severity. The aim of this article is to review muscle tears of unusual location, particularly in the pelvic area, but also evaluating the chest wall, abdomen, and upper and lower limbs. All patients were evaluated by 3 and 1.5 Tesla MRI units.

Neuralgia del trigémino: estudio funcional mediante tensor de difusión de alta densidad como herramienta diagnóstica / Trigeminal Neuralgia: functional study using high density diffusion tensor imaging as a diagnostic tool

Objetivo: El objetivo del presente artículo es demostrar la alteración de la fracción de anisotropía (FA) en la neuralgia esencial del trigémino (NET). Materiales y métodos: Se evaluaron 10 pacientes con diagnóstico de neuralgia esencial del trigémino mediante secuencias de tensor de difusión de alta densidad e imágenes anatómicas 3D en un resonador de alto campo 3 Tesla. En todos los casos se localizaron los nervios. Las imágenes obtenidas se posprocesaron para realizar la tractografía y medir la FA en 20 nervios. Resultados: Se correlacionaron los hallazgos patológicos entre la medición de la FA y la clínica de los pacientes. De los 10 casos, 6 presentaron compresión neurovascular de lado con neuralgia y un valor de FA descendido con respecto al contralateral en rango normal; mientras que 2 mostraron compresión neurovascular bilateral, pero solo descenso del valor de FA del lado afectado clínicamente. En los otros 2 pacientes no se determinó compresión neurovascular, aunque en el lado con manifestación clínica neurálgica la FA se encontraba descendida. Conclusión: La realización de la difusión anisotrópica de alta densidad y la medición de la FA pueden ser una herramienta en la evaluación de la neuralgia esencial del trigémino, ya que es un método reproducible y seguro que permite estudiar la función del nervio.

Objective: The objective of this article is to demonstrate the alteration of the anisotropy factor (FA) in essential trigeminal neuralgia. Materials and methods: Ten patients with essential trigeminal neuralgia were studied with sequences of high density diffusion tensor and anatomic 3D images with a high-field 3 Tesla resonator. The nerves were located in all cases studied. The obtained images were post-processed to perform tractography and FA was measured in 20 nerves. Results: There was correlation of pathological findings between measuring FA and clinical presentation of the patients. Six of the ten patients studied with neurovascular compression at the neuralgia side had decreased FA values compared to contralateral normal range. Two of the ten patients showed bilateral neurovascular compression, but only abnormal values of FA were found at the clinically affected side. In the remaining two patients no neurovascular compression was determined; however the FA was lower at the clinical manifestation neuralgic side. Conclusión: The performing of high density anisotropic diffusion and the measurement of the FA may be useful in the evaluation of Trigeminal neuralgia, since it is a safe and reproducible method that allows the study of nerve function.

Neuralgia del trigémino: estudio funcional mediante tensor de difusión de alta densidad como herramienta diagnóstica

Objetivo: El objetivo del presente artículo es demostrar la alteración de la fracción de anisotropía (FA) en la neuralgia esencial del trigémino (NET). Materiales y métodos: Se evaluaron 10 pacientes con diagnóstico de neuralgia esencial del trigémino mediante secuencias de tensor de difusión de alta densidad e imágenes anatómicas 3D en un resonador de alto campo 3 Tesla. En todos los casos se localizaron los nervios. Las imágenes obtenidas se posprocesaron para realizar la tractografía y medir la FA en 20 nervios. Resultados: Se correlacionaron los hallazgos patológicos entre la medición de la FA y la clínica de los pacientes. De los 10 casos, 6 presentaron compresión neurovascular de lado con neuralgia y un valor de FA descendido con respecto al contralateral en rango normal; mientras que 2 mostraron compresión neurovascular bilateral, pero solo descenso del valor de FA del lado afectado clínicamente. En los otros 2 pacientes no se determinó compresión neurovascular, aunque en el lado con manifestación clínica neurálgica la FA se encontraba descendida. Conclusión: La realización de la difusión anisotrópica de alta densidad y la medición de la FA pueden ser una herramienta en la evaluación de la neuralgia esencial del trigémino, ya que es un método reproducible y seguro que permite estudiar la función del nervio.(AU)

Objective: The objective of this article is to demonstrate the alteration of the anisotropy factor (FA) in essential trigeminal neuralgia. Materials and methods: Ten patients with essential trigeminal neuralgia were studied with sequences of high density diffusion tensor and anatomic 3D images with a high-field 3 Tesla resonator. The nerves were located in all cases studied. The obtained images were post-processed to perform tractography and FA was measured in 20 nerves. Results: There was correlation of pathological findings between measuring FA and clinical presentation of the patients. Six of the ten patients studied with neurovascular compression at the neuralgia side had decreased FA values compared to contralateral normal range. Two of the ten patients showed bilateral neurovascular compression, but only abnormal values of FA were found at the clinically affected side. In the remaining two patients no neurovascular compression was determined; however the FA was lower at the clinical manifestation neuralgic side. Conclusión: The performing of high density anisotropic diffusion and the measurement of the FA may be useful in the evaluation of Trigeminal neuralgia, since it is a safe and reproducible method that allows the study of nerve function.(AU)