Endoscopic ultrasound-guided gastrojejunostomy for benign gastric outlet obstruction (GOO): a retrospective analysis of patients and outcomes.

BACKGROUND AND STUDY AIMS: Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) has been well utilized in treating malignant gastric outlet obstructions (GOO) given its efficacy and lower risk profile compared to surgery. However, its efficacy and potential for use in patients with benign GOO who are poor surgical candidates is not well documented. The aim of this study was to examine the role of EUS-GJ in treatment of benign GOO in select patients. PATIENTS AND METHODS: This is a single-center, open-label, retrospective descriptive study that included all consecutive patients undergoing EUS-GJ to treat benign causes of GOO. Direct antegrade and direct retrograde methods were utilized. RESULTS: A total of 18 patients were included, 38.9% female with an average age of 63.3 years. Extrinsic GOO was present in (10 of 18) 55.5% of patients and intrinsic etiology was present in (8 of 18) 45.5% of patients. Technical success was achieved in 100% (18 of 18) patients and clinical success was achieved in 94% (17 of 18) patients. In total, 13 patients had follow-up endoscopy, 2 patients were treated relatively recently in time, 1 patient was lost to follow-up, and 2 patients died of other chronic illnesses. Stents remained in place for a median of 286 days (range 88-1444 days). In patients whose stents were removed, 75% (3 of 4) had extrinsic etiologies of GOO. CONCLUSIONS: This study reports a favorable long-term patency with excellent technical and clinical success of EUS-GJ in patients with benign GOO. Despite the limitations of sample size and retrospective nature, it adds to the extremely limited literature of EUS-GJ in management of patients with benign GOO.

Sacral neuromodulation in children and adolescents with defecation disorders.

BACKGROUND: Even if understanding of neuronal enteropathies, such as Hirschsprung's disease and functional constipation, has been improved, specialized therapies are still missing. Sacral neuromodulation (SNM) has been established in the treatment of defecation disorders in adults. The aim of the study was to investigate effects of SNM in children and adolescents with refractory symptoms of chronic constipation. METHODS: A two-centered, prospective trial has been conducted between 2019 and 2022. SNM was applied continuously at individually set stimulation intensity. Evaluation of clinical outcomes was conducted at 3, 6, and 12 months after surgery based on the developed questionnaires and quality of life analysis (KINDLR). Primary outcome was assessed based on predefined variables of fecal incontinence and defecation frequency. KEY RESULTS: Fifteen patients enrolled in the study and underwent SNM (median age 8.0 years (range 4-17 years)): eight patients were diagnosed with Hirschsprung's disease (53%). Improvement of defecation frequency was seen in 8/15 participants (53%) and an improvement of fecal incontinence in 9/12 patients (75%). We observed stable outcome after 1 year of treatment. Surgical revision was necessary in one patient after electrode breakage. Urinary incontinence was observed as singular side effect of treatment in two patients (13%), which was manageable with the reduction of stimulation intensity. CONCLUSIONS: SNM shows promising clinical results in children and adolescents presenting with chronic constipation refractory to conservative therapy. Indications for patients with enteral neuropathies deserve further confirmation.

Sacral neuromodulation for constipation and fecal incontinence in children and adolescents - study protocol of a prospective, randomized trial on the application of invasive vs. non-invasive technique.

BACKGROUND: A therapeutic effect of sacral neuromodulation (SNM) on fecal incontinence (FI) and quality of life has been proven in adults. SNM is, however, rarely used in pediatric cases. The aim of the study is to investigate effects of SNM in pediatric constipation in a prospective parallel-group trial. METHODS: A monocentric, randomized, unblinded, parallel-group trial is conducted. SNM is conducted in the invasive variant and in an innovative, external approach with adhesive electrodes (enteral neuromodulation, ENM). We include patients with constipation according to the ROME IV criteria and refractory to conventional options. Patients with functional constipation and Hirschsprung's disease are able to participate. Participants are allocated in a 1:1 ratio to either SNM or ENM group. Clinical data and quality of life is evaluated in regular check-ups. Neuromodulation is applied continuously for 3 months (end point of the study) with follow-up-points at 6 and 12 months. Findings are analyzed statistically considering a 5% significance level (p ≤ 0.05). Outcome variables are defined as change in (1) episodes of abdominal pain, (2) episodes of FI, (3) defecation frequency, (4) stool consistency. Improvement of proprioception, influence on urinary incontinence, quality of life and safety of treatment are assessed as secondary outcome variables. We expect a relevant improvement in both study groups. DISCUSSION: This is the first trial, evaluating effects of neuromodulation for constipation in children and adolescents and comparing effects of the invasive and non-invasive application (SNM vs. ENM). TRIAL REGISTRATION: The study is registered with clinicaltrials.gov, Identifier NCT04713085 (date of registration 01/14/2021).

Nanoparticles with cubic symmetry: classification of polyhedral shapes.

Structural studies of polyhedral bodies can help to analyze geometric details of observed crystalline nanoparticles (NP) where we consider compact polyhedra of cubic point symmetry as simple models. Their surfaces are described by facets with normal vectors along selected Cartesian directions (a, b, c) together with their symmetry equivalents forming a direction family {abc}. Here we focus on polyhedra with facets of families {100}, {110}, and {111}, suggested for metal and oxide NPs with cubic lattices. Resulting generic polyhedra, cubic, rhombohedral, octahedral, and tetrahexahedral, have been observed as NP shapes by electron microscopy. They can serve for a complete description of non-generic polyhedra as intersections of corresponding generic species, not studied by experiment so far. Their structural properties are shown to be fully determined by only three parameters, facet distancesR100,R110, andR111of the three facet types. This provides a novel phase diagram to systematically classify all corresponding polyhedra. Their structural properties, such as shape, size, and facet geometry, are discussed in analytical and numerical detail with visualization of typical examples. The results may be used for respective NP simulations but also as a repository stimulating the structural interpretation of new NP shapes to be observed by experiment.

International business in the digital age: Global strategies in a world of national institutions.

Digital technologies are changing how businesses strategize and organize internationally. They not only enable cost reduction in businesses crossing national boundaries but also enable novel types of products and business models. Yet, barriers to cross-border businesses persist or even re-emerge, such that the study of international business remains important in the digital age, but may have to shift focus. We argue that businesses operating internationally develop digital business strategies that are interdependent with their internationalization strategies. In doing so, they have to account for differences across national contexts including informal institutions, formal institutions, and resource endowments. We offer a conceptual framework linking external and internal antecedents to digital business and internationalization strategies. We focus in particular on three digital strategies: owning digital platforms, participating in digital platforms, and transforming traditional businesses for the digital world. On this basis, we discuss the contributions of the papers in this special issue and conclude by outlining an agenda for future research.

Les technologies numériques modifient la manière dont les entreprises élaborent leurs stratégies et s'organisent au niveau international. Elles permettent non seulement de réduire des coûts des entreprises transfrontalières, mais aussi de créer de nouveaux modèles économiques et types de produits. Pourtant, les obstacles aux entreprises transfrontalières persistent, voire réapparaissent, de sorte que la recherche en affaires internationales reste importante à l'ère du numérique, mais doit peut-être changer d'orientation. Nous argumentons que les entreprises opérant au niveau international développent des stratégies d'entreprise numériques qui sont interdépendantes de leurs stratégies d'internationalisation. Ce faisant, elles doivent tenir compte des différences entre les contextes nationaux, incluant les institutions informelles, les institutions formelles et les dotations en ressources. Nous proposons un cadre conceptuel reliant les antécédents externes et internes aux stratégies d'entreprise numériques et d'internationalisation. Nous nous focalisons en particulier sur trois stratégies numériques : posséder des plateformes numériques, participer à des plateformes numériques et transformer des affaires traditionnelles pour le monde numérique. Sur cette base, nous discutons les contributions des articles de ce numéro spécial, et concluons notre article en esquissant un programme de recherches futures.

Las tecnologías digitales están cambiando la forma en que las empresas formulan estrategias y se organizan internacionalmente. Estas no sólo permiten reducir costos en las empresas que cruzan las fronteras nacionales, sino que también habilitan tipos de productos y modelos de negocio novedosos. Con todo, las barreras a las empresas transfronterizas persisten o incluso vuelven a surgir, de modo que el estudio de los negocios internacionales sigue siendo importante en la era digital, pero puede que tenga un cambio de perspectiva. Sostenemos que las empresas que operan internacionalmente desarrollan estrategias de negocio digitales que son interdependientes de sus estrategias de internacionalización. Al hacerlo, deben tener en cuenta las diferencias entre los contextos nacionales, incluidas las instituciones informales, las instituciones formales y el patrimonio de recursos. Ofrecemos un marco conceptual que vincula los antecedentes externos e internos de las estrategias de negocio digital y de internacionalización. Nos centramos en particular en tres estrategias digitales: poseer plataformas digitales, participar en plataformas digitales y transformar los negocios tradicionales para el mundo digital. Sobre esta base, discutimos las contribuciones de los artículos de este número especial y concluimos esquematizando una agenda para futuras investigaciones.

Tecnologias digitais estão mudando como empresas criam estratégias e se organizam internacionalmente. Elas não apenas permitem a redução de custos em negócios que cruzam fronteiras nacionais, mas também permitem novos tipos de produtos e modelos de negócio. No entanto, barreiras para negócios transfronteiriços persistem ou até ressurgem, de modo que o estudo sobre negócios internacionais continua importante na era digital, mas pode precisar mudar o foco. Argumentamos que empresas que operam internacionalmente desenvolvem estratégias de negócios digitais que são interdependentes de suas estratégias de internacionalização. Ao fazê-lo, devem considerar diferenças entre contextos nacionais, incluindo instituições informais, instituições formais e dotações de recursos. Oferecemos um modelo conceptual que liga antecedentes externos e internos aos negócios digitais e às estratégias de internacionalização. Focamos particularmente em três estratégias digitais: possuir plataformas digitais, participar em plataformas digitais e transformar negócios tradicionais para o mundo digital. Com base nisso, discutimos as contribuições dos artigos nesta edição especial e concluímos delineando uma agenda para pesquisas futuras.

The Effects of Different Types of Classism on Psychological Outcomes: Preliminary Findings.

In interpersonal relationships, people make assumptions about others' social class standing and interact with them based on these assumptions, which constitutes classism. Classism has an adverse impact on people's overall functioning, although scholarly attention on the unique impact of different types of classism, as proposed the Social Class Worldview Model-Revised (SCMW-R; Liu, 2011), has lagged behind. To address this gap in the literature, we explored how different types of classism (i.e., downward, upward, and lateral) can account for unique variance as predictors of psychological outcomes. Overall, our findings indicate that there is a unique impact of different types of classism on psychological outcomes (i.e., stress, anxiety, well-being, attitudes toward mental health care), beyond social status and overall discrimination alone.

Patients with positive patch test to formaldehyde can be safely vaccinated with formaldehyde-containing vaccines.

BACKGROUND: Prophylactic vaccination against influenza and other epidemic viruses is recommended for citizens above 65 years. Several vaccines may contain traces of formaldehyde and are contra-indicated in patients hypersensitive (in the broadest possible meaning) to formaldehyde. Thorough knowledge on the various subtypes of hypersensitivity is sparse among non-dermatologists and non-allergists, and therefore many patients are prevented from vaccination based on a positive patch test to formaldehyde. The purpose of this retrospective study was to investigate whether patients with positive patch test to formaldehyde subsequently receiving a formaldehyde-containing vaccine and developed a severe adverse reaction. METHODS/MATERIALS: From January 2000 to June 2021, 169 patients (>50 years) had a positive formaldehyde patch test at the Department of Dermatology and Allergy Center, Odense University Hospital and were included into this retrospective study. The electronic medical record was assessed for receipt of a formaldehyde-containing vaccine after patch test and for subsequent contact with the Acute Ward in the Region of Southern Denmark within 14 days after vaccination. RESULTS: Of the 158 patients residing in the Region of Southern Denmark, 130 patients were vaccinated with one or more formaldehyde-containing vaccines of whom 123 received an influenza vaccine. No contacts to the acute wards were identified. DISCUSSION: Although prospective studies would be beneficial, patients with positive patch test to formaldehyde can be safely vaccinated with formaldehyde-containing vaccines.

The effects of online and institutional racism on the mental health of African Americans.

OBJECTIVES: Although a wealth of literature has documented the adverse physical and mental health effects associated with exposure to racism, little scholarly attention has focused on the specific impact of online racism. Online experiences of racism have increased significantly over the years, and the intersection of online and "offline" racism makes it difficult for African Americans to find respite from overall experiences of racial discrimination in their daily lives. To address this gap in the literature, the present study was designed to examine the possible compounded effect of online and institutional racism by investigating whether offline institutional racism would serve as a moderator of the effects of online racism on psychological outcomes in a sample of African Americans. METHOD: One hundred and eighty-two African Americans answered survey data on their experiences of institutional and online racism, as well as their overall mental health. Moderated regressions and simple slope analyses were performed to examine the effects of online, institutional, and the interaction of online and institutional racism on psychological symptoms (i.e., psychological distress and well-being). RESULTS: Online racism was the strongest and most consistent predictor of all outcome variables. The interaction of online and institutional racism was significantly associated with psychological distress but not well-being. CONCLUSIONS: Findings suggest that participants who endorsed institutional racism experience increased severity in psychological symptoms in relation to increased exposure to online racism. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Noninvasive Sacral Neuromodulation in Children and Adolescents: A Case-Control Study of Patients With Chronic Refractory Constipation.

OBJECTIVES: In adult patients with chronic refractory constipation, invasive sacral neuromodulation (SNM) has been applied successfully. There is a need for less invasive solutions while providing comparable therapeutic effects in children and adolescents. We present a prospective, interventional case-control study on the application of noninvasive SNM. MATERIALS AND METHODS: Patients with chronic constipation refractory to conservative treatment were prospectively included in the study from 2018 to 2021 and randomized to either SNM (SNM group: single current stimulation for 24 h/d, frequency 15 Hz, pulse width 210 µs, intensity 1-10 mA) or conventional treatment (controls: full range of pharmacologic and nonpharmacologic options). Treatment was conducted for 12 weeks. Treatment effects were collected with specialized questionnaires and quality-of-life analysis (KINDLR). Outcome variables were defecation frequency, stool consistency, fecal incontinence (FI) episodes, and abdominal pain. RESULTS: Analysis was conducted in 28 patients with SNM and 31 controls (median age 7.0, range 3-16 years). Overall responsiveness to treatment was 86% of the SNM group and 39% of the control group (p < 0.001). All outcome variables were positively influenced by SNM treatment. Defecation frequency improved in 46% of patients with SNM and in 19% of controls (p = 0.026), as did stool consistency in 57% of patients with SNM and in 26% of controls (p = 0.014). Fecal incontinence was significantly reduced in 76% of patients with SNM (n = 16/21 vs 42% of controls [n = 11/26], p = 0.042). Quality of life improved significantly during SNM treatment (71.32 [baseline] vs 85.00 [after 12 weeks], p < 0.001) and confirmed a positive influence of SNM treatment compared with the control group (85.00 [SNM after 12 weeks] vs 79.29 [controls after 12 weeks], p = 0.047). CONCLUSIONS: Outcome of noninvasive SNM treatment in patients with chronic refractory constipation is better than conventional treatment.

Patch Testing With Nickel Sulfate 5.0% Traces Significantly More Contact Allergy Than 2.5%: A Prospective Study Within the International Contact Dermatitis Research Group.

BACKGROUND: Nickel allergy is the most common contact allergy, and a nickel salt is, therefore, included in most baseline patch test series. In the baseline series of the International Contact Dermatitis Research Group and the American Contact Dermatitis Society, nickel sulfate hexahydrate (NSH) in petrolatum at 2.5% is included, whereas NSH at 5.0% is included in many other baseline series, such as the European and Swedish ones. OBJECTIVE: The aim of the study is to investigate whether NSH at 5.0% detects significantly more contact allergy than NSH 2.5% when both preparations are tested simultaneously in consecutive dermatitis patients. PATIENTS AND METHODS: Two thousand two hundred eighty-seven consecutive dermatitis patients were patch tested simultaneously with NSH in petrolatum at 2.5% and 5.0%. The allergy rates were compared for all clinics individually and combined using McNemar test, 2-sided. RESULTS: Contact allergy to NSH 5.0% and 2.5% was found in 20.3% and 16.8%, respectively ( P < 0.0001). In 6 of 11 clinics, significantly more patients tested positive to the higher NSH concentration. For the 2 clinics in North America combined, significantly more patients tested positive to NSH 5.0%. CONCLUSIONS: The NSH preparation in the International Contact Dermatitis Research Group baseline patch test series should be considered to be changed from NSH 2.5% (1 mg NSH/cm 2 ) to 5.0% (2 mg NSH/cm 2 ).

Regular support provided by dermatological nurses improves outcomes in patients with psoriasis treated with topical drugs: a randomized controlled trial.

BACKGROUND: Patient adherence to topical antipsoriatic drugs is often poor, leading to poor efficacy. Use of long-term support delivered by dermatological nurses to patients treated with topical drugs may improve outcome. AIM: To evaluate whether regular support from dermatological nurses improves outcome and treatment adherence in patients with psoriasis receiving topical medications. METHODS: We conducted a randomized controlled trial (RCT) (clinicaltrials.gov registration NCT04220554), in which patients received once-daily topical medications (containing corticosteroids and/or calcipotriol) for as long as their psoriasis was visible. The patients were randomly allocated to standard care by the dermatologist either with (n = 51) or without (n = 52) support from dermatological nurses. The nurse support intervention consisted of a structured dermatological consultation at baseline and Week 1, followed by contact with a nurse each month (in the outpatient clinic or by telephone). The primary outcome was severity of psoriasis, which was measured by the Lattice System Physician's Global Assessment (LS-PGA) and assessed by intention-to-treat analyses using linear mixed regression models for longitudinal data. Secondary outcomes were quality of life (measured by the Dermatology Life Quality Index; DLQI) and good adherence (defined as use of ≥ 80% of recommended doses). RESULTS: In total, 92 patients (89%) completed the 48-week trial period. The intervention group improved more than the nonintervention group from baseline to Week 24 in LS-PGA (2.21 vs. 1.28, P = 0.001) and in DLQI at Week 12 (6.50 vs. 1.55, P < 0.001). Differences between the two groups in favour of the intervention were observed throughout the study period. More participants in the intervention group had good adherence compared with the nonintervention group (36% vs. 14%, P < 0.001). CONCLUSION: Regular, continued patient support from dermatological nurses increased the efficacy of psoriasis treatment, improved quality of life and enhanced long-term adherence to topical antipsoriatic drugs. However, there is still room for more improvement.

Intraoperative robotic-assisted low anterior rectal resection performance assessment using procedure-specific binary metrics and a global rating scale.

BACKGROUND: This study aimed to evaluate the use of binary metric-based (proficiency-based progression; PBP) performance assessments and global evaluative assessment of robotic skills (GEARS) of a robotic-assisted low anterior rectal resection (RA-LAR) procedure. METHOD: A prospective study of video analysis of RA-LAR procedures was carried out using the PBP metrics with binary parameters previously developed, and GEARS. Recordings were collected from five novice surgeons (≤30 RA-LAR previously performed) and seven experienced surgeons (>30 RA-LAR previously performed). Two consultant colorectal surgeons were trained to be assessors in the use of PBP binary parameters to evaluate the procedure phases, surgical steps, errors, and critical errors in male and female patients and GEARS scores. Novice and experienced surgeons were categorized and assessed using PBP metrics and GEARS; mean scores obtained were compared for statistical purpose. Also, the inter-rater reliability (IRR) of these assessment tools was evaluated. RESULTS: Twenty unedited recordings of RA-LAR procedures were blindly assessed. Overall, using PBP metric-based assessment, a subgroup of experienced surgeons made more errors (20 versus 16, P = 0.158) and critical errors (9.2 versus 7.8, P = 0.417) than the novice group, although not significantly. However, during the critical phase of RA-LAR, experienced surgeons made significantly fewer errors than the novice group (95% CI of the difference, Lower = 0.104 - Upper = 5.155, df = 11.9, t = 2.23, p = 0.042), and a similar pattern was observed for critical errors. The PBP metric and GEARS assessment tools distinguished between the objectively assessed performance of experienced and novice colorectal surgeons performing RA-LAR (total error scores with PBP metrics, P = 0.019-0.008; GEARS scores, P = 0.029-0.025). GEARS demonstrated poor IRR (mean IRR 0.49) and weaker discrimination between groups (15-41 per cent difference). PBP binary metrics demonstrated good IRR (mean 0.94) and robust discrimination particularly for total error scores (58-64 per cent). CONCLUSIONS: PBP binary metrics seem to be useful for metric-based training for surgeons learning RA-LAR procedures.

The compounded effects of classism and racism on mental health outcomes for African Americans.

Much research exists demonstrating that experiences of racism are detrimental to the mental health of African Americans; however, Lewis and Van Dyke (2018) argued that examining the effects of racism alone neglects the intragroup diversity (and thus intersectional oppression) of African Americans. Thus, and given the economic oppression experienced by African Americans, the present study sought to examine the compounded effects or racism and classism on African Americans' mental health. African American participants (N = 113) were recruited from an online crowdsourcing platform. A multivariate multiple regression was performed to examine the effects of racism, classism, and the interaction of racism and classism on depression, stress, and well-being. After controlling for gender, age, and employment status, classism, but not racism, was significantly related to stress, well-being, and depression. The interaction effect of racism and classism was also significantly related to stress and well-being, with participants endorsing more of both racism and classism reporting better mental health outcomes, consistent with the resilience (rather than the greater risk) perspective. Findings suggested that experiences of classism are detrimental to the mental health and well-being of African Americans, but that greater experiences of both racism and classism were actually related to better, not poorer, mental health and well-being. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Feline cystadenomatosis affecting the ears and skin of 57 cats (2011-2019).

OBJECTIVES: This study aimed to understand epidemiological factors associated with feline cystadenomatosis, including signalment and papillomavirus PCR status. Cystadenomatosis is an uncommon condition primarily involving the ceruminous and apocrine skin and ear glands. METHODS: This was a retrospective case series. Clinical records from 2011 to 2019 from a tertiary referral hospital in Boston, MA, USA were screened for cases, and case data were re-evaluated and analyzed. The total patient pool contained 65,385 individual cats, of which 797 were referred to the dermatology service. Medical records and biopsy specimens were reviewed; the information collected included signalment, clinical signs, physical examination and diagnostic tests, comorbidities and histopathologic findings. PCR was performed on biopsy specimens to test for papillomavirus DNA. RESULTS: The cystadenomatosis population consisted of 57 cases (7.1% of total cases referred to the dermatology service) with 105 affected ears. Twenty-seven cases (48 ears) were confirmed via histopathology; four cats (7%) exhibited clinically cystic lesions on the periocular, periorbital and perianal regions; only one cat did not have pinnal lesions. Domestic shorthair cats were most often affected. Relative risk for cystadenomatosis was 2.24 times higher in male cats. In 48 cats (84.2%), ears were bilaterally affected. Seven cats (12.3%) had malignant neoplasia, which included: inflamed adenocarcinoma (n = 5); mast cell tumor (n = 1); or squamous cell carcinoma (n = 1). PCR testing on biopsy specimens from 24 cats revealed feline papillomavirus type 2 DNA in only four cats. CONCLUSIONS AND RELEVANCE: Cystadenomatosis was more prevalent in senior non-purebred cats, over-represented in male cats and did not appear to be associated with papillomavirus, feline infectious peritonitis, feline immunodeficiency virus/feline leukemia virus status or other identifiable illnesses. Further studies are needed to investigate the causes of cystadenomatosis.

Guidelines for diagnosis, prevention, and treatment of hand eczema.

BACKGROUND: Hand eczema is a common inflammatory skin disorder. Health care providers need continuously updated information about the management of hand eczema to ensure best treatment for their patients. OBJECTIVES: To update the European Society of Contact Dermatitis guideline on the diagnosis, prevention, and treatment on of hand eczema. METHOD: The Guideline Development Group (GDG) was established on behalf of the ESCD. A call for interest was launched via the ESCD website and via the ESCD members' mailing list. Appraisal of the evidence for therapeutic and preventive interventions was applied and a structured method of developing consensus was used and moderated by an external methodologist. The final guideline was approved by the ESCD executive committee and was in external review on the ESCD webpage for 1 month. RESULTS: Consensus was achieved for several statements and management strategies. CONCLUSION: The updated guideline should improve management of hand eczema.