Trans Enteric Rendezvous ERCP in a Patient with Loop Duodenal Switch.

Introduction: Performing endoscopic retrograde cholangiopancreatography (ERCP) in duodenal switch (DS) patients is challenging given their surgically altered anatomy. There have been very few reported cases of trans enteric rendezvous ERCP to relieve biliary obstruction in DS patients. More specifically, there has not been any reported cases of this procedure being performed in loop DS, also known as SADI (single anastomosis duodeno-ileostomy) or SIPS (stomach intestinal pylorus sparing procedure).

The Hitchhiker's Guide to Spine Awake Surgery. The Oxford SAS Protocol and Early Outcomes.

Objective: Spine awake surgery (SAS) aims to achieve faster recovery times, better outcomes, and a lesser economic impact on society. Our drive to establish SAS was to improve patient outcomes and health economics during the COVID-19 pandemic. After a systematic review and to the best of our knowledge, SAS, the Oxford Protocol, is the first protocolized pathway that aims to train bespoke teams performing SAS safely, efficiently, and in a standardized repeatable fashion.

Altered lung physiology in two cohorts after COVID-19 infection as assessed by computed cardiopulmonography.

The longer-term effects of COVID-19 on lung physiology remain poorly understood. Here, a new technique, computed cardiopulmonography (CCP), was used to study two COVID-19 cohorts (MCOVID and C-MORE-LP) at both ∼6 and ∼12 mo after infection. CCP is comprised of two components.

Regular performance feedback may be key to maintain good quality DKA management: results from a five-year study.

Objectives: We postulate that performance feedback is a prerequisite to ensure sustained improvement in diabetic ketoacidosis (DKA) management.

Design: The study was based on 'theory of change' concept that suggests changes of primary drivers determine the main outcome. A set of secondary drivers can be implemented to achieve improvements in these primary drivers and thus the main outcome.

Regular and frequent feedback of specific clinical criteria delivers a sustained improvement in the management of diabetic ketoacidosis .

Efficient management of diabetic ketoacidosis (DKA) improves outcomes and reduces length of stay. While clinical audit improves the management of DKA, significant and sustained improvement is often difficult to achieve. We aimed to improve the management of DKA in our trust through the implementation of quality improvement methodology.

Medical reconnaissance for the Defence Medical Services Dhaulagiri Expedition 2016.

The formation of a clear and well-informed medical plan is critical to the safe planning and execution of any expedition in remote locations. We performed a reconnaissance of medical facilities in Nepal in March 2015 prior to a large Defence Medical Services (DMS) expedition to the Dhaulagiri area in 2016. Visiting relevant medical facilities in person provides invaluable information and experience of what healthcare services may be relied upon in managing an expedition casualty, in scenarios ranging from minor illness to major trauma.

Acute spontaneous subdural hematoma in a middle-aged adult: case report and review of the literature.

Background: Acute spontaneous subdural hematomas (ASSDH) occur by a variety of pathological processes and are less common than trauma-related acute subdural hematomas (SDH). Both types are usually seen in the elderly, and only 22 cases of ASSDH in patients aged < 40 years have been reported in the medical literature.

Objectives: We report a rare case of ASSDH in a middle-aged male with no previous history of head trauma.

Twisted tethered tolanes: unanticipated long-lived phosphorescence at 77 K.

Influencing the communication within a conjugated system as diphenylacetylene is a challenging subject in molecular electronics. Some examples of twisted tolanes are known, where high twists have been achieved in the solid state by steric encumbrance. The insertion of a spacer system is an alternative way to tailor rotation.

From thia- to selenadiazoles: changing interaction priority.

The synthesis, optical, and electrochemical properties as well as solid-state structures of a series of alkynylated, benzannulated selenadiazoles are reported. This set of compounds is compared to the lighter homologue series, the thiadiazoles. The selenadiazoles show head-to-head dimerization in the solid state, while packing of the thiadiazoles was dominated by the steric bulk of the side groups.

Imine formation as a simple reaction to construct copper-reactive cruciform fluorophores.

We developed a series of new conjugated cruciform fluorophores (XF) featuring imine groups. The condensation of an XF containing aldehyde functionalities and selected primary amines leads to several XF-imine derivatives. Upon addition of Cu(2+) or Zn(2+) ions to solutions of the imine XFs in different solvents, a red-shifted emission is detected, resulting in an altered emission color.

Anion-dependent fluorescence in bis(anilinoethynyl)pyridine derivatives: switchable ON-OFF and OFF-ON responses.

Urea and sulfonamide derivatives of 1 exhibit ON-OFF and OFF-ON switchable fluorescent and colorimetric responses upon protonation. The magnitude of the fluorescence event is dictated by the anion, resulting in a rare, fully organic "turn-on" fluorescent sensor for chloride.

Synthesis, excited state dynamics, and optical characteristics of oligophenyl-based swivel cruciforms in solution and solid state.

Oligophenyl-based swivel cruciforms are an amorphous class of materials for potential use in display applications. In this work, we describe the design, synthesis, and structural and optical properties of a group of chromophores with varying degrees of π-conjugation that produce blue emission and high photoluminescence quantum yields (PLQYs). The swivel cruciforms are branched complexes consisting of two arms, and the relative rotation of these arms is an important factor that determines the optical properties of these systems.

Preliminary Exploration of the Effect of Background Color on the Speed and Accuracy of Search for an Aided Symbol Target by Typically Developing Preschoolers.

Aided augmentative and alternative communication can be used successfully with individuals with communication disabilities. Recent studies suggest that where possible, arranging symbols based on internal color (placing red fruits together) facilitates search for a target symbol by children with and without Down Syndrome (Wilkinson, Carlin, & Thistle, 2008). We explored whether color cuing of symbol background might offer similar benefits for symbols that cannot be readily arranged by internal color.

Multiple sclerosis pathology in the normal and abnormal appearing white matter of the corpus callosum by diffusion tensor imaging.

Lesions in the corpus callosum in multiple sclerosis (MS) include those that are hyperintense on T2-weighted images, which can be either focal (isolated) or connected, but there is evidence that the corpus callosum, similar to other white matter regions, contains normal appearing white matter (NAWM) which is abnormal based on quantitative MR methodologies. In this pilot study, diffusion tensor based measures were determined in corpus callosum from 10 patients with MS and 12 age and gender matched controls. T2-hyperintense lesions were carefully segmented out from normal appearing corpus callosum to minimize contamination of the NAWM fraction with these lesions.

Potential impact of population-based colorectal cancer screening in Canada.

Randomized controlled trials (RCT) have shown the efficacy of screening for colorectal cancer (CRC) using the faecal occult blood test (FOBT) with follow-up by colonoscopy. We evaluated the potential impact of population-based screening by FOBT followed by colonoscopy in Canada: mortality reduction, cost-effectiveness, and resource requirements. The microsimulation model POHEM was adapted to simulate CRC screening using Canadian data and RCT results about test sensitivity and specificity, participation, incidence, staging, progression, mortality and direct health care costs.

Structure of plaque at carotid bifurcation: high-resolution MRI with histological correlation.

Background And Purpose: The composition of carotid atherosclerosis was visualized by using 3D MRI at high resolution with 200-micrometer (3) voxels. Magnetic resonance signal characteristics were correlated with plaque components, including collagenous cap, necrotic core, and calcification, to define resolution and other requirements for future clinical carotid MRI.

Methods: Twenty-one en bloc carotid endarterectomy specimens were imaged ex vivo by 3D gradient-echo MRI by using a 1.

Two-point Dixon technique for water-fat signal decomposition with B0 inhomogeneity correction.

To separate water and lipid resonance signals by phase-sensitive MRI, a two-point Dixon (2PD) reconstruction is presented in which phase-unwrapping is used to obtain an inhomogeneity map based on only in-phase and out-of-phase image data. Two relaxation-weighted images, a "water image" and a "fat image," representing a two-resonance peak model of proton density, are output. The method is designed for T1- or density-weighted spin-echo imaging; a double-echo scheme is more appropriate for T2-weighted spin-echo imaging.

Incidence and mortality of neuroblastoma in Canada compared with other childhood cancers.

The incidence and mortality of neuroblastoma was reviewed in the general context of childhood cancer in Canada for the periods 1982-86 and 1987-91. This was done to complement the preliminary work of the Quebec Neuroblastoma Screening Project that is studying the impact of screening North American infants for the preclinical detection of neuroblastoma on population-based mortality. Annual age-standardized incidence rates for all childhood cancer in Canada appear to have declined slightly (nonsignificantly) from 155.

MRI distortion and stereotactic neurosurgery using the Cosman-Roberts-Wells and Leksell frames.

When not corrected, geometrically distorted magnetic resonance images may be unsuitable for stereotactic intracranial neurosurgical procedures where accuracy of target localization is critical. On a GE Signa 1.5-tesla system, we implemented an imaging protocol designed to improve the accuracy of the determination of target coordinates by means of multiple scans utilizing reversal of the frequency-encoded readout gradient.

Double-echo three-point-Dixon method for fat suppression MRI.

A double-echo two-excitation pulse sequence encoding fat and water signals for a phase-sensitive three-point Dixon-type analysis (DE-3PD) was developed and implemented on a 1.5 T MR imager. Data processing was performed using a previously developed two-dimensional (2D) region-growing algorithm, adapted to use double-echo data.

Segmentation of intensity basins in gray-scale images.

An algorithm to detect intensity basins in gray-scale images is described. An image is modeled as a topographical surface and illuminated by multiple light sources to form shadows in the intensity basins of the surface. A segmentation is then obtained by detecting regions of shadow.

Skin color measurements in terms of CIELAB color space values.

The principles of color measurement established by the Commission International d'Eclairage have been applied to skin and the results expressed in terms of color space L*, hue angle, and chroma values. The distribution of these values for the ventral forearm skin of a sample of healthy volunteers is presented. The skin-color characteristics of a European subgroup is summarized and briefly compared with others.

The search for Ixodes dammini and Borrelia burgdorferi in Nova Scotia.

Twenty-four Ixodes dammini ticks (23 adults and one nymph) have been recovered in Nova Scotia since 1984. There has not been a systematic search for larvae and none has been identified. The recovery of the nymph from a road-killed yellow throat bird, Geothypis trichas, in late May 1990 supports the contention that migrating birds are bringing deer ticks into the province every spring.

Variation and covariates of the number of benign nevi in adolescents.

Melanocytic nevi of diameter greater than or equal to 2 mm were counted on most of the skin surface of 349 adolescents aged 14-15 years of European race or ethnicity in Dunedin, New Zealand. Total counts are described by means of a form of Poisson-error log-linear modeling suitable for data showing unexplained variation (NE Breslow, Appl Statist 1984;33:38-44). There were marked interpersonal variation in the number of nevi; only some was attributable to observed factors.