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The advent of lumen apposing metal stents (LAMS) has revolutionized the management of many complex gastroenterological conditions that previously required surgical or radiological interventions. These procedures have garnered popularity due to their minimally invasive nature, higher technical and clinical success rate and lower rate of adverse events. By virtue of their unique design, LAMS provide more efficient drainage, serve as conduit for endoscopic access, are associated with lower rates of leakage and are easy to be removed. Initially used for drainage of pancreatic fluid collections, the use of LAMS has been extended to gallbladder and biliary drainage, treatment of luminal strictures, creation of gastrointestinal fistulae, pancreaticobiliary drainage, improved access for surgically altered anatomy, and drainage of intra-abdominal and pelvic abscesses as well as post-surgical fluid collections. As new indications of endosonographic techniques and LAMS continue to evolve, this review summarizes the current role of LAMS in the management of these various complex conditions and also highlights clinical pearls to guide successful placement of LAMS.

Teaching is an activity that requires understanding the class’s reaction to evaluate the teaching methodology effectiveness. This operation can be easy to achieve in small classrooms, while it may be challenging to do in classes of 50 or more students. This paper proposes a novel Internet of Things (IoT) system to aid teachers in their work based on the redundant use of non-invasive techniques such as facial expression recognition and physiological data analysis. Facial expression recognition is performed using a Convolutional Neural Network (CNN), while physiological data are obtained via Photoplethysmography (PPG). By recurring to Russel’s model, we grouped the most important Ekman’s facial expressions recognized by CNN into active and passive. Then, operations such as thresholding and windowing were performed to make it possible to compare and analyze the results from both sources. Using a window size of 100 samples, both sources have detected a level of attention of about 55.5% for the in-presence lectures tests. By comparing results coming from in-presence and pre-recorded remote lectures, it is possible to note that, thanks to validation with physiological data, facial expressions alone seem useful in determining students’ level of attention for in-presence lectures.

Autonomous driving cars hopefully could improve road safety. However, they pose new challenges, not only on a technological level but also from ethical and social points of view. In particular, social acceptance of those vehicles is a crucial point to obtain a widespread adoption of them. People nowadays are used to owning manually driven vehicles, but in the future, it will be more probable that the autonomous driving cars will not be owned by the end users, but rented like a sort of driverless taxis. Customers can feel uncomfortable while riding an autonomous driving car, while rental agencies will need to differentiate the services offered by their fleets of vehicles. If people are afraid to travel by these vehicles, even if from the technological point of view they are safer with respect to the manually driven ones, customers will not use them, making the safety improvements useless. To prevent the occupants of the vehicle from having bad feelings, the proposed strategy is to adapt the vehicle driving style based on their moods. This requires the usage of a neural network trained by means of facial expressions databases, of which there are many freely available online for research purposes. These resources are very useful, but it is difficult to combine them due to their different structures. To overcome this issue, a tool designed to uniform them, in order to use the same training scripts, and to simplify the application of commonly used postprocessing operations, has been implemented.

Liver tumors, excluding hepatocellular carcinoma and metastatic disease, are rare. However, it is important to understand how to distinguish these lesions from hepatocellular carcinoma. They run the spectrum of benign to malignant, some aggressive with relatively few therapeutic options. The goal of this paper is to review the most recent literature to provide current insights into diagnosis, treatment, and pathogenesis of these tumor types. Recent literature has focused on oncogenomics and putative targets for therapeutic intervention. Several ongoing studies are elucidating molecular pathways and evaluating novel therapies in these rare tumors and we focus on these findings, particularly in intrahepatic cholangiocarcinoma and fibrolamellar HCC. While these advances are promising, surgical resection continues to be associated with the greatest survival benefit for rare malignant tumors of the liver. Clinicians must be aware of rare liver tumors to distinguish them from hepatocellular carcinoma and to develop a differential diagnosis in complicated or atypical presentations. In these rare tumors, advances in understanding tumor biology hold the promise of expanding diagnostic and therapeutic possibilities.

INTRODUCTION: During the COVID-19 pandemic, differentiating between acute infectious diarrhea versus a chronic inflammatory bowel disease (IBD) presents a new challenge altering the way we approach the diagnosis and treatment of IBD CASE DESCRIPTION/METHODS: A 20-year-old gentleman with no known past medical history presented to his PCP with 14 bloody bowel movements daily He was started on a 5-day course of Azithromycin Stool studies were sent and his C Difficile stool antigen turned positive He was switched to oral Vancomycin He presented to the hospital 3 days later after no improvement On presentation, patient was febrile with diffuse abdominal and rectal pain Initial lab results revealed leukocytosis (29 5K) with elevated bands (35), CRP 127 3, Albumin 3 0, Ferritin 236, Procalcitonin 1 13, Fibrinogen 698, and D-Dimer 1 57 Repeat stool studies were negative His SARS CoV-2 PCR was positive Chest X-ray was unremarkable CT abdomen revealed diffuse colonic wall thickening and peri-colonic inflammation consistent with pancolitis without intra-abdominal or pelvic abscess Symptoms improved with antibiotics Flexible sigmoidoscopy revealed diffuse, severely edematous and erythematous mucosa with granularity and discontinuous areas of ulcers of varying size and depth seen in descending colon Ulcerations were superficial and circumferential Due to severity of disease and contact bleeding, scope was not advanced beyond this point The lumen became narrowed due to inflammation without overt stricture or obstructing lesions The sigmoid colon and rectum, ulcerations became mixed with exudates and the area was generally less effected Numerous biopsies were taken Pathology showed severe chronic active colitis with ulceration Histology showed frequent crypt abscesses, cystic crypt changes and basal lympho-plasmacytosis There is no definite Paneth cell metaplasia, pseudomembranous or viral cytopathic changes After multidisciplinary discussion, he was started on IV Solumedrol 72 hours later patient reported near resolution in symptoms and was transitioned to oral Prednisone taper He was started on Infliximab 10 mg/kg prior to discharge after a repeat COVID test was negative Outpatient follow up was arranged for repeat testing and interval colonoscopy DISCUSSION: The documentation of collective experiences with newly diagnosed IBD patients during the COVID pandemic presents a diagnostic and therapeutic dilemma possibly altering our decisions moving into a new era

Spontaneous intraperitoneal hemorrhage (SIPH), or abdominal apoplexy, is a rare complication of protracted vomiting. Although usually seen later in life, increased alcohol consumption may be contributory to the accelerated incidence of SIPH among younger populations. We describe a 22-year-old male who presented with abdominal pain after prolonged retching in the setting of binge drinking. A CT scan identified a highly attenuated intraperitoneal collection measuring 7.6 cm x 11.6 cm x 15.9 cm adjacent to the stomach. Due to hemodynamic instability, exploratory laparotomy was emergently performed and 1600 mL of blood was evacuated. A diagnosis of SIPH was made with bleeding visualized from a short gastric artery. Ultimately, vessel ligation failed to achieve hemostasis at the splenic hilum and a splenectomy was required. Given that a delay in identification may prove fatal, this case highlights the importance of recognizing SIPH as a differential diagnosis for unexplained abdominal pain and shock after persistent vomiting.

Intussusception is commonly seen in children but is rare in adults and represents only 5% of all intussusceptions causing 1% of intestinal obstructions. More than 50% of these intussusceptions in adults are due to intestinal neoplasms, including malignant lymphoma, e.g., Burkitt lymphoma. These lymphomas are more common in human immunodeficiency virus (HIV)-positive patients than in the general population. We present a case of a young male who was diagnosed with HIV when he developed intestinal obstruction and intussusception secondary to Burkitt lymphoma. He was managed with surgical resection followed by chemotherapy and antiretroviral treatment. HIV patients presenting with acute abdomen pose a diagnostic challenge to clinicians due to a wide range of differential diagnoses including inflammatory, infectious and neoplastic conditions. In a young HIV patient presenting with acute abdomen, intussusception caused by Burkitt lymphoma should be considered in the differential.

A new series of manganese(III), cobalt(II), nickel(II), zinc(II), cadmium(II) and mercury(II) complexes with monomethylsubstituted dithiocarbamates as ligands has been synthesized and studied. Their structures are discussed in relation to their spectroscopic, magnetic and thermal properties. The dithio-ligands exhibit bidentate behaviour acting as S,S′donors in all the complexes. In the far i.r. region particular attention is paid to a comparison of the spectra of the octahedral complexes with those of the other metal derivatives (1∶2 metal to ligand molar ratio). The e.s.r. spectra are indicative of aD2h symmetry in the cobalt(II) complexes.

The following complexes of 2-amino-5-methyl-1,3,4-thiadiazole (L) have been prepared and studied: CoL 2 X 2 (X = Cl, Br, I, OAc), pseudotetrahedral with C 2v symmetry; ML 4 (NO 3 ) 2 (M = Co, Ni), octahedral with uncoordinated NO − 3 ionic groups; NiLCl 2 , NiL 1.5 Br 2 ·0.025EtOH, NiL 2 I 2 ·0.75EtOH, with octahedral polymeric structures; Cu 4 L 5 Cl 8 , Cu 3 L 4 Br 6 , CuL 4 Br 2 and Cu 2 L 3 (OAc) 4 ; The ligand is coordinated to the metal atom through the aminic nitrogen atom in the CoL 2 X 2 and CuL 4 Br 2 complexes and through the aminic nitrogen together with one or two cyclic nitrogen atoms in the other complexes. Electronic spectra, with their crystal field parameters for cobalt and nickel, infrared and far infrared spectra, magnetic moments and some molar conductivities are reported and discussed.

The cobalt(II) complexes of 2, 5-dimethyl-1, 3, 4-thiadiazole (DTZ) Co(DTZ)2 X2 (X=Cl, Br, I, NO3) have been prepared and investigated. Their observed magnetic moments lie in the range 4.4–4.6 B.M. The complexes have a pseudo-tetrahedral coordination; a threefold splitting of the electronic v 2 and v 3 bands of the halide complexes indicate a C2v symmetry. In the nitrate complex the anion is coordinated as monodentate ligand as shown by its infrared bands; however a weak interaction of a second oxygen atom, with a consequent distortion of the pseudo-tetrahedral coordination toward a six-coordination, cannot be excluded. In all these complexes the ligand DTZ is coordinated to the metal ion through one of the two nitrogen atoms. The far i. r. v(CoN) and v(CoX) (X=Cl, Br, I, O) bands were identified.

We report the preparation and characterization of the complexes of rhodium(III), iridium(III), palladium(II) and platinum(II) with the following ligands: Pzdtc, N-MePzdtc, N-PhPzdtc, Pipdtc, 4- PhPipdtc, Morphdtc, Timdtc, and with their methyl esters. The dithio ligands act as bidentate S , S ′-donors in all the new derivatives. From the electronic absorption spectra the values of the ligand field parameters were determined. The nephelauxetic parameters are indicative of a strong covalency in the metal-ligand bond. All the compounds reported here are diamagnetic.