Search

Serrated polyposis syndrome (SPS) is the most common form of polyposis syndrome and has been shown to increase the risk of colorectal cancer (CRC). The genetic pathway of CRC in SPS is different from the classic adenomatous polyposis coli (APC) pathway, which accounts for 70–80% of cases of CRC. Most commonly, SPS mutations include BRAF and KRAS, with activation of the RAS-RAF-MAP kinase pathway involved in the pathogenesis of serrated lesions. We present a rare case of SPS in a 32-year-old woman with MSH6 and SMARCA4 variants, which have not previously been reported in the literature. LEARNING POINTS: Patients with serrated polyposis syndrome should receive frequent colon cancer screening. Patients and their relatives should undergo surveillance.

University scientists are frequently challenged to embrace stakeholder engagement in a way that departs from traditional contract-oriented relationships; this is occurring within water management a...

By comparing the accounting of 10 transaction methods designed to achieve the same net economic effect for a firm borrowing a given amount of money, we show that these 10 methods, under the current financial reporting standards, have markedly different consequences for a firm’s financial reporting. It follows that agents (e.g., managers, auditors, shareholders, and regulators, etc.) with different interests in financial reports may employ different methods of achieving the same net economic result. Accounting regulators can only specify how preparers should account for a given transaction; regulators have little control over the transactions and instruments firms choose to use. The broad range of financial reporting consequences of a given economic transaction, with regard to financial engineering, points to the difficulty — and even virtual impossibility — of regulators achieving comparability and consistency among firms’ financial reports. Despite attempts at regulation and the voluminous GAAP regulations, we reveal that managers remain free to engineer their transactions to publish their firm’s desired (or engineered) financial reports since these accounting methods are largely reported inconsistently with no comparability.

Acute pancreatitis (AP) accounts for over 230 000 US and 28 000 UK hospital admissions annually. Abdominal pain is the most common presenting symptom in AP but may not reflect severity. The clinical challenge is identifying the 20% of patients in whom AP will be severe. We summarise the common aetiologies, the risk stratification strategies including the simplified Bedside Index for Severity in Acute Pancreatitis, acute management approaches in the initial presentation setting, conditions for using advance imaging and opinions on antibiotic use. Some warning signs of impending complications are also discussed.

Background: To improve communication between clinical providers and the laboratory, we recently implemented secure text messaging for our critical value notifications. This was done to communicate laboratory critical values (CV) to providers faster so changes to patient care could be done faster. Our previous method of communicating CV to providers was paging and relied on a call back to receive the critical value. Methods: We implemented delivery of CV through a secure texting application in which the CV was directly communicated to the provider on their smart phone device. Results: The mean pre-implementation turnaround time (TAT) was 11.3 minutes (median: 7 minutes, range: 0 - 210 minutes). The mean post- secure text messaging implementation TAT was 3.03 minutes (median: 0.89 minutes, range: < 1 - 95 minutes).When comparing pre- and post-implementation, there was a significant reduction in the TAT from using secure text messaging (p < 0.001). Of the 234 surveys sent out, 81 providers responded (35%). Of these responses, 85% reported that critical value notification by secure text messaging has increased their efficiency and 95% reported that critical value notification is more effective than a pager-phone-call based system. 83% of providers reported that they were able to provide better, faster care to their patients. Conclusions: Using secure text messaging (STM) to deliver critical values significantly reduces the CV TAT. Furthermore, providers noted they preferred to receive CV notifications through STM and reported that they were able to provide more effective care to their patients.

Specific GI infections encompass a broad range of bacteria, viruses, and other organisms which are often not considered normal flora. Many of these infections are seen in both healthy and immunocompromised individuals within the USA and abroad. This chapter will focus on specific pharmacotherapies, indication of treatment, and alternative drug regimens in resistant or recurrent infection.

Motility disorders of the GI tract involve the smooth muscle and/or neurological component necessary for successful peristalsis. These disorders often complicate chronic medical diseases or surgical interventions, and can lead to significant morbidity, and chronic malabsorption. This chapter reviews the current recommended medications for various motility disorders.

Pancreatitis is a common etiology of emergency department evaluation and hospital admission. Pancreatitis is a common condition often induced by obstruction of the hepatobiliary tree, toxins, or metabolic causes. Recurrent episodes can lead to chronic inflammation, ductal abnormalities, and exocrine/endocrine insufficiency. This chapter will outline the pharmacological management in the acute setting, and discuss further treatment options regarding pain and malabsorption secondary to chronic pancreatitis and pancreatic insufficiency.

This chapter encompasses general GI motility disorders which are common entities, and for which there are many possible etiologies. Many are considered to be functional. Because of the lack of knowledge relating to the underlying mechanisms, much of the treatment is directed towards symptomatic relief. This chapter will review pharmacological therapies recommended for their treatment, and assumes that specific treatable causes have been excluded.

GI infections are common and are often due to obstruction, translocation, or peroration of the GI tract. This chapter will outline some of the guidelines for antibiotic and/or alternative therapies.

The blurring from diffraction for the infrared (IR) radiances on a geostationary satellite (GEO) e.g., the next generation of Geostationary Operational Environmental Satellite (GOES-R) was simulated by using Moderate Resolution Imaging Spectroradiometer Airborne Simulator data and the point spread function (PSF) model for an unobscured telescope. The portion of the total radiance contributed from each nearby geometrical field of view (GFOV) was calculated. For 90% ensquared energy (EE) (equivalent to 10% of the energy coming from outside the footprint), the closest GFOVs contribute 7%; the contribution from the closest GFOVs increases to 22% for 70% EE. The increased portion from the nearby GFOVs causes larger blurring and degrades the pixel-based retrieval product accuracy. Radiance contamination from the nearby field for the GEO IR radiances with 90%, 80%, and 70% EE causes 0.2-, 0.3-, and 0.4-K blurring errors, respectively, in the 12-mum IR longwave window band in clear 300-K scenes. The blurring error is doubled in cloudy 230-K scenes. For the 13.8-mum absorption band, the blurring error will be smaller than that of the 12-mum band because the atmospheric layer where the temperature sensitivity peaks for the 13.8 mum is more uniform than the surface where the 12 mum is most sensitive. This indicates that the PSF has a greater impact on a heterogeneous surface. Similar blurring errors occur at both 4- and 10-km spatial resolution IR sensors. The blurring error is not random, and it varies spectrally. These conclusions are very relevant to the design of a cost-effective GEO IR sounder that meets the science requirements

Context: Tumor-induced osteomalacia is a rare condition usually caused by benign mesenchymal tumors. When the tumor can be found, patients are usually managed by wide excision of the tumor. Objective: We report a 51-yr-old male with clinical and biochemical evidence of tumor-induced osteomalacia caused by a mesenchymal tumor in the right iliac bone. He declined surgery and appears to have been successfully managed by computed tomography-guided percutaneous ethanol ablation and percutaneous cryoablation. Results: Our patient appears to have had an excellent clinical and biochemical response to computed tomography-guided percutaneous ethanol ablation and percutaneous cryoablation. We found one prior case of image-guided ablation using radiofrequency ablation for tumor-induced osteomalacia. Conclusions: Although the standard treatment for tumor-induced osteomalacia is wide excision of the tumor, image-guided ablation may be an option in patients who cannot have appropriate surgery or who decline surgery.

This study is focused on exploring the feasibility of an all-optic surface scanning method in determining the size and position of a submerged, laser generated, optoacoustic (OA) source. The optoacoustic effect in this case was generated when the absorption of a short electromagnetic pulse in matter caused a dielectric breakdown, a plasma emission flash and a subsequent acoustic wave. In the experiment, a laser pulse with λ = 1064 nm and 12 ns pulse length was aimed at a volume of deionized water. When the laser beam was focused by a f = 16 mm lens, a single dielectric breakdown spot occurred. When a f = 40 mm was used several breakdowns in a row were induced. The breakdowns were photographed using a double shutter camera. The acoustic wave generated by the dielectric breakdowns were detected at a point on the water surface using a laser Doppler vibrometer (LDV). First, the LDV signal was used to calculate the speed of sound with an accuracy of 10 m/s. Secondly, the location and length of the dielectric breakdown was calculated with an accuracy of 1 mm. The calculated position matched the breakdown location recorded by a camera. The results show that it is possible to use LDV surface measurements from a single spot to determine both the position and length of the OA source as well as the speed of sound in the medium. Furthermore, the LDV measurements also show a secondary peak that originates from the OA source. To unravel the origin and properties of this interesting feature, further investigations are necessary

Shedding of membrane gangliosides is characteristic of human and experimental tumors. Because some shed tumor gangliosides have potent tumor-enhancing properties, significant ganglioside shedding could influence tumor progression. We examined this possibility in a human tumor, neuroblastoma. Ganglioside shedding, measured as circulating tumor-derived GD2 ganglioside, and the outcome of 74 patients with advanced stage (III and IV) disease were studied. Progression-free survival (PFS) was inversely related to circulating GD2 levels at the time of diagnosis (P = .018). By Kaplan-Meier analysis, the quartile of patients having the highest circulating GD2 levels (greater than or equal to 568 pmol/mL) had a strikingly different outcome from the quartile of patients with the lowest (less than or equal to 103 pmol/mL) GD2 levels (P = .013): median PFS was shorter (9 v 28 months), and the long-term survival rate lower (2-year PFS of 24% v 70%). We conclude that more rapid disease progression and lower survival rate are associated with high circulating GD2 levels at diagnosis and speculate that shed neuroblastoma tumor gangliosides play a role in accelerating tumor progression.