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This article presents the results of a set of 28 large-scale triaxial tests, including 12 consolidated-drained (CD) static tests and 16 consolidated-undrained (CU) dynamic tests, on an artificially cemented gravel. The strength, dilatancy, stiffness and damping behaviour of both the cemented and the uncemented specimens are compared. Cementation is found to have interrelated effects on increasing the peak strength, enhancing the dilative behaviour, increasing the static and dynamic stiffness, and reducing the damping ratio. Cementing the particles leads to a delayed but more evident dilative behaviour subsequent to an initial contraction, which is interpreted as the result of the existence of locked voids and the limited void-filling capacity of the cemented clusters. A cemented specimen generally yields before achieving its peak deviator strength, after which an increasing dilative behaviour is accompanied by strain softening. Cementation also increases the maximum shear modulus and reduces its dependence on the mean effective stress. Due to the bonds created near the contacts and their effect on restricting inter-particle sliding, the damping ratio of a cemented specimen is generally lower than that of an uncemented specimen, and the difference in the damping ratio becomes increasingly evident under an increasing shear strain amplitude. [ABSTRACT FROM AUTHOR]

Cardiac catheterization is an invasive diagnostic procedure for treating the cardiovascular diseases. This paper aims to understand the transport phenomena of blood nanofluid through a flexible arterial domain, which has stenosis/dilation with the catheter outer surface layered with nanoparticles. Blood is considered as a micro-polar fluid, governed by nonlinear equations, which are then solved by using the homotopy perturbation method. We consider the flexible nature of the arterial wall as a function of time due to the heart's pumping action. Different slip velocities with the Darcy effects in the constricted domain's abnormal segments represent the dysfunction of a blood vessel. In this paper, we explore the effects of the various fluid parameters and the embedded geometrical parameters on physiological characteristics. We observe that the radial velocity increases with the increasing value of Gr and Br. However, impedance has shown the opposite pattern in the dilation segment. Also, we understand the helical flow distribution in the abnormal segments of the considered blood vessel. These findings explain that the study of nanofluid could be an assuring therapeutic approach against arterial conditions. [ABSTRACT FROM AUTHOR]

Dilation of linear maps on vector spaces has been recently introduced by Bhat, De, and Rakshit. This notion is a variant of vector space dilation introduced by Han, Larson, Liu, and Liu. We derive vector space versions of Wold decomposition, Halmos dilation, N-dilation, inter-twining lifting theorem and a variant of Ando dilation. It is noted further that unlike a kind of uniqueness of Halmos dilation of strict contractions on Hilbert spaces, vector space version of Halmos dilation cannot be characterized. [ABSTRACT FROM AUTHOR]

In this paper, we report on cyclic hollow cylinder tests on Fujian sand and Nanjing sand subjected to different loading frequencies. Depending on the loading frequencies we observed two distinct failure modes, i.e. cyclic mobility and cyclic instability. We proceed to develop a plasticity model to capture the features of our observations. The model employed a new flow rule for the effect of loading frequency on shear dilation and contraction characteristics to better reflect the changes in excess pore water pressure, deformation and strength of the saturated sand under cyclic loading. The model was validated by comparing numerical simulations with experimental results. [ABSTRACT FROM AUTHOR]

The LEAP (Liquefaction Experiment and Analysis Project) is a continuing international collaboration to produce a reliable databank of high-quality experimental results for the validation of numerical tools. LEAP-2020, investigates the problem of a floating rigid sheet-pile quay wall embedded in dense sand layer. This paper discusses two experiments conducted at Rensselaer Polytechnic Institute (RPI) and investigates: (1) the repeatability potential of centrifuge testing in the presence of Soil-Structure Interaction (SSI), and (2) the effects of soil-structure Interaction on the system response during liquefaction. • Investigation of the response for a liquefiable sand deposit supported by a sheet-pile quay wall, using two centrifuge tests. • The two tests showed high repeatability in the soil and sheet-pile response. • The mechanism of excess pore water pressure generation is coupled with the sheet-pile response. [ABSTRACT FROM AUTHOR]

The efficiency of a graph embedding problem when simulating one interconnection network in another interconnection network is characterized by the influential parameter of wirelength. Obtaining the minimum wirelength in an embedding problem determines the quality of that embedding. In this paper, we obtained the convex edge partition of 3-Ary n-Cubes and the minimized wirelength of the embeddings of both 3-Ary n-Cubes and circulant networks.

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Objective: With increased focus on surgical management of the eustachian tube, clarifying management decisions benefits patients and surgeons. In this study, we examine the value of repeating the balloon dilation of the eustachian tube (BDET) procedure in patients who did not improve after the initial BDET. Study Design: Level IV retrospective review of 145 BDETs performed on 86 patients between January 1, 2014, and May 1, 2019, identified 10 patients who underwent BDET more than once. Setting: Managed care community otolaryngology practice. Methods: Demographic and outcome data were collected on both single and repeat BDET cohorts. Results: The Eustachian Tube Dysfunction Questionnaire 7 (ETDQ-7) was used as the primary outcome measure when comparing single vs repeat BDET cohorts. Generally, the 2 cohorts were similar in terms of sex and age distribution. Tobacco use and radioallergosorbent test–positive results were greater proportionally in the repeat BDET cohort. Preoperative ETDQ-7 scores were similar in both cohorts. Single BDET patients overall showed significant improvement in ETDQ-7 scores. ETDQ-7 scores for repeat BDET patients who did not improve after the first procedure similarly did not demonstrate improvement after the second procedure. Conclusions: Inevitably, some patients will not improve after an initial BDET procedure. The utility of a repeated BDET procedure should be considered in determining how to manage such failures. The results of this limited study suggest that patients who fail to improve meaningfully on ETDQ-7 scores after the initial procedure are unlikely to show substantial improvements after a repeated procedure. [ABSTRACT FROM AUTHOR]

Background: After multiple uncovered self-expandable metal stent (UCSEMS) deployments, endoscopic revision becomes complex and potentially challenging. A novel stent delivery system with a dilation function has recently been developed in Japan. This study evaluated the technical feasibility of this device for patients with unresectable malignant hilar biliary obstruction (MHO) after multiple UCSEMS deployments. Method: Participants comprised consecutive patients with unresectable MHO who had undergone multiple UCSEMS deployments and required endoscopic revision for the right or left hepatic bile ducts, as decided by cholangiography under endoscopic retrograde cholangiopancreatography (ERCP) guidance. Results: A total of 14 patients requiring endoscopic revision of right and left hepatic bile ducts were enrolled in this study. Among these 14 patients, guidewire insertion through the mesh of previously placed stents failed in 2 patients. As a result, these two patients underwent only unilateral UCSEMS deployment. Because clinical success was not obtained, transmural placement of the UCSEMS under Endoscopic Ultrasound (EUS) guidance to the segment of the liver not being drained was performed in those patients. The molting technique was attempted in 12 patients, proving successful in all patients. The technical success rate was therefore 92.8% (12/14). Mean procedure time was 23.2 min. Conclusion: This novel stent delivery system with a dilation function may be useful in endoscopic revision techniques for bilateral UCSEMS deployment. [ABSTRACT FROM AUTHOR]

Chronic administration of exogenous adiponectin restores nitric oxide (NO) as the mediator of flow-induced dilation (FID) in arterioles collected from patients with coronary artery disease (CAD). Here we hypothesize that this effect as well as NO signaling during flow during health relies on activation of Adiponectin Receptor 1 (AdipoR1). We further posit that osmotin, a plant-derived protein and AdipoR1 activator, is capable of eliciting similar effects as adiponectin. Human arterioles (80–200 μm) collected from discarded surgical adipose specimens were cannulated, pressurized, and pre-constricted with endothelin-1 (ET-1). Changes in vessel internal diameters were measured during flow using videomicroscopy. Immunofluorescence was utilized to compare expression of AdipoR1 during both health and disease. Administration of exogenous adiponectin failed to restore NO-mediated FID in CAD arterioles treated with siRNA against AdipoR1 (siAdipoR1), compared to vessels treated with negative control siRNA. Osmotin treatment of arterioles from patients with CAD resulted in a partial restoration of NO as the mediator of FID, which was inhibited in arterioles with decreased expression of AdipoR1. Together these data highlight the critical role of AdipoR1 in adiponectin-induced NO signaling during shear. Further, osmotin may serve as a potential therapy to prevent microvascular endothelial dysfunction as well as restore endothelial homeostasis in patients with cardiovascular disease. [ABSTRACT FROM AUTHOR]

A variety of psychological and physical phenomena elicit variations in the diameter of pupil of the eye. Changes in pupil size are mediated by the relative activation of the sphincter pupillae muscle (decrease pupil diameter) and the dilator pupillae muscle (increase pupil diameter), innervated by the parasympathetic and sympathetic branches, respectively, of the autonomic nervous system. The current guidelines are intended to inform and guide psychophysiological research involving pupil measurement by (1) summarizing important aspects concerning the physiology of the pupil, (2) providing methodological and data‐analytic guidelines and recommendations, and (3) briefly reviewing psychological phenomena that modulate pupillary reactivity. Because of the increased ease and tractability of pupil measurement, the goal of these guidelines is to promote accurate recording, analysis, and reporting of pupillary data in psychophysiological research. This report provides guidelines for publishing pupillary studies in psychophysiology. In addition to reporting criteria, there are general recommendations, and background on physiology and recording techniques for pupillary studies [ABSTRACT FROM AUTHOR]

In this paper, we study the dilations of frame generators and pairs of dual frame generators of two special structured unitary systems for Hilbert spaces, i.e. the product unitary system and group-like unitary system. We first introduce certain operators which are associated with the frame generators of the unitary system and some properties of the operators are established. Then, as an application, we show that the canonical dual of a frame of group-like unitary systems remain the group-like structure. And we use these properties to study the dilations of the frame generators and dual pairs of frame generators of these two types of unitary systems. [ABSTRACT FROM AUTHOR]

Background and aims: Efficacy of endoscopic balloon dilation (EBD) for intestinal strictures in patients with Crohn's disease (CD) receiving anti‐tumor necrosis factor alpha antibodies (anti‐TNF) as maintenance therapy is unclear. We investigated the long‐term efficacy and safety of EBD for intestinal strictures in patients with CD receiving anti‐TNF. Methods: We retrospectively analyzed data from patients with CD who received anti‐TNF as maintenance therapy from 2008 to 2017, underwent EBD, and were followed up for ≥6 months. The primary endpoint was the cumulative surgery‐free rate. The main secondary endpoints were technical success, repeat EBD rate, risk factors affecting surgical outcomes, and safety. Results: Seventy‐two patients with CD were assessed. The median observation period after EBD was 50 months. The technical success rate was 67%. The 3‐ and 5‐year cumulative surgery‐free rates were 81.1% and 73.5%, respectively. The repeat EBD rate was 74%. Multivariable analyses showed that risk factors affecting surgical outcomes were age at disease onset ≤16 years (hazard ratio 3.69; 95% confidence interval 1.36–10.01; P = 0.011). Serious complications requiring surgery developed in three patients. Conclusions: Endoscopic balloon dilation was an effective and safe short‐term treatment and a useful long‐term treatment for CD patients with intestinal strictures receiving anti‐TNF as maintenance therapy. [ABSTRACT FROM AUTHOR]

There is no previous research exploring the relationship between self-criticism and pupillary reactivity. Biomarkers such as pupillary reactivity inform about the quantity of the information being processed. Potentially, they can improve predictions of self-criticism levels and identification of pathological levels of self-criticism. The goal of our study is to test whether changes in pupil size act as predictors of self-criticism in participants viewing facial emotional stimuli. This is a first study that includes all basic emotions, and allows detailed analyses of pupillary reactivity predictors. Our results show that the pathological form of self-criticism, which is Hated Self in The Forms of Self-Criticizing/Attacking and Self-Reassuring Scale (FSCRS), was significantly predicted by enlarged pupils in the presence of Anger and Disgust and by narrowed pupils in the presence of Happiness. Greater information gain for Disgust predicted higher score in Inadequate Self and Hated Self measures and lower score for Reassuring Self. The greater information gain for Anger predicted higher score in Inadequate Self and Hated Self measures, but not lower score for Reassuring Self. Pupillary reactivity seems to be a promising biomarker in diagnosing the level of self-criticism and self-reassurance by different pupilar reactions to facial emotion expression especially for Disgust. Greater information gain for Disgust predicts higher score in Inadequate Self and Hated Self measures and lower score for Reassuring Self. In the future, this finding could help create a screening tool for diagnosing pathologically self-critical people without having to rely on self-reporting instruments, which are prone to numerous biases. [ABSTRACT FROM AUTHOR]

For the past 20 years, deforestation has been a major issue in Romania. While there have been reforestation attempts, it is still hard to get a clear picture of how the forest situation has changed over the years. This paper explores a possible solution to finding out how Romanian forests have evolved from the year 2000 to 2019 by using geospatial data in order to see where trees were cut down or where an effort was made to replant them. This is achieved by using a decision trees machine learning model and by using clear pictures of the ground as well as some ground variables to determine where a particular forest is. Furthermore, additional steps were taken in an effort to improve the result.

Introduction: Dorsal onlay urethroplasty with Buccal Mucosal Graft (BMG) is the single stage procedure and is most commonly used to treat long segment anterior urethral strictures. Unilateral mobilisation of the urethra prevents both chordee and ischaemia. Aim: To evaluate the feasibility, medium-term and long-term outcomes of dorsal onlay BMGs when used to treat long anterior segment penile urethral stricture with unilateral mobilisation of the urethra. Materials and Methods: A retrospective study was conducted in Kasturba Hospital, Manipal, Karnataka, India, from January 2008-December 2018. A total of 56 patients with long anterior segment penile urethral strictures underwent BMG substitution for urethroplasty, with a follow-up period ranging from 1.2-10 years. The outcome of the procedure was assessed through clinical history and physical examination, uroflowmetry, retrograde and voiding cystourethrography and urethroscopy {6 French gauge (Fr)}. Statistical analysis was performed using the mean and median. Results: The mean age of 56 patients was 51.8±9.9 years, with a mean±Standard Deviation (SD) Maximum Flow Rate (MFR) of 20.1±5.3 mL at one month and 18.1±4.3 mL at three and 18.7±3.7 mL six months, 17.3±5.1 mL, 19.3±4.3 mL and 18.6±3.7 mL at one year, 2-5 years and 10 years postoperative respectively. Postvoid Residual urine (PVR) volume was higher till one year follow-up (i.e., first month it was 38.6±23.6 mL in 47 patients, third month it was 45.8±22.4 mL in 12 patients, sixth month it was 49.0±28.8 mL in 14 patients and one year follow-up it was 43.9±30.8 mL in 24 patients). Minimal complications were noted over 5-10 years follow-up. Conclusion: For long segment anterior penile urethral strictures, unilateral mobilisation in BMG urethroplasty had shown success over both medium and long-term periods.

Chronic administration of exogenous adiponectin restores nitric oxide (NO) as the mediator of flow-induced dilation (FID) in arterioles collected from patients with coronary artery disease (CAD). Here we hypothesize that this effect as well as NO signaling during flow during health relies on activation of Adiponectin Receptor 1 (AdipoR1). We further posit that osmotin, a plant-derived protein and AdipoR1 activator, is capable of eliciting similar effects as adiponectin. Human arterioles (80–200 μm) collected from discarded surgical adipose specimens were cannulated, pressurized, and pre-constricted with endothelin-1 (ET-1). Changes in vessel internal diameters were measured during flow using videomicroscopy. Immunofluorescence was utilized to compare expression of AdipoR1 during both health and disease. Administration of exogenous adiponectin failed to restore NO-mediated FID in CAD arterioles treated with siRNA against AdipoR1 (siAdipoR1), compared to vessels treated with negative control siRNA. Osmotin treatment of arterioles from patients with CAD resulted in a partial restoration of NO as the mediator of FID, which was inhibited in arterioles with decreased expression of AdipoR1. Together these data highlight the critical role of AdipoR1 in adiponectin-induced NO signaling during shear. Further, osmotin may serve as a potential therapy to prevent microvascular endothelial dysfunction as well as restore endothelial homeostasis in patients with cardiovascular disease.

Identification of the cellular players and molecular messengers that communicate neuronal activity to the vasculature driving cerebral hemodynamics is important for (1) the basic understanding of cerebrovascular regulation and (2) interpretation of functional Magnetic Resonance Imaging (fMRI) signals. Using a combination of optogenetic stimulation and 2-photon imaging in mice, we demonstrate that selective activation of cortical excitation and inhibition elicits distinct vascular responses and identify the vasoconstrictive mechanism as Neuropeptide Y (NPY) acting on Y1 receptors. The latter implies that task-related negative Blood Oxygenation Level Dependent (BOLD) fMRI signals in the cerebral cortex under normal physiological conditions may be mainly driven by the NPY-positive inhibitory neurons. Further, the NPY-Y1 pathway may offer a potential therapeutic target in cerebrovascular disease.

In this article, the efficient image compression which consists of Burrows–Wheeler transform (BWT) with set partitioning in hierarchical trees (SPIHT). The main phases of the proposed system are: partitioning, compression of non‐ROI areas, Fusion and compression of ROI areas. To enhance the propose of the proposed methodology, the morphological functions are updated by dividing two types of images with the consideration of dilation and erosion control. After that, the convolution and correlation in the deformation provide good accuracy of the segmentation at the fastest speed. In this proposed methodology, SPIHT encryption is a lossy compression technique aimed at understanding the non‐ROI area, while the BWT is a lossless compression technique performed to achieve a summary of the ROI area. Finally, separating these two parts of the image merges the image and reconstructs it to the desired quality. The test sends a variety of images and analyzes the performance of the proposed system using compression ratio and PSNR measurements. [ABSTRACT FROM AUTHOR]

Introduction: In patients with benign and refractory esophageal strictures (BES), repeating initial dilations in short intervals could be recommended, but little data are available to validate this strategy. Our aim was to evaluate long-term results of a scheduled program of repeated and sustained esophageal dilations in patients with refractory strictures. Methods: Patients with BES requiring five or more dilations were retrospectively included and divided in two groups for analysis: a SCHEDULED group (SDG) where patients were systematically rescheduled for the 5 first dilations; ON-DEMAND group (ODG) where patients were dilated only in case of recurrence of the dysphagia. Comparison between SDG and ODG was done with a 1:1 matching analysis and etiology of stricture. Clinical success was defined as the absence of dysphagia for more than a year. Results: 39 patients with refractory BES were included with post-operative stenosis in 51.2% and post-caustic injury 28.2%; 10 were in SDG and 29 in ODG. In overall analysis (39 patients), the follow-up was 64.4 ± 32 months, success rate was 79.5% and duration of treatment was 27.3 ± 20 months, and mean number of dilations was 11.7 per patient. The need for dilations decreased significantly after 18 months of treatment with an average of 0.56 dilations per semester. Self-expandable metallic stent insertion was associated with an increased rate of complications (5.9% vs 59.1% p = 0.001). In matched analysis (10 ODG vs 10 SDG patients), the duration of treatment was lower in SDG (18.8 vs 41.4 months, p = 0,032) with a higher probability of remission (survival analysis, Log-rank: p = 0,019) and the success rate did not differ between ODG and SDG patients (80% vs 90%; NS). Conclusion: Overall, long-term esophageal dilations resulted in a 79.5% success rate and the need for further dilatations decreased significantly in both groups after 18-month follow-up. A scheduled dilation program was associated with a higher probability of final success and lower treatment duration. [ABSTRACT FROM AUTHOR]

Background: The Scoreflex NC scoring angioplasty catheter is designed with a short rapid-exchange tip distal to a non-compliant, high-pressure balloon and an integral wire outside of the balloon, such that the guidewire and the integral wire act as scoring elements during balloon inflation. The external scoring elements enable a focal stress pattern facilitating expansion of resistant lesions at lower pressures using a focused force angioplasty effect.Methods: Patients undergoing elective percutaneous coronary intervention (PCI) were enrolled in a prospective, single-arm study conducted at 12 centers in the United States. The primary endpoint was device procedural success, defined as the composite of successful device delivery to the target lesion with balloon inflation and deflation; absence of vessel perforation, flow-limiting dissection or reduction in TIMI flow from baseline; and achievement of final TIMI 3 flow.Results: Among 200 patients (234 lesions), lesion complexities included: bifurcation disease (37.6%), moderate/severe calcification (36.6%), and total occlusions (5.0%). Successful delivery to the target lesion, inflation and removal of the balloon catheter was achieved in 95.5% of patients (191/200). Procedural success was achieved in 93.5% (187/200) of patients, and final TIMI 3 flow was observed in 99.0% of cases (198/200). No unanticipated device-related events occurred. In-hospital major adverse events were reported in 4.5% of patients (9/200), related to periprocedural myocardial infarction (8/200, 4.0%) and target lesion revascularization (1/200, 0.5%).Conclusions: Among patients undergoing elective PCI and with varied lesion complexity, these results support the safety and effectiveness of a dilation strategy using the Scoreflex NC scoring catheter. [ABSTRACT FROM AUTHOR]

Natural geophysical mass flows are among the most complex granular systems and their dynamics are often modified by the presence of an interstitial fluid. Prediction of their runout requires the development of models estimating the solid stresses in these hazardous currents wherein excess pore-fluid pressure can develop. We use discrete element modelling (DEM-CFD) with a Coarse-Graining post-processing technique (CG) to investigate the rheology of unsteady gas-particle fluidized to non-fluidized granular beds placed on horizontal and inclined planes. Similar to fluidized beds immersed in viscous fluids, the effective friction coefficient of air-fluidized beds can be defined as a function of the classic μ(I)-rheology and the non-dimensional fluid or solid pressure to explain the failure and dynamics of granular flows with excess pore pressure on inclines. However, dilation imposed by fluid drag and particle collisions in gas-particle fluidized beds can drastically change its effective frictional properties. In contrast with the common assumption in water-particle flows that granular temperature is negligible, in our gas-particle simulations, the contribution of the velocity fluctuations to the stress tensor is significant. Hence, the shear stress is found to be non-zero even when the flow is fully fluidized in the inertial regime. These results suggest the need to better understand velocity fluctuations to predict the effective viscosity of sheared fluidized mixtures and are relevant for many applications. Notably, a unified approach is useful for many geophysical flows that encompass a range of fluidization conditions in a single flow such as pyroclastic density currents and snow avalanches. [ABSTRACT FROM AUTHOR]

A results of experimental and theoretical study of clay swelling are presented in this work. The model is based on previously developed evidential base showing that alteration of water density should be taken into account during investigation of such processes as water uptake under clay swelling and squeezing water out in clay rocks. From that evidential base it follows that another form of mass balance equation for water should be used instead equation of flow in ordinary porous media. Physically it is caused by formation of quasi-stable films of water which have density different from that of ordinary gravitational water, which was reflected in the mass balance equation of the model. Experiments were performed on the custom setup, experimental procedure was accorded with mathematical model of the process. The model of flow in swelling clays is based on the idea of alteration of density of water, stored between particles of clay minerals in microaggregates of clay. The alteration is caused by action of superficial forces from the clay particles in course of swelling/shrinkage processes. These forces influence on structural bonds of molecules of interlayer water and change their properties. We make an effort to take this change into consideration in explicit form during deduction of mass balance equation for water in case of filtration in clay rocks. This approach has two major advantages. First advantage is concluded in clear and natural procedure of experimental verification of theoretical results. Second advantage is discovery of important role of physically significant factor that influences on processes of clay swelling and shrinkage. The proposed model can describe various flow regimes, including blow-up regimes, and formation of long-existent zones with altered flow structure, which has significant practical importance for description of moisture transport and dynamics of water-retaining properties in swelling soils. [ABSTRACT FROM AUTHOR]

Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. Left untreated, EoE progresses to fibrous remodeling and stricture formation that impairs quality of life. Therefore, EoE requires either repeated treatments or maintenance therapy. Current guidelines recommend swallowed topical corticosteroids (STCs), proton-pump inhibitors (PPIs), or dietary intervention as initial options to induce and maintain long-term disease remission. Impractical exclusive elemental diets and suboptimal allergy testing-directed food avoidance paved the way for empirical elimination diets. These are moderately effective and highly reproducible in inducing EoE remission and allow for identification of specific food triggers. Step-up strategies, including two- and four-food rather than six-food elimination diets, should be considered as initial approaches for dietary treatment in patients of all ages, as they reduce the need for endoscopic procedures, shorten diagnostic processing time, and avoid unnecessary restrictions. Formulations of STC originally designed for asthma therapy are suboptimal for EoE treatment, with new effervescent orodispersible tablets and viscose formulations designed to coat the esophageal mucosa providing increased effectiveness at reduced doses. The anti-inflammatory effects of PPI in EoE are independent from gastric acid secretion inhibition; despite evidence from observational research, PPIs are the most commonly prescribed first-line therapy for EoE due to their accessibility, low cost, and safety profile. Double doses of PPI only induce remission in half of EoE patients, irrespective of the drug used or patients' age. Inflammatory rather than stricturing EoE phenotype and treatment duration up to 12 weeks increase chances of achieving EoE remission. Most responders effectively maintain long-term remission with standard PPI doses. Finally, endoscopic dilation should be considered in patients with reduced esophageal caliber or persistent dysphagia despite histological remission. This article provides a state-of-the-art review and updated discussion of current therapies and newly developed options for EoE. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the feasibility and guiding significance in postoperative management of the Whitaker test after complex reconstruction of the upper urinary tract.Materials and Methods: Patients who underwent complex ureteral reconstruction and received the Whitaker test after surgery between December 2018 and December 2019 were included. We judged it abnormal that the renal pelvis pressure was higher than 22 cmH2O or the pressure difference was greater than 15 cmH2O. The results were used as a reference for removing the nephrostomy tube. Based on whether the renal pelvic pressure was higher than 22 cmH2O, the patients were divided into the elevated pelvis pressure group and the normal group. Follow ups at 1 month and every 3 months were collected.Results: A total of 19 patients were included. Fifteen patients did not present obvious abnormalities. One patient suffered from contrast infiltrating into the renal parenchyma, and the pressure was higher than 15 cmH2O. Ureteral stent implantation was performed. The other 3 patients had either elevated pelvis pressure or insufficient image, 2 of which prolonged the duration of nephrostomy tubes. The median follow-up time was 12.6 months. CTU/MRU after removing nephrostomy tubes indicated improved/stable hydronephrosis in all patients. The creatinine in the elevated pelvis pressure group was higher than that in the normal group (91.4 ± 27.6 vs 86.7 ± 16.5 μmol/L, P = .782), and the eGFR was lower (76.0 ± 14.0 vs 81.8 ± 24.1 mL/min/1.73m2, P = .695), but without significant difference. The change in creatinine during follow-up in the elevated renal pelvic pressure group was significantly different from that in the normal group (-13.6 ± 1.0 vs -0.2 ± 10.6 umol/L, P = .047).Conclusion: Postoperative Whitaker test can help judge whether nephrostomy could be removed. Elevated pressure in upper urinary tract after reconstruction suggests the need to prolong the time of the nephrostomy tube or even re-intervene. Proper management for patients with elevated renal pelvis pressure can help restore the renal function. [ABSTRACT FROM AUTHOR]

Background: Achalasia is an esophageal motility disorder characterized by esophagogastric junction (EGJ) dysfunction and impaired esophageal peristalsis with significant impact on quality of life. While the functional luminal imaging probe (FLIP) has been used to assess EGJ distensibility in achalasia, its clinical utility in pediatrics is limited due to absence of normative values and correlations with clinical outcomes in children. Thus, we sought to evaluate FLIP's use in a pediatric achalasia cohort undergoing dilations and non‐achalasia controls. Methods: We conducted a retrospective study of pediatric patients with achalasia who underwent FLIP before and immediately after balloon dilations and compared to a non‐achalasia cohort. Key Results: Thirty patients with achalasia (mean age, 15.2 years; 40% female), including fourteen treatment‐naïve and thirteen controls (mean age, 7.9 years; 61% female) were identified. Median EGJ distensibility index (EGJ‐DI) 2.07 mm2 mmHg−1 and diameter (9.23 mm) in treatment‐naïve patients were significantly lower compared to controls (EGJ‐DI 6.8 mm2 mmHg−1; diameter 18.61 mm; (p < 0.001). Balloon dilations resulted in a significant increase in EGJ‐DI immediately after the dilation, particularly in treatment‐naïve patients (p < 0.001), and a significant improvement in Eckardt scores (p < 0.001). Conclusions & Inferences: Functional luminal imaging probe measurements of EGJ‐DI in pediatric patients with achalasia are mostly consistent with adult findings. However, normal EGJ‐DI is seen in symptomatic patients, including treatment‐naive, highlighting the need for pediatric reference data. Balloon dilations achieve a significant increase in EGJ‐DI with improvement in Eckardt scores, confirming the therapeutic value of dilations in achalasia management. [ABSTRACT FROM AUTHOR]

Background: Over the last 20 years, diverse outcome measures have been used to evaluate the effectiveness of therapies for eosinophilic esophagitis (EoE). This systematic review aims to identify the readouts used in observational studies of topical corticosteroids, diet, and dilation in adult EoE patients. Methods: We searched MEDLINE and Embase for prospective and retrospective studies (cohorts/case series, randomized open-label, and case-control) evaluating the use of diets, dilation, and topical corticosteroids in adults with EoE. Two authors independently assessed the articles and extracted information about histologic, endoscopic, and patient-reported outcomes and tools used to assess treatment effects. Results: We included 69 studies that met inclusion criteria. EoE-associated endoscopic findings (assessed either as absence/presence or using Endoscopic Reference Score) were evaluated in 24/35, 11/17, and 9/17 studies of topical corticosteroids, diet, and dilation, respectively. Esophageal eosinophil density was recorded in 32/35, 17/17, and 11/17 studies of topical corticosteroids, diet, and dilation, respectively. Patient-reported outcomes were not uniformly used (only in 14, 8, and 3 studies of topical corticosteroids, diet, and dilation, respectively), and most tools were not validated for use in adults with EoE. Conclusions: Despite the lack of an agreed set of core outcomes that should be recorded and reported in studies in adult EoE patients, endoscopic EoE-associated findings and esophageal eosinophil density are commonly used to assess disease activity in observational studies. Standardization of outcomes and data supporting the use of outcomes are needed to facilitate interpretation of evidence, its synthesis, and comparisons of interventions in meta-analyses of therapeutic trials in adults with EoE. [ABSTRACT FROM AUTHOR]

This paper proposes an accurate MRI brain tumor segmentation based on a Rotating Triangular Section with Fuzzy C-Means Optimization. Magnetic Resonance Imaging has become so popular due to its capability to differentiate tumors from the non-tumor region. The proposed method initially eliminates most of the background region by two level morphological reconstruction processes followed by thresholding. The two-level morphological reconstruction uses 'erosion' as the first level and 'dilation' as the second level. After eliminating the background, a region for Fuzzy C-Means (FCM) optimization is chosen using the Radius Contraction and Expansion process. The Radius Contraction and Expansion initially, selects the centroid and maximum radius of the region provided by the background elimination. The Radius Contraction and Expansion will give a contour whose shape is approximately the same as the shape of the tumor but larger than the size of the tumor region. The centroid of the new contour which acts as one of the vertices of the triangular region is again estimated. The remaining two vertex pixels are estimated from the contour pixels with a spacing provided by a spacing factor. FCM is then applied to this triangular region to obtain the accurate tumor pixels inside the triangular region. A new triangular region is estimated in the clockwise direction and FCM is again applied to the new triangular region. This process is repeated until the formation of the triangular region based FCM optimization completes one cycle. The performance of the proposed MRI brain tumor segmentation was evaluated using the T 1 - weighted contrast-enhanced image dataset with the metrics such as dice score, sensitivity, specificity, Hausdorff Distance, and Probabilistic Rand Index (PRI). Experimental results reveal that the proposed MRI brain tumor segmentation outperforms the other state-of-the-art MRI brain tumor segmentation method. [ABSTRACT FROM AUTHOR]

Mayer-Rokitansky-Küster-Hauser syndrome is a rare female congenital anomaly that presents with an inability to have coital sexual intercourse and absolute uterine factor infertility. Both surgical and nonsurgical approaches have been described for the treatment of vaginal agenesis to allow satisfactory coitus. Transplantation of the uterus has the challenge of achieving pregnancy and delivery of her own genetic and biological children in a woman without a natural uterus. Women of reproductive age with a congenital form of absolute uterine factor infertility are considered appropriate recipients of a uterus in the experimental phase of uterus transplantation trials. A neovagina in the normal anatomic position covered by natural non-keratinized mucosa is one of the main assumptions for surgical and reproductive success in transplant recipients. More than 70 uterine transplants have been performed to date, and more than 25 childbirths have been achieved by several research centers in the recipients of a uterus with uterine agenesis. In women with Mayer-Rokitansky-Küster-Hauser syndrome, skin-graft neovagina, Vecchietti's vaginoplasty, and selfdilation using Frank's and Ingram's methods are appropriate techniques to create a neovagina if transplantation of the uterus is intended in the future. [ABSTRACT FROM AUTHOR]

Aim: Although the association between left ventricular dilation and mitral annulus dilation is well understood, the potential variation in the size of the mitral annulus during dilation of the left atrium is currently unknown. In order to investigate the link between the two variables, we used multidetector computed tomography (MDCT) and looked at patients who had a dilated left atrium, assessing if the mitral valve also dilates. Materials and Methods: The study included 107 patients with paroxysmal and persistent atrial fibrillation, in whom catheter ablation was performed using pulmonary vein isolation ± atrial substrate modification. Eighty patients were male (74.8%), with a mean age of 55.8 years (±9.87 with a minimum age of 26 years and a maximum age of 79 years), of which 57.1% had paroxysmal AF and the rest had persistent fibrillation. All the patients underwent multiple-detector CT (MDCT) with contrast medium before the ablation. CT images were integrated into the three-dimensional mapping system CARTO 3, after which the diameters of the mitral annulus, area, and circumference were measured. Left atrial size was evaluated by measuring the diameters, area, and volume. Results: The left atrial area was 247 ± 65.7 cm2 and the left atrial volume was 139 ± 56.3 mL. The transverse mitral annulus (MA) was 29.9 ± 5.3 mm and the longitudinal diameter was 41.9 ± 7.6 mm. The MA circumference and area were 15.0 ± 3.5 cm and 14.2 ± 4.6 cm2, respectively. The following statistically significant correlation was identified between the dimensions of the mitral annulus and the diameters of the left atrium: the transverse mitral annulus correlates with the antero-posterior (AP) LA diameter (R = 0.594, p < 0.01) and the longitudinal MA diameter correlates with the latero-lateral (LL) LA diameter (R = 0.576, p < 0.01). Furthermore, the MA area correlates with the LA volume (R = 0.639, p < 0.001). Conclusions: The volume of the left atrium correlates with the area of the mitral annulus. In patients with paroxysmal and persistent AF, an increase in left atrial dimensions is further associated with an increase in mitral valve dimensions. [ABSTRACT FROM AUTHOR]

Abstract Introduction Vaginal dilation is often indicated as an intervention for the management of radiation therapy‐induced vaginal adhesions and stenosis (RTVAS). However, limited research exists underpinning this intervention and diversity in patient recommendations internationally are reported. In the absence of New Zealand (NZ) national guidelines regarding the management of RTVAS, a survey of NZ radiation therapy departments was conducted to gain an overview of current practice. Methods A two‐section online survey was developed to capture RTVAS education and management overview across NZ. Section one focused on departmental resourcing and section two on local standard practice regarding vaginal dilator usage. One RTVAS education representative from each department was invited to complete the survey. Results Eight of nine NZ departments completed the survey. Consistent treatment indications were identified for RTVAS patient education with the involvement of diverse staffing groups at various time‐points throughout the treatment process. Protocols for RTVAS management existed in each RT department with staff commonly trained by informal peer observation. Dilator usage was recommended regardless of patient sexual activity. Agreement was shown regarding the recommended start time of dilator usage and frequency. The recommended duration of dilator use post‐treatment varied from 6 months to greater than 36 months. Conclusions This work illustrates both concordance and diversity in practice and contributes to the limited body of literature available. Further research is warranted to explore patterns of practice between departmental protocols and individual practitioners in further detail.

Abstract Background To examine the effect of pharmacologic dilation on biometric parameters measured by the Lenstar LS 900, and whether these changes affect the power of the calculated intraocular lens (IOL) using multivariable formulas in an undilated versus pharmacologically dilated state. Methods Prospective study of 98 phakic eyes from 53 patients. Axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), and keratometry (K) readings were measured. The first set of measurements was taken prior to dilation. After dilation (pupil diameter ≥ 6.0 mm), a second set of measurements was taken. The Barrett, Olsen, Hill-RBF, Haigis, SRK/T, and Holladay I formulas were used to calculate IOL power before and after dilation. Two calculation methods were used: method A used a commonly available IOL targeted to achieve the lowest myopic spheroequivalent residual refraction; method B calculated ideal IOL power for emmetropia. Results Statistically significant increases were seen in CCT (p

Background/Aims We retrospectively analyzed Crohn’s disease (CD) patients with small intestinal strictures who underwent single-balloon enteroscopy (SBE) to ascertain whether prototype SBEs with a passive bending mechanism and high force transmission insertion tube had better insertability in the small intestine than a conventional SBE. Methods Among 253 CD patients who underwent SBE, we identified 94 CD patients who had undergone attempted endoscopic balloon dilatation (EBD) for small intestinal stenosis for inclusion in this study. We analyzed whether the type of scope used for their initial procedure affected the cumulative surgery-free rate. For the insertability analysis, patients who underwent SBE at least twice were divided into 3 groups according to the type of scope used: conventional SBE only, prototype SBE only, and both conventional and prototype SBEs. For each group, depth of insertion, procedure time, and number of EBDs were compared in the same patient at different time points. Results The success rate of EBD was 88.3%. The 5- and 10-year cumulative surgery-free rate was 75.7% and 72.8%, respectively. Cox regression analysis indicated that the factors contributing to surgery were long stricture (≥2 cm), EBD failure, and elevated Crohn’s Disease Activity Index, but not the type of scope used for EBD. The prototype SBEs significantly improved the depth of insertion (P=0.03, Wilcoxon’s signed-rank test). Conclusions In CD patients with small intestinal stenosis, the prototype SBEs with a passive bending mechanism and high force transmission insertion tube did not improve long-term EBD outcome but did improve deep insertability. (Clinical Trial Registration No. UMIN000037102)

Abstract A novel thermo-elastoplastic self-consistent homogenization model for granular materials that exhibit inter-granular plasticity is presented. The model, TEPSCA, is made possible by identifying a new inter-granular plastic Eshelby-like tensor. A micromechanical model of interfacial yielding between grains of a Mohr–Coulomb type is provided, which is relatable to the description of imperfect interfaces within the paradigm of self-consistent homogenization. The local grain constitutive laws are consistent with the description of an interphase layer comprised of local pore volume between grains, such that inelastic inter-particle displacements are directly relatable to changes in bulk porosity, i.e., dilation. The model was developed for the purpose of modeling thermally induced plasticity—the phenomenon known as thermal ratcheting or “ratchet growth”—of composites made from the high explosive triaminotrinitrobenzene (TATB). Model simulations are compared to ratchet growth measurements during cyclic thermal loading of a TATB pellet under stress-free conditions.

Abstract Background Laparoscopic one anastomosis gastric bypass has become a prominent bariatric procedure. Yet, early and late complications, primarily leaks and strictures, are not uncommon. This study summarizes our experience with endoscopic treatment of laparoscopic one anastomosis gastric bypass complications. Methods This is a retrospective study of consecutive patients referred to our hospital from 2015 to 2017 with post laparoscopic one anastomosis gastric bypass complications. Therapy was tailored to each case, including fully covered self-expandable metal stents, fibrin glue, septotomy, internal drainage with pigtail stents, through-the-scope and pneumatic dilation. Success was defined as resuming oral nutrition without enteral or parenteral support or further surgical intervention. Results Nine patients presented with acute or early leaks: 5 (56%) had staple-line leaks, 3 (33%) had anastomotic leaks and 1 (11%) had both. All were treated with stents. Adjunctive endoscopic drainage was applied in 4 patients (44%). Overall 5 patients (56%) with acute/ early leaks recovered completely, including all 3 patients with anastomotic leak and the patient with both leaks but only 1/5 with staple line leak (20%). Complication rate in the leak group reached 22%. Eight patients presented with strictures, 7 at the anastomosis and one due to remnant stomach misalignment. All anastomotic strictures were dilated successfully. However, the patient with the pouch stricture required conversion to Roux-en-Y gastric bypass after 3 failed attempts of dilation. Conclusion Endoscopic treatments of laparoscopic one anastomosis gastric bypass complications are relatively effective and safe. Anastomosis-related complications are more amenable to endoscopic treatment compared to staple line leaks.

The health monitoring technology of transmission towers based on vibration data had become a research hotspot. At present, vibration data mainly relied on sensors installed on the tower, which was time-consuming and laborious. Nevertheless, the ROI computer vision method could achieve long-distance, multi-point, and non-contact monitoring, which offers a new possibility for the structure-safety identification of power transmission towers. However, transmission towers are generally located in the field environment, and the background is complicated, resulting in the ROI key point method for vibration data acquisition encountering various types of noise. Thus, the key point in practice was clearing the noise and reducing the impact of noise on identification accuracy. The subpixel corner method was used to detect a minor error with the research object of pixel sets. The dilation + erosion method could reduce image noise. Under white noise with a variance of 0.05, the dilation + erosion could reduce average error (Emae) and mean square error (Emse) by 27% and 23% and increase percentages of data with absolute error less than 5 mm and 10 mm in the total number of data (σ5 and σ10) by 8% and 4.3%, respectively, which was compared to median filter + sharpen. The histogram equalization method was used to balance background lighting conditions and reduce identification errors from non-uniform illumination. Emae and Emse were reduced by 92% and 99%, and σ5 and σ10 were increased by 5 and 3 times, respectively, and the identification time was cut by 62% with the histogram equalization method. Under white noise with a variance of 0.15 or lower, the three methods combined increased the numerical stability of Emae, Emse, σ5, and σ10, which indicated that the combination of the three methods could improve the anti-noise performance, robustness, and identification accuracy of the ROI computer vision method for transmission tower displacement identification.

Aims: Vascular smooth muscle cell (VSMC) plasticity is a state in which VSMCs undergo phenotypic switching from a quiescent contractile phenotype into other functionally distinct phenotypes. Although emerging evidence suggest that VSMC plasticity plays critical roles in the development of vascular diseases, little is known about the key determinant for controlling VSMC plasticity and fate., Methods and Results: We found that smooth muscle cell-specific deletion of Lkb1 in tamoxifen-inducible Lkb1flox/flox; Myh11-Cre/ERT2 mice spontaneously and progressively induced aortic/arterial dilation, aneurysm, rupture, and premature death. Single-cell RNA sequencing and imaging-based lineage tracing showed that Lkb1-deficient VSMCs transdifferentiated gradually from early modulated VSMCs to fibroblast-like and chondrocyte-like cells, leading to ossification and blood-vessel rupture. Mechanistically, Lkb1 regulates polypyrimidine tract binding protein 1 (Ptbp1) expression and controls alternative splicing of pyruvate kinase muscle (PKM) isoforms 1 and 2. Lkb1 loss in VSMC results in an increased PKM2/PKM1 ratio and alters the metabolic profile by promoting aerobic glycolysis. Treatment with PKM2 activator TEPP-46 rescues VSMC transformation and aortic dilation in Lkb1flox/flox; Myh11-Cre/ERT2 mice. Furthermore, we found that Lkb1 expression decreased in human aortic aneurysm tissue compared to control tissue, along with changes in markers of VSMC fate., Conclusions: Lkb1, via its regulation of Ptbp1-dependent alterative splicing of PKM, maintains VSMC in contractile states by suppressing VSMC plasticity., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Objective: The shape of esophageal dilators has not changed in over 350 years. Clinical and animal research suggests that the upper esophageal sphincter (UES) is not round but approximates a kidney shape and that cylindrical dilators may be suboptimal. The Infinity UES Dilation System has been developed specifically for the anatomic configuration of the UES. This study evaluates the safety of the UES-specific Infinity Dilation System., Methods: All patients undergoing dilation of the UES between January 1, 2022 and September 1, 2023 were included. Demographics, procedure indication, dilator type, minor adverse events, and major complications were abstracted. Minor adverse events, complications, and maximum dilation dimension (mm) were compared between groups., Results: A total of 477 patients were included. Eight hundred and seventy-three total UES dilations were performed. The primary indications for UES dilation were cricopharyngeus muscle dysfunction (43%) and stenosis from radiation toxicity (40%). Twenty-three percent (202/873) of dilations were performed with an Infinity balloon, 31% (270/873) were performed using two conventional balloons placed side by side, and 46% (401/873) were performed with one singleton conventional balloon. The average maximum dilation dimension was 33 (±4.7) mm for Infinity balloons, 32 (±3.8) mm for two side-by-side balloons, and 18 (±3.4) mm for singleton balloons. There were three major complications with conventional balloons and none with Infinity balloons. There were no significant differences in minor adverse events between groups., Conclusions: A UES-specific esophageal dilator provides a greater maximum dilation dimension and appears to be at least as safe as dilation with a single cylindrical balloon designed to dilate the esophagus., Level of Evidence: Level 3 Laryngoscope, 2024., (© 2024 The Author(s). The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Background: Pancreatic duct (PD) dilation could be presented in both benign and malignant diseases. Endoscopic ultrasonography (EUS) is a sensitive modality that provides both structural assessment and tissue sampling. This study aims to explore the importance of PD dilation as a potential indicator related to various pancreatobiliary pathologies identified via EUS., Methods: Among 3109 subjects who underwent EUS, 599 had evidence of dilated PD and met the inclusion criteria of this retrospective study. Also, the patients underwent EUS fine needle aspiration (EUS-FNA) to evaluate the etiology when required. All data were extracted from patients' medical records to perform statistical analysis., Results: The study sample revealed 64% being male with a median age was 65-years. Pancreatic adenocarcinoma was the most common etiology diagnosed in 236 patients (39.4%), followed by sphincter of Oddi dysfunction (SOD) in 13% of subjects. Ampullary carcinoma, common bile duct stone, and cholangiocarcinoma were found at 9.5%, 8.8%, and 6.8%, respectively. Abdominal pain was the most common symptom seen in 440 (73.4%) patients. Opium consumption was reported in 170 (28.4%) subjects. Opium consumption was significantly more prevalent in patients with SOD ( P <0.05)., Conclusion: We suggest that PD dilation could be associated with a wide range of pancreaticobiliary pathologies, especially pancreatic neoplasms. In this regard, PD dilation should be considered as a crucial indicator of pancreatic neoplasm despite it may be associated with no clear etiologies., Competing Interests: Competing Interests The authors declare no conflict of interest related to this work., (© 2024 Middle East Journal of Digestive Diseases.)

This research study investigates Barrow holographic dark energy with an energy density of ρΛ=CH2−Δ by considering the Hubble horizon as the IR cut-off in the f(R,T) gravity framework. We employ Barrow holographic dark energy to obtain the equation of the state for the Barrow holographic energy density in a flat FLRW Universe. Concretely, we study the correspondence between quintessence, k-essence, and dilation scalar field models with the Barrow holographic dark energy in a flat f(R,T) Universe. Furthermore, we reconstruct the dynamics and potential for all these models for different values of the Barrow parameter: Δ. Via this study, we can show that for Barrow holographic quintessence, k-essence, and dilation scalar field models, if the corresponding model parameters satisfy some limitations, the accelerated expansion can be achieved.