Late Intestinal Obstruction due to an Intestinal Volvulus in a Pregnant Patient with a Previous Roux-en-Y Gastric Bypass

This is a case of a 33 weeks pregnant woman, presented 2 years after laparoscopic Roux-en-Y gastric bypass, with abdominal pain for 2 days. A laparoscopic cholecystectomy was performed 1 day earlier in another hospital, without improving the pain. She presented at our hospital with acute abdominal pain and clinical signs of intestinal obstruction, undergoing an exploratory laparotomy that revealed a volvulus and necrosis of the jejunum from the gastroenteroanastomosis through the lateral enteroenterostomy, which was resected with the reconstruction of the Roux-en-Y limb performed at the same operation. Patient and neonate presented with improvement after surgery and the patient was discharged on postoperative day 15. Internal hernias after bariatric surgery have been reported as the cause of acute abdomen problems during pregnancy, which may progress to necrosis and perforation. The delay of surgical intervention could have brought a tragic outcome for mother and neonate.     

Patient-maintained propofol sedation as premedication in day-case surgery: assessment of a target-controlled system

We have assessed the efficacy and safety of a system which allowed 20 patients undergoing day-case anaesthesia to operate a target-controlled infusion of propofol to provide anxiolytic premedication. A target- controlled infusion of propofol was started with a target blood concentration of 1 microgram ml-1, and the patient was allowed to increase the target by 0.2 microgram ml-1 by operating a control button. There was a lockout time of 2 min and a maximum target concentration of 3 micrograms ml-1. There were significant reductions in anxiety scores from presedation baseline values and those measured at 15 min after the start of sedation. Values remained low until induction of anaesthesia. Median blood target concentration of propofol varied from 1.0 to 1.2 micrograms ml-1 and mean propofol consumption was 50.3 (SD 17.6) micrograms kg-1 min-1. No patient became oversedated and all remained cardiovascularly stable. Two individuals required low- dose supplementary oxygen for mild arterial oxygen desaturation but there were no instances of airway obstruction. Patient satisfaction with the system was high.      

Influence of alcohol and tobacco habits on peri-implant marginal bone loss: a prospective study

A prospective clinical study was conducted to explore the possible link between peri-implant bone loss and the widespread habits of tobacco smoking and alcohol consumption. One hundred and eighty-five patients who received 514 implants were followed up for 3 years. Peri-implant marginal bone loss was evaluated by digital panoramic radiography and image analysis techniques. Multivariate analysis showed that peri-implant marginal bone loss was significantly related to a daily consumption of >10 g of alcohol, tobacco use and increased plaque levels and gingival inflammation. The present results indicate that daily alcohol consumption and tobacco use may have a negative influence on predictable long-term implant treatment outcomes, producing peri-implant bone loss and compromising restorative treatment with implant-supported prostheses.     

Conductivity,Thermal Stability and Morphology of a New Z‐IOPE Inorganic–Organic Network with the Formula [FexSny(CH3)2y(CN)zClv(C2nH4n+2On+1)Kl]

This paper reports accurate studies on the morphology, thermal stability and electrical spectroscopy of a zeolitic inorganic–organic polymer electrolyte (Z‐IOPE) with the formula [Fe_xSn_y(CH₃)_2y(CN)_zCl_v(C_2nH_4n+2O_n+1)K_l]. This material was prepared by means of a sol‐gel process. A possible mechanism of the sol‐gel process is proposed. Scanning electron microscopy showed that the Z‐IOPE resembles a gummy paste with a rough texture and grains on the surface of the bulk material. Thermogravimetric investigations indicated that the material is thermally stable up to approximately 200°C. A detailed study of the mechanism of ion conduction in this system was carried out using impedance spectroscopy in the 20 Hz to 1 MHz range. The analysis of real and imaginary components of conductivity spectra indicated that a full characterization of the AC electrical response for this Z‐IOPE system requires an equivalent circuit analysis for frequencies lower than 10 kHz and correlated ionic motion analysis based on the Universal Power Law for frequencies higher than 10 kHz. These studies demonstrated that the Z‐IOPE material conducts ionically by a mechanism mainly regulated by segmental motion of the host material, and that charge migration by ion hopping between equivalent coordination sites is not to be completely excluded in the host network. Finally, the conductivity of 4.77×10^–5 S·cm^–1 at 25°C classifies this hybrid inorganic–organic network as a good ionic conductor.     

Does a full bladder aid upper tract visualization in magnetic resonance urography?

The aim of this study was to evaluate whether a full bladder improved the visualization of the upper renal tract during magnetic resonance urography (MRU). Twenty volunteers were recruited into the study. The MRU imaging was carried out on a 1.5‐T MR system. Imaging was carried out in the coronal plane using a half‐Fourier acquired single‐shot turbo‐spin‐echo technique. All volunteers were examined in two separate MRU studies to visualize the urinary tract. The first study was carried out with a ‘full’ bladder followed by a study with an ‘empty’ bladder, leading to a total of 40 examinations. Two radiologists then reviewed maximum intensity projection images from both ‘full’ and ‘empty’ studies independently. Both left and right upper tracts were divided into five segments. A three‐point grading system was used to evaluate visualization. Excellent visualization = 3, good visualization = 2 and poor visualization = 1. Maximum score per patient was 30. Results were tabulated and analysed using an Excel database. The average score for visualization for the ‘full’ bladder group was 22.1/30 (73.8%) and the average score for the empty bladder was 16.2/30 (54%). Overall improvement in visualization was 5.9/30 (19.8%). There was strong interobserver agreement, with a concordance value of 92.5%. The MRU carried out in healthy young adult volunteers with a full bladder allows improved visualization of the upper tracts.     

The Longevity Revolution: The Benefits and Challenges of Living a Long Life by Robert N. Butler

This pilot, multiple case study primarily examined deconditioning effects on four physical fitness components in eight participants with fibromyalgia syndrome (FMS). Fitness results after training were contrasted with fitness results immediately following two periods of inactivity. These preliminary data suggest that aspects of physical deconditioning among people with FMS may be highly individualized; therefore, making any generalizations about physical detraining in this population requires more study. Also, results regarding FMS symptoms and psychosocial factors following training versus no training on these eight participants suggest that deconditioning on these factors is very individualized. Knowledge of data-based, deconditioning information relative to FMS is important for professionals who work with older adult patients, especially activity directors who coordinate/direct recreational exercise programs or physical rehabilitation programs that involve exercise in nursing homes. Deconditioning effects from program closings, activity staff absences, or missing sessions for any reason may potentially affect fitness, FMS symptoms, psychosocial function, and possibly activities of daily living (ADL). This potential negative effect on ADL can increase workload and place much more stress on the nursing staff. All of this requires more research for a more thorough understanding.     

High-resolution and quantitative spatial analysis reveal intra-ductal phenotypic and functional diversification in pancreatic cancer

A ‘classical’ and a ‘basal-like’ subtype of pancreatic cancer have been reported, with differential expression of GATA6 and different dosages of mutant KRAS. We established in situ detection of KRAS point mutations and mRNA panels for the consensus subtypes aiming to project these findings to paraffin-embedded clinical tumour samples for spatial quantitative analysis. We unveiled that, next to inter-patient and intra-patient inter-ductal heterogeneity, intraductal spatial phenotypes exist with anti-correlating expression levels of GATA6 and KRAS^G12D. The basal-like mRNA panel better captured the basal-like cell states than widely used protein markers. The panels corroborated the co-existence of the classical and basal-like cell states in a single tumour duct with functional diversification, i.e. proliferation and epithelial-to-mesenchymal transition respectively. Mutant KRAS^G12D detection ascertained an epithelial origin of vimentin-positive cells in the tumour. Uneven spatial distribution of cancer-associated fibroblasts could recreate similar intra-organoid diversification. This extensive heterogeneity with functional cooperation of plastic tumour cells poses extra challenges to therapeutic approaches. © 2023 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.