Difficult Passage Research Articles

Microbiota treatment of functional constipation: Current status and future prospects.

Functional constipation (FC) is a common disorder that is characterized by difficult stool passage, infrequent bowel movement, or both. FC is highly prevalent, recurs often, accompanies severe diseases, and affects quality of life; therefore, safe and effective therapy with long-term benefits is urgently needed. Microbiota treatment has potential value for FC treatment. Microbiota treatments include modulators such as probiotics, prebiotics, synbiotics, postbiotics, and fecal microbiota transplantation (FMT). Some probiotics and prebiotics have been adopted, and the efficacy of other microbiota modulators is being explored. FMT is considered an emerging field because of its curative effects; nevertheless, substantial work must be performed before clinical implementation.

Prospects for the use of moisture-temperature UAV metrics to assess the state of land-use territories in planning and conducting spring field work

In the Central region of the Russian Federation, the favorable period for spring field work is short, but extremely important for obtaining the planned harvest. The possibility of tillage is mainly determined by its humidity after snowmelt. For the preparation and adjustment of plans for mechanized work, operational georeferenced information on the hydrological state of the soil in the land-use area is necessary, for which moisture-temperature UAV-metry can be used. Purpose – to evaluate the possibility of using the data obtained by multisensory UAV-s during the survey of agricultural landscapes to identify economically significant hydrological heterogeneity of territories. Agricultural landscapes in the Yuriev-Polsky district of the Vladimir region on gray forest loams and in the Shatura district of the Moscow region on sod-podzolic and podzolic sandy soils were examined. Their significant hydrological heterogeneity has been revealed, including local waterlogged areas with different causes of water stagnation. It is established that the dynamics of the hydrology of fields and the network of country roads are closely related. The use of UAV sensing data will help to eliminate the problem of difficult passage to the fields by carrying out appropriate measures and establishing the correct order of processing of land plots. To obtain the necessary information by agricultural enterprises, interdepartmental cooperation of the Ministry of Agriculture, the Ministry of Ecology, the Ministry of Forestry, AVTODOR, the Ministry of Emergency Situations, Energy Networks, as well as the use of the “Digital Earth system” is promising. The inclusion of moisture-temperature UAV-s in the production system – a plan for the preparation and conduct of spring field work, opens up new opportunities for their high-quality performance due to the timely identification of risk areas and appropriate adjustments. The priority object of the development application at the first stage should be considered roads – a key factor for rural areas.

Difficult catheterization and previous urethral obstruction are associated with lower urinary tract tears in cats with urethral obstruction.

To retrospectively assess the hospital prevalence and risk factors associated with iatrogenic lower urinary tear in cats with urethral obstruction (UO). 15 client-owned cats diagnosed with concurrent UO and lower urinary tears and year-matched control population of 45 cats diagnosed with UO. University teaching hospital records were reviewed for cats presenting with UO between January 2010 and December 2022. Signalment, anatomic location of tear, experience of the individual passing the urinary catheter, difficulty level of catheter passage, history of previous UO, blood work parameters on presentation, presence of visible grit in urine, and survival to discharge were recorded. In addition, prevalence of lower urinary tears in cats presenting with UO was calculated. The prevalence of lower urinary tears was 0.92% in UO cats. Cats with lower urinary tears were significantly less likely to survive to discharge and had a longer period of hospitalization than cats without tears. In addition, cats with tears were more likely to have a history of previous UO and had more difficult urinary catheter passage than cats in the control group. Cats with tears also had a higher Hct than the control UO cats. Cats that develop lower urinary tears are more likely to have a history of previous UO and difficult catheter passage. This group of cats is also more likely to have a longer hospitalization period and lower survival to discharge rates.

Lucretius’ Allegoresis and Invective

Abstract The present paper suggests that Lucretius’ Magna Mater interpretation (2.598-660) can fruitfully be approached through the lens of invective oratory. While this difficult passage of De rerum natura has long puzzled scholars, this article argues that in his interpretation Lucretius masterfully transforms the encomiastic topos of allegoresis into a powerful means of blame: the poet allegorically interprets various aspects of the cult of Cybele with a view to showing how religious convictions and customs go awry. When thus exposing the cult as impious, Lucretius ingeniously exploits several topoi of rhetorical hymns (nurture, propitiation, etc.) for the purpose of making his vituperation all the more compelling. Hence, on the reading advocated here, the Magna Mater interpretation is a carefully constructed invective against those aspects of the cult (of Cybele) which an Epicurean is bound to frown upon (providential illusion, divine punishment, etc.).

An Unexpected Case of Chronic Constipation in A 16-Year-Old Girl Turned Out to Be Hirschsprung’s Disease

Background: Constipation is a disorder in the gastrointestinal tract, which can result in the infrequent stools, difficult stool passage with pain and stiffness. A large sum of public funds is also being spent on caring for children with constipation due to repeated hospital admissions, emergency room visits, and regular clinic visits because of recurrent exacerbations of their symptom. Case: An older children 16-year-old girl complaining of not having smooth bowel movements since birth. She complaints of nausea, vomiting, and flatulence are present. The stomach is minimal enlarged, but stomach pain is absent. the patient underwent a barium enema colon examination and underwent a punch biopsy operation which confirming the diagnosis of Hirschsprung’s disease. The patient underwent trans endorectal pull-through (TERPT). Several weeks later, the patient returned to the pediatric surgery clinic for a follow-up, and it was found that the patient’s intestinal function was normal. There were no complaints of vomiting, bloating, or abdominal pain. Conclusion: Chronic constipation in older children cannot rule out the possibility of a diagnosis of Hirschsprung disease. Medical history alarm symptoms or signs in children differ according to the age of onset of symptoms. A series of tests should be performed to exclude underlying diseases. so that the chosen treatment can become definitive therapy.

Mutation at the entrance of the quinone cavity severely disrupts quinone binding in respiratory complex I

In all resolved structures of complex I, there exists a tunnel-like Q-chamber for ubiquinone binding and reduction. The entrance to the Q-chamber in ND1 subunit forms a narrow bottleneck, which is rather tight and requires thermal conformational changes for ubiquinone to get in and out of the binding chamber. The substitution of alanine with threonine at the bottleneck (AlaThr MUT), associated with 3460/ND1 mtDNA mutation in human complex I, is implicated in Leber's Hereditary Optic Neuropathy (LHON). Here, we show the AlaThr MUT further narrows the Q-chamber entrance cross-section area by almost 30%, increasing the activation free energy barrier of quinone passage by approximately 5 kJ mol−1. This severely disrupts quinone binding and reduction as quinone passage through the bottleneck is slowed down almost tenfold. Our estimate of the increase in free energy barrier is entirely due to the bottleneck narrowing, leading to a reduction of the transition state entropy between WT and MUT, and thus more difficult quinone passage. Additionally, we investigate details of possible water exchange between the Q-chamber and membrane. We find water exchange is dynamic in WT but may be severely slowed in MUT. We propose that LHON symptoms caused by 3460/ND1 mtDNA mutation are due to slowed quinone binding. This leads to an increased production of reactive oxidative species due to upstream electron backup at the FMN site of complex I, thus resulting in a mt bioenergetic defect.

A Difficult Passage to Navigate: From Asylum Story to Refugee Tale

This article draws on the results of a life writing initiative, ARENA (Archive of Refugee Encounter Narratives), developed at the University of Innsbruck in Austria. It involves students of English collaborating with refugees over periods of three months to write down the latter’s stories. Like other storytelling ventures spawned by the perceived European refugee crisis of 2015, ARENA aims to enable a better understanding of the situation of refugees in Europe than the dominant asylum discourse allows. To this end, students arrange regular encounters with participating refugees and encourage them to tell whatever they consider to be their stories. The texts the students craft from these exchanges capture not only the refugees’ stories but also their own experience of hearing them. I will examine the embodied act of narration thus recorded in the ARENA corpus and contest critical claims that, too indebted to the rigid veracity standards defining official refugee testimonials, refugee life writing is unable to augment new ways of thinking about refugee experience and forced migration at large. My argument is that such criticism does not apply where the dialogic nature of live telling is consciously experienced and given due expression in the life writing it eventually becomes.

Veiling within the Corinthian Context: An Examination of Cynthia Long Westfall’s Reading of 1 Corinthians 11:2–16

Abstract Paul’s exhortation in 1 Cor 11:2–16, discussing (among other topics) the reason and purpose for a woman to cover her head, has proven to be a perennially difficult passage for exegetes. Cynthia Long Westfall has recently offered an intriguing interpretation, asserting that some modern, Western readings of the passage, which view Paul’s directives as reinforcing oppressive restrictions on women, fail to account for the way the veil acted to protect certain vulnerable women from potential exploitation. Westfall asserts that many women of the Greco-Roman world, especially of the lower strata, would have seen veiling as a desirable symbol of dignity, though socially and legally unavailable to them as members of repressed social groups. In this study, the authors test Westfall’s dual assertion that (1) veiling practices varied significantly depending on one’s social strata and that (2) authorities legally enforced veiling restrictions on certain groups. Ultimately, although the article supports aspects of Westfall’s argument, the authors find no evidence to uphold the assertion that veiling was off-limits for any female group in the Greco-Roman world. Rather, an array of sociocultural factors—including religious expectations, societal norms, and practical realities—appears primarily to have influenced a woman’s choice to veil.

Transphyseal distal humeral separation in neonates: A case series

IntroductionBirth trauma is a rare condition. Typically, injury in neonates occurs as a result of obstetrical manipulation to allow delivery or from trauma sustained during a difficult passage through the birth canal. Transphyseal separation of the humerus is particularly rare. Diagnosis is not always straightforward and is prone to mistakes. There is a general consensus that the outcome is usually favorable. It is generally agreed that the fracture needs to be realigned, while the suggested methods in contention vary from a simple plaster cast to closed and even open reduction and percutaneous Kirschner wire fixation. The purpose of this study was to review our experience in treating transphyseal distal humeral separation in neonates to better define the diagnostic and therapeutic pathway. MethodsTen consecutive cases of transphyseal distal humeral separation in neonates were treated at our institution between September 2008 and June 2021. All cases were reviewed and clinical data collected on birth injury risk factors, diagnostic workup, age at diagnosis and treatment, and type of treatment. Results of treatment and outcome were analyzed for time to fracture union, complications and clinical alignment, range of motion and residual pain at the latest follow-up. ResultsMean age at diagnosis was 4.2 days (range 0 to 9 days) and time between diagnosis and treatment varied from three to 26 h (average 15 h). Risk factors for birth injury were present in six patients. Four patients were initially treated with closed reduction and cast immobilization, all the other cases were treated with closed reduction and percutaneous pinning. Arthrography was performed at the time of treatment in six cases. Average follow-up was 37 months (range 12 to 120 months). At the latest follow-up, all fractures had healed with full range of motion. No clinical or radiographic deformity requiring repeated surgery or physeal damage was observed. ConclusionsThis rare lesion may occur both in the presence and in the absence of risk factors. Due to the rarity of the injury, misdiagnosis and delayed diagnosis are not uncommon. Treatment with closed reduction and percutaneous pin fixation is advisable and safe.

Awareness of the General Population Toward Constipation and Its Complications in the Western Region, Saudi Arabia.

Background and aim Constipation can be defined as unsatisfying defecation characterized by difficult stool passage, infrequent stools, or both. Complications include hemorrhoids, anal fissures, and prolapse of pelvic organs. Unfortunately, there needs to be more data available regarding awareness on this subject. Thus, in this study, we aim to measure the level of understanding of constipation and its complications in the western region of Saudi Arabia. Methods In this cross-sectional study, a valid and reliablequestionnaire was used in data collection. In addition, SPSS (IBM Corp., Armonk, NY) was used for the analysis of collected data. Results The present study included a total of 778 participants from the general public, 75.6% of whom were female and 24.4% of whom were male. We found that 70% of participants had an overall good awareness of constipation, with significant variation in levels of awareness among different groups; levels of awareness increased with age (P-value< 0.001), higher education also positively affected the level of understanding (P-value= 0.04), and participants who reported personal experience had higher levels of awareness than participants who did not have personal experience (P-value​​​​​​​= 0.002). There was no significant association between the level of awareness and gender or city of residence. Conclusion Much of our population was well aware of constipation and its complications, with significant variation in awareness among different age groups, educational levels, and personal experiences.

Entre justice et administration: la cour des aides de Montauban contre l'intendant lors des crises de l'Ancien Régime français

The relations between the sovereign courts and the intendants contain a tormented and unsuccessful history, marked since the Grand Siècle by the difficult passage from the traditional jurisdictional management of the kingdom, considered inefficient, to an organisation that supports the triumph of the absolute and administrative monarchy. In these southern lands of the kingdom of France, torn apart by the Protestant reformation and the wars, the institutional upheaval which prepared the modern state and the Napoleonic granite masses, was carried out through strong embarrassments which opposed the intendant of the generality to the court of aids in Montauban. As soon as they were created, the magistrates of the jurisdictional company multiplied the manoeuvres against the intendant to safeguard their contentious attributions and the control of the municipal funds. Their particularistic actions were denounced by the intendant, who was there to make the king present everywhere in the kingdom and was zealous in his service. Since then, all the elements were in place for the outbreak of a noisy quarrel – the lawsuit against the intendant Gaspard Lescalopier – which worried the government at the turn of the reign of Louis XV, in the middle of the tax war in 1749, when King Louis XV, whom the subjects looked upon as a charming prince, became „Louis the Unloved”. These tumults prevented the modernisation of the French monarchy and led to the troubles of the Revolution.

Knocking on the Doors of Scripture

Several times, when faced with a difficult passage of scripture in Sermones ad populum, Augustine implores his audience, “knock and it shall be opened” (Matt. 7:7c; par. Luke 11:9c). Augustine uses this phrase to stress humility and the human need for God’s activity when interpreting scripture. Studying the archeological record of domestic architecture of locked doors in Roman North Africa elucidates Augustine’s message. Knowledge of the material culture shows that Augustine calls upon Christians to “knock” upon scripture as if it were a door, locked and barred in such a way that it could only be opened from inside. Thus, a reader of scripture is like a petitioner calling from outside a locked door, needing God to open its meaning. Augustine’s use of “knocking” contrasts with the metaphor of “keys” to scripture, which was favored by Tyconius and other early Christian writers. In De doctrina Christiana, Augustine expresses concern that “keys” could lead a person into overconfidence, expecting to unlock obscure passages of the Bible by his or her own power. Augustine’s frequent use of Matt. 7:7c is a call for exegetes to approach scripture with humility. All members of the totus Christus, great and small, must humbly knock. The image of “knocking” provides a versatile theological message: human effort is important, but the meaning of the Bible is ultimately unlocked by God’s activity.

She Decides: Reading Genesis 34 in Conversation with Narrative Ethics

Genesis 34 is a troubling tale that includes an ambiguous sexual encounter (possibly rape), deception, brutal violence against an unsuspecting city, and the silence—or silencing—of the only female character, Dinah. This article models wrestling with this difficult passage through linguistic analysis and a narrative ethics framework that monitors the functions of reticence in narrative. Attending to the two major informational gaps—the narrator’s evaluation and the perspective of Dinah—alerts readers to the centrality of the latter as the key to unlocking the former.

Epidemiology of sport climbing injuries caused by a climbing fall among climbers of the French Federation of Mountain and Climbing.

Fall-related injuries (FRIs) are the most severe sport climbing injuries. The main objective of this study was to measure FRI prevalence and risk factors in a representative sample of climbers of the French Federation of Mountain and Climbing. The second objective was to explore FRI mechanisms. The study included 3919 climbers aged 16+. They were invited to fill out an online questionnaire where they reported sociodemographics, sport-related characteristics and whether they had sustained an FRI in the past 12 months (12-FRI), and over their entire career (ALL-FRI). The mechanisms of 12-FRI were asked for. Multivariable logistic regression analyses were performed to evaluate the association between sport-related characteristics and FRI. Nine per cent of the participants reported a 12-FRI and 29% an ALL-FRI. No statistically significant effect of sex, context of climbing, or onsight level was observed on 12-FRI. Climbers with 0-3 years of experience (YE) were 1.7 (95% CI: 1.2-2.6) and 3.6 (95% CI: 2.2-6.3) times more likely to have sustained a 12-FRI compared with those with 5-8 YE and 14-23 YE, respectively. An interaction effect was found between YE and onsight level. Among climbers with 0-8 YE, those with a higher onsight level had a higher risk of 12-FRI. Natural falls, unexpected falls and static belaying were the most commonly reported 12-FRI mechanisms. These results highlight that future FRI prevention programs should target priority-inexperienced climbers who have progressed rapidly. Climbers should be taught as a priority to stay focused while belaying even in the least difficult passage, and to belay dynamically.

Surgical treatment of esophageal diverticula with a rare complication

A patient with complaints of difficult passage of solid food through the oesophagus, putrid breath, general weakness, a CT scan of the oesophagus revealed signs of a fistulous passage in the lower third of the oesophagus with a cavity in 9-10 segments of the right lung, with fluid resembling an abscess with perifocal infiltrative changes in lung tissue. Esophagogastroduodenoscopy revealed a diverticulum in the lower third of the esophagus with two fistulous passages into the pleural cavity. The patient underwent right thoracotomy to empty the abscess cavity, excision of the fibrous capsule of the abscess wall, excision of the diverticula and restoration of the esophageal wall integrity. A complication of oesophageal diverticula in the form of a fistula with formation of an abscess in the pleural cavity is a casuistic case. The main treatment for this complication is surgery.

Use of Xylocaine to facilitate embryo transfer to Welsh pony recipient

Embryo transfer is a commonly used procedure in equine breeding worldwide. Embryos are trans-cervically transferred into the recipient uterus on Day 5 or 6 after ovulation and expected pregnancy rates range from 65 to 85% and 50 to 75% at days 14 and 45, respectively. Poorer results in pony mares may be attributed to the difficult passage of the cervix and the subsequent contamination of the cervix and/or release of inflammatory products. Paracervical block, i.e. local anesthesia of the cervical area is routinely used for gynecological procedures, such as intrauterine device placement, in women (Mody et al. Obstet Gynecol. 2018; 132(3): 575–582) but has not been reported for similar procedures in the equine. The present study aimed to evaluate the benefits of the application of an anesthetic gel on the cervix before transfer to facilitate the introduction of the transfer gun. Twenty-one grade 1 embryos (one morula and 20 blastocysts), 166-1300µm in diameter (mean±SEM=422±52µm), were collected from Welsh B pony mares at day 7 after ovulation. After collection, embryos were evaluated and conventionally transferred transcervically to recipient pony mares, under 8 years ofage, at day 5, 6, or 7 after ovulation (1 embryo per recipient). In the xylocaine group (XYL), 11 embryos were transferred 10 min after the application of 3ml of xylocaine gel (Xylocaine® gel 2%, AstraZeneca) at the base of the recipient's cervix. Ten other transfers were routinely performed without xylocaine as a control group (CTRL). Pregnancies were monitored by ultrasonography at day 14 and until an embryonic heartbeat was detected at day 21 days. In XYL, 8 (73%) and 6 (55%) recipients were pregnant on day 14 and 21, respectively. In CTRL, 6 (60%) and 4 (40%) recipients were pregnant on day 14 and 21, respectively. While, slightly better in XYL, both at day 14 and day 21, pregnancy rates were not statistically different between groups (P=0.66 and P=0.67 respectively). No significant difference was also obtained between the day of transfer for both groups (P>0.05). Transfers in XYL were subjectively found to be smoother by the operators. It can be concluded that the application of xylocaine on the recipient's cervix does not interfere with early gestation development and may ease cervical catheterization in pony mares. Further work with larger numbers is required to evaluate its potential benefits on transfer outcomes.

Complications of Medial and Lateral Knee Surgery and How to Best Avoid Them

In recent years, reconstruction of structures in the posteromedial and posterolateral corners of the knee has increased in popularity. While these procedures produce good objective and subjective patient outcomes, the increasing incidence of these procedures also results in a higher rate of complications. There is currently a paucity of literature on the avoidance, identification, and management of complications that can occur in the setting of medial and lateral knee surgery. Common complications of surgery of the lateral knee include common peroneal nerve injury, equinus deformity, fibular head fracture, difficult graft passage, incorrect tensioning of the graft, graft amputation, incorrect tunnel placement, recurrent instability, and arthrofibrosis. Common complications of medial sided surgery include heterotopic ossification, incorrect tunnel placement, tunnel convergence, incorrect graft length, incorrect graft tensioning, hardware irritation, recurrent instability, and arthrofibrosis. The aim of this article is to discuss ways to avoid these complications, and how to identify and manage them if they occur.

Qian Mu reads Zhuangzi: Regarding ‘there has not yet begun to be a “there has not yet begun to be nothing”’

ABSTRACT To advance our understanding of both the Book of Zhuāngzǐ 莊子 (c. fourth to third century BCE) and Qián Mù 錢穆 (1895–1990)’s Zhuāngzǐ studies 莊學, I aim to squarely face one of the more obscure passages in the former with recourse to an explanation from the latter. The passage in question is that from the second chapter beginning with the claim ‘there is a beginning’ (有始也者) and culminating with the claim that ‘there has not yet begun to be a “there has not yet begun to be nothing”’ (有未始有夫未始有無也者). I hope to show that Qián offers a compelling and novel interpretation of this difficult passage worthy of our consideration.

Plato’s Alcibiades on Self-Knowledge and the Forms

This paper aims to shed light on a difficult passage from Plato’s Alcibiades, in which Socrates presents an analogy between vision and knowledge. It argues that we can make sense of some puzzling Socratic claims if we acknowledge that the analogy points to the Theory of Forms. In urging Alcibiades to come to know himself, then, Socrates is urging him to come to know the Forms.

Ad astra: Graphic Signalling in theAcrostic Hymn of Nebuchadnezzar II(BM 55469)

AbstractThis article examines two orthographic features in the Acrostic Hymn of Nebuchadnezzar II. It aims to show that the text makes use of the possibilities of the cuneiform writing system to create various levels of meaning. The first example clarifies structure and content with regard to a difficult passage in the fourth and last stanza of the text, in which a possible change of actors is indicated by an orthographic feature. The second example shows how orthography is used in the first stanza of the text to augment its message. These examples demonstrate how structural elements and micro-features such as orthography were used creatively to enhance the message of the hymn.