Diverse Effects Research Articles

P0444 Frequency and Characteristics of Anorectal Pathologies in Patients with Inflammatory Bowel Disease

Abstract Background Inflammatory Bowel Disease (IBD), comprising Crohn’s disease (CD) and ulcerative colitis (UC), commonly manifests with gastrointestinal symptoms such as diarrhea and abdominal pain. Anorectal complications are more prevalent in CD and less frequent in UC. In CD, perianal involvement is a significant clinical concern, with the development of abscesses and fistulas that can complicate disease management. Additionally, benign anorectal conditions such as hemorrhoids and fissures are commonly observed. Managing anorectal pathologies in IBD is complex and may require anything from topical medications to surgery in severe cases. A comprehensive approach is essential to address both intestinal symptoms and perianal complications. The aim of this study is to describe the frequency and characteristics of anorectal pathologies in patients with IBD from the IBD Clinic of the General Hospital of Mexico "Dr. Eduardo Liceaga". Methods In a retrospective observational study at the IBD Clinic of the Hospital General de Mexico, 184 patients with IBD were analyzed over 12 months. Clinical and demographic data, diagnoses, treatments, and anorectal pathologies were evaluated. SPSS version 29 was used for statistical analysis, highlighting measures of central tendency, frequency distribution, and the Chi-square test for inferential analysis. Results In our study, the demographic and clinical characteristics of patients with IBD were evaluated, highlighting that 31.5% had anorectal pathologies (ARP). The most common among these were hemorrhoidal disease (16.8%), fistulas (6%), and anal fissure (3.3%). In the subgroup of patients with UC and ARP (n=46), males predominated (52.2%) with an average age of 40.13 years. Hemorrhoids (56.5%) were the most common ARP. In the group with CD and ARP (n=12), females predominated (83.3%) with an average age of 45.75 years, with fistulas (50%) being the most prevalent ARP. Medical treatment was effective in most cases (91.3% in UC, 75% in CD), with a small percentage requiring surgical treatment. No statistically significant differences were found in the characteristics between the IBD groups with and without ARP (p > 0.05). Conclusion The study highlighted a high prevalence of anorectal pathologies (31.5%) in patients with IBD, including hemorrhoidal disease, fistulas, and anal fissures. Differences in incidence were observed according to the type of IBD, with a higher presence of fistulas in CD. Most patients responded well to medical treatment, although some required surgery. These results underline the importance of comprehensive approaches in the management of IBD, focusing on adequately evaluating and treating perianal complications to improve quality of life. References Misselwitz B, Rickenbacher A, Brand S. Klinik, Diagnostik und Therapie proktologischer Beschwerden bei Patienten mit chronisch entzündlichen Darmerkrankungen. Therapeutische Umschau. Revue therapeutique. 2021;78(9):547-558. [citado 2024 Aug 29]. Disponible en: https://doi.org/10.1024/0040-5930/a001309 Truong A, Zaghiyan K, Fleshner P. Anorectal Crohn’s Disease. Surg Clin North Am. 2019;99(6):1151-1162. [citado 2024 Aug 29]. Disponible en: https://doi.org/10.1016/j.suc.2019.08.012 D’Ugo S, Stasi E, Gaspari AL, Sileri P. Hemorrhoids and anal fissures in inflammatory bowel disease. Minerva Gastroenterol Dietol. 2015;61(4):223-233. Hamzaoglu I, Hodin RA. Perianal problems in patients with ulcerative colitis. Inflamm Bowel Dis. 2005;11(9):856-859. [citado 2024 Aug 29]. Disponible en: https://doi.org/10.1097/01.mib.0000174373.75977.b9 Xu S, Zhang L, Li Z, et al. Enhancing surgical precision: unveiling the impact of preoperative colonoscopy in anal fistula patients. BMC Gastroenterol. 2023;23:442. [citado 2024 Aug 29]. Disponible en: https://doi.org/10.1186/s12876-023-03066-x Yamamoto T, Allan RN, Keighley MR. Effect of fecal diversion alone on perianal Crohn’s disease. World J Surg. 2000;24(10):1258-1263. [citado 2024 Aug 29]. Disponible en: https://doi.org/10.1007/s002680010250 Sands BE, Anderson FH, Bernstein CN, Chey WY, Feagan BG, Fedorak RN, Kamm MA, Korzenik JR, Lashner BA, Onken JE, Rachmilewitz D, Rutgeerts P, Wild G, Wolf DC, Marsters PA, Travers SB, Blank MA, van Deventer SJ. Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med. 2004;350(9):876-885. [citado 2024 Aug 29]. Disponible en: https://doi.org/10.1056/NEJMoa030815 Márquez Velásquez JR, González Awique PS, Miranda Ruíz CA, Muñoz Zuluaga M, Miranda Ruíz LF. Uso de la anoscopia de alta resolución para la detección de displasia anal por papilomavirus en pacientes con enfermedad inflamatoria intestinal. Rev Colomb Gastroenterol. 2023;38(4):419-2. [citado 2024 Aug 29]. Disponible en: https://revistagastrocol.com/index.php/rcg/article/view/1048 El-Gazzaz G, Hull T, Church JM. Biological immunomodulators improve the healing rate in surgically treated perianal Crohn’s fistulas. Colorectal Dis. 2012;14(10):1217-1223. [citado 2024 Aug 29]. Disponible en: https://doi.org/10.1111/j.1463-1318.2012.02944.x Gold SL, Cohen-Mekelburg S, Schneider Y, Steinlauf A. Perianal fistulas in patients with Crohn’s disease, part 1: current medical management. Gastroenterol Hepatol (N Y). 2018;14(8):470-481. Smith RK, Paulson EC. Perianal fistulas in patients with inflammatory bowel disease. Semin Colon Rectal Surg. 2014;25(4):216-220.

P0829 ‘Temporary’ faecal diversion in refractory Crohn’s Disease: too good to be true? A retrospective, single centre analysis

Abstract Background Refractory Crohn’s disease (CD) is associated with high morbidity and significantly impaired quality of life. Similarly, perianal fistulising disease is a debilitating condition for a subset of CD patients. As the faecal stream is believed to play an important role in disease pathophysiology, a diverting (ileo)stomy, is sometimes considered as a therapeutic option in patients with extensive colitis and/or refractory anal disease. Long-term outcomes of temporary faecal diversion are limited. We aimed to assess the long-term effect of faecal diversion in CD patients with refractory colon and/or perianal disease, and identify factors associated with successful ostomy reversal. Methods We conducted a single centre, retrospective observational cohort study in a large IBD referral centre. We included all CD patients who underwent an ileostomy as a temporary measure for managing their refractory disease between 2019 and 2023, enabling at least 12 months follow-up. We evaluated the clinical impact of faecal diversion, and explored the rate of (successful) restoration of transit. Clinical improvement was defined as significant symptomatic improvement, according to physician global assessment. Resolution of perianal disease was defined as the absence of perianal fistula at the time of the multidisciplinary assessment for transit restoration. Results A total of 42 patients, with a median age of 31.5 (interquartile range, IQR 24.2–40.9) and median disease duration of 12.4 (IQR 5.8-18.4) years at time of diversion were included. Patients were followed up for a median of 46.5 (IQR 30.2-67.5) months after ileostomy. Indication for faecal diversion was refractory colitis in 26.2% (n=11), and/or severe perianal disease in 73.8% (n=31). Advanced IBD therapy was restarted in 78.6% (n=33) of patients following diversion. Faecal diversion resulted in clinical improvement in 57.1% of patients (n=24), of whom 70.8% received advanced therapy (n=17/24), and resolution of perianal disease in 35.5% (n=11/31). A total of 14 patients (33.3%), of whom 7 with a perianal phenotype, were proposed for restoration of transit by the multidisciplinary team. Ultimately, in 9/14 patients, including 4 with perianal disease, the ileostomy was reverted with a persistent bowel continuity of 89.9% after 19.0 (IQR 10.7-27.2) months of follow-up. Conclusion Temporary faecal diversion in patients with severe refractory Crohn’s colitis and/or anal disease resulted in significant clinical improvement in almost two thirds of patients, but is often a bridge to a permanent stoma as stoma reversal could only be considered in one third of patients. In these selected cases where the transit was restored, persistent bowel continuity was high.

RETRACTION: Investigating the Effectiveness of Forensic Genetics and Population Genetic Diversity Using a Multi-InDel System in Chinese Hezhou and Southern Shaanxi Han Populations.

Wang, X., Q. Lan, Y. Lin, etal. "Investigating the Effectiveness of Forensic Genetics and Population Genetic Diversity Using a Multi-InDel System in Chinese Hezhou and Southern Shaanxi Han Populations," Annals of Human Genetics (Early View): https://doi.org/10.1111/ahg.12553. The above article, published online on 20 May 2024, in Wiley Online Library (http://onlinelibrary.wiley.com/), has been retracted by an agreement between the authors; the journal's Editor in Chief, Dr. Rosemary Ekong; University College London; and John Wiley & Sons, Ltd. The authors reported that a number of errors had been included in the published article, which would require corrections to the abstract, results, and conclusions, as well as Figure 5. The editors confirmed these errors. The retraction has been agreed to because the corrections required to amend these major errors would require substantial changes to the results and conclusions in the article. The authors have agreed to submit the revised version of this article for evaluation by the journal.

Migration and plugging laws of plugging-selection balls in fine profile control process of layered waterflooding wells

The ball-pitching plugging-selection profile control technology represents an effective and low-cost means of adjusting the profile of waterflooding well. The technology primarily utilizes polymer balls to plug the perforations, thereby achieving the effect of fine profile control. This paper aims to elucidate the migration and plugging laws of plugging-selection balls in wellbore and perforation plugging processes. Accordingly, the effects of flow rate of waterflooding, and density, diameter, quantity of plugging-selection balls on the plugging effect of perforation were investigated through numerical simulation and experiments. This revealed the movement laws of waterflooding and plugging-selection balls during ball-pitching process. The findings of the research indicated that the diversion effect mainly was primarily observed in the layers with strong water absorption capacity, and the migration process of plugging-selection balls demonstrated both single and multiple plugging effects, which were influenced by the parameters of waterflooding and plugging-selection balls. The well plugging effect could be achieved when the flow rate of waterflooding was 2 m3/h, the density of ball and waterflooding was similar, the plugging-selection ball diameter was 10 mm, and the ball-perforation number ratio exceeded 1.0. The application of typical wells indicated that, the ball-pitching plugging-selection profile control technology could enhance oil production, finely control reservoir utilization, and enhance economic benefits.

The effect of board of director diversity on company performance and the mediating role of director remuneration: Malaysia public companies’ evidence

Introduction: The board of director diversity plays a critical role in developing strategic options to improve company performance. The appropriate remuneration package for the director might bridge between the effectiveness of diversity of board and enhancing company performance.Objective: The study aims to examine the effect of board of director diversity on company performance, with a particular focus on the mediating role of director remuneration. Methodology: The nature of the study is quantitative. The current study focuses on the Malaysia public listed companies. The study used panel data from period 2015 to 2021 using secondary data which extracted from Bloomberg database and company annual report. The study utilized 601 sample observation. Result: Data was analysed through Stata software and the findings reveal a significant positive relationship between board diversity (gender, ethnicity, tenure) and company performance measured by Economic Value Added (EVA) and Environmental, Social and Governance (ESG) scores. Additionally, director remuneration is found to significantly mediate the impact of board diversity on EVA, although its mediation effect of ESG performance is less pronounced. These results highlight the importance of fostering diverse boards and implementing fair remuneration practices to enhance both financial and non-financial performance in companies. Conclusion: this study provides valuable insights for policymakers, stakeholders and investors aiming to improve corporate governance practices in Malaysia public listed companies

Impervious surface cover and number of restaurants shape diet variation in an urban carnivore

AbstractIn the past decade, studies have demonstrated that urban and nonurban wildlife populations exhibit differences in foraging behavior and diet. However, little is known about how environmental heterogeneity shapes dietary variation of organisms within cities. We examined the vertebrate prey components of diets of coyotes (Canis latrans) in San Francisco to quantify territory‐ and individual‐level dietary differences and determine how within‐city variation in land cover and land use affects coyote diet. We genotyped fecal samples for individual coyote identification and used DNA metabarcoding to quantify diet composition and individual niche differentiation. The highest contributor to coyote diet overall was anthropogenic food followed by small mammals. The most frequently detected species were domestic chicken, pocket gopher (Thomomys bottae), domestic pig, and raccoon (Procyon lotor). Diet composition varied significantly across territories and among individuals, with territories explaining most of the variation. Within territories (i.e., family groups), the amount of dietary variation attributed to among‐individual differences increased with green space and decreased with impervious surface cover. The quantity of anthropogenic food in scats also was positively correlated with impervious surface cover, suggesting that coyotes consumed more human food in more urbanized territories. The quantity of invasive, human‐commensal rodents in the diet was positively correlated with the number of food services in a territory. Overall, our results revealed substantial intraspecific variation in coyote diet associated with urban landscape heterogeneity and point to a diversifying effect of urbanization on population diet.

Evaluating the ASEAN-India FTA: Implications for India's Black Pepper trade

The impact of the ASEAN-India Free Trade Agreement (AIFTA) on Indian black pepper was analysed using the SMART and gravity models. The reduction in tariff under AIFTA increased black pepper imports from the Association of Southeast Asian Nations (ASEAN) countries after 2000 and caused a trade creation effect of 19.36 lakh US$. This allowed Indian consumers to benefitted from low-priced black pepper imports from ASEAN countries. Indonesia and Vietnam collectively accounted for nearly 100% of the trade creation. The distance between India and ASEAN was found to have a negative effect on trade, whereas the GDP of the importing country positively influenced the likelyhood of trade between India and ASEAN countries. The main variable of interest was the AIFTA dummy, which captured the effects of trade creation and trade diversion resulting from the regional trade agreement. The estimated coefficient of the AIFTA dummy was positive and significant, indicating a trade creation effect among AIFTA member countries as a result of the agreement.

Flipbook on Indonesian cultural diversity to enhance learning outcomes for fourth graders

Researchers have conducted observations at SDN Denanyar 3 Sragen and obtained problematic results, namely limited learning media and low student learning outcomes in Social Sciences subjects. This study aims to develop, test the feasibility, and effectiveness of the learning media Flipbook Indonesian Cultural Diversity. The type of method used in this research is Research and Development (R&D) with the Bord and Gall development model which has 10 steps and researchers only use 9 steps. The validity test of the product being developed was carried out by material and media expert lecturers as examiners of the learning media "Indonesian cultural diversity flipbook". Results of this research include: 1.) the process of developing Flipbook media as a learning medium on Indonesian cultural diversity material, 2.) the feasibility of the Indonesian cultural diversity Flipbook media was assessed as very valid by two material and media experts validators with an average validation score of 90 .5%, 3.) t-test results show a sig value (2-tailed) 0.000 < 0.005, so there is a difference in the average results before the pretest and in the limited test and broad test, thus it can be concluded that the media can improve the learning outcomes of class IV students at SDN Denanyar 3.

In vitro assessment of effect of initial specimen diversion device on detection of central venous catheter contamination or colonization.

The role of initial specimen diversion devices (ISDDs) in preventing contamination of central venous catheter (CVC) blood cultures is undefined. A model to simulate CVC colonization and contamination compared standard cultures with ISDD technique. ISDD detected 100% of colonized CVCs while decreasing false-positive cultures from 36% to 16%.

Effect of Limb Length on Weight Loss Outcomes Following Biliopancreatic Diversion with Duodenal Switch: A Multi-Centered Study.

The effectiveness of biliopancreatic diversion with duodenal switch (BPD/DS) for weight loss is well established, yet there remains ongoing debate over optimal limb lengths to maximize weight loss without compromising safety. We aimed to evaluate the impact of BPD/DS limb lengths on weight loss outcomes and comorbidity resolution. A multicenter review of patients who underwent primary BPD/DS between 2008 and 2022. Patient demographics, common channel (CC) length, Roux limb (RL) length, and weight loss outcomes at 6, 12, and 24months were collected. Postoperative complications and comorbidity resolution were reported. A total of 720 patients (60 with 100-cm CC/150-cm RL length, 596 with 125-cm CC/125-cm RL length, 64 with 150-cm CC/150-cm RL length) were included with a mean follow-up of 21 ± 19months. The %TWL at 24months was higher in the 100/150 (44.1 ± 10.3%) and 125/125 (40.6 ± 10.6%) groups compared to the 150/150 group (35.9 ± 10.8%) (p < 0.001). After adjusting for age, preoperative BMI, gender, and diabetes status, CC length was independently associated with %TWL, showing a 1.8% decrease at 24months for every 10-cm increase in CC length (p < 0.001). The 100/150 group had higher remission rates for T2DM (p = 0.007), OSA (p < 0.001), and HTN (p = 0.036) but also higher late complications (28.5% vs. 12.5%, 7%, p < 0.001). No significant early complications were observed (p = 0.149). A shorter CC length of 100cm is associated with greater weight loss and comorbidity resolution in BPD/DS patients up to 2years after the surgery. Careful consideration of long-term risks is needed to minimize a higher prevalence of late complications. Further studies are necessary for sustained long-term weight loss outcomes.

Application of deep learning models with spectral data augmentation and Denoising for predicting total phosphorus concentration in water pollution

BackgroundWith the increasing severity of global water pollution, accurate prediction models of water pollution content are critical for effective environmental management. However, traditional methods often exhibit low prediction accuracy for pollutant concentrations when data samples are limited and do not adequately address data noise. This study focuses on predicting total phosphorus (TP) concentrations in the Yangtze River Basin by integrating data augmentation and denoising methods with spectral technology and deep learning, using water samples collected from Wuhan to Anhui, China. MethodThe study utilized an improved Conditional Generative Adversarial Networks (CGAN) for data augmentation, increasing dataset diversity and training effectiveness. Adaptive threshold wavelet denoising is applied to reduce noise and improve data quality. A Convolutional Neural Network (CNN) with a coordinate attention (CA) mechanism is used to extract key spectral features linked to TP concentration prediction. Significant FindingsThis study introduces an innovative approach that combines advanced CGAN-based data augmentation, adaptive threshold wavelet denoising, and a CNN model incorporating a CA mechanism, achieving high accuracy in TP concentration prediction. The proposed model outperforms traditional methods, achieving R² = 0.9805, RMSE = 0.0019, and MAE = 0.0009. This novel method significantly enhances prediction performance, providing an effective solution particularly in scenarios with limited data samples.

Polypyrimidine Tract Binding Protein: A Universal Player in Cancer Development.

Polypyrimidine tract binding protein is a 57-Kda protein located in the perinucleolar compartment where it binds RNA and regulates several biological functions through the regulation of RNA splicing. Numerous research articles have been published that address the cellular network and functions of PTB and its isoforms in various disease states. Through an extensive PubMed search, we attempt to summarize the relevant research into this biomolecule. Besides its roles in embryonic development, neuronal cell growth, RNA metabolism, apoptosis, and hematopoiesis, PTB can affect cancer growth via several metabolic, proliferative, and structural mechanisms. PTB overexpression has been documented in several cancers where it plays a role as a novel prognostic factor. The diverse carcinogenic effect opens an argument into its potential role in inhibitory targeted therapy.

Analysis of Cultural Diversity and Employee Effectiveness in India

Objectives: The expansive target of the review is to distinguish the different perspectives and issues of overseeing social variety in projects. The present study is an exploratory investigation to examine the impact of Age, Gender and Income as a determinant of Cultural Diversity as independent variables on Employee Effectiveness as dependent variables in a Cross-Cultural Environment. Methods: Suitable factual devices like Microsoft Succeed and SPSS are utilized to determine the unwavering quality and legitimacy of the poll and to approve the Appraisals for degree of social variety and undertaking execution, Social variety and venture execution and Connection between factors impacting social variety and task execution. The techniques like Descriptive Statistics Chi-square, t-test, and ANOVA (one way/two way) have been used for the data analysis. Results: To figure out the critical drivers of social variety the executives and explore the significance of different issues associated with labor force social variety arrangements and activities. Conclusions: Many people encounter ‘Culture’ in numerous ways. Some defined it as tool for survival; some identified it as a full range of learned human behavior. Researchers defined it as “patterned way of thinking, feeling and reacting.

India’s Deep Integration with South Korea and Japan: A Trade Analysis

India has negotiated comprehensive economic partnership agreements (CEPAs) with highly industrialized giants, Japan and South Korea, aiming to unlock significant trade potential. However, a crucial question remains: How significantly have these regional trade agreements advanced after a decade of enforcement, and what impact are they having on global economies? To address this, we conducted a detailed analysis at the aggregate and sectoral levels, comparing the India–Japan and India–Korea deep integrations by evaluating the trade creation and diversion effects. Our research uses a structural gravity model for a panel of 205 exporting countries between 1988 and 2021. At the aggregate level, the findings reveal a modestly greater increase in intra-regional trade due to the India–Japan CEPA and greater export diversion effects of the India–Korea CEPA. However, the effects of import diversion on the India–Japan CEPA remain indeterminate. At the sectoral level, India’s trade with Japan has an advantage in more sectors than Korea, though the extent varies. The findings emphasize that sector-specific measures will notably nudge the strategies of competing trade partners.

The effect of urinary diversion on kidney function in posterior urethral valves and ureterovesical obstruction.

Posterior urethral valves (PUV) and ureterovesical junction obstruction (UVJO) are common etiologies of lower urinary tract obstruction. The primary objective of therapy is to alleviate the obstruction in the urinary system. Temporary urinary diversion may be necessary in certain situations, such as Urinary tract infection (UTI), sepsis, and unchanging hydronephrosis. This study, aims to assess kidney parameters after urinary diversion (either pyelostomy or ureterostomy) in patients with PUV and UVJO. We conducted a retrospective analysis of all patients diagnosed with PUV or UVJO and treated with urinary diversion following urinary undiversion at our facility between 2015 and 2020. The following variables were collected: demographic details, surgical interventions (type of diversion), serum creatinine throughout follow-up, anterior-posterior diameter of the pelvis (APP), anterior-posterior diameter of the ureter (APU), and sonographic findings of renal parenchymal thickness (PT) as documented by a pediatric radiologist. Additionally, before and after urinary diversion, a Dimercapto succinic acid (DMSA) nuclear renal scan was conducted to assess renal function. We analyzed 67 patients, with a mean follow-up of 38.3months, undergoing either ureterostomy (42 patients) or pyelostomy (25 patients). This included 38 patients with PUV and 29 with UVJO. In PUV patients, significant improvements were observed in APP (MD = 5.56 ± 11.6, p = 0.0194), APU (MD = 5.57 ± 7.28, p < 0.001), and PT (MD = 3.66 ± 2.75, p < 0.001). Similarly, UVJO patients experienced significant improvements in APP (MD = 12.18 ± 18.63, p = 0.005), APU (MD = 7.82 ± 8.98, p = 0.001), and PT (MD = 2.79 ± 3.33, p = 0.001). DMSA scores did not significantly change in either group (p > 0.05). Notably, APP improved more in UVJO patients compared to PUV patients (p = 0.047). Our study suggests that urinary diversion could improve APP, APU, and renal parenchymal thickness in PUV and UVJO patients. The improvement of APP in UVJO patients was greater than in the PUV group. We propose further multi-center studies with longer durations of follow-up and more detailed additional data to support and confirm our results.

Insights into Population Genetics and Phylogeography of Mycobacterium tuberculosis

The review summarizes the current understanding of population genetics and genetic classification of Mycobacterium tuberculosis. Articles accumulated in Elibrary and PubMed were used as a source of information. Using keywords, more than 100 publications were found and analyzed for the period from 2009 to 2023, 35 of which were included in the review. According to the current concept, M. tuberculosis is represented by nine lineages (superfamilies L1-L9), each of which has different characteristics of evolutionary status, genetic diversity, transmissibility, drug resistance, latency, and vaccine effectiveness.

Diverse Pharmacological Potential of different Substituted Pyrazole Derivatives.

The chemistry of heterocyclic compounds has been a topic of research interest. Some five-membered heterocyclic compounds have been the subject of extensive research due to their different types of pharmacological effects. The five-membered nitrogen-containing heterocyclic compounds pyrazole, pyrazoline, and pyrazolone derivatives have a lot of interest in the fields of medical and agricultural chemistry due to their diverse spectrum of therapeutic activities. Various substituted pyrazole, pyrazoline, and pyrazolone compounds exhibited diverse pharmacological effects like Anti-microbial, anti-inflammatory, anti-tubercular, anti-fungal, anti-malarial, anti-diabetic, diuretic, anti-depressant, anticonvulsant, antioxidant, anti-leishmanial, antidiabetic, and antiviral, etc. In recent decades, the synthesis of numerous pyrazole, pyrazoline, and pyrazolone derivatives by different synthetic methods as well as research into their chemical and biological behavior have become more important. This review focuses on synthetic methods of the pyrazole, pyrazoline, and pyrazolone derivatives, which have significant biological properties and a variety of applications.

Potential new treatment for inferior vena cava injury using extracorporeal membrane oxygenation applying flow diversion effect

BackgroundRetrohepatic inferior vena cava (IVC) injuries remain among the most lethal and serious liver injuries. Gauze packing is currently the first choice for IVC injuries; however, laparotomy itself poses the risk of circulatory collapse. Thus, less invasive treatment strategies are needed.MethodsIn this study, we conducted an animal experiment to replicate and validate successful treatments for an actual case of retrohepatic IVC injury that we had encountered.ResultsA woman in her 80s presented to our hospital due to cardiac arrest caused by a pulmonary artery embolism. Venoarterial extracorporeal membrane oxygenation (ECMO) was introduced, and the patient was resuscitated. After resuscitation, contrast-enhanced CT revealed liver and retrohepatic IVC injuries, possibly caused by chest compressions. Liver injury was treated using transarterial embolization of the left hepatic artery. To treat the retrohepatic IVC injury, ECMO flow was increased to enhance the negative drainage pressure. The extravasation of the contrast medium had resolved in IVC angiography, and we opted for nonoperative management. The patient’s hemodynamic status gradually stabilized, and ECMO was withdrawn on day 6. We confirmed these findings in a dog model of retrohepatic IVC injury.ConclusionsOur findings from the patient and the animal model suggest that the flow diversion effect of ECMO can effectively manage active bleeding from the IVC by inserting a drainage cannula across the injured lesion. We think this procedure represents a novel treatment option for retrohepatic IVC injuries.

National Trends in the Creation of Diverting Ileostomy at the Time of Ileal Pouch-Anal Anastomosis in Adults With Ulcerative Colitis.

The impact of diverting ileostomy in adults with ulcerative colitis (UC) undergoing ileal pouch-anal anastomosis (IPAA) is unclear. This study uses a novel approach with population-level data to identify patients with diverting ileostomy at the time of IPAA and determine the impact of diverting ileostomy on postoperative outcomes. Using the International Business Machines (IBM) MarketScan® database, adults (18-64years old) with a diagnosis of UC who underwent IPAA between 2000 and 2019 were examined. Patients were assigned to the diverting ileostomy (DI) cohort or no-DI cohort based on the presence of an ostomy closure code in the 1-year following their IPAA. Rates of ileostomy formation and readmissions were quantified and outcomes between cohorts compared. There were 540 patients in the no-DI and 2494 in the DI cohort. There were regional differences in the rate of ostomy creation, but the overall rate of ostomy creation remained stable across years. Patients with no-DI vs DI had a longer index length of stay (LOS) (7 vs 6days, P = .001). Adverse postoperative outcomes did not differ between cohorts. Diversion did not independently affect the likelihood of a 30-day readmission, and since 2000, readmission rates have declined for all IPAA patients. This is the first study to capture population-level data on the effect of diversion at the time of IPAA for adult UC patients. This study demonstrates that the rate of fecal diversion at the time of IPAA has remained stable over time, but readmission rates have declined.

Linguistic Diversity and Inclusion: Exploring International Students Attitudes Towards Their Own Accents and Those of Native English Speakers

International students studying in English-speaking countries represent a diverse linguistic background and may exhibit varying degrees of accent, which can influence their self-perception and their perception of others. Accordingly, the paper examines the attitudes of international students toward their own accents and those of native English speakers, with particular emphasis on their adaptation processes in academic and social contexts. In this paper, semi-structured interviews were conducted with undergraduate and postgraduate students from China, with varying levels of English proficiency and length of residence in the UK, which aims to elucidate the nuanced attitudes of international students towards accents and their adaptation strategies. The results show that while many students initially perceived British and American accents as prestigious and attempted to imitate them, as they progressed through the language environment they were more inclined to prioritize effective communication and intelligibility over achieving a perfect native accent. This shift is consistent with existing literature, which emphasizes the importance of prioritizing clarity and mutual understanding. Inclusive language policies that prioritize linguistic diversity and communicative effectiveness, thereby fostering learning environments that are conducive to language acquisition.