Small Loops Research Articles

Membrane structure and internalization dynamics of human Flower isoforms hFWE3 and hFWE4 indicate a conserved endocytic role for hFWE4

Human Flower (hFWE) isoforms hFWE1-4 are putative transmembrane (TM) proteins that reportedly mediate fitness comparisons during cell competition through extracellular display of their C-terminal tails. Isoform topology, subcellular localization, and duration of plasma membrane presentation are essential to this function. However, disagreement persists regarding the structure of orthologous fly and mouse FWEs, and experimental evidence for hFWE isoform subcellular localization or membrane structure is lacking. Here, we used AlphaFold2 and subsequent molecular dynamics-based structural predictions to construct epitope-tagged hFWE3 and hFWE4, the most abundant human isoforms, for experimental determination of their structure and internalization dynamics. We demonstrate that hFWE3 resides in the membrane of the endoplasmic reticulum (ER), while hFWE4 partially colocalizes with Rab4-, Rab5-, and Rab11-positive vesicles as well as with the plasma membrane. An array of imaging techniques revealed that hFWE4 positions both N- and C-terminal tails and a loop between second and third TM segments within the cytosol, while small (4-12aa) loops between the first and second and the third and fourth TM segments are either exposed to the extracellular space or within the lumen of cytoplasmic vesicles. Similarly, we found hFWE3 positions both N- and C-terminal tails in the cytosol, while a short loop between TM domains extends into the ER lumen. Finally, we demonstrate that hFWE4 exists only transiently at the cell surface and is rapidly internalized in an AP-2- and dynamin-1-dependent manner. Collectively, these data are consistent with a conserved role for hFWE4 in endocytic processes.

MR enterography in small bowel diseases, adding multipoint Dixon sequence, is it worth?

BackgroundMR enterography (MRE) has been increased in the last decade as a modality of choice in diagnosis and evaluation of small bowel diseases in both children and adults. Lacking ionizing radiation, non-invasiveness, excellent soft tissue resolution, adequate luminal distension of small bowel loops are the advantages of this technique. Acquisition of images was used to be: T2WI, steady-state free precession, and T1WI, fat-suppressed gadolinium contrast-enhanced sequences. Multipoint Dixon sequence was added recently to the routine MR enterography protocol. The current study aimed to evaluate the added value of multipoint Dixon sequence as a valuable modification of MR enterography protocol for better assessment of small bowel lesions as activity of Crohn’s disease, small bowel polyps, fibrotic strictures, with modification of MRE protocol in the future with less time consumption and better radiological evaluation.MethodsThe current research was a prospective cross-sectional study. Data were collected prospectively after getting ethical approval from the ethical committee of the faculty of medicine, in our university.Study populationThe sample size was 69 adult patients with suspected small bowel lesions, within the period from January 2022 to 30th December 2022. Written informed consent was obtained from all studied cases before the study, who were enrolled in this study. This number was calculated by using MedCalc 19 program by setting alpha error significance of 0.05%, 95% confidence level, and 80% power sample.ResultsThis study enrolled 69 patients with recurrent abdominal pain and/or bleeding in stool. The patients’ age ranged from 18 to 50 years, with a mean of 32.6 ± 8.8. There is slightly higher female prevalence. The most common positive imaging findings in the studied patients were mucosal thickening in terms of submucosal fat deposition (36.23% of the MRE examination and 39.13% of the MRE with added Dixon sequence). Adding Dixon sequence yielded significantly higher AUC (97.2% vs. 90.5%, p = 0.047), higher sensitivity (100% vs. 92.16%), specificity (94.4% vs. 88.89%), accuracy (98.55% vs. 91.3%), positive predictive value (98.08% vs. 95.92%), and negative predictive value (100% vs. 80%).ConclusionsMRE is an excellent imaging modality in the assessment of small bowel diseases without the use of ionizing radiation. Developing MR-based sequences as multi-point Dixon sequence have the potential to improve the ability of MRE to image the subtle changes as Crohn’s accompanying early inflammatory changes and fibrosis, as well as small intestinal polyps. Familiarity with MR enterography is essential for radiologists and gastroenterologists who participate in the clinical management of small intestinal diseases.

V-035 TRANSVAGINAL EVISCERATION, LAPAROSCOPIC APPROACH

Abstract Aim We present the laparoscopic approach of a case of transvaginal evisceration after hysterectomy. Material & Methods 50 yo Female, with a history of bilateral ovaric and endometrial endometroid carcinoma, for which bilateral laparoscopic anexectomy and subsequent hysterectomy and cytoreduction surgery were performed two months earlier. She consulted to emergency department for metrorrhagia and abdominal discomfort of one week's evolution. Physical examination revealed a dehisced vaginal vault with evisceration of small bowel loops. Abdominal CT scan was performed in which other intra-abdominal complications were ruled out. Urgent surgical intervention was decided and a minimally invasive approach was proposed. During the operation, dehiscence of the vaginal vault was observed without other findings. The separated edges are refreshed and a running suture is performed with a barbed suture. As reinforcement, a titanized polypropylene mesh was placed and fixed with cyanoacrylate. Results The patient was discharged on the 2nd postoperative day without incident. Conclusions Transvaginal evisceration is a rare complication that usually occurs after hysterectomies. If it is not possible to reduce the contents, it can cause suffering of the herniated structures. The treatment consists of closing the defect and acting on the complications it may cause. The minimally invasive approach provides the already known benefits for the patient and a better vision and surgical field for the surgeon.

P-068 A NOVEL TECHNIQUE TO REDUCE RECURRENCE IN PATIENTS WITH DONOR SITE HERNIAS IN ILIAC CREST BONE GRAFTS

Abstract Introduction Iliac crest bone grafts (ICBG) are commonly used to heal non-union fractures in orthopaedic and maxillofacial surgery. The most common complications are pain, haematoma, neurovascular injury and scarring however one complication that is mentioned less frequently is herniation of abdominal contents. We emphasise the importance of this complication, and describe a technique that can be used to repair this when there is herniation. Case A 76 year old gentleman developed squamous cell carcinoma of the right mandible in 2019. The right mandible was resected, followed by an iliac crest free flap from the left side with a prophylactic prolene mesh which was performed in 2020. The patient then received adjuvant chemotherapy. Shortly thereafter, the patient developed a lump which became increasingly painful. The patient was referred onto the general surgical team after a CT scan showed herniation of colon and small bowel loops at the donor site. The patient underwent a hernia repair in November 2022 and is recovering well. Discussion and conclusion Herniation of abdominal contents following ICBG are rare and potentially dangerous complication that can lead to significant morbidity and even mortality. Here we present an open repair of a recurrent hernia, using a pre-peritoneal mesh. A pre-peritoneal plane was developed all around to ensure there is good overlap of the mesh and was anchored to a mini-plate that was fixed to the iliac bone. Pre-peritoneal meshes should be preferred to fix hernia defects caused from ICBGs, which otherwise can cause significant morbidity in patients with ICBGs.

Abstract #1413762: Acute Mesenteric Ischemia: A Rare Presentation of Severe Hypothyroidism

Hypothyroidism has been associated with several gastrointestinal symptoms (GI) including constipation, ileus, atrophic gastritis, atony and dilation in various parts of the GI tract including myxedema megacolon. A more rarely reported association is ischemic colitis. We present a case of suspected mesenteric ischemia secondary to severe hypothyroidism. 65-year-old female with a history of oropharyngeal cancer treated with radiation therapy and Superior Mesenteric Artery syndrome with stent, presented with abdominal pain, nausea and vomiting for ten days. Imaging showed severe constipation with fluid-filled thick-walled small bowel loops. She was hemodynamically stable but with an elevated lactate (4 mmol/L) that improved with intravenous fluids. Overnight, she became disoriented, dyspneic and her abdominal pain worsened. She was upgraded to the ICU with suspected bowel ischemic. Her lactate was elevated but repeat CT was unchanged. Later, thyroid function tests were obtained showing an elevated TSH of 35.5 uIU/ml, low free T3 0.8 pg/ml and undetectable free T4. She was given a dose of intravenous levothyroxine that resulted in marked improvement in her abdominal pain and mental status by the next day. She was switched to oral levothyroxine. Over the course of her hospitalization, she developed staphylococcal bacteremia and later became obtunded requiring intubation. Over the subsequent days, she developed edema, hypothermia, bradycardia, and hypotension. Imaging showed bilateral pleural effusions, a new pericardial effusion, and ascites. She was diagnosed to be in myxedema coma and restarted on IV levothyroxine with high-dose steroids. After several days with minimal improvement in her condition, her family opted for palliative extubation. Hypothyroidism can result in decreased intestinal motility due to loss of gap junctions resulting in constipation and intestinal edema and can develop years after completion of radiation therapy as seen with our patient. We suspect that our patient’s symptoms were because of mechanical compression of the vascular supply of the small intestine due to severe dilation of the bowel wall as reported previously in cases of hypothyroidism-associated ischemic colitis. Given that the major focus was on the diagnosis of acute obstructive mesenteric ischemia, there was a delay in the diagnosis of severe hypothyroidism that later progressed to myxedema coma triggered by bacteremia. This case highlights the importance of checking thyroid function in patients with evidence of bowel dilation and ileus, since a delayed diagnosis of hypothyroidism can be fatal if left untreated.

Gallstone Ileus, A Rare Yet Deadly Cause of Small Bowel Obstruction

Introduction:Gallstone ileus is a rare cause of intestinal obstruction. It commonly affects older patients with significant medical conditions. This disease has a high mortality rate (12-17%), hence should be an important diagnosis to consider, especially as the geriatric population grows worldwide.Method: Case Report:84-year old gentleman, with diabetes and ischemic heart disease, presented with diarrhea, vomiting and fever for one day. He was febrile, tachycardic and hypotensive. There was lower abdominal tenderness with guarding. Labs done revealed metabolic acidosis with a raised lactate along with raised inflammatory markers. Impression was intra-abdominal sepsis, with a need to rule out mesenteric ischemia. He underwent CTAP which revealed gallstone ileus. The gallbladder was collapsed and pneumobilia was present in keeping with fistulation. Dilated small bowel loops were present with a transition point at the distal jejunum or proximal ileum, where there are two gallstones. Patient underwent exploratory laparotomy. There was an obstructing large gallstone 100cm from the DJ flexure. After removal of gallstone and decompression, the bowel was pink with areas of bruising. Patient was hypotensive intra-operatively likely contributed by septic shower, requiring dual vasopressors. He was transferred to the ICU post-operatively and developed cardiogenic shock with type 2 respiratory failure precipitated by sepsis. He demised on Day 2 post-operatively.Results:Gallstone ileus is caused by intestinal impaction of a gallstone that has migrated through a cholecystoenteric fistula. The classic radiologic sign of gallstone ileus is Rigler's triad. This is only picked up 15% of the time on plain abdominal x-rays. Early CT scans can reveal Rigler triad up to 80% of the time. Surgical management remains the cornerstone of treatment.Conclusion:Gallstone ileus remains a diagnostic challenge as patients present with non-specific signs and symptoms. It is prudent for emergency physicians to consider this disease in elderly patients who present with small bowel obstruction.

EVOLUTION OF THE DEFECT STRUCTURE OF Pd–11.3 at. % W ALLOY DURING RELAXATION AT MULTIPLE HYDROGENATION

The influence of the hydrogen and vacancies introduced into an alloy matrix as a result of electrolytic hydrogenation on the structural state of Pd–11.3 at % W alloy after fourfold hydrogenation has been studied. It is established that nonmonotonic changes in the sample defect structure are determined by the transformation of single vacancies into vacancy complexes (micropores and small dislocation loops), their decay during relaxation, and migration of vacancies from the matrix to the boundaries of coherent-scattering regions (CSRs) and backwards. The vacancy transformation rate into defect complexes depends on their concentration. Long-term relaxation of the alloy leads to almost complete transfer of vacancies from the matrix to the CSR boundaries. An interpretation of the obtained experimental data within the theory of development of hierarchical defect structures is proposed.

Slow solar wind sources

Context. The origin of the slow solar wind is still an open issue. One possibility that has been suggested is that upflows at the edge of an active region can contribute to the slow solar wind. Aims. We aim to explain how the plasma upflows are generated, which mechanisms are responsible for them, and what the upflow region topology looks like. Methods. We investigated an upflow region using imaging data with the unprecedented temporal (3 s) and spatial (2 pixels = 236 km) resolution that were obtained on 30 March 2022 with the 174 Å channel of the Extreme-Ultraviolet Imager (EUI)/High Resolution Imager (HRI) on board Solar Orbiter. During this time, the EUI and Earth-orbiting satellites (Solar Dynamics Observatory, Hinode, and the Interface Region Imaging Spectrograph, IRIS) were located in quadrature (∼92°), which provides a stereoscopic view with high resolution. We used the Hinode/EIS (Fe XII) spectroscopic data to find coronal upflow regions in the active region. The IRIS slit-jaw imager provides a high-resolution view of the transition region and chromosphere. Results. For the first time, we have data that provide a quadrature view of a coronal upflow region with high spatial resolution. We found extended loops rooted in a coronal upflow region. Plasma upflows at the footpoints of extended loops determined spectroscopically through the Doppler shift are similar to the apparent upward motions seen through imaging in quadrature. The dynamics of small-scale structures in the upflow region can be used to identify two mechanisms of the plasma upflow: Mechanism I is reconnection of the hot coronal loops with open magnetic field lines in the solar corona, and mechanism II is reconnection of the small chromospheric loops with open magnetic field lines in the chromosphere or transition region. We identified the locations in which mechanisms I and II work.

E020 Pneumatosis intestinalis with spontaneous pneumoperitoneum in a patient with systemic sclerosis-myositis overlap syndrome: a case report and review of the literature

Abstract Background/Aims Pneumatosis intestinalis (PI) is a rare complication of systemic sclerosis (SSc), characterised by submucosal and/or subserosal collections of free gas, forming cystic lesions within the gastrointestinal (GI) tract. Methods A 67-year-old man with SSc-myositis overlap syndrome presented acutely unwell with worsening abdominal pain, bloating, bloody diarrhoea and vomiting for three weeks. He was afebrile and haemodynamically stable. His abdomen was distended with generalised tenderness but soft and regular bowel sounds were audible. There were no palpable organomegaly or signs of peritonism. He had raised CRP, serum amylase, serum lactate and pre-renal acute kidney injury. He tested positive for ANA Hep2 (speckled) and anti-Mi-2b. His contrast-enhanced CT abdomen and pelvis displayed extensive pneumatosis changes, moderately dilated small bowel loops and pneumoperitoneum without portal venous gas or acute thrombotic occlusion in the main-stem superior or inferior mesenteric arteries. He was managed conservatively with bowel rest, elemental diet, cycling antibiotics for small intestinal bacterial overgrowth (SIBO) and commenced on end-of-life care as surgical exploration was deemed too risky considering that he has exceedingly poor cardiac reserve. He made a surprisingly excellent recovery and his repeat CT scans at approximately 11 weeks showed a complete resolution of pneumatosis intestinalis and pneumoperitoneum. Results PI in SSc generally runs a benign course and is usually managed conservatively. The development of PI is multifactorial, involving a complex interplay between mechanical, biochemical, bacterial and drug factors. PI is usually asymptomatic but patients can present with GI and constitutional symptoms or peritonism. CT scan is the most preferred diagnostic modality for PI. Conservative management is preferable to surgical intervention after careful exclusion of acute surgical causes. The underlying cause of PI should be appropriately addressed and managed in all cases. The management of PI is based on the severity of symptoms and it includes bowel rest, elemental diet or parenteral nutrition, antibiotics, high concentration oxygen, hyperbaric oxygen therapy and/or octreotide. Our patient was managed conservatively as he did not exhibit clinical signs of peritonism or bowel ischaemia and surgical interventions were deemed too risky. He was treated with and has responded well to cycling oral antibiotics for SIBO which was thought to be contributory to his PI. Conclusion This case illustrates that PI with or without pneumoperitoneum could be a rare complication of SSc, and contrary to common belief, it is usually benign and managed conservatively with favourable outcome. An accurate interpretation of its clinical significance is crucial as acute presentations and ambiguous imaging findings can simulate acute surgical emergency leading to diagnostic dilemma and unnecessary or risky surgical interventions. However, emergency laparotomy should be considered in patients who exhibit signs of peritonism or bowel ischaemia and therefore timely involvement of surgeons and multidisciplinary team is essential. Disclosure K. Lim: None. S. Knights: None. J. Pauling: None. J. Gotto: None.

A case report of a woman with SLE and lupus enteritis as the first manifestation of active systemic lupus erythematosus

Introduction: Lupus enteritis is a rare first manifestation of active systemic lupus erythematosus (SLE). diagnosis of this condition is hard, specially without other signs and symptoms associated with active SLE. this article will report a woman with SLE and lupus enteritis as the first manifestation of active systemic lupus erythematosus Case presentation: A 25-year-old woman presented to the Emergency department complaining of abdominal pain and vomiting. From her medical history, four years in the past, she reported the same signs and symptoms as now and turned into identified with appendicitis. Her abdomen examination found out mild abdominal distention without a abdominal tenderness. Wall thickening and irregularity of small and big bowel loops were observed on the CT abdomen. She turned into given a excessive dose glucocorticoid as initial treatment and turned into maintained with low dose glucocorticoid and cyclosporin. After 6 months of follow-up, the patient did not have a recurrence of signs and symptoms. Conclusion: A high index of suspicions is essential to differentiate lupus enteritis from other differential diagnoses. For lupus enteritis, excessive-dose steroids were an efficient initial treatment.

In situ studies on the evolution of damage microstructures in tungsten under heavy ion irradiation and post annealing

The evolution of heavy-ion irradiation induced microstructures, followed by annealing experiments, was analyzed in situ and characterized systematically in tungsten via transmission electron microscopy. The formation and evolution of loop rafts, dislocation decoration, and tangled dislocation networks were analyzed during irradiation. Consisting of 1/2<111> loops, raft structures had a preferred orientation, which was dependent on loop geometry. Decoration of a near-edge line dislocation with loops led the line first to curve and then annihilate. Drastic loss of loops, loop-loop coalescence, glide of jogged line dislocations as well as untangling of dislocation networks were observed during post-annealing. The gliding of glissile loops varied with its size, while the motion of line dislocations depended on their nature. The glide distance for the small loops with a size range from 1 to 3 nm was 6 times larger than the large loops with a size range from 5 to 8 nm. A near-edge dislocation had the largest mobility, a near-screw one had the lowest mobility, and a mixed one had the mobility in between. The direct observation and comprehensive analysis of the complicated interaction among dislocations will offer insights into the bridge between the microstructural evolution and macroscopic response to irradiation damages.

Update on theApplication of Monoclonal Antibody Therapy in Primary Membranous Nephropathy.

When first introduced, rituximab (RTX), a chimeric anti-CD20 monoclonal antibody, brought about an alternative therapeutic paradigm for primary membranous nephropathy (PMN). Rituximab was shown to be effective and safe in PMN patients with kidney dysfunction, with. patients receiving second-line rituximab therapy achievingremission as effectively as those patients who had not previously received immunotherapy. No safety issues were reported. TheB cell-driven protocol seems to be as efficient asthe 375 mg/m2 × 4 regimen or 1 g × 2 regimen in achieving B cell depletion and remission, but patients with high M-type phospholipase A2 receptor(PLA2R) antibody levels may benefit from a higher dose of rituximab. While rituximab added another therapeutic option to the treatment regimen, it does have limitations as 20 to 40% of patients do not respond. Not all patients respond to RTX therapy for lymphoproliferative disorders either, therefore further novel anti-CD20 monoclonal antibodies have been developed and these may provide alternative therapeutic options for PMN. Ofatumumab, a fully human monoclonal antibody, specifically recognizes an epitope encompassing both the small and large extracellular loops of the CD20 molecule, resulting in increased complement-dependent cytotoxic activity. Ocrelizumab binds an alternative but overlapping epitope region to rituximab and displays enhanced antibody-dependent cellular cytotoxic (ADCC) activities. Obinutuzumab is designed to have a modified elbow-hinge amino acid sequence, leading to increased direct cell death induction and ADCC activities. In PMN clinical studies, ocrelizumab and obinutuzumab showed promising results, while ofatumumab displayed mixed results. However, there is a lack of randomized controlled trials with large samples, especially direct head-to-head comparisons. Alternative molecular mechanisms have been suggested in this context to explore novel therapeutic strategies. B cell activator-targeted, plasma cell-targeted and complement-directed treatments may lead to novel therapy paradigms for PMN. Exploratory strategies for the use of drugs with different mechanisms, such as a combinationof rituximab and cyclophosphamide and a steroid, a combination of rituximab anda calcineurin inhibitor, may provide more rapid and efficient remission, but the combination of standard immunosuppression with rituximab could increase infection risk.

Some remarks on the performance of three advanced soil constitutive models in the small-strain region

ABSTRACT This short communication identifies some inconsistencies in the numerical predictions of three advanced soil constitutive models. The chosen constitutive models are subject to simple numerical tests in the small-strain range relevant to the cyclic response of soil in seismic, offshore and urban applications. The numerical tests comprise a cyclic simple shear test in the small-strain range, a simple shear test with very small strain unloading-reloading loops and a test on the dependence of the rate of the shear stiffness degradation on the changing mean confining stress. The results are briefly discussed and, in some cases, the reasons for the observed inconsistencies and potential improvements in the formulations of the investigated constitutive models are initially drafted.

A227 CTLA-4 DEFICIENCY PRESENTING AS CROHN DISEASE IN A TEENAGE BOY WITH MULTI-SYSTEM INVOLVEMENT : A CASE REPORT

Abstract Background Cytotoxic-T-lymphocyte-antigen-4 is a negative immune regulator. CTLA-4 deficiency can cause a complex immune dysregulation syndrome that may present as inflammatory bowel disease. Purpose Case Description: A 14-year-old male presented with several years of abdominal pain, diarrhea, short stature and poor weight gain. Endocolonoscopy diagnosed Crohn disease, with patchy chronic colitis, an ileal granuloma and active duodenitis with intraepithelial lymphocytosis and villous blunting. MRE showed multiple abnormal small bowel loops. Past history included appendicitis, immune thrombocytopenic purpura and an episode each of Aeromonas, Y enterocolitica and C difficile colitis. Family history was negative for consanguinity, autoimmune conditions or immune defects. The patient received sulfasalazine, exclusive enteral nutrition and then budesonide MMX with limited response. His pre-biologic workup identified bilateral pulmonary nodules, which were negative for infection or malignancy on further investigation. He began Adalimumab, and after 2 months had nearly normalized his fecal calprotectin to 90 ug/g. His history, together with chronic neutropenia and hypogammaglobulinemia (IgG 3.3 g/L, IgA 0.29g/L) led to a comprehensive immune and cytopenia panel, which revealed heterozygous pathogenic variants in the CTLA4 gene c.424G&amp;gt;C, p.(Gly142Arg), associated with CTLA-4 deficiency related immunodeficiency. Parental testing was negative, indicating a de novo mutation. The patient was subsequently admitted to hospital with severe headache and transient aphasia. Brain MRI found hyperintense foci concerning for CTLA-4 deficiency-associated CNS inflammation. He had papilledema and lumbar puncture found increased ICP. During this admission he developed Salmonella sepsis. Repeat chest CT found extensive worsening multifocal parenchymal lesions. Extensive investigations to exclude malignancy or infection were negative, and the lung findings were felt to be Granulomatous and Lymphocytic Interstitial Lung Disease. He had elevated soluble IL-2 receptor level (2884 U/ml) and elevated CD4+PD1+ T cells in peripheral blood. Adalimumab was stopped, and he received IVIg, then Diamox with resolution of headache, followed by pulse methylprednisolone. He has since been maintained on Abatacept (a soluble CTLA-4 analog that inhibits T-cell activation). Follow up soluble IL2 receptor level was normal. PJP prophylaxis was started, as well as prophylactic dosing of IVIg and regular screening for EBV and CMV. Method - Result(s) - Conclusion(s) Discussion: Our patient had CTLA-4 deficiency and immune dysregulation affecting multiple organs (CNS, lung, and intestinal inflammation, autoimmune neutropenia and previous ITP). Abatacept is the preferred steroid-sparing treatment of enteropathy in CTLA-4 deficiency. Soluble IL2 receptor level is an indicator of T cell activation used for treatment monitoring. This case illustrates the importance of considering immune defects even in older children presenting with apparent IBD. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared INTESTINAL DISORDERS

Crohn's disease: review and standardization of nomenclature.

Crohn's disease is an inflammatory bowel disease that can affect any segment of the gastrointestinal tract. It has a variable clinical course, with alternating periods of disease activity and remission. Because the incidence and prevalence of Crohn's disease have been increasing, evaluation by imaging methods has become more important. The most widely used methods are computed tomography enterography, magnetic resonance enterography (as an elective examination), and contrast-enhanced computed tomography (in the context of emergency). Computed tomography enterography and magnetic resonance enterography are useful for diagnosis, follow-up, evaluation of complications, and prognosis. Both can be used in order to evaluate the small bowel loops and the associated mesenteric findings, as well as to evaluate other abdominal organs. They both also can detect signs of disease activity, fibrosis, penetrating disease, and complications. The interpretation of such changes is essential to the multidisciplinary approach, as is the standardization of the nomenclature employed in the reports. In this paper, we review and illustrate the imaging findings of Crohn's disease, using the standardized nomenclature proposed in the multidisciplinary consensus statement issued by the Society of Abdominal Radiology, the Society of Pediatric Radiology, and the American Gastroenterology Association, with recommendations for descriptions, interpretations, and impressions related to those findings.

Diagnosis and surgical management strategy for pediatric small bowel obstruction: Experience from a single medical center.

Identifying Bowel strangulation and the approach and timing of surgical intervention for pediatric SBO are still uncertain. In this study, 75 consecutive pediatric patients with surgically confirmed SBO were retrospectively reviewed. The patients were divided into group 1 (n = 48) and group 2 (n = 27) according to the presence of reversible or irreversible bowel ischemia, which was analyzed based on the degree of ischemia at the time of operation. The results demonstrated that the proportion of patients with no prior abdominopelvic surgery was higher, the serum albumin level was lower, and the proportion of patients in which ascites were detected by ultrasonography was higher in group 2 than that in group 1. The serum albumin level was negatively correlated with ultrasonographic findings of the fluid sonolucent area in group 2. There were significant differences in the choice of surgical approach between group 1 and group 2. A symptom duration of >48 h was associated with an increased bowel resection rate. The mean length of hospital stay was shorter in group 1 than that in group 2. In conclusion, immediate surgical intervention should be considered in patients with a symptom duration of >48 h or the presence of free ascites between dilated small bowel loops on ultrasonography. Laparoscopic exploration is recommended as first-line treatment in patients with stable status.

Surface blistering and void swelling of α-Al2O3 irradiated with H2+ ions followed by 1000, 1200 °C annealing

Surface morphology and defect structures in α-Αl2O3 irradiated with 106 keV H2+ and post-irradiation-annealed at 1000, 1200 °C were investigated. The ion irradiations and annealing cause modifications to the Raman scattering peaks such as the peak disappearance and peak shifts. Surface blisters with several micrometers in diameter are visible. The mean blister sizes increase with increasing annealing temperatures and decrease with increasing irradiation fluences. Transmission electron microscopy characterizations reveal large numbers of spherical or oval shaped voids around the peak-damage zone. Faceted voids are also observed. The irradiation-induced dislocation loops are mostly annealed out with only some dislocation lines left inside. Nevertheless, small dislocation loops with sizes of ∼20–30 nm are characterized under different diffraction conditions, which are found to be associated with the void structures in the 1.5 × 1017 H2+/cm2 irradiated and annealed sample. These loop structures are considered to be induced through the ‘loop punching’ mechanism due to a high gas pressure inside during the bubble growth period.

Explosive Events in the Quiet Sun Near and Beyond the Solar Limb Observed with the Interface Region Imaging Spectrograph (IRIS)

We study point-like explosive events (EE), characterized by emission in the far wings of spectral lines, in a quiet region near the South Pole, using Interface Region Imaging Spectrograph (IRIS) spectra at two slit positions, slit-jaw (SJ) observations, and Atmospheric Imaging Assembly (AIA) images. The events were best visible in Si iv spectra; they were weak in SJs, occasionally visible in 1600 Å and 304 Å AIA images, and invisible in higher temperature AIA images. We identified EEs from position–time images in the far wings of the Si iv lines and measured their distance from the limb. A Gaussian model of the height distribution showed that EEs occur in a narrow (0.9′′) height range, centered at 3.2′′ above the continuum limb at 2832.0 Å. On the disk, we found that they occur in network boundaries. Further, we studied the line profiles of two bright EEs above the limb and one on the disk. We found that what appears as broad-band emission is actually a superposition of 2 – 3 narrow-band Gaussian components with well-separated line profiles, indicating that material is expelled towards and/or away from the observer in discrete episodes in time and in space. The expelled plasma accelerates quickly, reaching line-of-sight (LOS) velocities up to 90 km s−1. Overall, the motion was practically along the LOS, as the velocity on the plane of the sky was small. In some cases, tilted spectra were observed that could be interpreted in terms of rotating motions of up to 30 km s−1. We did not find any strong absorption features in the wing of the Si iv lines, although in one case, a very weak absorption feature was detected. No motions indicative of jets were detected in SJ or AIA images. Reconnection in an asymmetric magnetic-field geometry, in the middle or near the top of small loops, is a plausible explanation of their observational characteristics.

Accurate calculation of global hysteresis properties of grain-oriented silicon steel based on an improved J-A model with variable parameters

Based on the consideration of the magnetic domain motion under different magnetization levels, an improved J-A model with variable parameters is proposed to solve the problem of significant errors in the process of calculating the inner symmetric small loops. The proposed method introduces a variable scale parameter v(B) to correct the irreversible magnetization component of the J-A model. Meanwhile, based on the magnetic domain theory, a method with variable pinning parameter k(B) and a variable domain wall bending parameter c(B) is proposed. By comparing the measured data of B30P105 Grain-Oriented (GO) silicon steel, the calculation error for each magnetization level of the model is within 7%, which means that the global hysteresis properties of GO silicon steel can be well reproduced.

Uterine Prolapse as a Rare Cause of Intestinal Obstruction: A Case Report and Literature Review

Background: The etiology of pelvic organ prolapse is multifactorial. Age and parity are especially the two most important risk factors for this condition. Small bowel obstruction is one of the most common clinical presentations to the emergency department that can result in significant morbidity and mortality. Case presentation: A 79-year-old woman with a previous history of uterine prolapse and no previous history of intraabdominal surgery or malignancies presented with nausea and vomiting, abdominal pain, and constipation from 2 days ago. Upright and supine x-rays showed dilated small bowel loops and confirmed bowel obstruction. Due to primary obstruction, the patient was a candidate for surgery. During the surgery, we observed that 100 cm of the terminal ileum and the uterus protruded in the vaginal canal and the ileal loops were strangulated. We decided to perform a right hemicolectomy surgery. Conclusion: In patients with uterine prolapse, we suggest a careful examination and consideration of the entrapment of small bowel loops in the prolapse site as a rare cause of small bowel obstruction.