Salvage surgery for continent ileostomies (CI) after a first successful revision: more long-term blame on the reservoir than the nipple valve

Purpose The aim of the study was to investigate the underlying cause of long-term complications in patients requiring at least one revision surgery of a continent ileostomy (CI) and to analyze functional outcome. Methods Only patients with CI at least one revision were included in the retrospective data analysis. Four different classes of complications (Cl A–D) were defined: Cl A = Nipple valve (NV), Cl B = pouch, Cl C = outlet (stoma), and Cl D = afferent loop (AL). Associations between underlying disease and origin of complications were analyzed. Cumulative probabilities were calculated using Kaplan–Meier analysis. Results A total of 77 patients were identified with a follow-up of 30 years, requiring 133 surgeries for 148 complications (c.). Cl A 49 c. (33.1%), Cl B 50 c. (33.8%), Cl C 39 c. (26.4%), and Cl D 10 c. (6.8%). Cl A and C complications were not correlated to underlying disease, whereas Cl B and D complications were only found in ulcerative colitis (UC) and Crohn’s disease (CD). The cumulative probability of a second revision showed a linear rise, reaching 62.5% after 20 years. Cl A and B complications both reached 42.1%. Eleven (14.3%) patients (10 Cl B) had pouch failure in a follow-up period of 11.5 ± 8.7 years (1–31 years), whereas 66 (85.7%) had successful revisional surgery. Overall CI survival was 78.8% at 44 years. Conclusion CI survival is limited by inflammatory complications of the pouch based on the underlying disease and not by mechanical limitations of the NV. Trial registration numbers None.

Gravitational waves from GRB core spindown

We investigate long Gamma-Ray Bursts (GRB) which manifest a sharp linear rise followed by an exponential decay in their γ-ray prompt emission observed with the BAT instrument on board the Swift satellite. We offer a simple electrodynamic model that may account for these particular characteristics. We associate the sharp rise with the winding of the magnetic field by the fast rotating core that formed in the interior of the stellar precursor. We also associate the subsequent exponential decay with the electromagnetic spindown of the core following the release of the electromagnetic jet from the stellar interior. Any non-axisymmetric distortion in the rotating core will generate gravitational waves with exponentially decreasing frequency, a so-called ‘down-chirp’. We obtain a detailed estimate of the gravitational wave profile if the distortion of spacetime is due to the winding of a non-axisymmetric component of the magnetic field during that particular phase of the burst. We offer 7 particular time intervals during which one may look into LIGO archival data for the presence of our particular predicted waveforms in order to test our interpretation.

ESTIMATION OF TIME SINCE DEATH FROM THE CHANGES IN VITREOUS HUMOUR SODIUM (Na+) AND POTASSIUM (K+) LEVEL

Background: For investigation of crime, it is very important to determine ‘time since death’ i.e. the interval between death and the time of postmortem examination also called as ‘postmortem interval. This is very important in criminal cases as it shows the track to the investigators to reach the suspected person and to obligate the innocent ones. Methods: The present study was conducted in Forensic Medicine Department on cases died in Dr. S.N. Medical College & associated Group of Hospitals, Jodhpur in association with Department of Biochemistry. Results: The linear correlation of the vitreous sodium (Na+) ion concentration was found statistically insignificant (r=0.045) therefore the coefficient of correlation could not be derived. Conclusion: We have observed linear rise of potassium (K+) ion concentration in the vitreous humour. The linear relationship of the increase in vitreous potassium (K+) ion concentration with increasing postmortem interval is both arithmatic as well as logarithmatic (statistically significant). Keywords: Na, K, Postmortem.

Antihyperglycemic activity of Typha elephantina leaves using in vivo and in vitro Techniques

Looking at the increasing prevalence and inadequate treatments for diabetes mellitus, this study was carried to trace out hypoglycemic potentials of Typha elephantina leaves using in vitro and in vivo studies. α -amylase and α-glucosidase in vitro enzyme inhibition assay were incorporated to determine percent inhibition of Typha elephantina extracts. Typha elephantina methanol extract (TEME) at 125µg/ml in both α-amylase and α-glucosidase exhibited 57.48±1.42 and 53.64±0.92 percent inhibition in contrast to 66.7±0.94 and 70.31±1.25 of standard Acarbose, respectively. However, results obtained in Typha elephantina petroleum ether and chloroform extracts were insignificant. Further TEME antidiabetic properties were investigated by in vivo study, using Streptozotocin induced diabetic rats. Selected 250mg/kg and 500mg/kg doses of TEME were administered orally, which significantly (𝑃 < 0.001) reduces blood glucose of treated animals in contrast to diabetic control. 500mg/kg dose of TEME reduces blood glucose more efficiently. A significant linear rise of body weight and HDL were observed, while there was also remarkable reduction in cholesterol, TG, LDL, VLDL. Reduction in Liver function SGOT, SGPT along with creatinine and urea levels were observed in contrast to diabetic control group. In addition, antioxidant study of Typha elephantina extracts reflected significant results in comparison to that of ascorbic acid in DPPH and H2O2 assay. The whole study signified that Typha elephantina has hypoglycemic potentials.

MO394TWO POINT ESTIMATE OF KINETIC GFR IN ACUTE KIDNEY DISEASE

Background and Aims When anuria suddenly occurs, the rise in creatinine and consequently the decrease in the estimated glomerular filtration rate (eGFR) will always be delayed. Thus, the drug dose could be selected too high in the progressive phase whereas it could be adjusted too low in the restitution phase of acute kidney disease (AKD). Sheldon Chen proposed a solution for changing kidney function with the kinetic GFR (KeGFR). A simplified but also more general solution (kinetGFR) might even facilitate the automatic implementation into lab systems. Method Deterioration of kidney function is diagnosed when the creatinine increases within a definite time interval (Δ t) and the estimated eGFR declines (Δ eGFR). The new 2-point estimate of the kinetGFR can be derived when the prospective eGFRt+24 predicted for the next day (t+24) will be set equal to the present true GFR at critical day (t2). kinetGFR=eGFR2−eGFR1−eGFR2t2−t1⋅t+24 h The 24 h delay follows from anuria, the most extreme and most relevant case (GFR = 0). A zero GFR will be associated with a linear rise in creatinine according to the constant production rate by roughly 100 µmol/l every day. This rise leads to the corresponding bisection of the estimated eGFR nearly every day (100 =&gt; 50 =&gt; 25 =&gt; 13 =&gt; … ml/min). The curvilinear eGFR decline will never become zero even after &gt; 2 weeks. The new kinetGFR can identify a complete anuria already after one day (24 h). kinetGFR=50−100−5024−0⋅24=0.0 ml/min This is already at the critical day (t2). Results The retrospective look at the anonymized data from 20 patients with AKD allowed for comparing the former KeGFR with the new two-point kinetGFR estimate. For worsening kidney function, the average eGFR2 was 18 ml/min (+ 12) and the KeGFR estimate was not different with 19 ml/min (+ 17). The new 2-point kinetGFR, however, was 13 ml/min (+ 11) and 28 % less than eGFR2 at the critical day (t2). For improving kidney function, the eGFR2 was 15 ml/min (+ 4) and the KeGFR was already much higher at 27 ml/min (+ 3). The new 2-point estimate of the kinetGFR was in between at 21 ml/min (+ 7). Conclusion In AKD, the difference between eGFR and presumably true GFR was the higher the more rapidly kidney function declined. The new kinetGFR estimate appears clinically more plausible than the former KeGFR estimates.

ANIMAL REVOLT AND LINES OF FLIGHT IN LUCRETIUS, BOOK FIVE

Lucretius is the first classical author to have written a history of animal resistance. In a fifty-line passage from Book Five of De rerum natura, the ‘animal revolt’ (5.1297–349), Lucretius describes the rise of empire and its instrumentalization of animals for war. When the animals are led onto the battlefield, however, they swerve against their ‘armed teachers and savage masters’ (1311). The linear rise of empire, built on the abuse of animals’ bodies, is deterritorialized by those same animal bodies in a chaotic scene that takes place on what Monica Gale has called a ‘cosmic battlefield’. This paper follows Lucretius’ account in Book Five of De rerum natura of the linear rise of empire, its increasing capture of animal life, and the rupture of empire's linear trajectory by a clinamen, or ‘swerve’, of rebel animals. I compare Lucretius’ account of the rise of empire to what Deleuze and Guattari call a ‘molar line’, and the swerve of rebel animals to Deleuze and Guattari's notion of the ‘line of flight’.

Long-term trends of asthma, allergic rhinitis and atopic eczema in young Finnish men: a retrospective analysis, 1926–2017

The aim of this study was to assess the long-term time trends of the prevalence of asthma, allergic rhinitis and atopic eczema in young Finnish men.A retrospective analysis was carried out on cross-sectional data from the Finnish Defence Forces taken from call-up examinations of candidates for military conscription and examinations of conscripts discharged from service because of poor health. Roughly 1.7 million men aged 18‒19 years (98% of men of conscription age) were examined from 1966 to 2017. A proportional but unknown number of young men were examined from 1926 to 1961.The main outcome measures were asthma recorded at call-up examination as the main diagnosis in 1926‒2017 and any diagnosis in 1997‒2017, exemption or discharge from military service due to asthma, and allergic rhinitis and atopic eczema recorded as the main diagnosis in 1966‒2017 and any diagnosis in 1997‒2017.During 1926–1961 the prevalence of asthma remained low at between 0.02% and 0.08%. A linear rise began between 1961 and 1966, with a 12-fold increase in the prevalence from 0.29% in 1966 to 3.44% in 2001. Thereafter, the prevalence of asthma as the main diagnosis stabilised but continued to increase to 5.19% in 2017 if secondary diagnoses of asthma were included. Exemption rates from military service due to asthma have similarly increased but fluctuated more. The prevalence of allergic rhinitis increased from 0.06% to 10.70% and atopic eczema from 0.15% to 2.90% during the period 1966‒2017.In Finland, an increase in asthma and allergic conditions among young men became evident in the mid-1960s. The increase slowed in the 2000s and may be levelling off in the 2020s.

Discovery of a new WZ Sagittae-type cataclysmic variable in the Kepler/K2 data

ABSTRACT We identify a new, bright transient in the K2/Kepler Campaign 11 field. Its light curve rises over 7 mag in a day and then declines 3 mag over a month before quickly fading another 2 mag. The transient was still detectable at the end of the campaign. The light curve is consistent with a WZ Sge-type dwarf nova outburst. Early superhumps with a period of 82 min are seen in the first 10 days and suggest that this is the orbital period of the binary, which is typical for the WZ Sge class. Strong superhump oscillations develop 10 days after peak brightness with periods ranging between 83 and 84 min. At 25 days after the peak brightness a bump in the light curve appears to signal a subtle rebrightening phase implying that this was an unusual type-A outburst. This is the only WZ Sge-type system observed by K2/Kepler during an outburst. The early rise of this outburst is well fitted with a broken power law. In first 10 h, the system brightened linearly and then transitioned to a steep rise with a power-law index of 4.8. Looking at archival K2/Kepler data and new TESS observations, a linear rise in the first several hours at the initiation of a superoutburst appears to be common in SU Ursa Majoris stars.

Extensive eccentric contractions in intact cardiac trabeculae: revealing compelling differences in contractile behaviour compared to skeletal muscles

Force enhancement (FE) is a phenomenon that is present in skeletal muscle. It is characterized by progressive forces upon active stretching—distinguished by a linear rise in force—and enhanced isometric force following stretching (residual FE (RFE)). In skeletal muscle, non-cross-bridge (XB) structures may account for this behaviour. So far, it is unknown whether differences between non-XB structures within the heart and skeletal muscle result in deviating contractile behaviour during and after eccentric contractions. Thus, we investigated the force response of intact cardiac trabeculae during and after isokinetic eccentric muscle contractions (10% of maximum shortening velocity) with extensive magnitudes of stretch (25% of optimum muscle length). The different contributions of XB and non-XB structures to the total muscle force were revealed by using an actomyosin inhibitor. For cardiac trabeculae, we found that the force–length dynamics during long stretch were similar to the total isometric force–length relation. This indicates that no (R)FE is present in cardiac muscle while stretching the muscle from 0.75 to 1.0 optimum muscle length. This finding is in contrast with the results obtained for skeletal muscle, in which (R)FE is present. Our data support the hypothesis that titin stiffness does not increase with activation in cardiac muscle.