Graham patch

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Background Enhanced recovery after surgery (ERAS) protocols are nowadays considered the standard of care for various elective surgical procedures. However, its utilization remains low in tier-two and tier-three cities of India, and there exists a significant variation in the practice. In the present study, we have investigated the safety and feasibility of these protocols or pathways in emergency surgery for perforated duodenal ulcer disease. Methods A total of 41 patients with perforated duodenal ulcers were randomly divided into two groups...

INTRODUCTION AND IMPORTANCE: Gastric fistula is a complication in gastrointestinal surgery. For decades, patients with gastric fistulas were treated surgically, with high morbidity and mortality. Minimally invasive treatment through endoscopic therapy with stents and interventionism has allowed improvements. We present a case of successful hybrid laparoscopy and endoscopy for the treatment of a post-Nissen fundoplication gastric fistula. CASE PRESENTATION: A 44-year-old male underwent laparoscopic Nissen fundoplication surgery; at 10 days post-surgery, he presented with oral intolerance, abdominal pain, and laboratory results showing an inflammatory response...

Peptic ulcer disease causing perforation is extremely rare in children and primarily affects teenagers. We present a case of a perforated peptic ulcer in a 6-year-old with abdominal pain and emesis with CT findings of moderate pneumoperitoneum and pelvic free fluid without a distinct cause. He was emergently transferred, found to be peritonitic, and taken to the operating room for diagnostic laparoscopy revealing an anterior duodenal ulcer, and underwent laparoscopic Graham patch repair. Postoperatively, the child had positive fecal antigen for H...

The essential COPI coat mediates retrieval of transmembrane proteins at the Golgi and endosomes following recruitment by the small GTPase, Arf1. ArfGAP proteins regulate COPI coats, but molecular details for COPI recognition by ArfGAPs remain elusive. Biochemical and biophysical data reveal how β'-COP propeller domains directly engage the yeast ArfGAP, Glo3, with a low micromolar binding affinity. Calorimetry data demonstrate that both β'-COP propeller domains are required to bind Glo3. An acidic patch on β'-COP (D437/D450) interacts with Glo3 lysine residues located within the BoCCS (binding of coatomer, cargo, and SNAREs) region...

An isolated perforation of the duodenum is rare in cases of blunt abdominal trauma, and diagnosis is often delayed due to subtle clinical signs. We present the case of a 13-year-old male patient who presented to the hospital with an alleged history of being run over in the abdomen by a vehicle and a complaint of severe abdominal pain. Radiography of the abdomen in the standing position showed air under the diaphragm, and ultrasonography revealed free fluid in the pelvic and peritoneal cavities, clinching the diagnosis of hollow viscus perforation...

BACKGROUND: Patch testing is an important investigation when dermatitis is unresponsive to, or worsened by, topical corticosteroid treatment. There is a balance to be struck between testing too many allergens, which is expensive, time consuming and risks causing sensitization, and testing too few, which risks missing the diagnosis. The current British Society for Cutaneous Allergy (BSCA) corticosteroid series comprises eight allergens and was last updated in February 2007. AIM: To review and update the BSCA corticosteroid series...

In this paper, we examine the dynamics of contrast-comparison and contrast-normalization processes. Observers adapted (for 1 second) to a grid of Gabor patches at one contrast; then a test pattern (which varied in duration from 12 ms to 3012 ms) was shown; and then the adapt pattern was shown again (1 second). All the Gabor patches in all the adapt patterns had 50% contrast. The test pattern was the same as the adapt pattern except that the Gabor patches in the test pattern had two different contrasts; the test contrasts varied from row to row (horizontal test pattern) or column to column (vertical test pattern)...

IMPORTANCE: The common use of isothiazolinones as preservatives is a global cause of allergic contact dermatitis. Differences in allowable concentrations of methylisothiazolinone (MI) exist in Europe, Canada, and the US. OBJECTIVE: To compare the prevalence of positive patch test reactions to the methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) combination and MI alone in North America and Europe from 2009 to 2018. DESIGN, SETTING, AND PARTICIPANTS: This retrospective analysis of North American Contact Dermatitis Group, European Surveillance System on Contact Allergies (ESSCA), and the Information Network of Departments of Dermatology (IVDK) databases included data from patients presenting for patch testing at referral patch test clinics in North America and Europe...

We present an integrated fiber optic spectrally resolved downwelling irradiance sensor for pushbroom hyperspectral imagers. The system comprises of a cosine corrector and custom fiber patch cables, collecting the ambient light in a large solid angle and feeding it directly to the entrance slit of the spectrometer. The system enables simultaneous measurement of downwelling and upwelling irradiance using the main hyperspectral camera sensor. As a demonstration, the spectral reflectance of a soil sample was measured with a RMSE of 8...

Glycerol-3-phosphate acyltransferase (GPAT)1 is a mitochondrial outer membrane protein that catalyzes the first step of de novo glycerolipid biosynthesis. Hepatic expression of GPAT1 is linked to liver fat accumulation and the severity of nonalcoholic fatty liver diseases. Here we present the cryo-EM structures of human GPAT1 in substrate analog-bound and product-bound states. The structures reveal an N-terminal acyltransferase domain that harbors important catalytic motifs and a tightly associated C-terminal domain that is critical for proper protein folding...

Maintaining an appropriate balance between excitation and inhibition is critical for neuronal information processing. Cortical neurons can cell-autonomously adjust the inhibition they receive to individual levels of excitatory input, but the underlying mechanisms are unclear. We describe that Ste20-like kinase (SLK) mediates cell-autonomous regulation of excitation-inhibition balance in the thalamocortical feedforward circuit, but not in the feedback circuit. This effect is due to regulation of inhibition originating from parvalbumin-expressing interneurons, while inhibition via somatostatin-expressing interneurons is unaffected...

BACKGROUND: Since the onset of the COVID-19 pandemic, direct-to-patient, self-applied ECG patch use has substantially increased. There are limited data comparing clinic versus self-applied ECG patches. OBJECTIVES: To compare rates of ECG patch return, percentages of time patches yielded analyzable data (analyzable time), and percentages of prescribed time ECG patches were worn between clinic and self-applied ECG patches prior to and during COVID-19. METHODS: A retrospective analysis of patients prescribed an ECG patch during "pre-COVID" (3/1/2019-3/1/2020) and "COVID" (4/1/2020-4/1/2021) years was conducted...

The recent surge in performance for image analysis of digitised pathology slides can largely be attributed to the advances in deep learning. Deep models can be used to initially localise various structures in the tissue and hence facilitate the extraction of interpretable features for biomarker discovery. However, these models are typically trained for a single task and therefore scale poorly as we wish to adapt the model for an increasing number of different tasks. Also, supervised deep learning models are very data hungry and therefore rely on large amounts of training data to perform well...

Measuring and comparing activity patterns provide key insights into the behavioral trade-offs that result in animal activity and their extrinsic and intrinsic drivers. Camera traps are a recently emerged source of data for sampling animal activity used to estimate activity patterns. However, nearly 70% of studies using such data to estimate activity patterns apply a time-to-independence data filter to discard appreciable periods of sampling effort. This treatment of activity as a discrete event emerged from the use of camera trap data to estimate animal abundances, but does not reflect the continuous nature of behavior, and may bias resulting estimates of activity patterns...

Nucleus basalis magnocellularis (NBM) cholinergic projections to the basolateral amygdala (BLA) regulate the acquisition and consolidation of fear- and anxiety-like behaviors. However, it is unclear whether the alterations in the NBM-BLA circuit promote negative affect during ethanol withdrawal. Therefore, we performed ex vivo whole-cell patch clamp electrophysiology in both the NBM and the BLA of male Sprague-Dawley rats following 10 days of chronic intermittent ethanol (CIE) exposure and 24 hours of withdrawal (WD)...

Background: Computational pathology has seen rapid growth in recent years, driven by advanced deep-learning algorithms. Due to the sheer size and complexity of multi-gigapixel whole-slide images, to the best of our knowledge, there is no open-source software library providing a generic end-to-end API for pathology image analysis using best practices. Most researchers have designed custom pipelines from the bottom up, restricting the development of advanced algorithms to specialist users...

Duodenal ulcer disease is uncommon in paediatric age group. Its perforation is even rarer. However, it should be kept in mind when examining children with acute abdomen especially if there are signs of shock or possibility of upper gastrointestinal bleed. We report a case of a 6 years old female child, a known case of thalassemia major and taking oral Deferasirox since two years of age. She had atypical presentation as there was no previous history of peptic ulcer disease and she only suffered epigastric pain and vomiting for a week but due to lack of proper diagnosis at a local clinic developed duodenal ulcer perforation, which was ultimately diagnosed at a tertiary care hospital and managed with Graham Patch Closure...

Background: Diagnosis of duodenal perforation (DP) in children is often delayed. This worsens the clinical condition and complicates simple closure. Objectives: To explore the advantages of using T-tube in surgeries for DP in children. Patients and Methods: A retrospective study was conducted on all patients of DP managed in the Department of Paediatric surgery at a tertiary centre from January 2016 to December 2020. Clinical, operative and post-operative data were collected...

Ecological niche differences are necessary for stable species coexistence but are often difficult to discern. Models of dietary niche differentiation in large mammalian herbivores invoke the quality, quantity, and spatiotemporal distribution of plant tissues and growth forms but are agnostic toward food plant species identity. Empirical support for these models is variable, suggesting that additional mechanisms of resource partitioning may be important in sustaining large-herbivore diversity in African savannas...