A Rare Case of Cutaneous Gastric Adenocarcinoma With Signet Ring Cell Features.

Cutaneous metastatic disease from primary gastric cancer is quite scarce, often going unrecognized. In this case, the patient presented with an expanding rash that was biopsied, with findings concerning for metastatic adenocarcinoma from a suspected luminal upper gastrointestinal origin. Subsequent biopsies during an esophagogastroduodenoscopy confirmed poorly differentiated adenocarcinoma with signet ring cell features, most likely from an upper gastrointestinal primary (gastric vs gastroesophageal junction). We review this case to help providers identify signet cell type cutaneous metastases of gastric cancer quickly to improve patient outcomes.

COVID-19 related biliary injury: A review of recent literature.

Since its emergence in 2019, it has become apparent that coronavirus 2019 (COVID-19) infection can result in multi systemic involvement. In addition to pulmonary symptoms, hepatobiliary involvement has been widely reported. Extent of hepatic involvement ranges from minor elevation in liver function tests (LFTs) to significant hepatocellular or cholestatic injury. In majority of cases, resolution of hepatic injury or improvement in LFTs is noted as patients recover from COVID-19 infection. However, severe biliary tract injury progressing to liver failure has been reported in patients requiring prolonged intensive care unit stay or mechanical ventilation. Due to the timing of its presentation, this form of progressive cholestatic injury has been referred to as COVID-19 cholangiopathy or post-COVID-19 cholangiopathy, and can result in devastating consequences for patients. COVID-19 cholangiopathy is recognized by dramatic elevation in serum alkaline phosphatase and bilirubin and radiologic evidence of bile duct injury. Cholangiopathy in COVID-19 occurs weeks to months after the initial infection and during the recovery phase. Imaging findings and pathology often resemble bile duct injury associated with primary or secondary sclerosing cholangitis. Etiology of COVID-19 cholangiopathy is unclear. Several mechanisms have been proposed, including direct cholangiocyte injury, vascular compromise, and cytokine release syndromes. This review summarizes existing data on COVID-19 cholangiopathy, including reported cases in the literature, proposed pathophysiology, diagnostic testing, and long-term implications.

Intrapancreatic Accessory Spleen Diagnosed As Neuroendocrine Tumor: The Dangers of False Positives and Their Implications in Subsequent Management.

This case serves as a reminder to consider ectopic splenic tissue in the differential diagnosis of pancreatic masses. The literature shows a lack of awareness and overtreatment of this condition due to clinical and radiologic concern for malignancy, namely neuroendocrine tumors (NETs) identified on positron emission tomography (PET)-CT NETSPOT. Given the vast difference in management and prognosis of ectopic splenic anomalies and malignant neoplasms involving the pancreas, accurate diagnosis is imperative to avoid unnecessary invasive procedures such as Whipple or distal pancreatectomy and splenectomy, which are associated with increased morbidity and mortality.

Fracture Mechanics and Oxygen Gas Barrier Properties of Al2O3/ZnO Nanolaminates on PET Deposited by Atomic Layer Deposition.

Rapid progress in the performance of organic devices has increased the demand for advances in the technology of thin-film permeation barriers and understanding the failure mechanisms of these material systems. Herein, we report the extensive study of mechanical and gas barrier properties of Al2O3/ZnO nanolaminate films prepared on organic substrates by atomic layer deposition (ALD). Nanolaminates of Al2O3/ZnO and single compound films of around 250 nm thickness were deposited on polyethylene terephthalate (PET) foils by ALD at 90 °C using trimethylaluminium (TMA) and diethylzinc (DEZ) as precursors and H2O as the co-reactant. STEM analysis of the nanolaminate structure revealed that steady-state film growth on PET is achieved after about 60 ALD cycles. Uniaxial tensile strain experiments revealed superior fracture and adhesive properties of single ZnO films versus the single Al2O3 film, as well as versus their nanolaminates. The superior mechanical performance of ZnO was linked to the absence of a roughly 500 to 900 nm thick sub-surface growth observed for single Al2O3 films as well as for the nanolaminates starting with an Al2O3 initial layer on PET. In contrast, the gas permeability of the nanolaminate coatings on PET was measured to be 9.4 × 10-3 O2 cm³ m-2 day-1. This is an order of magnitude less than their constituting single oxides, which opens prospects for their applications as gas barrier layers for organic electronics and food and drug packaging industries. Direct interdependency between the gas barrier and the mechanical properties was not established enabling independent tailoring of these properties for mechanically rigid and impermeable thin film coatings.

Ionic transport through sub-10 nm diameter hydrophobic high-aspect ratio nanopores: experiment, theory and simulation.

Fundamental understanding of ionic transport at the nanoscale is essential for developing biosensors based on nanopore technology and new generation high-performance nanofiltration membranes for separation and purification applications. We study here ionic transport through single putatively neutral hydrophobic nanopores with high aspect ratio (of length L = 6 µm with diameters ranging from 1 to 10 nm) and with a well controlled cylindrical geometry. We develop a detailed hybrid mesoscopic theoretical approach for the electrolyte conductivity inside nanopores, which considers explicitly ion advection by electro-osmotic flow and possible flow slip at the pore surface. By fitting the experimental conductance data we show that for nanopore diameters greater than 4 nm a constant weak surface charge density of about 10(-2) C m(-2) needs to be incorporated in the model to account for conductance plateaus of a few pico-siemens at low salt concentrations. For tighter nanopores, our analysis leads to a higher surface charge density, which can be attributed to a modification of ion solvation structure close to the pore surface, as observed in the molecular dynamics simulations we performed.

Tuning of ZnO 1D nanostructures by atomic layer deposition and electrospinning for optical gas sensor applications.

We explored for the first time the ability of a three-dimensional polyacrylonitrile/ZnO material-prepared by a combination of electrospinning and atomic layer deposition (ALD) as a new material with a large surface area-to enhance the performance of optical sensors for volatile organic compound (VOC) detection. The photoluminescence (PL) peak intensity of these one-dimensional nanostructures has been enhanced by a factor of 2000 compared to a flat Si substrate. In addition, a phase transition of the ZnO ALD coating from amorphous to crystalline has been observed due to the properties of a polyacrylonitrile nanofiber template: surface strain, roughness, and an increased number of nucleation sites in comparison with a flat Si substrate. The greatly improved PL performance of these nanostructured surfaces could produce exciting materials for implantation in VOC optical sensor applications.

Dynamics of polymer nanoparticles through a single artificial nanopore with a high-aspect-ratio.

The development of nanometric Coulter counters for nanoparticle detection is an attractive and promising field of research. In this work, we have studied the influence of the nanopore surface state on charged polymer nanoparticle translocations. To make this, the translocation of carboxylate modified polystyrene microspheres (diameter 40, 70 and 100 nm) has been investigated through two kinds of high aspect ratio nanopores (negative and uncharged). The latter were tailored by a single track-etched and atomic layer deposition technique. It was shown that the mobility and the energy barrier are strongly dependent on nanopore surface charge. Typically if the latter exhibits negative surface charge, the microsphere mobility increases and the global energy barrier of entrance inside the nanopore decreases with its diameter, converse to the uncharged nanopore.

Variation in polyp size estimation among endoscopists and impact on surveillance intervals.

BACKGROUND: Accurate estimation of polyp size is important because it is used to determine the surveillance interval after polypectomy. OBJECTIVE: To evaluate the variation and accuracy in polyp size estimation among endoscopists and the impact on surveillance intervals after polypectomy. DESIGN: Web-based survey. PARTICIPANTS: A total of 873 members of the American Society for Gastrointestinal Endoscopy. INTERVENTIONS: Participants watched video recordings of 4 polypectomies and were asked to estimate the polyp sizes. MAIN OUTCOME MEASUREMENTS: Proportion of participants with polyp size estimates within 20% of the correct measurement and the frequency of incorrect surveillance intervals based on inaccurate size estimates. RESULTS: Polyp size estimates were within 20% of the correct value for 1362 (48%) of 2812 estimates (range 39%-59% for the 4 polyps). Polyp size was overestimated by >20% in 889 estimates (32%, range 15%-49%) and underestimated by >20% in 561 (20%, range 4%-46%) estimates. Incorrect surveillance intervals because of overestimation or underestimation occurred in 272 (10%) of the 2812 estimates (range 5%-14%). Participants in a private practice setting overestimated the size of 3 or of all 4 polyps by >20% more often than participants in an academic setting (difference = 7%; 95% confidence interval, 1%-11%). LIMITATIONS: Survey design with the use of video clips. CONCLUSION: Substantial overestimation and underestimation of polyp size occurs with visual estimation leading to incorrect surveillance intervals in 10% of cases. Our findings support routine use of measurement tools to improve polyp size estimates.

Evolution of microstructure and related optical properties of ZnO grown by atomic layer deposition.

A study of transmittance and photoluminescence spectra on the growth of oxygen-rich ultra-thin ZnO films prepared by atomic layer deposition is reported. The structural transition from an amorphous to a polycrystalline state is observed upon increasing the thickness. The unusual behavior of the energy gap with thickness reflected by optical properties is attributed to the improvement of the crystalline structure resulting from a decreasing concentration of point defects at the growth of grains. The spectra of UV and visible photoluminescence emissions correspond to transitions near the band-edge and defect-related transitions. Additional emissions were observed from band-tail states near the edge. A high oxygen ratio and variable optical properties could be attractive for an application of atomic layer deposition (ALD) deposited ultrathin ZnO films in optical sensors and biosensors.

Slow translocation of polynucleotides and their discrimination by α-hemolysin inside a single track-etched nanopore designed by atomic layer deposition.

We report the formation of a hybrid biological/artificial nanopore by the direct insertion of non-modified α-hemolysin at the entrance of a high aspect ratio (length/diameter) biomimetic nanopore. In this robust hybrid system, the protein exhibits the same polynucleotide discrimination properties as in the biological membrane and the polynucleotide dwell time is strongly increased. This nanopore is very promising for DNA sequencing applications where the high DNA translocation velocity and the fragility of the support are the main bottlenecks.

Utility of the short double-balloon enteroscope to perform pancreaticobiliary interventions in patients with surgically altered anatomy in a US multicenter study.

OBJECTIVE: Double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreaticography (DBE-ERCP) is an effective method for interventions in the pancreaticobiliary system in the post-surgical patient. However, use of currently available endoscopic accessories during this procedure is limited due of the length of the conventional instrument (200 cm). The aim of this study was to explore the utility of the short DBE (152 cm) for the management of pancreaticobiliary disorders in patients with surgically altered anatomies. METHODS: Data were collected retrospectively on patients with various anatomic variations in whom ERCP was performed using the short DBE from April 2008 to November 2011. Basic demographic information, clinical presentation, preoperative imaging, and type of surgery, procedural technical success rate, and adverse events were evaluated. Descriptive analysis was used to document the demographic and clinical data of the patients. RESULTS: We identified 79 patients in whom DBE-ERCP was attempted (38 % male, mean age 58 years). Indications for the procedure were removal of a previously placed stent (n = 5), suspected sphincter of Oddi dysfunction type 1 (n = 3), surgical biliary leak (n = 3), pancreatic anastomotic stricture (n = 2), suspected biliary stones (n = 48), and biliary strictures visualized on imaging (n = 18). Overall, the success rate of DBE-ERCP in all patients was 81 % (64/79). The scope could not reach the papilla or surgical anastomosis in 8 cases and duct cannulation failed in 7 cases. The following interventions were performed: biliary sphincterotomy (n = 39), dilation of CBD stenosis with a balloon (n = 30), biliary stent insertion (n = 25), stone removal (n = 35), brushing cytology of biliary strictures (n = 3), and stent retrieval (n = 4). Three patients developed post-procedure pancreatitis. There was 1 episode of self-limited bleeding. CONCLUSIONS: The current study demonstrates that DBE assisted ERCP for pancreaticobiliary interventions using a short enteroscope are feasible in patients with surgically altered anatomy.

Can outcomes of intensive care unit patients undergoing tracheostomy be predicted?

OBJECTIVE: To determine whether outcomes (mortality and need for intensive care unit [ICU] readmission) of patients undergoing tracheostomy in the ICU can be predicted by common clinical or historical criteria. METHODS: We conducted a retrospective review of data from the medical record and Project Impact database in a 24-bed medical-surgical ICU in a 500-bed university hospital. In 2004 through 2006, 60 adult patients underwent tracheostomy as part of their ICU management. We classified each patient as either not readmitted, readmitted, died on floor (after ICU discharge), died on first ICU admission, or combined readmitted/died-on-the-floor. Patients who died on the regular floor were significantly heavier than patients discharged without need for readmission (P = .03). Patients with a history of sepsis and those with a history of neurological disease had a tendency toward worse outcomes, but these did not reach statistical significance. CONCLUSIONS: These findings suggest that it is difficult to predict outcomes of patients who undergo tracheostomy in the ICU. Larger and prospective studies may help elucidate this matter.

[Orofacial and hearing specific problems among 340 wind instrumentalists in Lebanon]. / Problèmes spécifiques de la sphère oro-maxillo-faciale et de l'ouïe chez 340 musiciens libanais pratiquant les instruments à vent.

INTRODUCTION: The aim of this study is to detect the problems related to wind instruments in order to determine the contributing factors. MATERIAL AND METHOD: This study is a prospective study of a sample of Lebanese wind-instruments musicians. Questionnaire of 17 items about personal data, musical activities in general and specific problems related to wind instruments. RESULTS: 340 response out of 400 (85%). Gender: male 100%. Age: 28.5 +/- 6.5 years (13-50). Practice of any physical activity: 57.5%. Smokers: 40.5% Data about musical practice - Years of practice: 6.5 +/- 5.5. Daily practice: 2.5 +/- 1.5 hours with 3.5 +/- 2 rest periods of 16.5 +/- 15 minutes. Weekly practice: 5 +/- 2 days. Data about medical problems - Hear loss 34%; respiratory difficulties: 19.5%; wound of lips muscles: 5%; gums and tongue lesions: 7.8%; myospasms of the cheeks and lips: 34.5%; dental problems: 30.7%; temporo-mandibular disorders (TMD): 22.5%. There is a high association between risk factors and pathology. Risks related to the instrument's use : hear loss (p = 0.001), traumas to lips muscles (p = 0.065), myospasms (p = 0.064), TMD (p = 0.000). Other factors: physical activity is beneficial; smoking is harmful (breathing difficulties, spasms, headaches). Factors influencing the different problems: age (31 +/- 7 years); years of practice (9 +/- 6); hours of practice per day (2 +/- 1.5); days of practice per week (4.5 +/- 2.5). CONCLUSION: Wind instruments are related to problems of mouth, facial muscles and hearing. This may lead musicians to stop their activities or to irreversible professional disabilities. A medical follow-up during the musicians training is needed to prevent these problems.