Rare Cause of Gastrointestinal Bleeding: A Case Report of Pancreatic Arteriovenous Malformation.

BACKGROUND Arteriovenous malformation is an unusual cause of gastrointestinal bleeding, particularly in the pancreas. A definitive treatment strategy is not yet established. CASE REPORT We present the case of a 37-year-old man with underlying hypertension and no significant family history who presented with a 3-month history of intermittent epigastric pains and unintentional weight loss of 5 kg in 2 months. The upper endoscopy showed a large duodenal ulcer, which was uncontrolled with a standard dose of proton pump inhibitors. An abdominal computed tomography scan with contrast was indicated and revealed an enhanced mass of 2.5×3.5×4 cm in size, located on the second and third parts of the duodenum and head of the pancreas, indicating an arteriovenous malformation. On day 10 of hospitalization, the patient suddenly had melena and a drop of hemoglobin level to 5.6 g/dL; angiography intervention was successful to control the bleeding. However, gastrointestinal bleeding recurred after 2 weeks, and the patient successfully underwent a Whipple procedure. CONCLUSIONS The diagnosis and therapeutic management of arteriovenous malformations are uniquely challenging; therefore, pancreatic arteriovenous malformations should be listed on the differential diagnosis, particularly in those cases with non-healing and large duodenal ulcers. Otherwise, early imaging modalities should be performed to confirm the diagnosis. In particular, angiography can temporarily control bleeding before proceeding with more definitive therapy.

A sensorless anti-windup speed control approach to axial gap bearingless motors with nonlinear lumped mismatched disturbance observers.

In this paper, sensorless robust speed control with nonlinear lumped mismatched disturbance observers for a permanent magnet type axial gap bearingless motor (AGBM) is designed. Multistage anti-windup-based dynamic surface control combined with integral backstepping control is proposed to control the motor's axial displacement and rotor speed. The approach is against parameter uncertainties and external disturbances, improving steady-state accuracy, eliminating the derivative explosion phenomenon, no chattering problem, and reducing the magnitude of the control system when current saturation occurs. In addition, a novel nonlinear lumped mismatched disturbance observer is proposed to improve the approach under unmodeled dynamics and external disturbances. To obtain high-accuracy tracking control, the control system includes the robust controller combined with the disturbance observers and anticipatory activation of anti-windup (AW) compensation, which means the controller is more complex. Then, to design a sensorless robust speed control for the motor, the rotor position and speed observer require higher accuracy. High-gain back-EMF observer combined with an improved phase-locked loop is proposed to estimate rotor angular position and speed even when the motor speed is reversed. Overall stability of closed-loop system control, including a sensorless speed control approach for motors using back-EMF estimation combined with saturation of the currents and lumped disturbance observers, is mathematically proven. Finally, the simulation results under measurement noise show that the proposed control system are obtained the effectiveness, feasibility, and robustness.

Vietnam Association of Gastroenterology (VNAGE) consensus on the management of Helicobacter pylori infection.

Helicobacter pylori (H. pylori) infection is prevalent and has a rapidly increasing antibiotic resistance rate in Vietnam. Reinfection is quite common, and gastric carcinoma remains one of the most common malignancies, which is not uncommon to develop after successful eradication. The purpose of this consensus is to provide updated recommendations on the management of H. pylori infection in the country. The consensus panel consisted of 32 experts from 14 major universities and institutions in Vietnam who were invited to review the evidence and develop the statements using the Delphi method. The process followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The consensus level was defined as ≥80% for agreement on the proposed statements. Due to the limited availability of high-quality local evidence, this consensus was also based on high-quality evidence from international studies, especially those conducted in other populations in the Asia-Pacific region. The panel finally reached a consensus on 27 statements after two voting rounds, which consisted of four sections (1) indications for testing and selection of diagnostic tests (2), treatment regimens, (3) post-treatment confirmation of H. pylori status, and (4) reinfection prevention methods and follow-up after eradication. Important issues that require further evidence include studies on third-line regimens, strategies to prevent H. pylori reinfection, and post-eradication follow-up for precancerous gastric lesions. We hope this consensus will help guide the current clinical practice in Vietnam and promote multicenter studies in the country and international collaborations.

Image formation by a biological curved mirror array of the fisheye in the deep-sea environment.

In this paper, we present the imaging formation process of the piecewise mirror eyes of the deep-sea spookfish, which has a strange combination of refractive and reflective eyes. The biological reflective eye structure is formulated to the curved surface's flat mirror array. Zemax is utilized to evaluate optical features such as the modulation transfer function, distortion, and imaging performances. However, the natural images are highly distorted, and the resolution is lower than expected. Therefore, we increase the number of piecewise mirrors of the fisheye to see higher quality images, which can be improved entirely by the mirror shapes. Finally, the fisheye's imaging analysis reveals the deep-sea creature's resolution limit and also shows the possibility of artificial and biomimetic camera applications.

Overexpression of miR-210, a downstream target of HIF1α, causes centrosome amplification in renal carcinoma cells.

MiR-210 is significantly up-regulated in clear cell renal cell carcinoma (CCC), but the mechanism and biological consequences of miR-210 up-regulation are poorly understood. Here, we show that miR-210 is highly expressed in renal carcinoma cell lines and that its expression is clearly correlated with accumulation of hypoxia-inducible factor 1α (HIF1α) under normoxia as well as hypoxia, suggesting that miR-210 up-regulation in renal carcinoma cells is most likely due to accumulation of HIF1α. To reveal the effects of miR-210 up-regulation, the miR-210 precursor was transfected into renal carcinoma cells. After transfection, the cells accumulated at the G2/M phase of the cell cycle and their viability was decreased, suggesting that miR-210 overexpression may trigger an event that hinders normal cell division. Immunocytochemistry demonstrated a multipolar spindle accompanied by centrosome amplification in cells overexpressing miR-210. It has been reported that centrosome amplification induces chromosome mis-segregation, finally leading to chromosome instability and aneuploidy. Indeed, the proportion of aneuploid cells (>4n) was increased in miR-210 overexpressed cells. By using the TargetScan and PicTar algorithms, E2F3 was identified as one of the possible targets of miR-210 and was suppressed at the protein level by miR-210. Moreover, the proportion of aneuploid cells was increased in E2F3 siRNA transfected cells. On the basis of these results, we propose that miR-210 up-regulation due to HIF1α accumulation may induce aneuploidy via E2F3 down-regulation at least in part, and may play a role in tumourigenesis and/or progression of CCC.