Precipitation strengthening is investigated in binary Al–0.1Sc, Al–0.1Zr and ternary Al–0.1Sc–0.1Zr (at.%) alloys aged isochronally between 200 and 600
°C. Precipitation of Al
3Sc (L1
2) commences ...between 200 and 250
°C in Al–0.1Sc, reaching a 670
MPa peak microhardness at 325
°C. For Al–0.1Zr, precipitation of Al
3Zr (L1
2) initiates between 350 and 375
°C, resulting in a 420
MPa peak microhardness at 425–450
°C. A pronounced synergistic effect is observed when both Sc and Zr are present. Above 325
°C, Zr additions provide a secondary strength increase from the precipitation of Zr-enriched outer shells onto the Al
3Sc precipitates, leading to a peak microhardness of 780
MPa at 400
°C for Al–0.1Sc–0.1Zr. Compositions, radii, volume fractions and number densities of the Al
3(Sc
1−
x
Zr
x
) precipitates are measured directly using atom-probe tomography. This information is used to quantify the observed strengthening increments, attributed to dislocation shearing of the Al
3(Sc
1−
x
Zr
x
) precipitates.
This article aims to draw out some of the key continuities between Confucian and Reformed natural law traditions, the latter represented by John Calvin (1509-64). It seeks to undermine contemporary ...academic definitions of Confucianism and constitutionalism, which are premised on misinterpretations. The first misinterpretation occurs where Confucian moral theory is viewed overly prescriptively, as being synonymous with legalist orthodoxy. The second misinterpretation occurs where constitutionalism is defined exclusively in terms of its dominant liberal conception. These problematic definitions of the two core concepts reduce the space of convergence between Eastern and Western constitutional frameworks, giving rise to the misleading narrative that they are fundamentally incompatible. With these issues in mind, the article adopts a dialectic interpretive method to read both traditions in light of their historical context and authorial purpose, to see whether such a reading can support some form of duty-based constitutionalism. Ultimately, the article examines Eastern and Western natural law ideas to reveal deeper themes common to both and highlight the normative continuities of two prominent, albeit culturally disparate, constitutional foundations.
Abstract
John Calvin (1509–64), a central figure in Reformed theology, is perhaps best known for his bleak doctrine of total human depravity. This dismal view of human reason has commonly ...overshadowed his statement that ‘some sparks still shine’. This article proposes that Calvin’s account of conscience, by conserving an illuminated space in human nature, makes possible a formal doctrine of natural law. Calvin enlists the interconnectedness between the knowledge of God and human reason to frame his anthropology. According to this, human reason was originally created to perfectly access knowledge of God but after the Fall, can only attain imperfect access. Within this broader framework, by adopting a dialectic of dual perspectives, Calvin maintains that, however fallen, human nature still partially reflects the Imago Dei as first intended. As through a glass darkly, this divine image is reflected in human conscience endowing it with sufficient knowledge for moral discernment. Calvin’s emphasis on ‘common grace’ in the preservation of this knowledge allows him to simultaneously maintain human ignorance and their universal accountability to objective norms. In this way, Calvin’s account of conscience enables him to hold both apparent extremes in tension: the immanent fallibility of human beings with the external normative standards they ought to pursue.
The use of intercostal nerve cryoablation (INC) has been an effective modality for treating pain in patients undergoing pectus excavatum (PE) repair. This study sought to evaluate if PE patients ...undergoing Nuss procedures with INC and intercostal nerve block (INB) could safely be discharged the same day of surgery.
A prospective study with IRB approval of 15 consecutive patients undergoing PE Nuss repair with INC, INB, and an enhanced recovery after surgery (ERAS) protocol was conducted. The primary outcome measure was hospital length of stay (LOS) in hours. Secondary variables included same day discharge, postoperative complications, emergency department (ED) visits, urgent care (UC) visits, opioid use, and return to the operating room (OR).
LOS averaged 11.9 h amongst 15 patients. Ten patients (66.7%) went home on postoperative day (POD) 0, and the rest went home on POD 1. No patients stayed in the hospital due to pain. Reasons for failure to discharge included urinary retention, drowsiness, vomiting, and anxiety, but not pain. No patients were readmitted to the ED. One patient visited UC for constipation. One patient had bar migration requiring return to the OR for revision. Ten (66.7%) patients did not use opioids after discharge.
Same day discharge is feasible and safe in PE patients undergoing Nuss procedure with INC and INB. INC with INB can adequately control pain without significant complications. Same day discharge can be safely considered for PE patients undergoing Nuss procedure with INC with INB.
Prognosis study
Level II
Trypsin or Tumor associated trypsin (TAT) activation of Protease-activated receptor 2 (PAR-2) promotes tumor cell proliferation in gastrointestinal cancers. The role of the trypsin/PAR-2 network in ...esophageal adenocarcinoma (EA) development has not yet been investigated. The aim of this study is to investigate the role of trypsin/PAR-2 activation in EA tumorogenesis and therapy. We found that esophageal adenocarcinoma cells (EACs) and Barrett's Metaplasia (BART) expressed high levels of type 3 extra-pancreatic trypsinogen (PRSS3), a novel type of TAT. Activity of secreted trypsin was detected in cultured media from EA OE19 and OE33 cultures but not from BART culture. Surface PAR-2 expression in BART and EACs was confirmed by both flow cytometry and immunofluorescence. Trypsin induced cell proliferation (~ 2 fold; P<0.01) in all tested cell lines at a concentration of 10 nM. Inhibition of PAR-2 activity in EACs via the PAR-2 antagonist ENMD (500 µM), anti-PAR2 antibody SAM-11 (2 µg/ml), or siRNA PAR-2 knockdown, reduced cell proliferation and increased apoptosis by up to 4 fold (P<0.01). Trypsin stimulation led to phosphorylation of ERK1/2, suggesting involvement of MAPK pathway in PAR-2 signal transduction. Inhibition of PAR-2 activation or siRNA PAR-2 knockdown in EACs prior to treatment with 5 FU reduced cell viability of EACs by an additional 30% (P<0.01) compared to chemotherapy alone. Our data suggest that extra-pancreatic trypsinogen 3 is produced by EACs and activates PAR-2 in an autocrine manner. PAR-2 activation increases cancer cell proliferation, and promotes cancer cell survival. Targeting the trypsin activated PAR-2 pathway in conjunction with current chemotherapeutic agents may be a viable therapeutic strategy in EA.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Emergency ulcer surgery Lee, Constance W; Sarosi, Jr, George A
The Surgical clinics of North America,
10/2011, Letnik:
91, Številka:
5
Journal Article
Recenzirano
Odprti dostop
The rate of elective surgery for peptic ulcer disease has been declining steadily over the past 3 decades. During this same period, the rate of emergency ulcer surgery rose by 44%. This means that ...the gastrointestinal surgeon is likely to be called on to manage the emergent complications of peptic ulcer disease without substantial experience in elective peptic ulcer disease surgery. The goal of this review is to familiarize surgeons with our evolving understanding of the pathogenesis, epidemiology, presentation, and management of peptic ulcer disease in the emergency setting, with a focus on peptic ulcer disease-associated bleeding and perforation.
Same-day discharge following the Nuss repair: A comparison Rettig, R. Luke; Rudikoff, Andrew G.; Annie Lo, Hoi Yee ...
Journal of pediatric surgery,
January 2022, 2022-Jan, 2022-01-00, 20220101, Letnik:
57, Številka:
1
Journal Article
Recenzirano
Intercostal Nerve Cryoablation (INC) has significantly improved pain control following the Nuss repair of pectus excavatum (PE). This study sought to evaluate patients undergoing the Nuss repair with ...INC compared to the Nuss repair with an ERAS protocol, INC, and intercostal nerve blocks (INB).
In June 2020, a new protocol was implemented involving surgery, anesthesia, nursing, physical therapy, and child life with the goal of safe same day discharge for patients undergoing the Nuss repair. They were compared to a control group who underwent the Nuss repair with INC alone in 2017–2019. The primary outcome measure was hospital length of stay (LOS) in hours, secondary outcomes were number of patients discharged on postoperative day (POD) 0, and returns to the emergency department (ED), urgent care (UC), and operating room (OR).
The characteristics between the groups were the same (Table 1). The mean LOS was 11.8 h in the INB group versus 58.2 h in the INC group, p < 0.01. 10 of 15 patients in the INB group went home on POD 0 (average of 5.5 h postop), versus 0 patients in the INC only group, p < 0.01. Five patients in the INB stayed overnight. Two patients stayed owing to anxiety, one owing to urinary retention, one owing to nausea, and one owing to drowsiness. None stayed for pain control. Four patients in the INC group returned to the ED for pain control, versus 0 in the INB group, and 1 patient in the INB returned to UC for constipation.
The majority of patients undergoing the Nuss repair of PE with a multidisciplinary regimen of pre and postoperative nursing education, precise intraoperative anesthesia care, performance of direct vision INB and INC, as well as careful surgery can go home on the day of surgery without adverse outcomes or unanticipated returns to the hospital.
Level II.
Abstract Purpose The optimal management of achalasia in children and adolescents remains unclear. The aim of this study was to review a single institution's experience with endoscopic and surgical ...interventions in children with achalasia. Methods A retrospective review was conducted of the medical records of children treated for achalasia from 1978 to 2008. Patient demographics and interventions were reviewed. Outcomes after procedural intervention were evaluated. Results Thirty-five patients with achalasia were identified, and data were available for 34 (age, 13 ± 6 years; male, 62%). Eighteen patients underwent esophageal dilation (ED), and 16 patients underwent Heller myotomy (HM). Follow-up was available for 30 patients (ED, 15; HM, 15). There was symptom recurrence in 15 of 15 ED cases and 8 (53%) of 15 HM cases ( P < .01). Additional interventions were performed in 14 (93%) of 15 ED cases and 6 (40%) of 15 HM cases ( P < .01). Conclusions Heller myotomy may provide more durable long-term outcomes, as defined by symptom recurrence and need for subsequent intervention, and may be considered the procedure of choice.
Background We compared outcomes of arch debranching (AD) and elephant trunk (ET) techniques when used with thoracic endovascular aortic repair. Methods A review was performed of consecutive patients ...with proximal thoracic aortic pathologies repaired with a hybrid approach. Results Between 2005 and 2009, 58 patients underwent first-stage ET (n = 21) or AD (n = 37). Cardiopulmonary bypass was utilized in 100% of ET procedures and 68% of AD procedures ( p < 0.01). Circulatory arrest was used in 86% of ET and 27% of AD cases ( p < 0.01). The second stage was completed in 76% of ET and 76% of AD patients. Rates of spinal cord ischemia (ET 0 of 21, AD 0 of 37, p = 1.0), stroke (ET 2 of 21, AD 4 of 37, p = 1.0), and 30-day mortality (ET 4 of 21, AD 6 of 37, p = 1.0) were similar. Each group had one major aortic complication between the two stages. Type Ia endovascular leak at 1 and 12 months occurred in 13% ET patients and 4% AD patients at 1 month ( p = 0.54) and in 0% ET patients and 4% AD patients at 12 months ( p = 1.0). Kaplan-Meier estimates of survival at 1 and 12 months were 90.5% ± 6.4% and 73.1% ± 10% in the ET group, and 86.5% ± 5.6 and 71.6% ± 8.5 in the AD group, respectively ( p = 0.68). The risk of a secondary procedure at 1 and 12 months was 76.2% ± 9.3% and 58.7% ± 12% in the ET group, and 71.0% ± 7.8% and 52.8% ± 10% in the AD group, respectively ( p = 0.86). Conclusions Arch debranching achieves equivalent results to standard elephant trunk repair but with a decreased need for cardiopulmonary bypass and circulatory arrest.
Abstract Traumatic rupture of a cystic ovarian teratoma is extremely rare and has not been reported in a child. The free fluid can lead to diagnostic confusion for a ruptured viscus.
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