Vanghan4359

This review focuses on the technical aspects, including procedural details, as well as the complications of EUS-GBD.Neuroendocrine neoplasms (NEN) are frequently characterized by a high propensity for metastasis to the liver, which appears to be a dominant site of distant-stage disease, affecting quality of life and overall survival. Liver surgery with the intention to cure is the treatment of choice for resectable neuroendocrine liver metastases (NELM), aiming to potentially prolong survival and ameliorate hormonal symptoms refractory to medical control. Surgical resection is indicated for patients with NELM from well-differentiated NEN, while its feasibility and complexity are largely dictated by the degree of liver involvement. As a result of advances in surgical techniques over the past decades, complex 1- and 2-stage, or repeat liver resections are performed safely and effectively by experienced surgeons. Furthermore, liver transplantation for the treatment of NELM should be anchored in a multimodal and multidisciplinary therapeutic strategy and restricted only to highly selected individual cases. A broad spectrum of interventional radiology treatments for NELM have recently been available, with expanding indications that are more applicable, as they are less limited by patient- and tumor-related parameters, being therefore important adjuncts or alternatives to surgery. Overall, liver-targeted treatment modalities may precede the administration of systemic molecular targeted agents and chemotherapy for patients with liver-dominant metastatic disease; these appear to be a crucial component of multimodal management of patients with NEN. In the present review, we discuss surgical and non-surgical liver-targeted treatment approaches for NELM, each complementing the other, with a view to assisting physicians in optimizing multimodal NEN patient care.Diseases of the pancreas and hepatobiliary tree often require a therapeutic approach with endoscopic retrograde cholangiopancreatography (ERCP), generally following noninvasive imaging techniques. Appropriate indications and the correct timing for urgent ERCP would benefit both patients and clinicians and allow optimal utilization of health resources. Indications for urgent ( less then 24 h) ERCP include severe acute cholangitis, acute biliary pancreatitis with cholangitis, biliary or pancreatic leaks, in the absence of percutaneous drainage, and severe acute cholecystitis in patients who are unfit for surgery and do not respond to conservative management. In patients who have severe acute biliary pancreatitis with ongoing biliary obstruction but without cholangitis, early ( less then 48-72 h) ERCP is indicated. This overview aims to provide decisional flowcharts that can be easily used for managing patients with acute bilio-pancreatic disorders when they are referred to the Emergency Department.The COVID-19 pandemic has called worldwide for strong governmental measures to contain its spread, associated with considerable psychological distress. This study aimed at screening a convenience sample in Germany during lockdown for perceived vulnerability to disease, knowledge about COVID-19, symptoms of depression and anxiety, and behavioral responses. In an online survey, 1358 participants completed the perceived vulnerability to disease scale (PVD), the Patient Health Questionnaire (PHQ-4), and questionnaires on knowledge about COVID-19 and self-perceived change in behaviors in response to COVID-19. Lower and upper quartiles of the PVD were used to classify individuals into low and high PVD. A confirmatory factor analysis supported three factors representing risk, preventive and adaptive behavior as behavioral responses to COVID-19 lockdown. A structural equation model showed that the score of the knowledge scale significantly predicted the self-reported increase in adaptive and preventive behavior. The score in the PVD-subscale Perceived Infectability predicted a self-reported increase in preventive behavior, whereas the Germ Aversion score predicted a self-reported increase in preventive and a decrease in risk behavior. Pemigatinib The score in PHQ-4 predicted a higher score in the perceived infectability and germ aversion subscales, and a self-reported decrease in adaptive behavior. Low-, medium- and high-PVD groups reported distinct patterns of behavior, knowledge, and mental health symptoms. This study shows that perceived vulnerability to disease is closely linked to preventive behaviors and may enhance adaptation to COVID-19 pandemic.This article presents a conceptual model of cross-cultural alignments in education in the digital era. The intention was to explore and respond to urgent questions regarding learners and the learning environments in today's networked society. The model explores the enabling or constraining influences of educational systems, digital environments, learners, and educators on other learners and is based on the concept of social justice. The skills and competencies required for efficient learner development in a digital environment include digital competence, collaboration skills, intercultural competence, and lifelong learning skills. The interrelationship of these components and their influence on learners' skills and competencies are discussed through the lens of cross-cultural alignment by examining three intercultural projects worldwide. The authors recommend that educational systems provide educational institutions with a high-quality infrastructure as well as to support educators and learners in the development of digital skills. Future research may examine the model's components and their interrelationships so that it may serve researchers and practitioners as a basis for the design of future intercultural projects.Medical literature continues to get enriched through various researches and observations related to SARS-CoV-2 infection leading to COVID-19. Case reports play crucially to understand a novel clinical condition where much is yet to be known. Current pandemic is unique for the reason that its impacts upon front line health care workers (HCWs) are much higher than general population. In this situation, how an Ayurvedic physician has handled his own case leading to a cure from COVID-19 may furnish important information regarding mitigation and cure from the disease. This is also an unprecedented writing in medical literature as a physician reporting his own case is a rare phenomenon in medical history. This case report puts strongly the prophylactic and disease modifying potential of Ayurvedic interventions in COVID-19.

Outbreak of Corona Virus Disease in late 2019 (COVID-19) has become a pandemic global Public health emergency. Since there is no approved anti-viral drug or vaccine declared for the disease and investigating existing drugs against the COVID-19.

AYUSH-64 is an Ayurvedic formulation, developed and patented by Central Council of Research in Ayurvedic Sciences, India, has been in clinical use as anti-malarial, anti-inflammatory, anti-pyretic drug for few decades. Thus, the present study was undertaken to evaluate AYUSH-64 compounds available in this drug against Severe Acute Respiratory Syndrome-Corona Virus (SARS-CoV-2) Main Protease (M

 ; PDB ID 6LU7) via

techniques.

Different molecular docking software's of Discovery studio and Auto Dock Vina were used for drugs from selected AYUSH-64 compounds against SARS-CoV-2. We also conducted 100 ns period of molecular dynamics simulations with Desmond and further MM/GBSA for the best complex of AYUSH-64 with M

of SARS-CoV-2.

Among 36 compounds of four ingre highest Mpro binding energy along with other 34 chemical compounds having similar activity as part of AYUSH-64 make it a suitable candidate for repurposing to management of COVID-19 by further validating through experimental, clinical studies.Previous studies have demonstrated that there is an increase in Intimate Partner Violence (IPV) during times of crisis (e.g., financial, environmental, or socio-political situations). The COVID-19 pandemic has triggered an unprecedented global health and financial tragedy, but research is yet to establish exactly how the situation may impact on IPV. The present study investigates victims' experience of IPV during lockdown and the COVID-19 pandemic. We report a qualitative thematic analysis of 50 discussion forum posts written by victims of IPV. Of these, 48 forum posts were written by female victims of male perpetrated violence. All forum posts were obtained from the popular online platform, Reddit. We identified four themes associated with IPV victims' experiences during lockdown and the global pandemic (i) Use of COVID-19 by the Abuser, (ii) Service Disruption, (iii) Preparation to Leave, and (iv) Factors Increasing Abuse or Distress. The COVID-19 pandemic has had a substantial impact on those living with IPV, often increasing the severity of IPV experienced. The experiences of those affected by IPV during this period inform interventions and the guidance and support provided to IPV victims during times of crisis.Despite the importance of intimate partner violence (IPV) and homicide research to women's health and safety, much remains unknown about risk factors for intimate partner homicide (IPH). This article presents the Arizona Intimate Partner Homicide Study, pilot research that is being conducted in one U.S. state to update and expand on risk factors for IPH. In the context of presenting this study, we summarize the literature on data collection techniques, various marginalized and under researched populations, and the importance of gathering data about the victim-offender relationship and situational IPH risk factors. Additional research is needed to update risk factors for IPH to account for changes in technology and to examine differential risk across diverse populations. Local, community based data collection strategies are likely to provide more comprehensive and nuanced insight into IPH; though, to understand risk factors among marginalized populations, it may be necessary to increase sample size through a national strategy. Although not a panacea, we present this ongoing research as a model for other states to emulate and improve upon, in the hopes of developing more comprehensive data examining risk for IPH among victims of IPV.In the spot market for air cargo, airlines typically adopt dynamic pricing to tackle demand uncertainty, for which it is difficult to accurately estimate the distribution. This study addresses the problem where a dominant airline dynamically sets prices to sell its capacities within a two-phase sales period with only partial information. That partial information may show as the moments (upper and lower bounds and mean) and the median of the demand distribution. We model the problem of dynamic pricing as a distributional robust stochastic programming, which minimizes the expected regret value under the worst-case distribution in the presence of partial information. We further reformulate the proposed non-convex model to show that the closed-form formulae of the second-stage maximal expected regret are well-structured. We also design an efficient algorithm to characterize robust pricing strategies in a polynomial-sized running time. Using numerical analysis, we present several useful managerial insights for airline managers to strategically collect demand information and make prices for their capacities in different market situations.