Stentoftkatz3446

Malrotation is a congenital anomaly during the development of the embryonic intestine. Although it is generally considered a pediatric surgical condition, it can have significant implications for adult surgery in terms of reconstruction.

The patient was an 85-year-old man with pancreatic cancer and intestinal malrotation. He underwent pancreaticoduodenectomy with modified Child's reconstruction. Because the ascending colon and efferent loop twisted easily, we fixed the ascending colon to the abdominal wall. Thereafter, right twist and stenosis of the efferent loop occurred. On the 22nd day after the initial surgery, detorsion and Braun anastomosis were performed for efferent loop fixation. Postoperative oral intake was good, and the patient was discharged from our hospital on the 24th day after the reoperation.

This is a rare case of pancreaticoduodenectomy with malrotation following reoperation due to a complication after Child's reconstruction. In similar cases of intestinal malrotation, it is important to consider avoiding coaxial positioning of intestinal parts and an upper abdominal space while selecting a reconstruction method.

This is a rare case of pancreaticoduodenectomy with malrotation following reoperation due to a complication after Child's reconstruction. In similar cases of intestinal malrotation, it is important to consider avoiding coaxial positioning of intestinal parts and an upper abdominal space while selecting a reconstruction method.Pfaffia glomerata possesses potential pharmacological and medicinal properties, mainly owing to the secondary metabolite 20-hydroxyecdysone (20E). Increasing production of biomass and 20E is important for industrial purposes. This study aimed to evaluate the influence of irradiance on plant morphology and production of 20E in P. glomerata grown in vitro. Nodal segments of accessions 22 and 43 (Ac22 and Ac43) were inoculated in culture medium containing MS salts and vitamins. Cultures were maintained at 25 ± 2 °C under a 16-h photoperiod and subjected to irradiance treatments of 65, 130, and 200 μmol m-2 s-1 by fluorescent lamps. After 30 days, growth parameters, pigment content, stomatal density, in vitro photosynthesis, metabolites content, and morphoanatomy were assessed. Notably, Ac22 plants exhibited 10-fold higher 20E production when cultivated at 200 μmol m-2 s-1 than at 65 μmol m-2 s-1, evidencing the importance of light quantity for the accumulation of this metabolite. 20E production was twice as high in Ac22 as in Ac43 plants although both accessions responded positively to higher irradiance. Growth under 200 μmol m-2 s-1 stimulated photosynthesis and consequent biomass accumulation, but lowered carotenoids and anthocyanins. Furthermore, increasing irradiance enhanced the number of palisade and spongy parenchyma cells, enhancing the overall growth of P. Vardenafil glomerata. Graphical abstract.

This study was conducted to time-course changes of clotting function of withdrawing blood for acute normovolemic hemodilution (ANH).

Twelve enrolled patients who underwent ANH from August, 2018 to January, 2019. Blood was withdrawn into blood collection pack and shaken at 60-80rpm for 24h in room temperature. Clot formation was evaluated using rotational thromboelastometry (ROTEM™) just after blood withdrawal (control) and 4, 8, 12 and 24h after blood withdrawal. We compared with the control value and each value of extrinsically-activated test with tissue factor (EXTEM), intrinsically-activated test using ellagic acid (INTEM) and fibrin-based extrinsically activated test with tissue factor (FIBTEM).

Maximum clot firmness (MCF) of FIBTEM did not change significantly. MCF of EXTEM was significantly decreased time-dependent manner but all MCF of EXTEM were within a normal range. Maximum percent change in MCF of EXTEM was 12.4% [95% confidence interval (CI) 9.0-15.8%]. The difference in the maximum clot elasticity (MCE) between EXTEM and FIBTEM (MCE

-MCE

) was significantly decrease from 8h after blood withdrawal. Maximum percent change in MCE

-MCE

was 30.2% (95% CI17.6-42.9%) at 24h after blood withdrawal.

Even though the MCE significantly decreased in a time-dependent manner, MCF of FIBTEM and EXTEM was normal up to 24h storage. The blood of ANH can use for the purpose of hemostasis at least 8h stored at room temperature after blood withdrawal. Future studies are needed to elucidate the clinical impact on the patient after delayed transfusion of ANH blood with regard to patient's hemostasis.

Even though the MCE significantly decreased in a time-dependent manner, MCF of FIBTEM and EXTEM was normal up to 24 h storage. The blood of ANH can use for the purpose of hemostasis at least 8 h stored at room temperature after blood withdrawal. Future studies are needed to elucidate the clinical impact on the patient after delayed transfusion of ANH blood with regard to patient's hemostasis.In this study, we propose an evolution law of COVID-19 transmission. An infinite ordered lattice represents population. Epidemic evolution is represented by a wave-like free spread starting from a first case as an epicentre. Free energy of the virus on a given day is defined equal to the natural logarithm of active infected cases number. We postulate a form of free energy built using thermodynamics of irreversible processes in analogy to isotherm wave propagation in solids and non-local elastic damage behaviour of materials. The proposed expression of daily free energy rate leads to dissipation of propagation introducing a parameter quantifying measures taking by governments to restrict transmission. Entropy daily rate representing disorder produced in the initial system is also explicitly defined. In this context, a simple law of evolution of infected cases as function of time is given in an iterative form. The model predicts different effects on peak of infected cases Imax and epidemic period, including effects of population size N, effects of measures taking to restrict spread, effects of population density and effect of a parameter T similar to absolute temperature in thermodynamics. Different effects are presented first. The model is then applied to epidemic spread in Tunisia and compared with data registered since the report of the first confirmed case on March 2, 2020. It is shown that the low epidemic size in Tunisia is essentially due to a low population density and relatively strict restriction measures including lockdown and quarantine.