bluuebunny/crossref_metadata_2025_split huggingface dataset:
3235 Black Stomach: A Rare Clinical Entity in a Patient With Recurrent Primary Sclerosing Cholangitis With Cirrhosis
Authors: Stone Bryan , Real Mark , Hsu Christine 
Published: October 2019

INTRODUCTION:
Acute gastric necrosis is rarely encountered given the stomach's rich vascular distribution and collateral circulation. Reported causes of gastric necrosis include gastric outlet obstruction, intrathoracic herniation, ingestion of caustic substances, anorexia nervosa and bulimia, and systemic hypotension. We present a case of “black stomach” secondary to persistent shock in the setting of end-stage liver disease.

CASE DESCRIPTION/METHODS:
A 33-year-old female with a history of primary sclerosing cholangitis status post orthotopic liver transplant in 2017 was initially hospitalized for pneumonia complicated by worsening graft function (MELD 38). Liver biopsy confirmed recurrent PSC with cirrhosis. Her course deteriorated after developing multiple episodes of coffee-ground emesis and melena requiring pressors. Initial EGD showed mild portal hypertensive gastropathy and two, 5 mm clean-based ulcers in the gastric antrum. No esophageal varices were visualized. Despite medical therapy, her melena and hypotension continued, leading to acute renal failure requiring CVVH. Repeat EGD two days later showed an adherent clot in the gastric fundus and severe portal hypertensive gastropathy with spontaneous oozing. Despite supportive measures, she continued to have melena. A third EGD showed a large blood clot in the fundus that was unable to be removed. Friable mucosa was noted throughout, as well as a non-healing, clean-based antral ulcer. Two days later, a fourth EGD revealed mucosa in the fundus and proximal body that appeared black and diffusely necrotic with sloughing of mucosa, with normal mucosa distally. The patient was not a candidate for IR embolization, TIPS procedure or surgery. One week later, she decompensated and died of septic shock from VRE bacteremia.

DISCUSSION:
Our case demonstrates that persistent gastric ischemia in the setting of shock and underlying end-stage liver disease results in gastric necrosis noted endoscopically over the course of a week. It is possible that the patient's underlying decompensated graft cirrhosis predisposed her to developing segmental gastric necrosis and “black stomach” in the area supplied and drained by the left gastric vessels, which can be affected by shock and portal congestion. Despite aggressive measures and supportive care, gastric necrosis carries a high morbidity and mortality. Therefore, a high index of clinical suspicion is required to make an early diagnosis in order to guide potential therapeutic interventions in such critically ill patients.
3244 Acute Massive Gastric Distention in an Adult Patient With Cerebral Palsy
Authors: Cezar Carensa , Ayoola Rotimi , Osho Azeez , Aduli Farshad 
Published: October 2019

INTRODUCTION:
Cerebral Palsy (CP) is a motor impairment secondary to neurological abnormalities in the central and peripheral nervous systems. CP can affect the functioning of the gastrointestinal system. Common complications include dysphagia, constipation, regurgitation, vomiting and gastroesophageal reflux. Severe gastric distension is a very rare complication of CP with a high mortality risk. We present a case of severe gastric distension in a patient with CP.

CASE DESCRIPTION/METHODS:
A non-verbal 39-year-old man with history of CP, spastic quadriplegia, deep vein thrombosis, and obstipation status post colectomy and subtotal ileostomy presented with a 2-day history of poor oral intake, abdominal distention, and decreased ileostomy output. Patient had a similar presentation one-month prior. Vitals were within normal. Physical exam showed abdominal distension, abdominal tenderness, absent bowel sounds and tympany to percussion. Labs were normal except for hemoglobin of 8.3 g/dL, blood urea nitrogen of 42 mg/dL and a creatinine of 1.65 mg/dL. Computerized tomography showed markedly dilated stomach with air-fluid levels. Patient was placed on nothing by mouth. A nasogastric tube was placed to suction. An endoscopy was done that was negative for gastric outlet obstruction (GOO). Xrays showed resolution of the gastric distension. Patient tolerated liquids and then solids. He began to have stool output from the ileostomy and was discharged.

DISCUSSION:
Gastric distension in patients with CP is not fully understood. Gastric emptying and motility of the foregut are regulated by the vagus nerve. Predisposing factors include autonomic neuropathy, neuromuscular incoordination, air swallowing and malposition of the stomach. Death may be due to respiratory compromise by lung compression from a dilated stomach, or rupture of the stomach. Gastric distension can be seen in patients with GOO or diabetes mellitus with gastroparesis. Another cause is severe kyphoscoliosis of the vertebral columns causing malpositioning and posterior displacement resulting in mechanical obstruction preventing spontaneous decompression. In cases of recurrent or severe gastric distension, worsening of symptoms, or non-resolving distension after supportive management a venting gastrostomy may be needed. Severe gastric dilatation, with or without rupture, should be considered a potential cause of unexpected death in individuals with severe mental and physical disabilities.
3247 Don't Clean the Stomach With a Kitchen Sponge: Case of a Kitchen Sponge Presenting as a Gastric Bezoar
Authors: Mulat Baruh , Nawaz Waqas , Hertan Hilary 
Published: October 2019

INTRODUCTION:
Gastric bezoars are rare and caused by ingestion of indigestible material. They are called polybezoars if resulted from the accumulation of ingested foreign bodies in the stomach. We present a rare case of a gastric polybezoar secondary to the ingestion of a kitchen sponge in a 53-year-old female which presented a significant endoscopic challenge during the removal.

CASE DESCRIPTION/METHODS:
A 53-year-old female with a history of major depressive disorder and multiple abdominal surgeries including gastric bypass was admitted for abdominal pain and vomiting for the last three days. Physical exam was remarkable for abdominal scars from prior surgeries. Initial laboratory data showed elevated blood urea nitrogen and creatinine. CT abdomen showed evidence of gastric bypass with a foreign body in the gastric remnant without any intestinal obstruction. On further questioning, she revealed that she had ingested the pieces of a kitchen sponge one week ago. An upper endoscopy was done which revealed an eight cm polybezoar made up of food material coating a sponge in the gastric pouch. The bezoar was fragmented using the biopsy forceps and removal was accomplished using Roth net and Trapezoid basket. An over tube was used to facilitate the repeated passages of the scope. The procedure lasted for two hours thus presenting a significant challenge.

DISCUSSION:
A gastric bezoar is defined as a foreign body resulting from the accumulation of ingested material in the stomach. It is a rare condition with the incidence of 0.4-4%. Depending on the type of the ingested material, it can be a phytobezoar (fibers), a trichobezoar (hair), a pharmacobezoar (medications), a polybezoar (foreign body) or a lactobezoar (milk product). Stomach is the most common site involved. Most bezoars are clinically asymptomatic due to large capacity of the stomach and are diagnosed incidentally on imaging or endoscopy done for other reasons. When symptomatic, they may present with epigastric pain, vomiting, hematemesis or small bowel obstruction. The major risk factors for the formation of the bezoars are conditions associated with gastric dysmotility, previous gastric surgery and psychiatric disorders. Complicated gastric bezoars impose a great challenge to an endoscopist. Several modalities have been suggested for the management of bezoar including chemical dissolution (sodium bicarbonate, Coca Cola lavage etc.) and endoscopic fragmentation with removal. Surgery is reserved for intestinal obstruction or a failed endoscopic treatment.
1091 Time-Trend Analysis of Correlation of Liver Cirrhosis and Its Complications, Using NIS Database
Authors: Hayat Muhammad Hashim , Ali Ijlal Akbar , Nusrat Salman 
Published: October 2019

INTRODUCTION:
Liver cirrhosis has one of the highest associations with an increased mortality and morbidity, out of all liver diseases. Indirect and direct cost related to cirrhosis exceeded 10 billion dollars in 2010, and is expected to have risen since then. It has many complications such as esophageal varices, spontaneous bacterial peritonitis (SBP), portal hypertension and hepatorenal syndrome (HRS). We wanted to assess hospital admissions, stays and expenses of patient care from cirrhosis.

METHODS:
We reviewed the NIS Database for all hospitalizations with principal discharge diagnosis for cirrhosis, esophageal varices, SBP, portal hypertension or HRS between years 1993–2014.

RESULTS:
In 2014 total number of hospital admissions secondary to cirrhosis were 77,880. This was a persistent increase from 57,787 admissions in 1993. Age-sex standardized admission rates (per 100,000 patients) increased from 24.0 in 1993 to 32.3 in 2014. We saw decrease in hospital stay duration from 8.7 to 9.8 days. The total hospital charges for these admissions increased from $11,020 in 1993 to $59,130 in 2014. Average mortality per year decreased from 14.98% to 5.62%. On the other hand, opposite trends were observed in most of the complications of cirrhosis. We saw a steady decline in admission rate (per 100,000 patients) from esophageal varices, from 2.0 in 1993 to 1.4 in 2014. Mortality for the condition decreased from 8.13% to 6.04% over the course of the study period. Similar trends were observed in patients with HRS, with admission rate increasing from 0.5 to 1.1, in 1993 and 2014 respectively. In hospital death decreased from 70.9% in 1993 to 24% in 2014. Admission rate for portal hypertension from 1994 to 2014 increased from 1.5 to 1.8. Mortality from the disease continues to decrease from 6.1% in 1993 to 3.0% in 2013.Trend for SBP admissions over the past decade is concerning with numbers increasing from 0.3 in 2005, to 2.4 in 2014. Reassuringly, mortality for SBP is decreasing consistently from 8.34% in 2005 to 6.16% in 2014.

CONCLUSION:
The number of inpatient admissions for cirrhosis has increased from 1993 to 2014. During the same time period, length of stay and inpatient mortality improved but cost per admission increased almost five folds. These changes are likely representative of early recognition of complication and more effective treatment options. Use of diagnostic and therapeutic intervention should be judicious and further research on cost effectiveness of is needed.
1 Double High-Level Disinfection vs. Sterilization for Reprocessing of Duodenoscopes Used for ERCP: A Prospective Study
Authors: Gromski Mark A. , Sieber Marnie S. , Sherman Stuart , Rex Douglas K. 
Published: October 2019

INTRODUCTION:
The potential for transmission of pathogenic organisms is a problem inherent to the current duodenoscope design. Recent outbreaks of multi-drug resistant pathogenic organisms transmitted via duodenoscopes has brought to light the urgency of this problem. Microbiological culturing of duodenoscopes and reprocessing with repeat high-level disinfection or liquid chemical sterilization have been offered as supplemental measures to enhance duodenoscope reprocessing by the US Food and Drug Administration (FDA). This study aims to compare the efficacy of reprocessing duodenoscopes with double high-level disinfection (DHLD) versus liquid chemical sterilization.

METHODS:
We prospectively evaluated two different modalities of duodenoscope reprocessing from 10/23/17 to 9/24/18. All operable duodenoscopes were segregated to be reprocessed by either DHLD (i.e., complete manual cleaning followed by automated reprocessing, repeated for two total cycles) or manual cleaning followed by liquid chemical sterilization. Duodenoscopes were randomly cultured post-reprocessing for surveillance based on an internal protocol.

RESULTS:
During the study time period, there were 878 post-reprocessing surveillance cultures (453 in the DHLD group and 425 in the sterilization group). Of all of the cultures, 17 were positive (1.9%). There was no significant difference of positive cultures when comparing the duodenoscopes undergoing DHLD (8 positive cultures, 1.8%) to duodenoscopes undergoing sterilization (9 positive cultures, 2.1%, P > 0.05). Both groups had two cultures that grew high-concern organisms. No multi-drug resistant organisms (MDRO), including carbapenem-resistant enterobacteriaceae (CRE), were detected. Organisms from positive cultures are presented in Table 1.

CONCLUSION:
DHLD and liquid chemical sterilization both resulted in a low rate of positive cultures, both for all organisms and for high-concern organisms, but neither process eliminated positive cultures from reprocessed duodenoscopes. A liquid chemical sterilization protocol did not improve the growth of organisms on surveillance cultures compared to DHLD.
Compliance with hormone replacement therapy in perimenopause (work experience of the educational program "Health of a woman older than 45 years")
Authors: Berketova T. Yu. , Melnichenko G. A. , Bobrov A. E. , Kuligina M. A. , Samsonova L. S. , Rogozin A. K. , Chernogolov V. A. , Morgunova T. B. 
Published: October 2019

Although the efficacy of substitute hormone therapy (SHT) is proven, the list of contraindications to it is short, and new drugs and dosage forms have been created, the number of periand postmenopausal women administered SHT is scanty. Among the factors responsible for it is insufficient information and the level of education of women. Our research was aimed at improving the quality of life and prevention of complications in periand postmenopausal women by developing programs for treating and training women of periand postmenopausal age. The program was tried in 106 women aged 39 to 62 years (51.83±0.68), 24 of whom were offered a course of group psychotherapy. Control group consisted of 48 women matched for their social status and age who were not trained.
The training decreased the anxiety caused by somatic state, the women became more open and spontaneous, their mood improved, and anxiety decreased due to explanations offered by the doctor. Special psychotherapeutic training added to preparatory measures improved the psychological state of women still more.
The knowledge of women after a course of training essentially improved in comparison with the control: 3.64±0.02 (p<0.00001) and 2.68+0.03 points (p<0.00001). Ninety-three (87.7%) women decided to resort to SHT after training and so did 31 (64.6%) women who were not trained. About half of untrained women discontinued SHT or had an insufficient course for this or that reason, while in the trained group only about 17% women did so.
Assessing of adaptation ability of Listeria to benzalkonium chloride (BAC) by determination of its minimal inhibitory concentration
Authors: PODPAC Monika , JERŠEK Barbara 
Published: October 2019

Bacteria of the genus Listeria pose a problem in the food industry due to their wide distribution and their good survival in adverse conditions. L. monocytogenes (E. Murray et al. 1926) Pirie 1940 is human pathogen, while L. innocua Seeliger (ATCC® 33090™) as not pathogenic bacteria is the most often found listeria in food production environment. Disinfectants represents an important part of Listeria management in food processing environments and benzalkonium chloride (BAC) is used frequently. The purpose of the work was to determine whether strains of listeria can adapt to BAC. To carry out the adaptation, a precise determination of antibacterial activity of BAC was needed. Firstly minimum inhibitory concentration (MICMTP) of BAC was determined with broth microdilution method for each Listeria strain. Then, we checked whether MICMTP was indeed the lowest concentration of BAC, which had an influence on growth of strains with growth curves. We found out that growth inhibitory effect (MICGC) was achieved at concentrations of BAC that were lower than MICMTP (0.1-0.5x of MICMTP values). Adaptation of listeria to BAC was therefore performed by using 0.25x MICGC as the initial BAC concentration. Results showed that 50 % of the strains were able to adapt to BAC, and in L. monocytogenes ŽM500 this adaptation was even stable. The broth microdilution method was useful for approximate assessment of antimicrobial activity of BAC, while for the more precise determination of disinfectant activity it is necessary to determine it by using another method such as plate count method.
Meaningful and meaningless suffering
Authors: Pihlström Sami 
Published: October 2019

Abstract
The problem of suffering crucially focuses on meaninglessness. Meaningful suffering—suffering having some “point” or function—is not as problematic as absurd suffering that cannot be rendered purposeful. This issue is more specific than the problem of the “meaning of life” (or “meaning in life”). Human lives are often full of suffering experienced as serving no purpose whatsoever – indeed, suffering that may threaten to make life itself meaningless. Some philosophers—e.g., D.Z. Phillips and John Cottingham—have persuasively argued that the standard analytic methods of philosophy of religion in particular ought to be enriched by literary reading and interpretation, especially when dealing with issues such as this. The problem of evil and suffering can also be explored from a perspective entangling literary and philosophical approaches (Kivistö & Pihlström, 2016). This double methodology is in this paper applied to the problem of evil and suffering by considering an example drawn from Holocaust literature: Primo Levi’s work is analyzed as developing an essentially ethical argument, with a philosophical-cum-literary structure, against theodicies seeking to render suffering meaningful. By means of such a case study, I hope to shed light on the problem of meaningless suffering, especially regarding the moral critique of “theodicist” attempts to interpret all suffering as meaningful.
Screw dislocation in a Bi-medium within strain gradient elasticity revisited
Authors: Davoudi Kamyar M. , Aifantis Elias C. 
Published: October 2019

AbstractIn this paper, we consider a straight screw dis-location near a flat interface between two elastic media in the framework of strain gradient elasticity (as studied by Gutkin et. al. [1]) by now taking care of some incomplete calculations). Closed form solutions for stress components and the Peach-Koehler force on the dislocation have been derived. It is shown that the singularities of the stress components at the dislocation line are eliminated and both components are continuous and smooth across the interface. The effect of the distance of the dislocation position from the interface on the maximum value of stress is investigated. Unlike in the case of classical solution, the image force remains finite when the dislocation approaches the interface. It is shown that the dislocation is attracted by the medium with smaller shear modulus or smaller gradient coefficient.
Berry-Esseen bounds for wavelet estimator in time-varying coefficient models with censored dependent data
Authors: Zhou Xingcai , Ni Beibei , Wang Hongxia , Huang Xingfang 
Published: October 2019

Abstract
In this paper, we discuss wavelet estimation of time-varying coefficient models based on censored data where the survival and the censoring times are from a stationary α-mixing sequence. Under the appropriate conditions, the Berry-Esseen bouds of wavelet estimators are established. For the purpose of statistical inference, a random weighted wavelet estimator of the time-varying coefficient is also constructed, and some approximation rates are given.
Vibration Analysis of a Three-Layered FGM Cylindrical Shell Including the Effect Of Ring Support
Authors: Ghamkhar Madiha , Naeem Muhammad Nawaz , Imran Muhammad , Soutis Constantinos 
Published: October 2019

Abstract
In this work, we study vibrations of three-layered cylindrical shells with one ring support along its length. Nature of material of the central layer is a functionally graded material (FGM) type. The considered FGM is of stainless steel and nickel. The internal and external layers are presumed to be made of isotropic material i.e., aluminum. The functionally graded material composition of the center layer is assorted by three volume fraction laws (VFL) which are represented by mathematical expressions of polynomial, exponential and trigonometric functions. The implementation of Rayleigh-Ritz method has been done under the Sanders’ shell theory to obtain the shell frequency equation. Natural frequencies (NFs) are attained for the present model problem under six boundary conditions. Use of characteristic beam functions is made for the estimation of the dependence of axial modals. The impact of layer material variations with ring support is considered for many ring positions. Also the effect of volume fraction laws is investigated upon vibration characteristics. This investigation is performed for various physical parameters. Numerous comparisons of values of shell frequencies have been done with available models of such types of results to verify accuracy of the present formulation and demonstrate its numerical efficiency.
Using the Rating of Perceived Exertion and Heart Rate to Quantify Training Intensity in Female Soccer Players: Validity and Utility
Authors: Costa Júlio A. , Brito João , Nakamura Fábio Y. , Figueiredo Pedro , Rebelo António 
Published: October 2019

Abstract
Costa, JA, Brito, J, Nakamura, FY, Figueiredo, P, and Rebelo, A. Using the rating of perceived exertion and heart rate to quantify training intensity in female soccer players: validity and utility. J Strength Cond Res 36(1): 201–206, 2022—The aims of this study were as follows: (a) to analyze associations between session rating of perceived exertion (sRPE) and training impulse (TRIMP); (b) to verify whether significantly different ranges of percentage of heart rate peak (%HRpeak) would be reached in each discrete RPE category; and (c) to investigate the amount of time spent >90% of HRpeak and associated intraplayer and interplayer variability during soccer technical training sessions with similar contents and duration. This was a single-group observational study that measured the internal training load during 6 weeks of the competitive period in 17 high-level female soccer players. All training sessions started around 9 pm. and lasted on average 94 ± 5 minutes. During each training session, RPE, sRPE, TRIMP, HRex (%HRpeak), and time spent at >90% of HRpeak were assessed. A very large correlation was found between sRPE and TRIMP (r = 0.78; 95% confidence interval: [0.74–0.82]). Significant differences were observed between %HRpeak associated with each RPE value (i.e., RPE = 2 arbitrary unit [68%; 65–69% of %HRpeak]; RPE 3 [72%; 69–75%]; RPE 4 [79%; 76–82%]; RPE 5 [84; 81–87%]; χ2 = 73.34; df = 3; P < 0.001). Intraplayer and interplayer coefficients of variation for the time spent >90% of HRpeak (∼8% of training time, ∼7 minutes per session) during training sessions were 73 and 92%, respectively. In conclusion, it was confirmed that sRPE and TRIMP displayed good convergent validity, and different %HRpeak were observed for each discrete RPE. However, because of the high variability in the time >90% of HRpeak, careful monitoring of individual exercises should be performed to ensure the desired training stimulus for each player.