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Objectives To examine the effect of high-b-value computed diffusion-weighted imaging (cDWI) on solid lesion detection and classification in pancreatic intraductal papillary mucinous neoplasm (IPMN), using endoscopic ultrasound (EUS) and histopathology as a standard of reference. Methods Eighty-two patients with known or suspected IPMN were retrospectively enrolled. Computed high-b-value images at b = 1000 s/mm2 were calculated from standard (b = 0, 50, 300, and 600 s/mm2) DWI images for conventional full field-of-view (fFOV, 3 × 3 × 4 mm3 voxel size) DWI. A subset of 39 patients received additional high-resolution reduced-field-of-view (rFOV, 2.5 × 2.5 × 3 mm3 voxel size) DWI. In this cohort, rFOV cDWI was compared against fFOV cDWI additionally. Two experienced radiologists evaluated (Likert scale 1–4) image quality (overall image quality, lesion detection and delineation, fluid suppression within the lesion). In addition, quantitative image parameters (apparent signal-to-noise ratio (aSNR), apparent contrast-to-noise ratio (aCNR), contrast ratio (CR)) were assessed. Diagnostic confidence regarding the presence/absence of diffusion-restricted solid nodules was assessed in an additional reader study. Results High-b-value cDWI at b = 1000 s/mm2 outperformed acquired DWI at b = 600 s/mm2 regarding lesion detection, fluid suppression, aCNR, CR, and lesion classification (p = -resolution rFOV-DWI compared to conventional fFOV-DWI (p ≤ .001–.018). High-b-value cDWI images were rated non-inferior to directly acquired high-b-value DWI images (p = .095–.655). Conclusions High-b-value cDWI may improve the detection and classification of solid lesions in IPMN. Combining high-resolution imaging and high-b-value cDWI may further increase diagnostic precision. Clinical relevance statement This study shows the potential of computed high-resolution high-sensitivity diffusion-weighted magnetic resonance imaging for solid lesion detection in pancreatic intraductal papillary mucinous neoplasia (IPMN). The technique may enable early cancer detection in patients under surveillance. Key Points • Computed high-b-value diffusion-weighted imaging (cDWI) may improve the detection and classification of intraductal papillary mucinous neoplasms (IPMN) of the pancreas. • cDWI calculated from high-resolution imaging increases diagnostic precision compared to cDWI calculated from conventional-resolution imaging. • cDWI has the potential to strengthen the role of MRI for screening and surveillance of IPMN, particularly in view of the rising incidence of IPMNs combined with now more conservative therapeutic approaches.

A squirmer enclosed in a droplet represents a minimal model for some drug delivery systems. In the case of a spherical squirmer swimming with a spherical cage in a Newtonian fluid [Reigh et al., “Swimming with a cage: Low-Reynolds-number locomotion inside a droplet,” Soft Matter 13, 3161 (2017)], it was found that the squirmer and droplet always propelled in the same direction albeit at different speeds. We expand the model to include particles' shape and medium's heterogeneity, two biologically relevant features. Our results reveal a novel behavior: a configuration that consists of a spherical squirmer and a spheroidal droplet in highly heterogeneous media yields a backward motion of the droplet.

ObjectivesThis empirical study investigated the relationship between globalisation and suicide rates. We examined whether there is a beneficial or harmful relationship between economic, political and social globalisation and the suicide rate. We also estimated whether this relationship differs in high-, middle- and low-income countries.Study designUsing panel data from 190 countries over the period 1990–2019, we examined the relationship between globalisation and suicide.MethodWe compared the estimated effect of globalisation on suicide rates using robust fixed-effects models. Our results were robust to dynamic models and models with country-specific time trends.ResultsThe effect of the KOF Globalisation Index on suicide was initially positive, leading to an increase in the suicide rate before decreasing. Concerning the effects of economic, political, and social dimensions of globalisation, we found a similar inverted U-shaped relationship. Unlike the middle-income and high-income countries, we found a U-shaped relationship for the case of low-income countries, indicating that suicide decreased with globalisation and then increased as globalisation continues to increase. Moreover, the effect of political globalisation disappeared in low-income countries.ConclusionPolicy-makers in high- and middle-income countries, below the turning points, and low-income countries, above the turning points, must protect vulnerable groups from globalisation's disruptive forces, which can increase social inequality. Consideration of local and global factors of suicide will potentially stimulate the development of measures that might reduce the suicide rate.

The aim of this study was to determine the changes in some physicochemical and microbiological properties of Kuru Kaymak (KK) (Dry Clotted Cream) during 30 days of storage at 4°C. Kuru Kaymak samples were produced in a local family business on a small scale using the traditional method. The dry matter, fat, protein, lactose and ash content, and the water activity value of KK samples on the 30th day were 97.4%, 64.2%, 23.5%, 4.40%, 1.69% and 0.59, respectively. Unlike other high-fat dairy products, Kuru Kaymak samples were found to contain a fairly high amount of protein (23.5%). The free fatty acid value showed an enormous increase of 266.7% from 0 to 30 days. Yeast and mould counts of KK samples were below the countable level (

There are no established predictors for deciding between upfront surgery and PBD in pancreatic head malignancy. Once PBD is present, the ideal drainage-time remains elusive. The aim was, to identify predictors in jaundiced patients and ideal PBD-duration.Analysis of 304 patients with pancreatic head malignancy (56% with PBD, n = 170) undergoing pancreaticoduodenectomy was performed. Postoperative morbidity and survival were analyzed.Postoperative complications increased after PBD (98.2% vs. 88.8%; p 0.001). Patients with PBD received more postoperative antibiotics (42.4% vs. 21.6%; p 0.001) and wound infections were increased (21.4% vs. 9.4%; p = 0.006). INR predicted postoperative morbidity (p = 0.026), whereas serum-bilirubin (p = 0.708), leucocytes (p = 0.158) and MELD-score (p = 0.444) had no impact. Complications were not different between long (4 weeks) and short (4 weeks) PBD-duration (p = 0.608). No life-threatening complications (CDIV + V) occurred after long drainage (0.0% vs. 8.9%; p = 0.028) and long-term survival was not compromised.INR is a suitable predictor for postoperative outcome, while serum-bilirubin levels had no predictive value. The INR can help deciding between PBD and upfront surgery. If PBD is inevitable, drainage duration of4 weeks reduced major complications.Clinical study.

Coronavirus disease-2019 (COVID-19) is an emerging pandemic disease with high morbidity and mortality. The area primarily affected in COVID-19 is the pulmonary system, where the most destructive effect occurs. Symptoms range from asymptomatic illness to mild-to-moderate (mild pneumonia), severe (dyspnea, hypoxia), and critical illness symptoms (acute respiratory distress syndrome, respiratory failure, shock, or multiorgan system dysfunction) in patients with COVID-19. Neurological manifestations, such as acute ischemic stroke, intracerebral hemorrhage, cerebral venous sinus thrombosis, conscious disturbance, febrile seizures, convulsions, mental status change, and encephalitis are observed in severe patients. Mild encephalitis/encephalopathy with reversible splenial (MERS) lesions is a clinicoradiological diagnosis that is associated with a prominent reversible lesion in the corpus callosum (SCC) splenium, infectious agent, and mild encephalopathy. In this case report, the key clinical and radiological features of MERS were highlighted in an adult patient presented to the emergency department with nausea, vomiting, and unconsciousness and admitted to the neurology clinic due to diffusion restriction in the SCC splenium.

Postoperative pancreatic fistula/POPF is the most feared complication in pancreatic surgery. Although several systematic reviews investigated the impact of somatostatin analogues on POPF, no stratification was performed regarding type of pancreatic resection (pancreaticoduodenectomy/PD; distal pancreatectomy/DP) and different somatostatin analogues.This study was planed according to the Preferred-Reporting-Items-for-Systematic -Review-and-Meta-Analysis/PRISMA-guidelines. After screening databases for randomized controlled trials/RCT, studies were stratified into pancreatic resection techniques and data were pooled in meta-analyses containing subgroups of octreotide, somatostatin, lanreotide, pasireotide and vapreotide.The meta-analysis of studies with a mixed cohort of patients after pancreatic resection revealed a protective effect of somatostatin analogues for morbidity (RR: 0.71, p .00001) but not for mortality (RR: 1.07, = 0.78) or intra-abdominal abscesses (RR: 1.00, p = 1.00). Moreover, no effect was visible for mortality (RR: 1.57, p = .15), morbidity (RR: 0.87, p = .15) and intra-abdominal abscesses (RR: 0.92, p = .48) after PD. The meta-analysis of patients after PD revealed no impact of somatostatin analogues on POPF (RR: 0.87, p = .19) and clinically relevant POPF (RR: 0.69, p = .30). However, treatment with somatostatin analogues in the mixed cohort showed less POPF (RR: 0.60, p .00001) and clinically relevant POPF (RR: 0.47, p = .02), which was also the case after DP (RR: 0.41, p = .03).Somatostatin analogues did not affect POPF and clinically relevant POPF after PD, but seemed to be associated with less POPF after DP. As no sufficiently powered RCT could be identified by the systematic review, further RCTs are urgently needed to investigate the effect of somatostatin analogues after DP.CRD42018099808.

Internal derangement of the temporomandibular joint (TMJ) is usually treated conservatively, but about 5% require surgical treatment. We designed a retrospective study to assess the long-term outcomes of eminectomy combined with discectomy and silastic interpositional graft in 44 patients who had chronic TMJ dysfunction that had not responded to traditional conservative treatment and arthrocentesis. The maximum mouth opening, pain score, Wilkes stage, and clinical dysfunction index were measured before, and two years after, operation. All the patients showed significant improvement in mouth opening and reduced pain scores (p0.0001 in each case). There were no long-term operative complications, and postoperative magnetic resonance scans showed that the silastic interpositional graft was in a stable position with no evidence of degenerative changes on the surfaces of the joint and no lymphadenopathy.

Background Intestinal Ultrasound (IUS) is a non-invasive modality capable of assessing disease activity in IBD. IUS is reliable, patient-friendly, and allows frequent monitoring of disease activity. Elastography is a measure of tissue stiffness, that is usually studied for the evaluation of intestinal fibrosis in previous studies. However, the addition of elastography to standard IUS for assessing disease severity is still limited. Here we present novel data on the diagnostic value of 2D shear-wave elastography (SWE) in the evaluation of disease severity in patients with IBD. Methods In this prospective descriptive study performed in a single center, consecutive 38 patients with UC and 22 CD were included. Disease activities of UC patients were evaluated by Mayo score and Endoscopic Activity Index (EAI) while Crohn’s Disease Activity Index (CDAI) and Harvey-Bradshaw Index (HBI) evaluated disease activation of CD patients. The bowel wall thickness (BWT) and Limberg score were also measured. The intestinal segment held by an experienced single operator with the 2D-SWE technique was estimated, and its value in kilopascal (kPa) was recorded. Results A statistically significant correlation was found between the stiffness values obtained with SWE, BWT and disease activity scores. Tissue stiffness (kPa) was correlated with HBI (r=0.772, p Conclusion 2D-SWE is a promising tool in assessing disease activity in patients with CD and UC. Further studies are needed to understand the additive value of elastography in the clinical assessment of patients with IBD.

In this research work, the effects on the structural and optical properties of e-beam irradiated Al nanoparticles (Al-NPs) by three field sizes, [Formula: see text], [Formula: see text] and [Formula: see text] fluence were studied. As a result of systematic observations, it has been possible to study the effect of electron beam on X-ray diffraction (XRD), infrared (IR) spectroscopy and Raman band modifications and, consequently, on the crystal structure and atomic dynamics of Al-NPs. The XRD method determined that Al-NPs are combined with water molecules in the air to form aluminum hydroxide (Al(OH)3) groups. The Al(OH)3 formation was not observed in any of the samples irradiated with three different fluences, [Formula: see text], [Formula: see text] and [Formula: see text], respectively. Confirmation of these results was also shown in the method of IR spectroscopy. While 12 vibrational modes were observed in the non-irradiated samples, only the vibrational modes corresponding to Al–Al bonds were observed in [Formula: see text], [Formula: see text], and [Formula: see text] fluence irradiated samples. It was determined by the Raman spectroscopy method that a low concentration of Al(OH)3 remains in the samples irradiated with [Formula: see text] fluence. Only [Formula: see text] and [Formula: see text] fluence irradiated samples were found to correspond to the XRD and IR spectra, and Raman vibrational modes corresponding to Al–Al bonds were observed. In addition, electron irradiation is a suitable technique to increase the optical properties of nanoparticles by controlling the size of the particles.

SrZrO3 is used as the best suit for thermal barrier coatings, where it is used as the topcoat. In this study, SrZrO3-based plasma spray coating powders were produced by sintering and crushing method from zirconia and strontium carbonate. The mixture of zirconia and strontium carbonate powders with an atomic ratio of Sr/Zr to 1.136 was ground in a zirconia ball mill. To increase powder fluidity, the mixture of powder was sintered with a heating rate of 10 °C/min for 24 h at 1250 °C, 1350 °C and 6 h at 1600 °C. Sintered SrZrO3 powders were screened to optimum particle size range and coated onto AISI 304L stainless steel surfaces by atmospheric plasma spray coating technique. Thermal shock tests of the SrZrO3 coated samples were executed at 1000 °C and 1200 °C for 5 min (heating) and then for 2 min cooling cycle at room temperature. The radiation attenuation properties of strontium zirconate-coated steel substrates were investigated. The linear attenuation coefficients of the SrZrO3-coated specimens were carried out for Cs-137 and Co-60 gamma radiation sources. The resulting coating powders and coatings were characterized using SEM–EDS and XRD techniques. In conclusion, the gamma shielding properties of the stainless steel substrates increased by coating.

In this work cubic phase, silicon carbide nano-powders were irradiated at the high-flux pulsed reactor IBR–2 (Dubna, Russia). The 3C–SiC powder was irradiated with neutron doses up to 1015 n/cm2. The irradiated samples were then analyzed using X-ray diffraction, Raman spectroscopy, Positron annihilation spectroscopy, and Fourier Transform Infrared Spectroscopy. The XRD analysis showed a slight decrease in the lattice parameters with the increase in neutron fluences. The results obtained from positron annihilation measurements were compared to the theoretical calculations, to recognizing the type of structural defect in the samples. A positron lifetime component 355 ps associated with the calculated values for clusters containing of 13–21 vacancies was identified. The concentration of these defects was estimated to be in the region of 5 ppm, and was very similar to the one identified on the unirradiated sample. The results also indicate high irradiation resistivity of the 3C–SiC after irradiation.

In the present work, tungsten composites were mechanically alloyed for 6 h and sintered at 1750°C under N2, H2 gas flowing conditions. Phase and microstructural characterization investigations of tungsten alloys were carried out using X-ray diffraction, scanning electron microscopy, small-angle neutron scattering, and Raman spectroscopy. Tungsten boron and tungsten boride as major phases were determined in the X-ray diffraction patterns. Raman spectra indicated the existence of the carbon phases, which are the disordered graphite (D) and graphite (C). Small-angle neutron scattering measurements were performed to obtain the distribution of powders. The results were in good agreement with scanning electron microscopy findings.

Silicide hexaboride (SiB6) compound with a purity of 99.5% was irradiated using 60Co gamma radioisotope under the atmospheric pressure with a dose rate (D) of 0.27 Gy/s at the 9.7, 48.6, 97.2, 145.8 and 194.4 kGy doses at room temperature. The oxidation kinetics, diffusion velocity, and depth of oxidation of the SiB6 compound were determined by using a differential scanning calorimetry (DSC) in the temperature range of 920 ≤ T ≤ 1270K. The maximum thickness of the B2O3 and SiO2 oxide layers was determined on the surface of SiB6 from the caloritmetric analyzes. The thickness of the formed oxide layers was found in the range of 10 nm and 60 nm. The activation energy of oxide layers formed on the surface as observed from Arrhenius plots was found to increase up to 49.8 kJ mol−1 with respect to absorption dose of SiB6 samples in the temperature range between 950 K and 1270 K. The results have revealed that it has been observed a change in thermodynamic functions (ΔS, ΔH, and ΔG) from room temperature up to 1270 K.

Background Pancreatic fistula (PF) is a common complication after pancreatic surgery. It is unclear how microbes in PF fluid affect outcomes and which microbes are present after pancreatoduodenectomy (PD) and distal pancreatectomy (DP). The aim of this study was to compare the microbiological spectrum of PF fluid after PD versus DP, and its association with postoperative complications. Methods Bacterial strains and antibiotic resistance rates of bacterial swabs obtained from the PF fluid of patients who underwent DP or PD were analysed. Cultured bacteria were classified as Enterobacterales and as ‘other intestinal and non‐intestinal microorganisms’ based on whether they are typically part of the normal human intestinal flora. Results A total of 847 patients had a pancreatic resection (PD 600; DP 247) between July 2007 and December 2016. Clinically relevant PF was detected in 131 patients (15·5 per cent). Bacterial swabs were obtained from 108 patients (DP 47; PD 61), of which 19 (17·6 per cent) were sterile. Enterobacterales were detected in 74 per cent of PF fluid swabs after PD, and in 34 per cent after DP. Infected, polymicrobial or multidrug‐resistant PF fluid was more common after PD (rates of 95, 50 and 48 per cent respectively) than after DP (66, 26 and 6 per cent respectively). Patients with higher grade complications (Clavien–Dindo grade IV–V) or grade C PF had more Enterobacterales and multidrug‐resistant Enterobacterales in the PF fluid after DP. Conclusion Enterobacterales and multidrug‐resistant bacteria are detected frequently after PD and DP, and are associated with more severe complications and PF in patients undergoing DP., This study showed that, despite the absence of intestinal lumen opening, pancreatic fistulas after distal pancreatectomy frequently contain intestinal bacteria, which markedly worsen the clinical outcome. Understanding the pathogenetic mechanism behind this high prevalence of intestinal bacteria within distal pancreatectomy‐associated pancreatic fistulas may help to generate effective therapeutic regimens. Enterobacteria associated with complications after distal pancreatectomy

Boron carbide ( $$\hbox {B}_{\mathrm {4}}\hbox {C}$$ ) has been widely used in nuclear reactors and nuclear applications. In this work, the high-purity (99.9%) $$\hbox {B}_{\mathrm {4}}\hbox {C}$$ samples were irradiated using a gamma source ( $$^{\mathrm {60}}\hbox {Co}$$ ) with a dose rate (D) of 0.27 Gy/s at different gamma irradiation doses at room temperature. Phase and microstructural characterisation of $$\hbox {B}_{\mathrm {4}}\hbox {C}$$ samples were carried out using X-ray diffraction (XRD) and scanning electron microscopy (SEM). XRD results displayed some degradation of the diffraction peaks. The calculations reveal that 62% of $$\hbox {B}_{\mathrm {4}}\hbox {C}$$ has changed into the amorphous phase when the irradiation dose is 194.4 kGy. Fourier transform infrared spectroscopy (FTIR) was used to explain chemical bonds and functional groups of $$\hbox {B}_{\mathrm {4}}\hbox {C}$$ samples before and after gamma irradiation. The results showed that C–C chemical bonds are weaker than B–C chemical bonds and tend to break under gamma irradiation. Element mapping analysis for each gamma irradiation dose of $$\hbox {B}_{\mathrm {4}}\hbox {C}$$ samples was performed using SEM patterns. The dynamics of the elements on the surface and chemical formula of all $$\hbox {B}_{\mathrm {4}}\hbox {C}$$ samples were also determined after gamma irradiation.

Background/objective: Although a number of studies report an important effect of smoking on disc degeneration and herniation, others did not identify such a relationship. The purpose of this study was to assess the relationship of lumbar disc degeneration with hemoglobin value and smoking. Methods: The study included 200 adult patients who presented to the neurosurgery polyclinic with a complaint of back pain. Smoking habits were classified as “smoking for more than 10 years”, “smoking for less than 10 years”, and “not smoking”. Lumbar disc degeneration was classified on modified Pfirrmann score according to lumbar MR images. Degeneration level was compared according to smoking group on Kruskal-Wallis test. The relationship between hemoglobin value and disc degeneration according to smoking group was assessed on the Spearman correlation coefficient. Results: Disc degeneration values were significantly different between groups in L5-S1, L4-L5 and L3-L4 (P = 0.018, P = 0.012, P = 0.038). Degeneration levels in L5-S1 in those who did not smoke were significantly lower than in those who smoked for both less and more than 10 years (P = 0.048, P = 0.022). No significant differences were found in degeneration level between those who smoked for more versus less than 10 years. For L3-L4 degeneration, there was a significant relationship with hemoglobin value in the group that did not smoke and in the group that smoked for more than 10 years (r = ?0.395; P = 0.009, r = 0.329; P = 0.018). Conclusion: This study found that, when risk factors such as systemic disease, heavy working conditions, obesity, trauma and family history were excluded, smoking increased lumbar disc degeneration. In addition, chronic smoking was found to increase hemoglobin values. © 2020 Elsevier Masson SAS 2-s2.0-85091923580 PubMed: 32866500

Adolescence is a developmental period in which social interactions become increasingly important. Successful social interactions rely heavily on pragmatic competence, the appropriate use of language in different social contexts, a skill that is still developing in adolescence. In the present study, we used fMRI to characterize the brain networks underlying pragmatic language processing in typically developing adolescents. We used an indirect speech paradigm whereby participants were presented with question/answer dialogues in which the meaning of the answer had to be inferred from the context, in this case the preceding question. Participants were presented with three types of answers: (1) direct replies, i.e., simple answers to open-ended questions, (2) indirect informative replies, i.e., answers in which the speaker’s intention was to add more information to a yes/no question, and (3) indirect affective replies, i.e., answers in which the speaker’s intention was to express polite refusals, negative opinions or to save face in response to an emotionally charged question. We found that indirect affective replies elicited the strongest response in brain areas associated with language comprehension (superior temporal gyri), theory of mind (medial prefrontal cortex, temporo-parietal junction, and precuneus), and attention/working memory (inferior frontal gyri). The increased activation to indirect affective as opposed to indirect informative and direct replies potentially reflects the high salience of opinions and perspectives of others in adolescence. Our results add to previous findings on socio-cognitive processing in adolescents and extend them to pragmatic language comprehension.

Solar electricity generation has been investigated in three different sectors as residential, commercial and industrial. This study aims to forecast the solar electricity generation in 5 years by using statistical analysis and make projection of predictions about what could the solar technology can become in Turkey, using USA data on solar electricity generation since statistical analysis is made by using evaluation of regression analysis for these sectors. The results show that the PV generation for the sectors by years such as distributed solar photovoltaic generation value varies from 10.41 MkW h (1989) to 10,464.61 MkW h (2016) for the residential sector; from 14.72 MkW h (1989) to 7179.62 MkW h (2016) for the commercial sector; and from 3.26 MkW h (1989) to 1822.60 MkW h (2016) for the industrial sector. Additionally, forecast of energy distribution (million kW h) has been carried out that from 12783.96 to 28738.31; from 6524.67 to 8018.74; from 1927.91 to 3435.58 with respect to sectors of residential, commercial and industrial, respectively. These results are obtained with the R2 values (0.968667; 0.932558; 0.716024). Consequently, it would not be wrong to express that the solar energy is no more a novelty, but a necessity with the daily electricity usage. In this study, the novelty lies in study’s unique combination of analysing goals with a benchmarking evaluation between USA and Turkey. This is illustrated with the forecasting energy distribution of over 8%, a component usage of at least three equivalent sectors.