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Dysfunctions in the lower esophageal sphincter (LES) and the upper esophageal sphincter (UES) levels can occur owing to poor muscle coordination, contraction, or relaxation. Such condition can possibly be addressed by functional rehabilitation. The aim of this study was to measure pressure changes in the UES and LES at rest and during routine rehabilitation techniques, that is, cervical manual traction and trunk stabilization maneuver.This study was conducted in a University Hospital Gastrointestinal Endoscopy Center. Cervical manual traction and a trunk stabilization maneuver were performed in a convenient group of 54 adult patients with gastroesophageal reflux disease. High-resolution manometry was used to measure pressure changes in the LES and UES at rest and during manual cervical traction and trunk stabilization maneuver.Average initial resting UES pressure was 90.91 mmHg. A significant decrease was identified during both cervical traction (average UES pressure = 42.13 mmHg, P.001) and trunk stabilization maneuver (average UES pressure = 62.74 mmHg, P = .002). The average initial resting LES pressure was 14.31 mmHg. A significant increase in LES pressure was identified both during cervical traction (average LES pressure = 21.39 mmHg, P.001) and during the trunk stabilization maneuver, (average pressure = 24.09 mmHg, P.001).Cervical traction and trunk stabilization maneuvers can be used to decrease pressure in the UES and increase LES pressure in patients with gastroesophageal reflux disease.

We show that for a quasicompact quasiseparated scheme $X$, the following assertions are equivalent: (1) the category $\operatorname{QCoh}(X)$ of all quasicoherent sheaves on $X$ has a flat generator; (2) for every injective object $\mathcal E$ of $\operatorname{QCoh}(X)$, the internal hom functor into $\mathcal E$ is exact; (3) the scheme $X$ is semiseparated., Comment: 8 pages, added Section 3

Extending the Wedderburn-Artin theory of (classically) semisimple associative rings to the realm of topological rings with right linear topology, we show that the abelian category of left contramodules over such a ring is split (equivalently, semisimple) if and only if the abelian category of discrete right modules over the same ring is split (equivalently, semisimple). Our results in this direction complement those of Iovanov-Mesyan-Reyes. An extension of the Bass theory of left perfect rings to the topological realm is formulated as a list of conjecturally equivalent conditions, many equivalences and implications between which we prove. In particular, all the conditions are equivalent for topological rings with a countable base of neighborhoods of zero and for topologically right coherent topological rings. Considering the rings of endomorphisms of modules as topological rings with the finite topology, we establish a close connection between the concept of a topologically perfect topological ring and the theory of modules with perfect decomposition. Our results also apply to endomorphism rings and direct sum decompositions of objects in certain additive categories more general than the categories of modules; we call them topologically agreeable categories. We show that any topologically agreeable split abelian category is Grothendieck and semisimple. We also prove that a module $\Sigma$-coperfect over its endomorphism ring has a perfect decomposition provided that either the endomorphism ring is commutative or the module is countably generated, partially answering a question of Angeleri Hugel and Saorin., Comment: LaTeX 2e with tikz-cd, 69 pages; v.3: new Section 13 inserted, final Section 14 (former 13) rewritten with much more complete picture obtained using new results of arXiv:1911.11720, Lemma 7.2 deleted as no longer relevant, Examples 3.7(2) and 9.4 inserted; v.4: Remarks 3.11 and 7.2 inserted; v.5: misprints corrected, references updated, a reference to Example 10.2 in arXiv:2110.13105 added

BACKGROUND: Anorectal dysfunction (ARD), especially bowel incontinence, frequently compromises the quality of life in multiple sclerosis (MS) patients. The effect of rehabilitation procedures has not been clearly established. OBJECTIVE: To determine the effect of an individualized rehabilitation approach on bowel incontinence and anorectal pressures. METHODS: MS patients with ARD underwent 6-months of individually targeted biofeedback rehabilitation. High resolution anorectal manometry (HRAM) and St. Mark’s Fecal Incontinence Scores (SMIS) were completed prior to rehabilitation, after 10 weeks of supervised physiotherapy, and after 3 months of self-treatment. RESULTS: Ten patients (50%) completed the study. Repeated measures analysis of variance (ANOVA) demonstrated significant improvement in the SMIS questionnaire over time [14.00 baseline vs. 9.70 after supervised physiotherapy vs. 9.30 after self-treatment (p = 0.005)]. No significant improvements over time were noted in any HRAM readings: maximal pressure [49.85 mmHg baseline vs. 57.60 after supervised physiotherapy vs. 60.88 after self-treatment (p = 0.58)], pressure endurance [36.41 vs. 46.89 vs. 49.95 (p = 0.53)], resting pressure [55.83, vs 52.69 vs. 51.84 (p = 0.704)], or area under the curve [230.0 vs. 520.8 vs. 501.9 (p = 0.16)]. CONCLUSIONS: The proposed individualized rehabilitation program supports a positive overall effect on anorectal dysfunction in MS patients.

We define the notion of an infinitely generated tilting object of infinite homological dimension in an abelian category. A one-to-one correspondence between $\infty$-tilting objects in complete, cocomplete abelian categories with an injective cogenerator and $\infty$-cotilting objects in complete, cocomplete abelian categories with a projective generator is constructed. We also introduce $\infty$-tilting pairs, consisting of an $\infty$-tilting object and its $\infty$-tilting class, and obtain a bijective correspondence between $\infty$-tilting and $\infty$-cotilting pairs. Finally, we discuss the related derived equivalences and t-structures.

Over a twenty-year period, we performed 255 ERCP procedures in infants aged up to 1 year. ERCP was indicated in cholestatic infants with suspicion of biliary obstruction. The most common diagnosis was biliary atresia (48%), choledochal cysts (13%), and choledocholithiasis (4%). The procedure complication rate was 13.7%. Hyperamylasemia occurred in 12.9%. More severe complications were rare‐0.8% of ERCP procedure. There were no cases of postprocedural pancreatitis or death. Our study has proved that ERCP is a safe and reliable method in this age group. Its high specificity and negative predictive value for extrahepatic biliary atresia can prevent unnecessary surgeries in patients with normal bile ducts or endoscopically treatable pathologies.

We show that silting modules are closely related with localisations of rings. More precisely, every partial silting module gives rise to a localisation at a set of maps between countably generated projective modules and, conversely, every universal localisation, in the sense of Cohn and Schofield, arises in this way. To establish these results, we further explore the finite-type classification of tilting classes and we use the morphism category to translate silting modules into tilting objects. In particular, we prove that silting modules are of finite type., 20 pages; version 2: Subsection 6.4 added with an example of a silting ring epimorphism which is not a universal localisation, small changes in presentation (e.g. Proposition 3.3 now summarizes properties of set-generated cotorsion pairs), references added and updated

Introduction : Biliary cysts with an abnormal pancreatobiliary junction are one of the most common pancreatobiliary malformations. The main symptom is cholestasis; endoscopic retrograde cholangiopancreatography (ERCP) plays a key role in diagnosis. Aim : Retrospective evaluation of ERCP performed to diagnose abnormalities of the pancreatobiliary junction. Material and methods : We retrospectively evaluated ERCP performed to diagnose abnormalities of the pancreatobiliary junction, mainly choledochal cysts, in 112 children between 1990 and 2011. Results : We performed 112 examinations of 50 children with abnormal pancreatobiliary junction and choledochal cysts (15 males and 35 females, average age: 5 years, range: 1 month – 15 years). Cysts were associated with a common channel in 37 (74%) cases, were not associated with a common channel in 9 (18%) cases, and in 3 (6%) cases the common channel lacked cysts. We performed endoscopic papilla sphincterotomy on 33 (66%) patients; endoscopic drainage was performed 62 times, including 17 patients without papilla sphincterotomy. In 15 (30%) cases, we only performed sphincterotomy. Extraction of lithiasis was done in 2 (4%) cases. Both ERCP and magnetic resonance cholangiopancreatography (MRCP) were performed on 13 patients. There was concordance of the choledochal cyst and of the type of cyst in both methods; however, common channels could not be observed by MRCP. There was 1 serious complication (perforation after sphincterotomy) and 11 (9%) mild adverse events. Conclusions : When performed at an expert centre, ECRP is a safe and reliable procedure for children with choledochal cysts and/or an abnormal pancreatobiliary junction. Endoscopic retrograde cholangiopancreatography remains a reasonable alternative because MRCP has a limited ability to diagnose the precise anomalies of the pancreatobiliary junction and has no therapeutic capabilities.

The purpose of this study was to determine the relation between posturally increased intra-abdominal pressure and lower/upper esophageal sphincter pressure changes in patients with gastroesophageal reflux disease. We used high resolution manometry to measure pressure changes in lower and upper esophageal sphincter during bilateral leg rise. We also examined whether the rate of lower and upper esophageal sphincter pressure would increase during leg raise differentially in individuals with versus without normal resting pressure. Fifty eight patients with gastroesophageal reflux disease participated in the study. High resolution manometry was performed in relaxed supine position, then lower and upper esophageal sphincter pressure was measured. Finally, the subjects were instructed to keep their legs lifted while performing 90-degree flexion at the hips and knees and the pressure was measured again. Paired t-test and independent samples t-test were used. There was a significant increase in both lower (P 0.001) and upper esophageal sphincter pressure (P = 0.034) during leg raise compared to the initial resting position. Individuals with initially higher pressure in lower esophageal sphincter (10 mmHg) exhibited a greater pressure increase during leg raise than those with initially lower pressure (pressure ≤10 mmHg; P = 0.002). Similarly individuals with higher resting upper esophageal sphincter pressure (44 mmHg) showed a greater pressure increase during leg raise than those with lower resting pressure (≤44 mmHg; P 0.001). The results illustrate the influence of postural leg activities on intraesophageal pressure in patients with gastroesophageal reflux disease, indicating by means of high resolution manometry that diaphragmatic postural and sphincter function are likely interrelated in this population.

Background: Diaphragm (crural part), is considered to be a part of the antireflux barrier. This work is dedicated to the diaphragm in the role of the lower esophageal sphincter (LES). We want to point out the potential impact of the diaphragm on the competence of this LES by patients with esophageal reflux disease and to reveal the possibilities how physiotherapy can help in the training of this part of the skeletal muscle. Method: The group: 60 patients. average 46,5 (20 - 77) years, 29 women and 31 men. BMI 26.2. Examination using MMS9s High Resolution Esophageal Manometry using a 36-channel and a special spirometry focused on the strength of the respiratory muscles, so-called occlusal pressures (MasterScope version 5.5 from Jaeger). Results: The mean resting pressure in the region of the lower esophageal sphincter was 14mm/Hg. Cervical Traction: Increased statistically significantn LES pressure (p= 0.000276574). Manual Chest Stabilisation: LES pressure increased on 23 mm/Hg (p = 2,37727E-10). Abdominal Breathing: LES pressure increased on 22 mm/Hg (p = 0.00000852412). Leg Raise: LES pressure increased on 30mm/Hg (p = 1,96313E-8). Patients with GERD have a significantly lower PEmax than the norm (p= 0.0000055177) and PImax (p = 7.61528E-11). Summary: Patients with GERD have decreased inspiration and expiratory function. The results indicate the sphincter function of the diaphragm, the influence of postural and respiratory mechanics on the crural part of diaphragm and lower esophagus area and also the possibility of functional training in the LES area (during respiratory and postural maneuvers).

We introduce a general version of singular compactness theorem which makes it possible to show that being a $\Sigma$-cotorsion module is a property of the complete theory of the module. As an application of the powerful tools developed along the way, we give a new description of Gorenstein flat modules which implies that, regardless of the ring, the class of all Gorenstein flat modules forms the left-hand class of a perfect cotorsion pair. We also prove the dual result for Gorenstein injective modules., Comment: 34 pages; small changes made and details added

Compliance to therapy is a key factor in the efficacy of treatment in clinical practice. The aim of our study was to evaluate the rate of compliance with mesalazine in patients with ulcerative colitis (UC), to examine risk factors of noncompliance and especially find ways on how adherence can be improved.A total of 198 outpatients with UC completed two anonymous questionnaires including information on basic demographics, details of patient´s disease and the use of mesalazine medication and quality of life.We found noncompliance (percentage of used medication per day less than 80%) with 5-ASA in 21.2% patients. Our study proved that the education level of patients significantly influenced the compliance of patients using mesalazine. A significant difference (p = .014) was found between the compliance of patients with secondary school education (84.1 ± 16.73) and those with university education (94.1 ± 9.9). The majority of patients preferred mesalazine once daily and are less likely to forget to take medication in the morning. Better quality of life was observed based on our data from WHOQOL-BREF questionnaire in statistically significant way in patients using concomitant therapy of immuosuppressive or biological therapy, lower daily doses and using sachets not tablets.Our study proved that compliance with mesalazine in patients with UC was related only to education level. If we target mesalazine therapy based on patient's preferences, we can improve the adherence with mesalazine. Our data could be beneficial for the treatment strategy in clinical practice.

Trauma is one of the most common causes of morbidity and mortality in the pediatric population. The diagnosis of pancreatic injury is based on clinical presentation, laboratory and imaging findings, and endoscopic methods. CT scanning is considered the gold standard for diagnosing pancreatic trauma in children.This retrospective study evaluates data from 25 pediatric patients admitted to the University Hospital Motol, Prague, with blunt pancreatic trauma between January 1999 and June 2013.The exact grade of injury was determined by CT scans in 11 patients (47.8%). All 25 children underwent endoscopic retrograde cholangiopancreatography (ERCP). Distal pancreatic duct injury (grade III) was found in 13 patients (52%). Proximal pancreatic duct injury (grade IV) was found in four patients (16 %). Major contusion without duct injury (grade IIB) was found in six patients (24%). One patient experienced duodeno-gastric abruption not diagnosed on the CT scan. The diagnosis was made endoscopically during ERCP. Grade IIB pancreatic injury was found in this patient. One patient (4%) with pancreatic pseudocyst had a major contusion of pancreas without duct injury (grade IIA). Four patients (16%) with grade IIB, III and IV pancreatic injury were treated exclusively and nonoperatively with a pancreatic stent insertion and somatostatine. Two patients (8%) with a grade IIB injury were treated conservatively only with somatostatine without drainage. Eighteen (72 %) children underwent surgical intervention within 24 h after ERCP.ERCP is helpful when there is suspicion of pancreatic duct injury in order to exclude ductal leakage and the possibility of therapeutic intervention. ERCP can speed up diagnosis of higher grade of pancreatic injuries.

Background and study aims: The aim of this study was to assess the significance and safety of endoscopic retrograde cholangiopancreatography (ERCP) in diagnosing and treating bile duct injuries in children.Patients and methods: Fourteen pediatric patients, with traumatic or postoperative bile duct injury, in which ERCP was performed, were retrospectively evaluated.Results: We performed 46 ERCP and 12 endoscopic papillotomies in children with suspected bile duct injuries. A bile stent was primarily inserted in 13 patients and there were 20 replacements. Endoscopic treatment of bile leakage without need for bile duct sutures or reconstruction was successful in 85.7%. Post ERCP complications included cholangitis and recurrent bleeding, which occurred only in two patients each.Conclusions: ERCP and endoscopic bile stent insertion is a highly effective, minimally-invasive treatment for bile duct injury and should be included as part of the therapeutic procedures in pediatric patients with suspected bil...

A classic result by Raynaud and Gruson says that the notion of an (infinite dimensional) vector bundle is Zariski local. This result may be viewed as a particular instance (for n = 0) of the locality of more general notions of quasi-coherent sheaves related to (infinite dimensional) n-tilting modules and classes. Here, we prove the latter locality for all n and all schemes. We also prove that the notion of a tilting module descends along arbitrary faithfully flat ring morphisms in several particular cases (including the case when the base ring is noetherian)., Comment: 23 pages

We show, for a wide class of abelian categories relevant in representation theory and algebraic geometry, that the bounded derived categories have no non-trivial strongly finitely generated thick subcategories containing all perfect complexes. In order to do so we prove a strong converse of the Ghost Lemma for bounded derived categories., 15 pages; version 2: more details added and presentation improved, reference list expanded and updated including references to examples illustrating our results

We show that for an artin algebra $\Lambda$, the telescope conjecture for module categories is equivalent to certain idempotent ideals of mod-$\Lambda$ being generated by identity morphisms. As a consequence, we prove the conjecture for domestic standard selfinjective algebras and domestic special biserial algebras. We achieve this by showing that in any Krull-Schmidt category with local d.c.c. on ideals, any idempotent ideal is generated by identity maps and maps from the transfinite radical., Comment: 14 pages, a comment on the Krull-Gabriel dimension added to section 4

Background Clostridium difficile infection (CDI) is a major cause of antibiotic-associated diarrhoea. Given an increasing CDI incidence and global spread of epidemic ribotypes, a 1-year study was performed to analyse the molecular characteristics of C. difficile isolates and associated clinical outcomes from patients diagnosed with CDI in the Internal Medicine department at University Hospital Motol, Prague from February 2013 to February 2014. Results A total of 85 unformed stool samples were analysed and CDI was laboratory confirmed in 30 patients (6.8 CDI cases per 10,000 patient bed days and 50.6 CDI cases per 10,000 admissions). The CDI recurrence rate within 3 months of treatment discontinuation was 13.3% (4/30). Mortality within 3 months after first CDI episode was 26.7% (8/30), with CDI the cause of death in two cases. 51.9% of C. difficile isolates belonged to PCR-ribotype 176. MLVA of ribotype 176 isolates revealed two clonal complexes formed by 10/14 isolates. ATLAS scores and Horn’s index were higher in patients with ribotype 176 infections than with non-ribotype 176 infections. Conclusion This study highlights the clinical relevance of C. difficile PCR-ribotype 176 and its capacity to spread within a healthcare facility.

Objective. Neurological complications of inflammatory bowel diseases (IBDs) are not rare but are under-diagnosed; some are probably immune-mediated. Several previous studies have suggested a higher incidence of demyelinating diseases such as multiple sclerosis in IBD patients. In this single-center, prospective, observational study, the authors focus on T2 focal white-matter lesions of the central nervous system on magnetic resonance imaging (MRI) in IBD patients that may be due to demyelination. Material and methods. A total of 70 patients with Crohn’s disease were examined before beginning antiTNF-a therapy. These patients were treated with azathioprine, mesalazine or both. Patients were examined by a neurologist to detect possible signs of demyelinating disease, and patients underwent brain MRI (native T1, T2, and FLAIR sequences). Results. Thirty-seven patients (53%) exhibited abnormalities on neurological examination, and 26 patients (37%) displayed abnormalities on MRI. In seven cases, these MRI abnormalities (periventricular lesions) were suspected to be due to demyelination. Cerebral spinal fluid investigation (including polyclonal bands) was completely negative in five cases and was borderline in one case, and multiple sclerosis was confirmed in one case. Pathological MRI findings in 19 other patients were clinically nonsignificant; most were nonspecific sporadic lesions in white matter or mild atrophy. Conclusions. The results support previous data that the frequency of neurological findings in IBD patients is generally underestimated. With the extension of biological anti-TNF-a treatment for IBD, the possibility of a higher risk of developing multiple sclerosis should be considered.

A full subcategory of a Grothendieck category is called deconstructible if it consists of all transfinite extensions of some set of objects. This concept provides a handy framework for structure theory and construction of approximations for subcategories of Grothendieck categories. It also allows to construct model structures and t-structures on categories of complexes over a Grothendieck category. In this paper we aim to establish fundamental results on deconstructible classes and outline how to apply these in the areas mentioned above. This is related to recent work of Gillespie, Enochs, Estrada, Guil Asensio, Murfet, Neeman, Prest, Trlifaj and others., Comment: 20 pages; version 2: minor changes, misprints corrected, references updated

By the Telescope Conjecture for Module Categories, we mean the following claim: "Let R be any ring and (A, B) be a hereditary cotorsion pair in Mod-R with A and B closed under direct limits. Then (A, B) is of finite type." We prove a modification of this conjecture with the word 'finite' replaced by 'countable'. We show that a hereditary cotorsion pair (A, B) of modules over an arbitrary ring R is generated by a set of strongly countably presented modules provided that B is closed under unions of well-ordered chains. We also characterize the modules in B and the countably presented modules in A in terms of morphisms between finitely presented modules, and show that (A, B) is cogenerated by a single pure-injective module provided that A is closed under direct limits. Then we move our attention to strong analogies between cotorsion pairs in module categories and localizing pairs in compactly generated triangulated categories., 31 pages; minor changes, typos corrected, references added

To the Editor: Primary intestinal lymphangiectasia is a rare cause of exudative enteropathy. Symptoms include diarrhoea, peripheral oedema, lymph oedema of the limbs, malaise and weight loss. A 25-...

We show that over any ring, the double Ext-orthogonal class to all flat Mittag-Leffler modules contains all countable direct limits of flat Mittag-Leffler modules. If the ring is countable, then the double orthogonal class consists precisely of all flat modules and we deduce, using a recent result of \v{S}aroch and Trlifaj, that the class of flat Mittag-Leffler modules is not precovering in Mod-R unless R is right perfect., Comment: 7 pages; version 2: minor changes, more explanation added in the proof of Theorem 6 and Lemma 7, references added and updated

We show that the homotopy category of complexes K(B) over any finitely accessible additive category B is locally well generated. That is, any localizing subcategory L in K(B) which is generated by a set is well generated in the sense of Neeman. We also show that K(B) itself being well generated is equivalent to B being pure semisimple, a concept which naturally generalizes right pure semisimplicity of a ring R for B = Mod-R., 17 pages, minor changes, final version, to appear in Documenta Mathematica

We classify all tilting and cotilting classes over commutative noetherian rings in terms of descending sequences of specialization closed subsets of the Zariski spectrum. Consequently, all resolving subcategories of finitely generated modules of bounded projective dimension are classified. We also relate our results to Hochster's conjecture on the existence of finitely generated maximal Cohen-Macaulay modules., 28 pages; version 2: a citation of the closely related paper arXiv:1202.5605 by Dao and Takahashi added; version 3: minor changes, the proofs of Corollary 4.3 and Theorem 5.10 have been extended and some points in them clarified, and the assumptions of Theorem 5.16 have been made more restrictive