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Endoscopic necrosectomy has emerged as the preferred treatment modality for walled-off pancreatic necrosis. This study was designed to evaluate the safety and efficacy of direct endoscopic necrosectomy with and without hydrogen peroxide (H2O2) lavage.Retrospective chart reviews were performed for all patients undergoing endoscopic transmural management of walled-off pancreatic necrosis at 9 major medical centers from November 2011 to August 2018. Clinical success was defined as the resolution of the collection by imaging within 6 months, without requiring non-endoscopic procedures or surgery.Of 293 patients, 204 met the inclusion criteria. Technical and clinical success rates were 100% (204/204) and 81% (166/189), respectively. For patients, 122 (59.8%) patients had at least one H2O2 necrosectomy (H2O2 group) and 82 (40.2%) patients had standard endoscopic necrosectomy. Clinical success was higher in the H2O2 group: 106/113 (93.8%) vs 60/76 (78.9%), P = 0.002. On a multivariate analysis, the use of H2O2 was associated with higher clinical success rate (odds ratio 3.30, P = 0.033) and earlier resolution (odds ratio 2.27, P0.001). During a mean follow-up of 274 days, 27 complications occurred. Comparing procedures performed with and without H2O2 (n = 250 vs 183), there was no difference in post-procedure bleeding (7 vs 9, P = 0.25), perforation (2 vs 3, P = 0.66), infection (1 vs 2, P = 0.58), or overall complication rate (n = 13 [5.2%] vs 14 [7.7%], P = 0.30).H2O2-assisted endoscopic necrosectomy had a higher clinical success rate and a shorter time to resolution with equivalent complication rates relative to standard necrosectomy.See the visual abstract at http://links.lww.com/AJG/B714.(Equation is included in full-text article.).

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Islet autotransplantation (IAT) is increasingly being performed to mitigate against the diabetic complications of pancreatic resection in patients with benign inflammatory pancreatic disorders; however, the glycemic benefit of IAT in patients undergoing partial pancreatic resection is not known. We aimed to determine whether IAT improved glycemic outcomes in patients undergoing distal pancreatectomy for benign inflammatory disease. We performed a multicenter, retrospective case-control study of patients who underwent distal pancreatic resection with IAT at two U S tertiary care centers. The primary outcome was the mean change in pre- vs post-operative HgA1c following transplant as well as the development of new post-operative diabetes. Nine patients requiring distal pancreatectomy for benign disease underwent IAT and were compared to 13 historical controls without IAT. Baseline characteristics were similar between groups. With a median follow-up of 22 months, those who received an IAT had a smaller increase in their pre- vs post-operative HgA1c (0.42 vs 2.83, P = .004), and one case patient (14.3%) vs three control patients (23.1%) developed new post-operative diabetes (P = .581). We conclude that patients undergoing distal pancreatic resection for benign inflammatory disease should be considered for IAT, as long-term glycemic outcomes appear to be improved in those undergoing transplant.

This chapter examines the emergence of the horror genre in comics in the 1940s and 1950s. It argues that the hearings of the US Senate subcommittee on juvenile delinquency, in 1954, codified and enshrined generic discourses which had not fully coalesced until that point. In particular, publishers sought to distinguish between “horror” and “the weird,” which they described as more respectable and literary, in order to defend their own practices, while the two labels were perceived and used as differences of degrees up to that point. The chapter also argues that the potency of this moment of genre definition led to an unusual stability of the horror genre in the following three decades.

This chapter examines the theoretical blind spots in common uses of the notion of genre in comics studies. It argues that genres cannot be understood solely at the level of the texts themselves and that they do not constitute stable, finite categories, although a text-centric model of ahistorical categories often proves convenient as a shorthand. Offering a brief account of relevant genre theory in film and literature studies, the chapter argues for a socio-discursive approach to genres and their uses, based on a study of the specific context of production and reception of comics in the United States.

This chapter examines the case of comics architext whose status as a genre is contested. Examining in turn literary adaptations, graphic novels, manga and YA, it details the discourses claiming that each of these categories is or is not a genre, and tracks the arguments used by the proponent of each thesis. Using the comics of Mike Mignola as an example, the chapter also points to the existence of idiosyncratic text groupings which bear most of all of the functions of established genres. It offers a range of hypothesis regarding the threshold of genericity in the comics world, based on the existing of conflicting architextual claims and on the criteria used to adjudicate the resemblance between the various members of the grouping.

This chapter examines the role of genres in online amateur comics. After a brief historical overview, it uses a survey of four major platforms on which amateur comics producers can post their work (DeviantArt, Tumblr, Reddit, ImgUR) to chart the form and nature of the generic discourses to be found on these sites; while genres are present in all four cases, they play a limited role, which can be partly explained by the absence of a fixed context of consumption for digital content. The chapter also examines the distinction between hashtags and genres, even in cases in which the hashtags include traditional generic labels.

This chapter reflects on the interaction between genres and media, making the case that specific affordances and the fact that genres evolve in different ways across media makes it necessary to consider genre as medium-specific discourses. The chapter also examines the factors which reduce or obfuscate the distinction between these medium-specific versions of various genres, including convenience and the intermedial circulations of successful works and trends.

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This chapter examines the role played by critics and fans in the definition of genres in comics. It argues that among the competing generic claims in the comics world, established criticism plays a weaker role than in other mass media, and that online platforms further blur the hierarchy between fans and critics. Subsequently, the chapter examines two cases in which fans have used online tools to challenge the generic claims made by comics producers, in the controversy surrounding the 9/11 issue of the Amazing Spider-Man, in 2001, and more recently, as part of the Comicsgate movement.

This chapter investigates the ways in which genres are made manifest, both in the peritext of the comics and in the comics themselves. It argues that the use of the paratext to advertise genres has undergone a significant transformation since the 1940s, with a shift from genres to proprietary architexts, enabled by the physical properties of comic books and graphic novels. The chapter also examines the funny animal genre, to argue that nearly all of the stylistic and narrative choices to be found in these comics constitute genre signifiers.

This chapter examines the usefulness of genres for the producers of comics, including the creators, publishers and the other actors involved into the creation and distribution of these texts. It argues that genres and other architexts serve to mitigate risks in an industry of prototype, that they can serve as intertextual building blocks and that they can be used to trigger cultural memories, occasionally tied to cultural hierarchies.

This conclusion reflects on the relevance of traditional genres in view of some of the changes highlighted in the previous chapters. It argues that genres now have to contend with a variety of other technological and discursive tools to map personal affinities and families of text. It suggests that in spite of their diminished relevance in the comics world, genres retain their functions, as well as a nostalgic and referential appeal.

This chapter examines comics crossovers as privileged sites for the expression of publisher-centric discourses on genres. It argues that crossovers foreground conventions and narrative expectations in a compact and overt form. Through a close reading of the 1995 Superman/Aliens crossovers, the chapter examines the way inter-company crossovers call attention to the articulation between proprietary architexts, such as franchises and genres. In this case, the encounter between the two franchises reinscribes Superman and Alien explicitly in the science-fiction and body horror genres.

Article destiné à la préparation du Capes; National audience; Ce dossier diachronique est composé d'extraits de trois textes évoquant à la destinée internationale des Etats-Unis : « The American Century, » un éditorial du patron de presse Henry Luce paru dans Life ; « The End of History? » par l'économiste et politologue Francis Fukuyama, paru en 1989; enfin, le discours inaugural de Donald Trump, prononcé en janvier 2017. Les auteurs de ces trois textes convoquent Je passé pour expliquer la situation des Etats-Unis au plan international et pour promettre au pays un avenir meilleur; ce dossier est par conséquent traité sous l'angle du « passé dans le présent». Il s'agira notamment de voir comment la deuxième moitié du 20' siècle est décrite comme un idéal dans les deux premiers documents, idéal promis par Luce et constaté par Fukuyama, avant d'être redéfinie comme une période sombre par Donald Trump, afin de justifier ses propres options politiques.

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Many patients with recurrent acute and chronic pancreatitis who are candidates for total pancreatectomy and islet cell autotransplantation (TPIAT) undergo endoscopic retrograde cholangiopancreatography (ERCP). However, little is known on the impact of ERCP on TPIAT outcomes. We aimed to explore the effect of antecedent ERCP on islet yield and postoperative insulin requirement after TPIAT.Through a prospectively maintained database, we identified patients who underwent TPIAT at our institution between 2009 and 2016. After adjusting for confounders, islet cell yield and postoperative insulin requirement were compared between subjects who did and did not undergo ERCP within 2 years prior to TPIAT.Data were available on 167 TPIAT patients during the study period; 105 (62.9%) had undergone ERCP within 2 years prior. Prior ERCP was not associated with a reduction in islet equivalents per patient kilogram (odds ratio, 1.37; 95% confidence interval, 0.75-2.5; P = 0.31). Antecedent ERCP was not associated with increased postoperative insulin requirement among patients with no diabetes undergoing TPIAT (odds ratio, 0.85; 95% confidence interval, 0.39-1.83; P = 0.67).Antecedent ERCP does not appear to have a deleterious impact on islet cell yield during TPIAT. Additional multicenter data are needed to more clearly determine the impact of ERCP in this context.

Prior studies have demonstrated that existing risk stratification guidelines for the evaluation of suspected choledocholithiasis lack accuracy, leading to the overutilization of endoscopic retrograde cholangiopancreatography (ERCP). The aim of our study was to evaluate the performance characteristics of published guidelines in predicting choledocholithiasis and to determine the impact of laboratory trends on diagnostic accuracy.We identified patients with suspected choledocholithiasis hospitalized over a 5-year period (2009-2014) at a tertiary care academic medical center. Among eligible patients, we assessed the performance characteristics of the American Society for Gastrointestinal Endoscopy (ASGE) guidelines predicting the presence of choledocholithiasis, confirmed by endoscopic ultrasound, magnetic resonance cholangiography, ERCP, or intra-operative cholangiography. We also evaluated whether a second set of liver function tests improved the accuracy of the guidelines.On presentation, 71 of the 173 eligible patients (41.4 %) met ASGE high-probability criteria for choledocholithiasis. Of these, only 39 (54.9 %) were found to have a choledocholithiasis on confirmatory testing. Conversely, of the 102 patients (58.6 %) who were classified as low or intermediate probability, 32 (31.4 %) had choledocholithiasis. Overall, the accuracy of the guidelines was 63 % (sensitivity 54.9 %; specificity 68.6 %). Incorporating a second set of laboratory tests did not improve accuracy (62.7 %), and a significant decline in liver function tests did not reliably predict spontaneous stone passage.Existing guidelines performed suboptimally for predicting choledocholithiasis in our patient population, similar to other validation studies. These findings further underscore the importance of developing alternate risk stratification tools for choledocholithiasis, aiming to minimize unnecessary diagnostic ERCP.

On the day of Donald Trump’s election, Google recorded a spike in searches for Transmetropolitan, the science fiction series by Warren Ellis and Darick Robertson published 15 years before. This art...

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