Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure with significant complications. Splenic hematoma is an extremely rare but known complication following ERCP that has been increasingly reported in the past several years. We report the case of a 44-year-old patient with a history of sleeve gastrectomy who underwent an ERCP that was complicated by both acute pancreatitis and splenic hematoma. She was managed conservatively under close monitoring in the intensive care unit. Clinicians should be aware of this potentially life-threatening complication to make a prompt diagnosis and begin early appropriate management.

Although instabilities and large oscillations are traditionally considered as conditions to be avoided in structures, a new design philosophy based on their exploitation towards the achievement of innovative mechanical features has been initiated in the last decade. In this spirit, instabilities are exploited towards the development of systems that can yield designed responses in the post-critical state. Further, the presence of oscillating constraints may allow for a stabilization of the dynamic response. These subjects entail a rich number of phenomena due to the non-linearity, so that the study of such mechanical systems becomes particularly complex, from both points of view of the mechanical modeling and of the computational tools. Two elastic structures are studied. The first consists of a flexible and extensible rod that is clamped at one end and constrained to slide along a given profile at the other. This feature allows one to study the effect of the axial stiffness of the rod on the tensile buckling of the system and on the compressive restabilization. A very interesting effect is that in a region of parameters double restabilization is found to occur, involving four critical compressive loads. Also, the mechanical system is shown to work as a novel force limiter that does not depend on sacrificial mechanical elements. Further, it is shown that the system can be designed to be multi-stable and suitable for integration in metamaterials. The second analyzed structure is a flexible but inextensible rod that is partially inserted into a movable rigid sliding sleeve which is kept vertical in a gravitational field. The system is analytically solved and numerically and experimentally investigated, when a horizontal sinusoidal input is prescribed at the sliding sleeve. In order to model the system, novel computational tools are developed, implementing the fully nonlinear inextensibility and kinematic constraints. It is shown that the mathematical model of the system agrees with the experimental data. Further, a study of the inclusion of dissipative terms is developed, to show that a steady motion of the rod can be accomplished by tuning the amplitude or the frequency of the sliding sleeve motion, in contrast with the situation in which a complete injection of the rod inside the sleeve occurs. A special discovery is that by slowly decreasing the frequency of the sleeve motion, the length of the rod outside the sleeve can be increased significantly, paving the way to control the rod’s end trajectory through frequency modulation.

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Yes / Objective The hypothesis that sleeve gastrectomy (SG) is not associated with an increase in mucosal colorectal cancer (CRC) biomarkers, unlike Roux-en-Y gastric bypass (RYGB), was tested. Design and Methods Rectal mucosa, blood, and urine were obtained from morbidly obese patients (n = 23) before and after (median 28 months) SG, as well as from nonobese controls (n = 20). Rectal epithelial cell mitosis and apoptosis, crypt size/fission, and pro-inflammatory gene expression were measured, as well as systemic inflammatory biomarkers, including C-reactive protein (CRP). Results The mean pre-operative body mass index in SG patients was 65.7 kg/m2 (24.7 kg/m2 in controls). Mean excess weight loss post-SG was 38.2%. There was a significant increase in mitosis frequency, crypt size, and crypt fission (all P < 0.01) in SG patients versus controls, as well as evidence of a chronic inflammatory state (raised CRP and mononuclear cell p65 NFκB binding), but there was no significant change in these biomarkers after SG, except CRP reduction. Macrophage migration inhibitory factor mRNA levels were increased by 39% post-SG (P = 0.038). Conclusions Mucosal biomarkers of CRC risk do not increase at 6 months following SG, unlike RYGB. Biomarkers of rectal crypt proliferation and systemic inflammation are increased in morbidly obese patients compared with controls.

För ett företag som arbetar med fast-fashion, är en snabb produktutvecklingsprocess ett måste. Dessa företag anlitar ofta leverantörer till att sköta mönsterkonstruktionen i samband med tillverkningen av plaggen och den stora utmaningen som detta samarbete möter, är tidspressen. Mönsterkonstruktionen och passformen blir ofta lidande vilket leder till att framtagningen av nya produkter blir ineffektiv och en mer kostsam process än nödvändigt, både för företaget och leverantörerna, men också för miljön. En specifik modell som för företaget haft återkommande passformsproblem, är ett överdelsplagg för dam med en djupt v-formad halsringning fram respektive bak. Passformsproblemen har visat sig främst kring ärmhålet och ärmen, men också över plaggets balans generellt. Syftet med studien är att undersöka vad som händer med ett överdelsplaggs balans vid konstruktion av just en v-formad halsringning. Information om passformsproblem och balans av ärmhål och halsringningar saknas inom litteratur och forskning, vilket tyder på ett behov som sträcker sig utöver företagets. Metoden som använts i studien är experimentell och består av digital mönsterkonstruktion, sömnad av prototyper och avprovning på verkliga provpersoner. Resultatet pekar på behovet av att använda sig av noggrant framtagna grundmönster och studiens slutsats visar hur de viktigaste parametrarna för denna specifika modell bör vara konstruerade / For a fast-fashion clothing company, a fast product development process is essential. These companies often hire suppliers to handle the patternmaking in combination with the production of the merchandise and the main challenge that these type of collaborations faces is the time-sensitivity. The patternmaking and the fit of the garments are often the ones to suffer, which in turn makes the development process of new products inefficient and a more costly process than necessary, both for the clothing company and the supplier but also for the environment. A specific model that has recurring problems with fit is a ladies top with a deep v-shaped neckline in front or in back of the garment. The fit problems are mainly located around the armhole and the sleeve, but it is also shown on the overall balance of the garment. The purpose of this study is to investigate what happens with the balance of the garment when constructing a deep v-shaped neckline. Information about fit problems and balance of the arm and armhole in combination with necklines is lacking in literature and research, which indicates a need that extends beyond the company’s need. The method used in the study is experimental and consists of digital patternmaking, sewing of prototypes and fitting-sessions on real people. The result points to the need to use carefully developed block patterns and the conclusions states how the most important parameters for this specific model should be constructed.

Culverts throughout the country are approaching or are past their original design lives. These ‘baby boomer’ culverts will need to be repaired, rehabilitated, or replaced. Because entire culvert replacement is so expensive and intrusive, alternate measures to extend the culvert project life are growing increasingly popular. One such method is slip lining, where a ‘sleeve’ is installed within an existing culvert barrel and stabilized. Plastic pipe sleeves are very popular for slip lining primarily because the plastic material's lower Manning's roughness values allow for the culvert capacity to be maintained despite a reduction in culvert size. Unfortunately, the reduced friction within the barrel can create a barrier to fish passage due to increased water velocities. The increased velocities also cause greater outlet scour which can result in further obstacles to fish passage. These new fish barriers can greatly affect aquatic ecosystems by limiting the access that fish have to smaller tributaries used for spawning and rearing—access that is critical to the life cycles of many fish. It is suggested that mitigation of the increased velocities should go hand-in-hand with slip lined culvert design projects where fish passage (present or future) is to be considered. Can the demand for hydraulic capacity as well as the demand for fish passage be satisfied? Careful design and installation, coupled with post-project monitoring can result in slip lined culvert retrofits which successfully pass fish. Investigation of federal and state laws and various agency guidelines has informed the creation of a list of culvert conditions which should prompt consideration of slip lined culvert retrofit among other design alternatives. Additionally, a literature review and survey of all U.S. state Departments of Transportation as well as state Fish and Wildlife Departments has shown that there has been very limited experience in providing for fish passage through slip lined culverts. Literature and practice has pointed to the use of baffles and tailwater control weirs for velocity mitigation. Site visits have been made to the few states with this experience to assess developing technologies and record successful and unsuccessful installations. Additional hydraulic analysis using current software suggests general trends in the effects slip lined culvert retrofits on flow type, headwater, velocity as well as the effects of tailwater control weirs. Issues of sustainability, constructability and maintenance, as well as monitoring are addressed.

A obesidade e o Diabetes mellitus tipo 2 se tornaram importantes problemas de saúde pública nos últimos anos. O aumento da prevalência do diabetes está intimamente relacionado ao aumento da prevalência da obesidade. As cirurgias bariátricas surgiram nos últimos cinqüenta anos e vêm se popularizando como uma opção terapêutica efetiva para a redução do peso e controle ou reversão do diabetes no paciente obeso. Dentre as técnicas cirúrgicas disponíveis, o Sleeve gástrico, que era utilizado como parte integrante da técnica de derivação bílio-pancreática ou como primeiro estágio, em pacientes de alto risco, a fim de prepará-los para a cirurgia definitiva, tem sido adotado, por alguns grupos de cirurgiões, como técnica definitiva. Como é recente sua utilização como procedimento bariátrico definitivo, faltam estudos que avaliem sua efetividade. O presente estudo teve por objetivo avaliar o Sleeve gástrico, para o controle ou reversão do Diabetes mellitus tipo 2, no paciente obeso. Para tanto, foi realizada uma revisão sistemática. A busca na literatura resultou em 698 títulos e resumos. Após aplicação dos critérios de inclusão foram recuperados 96 textos completos e incluídos, na revisão sistemática, sete artigos com ensaios clínicos controlados. Foi possível realizar metanálise entre estudos comparando o Sleeve gástrico à derivação gástrica com Y de Roux e com a bandagem gástrica. Foram avaliados os desfechos glicemia de jejum e hemoglobina glicosilada. O resultado da metanálise foi favorável ao Sleeve gástrico, em comparação ao Y de Roux, para o desfecho redução pós-operatória da hemoglobina glicosilada. O Sleeve gástrico se apresenta como mais uma opção terapêutica para a obesidade e correção das co-morbidades associadas. Porém, os resultados são bastante preliminares, e ensaios clínicos controlados, de boa qualidade metodológica, são necessários para melhor avaliação. / Obesity and type 2 diabetes mellitus have become lately important public health problems. The increase of diabetes is closely related to the increase of obesity. The bariatric surgeries appeared in the last fifty years, and have become popular as an effective therapeutic option for reducing weight and for controlling or even reverting diabetes in obese patients. Among the available surgery techniques the sleeve gastrectomy, which was used as an inner part of the bilio-pancreatic diversion technique or as first step in high risk patients in order to prepare them for the final surgery, has been used by some surgeons groups as a definitive technique. As its use as a definitive bariatric procedure is quite recent, there are still not enough studies to evaluate its effectiveness. The present study aims at evaluating the sleeve gastrectomy as a technique for the control or reversion of the type 2 diabetes mellitus in obese patients. Therefore, a systematic review was done. A research in the existing literature presented 698 titles and summaries. After applying the inclusion criteria, 96 complete texts were considered; seven papers with controlled clinic tests were included in the systematic review. This allowed to perform a metanalysis between studies, comparing the sleeve gastrectomy with the Roux-en-Y gastric bypass and with the adjustable gastric band. The comparison was based on the evaluation of the outcome of fast glycemia and glucosided hemoglobin. The result of the metanalysis was favorable to the sleeve gastrectomy, in comparison to the Roux-en-Y gastric bypass, for the closing of the post-surgery reduction of the glycoside hemoglobin. The sleeve gastrectomy thus appears as another therapeutic option towards obesity and correction of the related co-morbidities. But the results are still at an early stage, and so controlled clinical tests with high quality methodology are required in order to achieve a better evaluation.

A obesidade e o Diabetes mellitus tipo 2 se tornaram importantes problemas de saúde pública nos últimos anos. O aumento da prevalência do diabetes está intimamente relacionado ao aumento da prevalência da obesidade. As cirurgias bariátricas surgiram nos últimos cinqüenta anos e vêm se popularizando como uma opção terapêutica efetiva para a redução do peso e controle ou reversão do diabetes no paciente obeso. Dentre as técnicas cirúrgicas disponíveis, o Sleeve gástrico, que era utilizado como parte integrante da técnica de derivação bílio-pancreática ou como primeiro estágio, em pacientes de alto risco, a fim de prepará-los para a cirurgia definitiva, tem sido adotado, por alguns grupos de cirurgiões, como técnica definitiva. Como é recente sua utilização como procedimento bariátrico definitivo, faltam estudos que avaliem sua efetividade. O presente estudo teve por objetivo avaliar o Sleeve gástrico, para o controle ou reversão do Diabetes mellitus tipo 2, no paciente obeso. Para tanto, foi realizada uma revisão sistemática. A busca na literatura resultou em 698 títulos e resumos. Após aplicação dos critérios de inclusão foram recuperados 96 textos completos e incluídos, na revisão sistemática, sete artigos com ensaios clínicos controlados. Foi possível realizar metanálise entre estudos comparando o Sleeve gástrico à derivação gástrica com Y de Roux e com a bandagem gástrica. Foram avaliados os desfechos glicemia de jejum e hemoglobina glicosilada. O resultado da metanálise foi favorável ao Sleeve gástrico, em comparação ao Y de Roux, para o desfecho redução pós-operatória da hemoglobina glicosilada. O Sleeve gástrico se apresenta como mais uma opção terapêutica para a obesidade e correção das co-morbidades associadas. Porém, os resultados são bastante preliminares, e ensaios clínicos controlados, de boa qualidade metodológica, são necessários para melhor avaliação. / Obesity and type 2 diabetes mellitus have become lately important public health problems. The increase of diabetes is closely related to the increase of obesity. The bariatric surgeries appeared in the last fifty years, and have become popular as an effective therapeutic option for reducing weight and for controlling or even reverting diabetes in obese patients. Among the available surgery techniques the sleeve gastrectomy, which was used as an inner part of the bilio-pancreatic diversion technique or as first step in high risk patients in order to prepare them for the final surgery, has been used by some surgeons groups as a definitive technique. As its use as a definitive bariatric procedure is quite recent, there are still not enough studies to evaluate its effectiveness. The present study aims at evaluating the sleeve gastrectomy as a technique for the control or reversion of the type 2 diabetes mellitus in obese patients. Therefore, a systematic review was done. A research in the existing literature presented 698 titles and summaries. After applying the inclusion criteria, 96 complete texts were considered; seven papers with controlled clinic tests were included in the systematic review. This allowed to perform a metanalysis between studies, comparing the sleeve gastrectomy with the Roux-en-Y gastric bypass and with the adjustable gastric band. The comparison was based on the evaluation of the outcome of fast glycemia and glucosided hemoglobin. The result of the metanalysis was favorable to the sleeve gastrectomy, in comparison to the Roux-en-Y gastric bypass, for the closing of the post-surgery reduction of the glycoside hemoglobin. The sleeve gastrectomy thus appears as another therapeutic option towards obesity and correction of the related co-morbidities. But the results are still at an early stage, and so controlled clinical tests with high quality methodology are required in order to achieve a better evaluation.