Cystic fibrosis (CF) is a multi-organ disease caused by loss-of-function mutations in CFTR (which encodes the CF transmembrane conductance regulator ion channel). Cystic fibrosis related diabetes (CFRD) occurs in 40-50% of adults with CF and is associated with significantly increased morbidity and mortality. CFRD arises from insufficient insulin release from β cells in the pancreatic islet, but the mechanisms underlying the loss of β cell function remain understudied. Widespread pathological changes in the CF pancreas provide clues to these mechanisms. The exocrine pancreas is the epicenter of pancreas pathology in CF, with ductal pathology being the initiating event. Loss of CFTR function results in ductal plugging and subsequent obliteration. This in turn leads to destruction of acinar cells, fibrosis and fatty replacement. Despite this adverse environment, islets remain relatively well preserved. However, islet composition and arrangement are abnormal, including a modest decrease in β cells and an increase in α, δ and γ cell abundance. The small amount of available data suggest that substantial loss of pancreatic/islet microvasculature, autonomic nerve fibers and intra-islet macrophages occur. Conversely, T-cell infiltration is increased and, in CFRD, islet amyloid deposition is a frequent occurrence. Together, these pathological changes clearly demonstrate that CF is a disease of the pancreas/islet microenvironment. Any or all of these changes are likely to have a dramatic effect on the β cell, which relies on positive signals from all of these neighboring cell types for its normal function and survival. A thorough characterization of the CF pancreas microenvironment is needed to develop better therapies to treat, and ultimately prevent CFRD.

Laparoscopic cholecystectomy is the standard of care for cholecystolithiasis but carries an increased risk of biliary injury compared to open cholecystectomy. Complications from laparoscopic cholecystectomy can be related to several factors. These include - (i) technical factors that depend on the skill of the surgeon, (ii) pathologic factors such as associated inflammation and adhesions, and (iii) anatomic factors such as biliary anatomy. Aberrant biliary anatomy is a major cause of bile duct injury during surgery. To the best of our knowledge familial aberrant biliary anatomy has not been previously reported in the literature. We report a case series of two biological sisters with isolated posterior right duct syndrome and present a brief literature review of this medical condition.

The development of the mouse salivary gland involves a tip-driven process of branching morphogenesis that takes place in concert with differentiation into acinar, myoepithelial, and ductal (basal and luminal) sub-lineages. By combining clonal lineage tracing with a three-dimensional (3D) reconstruction of the branched epithelial network and single-cell RNA-seq analysis, we show that in tips, a heterogeneous population of renewing progenitors transition from a Krt14+ multipotent state to unipotent states via two transcriptionally distinct bipotent states, one restricted to the Krt14+ basal and myoepithelial lineage and the other to the Krt8+ acinar and luminal lineage. Using genetic perturbations, we show how the differential expression of Notch signaling correlates with spatial segregation, exits from multipotency, and promotes the Krt8+ lineage, whereas Kras activation promotes proacinar fate. These findings provide a mechanistic basis for how positional cues within growing tips regulate the process of lineage segregation and ductal patterning.

Allergic rhinitis (AR) is a type I hypersensitivity reaction of the nasal mucosa, primarily mediated by IgE, with a complex etiology, determined by genetic and environmental interactions. Several mechanisms by which AR affect middle ear and cause conductive hearing loss have been well described. There is paucity of data regarding involvement of inner ear in AR patients leading to sensorineural hearing loss. However, endolymphatic sac and outer hair cells have been hypothesized to be the seat of immunoreactivity. To study the audiological profile in AR and effect of AR on inner ear functions. 100 cases of AR patients (55 males, 45 females, mean age group 21-30 years) and 100 controls (65 males, 35 females, mean age group 41-50 years) were enrolled in study. All underwent thorough clinical ear, nose and throat examination, diagnostic nasal endoscopy and otoendoscopy, followed by audiological assessment including pure tone audiometry, tympanometry and oto-acoustic emission test. Hearing results of both the groups were compared and analysed statistically. Thirty two patients among case group had sensorineural hearing loss, pronounced at 4000 and 8000 Hz frequencies. 18 patients showed conductive hearing loss in the form of type B or type C tympanogram. 32 patients of AR patients showed unusual oto-acoustic emission test. We found higher prevalence of high frequency sensorineural hearing loss in pure tone audiometry and abnormal OAEs in patients having upper airway allergy. The likely seat of damage appears to be the inner ear as evidenced by recordings of OAE in allergic patients.

Duct air quality monitoring (DAQM) is a typical process for building controls, with multiple infections outbreaks reported over time linked with duct system defilement. Various research works have been published with analyses on the air quality inside ducting systems using microcontrollers and low-cost smart sensors instead of conventional meters. However, researchers face problems sending data within limited range and cross-sections inside the duct to the gateway using available wireless technologies, as the transmission is entirely a non-line-of-sight. Therefore, this study developed a new instrument for DAQM to integrate microcontrollers and sensors with a mobile robot using LoRa as the wireless communication medium. The main contribution of this paper is the evaluation of mesh LoRa strategies using our instrument to overcome network disruption problems at the cross-sections and extend the coverage area within the duct environment. A mobile LoRa-based data collection technique is implemented for various data sensors such as DHT22, MQ7, MQ2, MQ135, and DSM50A to identify carbon monoxide, carbon dioxide, smoke, and PM2.5 levels. This study analyzed the efficiency of data transmission and signal strength to cover the air duct environment using several network topologies. The experimental design covered four different scenarios with different configurations in a multi-story building. The network performance evaluations focused on the packet delivery ratio (PDR) and the received signal strength indicator (RSSI). Experimental results in all scenarios showed an improvement in Packet Delivery Ratio (PDR) and significant improvement in the coverage area in the mesh network setup. The results conclude that the transmission efficiency and coverage area are significantly enhanced using the proposed LoRa mesh network and potentially expanded in larger duct environments.

UNASSIGNED: Post-cholecystectomy choledocholithiasis can occur from retained stones at the cystic duct stump remnant; however, most surgeons would not proceed with extensive dissection of the cystic duct during routine cholecystectomy, mainly in fear of inadvertent bile duct injuries, given the frequent anatomical variations of the extrahepatic biliary tree.
UNASSIGNED: To determine the need and feasibility of extensive dissection of the cystic duct during laparoscopic cholecystectomy, to reduce the risk of post-cholecystectomy choledocholithiasis.
UNASSIGNED: We performed a retrospective review of our institutional database of all patients who had magnetic resonance cholangiopancreatography (MRCP) prior to cholecystectomy over a 3-year period (03/2016-04/2019), assessing the anatomical variations of the cystic duct and the incidence of cystic duct stones.
UNASSIGNED: During the study period, from a total of 763 patients who underwent cholecystectomy for symptomatic gallstones, 284 had undergone pre-operative MRCP and were all included in the final analysis. The typical right lateral insertion of the cystic duct in the midpoint between the confluence of the main hepatic ducts and the ampulla of Vater was identified in less than 50% of the patients. In our series, cystic duct stones were present only in 1.8% of our patients.
UNASSIGNED: The presence of significant anatomical variations and the low likelihood of incidental cystic duct stones render prophylactic extensive dissection of the cystic duct during standard laparoscopic cholecystectomy a rather unnecessary and probably hazardous step.

A solitary dilated duct visualized by mammography is a rare event. According to the latest edition of BI-RADS® it is classified as category 4. This series of cases shows complementary ultrasound of a solitary dilated duct can reduce false-positive results on mammography.

BACKGROUND: In the classic descriptions of the human liver, the common hepatic duct forms at the confluence of left and right hepatic ducts. Many authors have documented variations in the intra-hepatic ductal system, but to the best of our knowledge there has been no report on bile duct variations in Caribbean populations.
OBJECTIVE: To evaluate the variations in bile duct anatomy using magnetic resonance cholangiography (MRC) in unselected patients at a major hepatobiliary referral centre in the Eastern Caribbean. Knowledge of the intra-hepatic biliary anatomy is important to optimize service delivery for any physician treating liver and biliary disorders.
METHODS: This study was carried out at a tertiary referral hospital for hepatobiliary diseases in the Eastern Caribbean. We retrospectively evaluated magnetic resonance cholangiograms in 152 consecutive patients at this facility over a two-year period from April 1, 2017 to March 31, 2019. Two consultant radiologists experienced in MRC interpretation reviewed all scans and described biliary anatomy according to the Huang\'s classification. A systematic review of published studies was performed and relevant data were extracted in order to calculate the global prevalence of each biliary variant. The variants in our population were compared to the global population.
RESULTS: There were 152 MRCs evaluated in this study in 86 males and 66 females. There were 109 (71.7%) persons with \"classic\" biliary anatomy (type A1) and variants were present in 43 (28.3%) persons. There was no statistical relationship between the presence of anatomic variants and gender or ethnicity. We encountered the following variants: 29 (19.1%) type A2, 7 (4.6%) type A3, 6 (3.95%) type A4, 0 type A5 and a single variant (quadrification) that did not fit the classification system. Compared to the global prevalence, our population had a significantly greater occurrence of A1 anatomy (71.7% vs 62.6%; P = 0.0227) and A2 trifurcations (19.1% vs 11.5%; P = 0.0069), but a significantly lower incidence of A3 variants (4.61% vs 11.5%; P = 0.0047).
CONCLUSIONS: There are significant differences in intra-hepatic biliary anatomy in this unselected Eastern Caribbean population compared to global statistics. Specifically, persons of Caribbean descent have a greater incidence of Huang A2 trifurcations and a lower incidence of Huang A3 variants.

A common question in organ regeneration is the extent to which regeneration recapitulates embryonic development. To investigate this concept, we compared the expression of two highly interlinked and essential genes for salivary gland development, Sox9 and Fgf10, during submandibular gland development, homeostasis and regeneration. Salivary gland duct ligation/deligation model was used as a regenerative model. Fgf10 and Sox9 expression changed during regeneration compared to homeostasis, suggesting that these key developmental genes play important roles during regeneration, however, significantly both displayed different patterns of expression in the regenerating gland compared to the developing gland. Regenerating glands, which during homeostasis had very few weakly expressing Sox9-positive cells in the striated/granular ducts, displayed elevated expression of Sox9 within these ducts. This pattern is in contrast to embryonic development, where Sox9 expression was absent in the proximally developing ducts. However, similar to the elevated expression at the distal tip of the epithelium in developing salivary glands, regenerating glands displayed elevated expression in a subpopulation of acinar cells, which during homeostasis expressed Sox9 at lower levels. A shift in expression of Fgf10 was observed from a widespread mesenchymal pattern during organogenesis to a more limited and predominantly epithelial pattern during homeostasis in the adult. This restricted expression in epithelial cells was maintained during regeneration, with no clear upregulation in the surrounding mesenchyme, as might be expected if regeneration recapitulated development. As both Fgf10 and Sox9 were upregulated in proximal ducts during regeneration, this suggests that the positive regulation of Sox9 by Fgf10, essential during development, is partially reawakened during regeneration using this model. Together these data suggest that developmentally important genes play a key role in salivary gland regeneration but do not precisely mimic the roles observed during development.

Recent progress regarding shortwave-infrared (SWIR) molecular imaging technology has inspired another modality of noninvasive diagnosis for early breast cancer detection in which previous mammography or sonography would be compensated. Although a SWIR fluorescence image of a small breast cancer of several millimeters was obtained from experiments with small animals, detailed numerical analyses before clinical application were required, since various parameters such as size as well as body hair differed between humans and small experimental animals. In this study, the feasibility of SWIR was compared against visible (VIS) and near-infrared (NIR) region, using the Monte Carlo simulation in voxelized media. In this model, due to the implementation of the excitation gradient, fluorescence is based on rational mechanisms, whereas fluorescence within breast cancer is spatially proportional to excitation intensity. The fluence map of SWIR simulation with excitation gradient indicated signals near the upper surface of the cancer, and stronger than those of the NIR. Furthermore, there was a dependency on the fluence signal distribution on the contour of the breast tissue, as well as the internal structure, due to the implementation of digital anatomical data for the Visible Human Project. The fluorescence signal was observed to become weaker in all regions including the VIS, the NIR, and the SWIR region, when fluorescence-labeled cancer either became smaller or was embedded in a deeper area. However, fluorescence in SWIR alone from a cancer of 4 mm diameter was judged to be detectable at a depth of 1.4 cm.