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PURPOSE ::: To describe the presentation and treatment of a case of autoimmune polyglandular syndrome type 1 (APS1)-associated keratopathy and to review the associated literature. ::: ::: ::: METHODS ::: A 23-year-old man with decreased vision secondary to APS1-associated keratopathy was treated with systemic immunosuppression and keratolimbal allograft (KLAL) stem cell transplantation. ::: ::: ::: RESULTS ::: The patient maintains excellent vision 27 months after KLAL and systemic immunosuppression. ::: ::: ::: CONCLUSIONS ::: An underlying etiology of APS1-associated keratopathy is stem cell deficiency, which can be treated effectively with KLAL and systemic immunosuppression. | Chronic kiratitis developed in two children with nonsurgical hypoparathyroidism, as part of an autosomal recessive syndrome that included adrenal insufficiency and moniliasis in what was postulated to be an autoimmune disease. The corneal changes may also have been caused by autoimmune mechanism. Activity of the keratitis diminished once the hypoparathyroidism had been brought under control. However, these patients were thought to be at risk for adrenal insufficiency: neither had moniliasis or adrenocortical insufficiency at present, but the features of the hypoparathyroidism adrenal insufficiency-moniliasis syndrome appeared at different ages and in differing sequences. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,500 |
Some employees may have recourse to gambling, notably as an adaptive strategy. Although many studies have been performed on specific occupational groups (i.e. gambling industry, transportation or teaching), none have been conducted with workers followed-up by Occupational Health Services (OHS). Our aim was to evaluate the prevalence of problem gambling in an employed population and its links with work. We performed a cross-sectional study between November 2016 and April 2017, in an OHS in France. We evaluated the prevalence of gambling using the Lie or Bet questionnaire and the Canadian Problem Gambling Index. Among the 410 employees included, 138 (33.7%) had gambled in the previous year, 12 (2.9%) considered their gambling experience to be work-related, 13 (3.2%) were identified as problem gamblers. The influence of colleagues and the workplace hierarchy and ease of access to gambling (in tobacco shops, bars…) could be risk factors. Screening for gambling behavior could be offered by occupational health services, using the Lie or Bet, especially for employees exposed to readily available gambling opportunities at their workplace. | Background and aimsSocial influences are key drivers of gambling, and can begin in youth through parental modeling and facilitation. Over time, social influence from friends and colleagues also bec... | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,501 |
Two cases of pneumoperitoneum of the newborn caused by perforation of the rectum by a rectal thermometer are presented. The infants presented with symptoms of respiratory distress and cyanosis associated with vomiting and abdominal distention. The literature on the subject is reviewed. Only seven such cases have been reported to date, and the mortality approximates 70%. The single most important factor affecting prognosis appears to be the state of maturity at the time of reparative surgery. Of five mature infants operated on within 24 hours of symptoms, four have survived and have done well. We strongly advocate caution in the use of rectal thermometers, and we would suggest that axillary temperatures or flexible rectal probes be used whenever possible. | Objective ::: To evaluate the efficacy and safety of passive cooling during transport of asphyxiated newborns. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,502 |
To study the effects of strain and sex on the development of injury-induced osteoarthritis (OA) in murine knee joints, two doses of highly purified bacterial collagenase (10 units and 30 units) were injected into male and female mice of two closely related strains, C57BL6 and C57BL10. Frontal histological sections of whole knee joints were made late in the disease process and examined for osteoarthritic lesions. Differences in prevalence of cartilage damage between strains and sexes were observed. Prevalence was higher in C57BL10 (male: almost 100%) than in C57BL6 (male: about 25%), and the prevalence was twice as high in males as in females in both strains. The amount of collagenase (10 or 30 units) did not affect the prevalence of lesions, however, it did influence the severity of the damage. The site of the damage appeared to be dose and strain dependent. Male C57BL6 always showed damage on the medial tibial plateau, independent of dose. In male C57BL10 damage almost always appeared on the lateral tibial plateau with 10 units, while with 30 units the medial plateau also became strongly involved. Since it is known that male mice are more prone to spontaneous OA than female mice and C57BL10 are more prone han C57BL6 mice, it can be concluded that predisposition to spontaneous osteoarthritis increases the risk of developing injury-induced osteoarthritis. Location and severity of the changes will probably be related to joint loading. | Objective Osteoarthritis (OA) is a chronic degenerative disease of the joints characterized by articular cartilage degradation. While there are clear sex differences in OA development in humans, most pre-clinical research has been conducted solely in male animals thus limiting the ability of these findings to be generalized to both sexes in the context of this disease. The objective of this study was to determine if sex impacts the progression and severity of OA in the rat medial meniscal tear (MMT) preclinical animal model used to surgically induce OA. It was hypothesized that differences would be observed between males and females following MMT surgery. Design A MMT model was employed in male and female Lewis rats to induce OA. Animals were euthanized 3 weeks post-surgery and EPIC-μCT was used to quantitatively evaluate articular cartilage structure and composition, osteophyte volumes and subchondral bone structure. Results Quantitative analysis of the medial 1/3 articular cartilage via EPIC-μCT showed increased cartilage thickness and proteoglycan loss in the MMT of both sexes, when compared to sham. Additionally, both male and female animals in the MMT group had increased subchondral bone mineral density and larger total osteophyte volumes due to MMT. Conclusion These data demonstrate that OA can be induced in both sexes using the rat MMT model. Moving forward, adding sex as a factor in preclinical OA studies should be standard practice in pre-clinical studies in order to elucidate more inclusive and translatable results into the clinic. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,503 |
Microbiology reference laboratories are critical in the development of high-quality clinical and public health services. In Belgium, the reference laboratories performed their activities on a voluntary basis and lacked a legal status. Pathogens or groups of pathogens necessitating a national reference center (NRC) were prioritized based on diagnostic and epidemiologic relevance. Terms of reference for each of these pathogens were developed. Recently, 40 NRCs for different pathogens or groups of pathogens have been installed in Belgium to fulfill the following core functions: offering reference diagnostics, collecting reference materials, sharing information and scientific advice, participating in national and international networks, collaborating with research workgroups, and contributing to surveillance activities. These NRCs are important focal points of the national and international network in public health microbiology. | OBJECTIVE ::: Since 1987 all fecal samples referred to the clinical microbiology laboratory of the UZ Brussel were screened for the presence of Shiga toxin-producing E. coli (STEC). In this study all STEC strains isolated over a period of 27 years (1987-2014) were reexamined to achieve deeper insight in the STEC infections in our patient population. ::: ::: ::: METHODS ::: A total of 606 STEC strains from 604 patients were subjected to molecular methods for shiga toxin (stx) subtyping, detection of additional virulence genes, typing of the O-serogroups, and phylogenetic relatedness assessment of STEC O157:H7/H-. ::: ::: ::: RESULTS ::: Since the introduction of PCR in 1991 the annual positivity rates varied between 1.1% and 2.7%. The isolation rate of STEC O157:H7/H- remained stable over the years while the isolation rate of non-O157 serotypes increased, mainly since 2011. The majority of the patients were children. Uncomplicated- and bloody diarrhea were the most prevalent gastrointestinal manifestations (respectively 51.9% and 13.6%), 4.3% of the strains were related to the hemolytic uremic syndrome (HUS), and 30.2% of the patients showed none of these symptoms. The strains were very diverse; they belonged to 72 different O-serovars and all stx subtypes except stx1d and stx2g were identified. Out of the 23 stx2f-positives one was associated with HUS and one belonged to the E. albertii species. As seen in other studies, the frequency of strains of the O157:H7/H- serotype and strains carrying stx2a, eaeA and ehxA was higher in patients with HUS. ::: ::: ::: CONCLUSIONS ::: The characteristics and trends of STEC infection seen in our patient population are similar to those noted in other countries. STEC infections in our hospital are mainly sporadic, and a substantial portion of the patients were asymptomatic carriers. Human STEC Stx2f infection was less rare than previously assumed and we report the first Belgian STEC stx2f HUS case and stx2f positive E. albertii infection. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,504 |
In this paper an air path model of a diesel engine is presented for control system design. The model was developed for common-rail, direct injected, turbocharged and intercooled commercial vehicle diesel engines which are equipped with compressed air booster system (PBS ® – Pneumatic Booster System)[12], high pressure exhaust gas recirculation loop (EGR) with EGR-cooler and exhaust brake (EB). In current and next generation emission standards and legislation introduced significant limitations for NO x and soot. It is really challenging to handle these components, especially at transient engine operations. Additionally the fuel economy and driveability requirements also have to be fulfilled. It is widely known that the nitric oxide formation can be limited with an appropriate amount of exhaust gas recirculation. It can be achieved even in transient modes with precisely controlled EGR-valve operation and with a suitable backpressure generation by the exhaust brake. The soot formation is influenced mainly by the air-fuel ratio of the mixture which can be affected by the intake manifold pressure in case of a desired engine load and EGR rate. With the compressed air booster system the intake manifold pressure can be controlled in transients arbitrarily. Therefore with a suitable air path controller the modeled engine setup is able to handle both the NO x and soot formation in transient cases. To solve the presented control problem a model based controller design is targeted. The reported model is the first step of this work. | This paper deals with the effects on diesel engine combustion and emissions of carbon dioxide and water vapour the two main constituents of EGR. It concludes the work covered in Parts 1, 2, and 3 of this series of papers. A comparison is presented of the different effects that each of these constituents has on combustion and emissions. The comparison showed that the dilution effect was the most significant one. Furthermore, the dilution effect for carbon dioxide is higher than that for water vapour because EGR has roughly twice as much carbon dioxide than water vapour. On the other hand, the water vapour had a higher thermal effect in comparison to that of carbon dioxide due to the higher specific heat capacity of water vapour. The chemical effect of carbon dioxide was, generally, higher than that of water vapour. The chemical effect of water vapour resulted in an increase in the particulate and carbon emissions, but, the chemical effect of carbon dioxide was to decrease these emissions. Similarly, opposite chemical effect were observed on the ignition delay. This is the fourth paper in a series which deals with the effects of EGR on combustion and emissions in diesel engines. The first, second and third papers are SAE 961165, SAE 961167, and SAE 971659 (to be published in 1997 by SAE), respectively. © 1997 Society of Automotive Engineers, Inc. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,505 |
We give new examples of discrete Schrodinger operators with potentials taking finitely many values that have purely singular continuous spectrum. If the hullX of the potential is strictly ergodic, then the existence of just one potentialx inX for which the operator has no eigenvalues implies that there is a generic set inX for which the operator has purely singular continuous spectrum. A sufficient condition for the existence of such anx is that there is az∈X that contains arbitrarily long palindromes. Thus we can define a large class of primitive substitutions for which the operators are purely singularly continuous for a generic subset inX. The class includes well-known substitutions like Fibonacci, Thue-Morse, Period Doubling, binary non-Pisot and ternary non-Pisot. We also show that the operator has no absolutely continuous spectrum for allx∈X ifX derives from a primitive substitution. For potentials defined by circle maps,x n =1 J (θ0+nα), we show that the operator has purely singular continuous spectrum for a generic subset inX for all irrational α and every half-open intervalJ. | We consider ergodic families of Schrodinger operators over base dynamics given by strictly ergodic subshifts on finite alphabets. It is expected that the majority of these operators have purely singular continuous spectrum supported on a Cantor set of zero Lebesgue measure. These properties have indeed been established for large classes of operators of this type over the course of the last twenty years. We review the mechanisms leading to these results and briefly discuss analogues for CMV matrices. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,506 |
Background, Breast cancer (BC) is one of the leading causes of cancer related deaths in Iran. This high ratio of mortality had a rising trend during the recent years which is probably associated with late diagnosis.Main bodyTherefore it is critical to define a unique panel of genetic markers for the early detection among our population. In present review we summarized all of the reported significant genetic markers among Iranian BC patients for the first time, which are categorized based on their cellular functions.ConclusionsThis review paves the way of introducing a unique ethnic specific panel of diagnostic markers among Iranian BC patients. Indeed, this review can also clarify the genetic and molecular bases of BC progression among Iranians. | Background: Stomach cancer is the fourth most common cancer and the second leading cause of cancerrelated death through the world. It is predicted that the number of new cancer cases will be more than 15 million cases by 2020. Regarding the lack of studies on this topic in the country, we have thoroughly examined the patho-epidemiology of stomach cancer in Iran. Materials and Methods: In this cross- sectional study data were collected retrospectively reviewing all new stomach cancer patients in Cancer Registry Center report of health deputy for Iran during a 6-year period (2003-2008). The study also examined the morphology of common stomach cancers. Trends in incidence and morphology underwent joinpoint regression analysis. Results: During the six-year period, a total of 35,171 cases of stomach cancer were registered. Average age standardized rate for females and males were equal to 7.1 and 15.1 per 100,000 persons, respectively. Most common histological type was adenocarcinoma, NOS with 21,980 cases (62.50%). The annual percentage change (APC) in age-standardized incidence rate (per 100,000) was increase in both females and males at 11.1 (CI: 4.3 to 18.3) and 9.2 (CI: 5.2 to 13.4), respectively. Conclusions: According to our results, the incidence of gastric cancer is increasing in Iran, so further epidemiological studies into the etiology and early detection are essential. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,507 |
The design of a simple biped robot primarily involves the control of balance. Controlling the direction of balance for a two legged walking robot typically means mimicking the human form and its walking locomotion. Even though the human locomotion approach is taken as the ultimate reference, gaits can be developed using less sophisticated methods. The ultimate aim is to maintain an upright torso while advancing one leg in front of the other continuously. The mechanical structure then forces us to consider a combination of factors such as weight of each leg mechanism, and its appropriate dynamics such as velocity, acceleration, and degrees of freedom. Without developing other established principles, an adequate biped robot should have at least two degrees of freedom. Two degrees of freedom will allow the robot to swing or swivel one leg in front of the other for a step. With increasing degrees of freedom the robotic gait becomes smoother but extremely complex with respect to control. For a simple biped robot, the hardware needed is mechanical links, servos, servo controller, and a power source. The required components can be arranged in different configurations, but for the true autonomous biped robot a self contain package is ideal. This paper discusses basic considerations, develops the hardware, and a simple gait algorithm. | Signature of Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Department of Mechanical Engineering August 31, 2000 Certified by. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Gill A. Pratt Assistant Professor of Electrical Engineering and Computer Science, MIT Thesis Supervisor Certified by. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ernesto Blanco Adjunct Professor of Mechanical Engineering, MIT Thesis Supervisor | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,508 |
Problems related with nasal intermittent positive pressure ventilation (NIPPV) are nasal and mouth dryness, soreness on the bridge of the nose, eye irritation and epistaxis. Gastrointestinal distention due to air swallowing has been reported in half of the patients. Acceleration of digestive function with drugs or reduction of the volume delivered to alleviate gastric distension are considered as the conventional treatment. It is also possible that the problem disappears spontaneously after a few weeks of NIPPV. We present a patient in whom conventional treatment was unsuccessful. When we changed to a different ventilator, symptoms disappeared, and the new one was very well tolerated. In our experience, changing ventilators should be included in the management of gastrointestinal distension due to NIPPV, especially if conventional procedures, such as drugs or gas flow modifications, fail. | From the experience of following 86 long-term ventilated neuromuscular patients, some aspects of the mode of ventilation are discussed: tolerance and problems, switching from one ventilation technique to another. As a general rule, the noninvasive methods are to be preferred. Tracheostomy may continue to be indicated in the event of an insufficient cultural level, recurrent aspirations, or low pulmonary compliance. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,509 |
The aims of this study were to: (1) evaluate the epidemiology of simultaneous upper gastrointestinal bleeding (UGIB) and myocardial injury using parameters including troponin I (TnI); and (2) investigate the predictive risk factors of this syndrome. One hundred and fifty-five patients (101 men, 54 women; mean age, 64.7+/-10.4 years; range, 38-94 years) at the emergency department (ED) with the major diagnosis of UGIB were included. They underwent serial electrocardiography (ECG) and cardiac enzyme follow-up. Emergent gastroendoscopy was performed within 24 hours in most patients except for those who refused or were contraindicated. Mild myocardial injury was defined as the presence of any of the following: typical ST-T change on ECG, elevated creatine kinase-MB (CK-MB)>12 U/L, or TnI>0.2 ng/dL. Moderate myocardial injury was defined as the presence of any two of the previously mentioned conditions. In total, 51 (32.9%) and 12 (7.74%) patients developed mild and moderate myocardial injuries, respectively. Myocardial injury was more common among patients with variceal bleeding (20/25=80.0%) than those with ulcer bleeding (23/112=20.5%). It could partially be attributed to a higher baseline TnI level in cirrhotic patients. After adjusting for significant risk factors revealed by the univariate analysis, UGIB patients with a history of liver cirrhosis and more than three cardiac risk factors comprised a high-risk group for simultaneously developing myocardial injury. Other factors including age, gender, the color of nasogastric tube irrigation fluid, history of nonsteroidal anti-inflammatory drug use, vasopressin or terlipressin administration, vital signs, and creatinine recorded at the ED were not significant predictors. Those who developed myocardial injury had a longer hospital stay (mean duration, 8.73+/-6.94 vs. 6.34+/-2.66 days; p=0.03) and required transfusion of more units of packed erythrocytes. | In cirrhosis, cardiac contractile function has been extensively documented to be abnormal. At baseline, cardiac output is increased, and this is one of the characteristics of hyperdynamic circulation. However, when cirrhotic patients are challenged by pharmacological or physiological stress, ventricular hyporesponsiveness is revealed. Similar patterns have been noted in cirrhotic animal models. This phenomenon has been termed "cirrhotic cardiomyopathy." Although alcohol abuse may contribute to some cases of cirrhotic cardiomyopathy, it has been clearly documented to occur even in the absence of alcohol ingestion. Diminished myocardial beta-adrenergic receptor signal transduction function, possibly caused by a persistent elevation in norepinephrine content, has been shown to play an important role. Alternation in cardiac plasma membrane properties due to impaired lipid metabolism is also crucial. Other possible pathogenic factors are reviewed, including accumulation of cardiodepressant substances caused by hepatocellular insufficiency, and ventricular overload secondary to increased blood volume and hyperdynamic circulation. Because the cardiac reserve function is borderline in patients with cirrhosis, cardiovascular status should be carefully monitored, especially when patients undergo stresses such as liver transplantation or portosystemic shunting procedures. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,510 |
Streptococcus pyogenes, also known as group A Streptococcus (GAS), is an exclusively human Gram-positive bacterial pathogen ranked among the 'top 10' causes of infection-related deaths worldwide. GAS commonly causes benign and self-limiting epithelial infections (pharyngitis and impetigo), and less frequent severe invasive diseases (bacteremia, toxic shock syndrome and necrotizing fasciitis). Annually, GAS causes 700 million infections, including 1.8 million invasive infections with a mortality rate of 25%. In order to establish an infection, GAS must counteract the oxidative stress conditions generated by the release of reactive oxygen species (ROS) at the infection site by host immune cells such as neutrophils and monocytes. ROS are the highly reactive and toxic byproducts of oxygen metabolism, including hydrogen peroxide (H2O2), superoxide anion (O2•(-)), hydroxyl radicals (OH•) and singlet oxygen (O2*), which can damage bacterial nucleic acids, proteins and cell membranes. This review summarizes the enzymatic and regulatory mechanisms utilized by GAS to thwart ROS and survive under conditions of oxidative stress. | Production of H(2)O(2) follows a growth phase-dependent pattern that mimics that of many virulence factors of Streptococcus pyogenes. To gain greater insight into mechanisms coupling virulence factor expression to growth phase, we investigated the molecular basis for H(2)O(2) generation and its regulation. Deletion of the gene encoding lactate oxidase (lctO) or culture in the presence of glucose eliminated H(2)O(2) production, implicating carbohydrate regulation of lctO as a key element of growth phase control. In examining known carbohydrate-responsive regulators, deletion of the gene encoding CcpA but not that encoding LacD.1 resulted in both derepression and an uncoupling of lctO transcription from its growth phase pattern. Expanding this analysis to additional virulence factors demonstrated both negative (cfa, encoding CAMP factor) and positive (speB, encoding a cysteine protease) regulation by CcpA and that CcpA mutants were highly cytotoxic for cultured macrophages. This latter property resulted from enhanced transcription of the streptolysin S biogenesis operon. Examination of CcpA-promoter interactions using a DNA pull-down assay mimicking physiological conditions showed direct binding to the promoters of lctO and speB but not those of sagA. CcpA but not LacD.1 mutants were attenuated in a murine model of soft-tissue infection, and analysis of gene expression in infected tissue indicated that CcpA mutants had altered expression of lctO, cfa, and speB but not the indirectly regulated sagA gene. Taken together, these data show that CcpA regulates virulence genes via at least three distinct mechanisms and that disruption of growth phase regulation alters transcriptional patterns in infected tissues. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,511 |
The natural history and mortality of type 1 diabetes in adolescents in Africa is not well characterized. Our aim is, therefore, to describe these characteristics for cases in the Rwanda Life For a Child (LFAC) program. Participants (≤25 years old) were the first 500 children and youth enrolled in the Rwanda LFAC program from 2004 to 2012. Clinical and demographic data were extracted from LFAC forms, and vital status was evaluated as of November 1, 2011. For the first 500 participants, 5-year survival was 93.8% while crude mortality was 13.9/1000 (95% CI 9.0–20.6/1000) person years of diabetes. However, since vital status is unknown for 134 participants, mortality could be as high as 40.2/1000 person years of diabetes if all missing cases died. Mortality was directly associated with age at diagnosis, and inversely to calendar year of first visit, BMI, and monitoring frequency. Hypertension prevalence reached 46% by 2012. Mortality rates associated with type 1 diabetes in Rwanda are similar to those in other African countries, but higher than rates in developed countries. Delayed diagnosis may contribute to excess mortality risk, but recent improvements in survival suggest that advancements are being made. Hypertension and loss to follow-up need to be addressed. | Aims/hypothesis ::: Surveys in northern Ethiopia have demonstrated that apparent type 1 diabetes occurs more frequently than elsewhere in Africa and, indeed, in other parts of the world. We therefore investigated in detail a cohort of diabetic patients from this region to clarify the nature of this type of diabetes. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,512 |
Background: Myopia has different prevalence rate worldwide and there is controversial points about its environmental risk factors. The prevalence of myopia in medical interns at Shiraz Medical School and its probable risk factors were studied. Method: In this retrospective cross-sectional study, three hundred interns (7 th -year medical students) at Shiraz University of Medical Sciences were examined by auto refractometer and subjective refraction. We Also administered a questionnaire to evaluate the age of the onset of myopia, the power of the first spectacles, and its power in the first year of medical school, parental refractive error, prematurity, mean amount of time spent for studying, sleeping, and TV watching per day among myopic students and a comparable control group. Results: Ninety-two out of 300 (31%) interns had myopia over 0.5 diopters with similar age, sex, time spent for sleeping and studying as 88 randomly selected non-myopic controls. Parental myopia was reported in 54% of cases and 25% of controls (p<0.05). 60% of myopic interns had more than 0.75 diopters of progression during medical school years with similar age, sex, and time spent for sleeping and studying as 40% with less than 0.75 diopters of progression. Mean age of onset of myopia was 17.00±2.88 years with mean initial amount of -0.96±0.45 diopters in former subgroup, but in the latter subgroup, these were 13.84±2.99 years and 1.37±1.40 diopters, respectively (p<0.05). | The prevalence rates of myopia are higher in urban Asian cities such as Hong Kong and Singapore. One observation over the past few decades is that the prevalence rates of myopia have been rising and there is an epidemic of myopia in Asia. The age-old question of the roles of nature and nurture in this process remains unanswered. The strongest evidence for an environmental link to myopia is near work activity. Childhood exposure to night lighting has also been explored in different studies but the results have been mixed. Twin studies, segregation analysis and association studies have demonstrated that hereditary factors play an important role in myopia development. The exact nature and interplay of genetic and environmental factors is not known and data suggest that environmental factors may interact with genetic factors to increase the risks of developing myopia. Future research is needed to identify specific modifiable lifestyle factors and genetic markers for myopia. This will enable preventive measures such as health education to be instituted. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,513 |
The Microarray Assay for Realtime Coregulator-Nuclear receptor Interaction (MARCoNI) technology allows the identification of nuclear receptor-coregulator interactions via flow-through microarrays. As such, differences in the coregulator profile between distinct nuclear receptors or of a single receptor in agonist or antagonist mode can be investigated, even in a single run. In this chapter, the method how to perform these peptide microarrays with cell lysates containing the overexpressed glucocorticoid receptor is described, as well as the influence of assay parameters, variations to the protocol and data analysis. | The endothelium plays a crucial role in inflammation. A balanced control of inflammation requires the action of glucocorticoids (GCs), steroidal hormones with potent cell-specific anti-inflammatory properties. Besides the classic anti-inflammatory effects of GCs on leukocytes, recent studies confirm that endothelial cells also represent an important target for GCs. GCs regulate different aspects of endothelial physiology including expression of adhesion molecules, production of pro-inflammatory cytokines and chemokines, and maintenance of endothelial barrier integrity. However, the regulation of endothelial GC sensitivity remains incompletely understood. In this review, we specifically examine the endothelial response to GCs in various inflammatory diseases ranging from multiple sclerosis, stroke, sepsis, and vasculitis to atherosclerosis. Shedding more light on the cross talk between GCs and endothelium will help to improve existing therapeutic strategies and develop new therapies better tailored to the needs of patients. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,514 |
Between August, 1974 and May, 1987, 486 patients were treated for infective endocarditis. In 16 of these patients (12 men, 4 women, mean age 44.3 +/- 18.0 years at the time of the first episode) the endocarditis recurred: once in 14 patients, twice in 2 patients. The time elapsed between recovery from the first episode and onset of the recurrence varied from 6 to 159 months (mean 54.3 +/- 35.1 months). Among the 18 recurrences, 10 affected native valves (mitral 6, aortic 4) and 8 aortic prostheses. In all but one case the organism isolated during the recurrence (Streptococcus in 14 cases, Staphylococcus in 3 cases, Rickettsia in 1 case) was different from the organism responsible for the previous infection. The 16 patients were followed up for periods of 28 to 203 months (mean 107.0 +/- 58.0 months), counting from the onset of the first episode. Ten patients were treated medically during the second episode: 4 died and 2 had a second recurrence, lethal in one of them (time elapsed between the onset of the first episode and the date of death: 32 to 149 months). Six patients were operated upon (valve replacement in 5 cases, closure of a left aorto-ventricular fistula in 1 case) without deaths. Nine of the 11 survivors are now asymptomatic. The actuarial survival rate in recurrent endocarditis (75 p. 100, 10 years after the onset of the first episode) is not different from that observed in non-recurrent endocarditis. | Infective endocarditis (IE) is uncommon but important because it is difficult to manage and universally fatal unless appropriately treated. The estimated incidence is 3–10 episodes each year per 100 000 population.1 In industrially developed countries, IE increasingly occurs in older adults with intracardiac devices (pacemakers and implantable defibrillators), replacement heart valves and medical interventions such as haemodialysis.2–4 Younger age groups are also affected, particularly intravenous drug users and those with adult congenital heart disease.5 Staphylococci are now the most common causative organisms in international series and streptococci the second most common.6 Resistance to antimicrobial agents, particularly vancomycin, is increasing.1 ,7 ::: ::: Patients with IE remain in hospital for a median of 4–6 weeks8 ,9 and approximately a half require inpatient cardiac surgery.1 ,10 ,11 The inhospital mortality rate is about 20%8 ,12 but varies widely according to age, comorbidity, heart failure, the presence of prosthetic material and the organism.13 For example, in prosthetic valve IE with associated renal failure, the reported mortality may be 40%–50%14 ,15 and with severe heart failure as high as 64%.15 The outcome can be improved by prompt diagnosis and antibiotic therapy and by early surgery when indicated.8 ,10 ,16 ,17 Despite this, the diagnosis may be delayed, mistakes may be made in the type, duration or dose of antibiotic18 or the antibiotic may be started before blood cultures are obtained.11 Patients are still frequently referred to a specialist only at an advanced stage with heart failure6 ,11 ,18–20 or may not receive surgery even when indicated.8 As expected, non-compliance with guidelines is associated with a worse outcome.20 ::: ::: A multidisciplinary team (MDT) approach is increasingly seen as best practice where decision … | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,515 |
The goal of successful induction of labour is to achieve vaginal delivery to avert anticipated adverse outcome associated with continuation of pregnancy. In the past decade, our knowledge of the mechanisms of labor has increased tremendously. In addition, the ability to detect and manage antepartum maternal and fetal complications has greatly improved. As a result, labor can be induced in an increasingly rational and successful manner. Induction of labour in an unripe cervix is associated with frequent maternal complications and high rates of failure to the extent of 20 50% and caesarean delivery Even when vaginal delivery is achieved these patients often have prolonged labour, with increased incidence of instrumental delivery and low APGAR. | Goodman and Gillman's The Pharmacological Basis of Therapeutics has been a trusted resource for medical students and physicians for the past 50 years. This edition, the eighth, consists of 67 chapters contributed by 61 authors. The book is divided into 17 sections that cover general principles, organ-specific therapeutics, anti-inflammatory agents, anti-infectious agents, chemotherapy of neoplastic diseases, immunosuppression, vitamins, and toxicology. A brief, 20-page section on dermatology has been written by Mary Margaret Shren and David Viccars. The basic format of Goodman and Gillman's The Pharmacological Basis of Therapeutics has not changed. The book begins with a thorough review of the general principles of pharmacology, including pharmacokinetics, mechanisms of action, and toxicology. The content, however, has been significantly updated to include recently acquired experimental information. As an example, this edition has a well-written review of transmembrane signaling mechanisms, including G proteins and the protein kinases. The information on organspecific and disease-specific drugs has | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,516 |
Burn is a global public health problem associated with significant morbidity and mortality, mostly in low- and middle-income countries. Southeast-Asian countries share a big burden of burn injuries, and Nepal is not an exception. We performed a systemic review to examine the epidemiological characteristics of burn injures in Nepal. Relevant epidemiological studies were identified through systemic search in PubMed, EMBASE, and Google Scholar. Reference lists from relevant review articles were also searched. Studies were included if they meet our selection criteria. Eight studies were included in our systemic review. Most of the burn victims belong to the working age group between 15–60 years old. Flame burns were found to be the most common cause of burn injury followed by scald burns, whereas scald burns were the most common cause of burn injury among the pediatric population. Most patients sustained less severe burn injuries, with home being the most common place of burn injury. The average hospital stay among the burn victims ranged from 13 to 60 days. Mortality among the burn victims ranged from 4.5 to 23.5%, with highest mortality among the flame burn patients. Developed nations have significantly reduced the burn incidence through effective intervention program. Although, burn injuries are the leading cause of morbidity and mortality in Nepal, effective intervention programs are lacking due to the limited epidemiological data related to burn injuries. Further large scale research is imperative to investigate the problem and assess the effectiveness of an intervention program. | Burn prevention requires adequate knowledge of the epidemiological characteristics and associated risk factors. While much has been accomplished in the areas of primary and secondary prevention of fires and burns in many developed or high-income countries (HICs), such as the United States, due to sustained research on the descriptive epidemiology and risk factors, the same cannot be said of developing or low- and middle-income countries (LMICs). To move from data to action and assist preventive efforts in LMICs, a review of the available literature was conducted to assess the current status of burn preventive efforts. A MEDLINE search (1974–2003) was conducted on empirical studies published in English on the descriptive epidemiology, risk factors, treatment, and prevention of burns in LMICs. Review of the 117 identified studies revealed basically the same descriptive epidemiological characteristics but slightly different risk factors of burns including the presence of pre-existing impairments in children, lapses in child supervision, storage of flammable substances in the home, low maternal education, and overcrowding as well as several treatment modalities and preventive efforts including immediate application of cool water to a burned area. Continuous evaluation of promising interventions and those with unknown efficacy that have been attempted in LMICs, along with testing interventions that have proven effective in HICs in these LIMC settings, is needed to spearhead the move from data to action in preventing burns in LMICs. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,517 |
Scalar field models have been a focal point in cosmology during the last two decades or so. They play a central role in inflationary models, they arise in modified gravity theories that extend Einstein’s General Relativity (GR) which are, often, quantum motivated, and, recently, they have been put forward as a dark component of the universe. Here we analyse their dynamics in the framework of isotropic cosmologies presenting an unified approach that encompasses models both in Einstein’s GR and more general metric gravity theories. We perform a qualitative analysis of the major dynamical features of these models, discussing the existence of asymptotic regimes and their connection to a classification of the scalar fields potentials and couplings. A special interest is devoted to the interplay between scalar fields and matter which gives rise to scaling behaviour. | In this work, we seek a cosmological mechanism that may define the sign of the effective gravitational coupling constant, G. To this end, we consider general scalar-tensor gravity theories as they provide the field theory natural framework for the variation of the gravitational coupling. We find that models with a quadratic potential naturally stabilize the value of G into the positive branch of the evolution and further, that de Sitter inflation and a relaxation to General Relativity is easily attained. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,518 |
BACKGROUND ::: We aimed to determine the utility of magnetic resonance imaging (MRI) compared with small bowel follow-through (SBFT) in the assessment of known Crohn's disease. ::: ::: ::: METHODS ::: Subjects, over age 18 yr who were to undergo SBFT investigations to assess for complications or extent of Crohn's disease were eligible. SBFT was performed by a single radiologist (IB), and within 4 wk MRI was performed by a single radiologist (HG) who was blinded to the SBFT results. For MRI, oral contrast was 2% barium sulfate (1,350 mL). After unenhanced T1 weighted images and single shot fast spin echo T2 imaging, intravenous (IV) glucagon and gadolinium were given. Fast multiplanar spoiled-gradient recalled T1 coronal sequences were obtained followed by abdominal and pelvic axial images. MRI and SBFT were compared for extent of disease, presence of complications, and for identification of extraintestinal disease. ::: ::: ::: RESULTS ::: Paired studies were undertaken within a mean of 22 days in 30 subjects. Ten studies were normal by both modalities and 8 studies showed similar extent of Crohn's disease. SBFT revealed additional information in 4, including a stricture in 1 and ileosigmoid fistulas in 2. MRI provided enhanced information in 8, including identifying active inflammation in strictured areas based on wall enhancement patterns, vasa recta changes, and lymphadenopathy. ::: ::: ::: CONCLUSIONS ::: On the basis of cost and accessibility, SBFT may still be a first line procedure of choice in some centers without MRI, but MRI's advantages of no radiation and the potential to identify active inflammation in strictured areas, extraintestinal, and colorectal disease make it an attractive alternative. | Objective ::: To describe the role of magnetic resonance enterography (MRE) in patients with inflammatory bowel disease (IBD), and to review the expected post-operative appearance, as well as, potential surgical complications in this unique patient population. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,519 |
Design systems can have considerable embedded value. Improvements in such systems are better achieved through upgrades than through complete replacements. To determine how best to make these upgrades requires a systems view of design. Such a view is provided by what we call TAO (test-aspect-operator) graphs. Nodes in these graphs represent aspects of the artifacts being designed while arcs represent operators (transforms between aspects) and tests (comparisons of aspects). Upgrades can be thought of as the additions of nodes or arcs to an existing TAO graph. To illustrate these ideas we will briefly describe the upgrades that we are making to a system for designing certain automobile parts. | A new variety of Oriental hybrid lily plant bearing large upright-facing flowers particularly characterized by their clear pink coloration with deeper midribs, their large size and substance, and their upright to semi-upright orientation, the flowers being of excellent form and long persistence both on the plant and as cut flowers. This combination is completely new in the Oriental hybrid divisions of lilies suited to forcing and to mass commercial cultivation. The plant is an excellent garden plant, highly resistant to disease and shows tolerance of virus; the bulbs may be precooled and forced for cut flower production and the clone is vigorous, a good grower and a good propagator. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,520 |
Purpose To compare the incidence, progression, and duration of retinopathy of prematurity (ROP) in low-birth-weight Hispanic and white non-Hispanic infants. Methods A total of 671 white non-Hispanic infants and 128 Hispanic infants with birth weights less than 1751 g were retrospectively evaluated to determine the incidence of both ROP and subthreshold or worse ROP. Multiple regression analysis was used to control for birth weight, gestational age at birth, year of birth, and newborn intensive care unit as contributing factors in the risk of ROP. The duration of ROP in untreated infants was calculated and compared for the two ethnic groups. Results There was no significant difference in the percentage of infants with ROP in the white non-Hispanic group (38.3%) versus the Hispanic group (41.4%). There was also no significant difference between white non-Hispanics (11.8%) and Hispanics (15.6%) in the risk of developing subthreshold or worse ROP. Multiple regression analysis showed no contribution of ethnicity to the risk of developing ROP ( t = −0.34, p = 0.74) or subthreshold or worse ROP ( t = 0.75, p = 0.45). The average duration of untreated ROP in white non-Hispanics (8.6 ± 5.4 weeks) and Hispanics (8.9 ± 7.0 weeks) also was not significantly different. However, Hispanic infants showed significantly higher variance in duration than white non-Hispanic infants ( p = 0.04). Conclusions ROP occurs with similar frequency in Hispanic and white non-Hispanic premature infants, as does subthreshold or worse ROP. Some Hispanic infants had an unusually short or long duration of ROP before regression, implying that the natural history of ROP may be somewhat different for the two ethnic groups. | We review what is known in each country of the Latin American region with regards to blindness and visual impairment and make some comparisons to Hispanic populations in the United States. Prevalence of blindness varied from 1.1% in Argentina to 4.1% in Guatemala in people 50 years of age and older, with the major cause being cataract. Diabetic retinopathy and glaucoma are starting to make serious inroads, although epidemiological data are limited, and age-related macular degeneration is now a concern in some populations. Infectious diseases such as trachoma and onchocerciasis are quickly diminishing. Although progress has been made, retinopathy of prematurity remains the major cause of childhood blindness. If VISION 2020 is to succeed, many more epidemiological studies will be needed to set priorities, although some can be of the Rapid Assessment of Avoidable Blindness design. Developing the infrastructure for screening and treatment of ophthalmic disease in Latin America continues to be a challenge. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,521 |
Background ::: Gastrointestinal bleeding (GIB) is a common adverse event after mechanical circulatory support device implantation. However, the majority of the reported data were obtained from small single-center studies. Our aim was to study the prevalence and predictors of GIB during the index hospitalization of mechanical circulatory support devices implantation using a nationwide database. | Objective: Outcomes after ventricular assist device (VAD) implantation have significantly improved during the last decade. However, bleeding episodesremain a seriouscomplicationof VAD support.This cannot be explainedby the individual anticoagulation regimen alone in several cases, but may be symptomatic of acquired von Willebrand disease (VWD). The leading finding in acquired VWD (AVWD) is the loss of large multimers which results in diminished binding to collagen and to the platelets. We, therefore, analysed patients with two VAD types for laboratory parameters of VWD and compared them with patients after heart transplantation (HTX). Materials and methods: Seven patients with a HeartMate II W left-ventricular assist device andfive patients who received a Thoratecbiventricular assist device were includedin this study. Eight HTX recipients served as controls. Analysis included international normalized ratio (INR), partial thromboplastin time (PTT), platelet count, von Willebrand factor (VWF) antigen, collagen binding capacity, ristocetin cofactor activity, the ratios of the latter two to the VWF antigen and presence of large VWF multimers. Results. The VAD and HTX groups did not differ with regard to age or time-point of analysis after surgery. INR and number of platelets were comparable in both groups, PTT was prolonged in VAD patients. Both VAD and HTX patients had elevated but comparable amounts of VWF antigen. However, large multimers were missing in all of 10 tested VAD patients. In contrast, five of six tested HTX recipients displayed normal multimer pattern. Indeed, collagen binding capacity and ristocetin cofactor activity (which measures binding of VWF to platelets) were lower in VAD patients compared to HTX recipients. Impaired coagulation associated with VADs was also reflected by the diminished ratios of collagen binding capacity and ristocetin cofactor activity to VWF antigen. A pathologic collagen binding ratio was found in all 10testedVADpatients andone ofthe eightHTXpatients, a reducedristocetincofactoractivityratioin 10of 12VADand oneof eightHTX patients. Conclusion: Non-surgical postoperative bleeding after VAD implantation could be explained by an AVWD. Several pharmacologic treatment options (tranexamic acid, desmopressin, VWF-factor VIII concentrate, recombinant factor VIIa) may arise from our data. Improved VAD design could prevent this problem in the future. # 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,522 |
Strategic transformation and strategic risk are both hot topics in foreign research. From the angle of strategic transformation and based on its connotation, theoretical basis and dynamics, this paper mainly analyses what causes the strategic risk and how it acts, and presents that strategic risk of strategic transformation has a close relation with a company's environment, dynamical mechanism, pressure inertia and support systems. In the end, it also provides some methods and countermeasures to keep away strategic risk. | Based on concept of enterprise strategic risk, a risk evaluation index system is set up which consists of five elements, including financial condition, market competition, enterprise resource, enterprise capability and business process firstly. Secondly, a corresponding comprehensive evaluation method based on wavelet network is proposed in detail for enterprise strategic risk evaluation. An empirical research for strategic risk evaluation was discussed by using the suggested method. Obviously, the application result of the method was comparatively more objective. Finally, the comparison between the mentioned approach and BPNN was discussed. It indicated that the method not only can evaluate enterprise strategic risk effectively and avoid some man-made mistakes, but also has better effective and efficient than BPNN. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,523 |
Background/Aims: Gastrointestinal (GI) symptoms are common among patients with chronic renal failure (CRF). The pathogenesis of these symptoms is probably multifactorial. Our aims w | In chronic kidney disease (CKD), influx of urea and other retained toxins exerts a change in the gut microbiome. There is decreased number of beneficial bacteria that produce short-chain fatty acids, an essential nutrient for the colonic epithelium, concurrent with an increase in bacteria that produce uremic toxins such as indoxyl sulphate, p-cresyl sulphate, and trimethylamine-N-oxide (TMAO). Due to intestinal wall inflammation and degradation of intercellular tight junctions, gut-derived uremic toxins translocate into the bloodstream and exert systemic effects. In this review, we discuss the evidence supporting a role for gut-derived uremic toxins in promoting multiorgan dysfunction via inflammatory, oxidative stress, and apoptosis pathways. End-organ effects include vascular calcification, kidney fibrosis, anemia, impaired immune system, adipocyte dysfunction with insulin resistance, and low turnover bone disease. Higher blood levels of gut-derived uremic toxins are associated with increased cardiovascular events and mortality in the CKD population. Clinical trials that have examined interventions to trap toxic products or reverse gut microbial dysbiosis via oral activated charcoal AST-120, prebiotics and probiotics have not shown impact on cardiovascular or survival outcomes but were limited by sample size and short trials. In summary, the gut microbiome is a major contributor to adverse cardiovascular outcomes and progression of CKD. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,524 |
Two cases of advanced abdominal pregnancy have been reviewed and two live babies have been delivered. Emphasis has been given to suggestive clinical features which may help in the pre-operative diagnosis of this rare condition. | Background: Abdominal pregnancy is potentially highly morbid and often complicated by postoperative fever. Case: A 29-year-old gravida 2 para 0 presented with a 17-week size-demised abdominal pregnancy. We describe the continued difficulty in determining the timing and type of intervention. In addition, we found that the gestational sac was colonized by group B streptococcus at the time of surgery. Conclusion: This case illustrates that preoperative colonization of the intra-abdominal gestational sac may contribute to postoperative febrile morbidity. We suggest treating patients with prophylactic antibiotics and avoiding spill of gestational sac contents into the peritoneal cavity. Placement of a sterile Foley bulb into the uterine cavity can confirm the extrauterine position of the pregnancy prior to undertaking surgery. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,525 |
A discrete-event simulation language was implemented in MATLAB. The approach is similar to the process/command modeling paradigm utilized in GPSS and other languages that followed. The language is a MATLAB Script File (m-file) and can be part of a larger analysis package as a sub-function of an optimization/simulation system. The modeler builds the simulation through support functions provided in this system but must insert them in the proper locations of the MATLAB master function. To develop a proper model, it is necessary to understand the internal simulation structure using the switch/cases statement and where various aspects of the simulation structure are located. To simplify this process, a model generator has been developed which parses a model text file and produces the required MATLAB master simulation function. The model generator also reduces the magnitude of understanding of the implementation specifics of the MATLAB simulation language and makes proper model development easier. | This book provides a basic treatment of one of the most widely used operations research tools: discrete-event simulation. Prerequisites are calculus, probability theory, and elementary statistics. Contents, abridged: Introduction to discrete-event system simulation. Mathematical and statistical models. Random numbers. Analysis of simulation data. Index. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,526 |
Objectives: In this large population study we set out to examine the profile of Mild Behavioral Impairment using the Mild Behavioral Impairment Checklist (MBI-C), and explore its factor structure when employed as a self-report and informant rated tool. Design: Population based cohort study. Setting: Online testing via the PROTECT study (http://www.protectstudy.org.uk) Participants: 5,742 participant-informant dyads. Measurements: Both participants and informants completed the MBI-C. The factor structure of the MBI-C was evaluated by exploratory factor analysis (EFA). Results: The most common MBI-C items as rated by self-report and informants related to affective dysregulation (mood/anxiety symptoms), being present in 34% and 38% of the sample respectively. The least common were items relating to abnormal thoughts and perception (psychotic symptoms) (present in 3 and 6% of the sample respectively). There were only weak correlations between self-report and informant-report MBI-C responses. EFA for both sets of respondent answers indicated a five-factor solution for the MBI-C was appropriate, reflecting the hypothesized structure of the MBI-C. Conclusion: This is the largest and most detailed report on the frequency of MBI symptoms in a non-dementia sample. The full spectrum of MBI symptoms was present in our sample, whether rated by self-report or informant report. However, we show that the MBI-C performs differently in self-report versus informant-report situations, which may have important implications for the use of the questionnaire in clinic and research. | INTRODUCTION ::: Mild behavioral impairment (MBI) is characterized by the emergence of neuropsychiatric symptoms in elderly persons. Here, we examine the associations between MBI and Alzheimer's disease (AD) biomarkers in asymptomatic elderly individuals. ::: ::: ::: METHODS ::: Ninety-six cognitively normal elderly individuals underwent MRI, [18 F]AZD4694 β-amyloid-PET, and [18 F]MK6240 tau-PET. MBI was assessed using the MBI Checklist (MBI-C). Pearson's correlations and voxel-based regressions were used to evaluate the relationship between MBI-C score and [18 F]AZD4694 retention, [18 F]MK6240 retention, and gray matter (GM) volume. ::: ::: ::: RESULTS ::: Pearson correlations revealed a positive relationship between MBI-C score and global and striatal [18 F]AZD4694 standardized uptake value ratios (SUVRs). Voxel-based regression analyses revealed a positive correlation between MBI-C score and [18 F]AZD4694 retention. No significant correlations were found between MBI-C score and [18 F]MK6240 retention or GM volume. ::: ::: ::: CONCLUSION ::: We demonstrate for the first time a link between MBI and early AD pathology in a cognitively intact elderly population, supporting the use of the MBI-C as a metric to enhance clinical trial enrolment. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,527 |
BACKGROUND: The objective of this study was to describe a population of children admitted to a tertiary care pediatric hospital with severe trauma to identify key areas for injury prevention research, and programming. METHODS: Retrospective chart review conducted on all children 0-17 years admitted to the Children's Hospital of Eastern Ontario (CHEO) between April 1, 1996, and March 31, 2000, following acute trauma. Each record was reviewed and assigned an ISS using the AIS 1990 revision. All cases with an ISS > 11 were included in the study. RESULTS: There were 2610 trauma cases admitted to CHEO over the study period. Of these, 237 (9.1%) had severe trauma (ISS > 11). Sixty-two percent were male. Twenty-nine percent were between the ages of 10 and 14 years, 27% between 5 and 9 years, 16% between 15 and 17 years, 15% between 1 and 4 years, and 13% less than 1 year old. The most common mechanisms of injury were due to motor vehicle traffic (39%), falls (24%), child abuse (8%), and sports (5%). Of those resulting from motor vehicle traffic, 53 (57%) were occupants, 22 (24%) were pedestrians, and 18 (19%) were cyclists. When combining traffic and nontraffic mechanisms, 26 (11% of all severe trauma cases) occurred as a result of cycling incidents. The most severe injury in 65% of patients was to the head and neck body region. CONCLUSION: Research efforts and activities to prevent severe pediatric trauma in our region should focus on road safety, protection from head injuries, avoidance of falls, and prevention of child abuse. | OBJECTIVES ::: A small proportion of pediatric sport- and recreation-related injuries are serious enough to be considered "major trauma." However, the immediate and long-term consequences in cases of pediatric major trauma are significant and potentially life-threatening. The objective of this study was to describe the incidence and outcomes of pediatric major traumas related to sport and recreational activities in Nova Scotia. ::: ::: ::: METHODS ::: This study was a retrospective case series. Data on major pediatric traumas related to sport and recreational activities on a provincial scope were extracted from the Nova Scotia Trauma Program Registry between 2000 and 2013. We evaluated frequency, type, severity, and outcomes of major traumas. Outcomes assessed included length of hospital stay, admission to a special care unit (SCU), and mortality. ::: ::: ::: RESULTS ::: Overall, 107 children aged three to 18 years sustained a major trauma (mean age 12.5 [SD 3.8]; 84% male). Most injuries were blunt traumas (97%). The greatest proportion were from cycling (59, 53%), followed by hockey (8, 7%), skateboarding (7, 7%) and skiing (7, 7%). The Nova Scotia Pediatric Trauma Team was activated in 27% of cases. Mean in-hospital length of stay was five days (SD 5.6), and nearly half (49%) of patients required SCU admission. Severe traumatic brain injury occurred in 52% of cases, and mortality in five cases. ::: ::: ::: CONCLUSIONS ::: Over a 13-year period, the highest incidence of pediatric major trauma related to sport and recreational activities was from cycling, followed by hockey. Severe traumatic brain injury occurred in over half of pediatric major trauma patients. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,528 |
OBJECTIVE ::: To determine the incidence and risk factors for injury associated with the performance of acrobatic gymnastics. ::: ::: ::: DESIGN ::: Retrospective injury and training survey. ::: ::: ::: SETTING ::: New South Wales acrobatic gymnastics clubs. ::: ::: ::: PARTICIPANTS ::: Surveys were completed by 73 acrobatic gymnasts (69 female) aged 8-26 years. ::: ::: ::: MAIN OUTCOME MEASUREMENTS ::: Data on injury incidence and frequency for injury site were collected. Multiple-regression and ROC curve analysis were used to evaluate training-associated injury risk factors. ::: ::: ::: RESULTS ::: Half (50.7%) of the participants had sustained an injury associated with acrobatic gymnastics in the past 12 months, with 28.8% of participants affected by chronic injury at the time of the study. Age of onset for acute and chronic acrobatics-related injury averaged 13.9 (SD +/- 3.03) and 14.7 (SD +/- 3.85) years, respectively. Injury sites were predominately the knee, ankle and wrist. Risk factors for injury were having an age of >or=13 years and training for >or=8 h per week at age 11 years. ::: ::: ::: CONCLUSIONS ::: The results suggest that the 11-15 years age period is critical for the occurrence of injury in acrobatic gymnasts. This is possibly due to the adolescent growth spurt which may create an increased vulnerability to injury if training volume during this time is above a certain threshold. | The asymmetry of use of lower limbs may influence balance beam results and injury risk. This research was performed to study how many elements which asymmetrically load lower extremities are included in balance beam routines of professional female gymnasts. We videorecorded all exercises of qualification round on balance beam at an international competition B World Cup in Ljubljana 2014. We analysed take-offs and landings to define the actions done by left leg, both legs simultaneously, or right leg. A delay of at least 0.01 second in recruitment of one of the lower limbs defined the action as being from a single leg. In the routines of 19 included gymnasts we found significant asymmetry of load: right leg initiated 42.87% of actions (on average 12.47±3.32 per routine), while left leg and both legs initiated 29.08 and 28.05% of actions (on average 8.58±2.97 and 8.21±3.07 per routine, respectively). The load on right leg was significantly larger compared to left leg and both legs (p=0.002 and 0.003). Only 4 gymnasts (20.8%) loaded left leg more than right leg. Additional review of code of points revealed that it mostly contains elements (in 60% of cases) where a single leg at take-off or at landing is loaded. We conclude that asymmetric lower limb loading is present at balance beam routines in elite gymnasts. We hypothesize that the unilateral distribution of load may be associated with the unilateral predominance of injuries and this should be analysed in further research. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,529 |
Aims The aims of this study were to evaluate the outcomes of treatment among hospitalized patients with diabetic foot ulcers, the risk factors for non-healing ulcers, and the rate of major amputation among Thai patients. Methods A retrospective study of hospitalized diabetic foot patients treated at Theptarin Hospital during the period of 2009–2013. The complete healing rate was assessed at 12 months after admission. Results During the study period, 232 patients (123 males and 109 females) with 262 admissions were included (mean age 65.6 ± 11.9 years, mean duration of diabetes 17.2 ± 9.9 years) with a mean follow-up of 17.5 ± 16.7 months. Major amputations were performed in 4.2% of the patients and peripheral vascular disease (PVD) was a predictive factor (OR 5.25; 95% CI [1.43–19.29]; p -value 0.006). Complete healing (including minor amputations) was achieved in 82.1% of the admissions. Only DFU of the heel was a statistically significant (OR 3.34; 95% CI [1.11–10.24]; p -value 0.041) predictor of non-healing ulcers. Three patients (1.1%) died during hospitalization. Conclusions Management of diabetes-related foot ulcers with a multidisciplinary approach resulted in a limb salvage rate that was greater than 90% and a complete healing rate that was greater than 80%. Successful management of diabetic foot ulcers might be possible in Thailand utilizing this approach. | *Visual by Dr. Francis Mislang Objective. To determine the factors associated with in-hospital mortality among diabetic patients admitted for lower extremity infection. Methodology. This is a retrospective analysis of diabetic patients with lower extremity infection admitted at the UP-Philippine General Hospital. Data was analyzed through multiple logistic regression after multiple imputation was performed for missing data. Results. 441 patients with diabetes were included in the analysis, of which 98.1% have Type 2 diabetes mellitus; 58.1% were males and the mean age of the cohort was 56.7 ±11.1 years. The mortality rate was 11.1% over the 3-year period from 2015 to 2017, of which 46% died from myocardial infarction (MI). Multivariate logistic regression showed the following were associated with increased likelihood of in-hospital mortality: non-performance of surgery (OR=4.22, 95%CI 1.10-16.27, p =0.036), elevated BUN (OR=1.06, 95%CI 1.01-1.11, p =0.016), MI (OR=27.19, 95%CI 6.38-115.94, p =0.000), respiratory failure requiring mechanical ventilation (OR=26.14, 95%CI 6.28-108.80, p =0.000), gastrointestinal bleeding (OR=10.08, 95%CI 1.87-54.38, p =0.007), hospital-acquired pneumonia (OR=9.46, 95%CI 2.52-35.51, p =0.001) shock (OR=7.09, 95%CI 2.17-23.22, p =0.001). Conclusion. In the in-patient setting, morbidity and mortality is high among diabetic patients with lower extremity infection. Non-performance of surgery, elevated BUN, MI, respiratory failure requiring mechanical ventilation, gastrointestinal bleeding, hospital acquired pneumonia and shock are associated with in-hospital death. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,530 |
The outcome of different treatment modalities after 7 years was investigated in a selected group of 50 patients with craniomandibular disorders of muscular origin. To minimize the possible effects of selection on the clinical mat erial, the selected treatment group was compared to a consecutive group of patients in terms of age, gender, intensity/duration of pain, and socioeconomic profile. Both groups were comparable in most respects, but the selected group had a longer duration and a higher intensity of pain at baseline. There were more men in the consecutive group than in the selected group. A combined treatment appraoch resulted in a better outcome than single treatments. Sixty-five percent of all patients in the selected group reported improvement at the 7-year follow-up. All of the 19 patients who received counseling combined with different occlusal treatments improved. Forty-three percent of the patients treated otherwise showed improvement. Patients who were aware of stress responded better to treatment. | The temporomandibular disorders (TMDs) comprise a constellation of symptoms affecting the joints and muscles involved in jaw movement. Patients complain of orofacial pain, limited jaw opening, and clicking or popping sounds. Although pain is generally the defining characteristic of TMD, patients often report marked degrees of stress and interference in daily life. This article reviews recent studies on epidemiology, sex differences, pediatric TMD, classification systems, comparisons to other chronic pain disorders of uncertain etiology, psychological assessment, depression, central modulation and hypervigilance, sleep disturbances, stress, and the management of TMD by conservative physical interventions and cognitive behavioral therapy. Both the assessment and the management of TMD requires a multidisciplinary perspective with strong emphasis on psychosocial variables. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,531 |
GrabCut is a renowned algorithm for image segmentation. It exploits iteratively the combinatorial minimization of energy function as introduced in graph-cut methods, to achieve background foreground classification with fewer user's interaction. In this paper it is proposed to extend GrabCut to carry out segmentation on RGB-D point clouds, based both on appearance and geometrical criteria. It is shown that an hybrid GrabCut method combining RGB and D information, is more efficient than GrabCut based only on RGB or D images. | Foreground segmentation enables dynamic reconstruction of the moving objects in static scenes. After KinectFusion had proposed a novel method that constructs the foreground from the Iterative Closest Point (ICP) outliers, numerous studies proposed filtration methods to reduce outlier noise. To this end, the relationship between outliers and the foreground is investigated, and a method to efficiently extract the foreground from outliers is proposed. The foreground is found to be directly connected to ICP distance outliers rather than the angle and distance outliers that have been used in past research. Quantitative results show that the proposed method outperforms prevalent foreground extraction methods, and attains an average increase of 11.8% in foreground quality. Moreover, real-time speed of 50 fps is achieved without heavy graph-based refinements, such as GrabCut. The proposed depth features surpass current 3D GrabCut, which only uses RGB-N. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,532 |
Housing is a key social determinant of health. The relationship between housing outcomes and health outcomes is bi-directional: housing affects healthoutcomes, and health affects housing outcomes. There are clear links between the quality and location of housing and health outcomes. The impacts of housing on health vary between geographic and climatic locations and contexts. There is a wide range of housing interventions that positively impact Indigenous health. One way of categorisingthese is: infrastructure improvements; addressing behavioural factors; and adjustments to policy environments. | There is a long tradition of using housing interventions to promote public health, despite causative factors being unclear. This article reviews the research evidence on the key aspects of poor housing such as inadequate maintenance, over crowding, low temperatures and dampness, that have been identified as contributing to the impact of housing on health. Possible intervening factors such as house dust mites and fungi are also reviewed. This evidence is discussed in the context of possible confounding factors such as housing location and tenure. Conclusions are drawn about the adequacy of the research evidence as a basis for changing building regulations and other policy measures as a way of improving health. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,533 |
Background Seizures are common in encephalitis but there is paucity of comprehensive studies evaluating predictors of seizures. Aim To evaluate the frequency and predictors of seizures in encephalitis patients and its effect on outcome. Methods In a prospective hospital based study, the patients with encephalitis were evaluated clinically and presence of seizure, its type and duration were noted. Patients' consciousness was assessed by Glasgow coma scale (GCS) score and neurological findings were recorded. Blood count, serum chemistry, electroencephalography (EEG), cranial MRI and CSF examination were done. The diagnosis of encephalitis was based on ELISA and PCR and grouped into herpes, Japanese, dengue and nonspecific encephalitis. Hospital mortality and 3-month outcome were noted. Results 148 patients with encephalitis whose median age was 26 (range 1–75) years were included. Seizures occurred in 63 (42.6%) patients; 18 of whom had status epilepticus. Seizures were more common in herpes (75%) followed by Japanese (54%) encephalitis. The predictors of seizure in encephalitis were age, GCS score and cortical involvement on MRI. 61% children had seizures compared to 36.6% adults and 53.3% with cortical involvement on MRI had seizure compared to 14.3% without. Seizures were not related to mortality but associated with poor outcome. Conclusion In encephalitis, seizures occur in 42.6% patients especially in children with low GCS score and having cortical involvement on MRI. | BackgroundInfection of the CNS is considered to be the major cause of encephalitis and more than 100 different pathogens have been recognized as causative agents. Despite being identified worldwide as an important public health concern, studies on encephalitis are very few and often focus on particular types (with respect to causative agents) of encephalitis (e.g. West Nile, Japanese, etc.). Moreover, a number of other infectious and non-infectious conditions present with similar symptoms, and distinguishing encephalitis from other disguising conditions continues to a challenging task.MethodsWe used canonical correlation analysis (CCA) to assess associations between set of exposure variable and set of symptom and diagnostic variables in human encephalitis. Data consists of 208 confirmed cases of encephalitis from a prospective multicenter study conducted in the United Kingdom. We used a covariance matrix based on Gini's measure of similarity and used permutation based approaches to test significance of canonical variates.ResultsResults show that weak pair-wise correlation exists between the risk factor (exposure and demographic) and symptom/laboratory variables. However, the first canonical variate from CCA revealed strong multivariate correlation (ρ = 0.71, se = 0.03, p = 0.013) between the two sets. We found a moderate correlation (ρ = 0.54, se = 0.02) between the variables in the second canonical variate, however, the value is not statistically significant (p = 0.68). Our results also show that a very small amount of the variation in the symptom sets is explained by the exposure variables. This indicates that host factors, rather than environmental factors might be important towards understanding the etiology of encephalitis and facilitate early diagnosis and treatment of encephalitis patients.ConclusionsThere is no standard laboratory diagnostic strategy for investigation of encephalitis and even experienced physicians are often uncertain about the cause, appropriate therapy and prognosis of encephalitis. Exploration of human encephalitis data using advanced multivariate statistical modelling approaches that can capture the inherent complexity in the data is, therefore, crucial in understanding the causes of human encephalitis. Moreover, application of multivariate exploratory techniques will generate clinically important hypotheses and offer useful insight into the number and nature of variables worthy of further consideration in a confirmatory statistical analysis. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,534 |
Fertility rates have been declining worldwide, with a growing number of young women suffering from infertility. Infectious and inflammatory diseases are important causes of infertility, and recent evidence points to the critical role of the early-life microbial environment in developmental programming of adult reproductive fitness. Our laboratory and others have demonstrated that acute exposure to an immunological challenge early in life has a profound and prolonged impact on male and female reproductive development. This review presents evidence that perinatal exposure to immunological challenge by a bacterial endotoxin, lipopolysaccharide, acts at all levels of the hypothalamic-pituitary-gonadal axis, resulting in long-lasting changes in reproductive function, suggesting that disposition to infertility may begin early in life. | Chronic low-grade subclinical inflammation has been increasingly recognized as an interposer in the endocrine, metabolic and reproductive disturbances that characterize the polycystic ovary syndrome (PCOS). Abdominal adiposity and obesity are often present in PCOS. Mounting evidence indicates that adipose tissue is involved in innate and adaptive immune responses. Continuous release of inflammatory mediators such as cytokines, acute phase proteins, and adipokines perpetuates the inflammatory condition associated with obesity in women with PCOS, possibly contributing to insulin resistance and other long-term cardiometabolic risk factors. Genetic variants in the genes encoding inflammation-related mediators underlie the development of PCOS and their interaction with environmental factors may contribute to the heterogeneous clinical phenotype of this syndrome. In the future, strategies ameliorating inflammation may prove useful for the management of PCOS and associated conditions. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,535 |
Purpose ::: To conduct a telephone survey establishing pancreatic cancer survivors’ level of interest in, preferences for, and perceived barriers and facilitators to participating in exercise and diet intervention programming. These data will inform the development of such interventions for newly-diagnosed patients. | Background:The study assessed the effects of a counselling intervention on lifestyle changes in certain-aged people at risk of cardiovascular disease.Design and methods:This was an intervention study at baseline and six- and 12-month follow-ups. The participants were 40 years old (n= 53 at baseline, n=33 at six months and n=34 at 12 months). The main outcomes were cardiovascular health parameters, such as weight, BMI, waist circumference, blood pressure, cholesterol (total, high density lipoprotein, low density lipoprotein), blood glucose, and self-assessed and reported lifestyle and adherence to lifestyle changes. The counselling intervention was Internet-based and carried out via Skype or face-to-face in small groups (on average, six participants).Results:There were statistically significant differences between the baseline and the 12-month follow-up with respect to the consumption of fat and snacks. Some positive cardiovascular health improvements were detected between baseline and six months, but not ... | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,536 |
To examine the effect of age on the glomerular basement membrane, compositional analyses were performed on membranes isolated in highly purified form from rats at different stages of their growth (35 to 200 days old). Substantial age-related changes were observed in the amino acid composition of the basement membranes. A significant correlation with age ( P P P | The glycosaminoglycan (heparan sulfate) component of glomerular basement membranes from human kidneys of diabetic and nondiabetic subjects has been quantitated after isolation from protease digests of the membranes on DEAE-cellulose microcolumns. A significant decrease (P less than 0.005) in the glycosaminoglycan content of diabetic membranes was observed. Heparan sulfate was identified as the predominant glycosaminoglycan in both diabetic and control subjects and the extent of its sulfation appeared to be similar. The reduced level of glycosaminoglycan in the diabetic glomerular basement membrane was accompanied by a significant elevation of hexoses, which are primarily associated with the collagen component, suggesting that a redistribution of basement membrane macromolecules occurs in the diabetic state. Since heparan sulfate has been implicated as a major component of the glomerular anionic filtration barrier, its decreased content in diabetic basement membranes may contribute to the proteinuria observed in this disease. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,537 |
Geriatric Psychopathology 2 The elderly represent nearly a third of the population in public psychiatric facilities. The social and physiological changes associated with aging can lead to a variety of psychiatric disturbances which necessitate institutionalization of the elderly individual. Treatment of these disturbances is likely to be based on the medical model of psychopathology, although findings indicate that behaviorally-oriented therapy may often be the more appropriate course of action. The reported findings carry implications pertinent to the future of geropsychology. Geriatric Psychopathology | The most widely known substances that have been investigatedfor treating cognitive deterioration in the aged are cerebral vasodilators, Gerovital H3, psychostimulants, ‘ ‘nootropics, ‘ ‘ neuropeptides, and neurotransmitters. The rationale for the choice of specific agents has shifted as our conceptions regarding the origins of cognitive decline have changed; we now know that most cognitive deterioration occurs independently of arteriosclerotic vascular changes. Substances currently being investigated because of their effects on brain electrophysiology, on neurohumoral processes, or on central neurotransmitters show promise. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,538 |
We outline results on varieties of groups generated by Cartesian and direct wreath products of abelian groups and pose two problems related to our recent results in that direction. A few related topics are also considered. | Part 1 Wreath products of groups: construction and basic properties centralizers conjugacy and direct decomposition nilpotency automorphisms classes of groups some special constructions generalized wreath products twisted wreath products and crown products. Part 2 Wreath products of semigroups: construction and basic properties regular semigroups generalized wreath products the Krohn-Rhodes theorem applications and further developments. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,539 |
Up to 79% of IBS patients report gastroesophageal reflux disease (GERD) symptoms, and up to 71% of GERD patients report irritable bowel syndrome (IBS) symptoms. There are two principal hypotheses for the common presence of IBS symptoms in GERD patients. The first theory suggests that GERD and IBS overlap in a significant number of patients. The second theory suggests that IBS-like symptoms are part of the spectrum of GERD manifestation. The first theory is supported by genetic studies and similarities in gastrointestinal sensory-motor abnormalities potentially due to general gastrointestinal disorder of smooth muscle or sensory afferents. The other theory is primarily supported by studies demonstrating improvement of IBS-like symptoms in GERD patients receiving anti-reflux treatment. The close relationship between GERD and IBS could be explained by either GERD affecting different levels of the GI tract or a high overlap rate between GERD and IBS due to similar underlying GI dysfunction. | To assess the prevalence of laryngopharyngeal reflux (LPR) in the Greek general population and its risk factors. Questionnaire based epidemiological, adult participants’ survey. The Reflux Symptom Index (RSI) was used for the assessment of LPR prevalence. The RSI questionnaire was completed by 340 (183 male and 157 female) randomly selected subjects. Subjects with RSI score ≥13 were considered as LPR patients and those with RSI score <13 were considered as non LPR subjects. The prevalence of LPR in the general Greek population was found to be 18.8 % with no statistically significant difference between the two genders (p > 0.05). The age group of 50–64 years showed the higher prevalence rate. Tobacco smoking and alcohol consumption were found to be related with LPR. No reported concomitant disease or medication was found to be related with LPR. LPR prevalence in the Greek general population was found to be 18.8 %. Tobacco smoking and alcohol consumption were found to be related with LPR. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,540 |
The purpose of this study was to assess the gross motor skills development among visually impaired children Total of 15 visually-impaired children participated in this study (7 males and 8 females), divided into three disability groups that are B1,B2 and B3 with age range between 7 -10 years old. They were assessed on locomotor and object control skills that include running, galloping, hoping, leaping, horizontal jumping, and sliding, striking, dribbling, kicking, catching, throwing and underhand roll. The subjects perform the Test of Gross Motor Development-2. One Sample T-Test was used to analyze the significant of the hypothesize showed that there was significant lower object control but not locomotor skill scores. (t=19.007, p=.000<0.05). The mean value for Locomotor Skills for running group B1 is 6.60±.894, group B2 is 7.00±1.732 and group B3 is 7.20±1.095 while for gallop group B1 is 4. 6.00±2.828.The gross motor skill result of the subjects are at the satisfactory level and the subjects give a full cooperation. | 1. Introduction to the Developmental Perspective. 2. Heredity and Neurological Changes. 3. Physical Growth Changes. 4. Physiological Changes. 5. Factors Affecting Growth and Development. 6. Perceptual Development. 7. Information Processing and Motor Control. 8. Early Movement Behavior. 9. Motor Behavior during Early Childhood. 10. Motor Behavior during Later Childhood and Adolescence. 11. Motor Behavior in the Adult Years. 12. Assessment. 13. Sociocultural Influences on Motor Development. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,541 |
BACKGROUND ::: The aim of this study was to establish the reference intervals (RIs) of total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate transaminase (AST), and creatinine (CREA) for apparently healthy elderly (Han ethnicity) in Shuyang, China. ::: ::: ::: MATERIAL AND METHODS ::: A total of 54 912 blood specimens from elderly residents age 65-104 years were collected by standard procedures in Shuyang county of Jiangsu province. TBIL, ALT, AST, and CREA for each participant were determined by automatic biochemical analyzer. Distribution and differences of TBIL, ALT, AST, and CREA were analyzed and compared between the elderly of the same age of different sexes and different ages of the same sex. RIs of TBIL, ALT, AST, and CREA were compared with the current RIs. The RIs and 95% confidence intervals were calculated using nonparametric method (2.5th-97.5th percentiles) according to the guideline of the Clinical and Laboratory Standards Institute. ::: ::: ::: RESULTS ::: RIs established for the healthy elderly include: TBIL 7.8~30.6 µmol/L for males and 7.3~26.1 µmol/L for females; ALT 8.7~47.3 U/L for males and 8.4~45.2 U/L for females; AST 15.7~46.9 U/L for males and 15.1~46.2 U/L for females; and CREA 45.1~100.9 µmol/L for males and 38.7~85.0 µmol/L for females. Reference intervals of TBIL, ALT, AST, and CREA for male elderly were higher than those of females, and values of CREA increased with increasing age. ::: ::: ::: CONCLUSIONS ::: We have established a panel of locally relevant RIs. It is necessary to establish scientific and reasonable RIs of TBIL, ALT, AST, and CREA for the healthy elderly in our region, which will provide a reference for clinicians and inspection officers. | ObjectiveThere is a scarcity of reference interval studies on the elderly in Africa. This study establishes reference interval for the elderly for some commonly used biochemical parameters. In this study, 255 conveniently sampled, healthy elderly, participants meeting Clinical and Laboratory Standards Institute (CLSI C28-A3) guidelines were enrolled. The results obtained may have utility in clinical diagnosis, patient management and research.ResultsIn general, the consensus reference interval established in this study tended to be higher than reference interval from Caucasian populations; but lower than those obtained from reference interval studies in several African countries. This pattern was observed in a number of analytes including Alanine aminotransferase; aspartate aminotransferase; alkaline phosphatase; sodium; potassium among others. Significant sex-related variations were also observed in total bilirubin; direct bilirubin; indirect bilirubin; albumin; sodium; chloride; plasma carbon dioxide, creatinine and anion gap. The results demonstrate that reference interval for Eritrean urban population differs from those derived from other African or North American populations. In this regard, the use of reference interval values obtained from Caucasian populations may result in misdiagnosis. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,542 |
Guanine-quadruplexes (G4) are highly stable DNA secondary structures known to mediate gene regulation and to trigger genomic instability events during replication. G4 are known to be associated with DNA damage and we propose that G4 are involved in the ageing disorder mild cognitive impairment (MCI). Lymphocytes were obtained from healthy controls and individuals with MCI. The intensity and frequency of G4 foci as well as γH2AX (a marker of DNA damage) intensity were measured by quantitative immunofluorescence and were correlated with cognitive function and cytokinesis-block micronucleus cytome markers of DNA damage. γH2AX intensity as well as G4 frequency and intensity were significantly elevated in MCI lymphocytes compared to controls. The combined biomarker panel was tested in a predictive statistical model, which improved the demarcation of MCI from controls with 80.3% accuracy. The results obtained from this pilot study showed for the first time that G4 levels are increased with cognitive impairment and thus, may be involved in the early development of Alzheimer’s disease possibly via an association with chromosomal DNA damage and DNA double strand breaks. | Purpose of Review ::: The micronucleus (MN) assay is a validated method of genetic toxicology, widely used for human biomonitoring studies. This review summarizes and discusses current data regarding involvement of MN in pathogenesis of different diseases, potential of MN assay to be used as cytogenetic diagnostic technique, as well as highlights current achievements in studies concerning clinically relevant chromosomal instability using MN assay. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,543 |
Summary. Data from the population-based Metropolitan Atlanta Developmental Disabilities Study were used in a case-control study to assess the association between low birthweight and mental retardation (intelligence quotient ≤70) among 10-year-old children who were born in 1975 or 1976. Children with mental retardation were identified from existing records at multiple sources and control children were selected from public school rosters. Data on birthweight and other covariates (sex, birth order, maternal age, maternal race, maternal education and gestational age) came from birth certificates. We used multiple logistic regression modelling to obtain adjusted odds ratios for mental retardation, with normal birthweight children (those weighing ≥2500g) as the referent group. For low birthweight children as a whole, the odds ratio for mental retardation was 2.8 (95% CI 1.9-4.2). The risk was higher for very low birthweight (<1500 g) children than for moderately low birthweight (1500–2499 g) children, and higher for severe mental retardation (intelligence quotient <50) than for mild mental retardation (intelligence quotient 50–70). Adding gestational age to the models revealed that normal birthweight children who were born preterm also were at increased risk of having mental retardation at age 10 years. | Low birth weight (LBW), defined as a live birth weighing <2,500 g, is a significant public health problem in the United States, especially a few states including Georgia. Although much work has been done to study the epidemiology of LBW in various regions, the spatial–temporal patterns of LBW prevalence in Georgia remain unclear to a large degree. This paper investigates the temporal trend of LBW rates over a time span of 11 years and the spatial clusters of LBW prevalence in the state of Georgia at the county level. Comparison is also made between race and gender groups, and between county groups of different socioeconomic statuses to uncover disparities. Results showed a steady and prevalent increase of LBW rate in the state over the study period. Three counties and two county clusters with significantly higher LBW rates than the state rate were detected for 1999–2001, while one more county and two more county clusters of high LBW rates were detected for 2007–2009. More urbanized counties were found to have a relatively lower LBW rate when compared with the less urbanized ones as groups. The findings from this paper are expected to provide valuable insights to better understanding the etiology of LBW and more effective allocating prenatal health care resources in the future. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,544 |
Despite the efforts of the governmental child protection programs, child fatalities due to maltreatment remain a serious problem in Arab countries. This retrospective study identified 87 as a total questionable child death (QCD) cases in Riyadh, the capital of Kingdome of Saudi Arabia. 52 victims (60%) were Saudi children. Nearly one-third (29%) of the cases involved the death of children ages 1–5. 21 QCDs occurred in middle and the eastern regions of the country. QCDs were most commonly reported as accidental (29%), followed by homicidal (25%). A parent was the main assailant in (38%) of the homicidal cases, and the child’s relative was reported in (18%). Wounds were detected as the cause of death in 39 cases (45%). Upon examination, child negligence was reported or observed in 5 cases. This study provides appropriate data for planning preventive measures. | AIM ::: To identify the leading causes of injury in children aged 0-4 years by single year of age using injury submechanisms and present a brief epidemiologic profile of each cause. ::: ::: ::: METHODS ::: Hospitalisation data for New South Wales from 1999 to 2009 were used to identify the leading causes of injury for children aged 0-4 years by single year of age. For each leading cause, rates over time and by sex were calculated by single year of age. Associated age and sex risk ratios were estimated. ::: ::: ::: RESULTS ::: The leading causes of injury for children aged <1, 1 and 2 years were falls while being carried, burns by hot non-aqueous substances and poisoning by other and unspecified pharmaceutical substances, respectively. Falls involving playground equipment ranked first for children aged 3-4 years. Each leading injury cause exhibited an age pattern that remained stable over time and by sex. Age predicted falls while being carried and both age and sex predicted the remaining leading injury causes, with age and sex interacting to predict burns by hot non-aqueous substances. ::: ::: ::: CONCLUSIONS ::: Epidemiologic analysis using single-year age intervals and injury submechanisms results in a clearer picture of injury risk for young children. The findings of this study provide detailed information regarding the leading causes of hospitalised injury in young children by age and sex. Child health-care providers can use this information to focus discussions of child development and injury risk with families of young children and suggest appropriate prevention measures in terms of a child's age and sex. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,545 |
Current theory concerning the combination of relational databases addresses the problem as a layered approach, focusing on differences in physical platform, operating system, and database management systems as well as differences in the database schema. With the dynamic relational database the structure of the tables adapts to accept epidemiological survey records of differing clinical content. The database schema is not determined until an attempt is made to combine two data stores together. Two or more dynamic dental relational databases may be combined in order to amalgamate the data from two databases from one region of the country, or from data collected in two different regions. Combining data stores will allow data trends from different areas to be analysed and contrasted. | Veterinary epidemiology is a rapidly developing science. A key factor for success is the ease of data capture. However, real-time data collection is quite hard because in many such systems, users must return to the home or office to import the data to computer or fill a paper-based data entry form. This paper presents an embedded application system for animal disease report and Surveillance system in Veterinary Science which provides real-time Surveillance and allows instant analysis. Using the system, users can access user-friendly software to help diagnose diseases or problems in herds. It designed to deliver benefits to producers, veterinarians, animal health workers, stock agents, government departments and the beef industry. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,546 |
A report on the application of standard 2D-FT MR combined with RARE-MR-Urography in a pregnant woman with right sided abdominal pain, dilated upper urinary tract and possible stone or inflammatory disease. This technique visualised the complete obstructed ureter in relation to the surrounding organs (uterus, vessels), allows precise diagnosis of the cause of the obstruction and avoids ionising radiation. | Objective. A new approach, combined static-dynamic MR urography is evaluated to determine its potential utility for the functional-morphological diagnosis of paediatric urinary tract obstruction. In this initial investigation we sought to evaluate the procedure by imaging the urinary tract of piglets. Materials and methods. Twenty-nine healthy piglets were studied with MR urography (MRU), 99 mTc-MAG3 diuretic renal scintigraphy (DRS), ultrasound (US) and excretory urography (EU). The functional and morphological findings were compared. For MRU we combined a respiration-triggered 3D-IR-TSE sequence and a dynamic 2D-FFE sequence after Gd-DTPA injection. Results. MRU depicted the complete urinary tract with superior image quality compared to EU. Calculation of time-intensity curves from the dynamic sequence permitted determination of single kidney function from parenchymal ROIs and urinary excretion using the whole kidney ROI. MRU and DRS showed significant agreement in the assessment of both single kidney function and urinary excretion. Disturbances of urinary drainage were generally caused by an overfilled bladder. Conclusions. Combined static-dynamic MRU is well suited for the depiction of the complete urinary tract and for the determination of individual kidney function and urinary excretion in the piglet. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,547 |
Objective: To evaluate the safety and efficacy of a once-daily gastroretentive formulation of gabapentin (G-GR; 1800 mg). Methods: This was an 11-week, double-blind, randomized, placebo-controlled Phase 3 clinical trial in patients with postherpetic neuralgia. Patients underwent a 2-week dose titration, 8 weeks of stable dosing, and 1 week of dose tapering. The primary endpoint was the change in average daily pain intensity score from Baseline to Week 10 using Baseline Observation Carried Forward (BOCF) imputation. Results: Four-hundred and fifty-two patients (mean age 65.6 y, BMI 29 Kg/m2) were randomized. Baseline average daily pain intensity score during the week prior to randomization was 6.6 and 6.5 for the G-GR and placebo treatment groups, respectively. Three hundred and seventy-seven patients completed the study (84% G-GR, 83% placebo). G-GR significantly reduced BOCF change in average daily pain intensity compared with placebo (−2.1 vs. −1.6; G-GR vs. placebo, P=0.013). Compared with placebo, more G-GR-treated patients reported “much” or “very much” improvement (patient global impression of change, 43% vs. 34%; P Conclusion: Once-daily G-GR 1800 mg was effective and well tolerated for the relief of pain in patients with postherpetic neuralgia. | Background ::: In new drug development in neuropathic pain (NeP), randomized, double-blind, placebo-controlled trials (PCTs) with long treatment durations in a parallel-group design are recommended for confirmatory trials. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,548 |
OBJECTIVE ::: To evaluate the clinical and demographic characteristics, rationale for transfer of critically ill obstetric patients to intensive care unit and their management therein. ::: ::: ::: METHODS ::: The observational retrospective case series study was conducted at Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Pakistan, and comprised critically ill female patients transferred to intensive care unit from the department of Obstetrics and Gynaecology between August 2011 and June 2013. The data was collected on pre-designed proforma which included demographic characteristics of patients, their symptomatology and initial diagnosis, intervention in the department, continuing or subsequent complications/reasons for admission to intensive care unit, management and stay there and, finally, outcome. Data was analysed using SPSS 21. ::: ::: ::: RESULTS ::: The mean age of 150 patients in the study was 30.3±5.047years,mean parity was 2.49±2.207.The most common condition affecting women and leading to their transfer to intensive care was eclampsia/pre-eclampsia in 80(53.33%) followed by bleeding disorders in 25(16.65%) and septic shock in 24(16%). The mean stay in intensive care was 4.47±2.53 days, and 38(25.3%) patients required ventilator support, while 112(74.7%) were managed with oxygen and inotropic support. The overall maternal mortality rate was 41(27.3%), which included 19(16.9%) patients managed without ventilator, and 22 (57.8%) managed with ventilator (p<0.05). ::: ::: ::: CONCLUSIONS ::: Hypertensive and bleeding disorders were the main reasons for transfer of obstetric patients to intensive care unit, and maternal mortality was high among patients treated on ventilator support. | st to 31 st December 2006. Data included demographics, disease responsible for critical illness, complications that prompted ICU admissions, intervention required, length of ICU stay and the resulting foeto-maternal mortality and morbidity. Results: Over the study period, 30 obstetric patients were transferred to general ICU, representing 1.34% of 2224 deliveries. Seventy three % of women belonged to rural areas, 96% were un-booked while history of surgical intervention was present in 87% of cases. Hypertensive disorders of pregnancy (50%) and sepsis (17%) were the two main obstetrical conditions responsible for maternal illness. Respiratory failure (57%) and haemodynamic instability (40%) were the major indications for ICU transfer. Mechanical ventilatory support was the commonest intervention required in the ICU followed by the ionotropic support (33%).The foetal mortality rate was 43%, while maternal mortality rate was 33%. Conclusion: Maternal morbidity and mortality can be reduced by meticulous adaptation of safe motherhood initiative, provision of separate ICU services for critically ill obstetrical patients and early assessment and aggressive | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,549 |
SummaryAdolescents with celiac disease often fail to adhere to a strict gluten-free diet. The value of endomysial antibodies in assessing the dietary compliance of such adolescents has been assessed in 23 patients divided into four groups according to their daily gluten intake. Serum endomysial anti | OBJECTIVE ::: To assess the association between seroconversion and catch-up growth during the first year of a gluten-free diet (GFD) program in children with celiac disease (CD). ::: ::: ::: METHODS ::: All prepubertal and biopsy-proven children diagnosed with CD between January 1999 and August 2009 were included in a retrospective study (n=55). Growth parameters and celiac antibodies were documented before and after 6 (period 1) and 12 months (period 2) of GFD, respectively. ::: ::: ::: RESULTS ::: Mean height velocity-standard deviation score (SDS) was significantly higher in period 1 compared with that in period 2 (2.90 +/- 3.20 vs. 0.20 +/- 2.08, p<0.001) irrespective of the serology status, with marginal difference in mean weight-SDS gain (p=0.074). Mean levels of height velocity-SDS and the weight-SDS gain were similar in the seropositive and seronegative groups in both periods of the study. Mean height-SDS and weight-SDS levels after 6 months were higher than those in baseline levels, both in seropositive (-0.47 +/- 0.91 vs. -0.82 +/- 0.82, p<0.001 and -0.59 +/- 1.17 vs. -1.11 +/- 1.33, p<0.001, respectively) and seronegative patients (-1.02 +/- 1.14 vs. -1.50 +/- 1.12, p<0.001 and -1.19 +/- 1.27 vs. -1.45 +/- 1.40, p=0.048, respectively). These growth parameters were higher at the end compared with the beginning of period 2, but only in seropositive patients. ::: ::: ::: CONCLUSIONS ::: The most remarkable catch-up growth in children with CD can be expected during the first 6 months of GFD, irrespective of the serology status. | A 75-year-old woman suffered severe haemoptysis after insertion of a Swan-Ganz catheter in an intensive care unit. Control of the pulmonary artery haemorrhage was quickly and successfully achieved with stainless steel coils as the embolic material. | eng_Latn | 14,550 |
OBJECTIVE ::: The aim of this study was to describe the prevalence of the chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) among middle-aged men in a region with a temperate climate, i.e. a community in western Sweden. ::: ::: ::: MATERIAL AND METHODS ::: Men aged 40-69 years who, on the basis of postal invitation, volunteered to participate in a study regarding erectile dysfunction as a risk factor for cardiovascular disease, were asked also to complete the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). ::: ::: ::: RESULTS ::: In total, 459 of 900 men responded to the invitation. CP/CPPS-like symptoms, i.e. perineal and/or ejaculatory pain and an NIH-CPSI pain score of 4 or greater, were reported by 23 men (5%). More severe symptoms, with a pain score of at least 8 and perineal and/or ejaculatory pain, were reported by 15 men (3.3%). ::: ::: ::: CONCLUSIONS ::: In this cross-sectional population-based study 5% had NIH-CPSI scores suggestive of CP/CPPS, which is in the lower range compared with studies from other regions, refuting the idea that CP/CPPS should be more common in regions with a temperate climate. | Chronic Pelvic Pain (CPP) and Chronic Pelvic Pain Syndrome (CPPS) have a significant impact on men and women of reproductive and nonreproductive age, with a considerable burden on overall quality of life (QoL) and on psychological, functional, and behavioural status. Moreover, diagnostic and therapeutic difficulties are remarkable features in many patients. Therefore evaluation, assessment and objectivation tools are often necessary to properly address each patient and consequently his/her clinical needs. Here we review the different tools for pain assessment, evaluation, and objectivation; specific features regarding CPP/CPPS will be highlighted. Also, recent findings disclosed with neuroimaging investigations will be reviewed as they provide new insights into CPP/CPPS pathophysiology and may serve as a tool for CPP assessment and objectivation. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,551 |
OBJECTIVE ::: To test the accuracy and reproducibility of ultrasound and computed tomography (CT) for the quantification of abdominal fat in correlation with the anthropometric, clinical, and biochemical assessments. ::: ::: ::: MATERIALS AND METHODS ::: Using ultrasound and CT, we determined the thickness of subcutaneous and intra-abdominal fat in 101 subjects-of whom 39 (38.6%) were men and 62 (61.4%) were women-with a mean age of 66.3 years (60-80 years). The ultrasound data were correlated with the anthropometric, clinical, and biochemical parameters, as well as with the areas measured by abdominal CT. ::: ::: ::: RESULTS ::: Intra-abdominal thickness was the variable for which the correlation with the areas of abdominal fat was strongest (i.e., the correlation coefficient was highest). We also tested the reproducibility of ultrasound and CT for the assessment of abdominal fat and found that CT measurements of abdominal fat showed greater reproducibility, having higher intraobserver and interobserver reliability than had the ultrasound measurements. There was a significant correlation between ultrasound and CT, with a correlation coefficient of 0.71. ::: ::: ::: CONCLUSION ::: In the assessment of abdominal fat, the intraobserver and interobserver reliability were greater for CT than for ultrasound, although both methods showed high accuracy and good reproducibility. | Computed tomography (CT) produces thin cross-sectional radiographs that may prove very useful in body composition research. CT images of the abdomen allow computerized measurement of total fat area, and also enable the differentiation of subcutaneous fat from intraabdominal fat. The preset investigation examines whether a single CT scan of the abdomen provides an accurate indication of overall abdominal adiposity. Graphs of measurements from seven sequential scans of the abdomen in eight patients showed that rankings of total abdominal area, total fat area, subcutaneous and intraabdominal fat area are relatively consistent no matter which abdominal level is chosen. Correlations of 0.89 to 0.99 between single scans and the average values for all scans show that a single CT image contains the same information on adiposity as a series of scans. These results suggest that future CT studies of body composition can limit radiation exposure by using single scans at different anatomical sites. If only a single scan at one site can be obtained, the level of the umbilicus may be the most useful, because it contains the largest percentage of fat in the body, and best allows differentiation of intraabdominal from subcutaneous fat. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,552 |
Instrumental learning involves three primary events: a stimulus (S), a response (R), and an outcome (O). Evidence is reviewed indicating the presence of binary associations among those events, as well as a hierarchical structure of the form S–(R–O). Experiments examining the conditions that produce learning, the content of the learning once it has occurred, and the way learning maps into performance all suggest the presence of such a hierarchical structure. | Predictions, desires, or intentions have recently shown to strongly influence behavior, adaptation, and learning. These anticipations influence behavior mediating decision making and action execution as well as attention. Although it is not the future itself that influences the present but the anticipated future states or future properties, the difference to purely stimulus‐driven behavior and learning is highly significant. Recent analyses investigate under which environmental properties which type of anticipatory mechanism is helpful to improve behavior. Vice versa, since anticipatory mechanisms also bias attention, future sensory processing and thus future learning capabilities are immediately influenced by current anticipations. The impact on the understanding of the world, social systems, human learning and understanding, as well as education principles might be immense. The perspective of expectation and purpose as part of the cause in the general case might have been underestimated and requires further investigations and considerations. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,553 |
BACKGROUND ::: Little is known about the incidence and characteristics of primary, or external, shoulder impingement in an occupationally and physically active population. A longitudinal, prospective epidemiologic database was used to determine the incidence and risk factors for shoulder subacromial impingement in the United States (U.S.) military. Our hypothesis was that shoulder impingement is influenced by age, sex, race, military rank, and branch of service. ::: ::: ::: METHODS ::: The Defense Medical Epidemiology Database was queried for all shoulder impingement injuries using International Classification of Disease, Ninth Addition, Clinical Modification code 726.10 within a 10-year period from 1999 through 2008. An overall injury incidence was calculated, and a multivariate analysis performed among demographic groups. ::: ::: ::: RESULTS ::: In an at-risk population of 13,768,534 person-years, we identified 106,940 cases of shoulder impingement resulting in an incidence of 7.77/1000 person-years in the U.S. military. The incidence of shoulder impingement increased with age and was highest in the group aged ≥40 years (incidence rate ratio [IRR], 4.90; 95% confidence interval [CI], 4.61-5.21), was 9.5% higher among men (IRR, 1.10, 95% CI, 1.06-1.13), and compared with service members in the Navy, those in the Air Force, Army, and Marine Corps were associated with higher rates of shoulder impingement (IRR, 1.46 [95% CI, 1.42-1.50], 1.42 [95% CI, 1.39-1.46], and 1.31 [95% CI, 1.26-1.36], respectively). ::: ::: ::: CONCLUSIONS ::: The incidence of shoulder impingement among U.S. military personnel is 7.77/1000 person-years. An age of ≥40 years was a significant independent risk factor for injury. | Objective ::: ::: Although multiple studies have reported the prevalence of primary hip osteoarthritis (OA), little has been reported on incidence rates of hip OA. We sought to determine the incidence rate and demographic risk factors of hip OA in an ethnically diverse and physically active population of US military servicemembers. ::: ::: ::: ::: Methods ::: ::: A query was performed using the US Defense Medical Epidemiology Database for the International Classification of Diseases, Ninth Revision, Clinical Modification code for hip OA (715.95). Multivariate Poisson regression analysis was used to estimate the rate of hip OA per 100,000 person-years, controlling for sex, race, age, rank, and service. ::: ::: ::: ::: Results ::: ::: The overall unadjusted incidence rate of hip OA was 35 per 100,000 person-years. Women, compared with men, had a significantly increased adjusted incidence rate ratio for hip OA of 1.87 (95% confidence interval [95% CI] 1.73–2.01). The adjusted incidence rate ratio for black servicemembers when compared with white servicemembers was 1.32 (95% CI 1.23–1.41). The adjusted incidence rate ratio for the ≥40-year-old age group compared with the 20-year-old group was 22.21 (95% CI 17.54–28.14). With junior officers as the referent category, junior enlisted, senior enlisted, and senior officers rank groups had a significantly increased adjusted incidence rate ratio for hip OA. With the Air Force as the referent category, each service had a significantly increased adjusted incidence rate ratio for hip OA. ::: ::: ::: ::: Conclusion ::: ::: Female sex; black race; age ≥40 years; junior enlisted, senior enlisted, and senior officer rank groups; and military service in the Navy, Army, or Marines were all risk factors for hip OA. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,554 |
The history of water on Mars is a crucial question for our understanding of the geologic history of the planet. Arabia Terra is a region that can help us address this question. This region is located on the lowland-highland dichotomy boundary and contains the largest expanse of heavily cratered terrain in the Martian northern hemisphere. The northern plains are proposed to be the location of ancient oceans, and evidence of this may lie in the morphology of the craters located along the edge of Arabia Terra. Because of its location, Arabia Terra provides us with a window into the extent of the role volatiles have played in shaping the Martian surface. This uniqueness of Arabia Terra has prompted previous studies but all have been limited in their spatial extent and/or features studied. Our study will provide a complete look at the extent to which volatiles have influenced the impact crater record in the Arabia Terra region. | Themes in the study of impact cratering Crater morphology Stress waves in solids Cratering mechanics: contact and compression stage Ejecta deposits Scaling of crater dimensions Cratering mechanics: modification stage Multiring basins Cratered landscapes Atmospheric interactions Impact cratering and planetary evolution Appendix I: Derivation of the Hugoniot equations Appendix II: Equations of the state for impact cratering General bibliography Index. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,555 |
A very severe cyclonic storm with wind speeds of over 240 km/h struck the coastal areas of Bangladesh in the full moon night of 29 April 1991. The path of the eye, close to the shore, raised a storm surge of unusual height, reportedly more than 9 m above the mean sea level, which devastated the offshore islands and the mainland coast. The damage to the physical infrastructure of the port of Chittagong and adjoining industrial area has been colossal, and recovery will take years. Death tolls from the cyclone, storm surge and its aftermath exceeded 145 000 making it one of the world's major natural disasters of this century. | This study is concerned with the development of storm surge model to predict water level accurately due to surge associated with a cyclone along the coast of Bangladesh. Considering the funnel shape of the Bay of Bengal, coastal bending and the existence of off-shore islands, a vertically integrated model in cylindrical polar coordinate system is developed using nested numerical scheme. A fine mesh scheme capable of incorporating coastal bending and offshore islands properly in the numerical scheme is nested into a coarse mesh scheme covering up to 15° N latitude of the Bay of Bengal. The developed model is used to estimate water levels at different coastal and island stations associated with a few storms that hit the coast of Bangladesh. The computed surge levels compared well with observed ones and predicted surge levels investigated with different approaches. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,556 |
Growth arrest-specific protein 6 (Gas6) is a serum protein involved in granulocyte, platelet and endothelium interaction, and is implicated in both anti-inflammatory response as well as platelet/leukocytes activation. We investigated serum Gas6 level in different clinical manifestations of systemic lupus erythematosus (SLE). Data were collected in 83 patients with SLE and 40 non-lupus controls. The Gas6 levels were detected by enzyme-linked immunosorbent assay. Our results demonstrated that the Gas6 level was higher in SLE patients as compared to the non-lupus control subjects (SLE vs. non-lupus control, median [inter-quartile range (IQR)] 22.67 [19.40-28.60] vs. 18.97 [16.05-20.62] ng/mL, p < 0.01). Furthermore, Gas6 level was higher in patients with nephritis (nephritis vs. non-nephritis, median [IQR] 26.21 [21.17-31.61] vs. 22.22 [18.98-26.98] ng/mL, p = 0.03) and in patients with cutaneous vasculitis (vasculitis vs. non-vasculitis, median [IQR] 27.89 [23.24-34.26] vs. 22.30 [19.32-27.16] ng/mL, p = 0.03). Our results indicate that the serum Gas6 level is increased in SLE patients with lupus nephritis or cutaneous vasculitis, implicating a potential to serve as a SLE disease activity marker. | Systemic lupus erythematosus is a multiorgan autoimmune disease with a highly variable clinical course, typically involving women in childbearing age. At present, many aspects of its pathogenesis still remain unclear. Moreover, although a significant increase of patient survival has been observed in the last decades, morbidity and mortality remain high. Finally, SLE impacts negatively on the health-related quality-of-life of patients. Therefore, multiple aspects of SLE still remain challenging and it continues to be the object of both clinical and translational clinical research. Herewith, we provide a critical digest of the recent literature on this topic. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,557 |
We measured basal and peak acid outputs, food-stimulated acid secretion, and basal and food-stimulated serum gastrin concentrations in a large group of duodenal ulcer patients and normal subjects. Basal and peak acid outputs were significantly higher in ulcer patients. In contrast, acid secretion was similar in the groups when food was infused into the stomach and when sham feeding was combined with meal infusion to simulate normal eating. Meal-stimulated acid secretion, expressed as a percentage of peak acid output to correct for differences in secretory capacity, was lower in ulcer patients (P less than 0.002). Basal serum gastrin concentrations were higher in ulcer patients, which may have contributed to higher basal acid output. However, increases in serum gastrin after food were similar in the groups. Duodenal ulcer patients, as a group, have increased basal and maximal acid secretion, but the amount of acid secreted and gastrin released after eating is normal. | Until recently, the secretion of gastric acid, which plays an important role in the pathogenesis of peptic ulcer, was thought to be controlled by diet, the autonomic nerves and gut hormones. However, peptic ulcer is now known to be caused by the infection with Helicobacter pylori (H. pylori), so it is possible that inflammation modifies the secretion of gastric acid. We used gastric-lumen-perfused rats to first examine the effect of interleukin-8 (IL-8) on acid secretion and then the involvement of free radicals and neutrophils in the action of IL-8. IL-8 enhanced tetragastrin-stimulated acid secretion and free radical scavengers or inhibitors and the pretreatment with anti-rat neutrophil serum inhibited this effect, which indicates that IL-8 enhances gastrin-stimulated acid secretion and that neutrophil-derived hydroxyl radicals mediate the IL-8-induced increase in acid secretion. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,558 |
Abdominal wound dehiscence is a surgical complication with a high morbidity rate but which is associated with predictable and preventable factors. During a 10 year period (1966 to 1975) at the New York Lying-In Hospital, 70 cases were found on the obstetric-gynecologic service, and these cases were analyzed to see why dehiscence remains a problem. Those factors contributing to dehiscence include obesity, pre-existing pulmonary and cardiovascular problems, vertical incisions, the triad of ileus, vomiting, and coughing, and, to a lesser extent, hypoproteinemia, fluid and electrolyte imbalance, and wound infection. The incidence of abdominal wound dehiscence would be much lower if high-risk patients were identified, adequate pulmonary toilet was used, ileus was promptly treated with abdominal decompression, and strict attention was paid to electrolyte and protein balance in the pre- and post-operative period. The management of abdominal wound dehiscence is also discussed. | Once a hysterectomy is indicated for the treatment of gynecologic disease, the surgeon must determine the safest and most efficient route—abdominal, vaginal, or laparoscopic-assisted vaginal. Here, the authors outline each approach, including patient selection, technical pearls, and advantages and disadvantages. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,559 |
PURPOSE ::: Few studies are available on withdrawal seizures about dexmedetomidine (DEX). Thus, we retrospectively evaluated the incidence of withdrawal seizures after discontinuation of DEX and examined potential risk factors in infants after cardiovascular surgery. ::: ::: ::: METHODS ::: The medical records of 142 infants who had undergone cardiovascular surgery between April 2010 and November 2013 were examined. Clinical characteristics and usage of DEX were analyzed. DEX withdrawal seizures were evaluated using Withdrawal Assessment Tool - version 1 (WAT-1). All the patients and controls were categorized according to DEX discontinuation strategy, which was either gradual or abrupt. ::: ::: ::: RESULTS ::: Nine patients (6.3%) developed generalized clonic or generalized tonic-clonic seizures accompanied by preceding fever of >38°C approximately four to eight hours following the discontinuation of DEX, and were clinically diagnosed as DEX withdrawal seizures with a median WAT-1 score of 3. Clinical characteristics and operative data were similar, but median cumulative dose and maximum temperature after discontinuation of DEX were significantly higher in infants with withdrawal seizures than in those without (P=0.007 and P<0.001, respectively). Eight of the 9 patients with withdrawal seizures (88.9%) and 20 of the 133 patients (15.0%) with no withdrawal seizures had discontinued DEX abruptly (P<0.001). Cumulative dose and abrupt discontinuation of DEX were significantly associated with DEX withdrawal seizures in infants after cardiovascular surgery (R=0.619, P=0.004). ::: ::: ::: CONCLUSIONS ::: Physicians should be aware that infants who received DEX after cardiovascular surgery had potential to cause withdrawal seizures accompanied by preceding pyrexia after discontinuation of DEX. Higher cumulative dose and abrupt discontinuation of DEX appears to increase the risk for these withdrawal seizures. | ObjectiveTo study the brain protective effect of dexmedetomidine (DEX) during surgery in paediatric patients with congenital heart disease (CHD).MethodsThis randomized single-blind controlled study... | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,560 |
The acute abdomen is one of the most frequent causes for presentation to the emergency department. Imaging plays an important role for an accurate diagnosis, which in turn diminishes morbidity and mortality. The aim of this study was to demonstrate optimum CT aspects and emphasize on the important features of CT for those patients presenting with an acute abdominal pain at the Emergency Department both in general and in a number of selected conditions (appendicitis, small-bowel obstruction, acute pancreatitis, and diverticulitis). The reported data by this study are based on the author working experience, which forms a continuous protocol adjustment process. The present study provides evidence that CT would result in definite diagnosis of patients with abdominal pain in terms of the detection of some urgent conditions. | OBJECTIVE ::: The purpose of this study was to evaluate the added value of plain radiographs on top of clinical assessment in unselected patients presenting with acute abdominal pain at the emergency department (ED). ::: ::: ::: METHODS ::: In a multicenter prospective trial, patients with abdominal pain more than 2 hours and less than 5 days presented at the ED were evaluated clinically, and a diagnosis was made by the treating physician. Subsequently, all patients underwent supine abdominal and upright chest radiographs, after which the diagnosis was reassessed by the treating physician. A final (reference) diagnosis was assigned by an expert panel. The number of changes in the primary diagnosis, as well as the accuracy of these changes, was calculated. Changes in the level of confidence were evaluated for unchanged diagnoses. ::: ::: ::: RESULTS ::: Between March 2005 and November 2006, 1021 patients, 55% female, mean age 47 years (range, 19-94 years), were included. In 117 of 1021 patients, the diagnosis changed after plain radiographs, and this change was correct in 39 patients (22% of changed diagnoses and 4% of total study population). Overall, the clinical diagnosis was correct in 502 (49%) patients. The diagnosis after evaluation of the radiographs was correct in 514 (50%) patients, a nonsignificant difference (P = .14). In 65% of patients with unchanged diagnosis before and after plain radiography, the level of confidence of that diagnosis did not change either. ::: ::: ::: CONCLUSION ::: The added value of plain radiographs is too limited to advocate their routine use in the diagnostic workup of patients with acute abdominal pain, because few diagnoses change and the level of confidence were mostly not affected. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,561 |
BACKGROUND ::: Maternal obesity and diabetes are both associated with increased risk of congenital central nervous system (CNS) malformations in the offspring and may share a common underlying mechanism. Our objective was to evaluate whether gestational diabetes influenced the association of prepregnancy maternal obesity and risks for CNS birth defects. ::: ::: ::: METHODS ::: This Texas population-based case-control study evaluated births occurring January 1997 through June 2001. Data came from structured telephone interviews. Cases (n=477) were mothers of offspring with anencephaly (n=120), spina bifida (n=184), holoprosencephaly (n=49), or isolated hydrocephaly (n=124). Controls (n=497) were mothers of live infants without abnormalities randomly selected from the same hospitals as cases. Response rates were approximately 60% for both cases and controls. We evaluated maternal obesity (body mass index > or =30.0 kg/m) and risks for CNS birth defects, as well as whether gestational diabetes influenced the risks. ::: ::: ::: RESULTS ::: After adjusting for maternal ethnicity, age, education, smoking, alcohol use, and periconceptional vitamin use, obese women had substantially increased risks of delivering offspring with anencephaly (odds ratio=2.3; 95% confidence interval=1.2-4.3), spina bifida (2.8; 1.7-4.5), or isolated hydrocephaly (2.7; 1.5-5.0), but not holoprosencephaly (1.4; 0.5-3.8). Odds ratios were higher for the joint effects of maternal obesity and gestational diabetes, with evidence for interaction on a multiplicative scale. ::: ::: ::: CONCLUSIONS ::: Maternal obesity and gestational diabetes may increase the risk of CNS birth defects through shared causal mechanisms. | The association between maternal diabetes mellitus and congenital defects has been well documented. However, few data exist on the potential teratogenic effect of gestational diabetes (GD). We analyzed 19,577 consecutive infants with malformations of unknown cause and compared the offspring of mothers with GD with those of nondiabetic mothers. The children with each of 20 types of selected anomalies among the two groups were used to calculate the odds ratio (OR). Because we used as a reference group for each congenital defect the rest of malformed infants, the value of the OR gives us the specificity between the association of GD and each congenital defect. Our analysis strongly supports the suggestion that GD is a significant risk for holoprosencephaly, upper/lower spine/rib, and renal and urinary system anomalies. GD is a heterogeneous disorder, which includes previously unrecognized and newly diagnosed nongestational diabetes mellitus (DM). Thus, it is possible that the teratogenic effect is related to latent DM. However, because it is not possible at this time to differentiate between these situations, pregnancies complicated by GD should be considered at risk for congenital anomalies. Prenatal ultrasound examination should be aimed particularly at the detection of abnormalities of the central nervous system, the renal and urinary system, and the spine/rib developmental field. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,562 |
Background There is an inherited maternal predisposition to preeclampsia. Whether there is a paternal component, however, is not known. Methods We used records of the Utah Population Database to identify 298 men and 237 women born in Utah between 1947 and 1957 whose mothers had had preeclampsia during their pregnancy. For each man and woman in the study group, we identified two matched, unrelated control subjects who were not the products of pregnancies complicated by preeclampsia. We then identified 947 children of the 298 male study subjects and 830 children of the 237 female study subjects who had been born between 1970 and 1992. These children were matched to offspring of the control subjects (1973 offspring of the male control group and 1658 offspring of the female control group). Factors associated with preeclampsia were identified, and odds ratios were calculated with the use of stepwise logistic-regression analysis. Results In the group of men whose mothers had had preeclampsia (the male study gro... | Preeclampsia is one of the leading causes of maternal morbidity/mortality. The pathogenesis of preeclampsia is still under investigation. The aim of this paper is to present the molecular mechanisms implicating in the pathway leading to preeclampsia. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,563 |
Objective: The aims of this point-prevalence study were to investigate a representative inpatient population to determine the prevalence of people admitted to hospital for the reason of a foot-related condition, and identify associated independent factors. ::: ::: Methods: Participants were adult inpatients in five different representative hospitals, admitted for any reason on the day of data collection. Maternity, mental health and cognitively impaired inpatients were excluded. Participants were surveyed on a range of self-reported demographic, social determinant, medical history, foot disease history, self-care, footwear, past foot treatment prior to hospitalisation and reason for admission variables. Physical examinations were performed to clinically-diagnose a range of foot disease and foot risk factor variables. Independent factors associated with being admitted to hospital for the primary or secondary reason of a foot-related condition were analysed using multivariate logistic regression. ::: ::: Results: Overall, 733 participants were included; mean(SD) age 62(19) years, male 55.8%. Foot-related conditions were the primary reason for admission in 54 participants (7.4% (95% CI: 5.7-9.5)); 36 for foot disease (4.9%), 15 foot trauma (2.1%). Being admitted for the primary reason of a foot-related condition was independently associated with foot infection, critical peripheral arterial disease, foot trauma and past foot treatment by a general practitioner and surgeon (p < 0.01). Foot-related conditions were a secondary reason for admission in 28 participants (3.8% (2.6-5.6)), and were independently associated with diabetes and current foot ulcer (p < 0.01). ::: ::: Conclusions: This study, the first in a representative inpatient population, suggests the direct inpatient burden caused by foot-related conditions is significantly higher than previously appreciated. Findings indicate one in every thirteen inpatients was primarily admitted because of a foot-related condition with most due to foot disease or foot trauma. Future strategies are recommended to investigate and intervene in the considerable inpatient burden caused by foot-related conditions. | Background High Risk Foot Clinic (HRFC) patients have foot ulceration commonly associated with poorer quality of life (QoL). A positive SARC-F test is predictive of sarcopenia. The objective of this study is to investigate whether SARC-F positive status is associated with lower QoL among attendees of HRFC, which is currently unknown. Methods In this cross-sectional study ambulatory HRFC patients were recruited at metropolitan tertiary referral hospital over one year. Demographics, comorbidities, SARC-F and EQ-5D-3L (EuroQol Group) outcomes were collected. Association between SARC-F status and EQ-5D visual analogue scale measurement, as well as individual EQ-5D-3L dimensions were investigated using, respectively, linear robust and ordinal logistic regression modelling. Results The clinic was attended by 122 new patients, 85 of whom (69%) completed the questionnaires with no selection bias identified. 43/85 (51%) patients were SARC-F positive as indicated by a score of 4 or greater. No significant differences between SARC-F positive and negative patients were identified in age or diabetes status. SARC-F positive patients had consistently lower EQ-5D-3L visual analogue scale measurement [mean 5.3 (SD 2.0); median 5 (IQR: 4, 6.5)] compared to SARC-F negative patients [6.6 (SD 1.9); 7 (5.5, 7.5)], adjusted mean difference -1.2 (95%CI: -2.1, -0.4; p=0.007). SARC-F positive patients demonstrated consistent and statistically significantly worse EQ-5D-3L scores on mobility, personal care and usual activities, but not on anxiety/depression and pain/discomfort components. Conclusions Approximately half of HRFC patients are SARC-F positive and exhibit significantly lower QoL as measured by EQ-5D-3L compared to SARC-F negative patients. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,564 |
A general viewpoint of pattern recognition is introduced. Two major approaches to pattern recognition; namely, decision-theoretic (or statistical) and syntactic (or structural), are then discussed within the general framework. The approach of template- matching can be interpreted as a special case of the two major approaches. Various ways of mixing the approaches are discussed. | Massively parallel learning networks are applied to the classification of sonar returns from two undersea targets and the ability of networks to correctly classify both training and testing examples is studied. Networks with an intermediate layer of hidden processing units achieved a classification accuracy as high as 100% on a training set of 104 returns. These networks correctly classified a test set of 104 returns not contained in the training set with an accuracy of up to 90.4%. Networks without an intermediate layer of processing units achieved only 73.1% correct on the same test set. Performance improved and the variability due to the initial conditions for training decreased with the number of hidden units. The effect of training set design on test set performance was also examined. The performance of a three-layered network was better than trained human listeners and the network generalized better than a nearest-neighbor classifier. > | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,565 |
Techniques of in situ hybridization histochemistry, Northern blot hybridization, and immunocytochemistry were used to investigate the biosynthesis of glucagon-like immunoreactants (GLIs) in rat brain. Cells in the nucleus tractus solitarius of the medulla oblongata of adult rat brain hybridized to a synthetic oligonucleotide probe (GLP-I oligomer) corresponding to nucleotide sequences in pancreatic proglucagon mRNA encoding glucagon-like peptide I (GLP-I), and stained with antisera specific for two antigenic determinants of pancreatic proglucagon, glucagon, and GLP-I. These data suggest that there is de novo synthesis of proglucagon in cells of the nucleus tractus solitarius via expression of a proglucagon mRNA similar to that produced in pancreas. Previous studies have shown that cells in hypothalamus stain with GLP-I antisera, but not with glucagon antisera. However, cells in the hypothalamus did not hybridize with the GLP-I oligomer and may therefore produce a GLP-I immunoreactant that is encoded by a mRNA different from the pancreatic proglucagon-mRNA-encoding glucagon and GLP-I. Northern blot hybridizations with a cDNA probe encoding the entire pancreatic proglucagon sequence did not detect proglucagon/GLP-I mRNAs in polyadenylated RNAs (Poly A RNA) from adult rat brainstem and hypothalamus, probably because of their low abundance. Poly A RNAs from fetal rat brain, however, contained two mRNAs that hybridized to the proglucagon cDNA probe. One mRNA of 1,300 bases is the same size as pancreatic proglucagon mRNA. The second mRNA of 1,500 bases may encode the GLP-I immunoreactant detected in the hypothalamus of adult rat brain. The presence of neurons with glucagon and glucagon-like peptides in the nucleus tractus solitarius suggests a role of these peptides in gustatory and/or cardiopulmonary control. | Glucagon-like peptide-1 (GLP-1) is a glucoincretin hormone most intensively studied for its actions on insulin secreting β-cells. GLP-1 and its receptor are also found in brain and accumulating evidence indicates that GLP-1 has neuroprotective actions. Here, we investigated whether GLP-1 protects neuronal cells from death evoked by nerve growth factor (NGF) withdrawal. Compromised trophic factor signaling may underlie neurodegenerative diseases ranging from Alzheimer disease to diabetic neuropathies. We report that GLP-1 provides sustained protection of cultured neuronal PC12 cells and sympathetic neurons from degeneration and death caused by NGF deprivation. Past work shows that NGF deprivation induces the pro-apoptotic protein Bim which contributes to neuron death. Here, we find that GLP-1 suppresses Bim induction promoted by NGF deprivation. Thus, GLP-1 may protect neurons, at least in part, by suppressing Bim induction. Our findings support the idea that drugs that mimic or elevate GLP-1 represent potential therapeutics for neurodegenerative diseases. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,566 |
The relationships between the spatial distribution of gully erosion and topographic thresholds in the form of slope angle, position and configuration, as well as land use change in the form of abandoned lands were examined in several affected catchments of the Eastern Cape Province, South Africa. Land use and permanent gullies were mapped, digitized from orthophoto maps in Arc/info 3.5.2 GIS and converted to shapefiles using ArcView 3.2 GIS. Relationships between the mapped phenomena and topographic variables were sought using a Digital Elevation Model (DEM) in Idrisi Kilimanjaro GIS. A comparison between areas with a high potential for gullying and actual gully erosion was made using the Stream Power Index (SPI) as a surrogate for critical flow shear stress. Field surveys were also conducted to assess the present condition of the gullied sites as well as to validate DEM derivations. Seventy five percent of the gullied area was noted to lie on abandoned lands. A predominance of gullying in concave bottom lands was also identified. The SPI values highlighted a distinct preferential topographic zone for gully location. A conceptual model depicting the interaction between land use and topographic parameters to induce gully erosion was developed. This should assist local authorities to develop a policy regarding management of abandoned lands. | Gullied and ungullied catchments in four areas of deeply weathered saprolite in the Middle Veld of Swaziland can be successfully separated (p | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,567 |
The authors propose a more extensive lipectomy than usual along and above the mandibular branch, to obtain better results in the neck and lower face in rhytidectomy. The operative technique is based on anatomical findings. Results are excellent when the procedure is indicated and properly performed. Lipectomy is recommended in patients with abnormal fat deposits about the lower face and neck; it is not advised for obese patients. | A technique of double-layered face-lifting has been used with 143 consecutive patients over the past 5 years for correction of the “turkey neck” condition. This procedure offers a satisfactory, long-lasting solution to this heretofore untreatable condition. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,568 |
Monolithic millimeter-wave integrated circuits have been designed and fabricated on semi-insulating GaAs substrates using microstrip transmission lines. Circuits using hybrid techniques have also been constructed on quartz and ceramics. This paper shows that microstrip-line integrated circuits are feasible at millimeter-wave frequencies. Circuit functions have been constructed and tested in the 25- to 100-GHZ range. The loss in microstrip line on semi-insulating GaAs was found to be less than 0.3 dB//lambda/. Couplers from waveguide to microstrip have been made with transmission losses less than 0.5 dB. Monolithic integrated detectors showed 5-dB better sensitivity than a 1N53 diode in a Philips detector mount. Monolithic diodes delivered 1.5 mW at 28 GHz. The results are encouraging and a fully monolithic integrated receiver is under development. | The purpose of this paper is the formulation of a Wave Concept Iterative Process (WCIP) for the analysis of the microwave planar circuits printed between two dielectric mediums in a cylindrical metallic box. This method is based on the transverse wave formulation. It also uses the Hankel Transform to express the integral relation in a spectral domain. An example of annular ring and circular patch loaded by annular ring has been studied and the obtained results validate the new approach. The good agreement between the simulation results and the experimental published data justifies the design procedure and validates the present analysis approach. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,569 |
In this paper, we provide first evidence of the impact of public and private expenditures in health and education on economic growth, via their influence on people's health, skills and knowledge. We consider a growth accounting framework in order to test whether countries that devote a larger amount of resources to the consumption of health and educational services experience higher growth rates. We also test whether the effects on economic growth of public expenditure in health and education differ from those of private expenditure. Our empirical analysis is based on a panel of 19 OECD countries observed between 1971 and 1998. The results are consistent with the hypothesis that health and education expenditure affects positively growth. The estimated impact is stronger for health than for education. More importantly, we find some evidence that public expenditure influences GDP growth more than private expenditure. | Human capital is increasingly believed to play an important role in the growth process, however, adequately measuring its stock remains controversial. In this paper three general approaches to measurement are identified; cost-based, income-based and educational stock-based. This survey focuses on the first two approaches and provides a critical review of the theories and their applications to data from a range of countries. Particular emphasis is placed upon the work of Jorgenson and Fraumeni l1989, 1992r and some new results for New Zealand based upon their approach are also presented. Copyright Blackwell Publishing Ltd, 2003. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,570 |
In this paper, a novel method is presented for unsupervised image segmentation based on local homogeneity analysis. First, a criterion for homogeneity of a certain pattern is proposed. Applying the criterion to local windows in the original image results in the "H-image". The high and low values of the H-image correspond to possible region boundaries and region interiors respectively. Then, a region growing method is used to segment the image based on the H-image. Finally, visually similar regions are merged together to avoid over-segmentation. Experimental results on real images show the effectiveness and robustness of the method. | Texture-segmentation is the crucial initial step for texture-based image retrieval. Texture is the main difficulty faced to a segmentation method. Many image segmentation algorithms either can't handle texture properly or cannot obtain texture features directly during segmentation which can be used for retrieval purpose. This paper describes an automatic texture segmentation algorithm based on a set of features derived from wavelet domain, which are effective in texture description for retrieval purpose. Simulation results show that the proposed algorithm can efficiently capture the textured regions in arbitrary images, with the features of each region extracted as well. The features of each textured region can be directly used to index image database with applications as texture-based image retrieval. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,571 |
Despite having achieved unconstrained stable flight, the insect-scale flapping-wing robot is still tethered for power and control. Towards the goal of operating a biologically-inspired robot autonomously outside of laboratory conditions. In this paper, we simulate outdoor disturbances in the laboratory setting and investigate the effects of wind gusts on the flight dynamics of a millimeter-scale flapping wing robot. Simplified models describing the disturbance effects on the robot's dynamics are proposed, together with two disturbance rejection schemes capable of estimating and compensating for the disturbances. The proposed methods are experimentally verified. The results show that they reduced the root mean square position errors by approximately 50% when the robot was subject to 60 cm·s−1 horizontal wind. | Articulation based on flexure hinges is increasingly popular in microrobotics because of the absence of Coulomb friction, ease of manufacturability, fluid motion, durability, and large angular ranges. However, the inherent flexibility of these hinges makes modeling very complex and specific to the particular engineering applications for which they were developed. In this paper we describe the development and testing of a simplified, versatile method for modeling the stress on a flexure hinge under multi-axis loads in order to maximize hinge lifespan. We also discuss other stress concentration reducing features and design rules that can be applied to more general flexure hinge designs to further extend hinge lifespan. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,572 |
Children are frightening. Frightening? In nearly all contexts this statement would be indefensible. In medicine, however, children are often frightening. For one thing, clinical evaluation in young children can be more difficult than with adults. In addition, in the acutely ill or injured child, reserve can be limited and appropriate assessment, including imaging evaluation, and subsequent care are critically important in improving outcome. Many care providers are not pediatric specialists by practice, and evaluation and treatment of children is less familiar than with adults. Moreover, the spectrum of disorders that affects the pediatric population can be quite different from disorders more easily recognized in adults. Often there is an extra layer of emotional concern, or anxiety, because a child is involved. Together, these issues reinforce the importance of resources which facilitate the diagnosis and care of the sick or injured child. This is especially relevant to chest disorders, because thoracic abnormalities are common in children, and is also relevant to radiologists, because imaging evaluation of the chest is frequently one of the first (or only) tools used after the clinical assessment. Presumably, you are reading this because you are an imager, or interested in imaging evaluation, | Poster: "ECR 2019 / C-1552 / Pediatric chest pathology" by: "H. GUERMAZI1, F. Hela2, F. Wiem2, D. Emna2; 1Sfax Ville, -/TN, 2Sfax/TN" | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,573 |
Thirteen goats (9 does and 4 bucks) were each inoculated orally with 10,000 infective Toxoplasma gondii oocysts. Three does and one buck were used as noninoculated controls. In 2 to 4 days after inoculation (DAI), inoculated goats became dull, pyrectic (40 to 41 C), and anorectic. Three goats died (10, 10, and 14 DAI) and two goats were killed (7 and 32 DAI) because they were moribund; also, 3 does aborted, 2 had weak kids, and 2 had dead fetuses. Toxoplasma was isolated from the placenta of three goats, and the fetal tissues of four goats. The control goats remained asymptomatic. The distribution of T gondii in blood and other tissues was studied by inoculation of mice with caprine tissues. Parasitemia was detected in 7 of 7 goats--beginning 4 DAI in 1 goat, 5 DAI in 5 goats, and 8 DAI in 1 goat. The parasitemia lasted 3 to 10 days. Toxoplasma was isolated from the milk of 2 goats at 12 and 14 DAI. Toxoplasma was isolated from 15 or more tissues of 5 goats killed 7 to 35 DAI and from 10 tissues of 2 goats killed 69 and 95 DAI. | We compared the relative risks of mother-to-child transmission of Toxoplasma gondii and clinical manifestations due to congenital toxoplasmosis associated with intensive prenatal treatment in Lyon and Austria, short term treatment in 51% of Dutch women, and no treatment in Danish women. For each cohort, relative risks were standardized for gestation at seroconversion. In total, 856 mother-child pairs were studied: 549 in Lyon, 133 in Austria, 123 in Denmark and 51 in The Netherlands. The relative risk for mother-to-child transmission compared to Lyon was 1.24 (95% CI: 0.88, 1.59) in Austria; 0.59 (0.41, 0.81) in Denmark; and 0.65 (0.37, 1.01) in The Netherlands. Relative risks for clinical manifestations compared with Lyon (adjusted for follow-up to age 3 years) were: Austria 0.19 (0.04, 0.51); Denmark 0.60 (0.13, 1.08); and The Netherlands 1.46 (0.51, 2.72). There was no clear evidence that the risk of transmission or of clinical manifestations was lowest in centres with the most intensive prenatal treatment. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,574 |
Chronic pancreatitis is an irreversible and progressive disorder of the pancreas characterized by inflammation, fibrosis, and scarring. Exocrine and endocrine functions are lost, often leading to chronic pain. The etiology is multifactorial, although alcoholism is the most significant risk factor in adults. The average age at diagnosis is 35 to 55 years. If chronic pancreatitis is suspected, contrast-enhanced computed tomography is the best imaging modality for diagnosis. Computed tomography may be inconclusive in early stages of the disease, so other modalities such as magnetic resonance imaging, magnetic resonance cholangiopancreatography, or endoscopic ultrasonography with or without biopsy may be used. Recommended lifestyle modifications include cessation of alcohol and tobacco use and eating small, frequent, low-fat meals. Although narcotics and antidepressants provide the most pain relief, one-half of patients eventually require surgery. Therapeutic endoscopy is indicated to treat symptomatic strictures, stones, and pseudocysts. Decompressive surgical procedures, such as lateral pancreaticojejunostomy, are indicated for large duct disease (pancreatic ductal dilation of 7 mm or more). Resection procedures, such as the Whipple procedure, are indicated for small duct disease or pancreatic head enlargement. The risk of pancreatic cancer is increased in patients with chronic pancreatitis, especially hereditary pancreatitis. Although it is not known if screening improves outcomes, clinicians should counsel patients on this increased risk and evaluate patients with weight loss or jaundice for neoplasm. | BACKGROUND AND STUDY AIMS: Previous studies have shown that endoscopic ultrasonography (EUS) sensitively detects morphologic abnormalities due to chronic pancreatitis. However, morphologic EUS findings have limited specificity, particularly at the early stages of chronic pancreatitis. Our aims were to study pancreatic morphology and inflammation in patients with chronic pancreatitis, using EUS and fine-needle aspiration cytology (EUS-FNA), and to compare the results with those of endoscopic retrograde cholangiopancreatography (ERCP) and pancreatic function tests. PATIENTS AND METHODS: 37 patients (48 +/- 13 years) with clinical symptoms and laboratory test findings suggestive of chronic pancreatitis were prospectively studied. Patients with malignancy or major concomitant disorders were excluded. Clinical evaluation included indirect pancreatic function tests. Morphologic criteria for chronic pancreatitis included echo-intense septae/echo-reduced foci (i. e. pseudolobularity), ductal irregularities, and calcifications. EUS-FNA was performed in 27/37 patients, by means of the Hitachi FG34-UX echo endoscope and a 22-gauge needle, and tissue specimens were submitted for standard cytological evaluation. ERCP served as reference in all patients, using the Cambridge classification. RESULTS: 31 patients had chronic pancreatitis while six had normal findings at ERCP. EUS showed morphologic abnormalities of the pancreas in 33 patients. Morphologic abnormalities alone reached a sensitivity of 97 % for chronic pancreatitis with a specificity of only 60 %, while the positive predictive value (PPV) was 94 %, and the negative predictive value (NPV) was 75 %. EUS-FNA increased the negative predictive value to 100 % and the specificity to 67 %. On average, 2.3 needle passes were necessary to obtain sufficient amounts of tissue. The correlation of EUS findings with pancreatic function tests was poor. EUS results were in agreement with regard to the severity of chronic pancreatitis in 5/8 patients with grade I disease, in 11/13 patients with grade II, and in 10/10 patients with grade III disease. Minor complications occurred in two patients (7 %). CONCLUSIONS: EUS is as sensitive and effective as ERCP in the detection of chronic pancreatitis, particularly when only mild disease is present. However, EUS findings have limited specificity, particularly in patients with mild disease. EUS-FNA with cytology is safe and improves the negative predictive value. Negative EUS-FNA findings rule out chronic pancreatitis, but cytological investigation alone does not improve the specificity of EUS findings, suggesting that further improvements in tissue sampling and analysis are necessary to support routine use of FNA in patients with chronic pancreatitis. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,575 |
: This study explores demographic, medical, and psychological variables which appear to be related to survival in institutionalized elderly chronically ill patients. Patients who died within 12 months of an assessment procedure were compared with patients who were still alive over 12 months later. Those who died within the year tended to be younger and less religious, to have a somewhat poorer prognosis, greater cognitive impairment, lower life satisfaction, and higher scores on a suicide potential scale and on an observation checklist of indirectly self-destructive behaviors. | A meta-analysis of data from 42 independent samples examining the association of a measure of religious involvement and all-cause mortality is reported. Religious involvement was significantly associated with lower mortality (odds ratio = 1.29; 95% confidence interval: 1.20-1.39), indicating that people high in religious involvement were more likely to be alive at follow-up than people lower in religious involvement. Although the strength of the religious involvement-mortality association varied as a function of several moderator variables, the association of religious involvement and mortality was robust and on the order of magnitude that has come to be expected for psychosocial factors. Conclusions did not appear to be due to publication bias. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,576 |
In order to develop technology that promotes social interaction rather than isolation, we are exploring the space between board games and video games. We created a hybrid game that leverages the advantages of both physical and digital media. A custom sensor interface promotes physical interaction around the shared public display while the un-oriented tabletop display encourages players to focus on each other rather than on the interface to the game. The ensuing social interactions define the course that the game takes, while the computer enhances the gaming experience by completing the menial tasks and providing dynamic, exciting environments. Our hybrid board/video game has the potential to enhance natural and enjoyable recreational interaction between friends. | Emerging technologies offer new ways of using entertainment technology to foster interactions between players and connect people. Evaluating entertainment technology is challenging because success isn't defined in terms of productivity and performance, but in terms of enjoyment and interaction. Current subjective methods of evaluating entertainment technology aren't robust. This research uses previous literature and empirical results to create a methodology for objective evaluation of entertainment technology. By gathering physiological data in the context of game play, we intend to correlate physiological responses with subjective reports and with game events. This framework would be a powerful tool used by designers, developers, and researchers to inform their design and evaluate their decisions. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,577 |
Small-bowel films of 51 patients who had undergone a pyloroplasty and vagotomy at least 2 years previously were compared with films of 50 normal controls. The postsurgical group showed significant luminal widening of all bowel segments, prolonged transit time, and increased barium precipitation. It was impossible to differentiate these roentgenographic changes from those seen in sprue. Patients with an incomplete vagotomy or pyloroplasty were also compared with those in whom both procedures were adequate. There were no differences among the roentgenograms from these three groups. | The changes in pH and concentration of electrolytes in the jejunal lumen after a hypertonic fluid meal have been studied after truncal vagotomy and drainage, with and without diarrhoea. The results show that, in these respects, there are no specific changes in the jejunal content associated with post-vagotomy diarrhoea, but that these measurements are markedly affected by the completeness of vagotomy, as judged by the insulin test. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,578 |
PURPOSE ::: The classification of epilepsies and epileptic syndromes recognizes three syndromes with typical absences [TA, i.e., childhood and juvenile absence epilepsies (CAE and JAE), and epilepsy with myoclonic absences (EMA), none of which is characterized by onset in early childhood]. Although several other forms of absence epilepsies have been described recently, none concerns infants and very young children, and little is known about the nosology and prognosis of early-onset absences. ::: ::: ::: METHODS ::: We retrospectively selected all cases with onset of absences as the only or major seizure type before age 3 years and >/=2 years of follow-up among cases newly referred between 1986 and 2002. Neuropsychological assessments (generally IQ measure), behavior patterns, and schooling situations were reviewed for each child. ::: ::: ::: RESULTS ::: We found 10 patients (7 F, 3 M). No child had sensory or motor deficits: neuroimaging was performed in nine and was normal in eight, with aspecific findings in one. Only two could be characterized as CAE and EMA, respectively, both with seizure control and a good cognitive outcome. Among the remaining eight cases, four had a fairly homogeneous presentation with predominantly brief absences and clearly asymmetric interictal EEGs. All eight had neuropsychological and/or behavioral difficulties. Three had full seizure control, and five, persisting absences, with a follow-up ranging between 2 years 8 months to 9 years 4 months; only one child was older than 12 years. ::: ::: ::: CONCLUSIONS ::: Great heterogeneity exists among absence epilepsies of early onset, which are rare conditions. Only a few patients can be categorized into well-known syndromes. The overall prognosis is poor. Early onset of absences is uncommon, and multicenter studies should help clarify the nosology and prognosis. | Objective:To use family studies to investigate the clinical genetics of photosensitivity to understand the interrelationship of different photosensitive epilepsy syndromes. Methods:Twenty-nine families were recruited in which at least 2 members had idiopathic epilepsy and either clinical or electrical photosensitivity on EEG studies. We performed electroclinical analysis of these individuals and all other affected family members and analyzed the phenotypic patterns in families. Results:An earlier age at seizure onset was observed in photosensitive patients compared with nonphotosensitive individuals. A significant female bias for photosensitivity was confirmed. All subjects with visual seizures were photosensitive. Subjects could be classified into 3 main photosensitive phenotypes: genetic (idiopathic) generalized epilepsies (GGE), idiopathic photosensitive occipital epilepsy (IPOE), and mixed GGE/IPOE. Within each category, subjects with purely photosensitive seizures were observed. We report a distinctive syndrome of early-onset photosensitive absence epilepsy, with onset beginning by 4 years of age, which was more refractory than childhood absence epilepsy. Conclusions:The clinical genetics of the idiopathic photosensitive epilepsies show a phenotypic spectrum from the GGEs to IPOE with overlap between the focal features of IPOE and all the GGE syndromes. Shared genetic determinants are likely to contribute to the complex inheritance pattern of photosensitivity, IPOE, and the GGEs. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,579 |
Through the analysis on the elderly people bathing behaviors,the relation between the needs of the elderly people and the design of the bathtub is discussed. Combined with the characteristics of the elderly people,it is analyzed that the function,safety,modeling,physical feeling,the emotional communication between the user and the product and the special needs of elderly people for bathtub. The humanization design concept of the bathtub for elderly people is illuminated from several aspects and the design case is presented. The idea and strategy for the design of the bathtub for elderly people are proposed. | The number of elderly people with a mobility disorder is increasing rapidly. To improve the quality of life of these people, devices that can assist them to deal with their activities of daily living are of great demand. As an important aid devices, bathing aid devices have been widely studied and applied recently. By contrast, bathing aid devices can release the burden of care workers as well. In the past decade, bathing aid devices have undergone great progress, and some products have recently been commercialized. This paper first introduces the general concept of bathing aid devices and its classification. The application objects of the currently developed bathing aid devices have been summarized. Design principles and development directions are discussed. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,580 |
Atrial fibrillation (AF) is the most common arrhythmia in humans. After successful cardioversion, there is a recurrence of 60% due to atrial remodeling, and it has been shown that the global peak atrial longitudinal strain (GPALS) is decreased in these subjects. The aim of this study was to evaluate the predictive value of GPALS for AF recurrence. A prospective cohort of patients with persistent (PnVAF) and long standing persistent non-valvular AF (LSPnVAF) which underwent electrical cardioversion was evaluated with standard echocardiographic variables and GPALS quantification. The primary endpoint was AF recurrence at 6 months. We included PnVAF (n = 50, aged 68.4 ± 10.2 years, female 46%, lasted AF 6 months) and LSPnVAF (n = 81, aged 66.5 ± 13.1 years, female 36%, lasted AF 18 months). At 6 months there were a 68% of recurrence of AF in PnVAF and 53% in LSPnVAF group. GPALS was lower in recurrence 7.8 ± 2.0% versus 21.2 ± 8.9% (p < 0.001) for PnVAF and 7.3 ± 2.7% versus 20.7 ± 7.6% (p < 0.001) in LSPnVAF. GPALS ≤ 10.75% discriminates recurrence at 6 months with a sensitivity of 85%, specificity 99%, PPV 85%, NPV 90%, LR + 8.5 and LR- 0.17. The independent predictors of recurrence in PnVAF were GPALS ≤ 10.75% HR 8.89 [(2.2–35.7), p < 0.01] meanwhile in LSPnVAF were age HR 1.039 [(1.007-1.071), p = 0.01], and GPALS ≤ 10.75% HR 28.1 [(7.2–109.1), p < 0.001]. In subjects with PnVAF and LSPnVAF with successful electrical cardioversion, GPALS ≤ 10.75% predicts arrhythmia recurrence at 6-month follow-up. | Atrial fibrillation (AF) is the most common cardiac arrhythmia, its prevalence increasing markedly with age. Atrial fibrillation is strongly associated with increased risk of morbidity, including stroke and thromboembolism. There is growing awareness of the economic burden of AF due to ageing populations and constrained public finances. A systematic review was performed (1990-2009). Cost studies for AF or atrial flutter were included; acute-onset and post-operative AF were excluded. Total, direct, and indirect costs were extracted. Of 875 records retrieved, 37 studies were included. The cost of managing individual AF patients is high. Direct-cost estimates ranged from $2000 to 14,200 per patient-year in the USA and from €450 to 3000 in Europe. This is comparable with other chronic conditions such as diabetes. The direct cost of AF represented 0.9-2.4% of the UK health-care budget in 2000 and had almost doubled over the previous 5 years. Inpatient care accounted for 50-70% of annual direct costs. In the USA, AF hospitalizations alone cost ∼$6.65 billion in 2005. In this first systematic review of the economic burden of AF, hospitalizations consistently represented the major cost driver. Costs and hospitalizations attributable to AF have increased markedly over recent decades and are expected to increase in future due to ageing populations. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,581 |
The purpose of this study was to review the clinical features of oromaxillofacial infections in patients presenting to a hospital emergency ward, to identify the key factors affecting the requirement for hospitalization, and the potential risk factors predisposing to a prolonged length of hospital stay. A retrospective medical record review of the 598 patients treated for oromaxillofacial infection from 2013 to 2017 at the oral and maxillofacial surgery department, Yangsan Pusan National University Hospital, was conducted. The following information was collected from each patient: sex, age, past medical history, site of infection, etiology, admission or outpatient care, level of C-reactive protein (mg/dL), fascial spaces involved, treatment method, and duration of hospitalization. Chi-squared tests were used to identify risk factors, which were further analyzed using multivariable logistic regression. A total of 606 patients were eligible for inclusion in the study, of which eight were excluded due to having incomplete charts; thus, 598 patients were included: 55% were male, mean patient age was 47.1 ± 19.9 years, and 12.9% of patients were diabetic. Furthermore, 71.2% of patients had infection originating in the mandible; the most common tooth of origin was lower posterior, and 29.8% of patients were hospitalized. Risk factors for hospital admission were elderly patients with concurrent disease, elevated C-reactive protein level, and multiple-space infection in the oromaxillofacial area. The duration of hospitalization was correlated with both diabetes and age. The requirement for hospital admission is determined by the severity of the infection; even severe infections, once treated with appropriate surgery, have no relation to the length of hospital stay. The important risk factors for increased duration of hospitalization are diabetes mellitus and older age. The understanding of risk factors associated with a prolonged hospital stay during the treatment of oromaxillofacial infection will aid in treatment planning as well as highlight the importance of adequate diabetes control in patients at risk of such infection. | PURPOSE ::: This study identified potential risk factors associated with increasing hospital length of stay (LOS) in patients with odontogenic maxillofacial infections. ::: ::: ::: PATIENTS AND METHODS ::: One hundred twenty-eight patients admitted to Brigham and Women's Hospital by the Division of Oral Surgery between October 1, 1984 and March 31, 1995 with a maxillofacial infection of dental origin were retrospectively identified by a medical chart review. Linear regression techniques were used to explain the relationship between patient admission characteristics and LOS. Variables considered included age, gender, infection location, admission white blood count (WBC), admission temperature, antibiotic treatment during hospitalization, attending surgeon, insurance class, operating room use (ORU), and preexisting medical conditions associated with chronic immunosuppression. ::: ::: ::: RESULTS ::: The following variables were found to significantly increase LOS: ORU (P = .007), preexisting medical conditions (P < .0001), admission temperature (P = .022), and deep infection (P = .063). ::: ::: ::: CONCLUSION ::: LOS is best predicted on the basis of underlying medical conditions and location of the infection. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,582 |
In this note we shall study the stable homotopy types (S-types) of the stunted spaces N'{(G) = N»(G)/N-(Gl where JV»(G) = S" modG are quotients of S* by free orthogonal actions of a closed subgroup G of S. In §2, we show that N'l(G) are homeomorphic to the Thorn spaces N(G)^. If G is not finite, then G is S, S or the normalizer N(S*) of S in S. The case with G = S or S has been treated by Feder and Gitler [8], [9]. We consider the case with G = N(S) in §3. The case with G = Zm (cyclic group of order m) has been treated in [12], [15]. On and after §4, we consider the remaining cases, i.e. the cases with G the binary dihedral or binary polyhedral groups (see §2 for definitions). We examine the representation groups of the generalized quaternion groups D*(2) in §4 and evaluate the orders of some elements of KF(N (D*(2TMyj) in §5 or J(N«(D*(2))) in §§6-7 and study the S-types of NjJ(G) in the final section §8. | A formula is given to calculate the last n number of symplectic characteristic classes of the tensor product of the vector Spin(3)- and Sp(n)-bundles through its first 2n number of characteristic classes and through characteristic classes of Sp(n)-bundle. An application of this formula is given in symplectic cobordisms and in rings of symplectic cobordisms of generalized quaternion groups. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,583 |
Objectives We investigated possible differences between male and female patients regarding ablation therapy. Background Gender-related differences might have a major impact on different aspects of radiofrequency ablation therapy. Data on this topic are very limited, focusing almost exclusively on success and recurrence rates. Methods The study population consisted of 894 consecutive patients who underwent catheter ablation of accessory pathways (n = 519) and/or atrioventricular nodal re-entrant tachycardia (AVNRT) (n = 379). There were 418 (46.8%) male and 476 (53.2%) female patients. Results Female patients were referred for ablation later than male patients (185 ± 143 vs. 157 ± 144 months after onset of symptoms, p 1 tachycardia episode per month (80.3% vs. 70.3% in men, p Conclusions Physicians and/or patients tend toward a more conservative approach in female patients. Women are referred for ablation later than are men, after a longer duration of symptoms, and after having been given more antiarrhythmic drugs. However, potential concerns on behalf of physicians or female patients do not seem to be justified: ablation procedures in women had equally high success, low complication, and low recurrence rates as those procedures in male patients. | Purpose ::: Is onset of symptoms in AV nodal re-entrant tachycardia (AVNRT) and accessory pathway-mediated re-entrant tachycardia (AVRT) patients gender-specific? | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,584 |
We examined different patient outcomes following diagnosis of tuberculosis (TB). Incident cases were reported to the enhanced surveillance system in the East of England, between 2000 and 2003. For the 575 cases reported in 2001 and 2002, outcomes were assessed 1 year after initiating treatment. The crude clinical incidence rate of TB was 6·0 cases/100 000 person-years (pyr) [95% confidence interval (CI) 5·7–6·4], highest in the 25–29 years age group (14·9, 95% CI 12·9–17·1 cases/100 000 pyr) and among Black Africans (328·6, 95% CI 286·9–374·6 cases/100 000 pyr). Patients born abroad were 2·35 (95% CI 1·03–5·32) times more likely to be lost to follow-up than those born in the United Kingdom. Age at diagnosis (OR 1·05, 95% CI 1·04–1·07) and pulmonary disease (OR 2·73, 95% CI 1·21–6·15) were independently associated with mortality. Elderly patients and those with pulmonary TB appear to have worse outcomes despite treatment. Foreign-born patients may need closer follow-up to ensure favourable outcomes. | Background ::: Long-term mortality and causes of death in patients with pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) are poorly documented. In this study, long-term mortality and causes of death in PTB and EPTB patients were compared with the background population and it was investigated whether mortality was associated with family-related risk factors. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,585 |
We use a graphical chain model to investigate the reciprocal relationships between changes in women's labour force participation following entry into parenthood and changes in gender role attitude. Results suggest that attitudes are not fixed and that revision of these attitudes in the light of recent life course events is an important process. The adaptation of attitudes to events appears to be stronger than the selection of individuals on the basis of attitudes. We show that it is not entry into parenthood as such, but the change in economic activity that is related to this event that is associated with attitude change. Copyright 2008 Royal Statistical Society. | A graphical chain modelling approach is used to study the determinants of neonatal and post-neonatal mortality in Malaysia. This approach provides an easily interpretable empirical description and illustrates explicitly the conditional independence structure between each pair of variables. The interpretation can be read directly from a mathematical graph. Besides examining the direct association of each determinant on mortality, we also examine the effects of socioeconomic determinants on intermediate determinants to understand the pathways through which the socioeconomic determinants affect the chance of mortality. The data analysed come from the second Malaysian Family Life Survey, fielded between August 1988 and January 1989. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,586 |
. Objectives: Sledding is a common recreational activity in northern communities. The objective of this study was to examine the frequency and nature of sledding injuries (SIs) in patients presenting to emergency departments (EDs). Methods: The data were derived from a cohort of patients treated at all five EDs in an urban Canadian health region over a two-year period. Following chart review, consenting patients were interviewed by telephone about their sledding activities and the circumstances surrounding the injury. Results: Three hundred twenty-eight patients were correctly coded as having SIs, with 212 patients (65%) reached during the follow-up survey. The median age of those with SIs was 12 years (IQR = 8, 21), and 206 (59%) were male. Injury rates peaked in the 10-14-year age group (87/100,000) for boys and in the 5-9-year age group (75/100,000) for girls. Most patients stated they were drivers (75%), fewer than half were thrown from the sled (42%), and fewer than half (44%) were sledding on community-designated sledding hills at the time of injury. Injuries to the lower extremity (32%), upper extremity (31%), and head (13%) were most common. Thirty-seven (11%) patients with SIs were admitted to hospital vs 4% of patients with other sports/recreation injuries (p 20 years) have poorer outcomes (hospitalization, lost time from work/school) than their younger counterparts. The SIs treated in the ED appear to lead to hospitalization more frequently than other types of sport/recreation injury, and injury prevention strategies appear warranted. | Though a pastime rarely considered rough or dangerous, sledding is not risk-free. The presentation of several serious injuries to Rainbow Babies and Children's Hospital in Cleveland, Ohio, led us to examine our emergency department and admitting records to determine the incidence of neurological injury among children involved in sledding accidents. We discovered 24 children who had sustained brain or spine injuries as sequelae to sledding mishaps during a 5-year period. The ages ranged from 3 months to 15 years. Injuries included multiple skull fractures, 2 epidural hematomas, 1 subdural hematoma, 1 odontoid fracture and 1 anoxic brain injury. There was 1 death. Twenty-one of 24 patients incurred their injuries by colliding with fixed objects. Both improvised crafts and models intended for sledding were involved in the injuries. Only 3 sleds possessed steering capability. Eight of the 9 children who sustained a serious neurosurgical injury were supervised by an adult. Only 2 children had received instruction before sledding. The lack of awareness of the potential for injury together with the dearth of instruction and lack of control over a vehicle dashing down a hill studded with obstacles can change a carefree pastime into a hazardous activity. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,587 |
Nineteen patients with squamous-cell cancer of the anal canal have been treated with combined chemotherapy and radiation therapy, followed by appropriate surgery. The authors are convinced that the combined therapy is effective enough to avoid abdominoperineal resection if disappearance of the lesion is proven by adequate examination and biopsy. Although they believe cancers 5 cm or less in maximum diameter are generally adequately managed in this manner, experience is still too limited to justify, a recommendation, to change currently accepted management. | Spontaneous coronary artery dissection (SCAD) is thought to be a rare condition that is hard to predict due to the lack of easily identifiable warning signs. We report the case of a 49-year-old woman with a locally advanced Stage IIIB anal squamous cell carcinoma who presented with chest pain and a positive stress test, ST elevations in her inferior echocardiogram leads, and induced chest pain with exercise without heart perfusion defects. Coronary catheterization revealed a right coronary artery dissection, which led to the diagnosis of SCAD. Our patient was diagnosed while undergoing a combination treatment of fluorouracil (5-FU), mitomycin, and pelvic radiotherapy. We reviewed the current literature and update the etiologies that have been proposed since the publication of this case report. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,588 |
Although recently more research has considered children with bipolar disorder than in the past, much controversy still surrounds the validity of the diagnosis. Furthermore, questions remain as to whether or not childhood expressions of bipolarity are continuous with adult manifestations of the illness. In order to advance current knowledge of bipolar disorders in children, researchers have begun to conduct phenomenological, longitudinal, treatment, and neuroimaging studies in youths who exhibit symptoms of bipolar illness, as well as offspring of parents with bipolar disorders. Regardless of the differences between research groups regarding how bipolar disorder in children is defined, it is agreed that pediatric bipolarity is a serious and pernicious illness. With early intervention during the period of time in which youths are exhibiting subsyndromal symptoms of pediatric bipolarity, it appears that the progression of the illness to the more malignant manifestation of the disorder may be avoided. This paper will review what is currently known and what still is left to learn about clinically salient topics that pertain to bipolar disorder in children and adolescents. | Despite compelling evidence that genetic factors contribute to bipolar disorder (BP), attempts to identify susceptibility genes have met with limited success. This may be due to the genetic heterogeneity of the disorder. We sought to identify susceptibility loci for BP in a genome-wide linkage scan with and without clinical covariates that might reflect the underlying heterogeneity of the disorder. We genotyped 428 subjects in 98 BP families at the Center for Inherited Disease Research with 402 microsatellite markers. We first carried out a non-parametric linkage analysis with MERLIN, and then reanalyzed the data with LODPAL to incorporate clinical covariates for age at onset (AAO), psychosis and comorbid anxiety. We sought to further examine the top findings in the covariate analysis in an independent sample of 64 previously collected BP families. In the non-parametric linkage analysis, three loci were nominally significant under a narrow diagnostic model and seven other loci were nominally significant under a broader model. The top findings were on chromosomes 2q24 and 3q28. The covariate analyses yielded additional evidence for linkage on 3q28 with AAO in the primary and independent samples. Although none of the linked loci were genome-wide significant, their congruence with prior results and, for the covariate analyses, their identification in two separate samples increases the likelihood that they are true positives and deserve further investigation. These findings further demonstrate the value of considering clinical features that may reflect the underlying heterogeneity of disease in order to facilitate gene mapping. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,589 |
In this paper a new method of global path planning for an autonomous automated guided vehicle is presented. The strategy of the developed method is based on two parts: partition of free working space according to obstacles models, and calculation of a set of points within the free working space according to the dimensions of the mobile robot. This set of points constitutes the eventual passage points for the AGV during its navigation between starting and goal points. Once starting and goal points are given, a visibility graph is constructed and an optimal path is searched. The new approach in this method is that the mobile robot is not punctual and the obstacles are not expanded. The validity and the efficiency of the developed algorithm are confirmed by the results obtained by simulation. | Development of mobile robots is a very difficult and time consuming task. If good development tools were available the development work would be more productive and products would be more reliable. The authors present an efficient design approach for wheeled mobile robot development and give an overall description of tools, which are useful during the development cycle. The problem is divided into several parts: control software, at high and low level; electronics, divided into digital, analogue and power; mechanics, actuators; and sensors. > | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,590 |
A correct interpretation of musculoskeletal imaging studies of children requires an in-depth knowledge of normal skeletal growth and physiologic changes in growing bones. During childhood the growing bones are more prone to acute and chronic injuries because of the imbalance between osseous structures and tendons and ligaments, so physeal injuries are the most commonly encountered types of lesions. This review addresses acute and chronic injuries involving the upper extremities in the pediatric population. These injuries may be subtle to recognize or atypical. The radiologist has to choose the most appropriate technique that can best recognize the problem and establish the correct diagnosis, thus avoiding diagnostic errors and potential delayed complications. | The discoid meniscus is the most common abnormal meniscal variant in children. It is most likely a congenital deviation and usually occurs laterally. The discoid shape results in greater coverage of the tibia and usually is associated with increased thickness of the meniscus that may lead to abnorma | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,591 |
Pathological alcohol use is a complex and costly problem. This chapter focuses on recent developments in the etiology of alcohol use disorders. Literature is reviewed from the fields of epidemiology, genetics, personality, neuropsychology, parenting, and social influences. In addition, theoretical models that describe pathways to the development of alcohol use disorders are presented. Particular emphasis is given to ways in which genetic, environmental, psychopharmacological, and personological literatures can inform one another. | A sample of 253 children of alcoholics (COAs) and 237 children of nonalcoholics (non-COAs) were compared on alcohol and drug use, psychopathology, cognitive ability, and personality. COAs reported more alcohol and drug problems, stronger alcohol expectancies, higher levels of behavioral undercontrol and neuroticism, and more psychiatric distress in relation to non-COAs. They also evidenced lower academic achievement and less verbal ability than non-COAs. COAs were given Diagnostic Interview Schedule alcohol diagnoses more frequently than non-COAs. The relation between paternal alcoholism and offspring alcohol involvement was mediated by behavioral undercontrol and alcohol expectancies. Although gender differences were found, there were few Gender X Family History interactions; the effects of family history of alcoholism were similar for men and women. When gender effects were found, they showed greater family history effects for women. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,592 |
Successful development of shale gas by the United States has changed its energy structure tremendously,and also had great influence on the global energy development process and geopolitical landscape.With energy security and environmental factors in mind,China also actively participates in the shale gas revolution.However,shale gas exploration and development work in China is still in its infancy;and the technology is immature with slow progress.Under such a situation,this paper argues that Chinese oil and gas companies must increase the pace of "going global" and get into a partnership with the international energy companies,and then obtain the overseas shale gas resources,as well as the core technology and managerial experience with regard to shale gas exploration development.This paper goes on to look at that in terms of the strategy of "going global" for shale gas development we should pay attention to tackling key problems in science and technology by ourselves,promote the diversification of the investment,unveil or perfect the relevant system and support policy,strengthen the construction of market environment and supervision regulation for minimizing environmental pollution. | As the shale gas revolution expands globally, the future potential and economic profits of overseas shale gas reserves have attracted the interest of Chinese investors. Overseas shale gas development is becoming an investment hotspot for Chinese oil companies. However, this multibillion-dollar venture is surrounded by a complex and uncertain environment. Therefore, this paper carries out an integrated and publicly available model for assessing risk in overseas shale gas investments. The purpose of this model is to address the index weight calculation and risk ranking and provide investor with risk information. In view of this, the comprehensive weights are obtained based on an analytic hierarchy process (AHP) and entropy weight methods; and the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method is performed to rank target countries. First, the paper identities five categories of risks with full consideration of the economic risk, political risk, geological risk, technological risk, and internal managements risk. Based on the risk identification, the assessment index system is established and valued. Secondly, China is taken as an example nation to use this model to prove the effectiveness of the proposed model and help the investor make wise decisions. According to the results, low-risk countries, such as Canada, Argentina, United States, and Algeria can be considered to be future key targets of shale gas investment abroad, while investors should be more cautious of high-risk countries such as South Africa and Brazil. Finally, policy recommendations are proposed to optimize the overseas shale gas investments from both the government and investor perspectives. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,593 |
Background and Aim. Although many epidemiologic studies have shown that Helicobacter pylori eradication has prophylactic effects on gastric cancer, it does not completely eliminate the risk of gastric cancer. We aimed to investigate the changes in histological gastritis in patients receiving rebamipide treatment after H. pylori eradication. Methods. 206 patients who had undergone H. pylori eradication were evaluated. Of these, 169 patients who achieved successful eradication were randomly allocated to 2 groups: the rebamipide group (n = 82) and the untreated group (n = 87). The primary endpoints were histopathological findings according to the updated Sydney system at the start of the study and after 1 year. Results. Final assessment for histological gastritis was possible in 50 cases from the rebamipide group and 53 cases from the untreated group. The activity and atrophy improved in both the rebamipide and untreated groups, and no significant intergroup differences were observed. Chronic inflammation affecting the lesser curvature of the corpus was significantly improved in the rebamipide group compared to in the untreated group (1.12 ± 0.08 versus 1.35 ± 0.08; P = 0.043). Conclusions. Rebamipide treatment after H. pylori eradication alleviated chronic inflammation in the lesser curvature of the corpus compared to that in the untreated group. This trial is registered with UMIN000002369. | The Sydney System for the classification of gastritis emphasized the importance of combining topographical, morphological, and etiological information into a schema that would help to generate reproducible and clinically useful diagnoses. To reappraise the Sydney System 4 years after its introduction, a group of gastrointestinal pathologists from various parts of the world met in Houston, Texas, in September 1994. The aims of the workshop were (a) to establish an agreed terminology of gastritis; (b) to identify, define, and attempt to resolve some of the problems associated with the Sydney System. This article introduces the Sydney System as it was revised at the Houston Gastritis Workshop and represents the consensus of the participants. Overall, the principles and grading of the Sydney System were only slightly modified, the grading being aided by the provision of a visual analogue scale. The terminology of the final classification has been improved to emphasize the distinction between the atrophic and nonatrophic stomach; the names used for each entity were selected because they are generally acceptable to both pathologists and gastroenterologists. In addition to the main categories and atrophic and nonatrophic gastritis, the special or distinctive forms are described and their respective diagnostic criteria are provided. The article includes practical guidelines for optimal biopsy sampling of the stomach, for the use of the visual analogue scales for grading the histopathologic features, and for the formulation of a comprehensive standardized diagnosis. A glossary of gastritis-related terms as used in this article is provided. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,594 |
The gait of seven hypotonic schizophrenic children aged between five and eight years was compared with that of seven normal children aged between seven and eight years. Electromyographic studies revealed that in schizophrenic children the tibialis anterior was 'on' during a significantly smaller proportion of the stance phase than in the age-matched controls, and that the quadriceps muscle was 'on' during a significantly smaller proportion of the swing phase than in the controls. In addition, the gait of the schizophrenic children tended to be broad-based and slow, consisting of smaller steps in a longer pace period. In general, the gait of the schizophrenic children resembled that of younger, inexperienced walkers. | The aim of the study was to compare a variety of surface EMG (sEMG) parameters in several groups of schizophrenia (SZ, n=69) patients and healthy controls (n=44). We computed spectral, mutual information (MI) based and recurrence quantification analysis (RQA) parameters of sEMG. The major finding is that sEMG of the controls had higher values of the MI-based parameter, mean and median spectrum frequencies, and lower values of most of RQA parameters. It means higher content of recurrent fragments in sEMG of SZ patients. We suggest that the differences might be caused by either denervation/renervation process of single muscle fibers in SZ patients and/or by increased motor unit synchronization induced by antipsychotic therapy. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,595 |
Interleukin-22 (IL-22) maintains gut epithelial integrity and expression of antimicrobial peptides Reg3β and Reg3γ. Our laboratory has shown that acute alcohol/ethanol (EtOH) exposure before burn injury results in increased gut permeability, intestinal T-cell suppression, and enhanced bacterial translocation. Herein, we determined the effect of combined EtOH intoxication and burn injury on intestinal levels of IL-22 as well as Reg3β and Reg3γ expression. We further examined whether in vivo restitution of IL-22 restores gut permeability, Reg3β and Reg3γ levels, and bacterial load (e.g., gut bacterial growth) within the intestine after EtOH and burn injury. Male mice, ∼25g, were gavaged with EtOH (2.9 mg/kg) before receiving a ∼12.5% total-body-surface-area, full-thickness burn. Mice were immediately treated with saline control or IL-22 (1 mg/kg) by i.p. injection. One day after injury, there was a significant decrease in intestinal IL-22, Reg3β, and Reg3γ expression along with an increase in intestinal permeability and gut bacterial load after EtOH combined with burn injury, as compared with sham injury. Treatment with IL-22 normalized Reg3β and Reg3γ expression and attenuated the increase in intestinal permeability after EtOH and burn injury. Qualitatively, IL-22 treatment reduced the bacterial load in nearly half of mice receiving EtOH combined with burn injury. Our data indicate that IL-22 maintains gut epithelial and immune barrier integrity after EtOH and burn injury; thus, the IL-22/antimicrobial peptide pathway may provide a therapeutic target for the treatment of patients who sustain burn injury under the influence of EtOH. | Mammals constantly face stressful situations, be it extended periods of starvation, sleep deprivation from fear of predation, changing environmental conditions, or loss of habitat. Today, mammals are increasingly exposed to xenobiotics such as pesticides, pollutants, and antibiotics. Crowding conditions such as those created for the purposes of meat production from animals or those imposed upon humans living in urban environments or during world travel create new levels of physiologic stress. As such, human progress has led to an unprecedented exposure of both animals and humans to accidental pathogens (i.e those that have not co-evolved with their hosts). Strikingly missing in models of infection pathogenesis are the various elements of these conditions, in particular host physiologic stress. The compensatory factors released in the gut during host stress have profound and direct effects on the metabolism and virulence of the colonizing microbiota and the emerging pathobiota. Here we address unanswered questions to highlight the relevance and importance of incorporating host stress to the field of microbial pathogenesis. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,596 |
Entry, response, and evaluation criteria for design of clinical protocols for management and therapy of soft-tissue sarcomas have been developed. Patient selection, eligible histologic diagnose, baseline information, response criteria, and guidelines for evaluation of results have been codified for studies of primary and advanced sarcomas. | Purpose. To define the maximally tolerated dose (MTD) of ifosfamide when given with G-CSF on an every other week schedule, and to define the MTD of edatrexate that can be given every two weeks with an intense schedule of ifosfamide.Patients and Methods. Forty-one patients with metastatic or unresectable, locally advanced sarcoma participated in this 2-step phase I trial.The starting dose of ifosfamide was 10 gm/m(2) given by continuous intravenous infusion over 4 days every 2 weeks.When the MTD was defined, edatrexate, beginning at a dose of 40 mg/m(2) intravenously every 2 weeks was added in subsequent cohorts of patients.Results. Myelosuppression was the most prominent toxicity. Fatigue, nausea, and vomiting were observed in the majority of patients. Ifosfamide 12 gm/m(2) given every 2 weeks approached or exceeded the MTD. Edatrexate 100 mg/m(2) could be given safety as an intravenous bolus with ifosfamide 10 gm/m(2) every 2 weeks. Therapeutic responses were observed in patients with measurable disease.Conclusions. This study demonstrates the feasibility of administering a dose-intense schedule of ifosfamide alone or ifosfamide with edatrexate that might be applied in the adjuvant or neo-adjuvant setting. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,597 |
The challenges of the geriatric years require cognitive integrity through organic resilience of the brain. Impaired cognition in geriatric patients (age >65 years) is commonly ascribed to age but is multifactorial. Among those multiple factors this author hypothesizes that mood disorders, with major depressive disorder (MDD) as one focus of this paper and traumatic brain injury (TBI) are part of a common spectrum of pathology that, when undiagnosed and untreated at age <65 years, reduces the resilience of the brain to negotiate common challenges during geriatric years. Mood disorders and TBI may be acute, transient, and benign; however, chronic mood disorders may be an organic brain disease, as shown by objective studies. The consequence of the ineffective treatment of MDD and TBI at an earlier age may cause geriatric patients to have impaired capacity to manage stressors. The solution may include more astute observation of the presentation to enable earlier diagnosis and treatment. Mitigating the consequences of mood disorders and TBI may enable greater resilience to face the challenges of aging. | Summary Background Human genome evolution has been shaped by infectious disease. Although most genetic studies have focused on the immune system, recovery after sepsis is directly related to physiological reserve that is critically dependent on mitochondrial function. We investigated whether haplogroup H, the most common type of mitochondrial DNA (mtDNA) in Europe, contributes to the subtle genetic variation in survival after sepsis. Methods In a prospective study, we included 150 individuals who were sequentially admitted to the intensive care unit in a hospital in Newcastle upon Tyne, UK. After clinical data were obtained, patients underwent mtDNA haplotyping by analysis with PCR and restriction fragment length polymorphism. As endpoints, we used death during the 6-month period or survival at 6 months. Findings Follow-up was complete for all study participants, although the haplotype of two patients could not be reliably determined. On admission to the intensive care unit, the frequency of mtDNA haplogroup H in study patients did not differ between study patients admitted with severe sepsis and 542 age-matched controls from the northeast of England. MtDNA haplogroup H was a strong independent predictor of outcome during severe sepsis, conferring a 2·12-fold (95% CI 1·02–4·43) increased chance of survival at 180 days compared with individuals without the haplogroup H. Interpretation Although haplogroup H is the most recent addition to the group of European mtDNA, paradoxically it is also the most common. Increased survival after sepsis provides one explanation for this observation. MtDNA haplotyping offers a new means of risk stratification of patients with severe infections, which suggests new avenues for therapeutic intervention. | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,598 |
BACKGROUND ::: Children with autism spectrum disorders (ASD) are more likely to have difficulties accessing health care compared to other children with special health care needs. National data based on parent report indicate that children with ASD are overutilizing emergency department (ED) services, but data on actual ED use has been limited to children with psychiatric diagnoses. This study examined factors associated with ED utilization (rate, urgency, and hospital admissions) among children with ASD compared to those without ASD. ::: ::: ::: METHODS ::: Data from an urban, tertiary children's hospital level 1 trauma center were examined retrospectively 2006-2009. Anderson's model of health services utilization served as the study framework. The NYU ED algorithm was used to predict nonurgent visits. Multivariate linear and logistic regression analyses were performed on the rate, urgency, and subsequent hospital admissions of these ED visits. ::: ::: ::: RESULTS ::: There were 115,443 children 2-21 years old, accounting for a total of 157,902 visits. The top three reasons for visiting the ED for children with and without ASD were acute upper respiratory infections, viral infections and otitis media. Children with ASD had on average 0.26 more ED visits annually than children without ASD (p < 0.01) and were 2.6 % points more likely to have nonurgent visits; p < 0.01). Their visits were also less likely to result in hospital admissions (OR 0. 61; p < 0.01). ::: ::: ::: CONCLUSIONS ::: Examination of predisposing, enabling, and reinforcing factors suggest that children with ASD were more likely to visit the ED and for nonurgent reasons. | Objective:To estimate the prevalence of and to identify factors associated with prolonged emergency department length-of-stay (ED-LOS) for admitted children.Methods:Data were from the 2001-2006 National Hospital Ambulatory Medical Care Survey. The primary outcome was prolonged ED-LOS (defined as tot | Blunt trauma abdomen rarely leads to gastrointestinal injury in children and isolated gastric rupture is even rarer presentation. We are reporting a case of isolated gastric rupture after fall from height in a three year old male child. | eng_Latn | 14,599 |
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