Spinal cord tethering in children with myelomeningocele Zakotwiczenie rdzenia u dzieci z przepukliną oponowo-rdzeniową

STRESZCZENIE Zespół zakotwiczenia rdzenia kręgowego (TCS, ang. tethered cord syndrome) jest zróżnicowaną jednostką chorobową, spowodowaną przez nadmierne naciąganie rdzenia kręgowego. Może występować w każdej grupie wiekowej, a objawia się w zależności od stanu patologicznego i wieku bólem, zmianami skórnymi, deformacjami ortopedycznymi, neurologicznymi i urologicznymi. Wczesna interwencja chirurgiczna jest związana z poprawą obrazu klinicznego, głównie w ustąpieniu dolegliwości bólowych, stabilizacji funkcji neurologicznych i postępu skoliozy. Zespół rehabilitacyjny prowadzący terapię dziecka z przepukliną oponowo-rdzeniową powinien pamiętać, że TSC jest istotnym powodem pogorszenia stanu neurologicznego u dziecka z rozszczepem kręgosłupa. Słowa kluczowe: zakotwiczenie rdzenia, przepuklina oponowo-rdzeniowa, rehabilitacja ABSTRACT We retrospectively assessed tethered cord syndrome among patients with myelomeningocele in the Department of Pediatric Rehabilitation in the years 2004-2011. Fifteen (16.5% of 91 subjects with myelomeningocele) patients with tethered cord syndrome were diagnosed, aged 4-17 years (mean 11.4 ± 4.4), 11 girls and 4 boys. Reduced muscle strength and increased spasticity within the lower limbs, pain in the thoracolumbar region, and deterioration of bladder function were symptoms of tethered cord syndrome. The level of spinal cord injury in Th8-L3 prevented 9 patients from walking (use of a wheelchair); 6 children -level of spinal cord injury L4 and below -were able to walk with orthopedic equipment (crutches, walker, severely handicapped). MRI revealed the various pathologic etiologies of tethering included: lipomyelomeningocele, diastematomyelia, syringohydromyelia, and hydrosyringomyelia. A neurological or rehabilitation team working with children with myelomeningocele should remember that tethered cord syndrome is a significant cause of neurological deterioration

Invited review Immune evasion genes from ®larial nematodes

Abstract Helminth parasites have large genomes (~10 8 bp) which are likely to encode a spectrum of products able to block or divert the host immune response. We have employed three parallel approaches to identify the ®rst generation of`immune evasion genes' from parasites such as the ®larial nematode Brugia malayi. The ®rst strategy is a conventional route to characterise prominent surface or secreted antigens. In this way we have identi®ed a 15-kDa protein, which is located on the surface of both L3 and adult B. malayi, and secreted by these parasites in vitro, as a member of the cystatin (cysteine protease inhibitor) family. This product, Bm-CPI-2, blocks conventional cysteine proteases such as papain, but also the aspariginyl endopeptidase involved in the Class II antigen processing pathway in human B cells. In parallel, we identi®ed the major T cell-stimulating antigen from the micro®larial stage as a serpin (serine protease inhibitor), Bm-SPN-2. Micro®lariae secrete this product which blocks two key proteases of the neutrophil, a key mediator of in¯ammation and innate immunity. The second route involves a priori hypotheses that helminth parasites encode homologues of mammalian cytokines such as TGF-b which are members of broad, ancient metazoan gene families. We have identi®ed two TGF-b homologues in B. malayi, and shown that one form (Bm-TGH-2) is both secreted by adult parasites in vitro and able to bind to host TGF-b receptors. Likewise, B. malayi expresses homologues of mammalian MIF, which are remarkably similar in both structure and function to the host protein, even though amino acid identity is only 28%. Finally, we deployed a third method of selecting critical genes, using an expression-based criterion to select abundant mRNAs taken from key points in parasite life histories. By this means, we have shown that the major transcript present in mosquito-borne infective larvae, Bm-ALT, is a credible vaccine candidate for use against lymphatic ®lariasis, while a second abundantly-expressed gene, Bm-VAL-1, is similar to a likely vaccine antigen being developed against hookworm parasites.

Orbital exenteration for eyelid skin carcinoma

Abstract Exenteration of the orbit is a disfiguring and destructive procedure; it is generally performed for orbital malignancies and often provides a significant reconstructive challenge. Our purpose was to evaluate the clinical indications for orbital exenteration in a tertiary referral center and to assess the reconstructive options employed. A retrospective nonrandomized analysis was performed, selecting all patients undergoing orbital exenteration over a 5-year period, between January 2005 and January 2010. Patient demographics, tumor characteristics, and reconstructive techniques used were evaluated. Twenty patients with a mean age of 76.5 years underwent total orbital exenteration. Basal cell carcinoma was the main operative indication (45%), followed by squamous cell carcinoma (15%). Reconstructive techniques included cover of the raw orbital cavity with a temporal muscular flap in all cases followed with split skin grafting (25%), bilaterally pedicle V-Y advancement flap (10%) and a fasciocutaneous island flap of the retroauricular region (65%). Twenty percent of patients had local complications and all were treated in a satisfactory fashion. Eyelid skin tumors remain an important cause of orbital exenteration. Temporal muscle flap is a reliable and stable reconstructive solution after orbital exenteration and additional aid is supplied with skin grafts or local flaps. This technique ensures a good aesthetic outcome and better situation for later complementary treatments and minimal associated donor site morbidity

EFFECTS OF PHENOLIC RESIN AND FLY ASH ON COEFFICIENT OF FRICTION OF BRAKE SHOE COMPOSITE

ABSTRACT The friction performance of brake shoe composite indicated by coefficient of friction is influenced by braking conditions including contact pressure, sliding speed or temperature. This behavior is influenced by composite formulation. In the present work, we focus to investigate effect of phenolic resin and fly ash with variation in braking condition on coefficient of friction. Particular attentions are paid to changes in coefficient of friction with respect to the variation of contact pressure, sliding speed and disc temperature. Friction wear test was performed using pin on disc machine. The results show that coefficient of friction decreases with increasing volume fraction of phenolic resin and increases as the amount of fly ash is increased. In addition, phenolic resin affects load and speed sensitivity of coefficient of friction. In contrast, fly ash does not affect load and speed sensitivity of coefficient of friction. The coefficient of friction increases as disc temperature is increased from 29 o C to 200 o C. Phenolic resin does not affect disc temperature sensitivity of coefficient of friction. Conversely, fly ash affects disc temperature sensitivity of coefficient of friction

Hereditary Sensory and Autonomic Neuropathy: Case Report and Discussion

Abstract Hereditary sensory and autonomic neuropathies (HSAN) are a diverse group of diseases involving the peripheral nervous system. Patients present with profound distal sensory loss and variable degrees of autonomic disturbances. Multiple subtypes have been defined based on clinical symptoms and genetic testing. We present a case report of a nine month-old female with recurrent hand lesions and an absent response to noxious stimuli who was ultimately diagnosed with HSAN. A review of the literature and discussion of the pathogenetic mechanisms, current treatment, and future therapies for HSAN are also provided. Introduction Hereditary Sensory and Autonomic Neuropathies (HSAN) comprise a heterogeneous group of disorders involving the peripheral nervous system. The first description of these conditions was made in 1852 with a report of three brothers with neurotrophic plantar ulcers HSANs can be broadly subdivided based on mode of inheritance into autosomal dominant forms, with either juvenile or adultonset, and autosomal recessive forms with congenital or early childhood onset Case Report A nine month-old female was brought in to the Emergency Department for evaluation of rapidly progressive skin lesions on the hands and a small resolving vesicular lesion on the tip of the tongue. The patient's mother reported first noticing a small, red bump on the left thumb that grew and turned black over the course of one day. Small blisters were also noted on other fingers. Aside from these lesions, the patient's mother reported no other symptoms. The patient was born full-term and had met gross motor milestones. Physical examination revealed a 2 x 1 cm black, well-demarcated eschar on the volar surface of the left thumb ( Initial differential diagnosis included herpetic whitlow with associated Herpes Simplex Virus (HSV) infection, gingivostomatitis, ecthyma, bullous impetigo, pyoderma gangrenosum, vasculitis, spider bite, or anthrax. The patient was placed in isolation and started on intravenous antibiotics and acyclovir empirically. A HSV/varicella zoster virus direct fluorescent antibody test was performed on the Journal of Clinical & Medical Case Reports Case Report Open Acces

Student use of technologies for learning -what has changed since 2010?

This paper reports on a large longitudinal survey of students and their use of technologies in two Australian universities. The SEET survey is unique in Australia because it includes not just current use, but students' expectations about their future use of technology. The survey was originally run in 2010 and then repeated, with slight modifications to reflect changes in technologies, in 2013. This paper compares the results from 2013 with the 2010 results. Whilst some changes reflect the wider access to freely available open resources and new technologies such as Smartphones and iPads, other results are remarkably consistent with the 2010 results. Overall students are increasingly satisfied with their use of technologies and despite the increase in uptake of freely available technologies, it is evident that the LMS and its inbuilt tools and functions remain a key platform for learning and teaching at universities

Casewise Visual Evaluation for High-Performance Collaborative Visioning of PGDP Nuclear Enrichment Plant End State

Abstract This article describes the adaptation of the authors' Structured Public Involvement, or SPI, framework for community involvement in the end-state visioning process for the PGDP facility. The SPI framework is designed to elicit community values and provide access to these as a decision support system for the development of feasible, legitimate, and durable end-state management plans. This SPI protocol is designed around community evaluation of visualizations. Key properties of visual evaluation methods for large group visualization are discussed and the Casewise Visual Evaluation method is outlined. CAVE uses a fuzzy logic based neural network modeling approach to build a knowledge base for community preferences across all feasible end-state scenarios. The potential PDGP end-state land-use properties developed from focus group work are integrated into a sample range of dynamic visualizations and the sampling protocol is described. Preliminary results will be presented at the conference

Improving Generation in Machine Translation by Separating Syntactic and Morphological Processes

Abstract-This paper presents a generation approach in a Lexical Functional Grammar (LFG) based machine translation system that subdivides the process and uses rule based modules to address the problem. The results show improvement in performance compared to the earlier work which generates the translation into Urdu using a single integrated process

Low Noise Technique for Reduction of Peak Power and BER in High Rate Wireless Communication System

Abstract Orthogonal Frequency Division Multiplexing (OFDM