How Should the Low Anterior Resection Syndrome Score Be Interpreted?

BACKGROUND: Bowel dysfunction after low anterior resection is often assessed by determining the low anterior resection syndrome score. What is unknown, however, is whether this syndrome is already present in the general population and which nonsurgical factors are associated. OBJECTIVE: The purpose of this study was to determine the prevalence of minor and major low anterior resection syndrome in the general Dutch population and which other factors are associated with this syndrome. DESIGN: This was a cross-sectional study. SETTINGS: The study was conducted within the general Dutch population. PATIENTS: The Groningen Defecation and Fecal Continence Questionnaire was distributed among a general Dutch population-based sample (N = 1259). MAIN OUTCOME MEASURES: Minor and major low anterior resection syndrome were classified according to the scores obtained. RESULTS: The median, overall score was 16 (range, 0-42). Minor low anterior resection syndrome was more prevalent than the major form (24.3% vs 12.2%; p <0.001). Bowel disorders, including fecal incontinence, constipation, and irritable bowel syndrome were associated with the syndrome, whereas sex, age, BMI, and vaginal delivery were not. Remarkably, patients with diabetes mellitus were significantly more prone to experience minor or major low anterior resection syndrome. The ORs were 2.8 (95% CI, 1.8-4.4) and 3.7 (95% CI, 2.2-6.2). LIMITATIONS: We selected frequent comorbidities and other patient-related factors that possibly influence the syndrome. Additional important factors do exist and require future research. CONCLUSIONS: Minor and major low anterior resection syndrome occur in a large portion of the general Dutch population and even in a healthy subgroup. This implies that the low anterior resection syndrome score can only be used to interpret the functional result of the low anterior resection provided that a baseline measurement of each individual is available. Furthermore, because people with low anterior resection syndrome often experience constipation and/or fecal incontinence, direct examination and diagnosis of these conditions might be a more efficient approach to treating patient bowel dysfunctions

Tuberculose uro-génitale : A propos de 95 cas

Objectif: Préciser les aspects cliniques, iconographiques et thérapeutiques de la tuberculose urogénitale. Patients et méthodes: D’avril 1992 à avril 2007, 95 patients atteints de tuberculose uro-génitale ont été vus. Il s’agissait de 53 hommes et 42 femmes âgés de 18 à 72 ans. Tous nos malades ont bénéficié d’un interrogatoire, avec recherche des antécédents de tuberculose extra urinaire, d’un examen clinique, d’une créatinémie, d’une urographie intra veineuse (UIV), d’une échographie et/ou tomodensitométrie, de la recherche du bacille de Koch (BK) dans les urines, d’un ECBU, d’une cystoscopie, et d’une analyse histologique des fragments biopsiques et/ou de la pièce d’exérèse. Résultats: Le diagnostic était basé sur un faisceau d’arguments cliniques, bactériologiques et radiologiques. L’irritation vésicale représentait la manifestation clinique la plus fréquente (51,5%). L’atteinte génitale isolée était présente chez 17,8% des patients. 16,8% de nos malades avaient une insuffisance rénale inaugurale (créatinine moyenne de 24 mg/l). La recherche de BK a été réalisée chez tous les patients et n’a été positive que dans 9,4% des cas. Les anomalies à l’UIV concernaient 86% des malades avec un rein muet dans 42% des cas. On a traité tous nos patients par une chimiothérapie antibacillaire associée à la chirurgie (85,2%) et/ou à des manoeuvres endo-urologiques (20%). Avec un recul moyen de 3 ans (extrêmes allant de 1 à 9 ans), la plupart de nos patients ont bien évolué sous traitement. L’amélioration clinique a été spectaculaire avec disparition des signes cliniques chez 88% des patients. La fonction rénale a été normalisée chez 70% des cas. Conclusion: La tuberculose reste une maladie grave par son évolution latente et le diagnostic tardif. L’amélioration de son pronostic passe par la prévention et par une bonne prise en charge diagnostique et thérapeutique.Mots clés : Tuberculose uro-génitale, diagnostic, traitemen

Proton MRS of the unilateral substantia nigra in the human brain at 4 tesla: Detection of high GABA concentrations

Parkinson's disease (PD) is characterized by loss of dopaminergic neurons in the substantia nigra (SN), the cause of which is unknown. Characterization of early SN pathology could prove beneficial in the treatment and diagnosis of PD. The present study shows that with the use of short-echo (5 ms) Stimulated-Echo Acquisition Mode (STEAM) spectroscopy and LCModel, a neurochemical profile consisting of 10 metabolites, including γ-aminobutyric acid (GABA), glutamate (Glu), and glutathione (GSH), can be measured from the unilateral SN at 4 tesla. The neurochemical profile of the SN is unique and characterized by a fourfold higher GABA/Glu ratio compared to the cortex, in excellent agreement with established neurochemistry. The presence of elevated GABA levels in SN was validated with the use of editing, suggesting that partial volume effects were greatly reduced. These findings establish the feasibility of obtaining a neurochemical profile of the unilateral human SN by single-voxel spectroscopy in small volumes. © 2006 Wiley-Liss, Inc

Synthesis and characterization of new Ti–Bi2O3 anode and its use for reactive dye degradation

This paper reports the synthesis, characterization and application of a Ti–Bi2O3 anode for the electrochemical decolorization of the textile dye Reactive Red 2. The anode was synthesized by electrodeposition on a Ti substrate immersed in an acidic bismuth (III) solution at constant potential, followed by calcination in air at 600 °C. Thermogravimetric Analysis (TGA), Energy-dispersive X-ray spectroscopy (EDX) and X-ray diffraction (XRD) analysis revealed that the electrodeposited material was predominantly metallic bismuth, which was oxidized to pure α-Bi2O3 during the calcination in air. SEM micrographs revealed that the Bi2O3 coat at the anode surface was inhomogeneous and porous. Reactive Red 2 was completely electrochemically decolorized at the synthesized anode in the presence of H2O2. The applied current density, H2O2 and Na2SO4 concentration, medium pH and initial dye concentration affected the dye decolorization rate. The optimal process parameters were found to be as follows: an applied current density of 40 mA cm−2 using a mixture of 10 mmol dm−3 H2O2 and 10 mmol dm−3 Na2SO4 at pH 7. The dye decolorization rate was shown to decrease as its initial concentration increased. The decolorization reactions were found to follow pseudo-first order kinetics

A Method for Determining Skeletal Lengths from DXA Images

<p>Abstract</p> <p>Background</p> <p>Skeletal ratios and bone lengths are widely used in anthropology and forensic pathology and hip axis length is a useful predictor of fracture. The aim of this study was to show that skeletal ratios, such as length of femur to height, could be accurately measured from a DXA (dual energy X-ray absorptiometry) image.</p> <p>Methods</p> <p>90 normal Caucasian females, 18–80 years old, with whole body DXA data were used as subjects. Two methods, linear pixel count (LPC) and reticule and ruler (RET) were used to measure skeletal sizes on DXA images and compared with real clinical measures from 20 subjects and 20 x-rays of the femur and tibia taken in 2003.</p> <p>Results</p> <p>Although both methods were highly correlated, the LPC inter- and intra-observer error was lower at 1.6% compared to that of RET at 2.3%. Both methods correlated positively with real clinical measures, with LPC having a marginally stronger correlation coefficient (r²= 0.94; r²= 0.84; average r²= 0.89) than RET (r²= 0.86; r²= 0.84; average r²= 0.85) with X-rays and real measures respectively. Also, the time taken to use LPC was half that of RET at 5 minutes per scan.</p> <p>Conclusion</p> <p>Skeletal ratios can be accurately and precisely measured from DXA total body scan images. The LPC method is easy to use and relatively rapid. This new phenotype will be useful for osteoporosis research for individuals or large-scale epidemiological or genetic studies.</p

Latent provisions for building information modeling (BIM) contracts: a social network analysis approach

The effective adoption and use of Building Information Modeling (BIM) require appropriate contract design to fairly allocate the contracting parties’ rights and responsibilities. Several standards for BIM protocols and contracts have been developed for the industry. However, the awareness and the use of these are rather limited, leading to unclear provisions in BIM contracts. Therefore, the research aims to identify the influential legal aspects that serve as the latent contract provisions in BIM contracts. A questionnaire survey was conducted to survey experts and active BIM users in construction projects. The data were analyzed using social network analysis (SNA) by assuming interdependent relationships among various the legal aspects in BIM contacts. The key legal aspects associated with BIM contracts pertain to the roles and responsibilities of the project participants. The results also reveal that data security is the center of all latent legal aspects in the contracts. The study provides significant new insights into clarifying the required contract provisions in BIM contracts

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Hydrothermal Synthesis, Microstructure and Photoluminescence of Eu3+-Doped Mixed Rare Earth Nano-Orthophosphates

Eu3+-doped mixed rare earth orthophosphates (rare earth = La, Y, Gd) have been prepared by hydrothermal technology, whose crystal phase and microstructure both vary with the molar ratio of the mixed rare earth ions. For LaxY1–xPO4: Eu3+, the ion radius distinction between the La3+ and Y3+ is so large that only La0.9Y0.1PO4: Eu3+ shows the pure monoclinic phase. For LaxGd1–xPO4: Eu3+ system, with the increase in the La content, the crystal phase structure of the product changes from the hexagonal phase to the monoclinic phase and the microstructure of them changes from the nanorods to nanowires. Similarly, YxGd1–xPO4: Eu3+, Y0.1Gd0.9PO4: Eu3+ and Y0.5Gd0.5PO4: Eu3+ samples present the pure hexagonal phase and nanorods microstructure, while Y0.9Gd0.1PO4: Eu3+ exhibits the tetragonal phase and nanocubic micromorphology. The photoluminescence behaviors of Eu3+ in these hosts are strongly related to the nature of the host (composition, crystal phase and microstructure)