Pyloric Stenosis Leading to Sinus Venous Thrombosis; A Case Report

Pyloric stenosis is typically diagnosed early and repaired after resuscitation and electrolyte correction in a timely manner. Delay in diagnosis or presentation of patient can lead to significant morbidity and even mortality. Here we present a case of pyloric stenosis leading to dehydration severe enough to lead to venous sinus thrombosis. This case highlights the importance of early detection of pyloric stenosis with timely correction of fluid status and electrolytes. Venous sinus thrombosis is a serious complication associated with our patient’s pyloric stenosis that has not yet been reported in literature

Deciding Finiteness for Matrix Groups Over Function Fields

Let S be any finite subset GLn(F(t)) where F is a field. In this paper we give algorithms to decide if the group generated by S is finite. In the case of characteristic zero, slight modifications of earlier work of Babai, Beals and Rockmore [1] give polynomial time deterministic algorithms to solve this problem. The case of positive characteristic turns out to be more subtle and our algorithms depend on a structure theorem proved here, generalizing a theorem of Weil. We also present a fairly detailed analysis of the size of finite subgroups in this case and give bounds which depend upon the number of generators. To this end we also introduce the notion of the diameter of a finitely generated algebra and derive some upper bounds related to this quantity. In positive characteristic the deterministic algorithms we present are exponential. A randomized algorithm based on ideas of the Meat-Axe is also given. While not provably efficient, the success of the Meat-Axe suggests the randomized algorithm will be useful

Secondary Scoliosis from a Retroperitoneal Ganglioneuroma in a 9-year-old Female: Case Report

Ganglioneuromas are rare benign tumors that tend to be asymptomatic until large enough to compress adjacent structures. These tumors are often found during childhood during evaluations for other pathologies. Retroperitoneal ganglioneuromas may be a secondary cause of scoliosis. Here, we present a case of a child who was found to have a retroperitoneal ganglioneuroma during an evaluation for scoliosis.

Obesity alters the muscle protein synthetic response to nutrition and exercise

Improving the health of skeletal muscle is an important component of obesity treatment. Apart from allowing for physical activity, skeletal muscle tissue is fundamental for the regulation of postprandial macronutrient metabolism, a time period that represents when metabolic derangements are most often observed in adults with obesity. In order for skeletal muscle to retain its capacity for physical activity and macronutrient metabolism, its protein quantity and composition must be maintained through the efficient degradation and resynthesis for proper tissue homeostasis. Life-style behaviors such as increasing physical activity and higher protein diets are front-line treatment strategies to enhance muscle protein remodeling by primarily stimulating protein synthesis rates. However, the muscle of individuals with obesity appears to be resistant to the anabolic action of targeted exercise regimes and protein ingestion when compared to normal-weight adults. This indicates impaired muscle protein remodeling in response to the main anabolic stimuli to human skeletal muscle tissue is contributing to poor muscle health with obesity. Deranged anabolic signaling related to insulin resistance, lipid accumulation, and/or systemic/muscle inflammation are likely at the root of the anabolic resistance of muscle protein synthesis rates with obesity. The purpose of this review is to discuss the impact of protein ingestion and exercise on muscle protein remodeling in people with obesity, and the potential mechanisms underlining anabolic resistance of their muscle

Therapeutic relationships in day surgery: a grounded theory study

Aim: The aim of the study was to explore patients’ experiences of day surgery. Background: Therapeutic relationships are considered to be a core dimension of nursing care. However in modern healthcare with short hospital stays the formation of these relationships may be impeded. A major theme to emerge from this study was the development of therapeutic relationships in the day surgery setting. Methodology: The Glaserian method of Grounded Theory was utilised. Semi –structured interviews with 145 patients took place from 2004-2006 in two day surgery units in the United Kingdom. Analysis involved transcriptions of interviews and memos. Lists of key words and phrases were made and constantly compared until core categories began to emerge. Results: Patients spoke highly of the relationships they developed with nurses during their stay in the day surgery unit. Analysis of the data revealed the core category of therapeutic relationships and four sub core categories: “presence,” “extra special” “befriending” and “comfort-giving.” Conclusion: This paper adds to the growing body of literature which demonstrates that therapeutic relationships can be developed within the short stay arena of health care : routine interactions which may not be considered to be significant by nurses may be of importance to patients. The patients in this study felt supported, comforted and befriended by day surgery nurses. However a minority of patients were disappointed with the nursing staff responses to patient needs. Relevance to clinical practice: Anecdotal and empirical evidence suggests that personnel working within day surgery are not always aware of their therapeutic potential. Therefore raising awareness of this through research generated from patients’ experiences might encourage nurses to further realise their capabilities in this fundamental area of nursing

Actin polymerization in cellular oxidant injury

Microfilaments undergo an ATP-dependent disruption into shortened bundles following cellular exposure to oxidants. This phenomenon does not require a net change in the amount of polymerized actin. However, increased amounts of polymerized actin have been detected in oxidant-injured cells and it was the purpose of this study to determine the conditions under which the actin polymerization may occur. Utilizing the formation of oxidized glutathione (GSSG) as an indicator of cellular sulfhydryl oxidation, conditions were chosen to accentuate sulfhydryl oxidation within the target P388D1 cell line following exposure to the oxidants, H2O2 and diamide. Using the DNase I and flow cytometric assays of actin polymerization, significant polymerization of actin was detected only under conditions in which sulfhydryl oxidation occurred after exposure to the two oxidizing agents. Greater sulfhydryl oxidation early in the course of injury was associated with a greater rate and extent of actin polymerization in the injured cells. Experiments with cells depleted of glutathione (GSH) demonstrated that neither loss of GSH nor absolute levels of GSSG formed during oxidant exposure were responsible for the polymerization of actin. The data presented are consistent with the hypothesis that oxidizing conditions which induce significant sulfhydryl oxidation in target cells are correlated with assembly of polymerized actin and that this represents a process which is distinct and separate from the ATP-dependent gross disruption of microfilaments.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29200/1/0000254.pd

Feasibility of Surgeon-Delivered Audit and Feedback Incorporating Peer Surgical Coaching to Reduce Fistula Incidence following Cleft Palate Repair: A Pilot Trial

Background: Improving surgeons\u27 technical performance may reduce their frequency of postoperative complications. The authors conducted a pilot trial to evaluate the feasibility of a surgeon-delivered audit and feedback intervention incorporating peer surgical coaching on technical performance among surgeons performing cleft palate repair, in advance of a future effectiveness trial. Methods: A nonrandomized, two-arm, unblinded pilot trial enrolled surgeons performing cleft palate repair. Participants completed a baseline audit of fistula incidence. Participants with a fistula incidence above the median were allocated to an intensive feedback intervention that included selecting a peer surgical coach, observing the coach perform palate repair, reviewing operative video of their own surgical technique with the coach, and proposing and implementing changes in their technique. All others were allocated to simple feedback (receiving audit results). Outcomes assessed were proportion of surgeons completing the baseline audit, disclosing their fistula incidence to peers, and completing the feedback intervention. Results: Seven surgeons enrolled in the trial. All seven completed the baseline audit and disclosed their fistula incidence to other participants. The median baseline fistula incidence was 0.4 percent (range, 0 to 10.5 percent). Two surgeons were unable to receive the feedback intervention. Of the five remaining surgeons, two were allocated to intensive feedback and three to simple feedback. All surgeons completed their assigned feedback intervention. Among surgeons receiving intensive feedback, fistula incidence was 5.9 percent at baseline and 0.0 percent following feedback (adjusted OR, 0.98; 95 percent CI, 0.44 to 2.17). Conclusion: Surgeon-delivered audit and feedback incorporating peer coaching on technical performance was feasible for surgeons

Steatosis drives monocyte-derived macrophage accumulation in human metabolic dysfunction-associated fatty liver disease

BACKGROUND & AIMS: Metabolic dysfunction-associated fatty liver disease (MAFLD) is a common complication of obesity with a hallmark feature of hepatic steatosis. Recent data from animal models of MAFLD have demonstrated substantial changes in macrophage composition in the fatty liver. In humans, the relationship between liver macrophage heterogeneity and liver steatosis is less clear. METHODS: Liver tissue from 21 participants was collected at time of bariatric surgery and analysed using flow cytometry, immunofluorescence, and H&E microscopy. Single-cell RNA sequencing was also conducted on a subset of samples (n = 3). Intrahepatic triglyceride content was assessed via MRI and tissue histology. Mouse models of hepatic steatosis were used to investigate observations made from human liver tissue. RESULTS: We observed variable degrees of liver steatosis with minimal fibrosis in our participants. Single-cell RNA sequencing revealed four macrophage clusters that exist in the human fatty liver encompassing Kupffer cells and monocyte-derived macrophages (MdMs). The genes expressed in these macrophage subsets were similar to those observed in mouse models of MAFLD. Hepatic CD14 CONCLUSIONS: The human liver in MAFLD contains macrophage subsets that align well with those that appear in mouse models of fatty liver disease. Recruited myeloid cells correlate well with the degree of liver steatosis in humans. MdMs appear to participate in lipid uptake during early stages of MALFD. IMPACT AND IMPLICATIONS: Metabolic dysfunction associated fatty liver disease (MAFLD) is extremely common; however, the early inflammatory responses that occur in human disease are not well understood. In this study, we investigated macrophage heterogeneity in human livers during early MAFLD and demonstrated that similar shifts in macrophage subsets occur in human disease that are similar to those seen in preclinical models. These findings are important as they establish a translational link between mouse and human models of disease, which is important for the development and testing of new therapeutic approaches for MAFLD

On integrability of the vector short pulse equation

Using the Painleve analysis preceded by appropriate transformations of nonlinear systems under investigation, we discover two new cases in which the Pietrzyk-Kanattsikov-Bandelow vector short pulse equation must be integrable due to the results of the Painleve test. Those cases are technologically important because they correspond to the propagation of polarized ultra-short light pulses in usual isotropic silica optical fibers.Comment: 10 page

Measuring emotional and social wellbeing in Aboriginal and Torres Strait Islander populations: an analysis of a Negative Life Events Scale

Aboriginal and Torres Strait Islander Australians experience widespread socioeconomic disadvantage and health inequality. In an attempt to make Indigenous health research more culturally-appropriate, Aboriginal and Torres Strait Islander Australians have called for more attention to the concept of emotional and social wellbeing (ESWB). Although it has been widely recognised that ESWB is of crucial importance to the health of Aboriginal and Torres Strait Islander peoples, there is little consensus on how to measure in Indigenous populations, hampering efforts to better understand and improve the psychosocial determinants of health. This paper explores the policy and political context to this situation, and suggests ways to move forward. The second part of the paper explores how scales can be evaluated in a health research setting, including assessments of endorsement, discrimination, internal and external reliability