Basal cell carcinoma of the vulva: a case report and systematic review of the literature

The vulva is an unusual site for basal cell carcinoma (BCC). Vulvar BCC accounts for <1% of all BCCs and <5% of all vulvar malignancies. We report the case of an 83 year‐old woman who presented with a 2‐month history of a tender labial growth, with histopathology confirming nodular BCC. We conducted a systematic literature review of the characteristics of reported cases of vulvar BCCs. A comprehensive systematic review of articles indexed for MEDLINE and Embase yielded 96 reports describing 437 patients with 446 BCCs of the vulva. The mean age at presentation was 70 (range 20–100). Most women had no underlying vulvar disease. Approximately 60% of cases were of the nodular subtype. Treatment approach varied widely with over half of cases treated with wide local or local excision. Mohs micrographic surgery (MMS) for vulvar BCC was first reported in 1988 with seven total MMS cases reported. Twenty‐three cases of recurrence have been reported; 21 of these cases after local excision but none following MMS. Vulvar BCC is a rarely reported cancer that affects older women predominantly. MMS represents a promising treatment for BCC in this anatomic location.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150570/1/ijd14307.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150570/2/ijd14307_am.pd

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Shear Strengthening of Short Span Reinforced Concrete Beams with CFRP Sheets

This paper presents the results of a series of tests on short span reinforced concrete beams which were strengthened in shear with various arrangements of externally bonded carbon fibre reinforced polymer (CFRP) sheets. The objective of the tests was to determine the effect of changing the area and location of the CFRP sheet within the shear span. A total of fifteen 150 mm × 300 mm × 1,675 mm concrete beams were tested of which four were un-strengthened control specimens. The remaining 11 beams were strengthened with varying configurations of CFRP sheets. Parameters varied in the tests included the area of CFRP sheet, its anchorage length and the distance of the CFRP sheet from the support. The experimental results revealed that the CFRP is more effective when it is placed close to the supports and even small areas of CFRP can give significant increases in shear strength. The experimental results were compared with the three different existing shear prediction models for estimating shear contribution of CFRP sheets. A simple strut-and-tie model is presented which gives reasonable predictions of shear strength for the beam specimens, which were strengthened with CFRP over the full depth of the beam. The superposition method of design is replaced in EC2 by the variable angle truss model in which all the shear is assumed to be resisted by the truss mechanism. A simple regression equation is proposed for the calculation of effective stress in FRP to be used in EC2. © 2012 King Fahd University of Petroleum and Minerals

Shear Strengthening of Short Span Reinforced Concrete Beams with CFRP Sheets

This paper presents the results of a series of tests on short span reinforced concrete beams which were strengthened in shear with various arrangements of externally bonded carbon fibre reinforced polymer (CFRP) sheets. The objective of the tests was to determine the effect of changing the area and location of the CFRP sheet within the shear span. A total of fifteen 150 mm × 300 mm × 1,675 mm concrete beams were tested of which four were un-strengthened control specimens. The remaining 11 beams were strengthened with varying configurations of CFRP sheets. Parameters varied in the tests included the area of CFRP sheet, its anchorage length and the distance of the CFRP sheet from the support. The experimental results revealed that the CFRP is more effective when it is placed close to the supports and even small areas of CFRP can give significant increases in shear strength. The experimental results were compared with the three different existing shear prediction models for estimating shear contribution of CFRP sheets. A simple strut-and-tie model is presented which gives reasonable predictions of shear strength for the beam specimens, which were strengthened with CFRP over the full depth of the beam. The superposition method of design is replaced in EC2 by the variable angle truss model in which all the shear is assumed to be resisted by the truss mechanism. A simple regression equation is proposed for the calculation of effective stress in FRP to be used in EC2. © 2012 King Fahd University of Petroleum and Minerals

1-trifluoromethoxyphenyl-3-(1-propionylpiperidin-4-yl) urea (TPPU), a soluble epoxide hydrolase inhibitor, lowers L-NAME-induced hypertension through suppression of angiotensin-converting enzyme in rats.

ObjectiveThis study evaluated the efficacy of the soluble epoxide hydrolase (sEH) inhibitor, TPPU on chronic NG-Nitro L-arginine methyl ester (L-NAME)-induced hypertension in rats and its effects on plasma Angiotensin II (Ang II), cardiac Angiotensin-converting enzyme (ACE) and Angiotensin II receptor type 1 (AT1R) expressions.Materials and methodsForty Sprague Dawley rats were divided into 5 groups. Two groups served as control and received orally either vehicle or TPPU (3 mg/kg) for five weeks. The other three groups were given L-NAME (50 mg/kg/day) in drinking water for five weeks. Two weeks after the L-NAME treatment, animals received orally either saline or TPPU (3 mg/kg/day) or lisinopril (10 mg/kg/day) daily for 3 weeks. Blood pressure (BP) was measured weekly. At the end of the experiment, plasma Ang II, cardiac ACE and AT1R protein and gene expressions were determined.ResultsL-NAME caused a significant increase in BP of the animals. TPPU and lisinopril resulted in normalization of L-NAME-induced hypertension. They also caused a significant reduction in Ang II and ACE protein and gene expressions compared to L-NAME and vehicle-treated animals.ConclusionsThis study demonstrates that TPPU effectively lowers L-NAME-induced hypertension in rats. The mechanism of its antihypertensive effect is likely mediated by the suppression of ACE gene and protein expression, leading to a lower Ang II level