Effect in dogs of various portal vein shunts on response to insulin

Surgical alterations of portal drainage patterns were made in dogs in order to determine the effect of redistribution of endogenous and injected insulin. With an Eck fistula, progressive diminution of hypoglycemic response to insulin was noted. With a reverse Eck fistula, the fall in venous blood sugar was comparable whether injection was given via the portal system or systemically. With portacaval transposition, in which the pancreatic drainage is diverted from the liver, no alterations in general health, fasting blood sugars, or insulin response were noted. The results are discussed in relation to recent concepts in which insulin is thought to regulate or be regulated by the liver

Regaining Motion among Patients with Shoulder Pathology - Are All Exercises Equal?

Background: Little information exists to guide the choice of exercise for regaining shoulder range of motion (ROM). The purpose of this study was to compare the maximal ROM reached, pain and difficulty associated with 4 commonly prescribed exercises. Methods: Forty (9 females) patients with various shoulder disorders and a limited flexion ROM performed 4 exercises for regaining shoulder flexion ROM in a randomized order. Exercises included the self-assisted flexion, forward bow, table slide and rope-and-pulley. Participants were videotaped while performing all exercises and the maximal flexion angle reached during each exercise was recorded using Kinovea motion analysis freeware (Kinovea 0.8.15). Pain intensity and the perceived level of difficulty associated with each exercise were also recorded. Results: The forward bow and table slide generated significantly greater ROM compared with the self-assisted flexion and rope-and-pulley (P≤0.005). The self-assisted flexion was associated with a greater pain intensity compared with the table slide and rope-and-pulley (P=0.002) and a greater perceived level of difficulty compared with the table slide (P=0.006). Conclusions: Due to the greater ROM allowed, and similar or even lower level of pain or difficulty, clinicians may wish to initially recommend the forward bow and table slide for regaining shoulder flexion ROM

The supine moving apprehension test—Reliability and validity among healthy individuals and patients with anterior shoulder instability

Background: Performance-based tests for patients with anterior shoulder dislocation are lacking. This study determined the reliability and validity of the supine moving apprehension test designed to assess the ability to control anterior instability loads. Methods: Thirty-six participants were recruited (18 healthy individuals, and 18 patients following anterior shoulder dislocation). Healthy participants performed the supine moving apprehension test on 2 separate occasions to determine test-retest reliability. Patients completed the supine moving apprehension test and the Western Ontario Shoulder Instability index before and 6 months after surgical stabilization of their shoulder. The presence of anterior apprehension was also documented post-operatively. Results: The supine moving apprehension test demonstrated good test-retest reliability (intraclass correlation coefficient =0.74−0.84). Patients performed 18−30 repetitions less than healthy individuals during the supine moving apprehension test (P \u3c 0.01). A strong correlation was found between supine moving apprehension test scores and Western Ontario Shoulder Instability post-operatively (r=−0.74, P ≤ 0.01). Supine moving apprehension test scores significantly improved among patients following surgery (P \u3c 0.01). Patients with a negative apprehension test post-operatively performed the supine moving apprehension test significantly better than patients with a positive apprehension test (P \u3c 0.01). Conclusions: The supine moving apprehension test is reliable and valid among patients with anterior shoulder dislocation and may serve to assess patients’ ability to control shoulder anterior instability loads

Expanding Access to Parasite-based Malaria Diagnosis through Retail Drug shops in Tanzania: Evidence from a Randomized Trial and Implications for Treatment.

Tanzania has seen a reduction in the fraction of fevers caused by malaria, likely due in part to scale-up of control measures. While national guidelines require parasite-based diagnosis prior to treatment, it is estimated that more than half of suspected malaria treatment-seeking in Tanzania initiates in the private retail sector, where diagnosis by malaria rapid diagnostic test (RDT) or microscopy is illegal. This pilot study investigated whether the introduction of RDTs into Accredited Drug Dispensing Outlets (ADDOs) under realistic market conditions would improve case management practices.\ud Dispensers from ADDOs in two intervention districts in Tanzania were trained to stock and perform RDTs and monitored quarterly. Each district was assigned a different recommended retail price to evaluate the need for a subsidy. Malaria RDT and artemisinin-based combination therapy (ACT) uptake and availability were measured pre-intervention and 1 year post-intervention through structured surveys of ADDO owners and exiting customers in both intervention districts and one contiguous control district. Descriptive analysis and logistic regression were used to compare the three districts and identify predictive variables for testing. A total of 310 dispensers from 262 ADDOs were trained to stock and perform RDTs. RDT availability in intervention ADDOs increased from 1% (n = 172) to 73% (n = 163) during the study; ACT medicines were available in 75% of 260 pre-intervention and 68% of 254 post-intervention ADDOs. Pre-treatment testing performed within the ADDO increased from 0 to 65% of suspected malaria patients who visited a shop (95% CI 60.8-69.6%) with no difference between intervention districts. Overall parasite-based diagnosis increased from 19 to 74% in intervention districts and from 3 to 18% in the control district. Prior knowledge of RDT availability (aOR = 1.9, p = 0.03) and RDT experience (aOR = 1.9, p = 0.01) were predictors for testing. Adherence data indicated that 75% of malaria positives received ACT, while 3% of negatives received ACT. Trained and supervised ADDO dispensers in rural Tanzania performed and sold RDTs under real market conditions to two-thirds of suspected malaria patients during this one-year pilot. These results support the hypothesis that introducing RDTs into regulated private retail sector settings can improve malaria testing and treatment practices without an RDT subsidy. Trial registration ISRCTN ISRCTN14115509

Less is better than more with resection of periacetabular tumors – A retrospective 16 years study and literature review

IntroductionWide resections of periacetabular tumors create a sizeable bony defect that inevitably results in severe loss of function. Reconstruction of such defects usually requires using large metal implants, a feature associated with considerable surgery extension and complications. The aim of this study is to report resection with no reconstruction of the bony defect. In this retrospective study, we reviewed a consecutive series of 16 patients diagnosed with malignant periacetabular tumors and underwent en-bloc resection without reconstructing their remaining bone defect.MethodsRecords were reviewed of 16 consecutive patients diagnosed with malignant periacetabular tumors and underwent en-bloc resection without reconstructing their remaining bony defect. Measurements included: the duration of surgery, blood loss, hemoglobin levels and the need for blood transfusions, data on other hospitalization characteristics, and intraoperative and postoperative complications.ResultsSixteen patients with malignant periacetabular bone tumors and extensive bone destruction underwent wide periacetabular tumor resection with a mean follow-up of 75 months and a mean age of 53 years. The average HOOS score was 46 (range: 20 to 76), and the mean MSTS score was 13% (range: 0 to 15). The mean operative time was 4.1 h, and the mean blood loss was 1200 ml. At their most recent follow-up, patients had a mean shortening of their operated extremity of 4.8 cm, and all could ambulate with assisting devices.ConclusionWide resection of periacetabular tumors without reconstruction provides acceptable levels of function and was associated with shorter surgical time, less blood loss and fewer postoperative complications compared to resection with reconstruction. Therefore, this approach may be considered a viable surgical option in patients with an extensive malignant periacetabular.Level IIIRetrospective study

Camp Lwandle: Rehabilitating a migrant labour hostel at the seaside

In southern African narratives of migrant labour, hostels and compounds are represented as typical examples of colonial and apartheid planning. Visual and spatial comparisons are consistently made between the regulatory power of hostels and those of concentration camps. Several of these sites of violence and repression are today being reconfigured as sites of conscience, their artefactual presence on the landscape being constructed as places of remembrance. In this trajectory, a space of seeming anonymity in Lwandle, some 40 km outside of Cape Town, was identified by the newly established museum, at the beginning of the twenty-first century, as a structure of significance. The migrant labour compound in Lwandle, of which Hostel 33 is the last remnant, was designed by planners and engineers and laid out as part of a labour camp for male migrant workers in the 1950s. This article explores the ambitious project initiated in 2008, by the Lwandle Migrant Labour Museum (and funded largely by the US Ambassadors Cultural Restoration Fund), to restore Hostel 33. Although Hostel 33 was not a very old structure, having been built in 1958/9, nor was it easily considered to have conventional architectural significance, its material presence in present-day Lwandle represents a reminder of the conditions of life in the labour camp. The article traces the work entailed in the restoration process through paying attention to both the built fabric and its materiality, and by giving an account of the explorations into finding ways to restore the hostel to the museum through making it into a site of significance. In place of the centrality of the building as the object of restoration, the work shifted to considering how the hostel could function most effectively as a stage and destination for the Museum’s narrations of the past. Retaining and maintaining Hostel 33 was less concerned with the fabric as an empirical fact of the past, than with its projection into an envisaged future for museum purposes.Department of HE and Training approved lis

Yawning and cortisol levels in multiple sclerosis: Potential new diagnostic tool.

Yawning is a significant behavioural response and, together with cortisol, is potentially a new diagnostic marker of neurological diseases. Evidence of an association between yawning and cortisol was found which supports the Thompson Cortisol Hypothesis and thermoregulation hypotheses, indication that brain cooling occurs when yawning. 117 volunteers aged 18-69 years were randomly allocated to experimentally controlled conditions to provoke yawning. Thirty-three had been diagnosed with multiple sclerosis. Saliva cortisol samples were collected before and after yawning or after stimuli presentation in the absence of yawning. Hospital Anxiety and Depression Scale, General Health Questionnaire, demographic and health details were collected. Comparisons were made of yawners and non-yawners, healthy volunteers and MS participants. EXCLUSION CRITERIA: chronic fatigue, diabetes, fibromyalgia, heart condition, high blood pressure, hormone replacement therapy, stroke. Yawners had significant differences between saliva cortisol sample 1 and 2 among healthy participants (p < .007) and MS participants (p < .003). There was significant difference between the healthy versus MS non-yawners (P < .042) but not between yawners (p < .862). These results support the Thompson Cortisol Hypothesis suggesting that cortisol levels are elevated during yawning. Furthermore, this evidence suggests cortisol levels in the MS participants (non-yawners) are significantly different to those of healthy participants. Changes in cortisol levels may be similar in healthy and MS participants but when associated with observations of excessive yawning may become a new diagnostic tool in the early diagnosis of neurological symptoms. DRYAD DOI: https://doi.org/10.5061/dryad.r09m1

Lipids induce expression of serum-responsive transmembrane kinase EhTMKB1-9 in an early branching eukaryote Entamoeba histolytica

Mechanisms underlying the initiation of proliferative response are known only for a few organisms, and are not understood for the medically important organisms including Entamoeba histolytica. The trans membrane kinase EhTMKB1-9 of E. histolytica is one of the early indicators of proliferation and its' expression is regulated by serum, one of the components necessary for cellular proliferation in vitro. In this study we show that bovine serum albumin (BSA) can induce EhTMKB1-9 expression in place of serum, and that both follow the same mechanism. Both serum and BSA use the same promoter element and the activation process is initiated through a PI3 kinase-mediated pathway. We further show that BSA activates EhTMKB1-9 due to the lipids associated with it and that unsaturated fatty acids are responsible for activation. These results suggest that lipid molecules are ligand(s) for initiation of a signaling system that stimulates EhTMKB1-9 expression

Inter- and intra-observer variability in Sonographic measurements of the cross-sectional diameters and area of the umbilical cord and its vessels during pregnancy

Background. The purpose of the study was to evaluate inter- and intra-observer variability in sonographic measurements of the cross-sectional area of the umbilical cord and the diameters of its vessels in low-risk pregnancies of 12 to 40 weeks of gestation. Methods. A prospective cross sectional study was performed in 221 pregnant women at different gestational ages. Measurements were carried out also by a second observer to evaluate inter-observer variability and repeated once again by the first observer to assess intra-observer variability. The linear correlation between the measurements (Spearman's coefficient of correlation) and their reliability through the intraclass correlation coefficient (ICC), the Cronbach's alpha coefficient and the limits of agreement proposed by Bland and Altman were evaluated. Results. The results showed that inter-observer and intra-observer variability did not show any significant difference between examiners. A good linear correlation between the measurements and reliability was obtained, with values of R, ICC and Cronbach's alpha all above the standard limits. Conclusion. It is possible to conclude that inter- and intra-observer variability in the measurements of the umbilical cord and its vessels was small; their reliability and agreement were good. © 2008 Barbieri et al; licensee BioMed Central Ltd

The Politics of Race and Class and the Changing Spatial Fortunes of the McCarren Pool in Brooklyn, New York, 1936-2010

This paper explores the changing spatial properties of the McCarren Pool and connects them to the politics of race and class. The pool was a large liberal government project that sought to improve the leisure time of working class Brooklynites and between 1936 and the early 1970s it was a quasi-public functional space. In the 1970s and the early 1980s, the pool became a quasi-public dysfunctional space because the city government reduced its maintenance and staffing levels. Working class whites of the area engaged into neighborhood defense in order to prevent the influx of Latinos and African Americans into parts of Williamsburg and Greenpoint and this included the environs of the McCarren Pool. The pool was shut down in 1983 because of a mechanical failure. Its restoration did not take place because residents and storekeepers near the vicinity of the pool complained that by the 1970s, it was only African Americans and Latinos who patronized the pool and that their presence in the neighborhood undermined white exclusivity. For two decades, the McCarren Pool became a multi-use alternative space frequented by homeless people, graffiti artists, heroin users, teenagers, and drug dealers. Unlike previous decades, during this period, people of various racial and ethnic backgrounds frequented the pool area in a relatively harmonious manner. In the early part of the twenty-first century, a neoliberal city administration allowed a corporation to organize music concerts in the pool premises and promised to restore the facility into an operable swimming pool. The problem with this restoration project is that the history of the pool between the early 1970s and the early 2000s is downplayed and this does not serve well former or future users of the poo