Airgun shot wound to the orbit with retention of pellet. Case report and review of the literature

Shot wounds become a growing clinical concern in the civilian setting, due to increasing popularity of air guns among minors. We present a pediatric case of a shot wound to the orbit with sparing of the eyeball and retention of airgun pellet in the retrobulbar space. The pellet was removed 3 months after injury via lateral orbitotomy. Pathophysiology and ballistics of shot wounds are briefly reviewed and current views on the management strategy of shot wounds with retained projectile are discussed

The word, the self, and the underground estate of pierce inverarity in Thomas Pynchon's "The Crying of Lot 49"

"Not least among the possible forms of dychotomization to which Pynchon’s fiction lends itself is the division into the “overground” realm of the visible and various forms of the underground. Thus in V., Benny Profane, tired of the street, the spurious alternative to the hot-house of paranoid speculation and a metaphysical cul-de-sac, is offered a chance to try his luck under the arid thoroughfares of the West: he literally climbs down under the streets of New York, and his peregrinations in the sewers of this city are not free of anticipatory desire for some sort of soteriological revelation. On a less literal level, Malta, with its supposedly rich deposits of myth and ancient wisdom, stands in opposition to the superficiality of a civilization where people tend to oscillate between self-induced mindlessness and self-created façades. Godolphin makes his terrible discovery under the gaudy skin of reality, and Stencil’s quest centers upon a conspiracy whose alleged aim is to undermine the metaphysical foundations of the West. In all cases, whether they are imagined or real, and whether their message appears to be hope-inspiring or frightening, Pynchon’s murky underworlds lure with the promise of transcendence, of going beyond the predictable mendacities of daylight." (fragm.

Mobility of interacting inorganic nanoparticles

The mobility of the 110 nm-Fe_{2}O_{3} particles in a viscous sucrose solution depends on the concentration of the nanoparticles. When the average particle particle nearest neighbor distance is less than 250 rim, the particle interaction slows down their mobility. When is more than 170 rim, the small mobility of nanoparticles does not depend on their concentration. The critical distance is approximately equal to 2R_{h} = 260 nm, where R_{h} is the hydrodynamic radius, determined by the dynamic light scattering (DLS) method

Sex-related differences in the dioecious species Rumex thyrsiflorus Fingerh : analysis of the content of phenolic constituents in leaf extracts

Rumex thyrsiflorus Fingerh. is mentioned as a European folk medicinal plant. This species has also been traditionally used as an edible plant in Eastern Europe because of its nutritional value. During the study, qualitative and quantitative sex-related differences of phenolic constituents in methanolic leaf extracts of R. thyrsiflorus were evaluated. The presence of the same substances (nine phenolic acids before, and six phenolic acids after acid hydrolysis, nine flavonoids, and a catechin) was estimated in both female and male specimens, using the HPLC-DAD method. A statistically significant higher content of eleven constituents in female plant extracts (acids: chlorogenic, p-coumaric, cryptochlorogenic, gallic, protocatechuic, neochlorogenic, vanillic; flavonoids: quercitrin, rhamnetin, rutoside; and a catechin) was shown. This is the first report concerning the relation between the sex and the content of biologically active phenolic secondary metabolites in leaf extracts of R. thyrsiflorus. Female plants of R. thyrsiflorus could be useful for pharmaceutical purposes as a preferential source of bioactive phenolic acids, flavonoids and especially catechin

Benign versus atypical meningiomas: Risk factors predicting recurrence

Objective The aim of the study is to determine which clinic, radiologic, and surgical characteristics of benign and atypical meningioma are associated with tumor progression. Methods 335 patients who underwent gross-total resection of intracranial benign and atypical meningiomas between 2000 and 2009 were followed during the period of at least 3 years. Clinical, radiological and surgical features possibly associated with progression-free survival and influencing tumor recurrence were assessed. Results 291 lesions were benign (WHO Grade I) and 44 were atypical (WHO Grade II). In the median follow-up period of 82 months 34 meningiomas recurred. The 3-, 5- and 10-year progression-free survival (PFS) rates for benign and atypical tumors were 99.7 and 81.4%, 97.5 and 69.7%, 87.5 and 69.7%, respectively. In a Kaplan–Meier analysis subpial plane of surgical dissection (pial invasion) was associated with increased tumor progression both in benign (p=0.0084) and atypical cohort (p=0.0104), and bone involvement (p=0.0033) and peritumoral brain edema (p=0.0073) were associated with increased tumor progression only in atypical meningiomas. In a multivariate analysis pial invasion and WHO Grade II type were significantly associated with tumor recurrence. All recurrences in atypical meningioma group occurred within 4 years of the surgical resection. Conclusion Pial invasion is an important predictor of tumor recurrence in benign and atypical meningiomas. In atypical meningiomas bone involvement and large peritumoral brain edema are associated with increased tumor progression

Vitamin D in children with primary hypertension

Introduction: Recent evidence suggests that vitamin D plays a role in pathogenesis of arterial hypertension. The aim was to assess vitamin D in children and adolescents with arterial hypertension. Material and methods: In 49 children (14.29 ± 3.17 years) with arterial hypertension we evaluated vitamin D status (according to Polish 2018 Guidelines), serum calcium, phosphorus, parathormone, alkaline phosphatase, office blood pressure, ABPM (including ambulatory arterial stiffness index [AASI]), BMI, GFR, uric acid, lipids and albuminuria. None of the children were supplemented with vitamin D. Results: Mean vitamin D concentration was 19.74 ± 9.68 ng/mL. Vitamin D severe deficiency (0–10 ng/mL) was found in 5 (10.2%), deficiency (> 10–20 ng/mL) in 29 (49.0%), suboptimal concentration (> 20–30 ng/mL) in 17 (34.7%), optimal concentration (> 30 to 50 ng/mL) in 1 (2.0%), and high concentration (> 50 to 100 ng/mL) in 2 (4.1%) children. Vitamin D was higher in spring-summer vs. autumn-winter (21.79 ± 10.19 vs. 15.53 ± 7.08 ng/mL, p = 0.03). Vitamin D correlated with height Z-score (r = 0.39, p < 0.01), BMI Z-score (r = -0.34, p = 0.02), uric acid (r = -0.31, p = 0.04), triglycerides (r = -0.37, p = 0.01), but not with office blood pressure and ABPM parameters except for heart rate (r = -0.38, p < 0.01). In 24 children treated with antihypertensive medications vitamin D correlated with AASI (r = 0.50, p = 0.04). Conclusions: Inadequate vitamin D supply is ubiquitous in children with arterial hypertension. Vitamin D deficiency should be suspected especially in autumn-winter period and among obese and short children. The relation between vitamin D status and ambulatory arterial stiffness index suggests negative influence of vitamin D on arterial wall but requires further investigations

The future of work in automated warehouse from the perspective of the employees

Contemporary enterprises operate in conditions of high uncertainty, where competition takes place not only at the level of prices of products or services offered, but above all on quality. The time taken to deliver a product or service is one of the most important quality measures. The role and importance of the logistics system in the current competitive environment is of fundamental importance. Warehouses have ceased to be perceived as cost centers, just being a central place in the flow of goods, and are gaining ever more importance in building a lasting competitive advantage. There are also growing requirements for modern warehouses (identification of the place where the goods are stored, efficient means of internal transport, the possibility of quick product picking). Technological progress and automation has a huge impact on the way warehouse processes are carried out and managed. And this technology is developing extremely quickly, radically changing work in the warehouse. Elimination of errors, increased efficiency, significant reduction of operating costs, assurance of constant availability of the full range of goods, the improvement of process control, increase of precision and speed of information flow are some of the benefits of introducing automation in the warehouse. Although warehouse processes are becoming increasingly automated, people will still have to a role by collaborating and interacting with machines. Due to the fact that the interaction between man and machine in warehouse work has not been the subject of much attention in contemporary literature on the subject, the purpose of the article is to assess the impact of automation on warehouse work, through CAPI research directed at warehouse employees. What impact the current technology has on people’s work was assessed, whether large fluctuations and staff shortages among warehouse workers are not a repercussion of treating them as supplementary to modern machines, or whether they feel at risk of losing their jobs due to automation

The molecular basis of conformational instability of the ecdysone receptor DNA binding domain studied by in silico and in vitro experiments

The heterodimer of the ecdysone receptor (EcR) and ultraspiracle (Usp), members of the nuclear receptors superfamily, regulates gene expression associated with molting and metamorphosis in insects. The DNA binding domains (DBDs) of the Usp and EcR play an important role in their DNA-dependent heterodimerization. Analysis of the crystal structure of the UspDBD/EcRDBD heterocomplex from Drosophila melanogaster on the hsp27 gene response element, suggested an appreciable similarity between both DBDs. However, the chemical denaturation experiments showed a categorically lower stability for the EcRDBD in contrast to the UspDBD. The aim of our study was an elucidation of the molecular basis of this intriguing instability. Toward this end, we mapped the EcRDBD amino acid sequence positions which have an impact on the stability of the EcRDBD. The computational protein design and in vitro analyses of the EcRDBD mutants indicate that non-conserved residues within the α-helix 2, forming the EcRDBD hydrophobic core, represent a specific structural element that contributes to instability. In particular, the L58 appears to be a key residue which differentiates the hydrophobic cores of UspDBD and EcRDBD and is the main reason for the low stability of the EcRDBD. Our results might serve as a benchmark for further studies of the intricate nature of the EcR molecule

Early, posttraumatic, frontal instability of the knee joint deriving from injured medial collateral ligament, after total knee arthroplasty, complicated by wound dehiscence and Clostridium difficile infection in a 70-year-old patient

Gonarthrosis is a joint disease in which a balance between regenerative and degenerative processes of articular cartilage is impaired. Its main symptoms are: pain, swelling, rigidity, function restraint as well as articular deformation [1]. It is estimated that about 40% of the knee joint degeneration is a consequence of ageing of the body. 60% of remaining cases of gonarthrosis is a result of excessive strain, contusion and injury. Patients with advanced arthrosis are qualified for total arthroplasty of the knee. Medial collateral ligament (MCL) is responsible for the medial stability of the knee joint, it prevents from valgus deformity and restraints external rotation of tibia relative to the femur. Injury, most often distorting the knee, may lead to straining as well as complete rupture of the MCL [2,3]. We present a case of a 70-year-old patient with MCL injury that happened three weeks after total knee arthroplasty, complicated by wound dehiscence. Insufficiency of the medial collateral ligament in our patient had an effect in longer healing process and rehabilitation. Main treatment options are: revision surgery with use of constrained implants and injured medial collateral ligament reconstruction. Constrained implants may have reduced longevity in some patients through aseptic loosening. Our patient underwent a MCL reconstruction. Reconstruction of MCL without revision arthroplasty has good results for injured MCL after total arthroplasty of the knee

Przezczaszkowa ultrasonografia dopplerowska (TCD) u chorych z poszerzonym układem komorowym : poszukiwanie dodatkowych wskaźników kwalifikacji do zabiegu implantacji układu zastawkowego

Background: Ventriculomegaly without increased intracranial pressure is observed both in normal-pressure hydrocephalus (NPH) and idiopathic cerebral atrophy (CA). Investigating additional parameters to differentiate these diseases is important for a good qualification of shunt implantation. The study presents the influence of intravenous administration of acetazolamide on cerebral blood flow velocity (BFV) and cerebrovascular reactivity (CVR) in 23 patients with ventriculomegaly and symptoms of cognitive function disorders. The aim was to establish the differences in the dynamic cerebral hemodynamics parameters in NPH and CA patients. Material/Methods: Measurement of BFV was performed in 23 patients using transcranial Doppler (TCD) ultrasonography before and 20 minutes after intravenous administration of 1000 mg acetazolamide. CVR was calculated as the percent change from the baseline mean BFV value and assessed bilaterally in the middle (MCA), anterior (ACA), posterior (PCA), and internal carotid cerebral (ICA) arteries in the intracranial part. Additionally, BFV was evaluated in selected patients during a lumbar infusion test. The patients were divided into 2 groups: those with NPH and those with CA. Results: BFV values were decreased both in the NPH and the CA group compared with the control group (healthy volunteers of the same age). There were no significant differences between the two groups. In the CA group a complete lack of CVR was observed in all examined arteries. In the NPH group, CVR was maintained, while mean BFV (MFV) changed 37±4% in the MCA, 26±6% in the ACA, 33±5% in the PCA, and 30±4% in the ICA. There were statistically significant differences in CVR values between the groups. A decrease in initial BFV in all examined intracranial arteries and a complete lack of CVR is characteristic of the CA group. Conclusions: Maintenance of CVR and a simultaneous decrease in BFV is a characteristic of the NPH group, but among the patients in that group we found differences in cerebrovascular response to acetozolamide, In both groups there were no significant differences in BFV in the MCA during the lumbar infusion test. The acetazolamide test appears as an additional factor in the differential diagnosis of NPH and CA