Bilateral proximal tibia fracture

A bilateral fracture of the proximal tibia is rare in children. We describe a girl with a bilateral fracture just distal of the epiphyseal plate after minimal trauma

Calculations of the Knight Shift Anomalies in Heavy Electron Materials

We have studied the Knight shift $K(\vec r, T)$ and magnetic susceptibility $\chi(T)$ of heavy electron materials, modeled by the infinite U Anderson model with the NCA method. A systematic study of $K(\vec r, T)$ and $\chi(T)$ for different Kondo temperatures $T_0$ (which depends on the hybridization width $\Gamma$) shows a low temperature anomaly (nonlinear relation between $K$ and $\chi$) which increases as the Kondo temperature $T_0$ and distance $r$ increase. We carried out an incoherent lattice sum by adding the $K(\vec r)$ of a few hundred shells of rare earth atoms around a nucleus and compare the numerically calculated results with the experimental results. For CeSn_3, which is a concentrated heavy electron material, both the ^{119}Sn NMR Knight shift and positive muon Knight shift are studied. Also, lattice coherence effects by conduction electron scattering at every rare earth site are included using the average-T matrix approximation. Also NMR Knight shifts for YbCuAl and the proposed quadrupolar Kondo alloy Y_{0.8}U_{0.2}Pd_{3} are studied.Comment: 31 pages of RevTex, 22 Postscript figures, submmitted to PRB, some figures are delete

Management of trichobezoar: case report and literature review

Trichobezoars (hair ball) are usually located in the stomach, but may extend through the pylorus into the duodenum and small bowel (Rapunzel syndrome). They are almost always associated with trichotillomania and trichophagia or other psychiatric disorders. In the literature several treatment options are proposed, including removal by conventional laparotomy, laparoscopy and endoscopy. We present our experience with four patients and provide a review of the recent literature. According to our experience and in line with the published results, conventional laparotomy is still the treatment of choice. In addition, psychiatric consultation is necessary to prevent relapses

Visuospatial Integration: Paleoanthropological and Archaeological Perspectives

The visuospatial system integrates inner and outer functional processes, organizing spatial, temporal, and social interactions between the brain, body, and environment. These processes involve sensorimotor networks like the eye–hand circuit, which is especially important to primates, given their reliance on vision and touch as primary sensory modalities and the use of the hands in social and environmental interactions. At the same time, visuospatial cognition is intimately connected with memory, self-awareness, and simulation capacity. In the present article, we review issues associated with investigating visuospatial integration in extinct human groups through the use of anatomical and behavioral data gleaned from the paleontological and archaeological records. In modern humans, paleoneurological analyses have demonstrated noticeable and unique morphological changes in the parietal cortex, a region crucial to visuospatial management. Archaeological data provides information on hand–tool interaction, the spatial behavior of past populations, and their interaction with the environment. Visuospatial integration may represent a critical bridge between extended cognition, self-awareness, and social perception. As such, visuospatial functions are relevant to the hypothesis that human evolution is characterized by changes in brain–body–environment interactions and relations, which enhance integration between internal and external cognitive components through neural plasticity and the development of a specialized embodiment capacity. We therefore advocate the investigation of visuospatial functions in past populations through the paleoneurological study of anatomical elements and archaeological analysis of visuospatial behaviors

Spatial content of painful sensations

Philosophical considerations regarding experiential spatial content have focused on exteroceptive sensations presenting external entities, and not on interoceptive experiences that present states of our own body. A notable example is studies on interoceptive touch, in which it is argued that interoceptive tactile experiences have rich spatial content such that tactile sensations are experienced as located in a spatial field. This article investigates whether a similarly rich spatial content can be attributed to experiences of acute, cutaneous pain. It is argued that such experiences of pain do not have field-like content, as they do not present distance relations between painful sensations

Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit

Background: To compare hospital outcomes of aortic aneurysm surgery, casemix correction for preoperative variables is essential. Most of these variables can be deduced from mortality risk prediction models. Our aim was to identify the optimal set of preoperative variables associated with mortality to establish a relevant and efficient casemix model. Methods: All patients prospectively registered between 2013 and 2016 in the Dutch Surgical Aneurysm Audit (DSAA) were included for the analysis. After multiple imputation for missing variables, predictors for mortality following univariable logistic regression were analyzed in a manual backward multivariable logistic regression model and compared with three standard mortality risk prediction models: Glasgow Aneurysm Score (GAS, mainly clinical parameters), Vascular Biochemical and Haematological Outcome Model (VBHOM, mainly laboratory parameters), and Dutch Aneurysm Score (DAS, both clinical and laboratory parameters). Discrimination and calibration were tested and considered good with a C-statistic > 0.8 and Hosmer-Lemeshow (H-L) P > 0.05. Results: There were 12,401 patients: 9,537 (76.9%) elective patients (EAAA), 913 (7.4%) acute symptomatic patients (SAAA), and 1,951 (15.7%) patients with acute rupture (RAAA). Overall postoperative mortality was 6.5%; 1.8% after EAAA surgery, 6.6% after SAAA, and 29.6% after RAAA surgery. The optimal set of independent variables associated with mortality was a mix of clinical and laboratory parameters: gender, age, pulmonary comorbidity, operative setting, creatinine, aneurysm size, hemoglobin, Glasgow coma scale, electrocardiography, and systolic blood pressure (C-statistic 0.871). External validation overall of VBHOM, DAS, and GAS revealed C-statistics of 0.836, 0.782, and 0.761, with an H-L of 0.028, 0.00, and 0.128, respectively. Conclusions: The optimal set of variables for casemix correction in the DSAA comprises both clinical and laboratory parameters, which can be collected easily from electronic patient files and will lead to an efficient casemix model