Cranial nerve injuries after carotid artery surgery. A prospective study of 663 operations

Objective:To establish the incidence of cranial nerve injuries caused by carotid artery surgery.Methods:During the years 1982 to 1992, 689 carotid artery operations were performed at Malmö General Hospital. Of these 656 were pre- and postoperatively examined at the Department of Phoniatrics concerning the function of the cranial nerves IX, X, and XII.Results:There was injury to one or more of the examined nerves after 75 operations (11.4%). In 70 (10.7%) operations the hypoglossal nerve was injured, in eight (1.2%) the recurrent laryngeal nerve, in two (0.3%) the glossopharyngeal nerve and in two (0.3%) the superior laryngeal nerve. Seven patients complained of postoperative hoarseness, but had no injuries. One hypoglossal and one recurrent nerve injury was permanent. Nerve injury was more frequent in operations performed with a shunt (p = 0.05), with patch closure (p = 0.01) and by a junior surgeon (p = 0.05).Conclusion:In a prospective series, the incidence of cranial nerve injuries after carotid surgery was significant but the vast majority were reversible

Malnutrition, functional ability and mortality among older people aged ⩾60 years: a 7-year longitudinal study

BACKGROUND/OBJECTIVES: This study aimed to assess the association between risk of malnutrition and 7-year mortality, controlling for functional ability, socio-demographics, lifestyle behavior and diseases, and investigate the interaction between risk of malnutrition and functional ability on the risk of mortality. SUBJECTS/METHODS: A longitudinal study on home-living and special-housing residents aged [greater than or equal to] 60 years was conducted. Of 2312 randomly invited participants, 1402 responded and 1203 provided information on both nutritional status and functional ability. The risk of malnutrition was estimated by the occurrence of at least one anthropometric measure (BMI, MAC and CC) below cut-off in addition to the presence of at least one subjective measure (decreased food intake, weight loss and eating difficulty). RESULTS: At baseline, 8.6% of subjects were at risk of malnutrition and during the 7-year follow-up 34.6% subjects died. The risk of malnutrition was independently associated with 7-year mortality (hazard ratio (HR) 1.84, 95% confidence interval (CI) 1.28-2.65). Additional independent predictors were dementia (HR 2.76, 95% CI 1.85-4.10), activity of daily living (ADL) dependence (HR 2.08, 95% CI 1.62-2.67), heart disease (HR 1.44, 95% CI 1.16-1.78), diabetes (HR 1.41, 95% CI 1.03-1.93) and older age (HR 1.09, 95% CI 1.07-1.10). Moreover, the risk of malnutrition and ADL dependence in combination predicted the poorest survival rate (18.7%, P < 0.001). CONCLUSIONS: The risk of malnutrition significantly increases the risk of mortality in older people. Moreover, risk of malnutrition and ADL dependence together explain a significantly poorer survival rate; however, the importance of this interaction decreased in the multivariable model and risk of malnutrition and ADL dependence independently explained a significant risk of mortality

Researching and Designing for the Orchestration of Learning in the CSCL Classroom

Designing tools for teachers to orchestrate computer supported collaborative learning activities in their classrooms requires that attention be paid to the range of roles and activities a teacher must take throughout the process. Drawing on the Implementing Collaborative Learning in the Classroom framework proposed by Kaendler, Wiedmann, Rummel and Spada (2014), the contributors to this symposium will speak to the way their designs address the various parts of this framework, allowing us to draw conclusions about what has been successful for different parts of this process, and identifying future directions for development and research

Effect of enzymatic transesterification on the melting points of palm stearin-sunflower oil mixtures

Transesterification with lipases may be used to convert mixtures of fats to plastic fats, making them more suitable for use in edible products. In our study, 1,3-specific (Aspergillus niger, Mucor javanicus, Rhizomucor miehei, Rhizopus javanicus, and Rhizopus niveus) and nonspecific (Pseudomonas sp. and Candida rugosa) lipases were used to transesterify mixtures of palm stearin and sunflower oil (PS-SO) at a 40:60 ratio in a solvent-free medium. The transesterified mixtures of PS-SO were analyzed for their percentage free fatty acids (FFA), degree and rate of transesterification, solid fat content, slip melting point (SMP), and melting characteristics by differential scanning calorimetry. Results indicated that Pseudomonas sp. lipase produced the highest degree (77.3%) and rate (50.0 h−1) of transesterification, followed by R. miehei lipase at 32.7% and 27.1 h−1, respectively. The highest percentage FFA liberated was also in the reaction mixtures catalyzed by Pseudomonas sp. (2.5%) lipase and R. miehei (2.4%). Pseudomonas-catalyzed mixtures produced the biggest drop in SMP (13.5°C) and showed complete melting at below body temperature. All results indicated conversion of the PS-SO mixtures to a more fluid product. The findings also suggest that the specificity of lipases may not play a significant role in lowering the melting point of the PS-SO mixtures

Sustainable Development for Rural Areas: A Survey on the Agritourism Rural Networks

The topic of sustainable growth is becoming central in the debate over the rural development policies. Rural communities can completely fulfil the new challenges in the area of sustainability only with the implementation of innovative forms of collaborations among their business networks. In this work, we consider a particular form of business collaboration arising within rural communities, namely Agritourism Rural Network (ARN). In an ARN, a farm, providing agritourism activities, represents a touchpoint between a network of business and organizations in a rural area and tourists interested in enjoying the local territory. With the aim to deeper the extend of the agritourism phenomenon in a rural region and the potential of the related ARNs in being means of sustainable development, we report main results of an empirical survey carried out in 2016 on a sample of 105 agritourism farms all belonging to the same region (Calabria, Italy). Results confirm our intuitions about the importance at farm level of setting agritourism activities and their impact for the ARN related to the farm and for the sustainable development of a local community as a whole

Successful receptor-mediated radiation therapy of xenografted human midgut carcinoid tumour

Somatostatin receptor (sstr)-mediated radiation therapy is a new therapeutic modality for neuroendocrine (NE) tumours. High expression of sstr in NE tumours leads to tumour-specific uptake of radiolabelled somatostatin analogues and high absorbed doses. In this study, we present the first optimised radiation therapy via sstr using [177Lu-DOTA0-Tyr3]-octreotate given to nude mice xenografted with the human midgut carcinoid GOT1. The tumours in 22 out of 23 animals given therapeutic amounts showed dose-dependent, rapid complete remission. The diagnostic amount (0.5 MBq [177Lu-DOTA0-Tyr3]-octreotate) did not influence tumour growth and was rapidly excreted. In contrast, the therapeutic amount (30 MBq [177Lu-DOTA0-Tyr3]-octreotate) induced rapid tumour regression and entrapment of 177Lu so that the activity concentration of 177Lu remained high, 7 and 13 days after injection. The entrapment phenomenon increased the absorbed dose to tumours from 1.6 to 4.0 Gy MBq−1 and the tumours in animals treated with 30 MBq received 120 Gy. Therapeutic amounts of [177Lu-DOTA0-Tyr3]-octreotate rapidly induced apoptosis and gradual development of fibrosis in grafted tumours. In conclusion, human midgut carcinoid xenografts can be cured by receptor-mediated radiation therapy by optimising the uptake of radioligand and taking advantage of the favourable change in biokinetics induced by entrapment of radionuclide in the tumours