Postattenuation neurologic signs after surgical attenuation of congenital portosystemic shunts in dogs:A review

The development of postattenuation neurologic signs (PANS) is a poorly understood and potentially devastating complication after surgical attenuation of congenital portosystemic shunts in dogs. Postattenuation neurologic signs include seizures but also more subtle neurologic signs such as depression, behavioral changes, tremors, and twitching. They most commonly occur within 7 days postoperatively and are typically unrelated to hyperammonemia, hypoglycemia, or electrolyte disturbances. This narrative review summarizes the findings of 50 publications from 1988-2020 that report occurrence of PANS. While most published reports included only dogs affected by postattenuation seizures (PAS), others included dogs with any form of PANS. Overall, PANS (including PAS) affected 1.6%-27.3% of dogs, whereas incidence of PAS ranged from 0%-18.2%. The etiology of PANS remains unknown; however, several theories have been proposed. Risk factors include preoperative hepatic encephalopathy, increasing age, and possibly certain breeds and extrahepatic shunt morphology. There is increasing evidence that prophylactic antiepileptic drugs do not prevent PANS. Treatment is centered around controlling neurologic signs with antiepileptic drugs and providing supportive intensive care. The 30-day survival rate in studies that included a minimum of four dogs affected by PANS was 0%-100% (median, 50.0%) and 0%-75.0% (median, 37.5%) for those with PAS. Mortality associated with PANS was typically related to occurrence of generalized seizure activity. Prognostic factors positively associated with short-term survival included having a history of preoperative seizures and development of focal seizures only. If affected dogs survived to discharge, survival for several years was possible, and the majority of neurologic signs manifested as part of the phenomenon of PANS appeared to resolve

The dual phosphodiesterase 3 and 4 inhibitor RPL554 stimulates CFTR and ciliary beating in primary cultures of bronchial epithelia

Cystic fibrosis (CF), a genetic disease caused by mutations in the CFTR gene, is a life-limiting disease characterized by chronic bacterial airway infection and severe inflammation. Some CFTR mutants have reduced responsiveness to cAMP/PKA signaling; hence, pharmacological agents that elevate intracellular cAMP are potentially useful for the treatment of CF. By inhibiting cAMP breakdown, phosphodiesterase (PDE) inhibitors stimulate CFTR in vitro and in vivo. Here, we demonstrate that PDE inhibition by RPL554, a drug that has been shown to cause bronchodilation in asthma and chronic obstructive pulmonary disease (COPD) patients, stimulates CFTR-dependent ion secretion across bronchial epithelial cells isolated from patients carrying the R117H/F508del CF genotype. RPL554-induced CFTR activity was further increased by the potentiator VX-770, suggesting an additional benefit by the drug combination. RPL554 also increased cilia beat frequency in primary human bronchial epithelial cells. The results indicate RPL554 may increase mucociliary clearance through stimulation of CFTR and increasing ciliary beat frequency and thus could provide a novel therapeutic option for CF

Rethinking the learning space at work and beyond: The achievement of agency across the boundaries of work-related spaces and environments

This paper focuses on the notion of the learning space at work and discusses the extent to which its different configurations allow employees to exercise personal agency within a range of learning spaces. Although the learning space at work is already the subject of extensive research, the continuous development of the learning society and the development of new types of working spaces calls for further research to advance our knowledge and understanding of the ways that individuals exercise agency and learn in the workplace. Research findings suggest that the current perception of workplace learning is strongly related to the notion of the learning space, in which individuals and teams work, learn and develop their skills. The perception of the workplace as a site only for work-specific training is gradually changing, as workplaces are now acknowledged as sites for learning in various configurations, and as contributing to the personal development and social engagement of employees. This paper argues that personal agency is constructed in the workplace, and this process involves active interrelations between agency and three dimensions of the workplace (individual, spatial and organisational), identified through both empirical and theoretical research. The discussion is supported by data from two research projects on workplace learning in the United Kingdom. This paper thus considers how different configurations of the learning space and the boundaries between a range of work-related spaces facilitate the achievement of personal agency

Intracavity incoherent supercontinuum dynamics and rogue waves in a broadband dissipative soliton laser

Understanding dynamical complexity is one of the most important challenges in science. Significant progress has recently been made in optics through the study of dissipative soliton laser systems, where dynamics are governed by a complex balance between nonlinearity, dispersion, and energy exchange. A particularly complex regime of such systems is associated with noise-like pulse multiscale instabilities, where sub-picosecond pulses with random characteristics evolve chaotically underneath a much longer envelope. However, although observed for decades in experiments, the physics of this regime remains poorly understood, especially for highly-nonlinear cavities generating broadband spectra. Here, we address this question directly with a combined numerical and experimental study that reveals the physical origin of instability as nonlinear soliton dynamics and supercontinuum turbulence. Real-time characterisation reveals intracavity extreme events satisfying statistical rogue wave criteria, and both real-time and time-averaged measurements are in quantitative agreement with modelling

A 32‐society investigation of the influence of perceived economic inequality on social class stereotyping

There is a growing body of work suggesting that social class stereotypes are amplified when people perceive higher levels of economic inequality—that is, the wealthy are perceived as more competent and assertive and the poor as more incompetent and unassertive. The present study tested this prediction in 32 societies and also examines the role of wealth-based categorization in explaining this relationship. We found that people who perceived higher economic inequality were indeed more likely to consider wealth as a meaningful basis for categorization. Unexpectedly, however, higher levels of perceived inequality were associated with perceiving the wealthy as less competent and assertive and the poor as more competent and assertive. Unpacking this further, exploratory analyses showed that the observed tendency to stereotype the wealthy negatively only emerged in societies with lower social mobility and democracy and higher corruption. This points to the importance of understanding how socio-structural features that co-occur with economic inequality may shape perceptions of the wealthy and the poor.info:eu-repo/semantics/publishedVersio

Near-infrared properties of blue compact dwarf galaxies: the link between solar and low metallicity

We have obtained near-infrared images and spectra of three blue compact dwarf galaxies of intermediate sub-solar metallicity Tol~35, Tol~3 and UM 462. This work is part of a larger project aimed to study the star formation and the stellar populations of low metallicity galaxies in the near-infrared. In this frame work galaxies of intermediate metallicity represent an important step in understanding the most extreme cases filling the gap between solar and very low metallicity galaxies. We have observed HII region like spectra in all three galaxies; in all cases the star formation episodes are only a few Myr old. Consistently with a young age our spectra show no evidence for stellar absorption features typical of supergiants, nor of [FeII] emission typical of supernovae. The K-band gas fraction ranges from 20 to 40 % showing that gas emission can significantly contaminate broadband near-infrared colors in young metal-poor starbursts. We have detected molecular hydrogen in emission in all three objects. All sources show bright knots superimposed on a lower surface brighness envelope. The knots are identified with Super Star Clusters; six of them are present in UM 462. In all galaxies we detect the presence of an old stellar population.Comment: 10 pages, 10 figure

Abdominal wall paresis as a complication of laparoscopic surgery

Purpose: Abdominal wall nerve injury as a result of trocar placement for laparoscopic surgery is rare. We intend to discuss causes of abdominal wall paresis as well as relevant anatomy. Methods: A review of the nerve supply of the abdominal wall is illustrated with a rare case of a patient presenting with paresis of the internal oblique muscle due to a trocar lesion of the right iliohypogastric nerve after laparoscopic appendectomy. Results: Trocar placement in the upper lateral abdomen can damage the subcostal nerve (Th12), caudal intercostal nerves (Th7-11) and ventral rami of the thoracic nerves (Th7-12). Trocar placement in the lower abdomen can damage the ilioinguinal (L1 or L2) and iliohypogastric nerves (Th12-L1). Pareses of abdominal muscles due to trocar placement are rare due to overlap in innervation and relatively small sizes of trocar incisions. Conclusion: Knowledge of the anatomy of the abdominal wall is mandatory in order to avoid the injury of important structures during trocar placement

Appropriate referral and selection of patients with chronic pain for spinal cord stimulation: European consensus recommendations and e-health tool

Background: Spinal cord stimulation (SCS) is an established treatment for chronic neuropathic, neuropathic-like and ischaemic pain. However, the heterogeneity of patients in daily clinical practice makes it often challenging to determine which patients are eligible for this treatment, resulting in undesirable practice variations. This study aimed to establish patient-specific recommendations for referral and selection of SCS in chronic pain. Methods: A multidisciplinary European panel used the RAND/UCLA Appropriateness Method (RUAM) to assess the appropriateness of (referral for) SCS for 386 clinical scenarios in four pain areas: chronic low back pain and/or leg pain, complex regional pain syndrome, neuropathic pain syndromes and ischaemic pain syndromes. In addition, the panel identified a set of psychosocial factors that are relevant to the decision for SCS treatment. Results: Appropriateness of SCS was strongly determined by the neuropathic or neuropathic-like pain component, location and spread of pain, anatomic abnormalities and previous response to therapies targeting pain processing (e.g. nerve block). Psychosocial factors considered relevant for SCS selection were as follows: lack of engagement, dysfunctional coping, unrealistic expectations, inadequate daily activity level, problematic social support, secondary gain, psychological distress and unwillingness to reduce high-dose opioids. An educational e-health tool was developed that combines clinical and psychosocial factors into an advice on referral/selection for SCS. Conclusions: The RUAM was useful to establish a consensus on patient-specific criteria for referral/selection for SCS in chronic pain. The e-health tool may help physicians learn to apply an integrated approach of clinical and psychosocial factors. Significance: Determining the eligibility of SCS in patients with chronic pain requires careful consideration of a variety of clinical and psychosocial factors. Using a systematic approach to combine evidence from clinical studies and expert opinion, a multidisciplinary European expert panel developed detailed recommendations to support appropriate referral and selection for SCS in chronic pain. These recommendations are available as an educational e-health tool (https://www.scstool.org/)