Anatomic variability of groin innervation

Inguinal hernia repairs are very common yet fairly complex surgical procedures.Variations in the anatomical course of the inguinal nerves require that diligenceis taken in their proper recognition. Inadvertent surgical injury to these nerves isassociated with long term postoperative pain and complications. The aim of thepresent study was to highlight the complexity and variation in the innervation ofthe inguinal region in order to increase proper nerve identification during surgicalinterventions. Bilateral dissection of the inguinal and posterior abdominal regionsin one human male cadaver revealed an atypical anatomic topography of thegroin innervation. This unusual case was observed at the Jagiellonian UniversityAnatomy Department during routine cadaveric preparations. The left ilioinguinalnerve was absent. The left genital branch of the genitofemoral nerve arose higherthan expected from the lumbar plexus and supplied the groin region, which istypically innervated by the ilioinguinal nerve. Furthermore, the left lateral cutaneousfemoral nerve and the right genital branch of the genitofemoral nerve alsofollowed uncharacteristic courses. Awareness of topographical nerve variationsduring inguinal hernia repair will help surgeons identify and preserve importantnerves, thus decreasing the incidence of chronic postoperative pain

Cancer with unknown primary: finding a needle in a hay stack

Detection and resection of small neuroendocrine tumours (NET) is like finding a needle in a hay stack. Use of specific tracers such as 68Ga-DOTATOC in a PET/CT study has been proven to have a high sensitivity and specificity to cells expressing somatostatin-SSR receptors. The use of 99mTc-Octreotide to detect neuroendocrine tumours during surgery is an effective adjunct for therapy. We here present a clinical case of patient with NET where these modalities help in both diagnostic and therapeutic surgery

Functional analysis and transcriptional output of the Göttingen minipig genome

In the past decade the Göttingen minipig has gained increasing recognition as animal model in pharmaceutical and safety research because it recapitulates many aspects of human physiology and metabolism. Genome-based comparison of drug targets together with quantitative tissue expression analysis allows rational prediction of pharmacology and cross-reactivity of human drugs in animal models thereby improving drug attrition which is an important challenge in the process of drug development.; Here we present a new chromosome level based version of the Göttingen minipig genome together with a comparative transcriptional analysis of tissues with pharmaceutical relevance as basis for translational research. We relied on mapping and assembly of WGS (whole-genome-shotgun sequencing) derived reads to the reference genome of the Duroc pig and predict 19,228 human orthologous protein-coding genes. Genome-based prediction of the sequence of human drug targets enables the prediction of drug cross-reactivity based on conservation of binding sites. We further support the finding that the genome of Sus scrofa contains about ten-times less pseudogenized genes compared to other vertebrates. Among the functional human orthologs of these minipig pseudogenes we found HEPN1, a putative tumor suppressor gene. The genomes of Sus scrofa, the Tibetan boar, the African Bushpig, and the Warthog show sequence conservation of all inactivating HEPN1 mutations suggesting disruption before the evolutionary split of these pig species. We identify 133 Sus scrofa specific, conserved long non-coding RNAs (lncRNAs) in the minipig genome and show that these transcripts are highly conserved in the African pigs and the Tibetan boar suggesting functional significance. Using a new minipig specific microarray we show high conservation of gene expression signatures in 13 tissues with biomedical relevance between humans and adult minipigs. We underline this relationship for minipig and human liver where we could demonstrate similar expression levels for most phase I drug-metabolizing enzymes. Higher expression levels and metabolic activities were found for FMO1, AKR/CRs and for phase II drug metabolizing enzymes in minipig as compared to human. The variability of gene expression in equivalent human and minipig tissues is considerably higher in minipig organs, which is important for study design in case a human target belongs to this variable category in the minipig. The first analysis of gene expression in multiple tissues during development from young to adult shows that the majority of transcriptional programs are concluded four weeks after birth. This finding is in line with the advanced state of human postnatal organ development at comparative age categories and further supports the minipig as model for pediatric drug safety studies.; Genome based assessment of sequence conservation combined with gene expression data in several tissues improves the translational value of the minipig for human drug development. The genome and gene expression data presented here are important resources for researchers using the minipig as model for biomedical research or commercial breeding. Potential impact of our data for comparative genomics, translational research, and experimental medicine are discussed

Considerations of Efficiency and Distributive Justice in Multidimensional Poverty Measurement

Ab den 1980er Jahren entwickelte Amartya Sen eine neue Wohlfahrtstheorie: den Capability Approach (Sen, 1979; 1985; 1992; 1999; 2009). Dabei ersetzen Capabilities und Functionings, d.h. das, was Personen tatsächlich in der Lage sind zu tun und zu sein, den traditionellen Einkommensansatz. Armut ist im Capability Approach das Unvermögen, ein bestimmtes Minimum an zentralen Capabilities zu erreichen, die benötigt werden, um das Leben nach den eigenen Vorstellungen zu gestalten. Der Capability Approach hat so viele interessante Eigenschaften, besonders in Bezug auf die Armutsmessung, dass er zunehmend Einfluss in der Wohlfahrtsökonomie gewinnt. Diese Entwicklung wird durch empirische Untersuchungen gefördert, die zeigen, dass dieser multidimensionale Ansatz zur Armutsmessung deutlich andere Ergebnisse generiert als der traditionelle Einkommensansatz (vgl. Klasen, 2000, Alkire und Santos, 2010, Figari, 2012). Der derzeitige multidimensionale Ansatz hat jedoch eine methodische Schwäche: Ungleichheit zwischen Armutsdimensionen wird entweder als Korrelationssensitivität definiert – womit Effizienz aber nicht Verteilungsgerechtigkeit berücksichtigt wird – oder als die Verteilung multipler Mangelerscheinungen in einer Gesellschaft – womit Verteilungsgerechtigkeit aber nicht Effizienz berücksichtigt wird. Die ersten beiden Kapitel dieser Dissertation widmen sich der Behebung dieser methodischen Schwäche. Dazu wird Ungleichheit zwischen Dimensionen zunächst als „korrelationssensitive Verteilung multipler Mangelerscheinungen in einer Gesellschaft“ definiert. Die ersten beiden Kapitel operationalisieren diese erweiterte Definition für den Fall ordinaler und kardinaler Armutsindices. Im Einzelnen wird ein neues Axiom für den ordinalen sowie den kardinalen Fall eingeführt, das das Ausmaß, mit dem ein Ungleichheitsfördernder Tausch Armut sinken (oder steigen) lässt, von der Beziehung zwischen den Armutsdimensionen abhängig macht. Diese Neuerung wird benutzt um eine neue Klasse ordinaler bzw. kardinaler Armutsindices herzuleiten. Diese zwei Klassen sind die ersten additiven Armutsindices die in der Lage sind, sowohl Ungleichheit als auch Korrelationssensitivität zu erfassen. Das dritte Kapitel nutzt das deutsche sozio-ökonomische Panel um zwei ordinale Armutsindices für Deutschland vorzuschlagen, die auf der zuvor entwickelten Methode basieren: den „Deutschen Korrelationssensitiven Armutsindex“ und den „Subjektiven Korrelationssensitiven Armutsindex“. Die beiden Indices werden mit dem offiziellen deutschen Armutsmaß, der Armutsgefährdungsquote, über Dimensionen, Regionen und über die Zeit hinweg verglichen. Die Resultate zeigen vor allem eines: die signifikanten Unterschiede in der Beurteilung von Armut und Armutstrends die durch die verschiedenen Indices versursacht werden und den hohen Mehrwert den die Operationalisierung des Capability Approachs darstellt

The future of sovereignty in multilevel governance Europe: a constructivist reading

Multilevel governance presents a depiction of contemporary structures in EU Europe as consisting of overlapping authorities and competing competencies. By focusing on emerging non-anarchical structures in the international system, hence moving beyond the conventional hierarchy/anarchy dichotomy to distinguish domestic and international arenas, this seems a radical transformation of the familiar Westphalian system and to undermine state sovereignty. Paradoxically, however, the principle of sovereignty proves to be resilient despite its alleged empirical decline. This article argues that social constructivism can explain the paradox, by considering sovereign statehood as a process-dependent institutional fact, and by showing that multilevel governance can feed into this process

Power, norms and institutional change in the European Union: the protection of the free movement of goods

How do institutions of the European Union change? Using an institutionalist approach, this article highlights the interplay between power, cognitive limits, and the normative order that underpins institutional settings and assesses their impact upon the process of institutional change. Empirical evidence from recent attempts to reinforce the protection of the free movement of goods in the EU suggests that, under conditions of uncertainty, actors with ambiguous preferences assess attempts at institutional change on the basis of the historically defined normative order which holds a given institutional structure together. Hence, path dependent and incremental change occurs even when more ambitious and functionally superior proposals are on offer

Integration of CT urography improves diagnostic confidence of 68Ga-PSMA-11 PET/CT in prostate cancer patients

Background: To prove the feasibility of integrating CT urography (CTU) into 68Ga-PSMA-11 PET/CT and to analyze the impact of CTU on assigning focal tracer accumulation in the ureteric space to either ureteric excretion or metastatic disease concerning topographic attribution and diagnostic confidence. Methods: Ten prostate cancer patients who underwent 68Ga-PSMA-11 PET/CT including CTU because of biochemical relapse or known metastatic disease were retrospectively analyzed. CTU consisted of an excretory phase 10 min after injection of 80 mL iodinated contrast material. Ureter opacification at CTU was evaluated using the following score: 0, 0% opacification; 1, < 50%; 2, 50–99%; 3, 100%. Topographic attribution and confidence of topographic attribution of focal tracer accumulation in the ureteric space were separately assessed for 68Ga-PSMA-11 PET/CT without and with CTU. Diagnostic confidence was evaluated using the following score: 0, < 25% confidence; 1, 26–50%; 2, 51–75%; 3, 76–100%. Results: At CTU, mean ureter opacification score was 2.6 ± 0.7. At 68Ga-PSMA-11 PET/CT without CTU, mean confidence of topographic attribution of focal tracer accumulation was 2.5 ± 0.7 in total and 2.6 ± 0.7 for metastatic disease. At 68Ga-PSMA-11 PET/CT with CTU, mean confidence of topographic attribution of focal areas of tracer accumulation was significantly higher with 2.9 ± 0.2 in total and 2.7 ± 0.9 for metastatic disease (p < 0.001). In 4 of 34 findings (12%) attribution to either ureteric excretion or metastatic disease was discrepant between 68Ga-PSMA-11 PET/CT without and with CTU (n.s). Conclusions: Integration of CTU into 68Ga-PSMA-11 PET/CT is feasible and increases diagnostic confidence of assigning focal areas of tracer accumulation in the ureteric space to either metastatic disease or ureteric excretion