Angioleiomyoma of the small intestine – a rare cause of gastrointestinal bleeding

<p>Abstract</p> <p>Background</p> <p>Benign tumors are a rare cause of gastrointestinal hemorrhage of which angioleiomyomas constitute a very small minority. They have been reported in literature to present with volvulus, bleeding or intussusceptions.</p> <p>Case presentation</p> <p>An interesting case of a patient presenting with gastrointestinal bleeding from an underlying angioleiomyoma is discussed along with its management options.</p> <p>Conclusion</p> <p>Angioleiomyoma though rare can be managed successfully by surgical and/or minimally invasive endovascular procedures.</p

Man and the Last Great Wilderness: Human Impact on the Deep Sea

The deep sea, the largest ecosystem on Earth and one of the least studied, harbours high biodiversity and provides a wealth of resources. Although humans have used the oceans for millennia, technological developments now allow exploitation of fisheries resources, hydrocarbons and minerals below 2000 m depth. The remoteness of the deep seafloor has promoted the disposal of residues and litter. Ocean acidification and climate change now bring a new dimension of global effects. Thus the challenges facing the deep sea are large and accelerating, providing a new imperative for the science community, industry and national and international organizations to work together to develop successful exploitation management and conservation of the deep-sea ecosystem. This paper provides scientific expert judgement and a semi-quantitative analysis of past, present and future impacts of human-related activities on global deep-sea habitats within three categories: disposal, exploitation and climate change. The analysis is the result of a Census of Marine Life – SYNDEEP workshop (September 2008). A detailed review of known impacts and their effects is provided. The analysis shows how, in recent decades, the most significant anthropogenic activities that affect the deep sea have evolved from mainly disposal (past) to exploitation (present). We predict that from now and into the future, increases in atmospheric CO2 and facets and consequences of climate change will have the most impact on deep-sea habitats and their fauna. Synergies between different anthropogenic pressures and associated effects are discussed, indicating that most synergies are related to increased atmospheric CO2 and climate change effects. We identify deep-sea ecosystems we believe are at higher risk from human impacts in the near future: benthic communities on sedimentary upper slopes, cold-water corals, canyon benthic communities and seamount pelagic and benthic communities. We finalise this review with a short discussion on protection and management methods

Abstracts from the NIHR INVOLVE Conference 2017

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Chemisorbed Oxygen at Pt(111): a DFT Study of Structural and Electronic Surface Properties

Simulations based on density functional theory are used to study the electronic and electrostatic properties of a Pt(111) surface covered by a layer of chemisorbed atomic oxygen. The impact of the oxygen surface coverage and orientationally ordered interfacial water layers is explored. The oxygen adsorption energy decreases as a function of oxygen coverage due to the lateral adsorbate repulsion. The surficial dipole moment density induced by the layer of chemisorbed oxygen causes a positive shift of the work function. In simulations with interfacial water layers, ordering and orientation of water molecules strongly affect the work function. It is found that the surficial dipole moment density and charge density are roughly linearly dependent on the oxygen surface coverage. Moreover, we found that water layers exert only a small impact on the surface charging behavior of the surface

Atlas des commençants, renfermant 11 cartes... avec texte en regard, à l'usage des classes les plus élémentaires, servant d'introduction au Nouvel atlas classique du même auteur, 2e édition, par L. Vat

Avec mode text

Targeted dorsal root entry zone stimulation alleviates pain due to meralgia paresthetica.

Objective.Meralgia paresthetica (MP) is a mononeuropathy of the exclusively sensory lateral femoral cutaneous nerve (LFCN) that is difficult to treat with conservative treatments. Afferents from the LFCN enter the spinal cord through the dorsal root entry zones (DREZs) innervating L2 and L3 spinal segments. We previously showed that epidural electrical stimulation of the spinal cord can be configured to steer electrical currents laterally in order to target afferents within individual DREZs. Therefore, we hypothesized that this neuromodulation strategy is suitable to target the L2 and L3 DREZs that convey afferents from the painful territory, and thus alleviates MP related pain.Approach.A patient in her mid-30s presented with a four year history of dysesthesia and burning pain in the anterolateral aspect of the left thigh due to MP that was refractory to medical treatments. We combined neuroimaging and intraoperative neuromonitoring to guide the surgical placement of a paddle lead over the left DREZs innervating L2 and L3 spinal segments.Main results.Optimized electrode configurations targeting the left L2 and L3 DREZs mediated immediate and sustained alleviation of pain. The patient ceased all other medical management, reported improved quality of life, and resumed recreational physical activities.Significance.We introduced a new treatment option to alleviate pain due to MP, and demonstrated how neuromodulation strategies targeting specific DREZs is effective to reduce pain confined to specific regions of the body while avoiding disconfort

Onderzoek naar de overdracht van patiëntinformatie tussen ziekenhuizen en VVT.

Jaarlijks worden 300.000 kwetsbare ouderen opgenomen in het ziekenhuis. Er zijn echter weinig standaarden voor de informatieoverdracht tussen ziekenhuis en instellingen voor ouderenzorg. De meeste standaarden bestaan tussen huisartsen en ziekenhuizen terwijl er bijvoorbeeld nauwelijks standaarden zijn voor overdracht van en naar de thuiszorg. In de Staat van de Gezondheidszorg 2011 pleitte de Inspectie voor de Gezondheidszorg (IGZ) al voor meer aandacht voor informatieoverdracht. Overdracht van informatie over patiënten is cruciaal voor goede zorg. Zeker voor kwetsbare groepen zoals ouderen met verschillende ziektes die veel zorg krijgen. Deze ouderen krijgen bijvoorbeeld thuiszorg, gaan naar de dagopvang, de huisarts schrijft medicijnen voor, de internist schrijft nieuwe medicijnen voor en de thuiszorg verstrekt deze medicijnen en verzorgt bijvoorbeeld operatiewonden. Het is dus belangrijk dat de informatie tussen de verschillende zorgverleners correct, compleet en tijdig wordt overgedragen. De Inspectie voor de Gezondheidszorg wil dat veldpartijen de informatieoverdracht goed en eenduidig gaan regelen. Weinig standaarden Het NIVEL (Nederlands instituut voor onderzoek van de gezondheidszorg) heeft met Vilans, EMGO+ VUmc en Kiwa Prismant voor de inspectie onderzocht hoe het ervoor staat met de standaarden over informatieoverdracht. Deze blijken nauwelijks te bestaan tussen ziekenhuis en verpleeg- en verzorgingshuizen en thuiszorg. Voor de weinige standaarden die er wel zijn, is het de vraag of alle relevante zorgverleners daarin betrokken zijn. Zo worden specialisten ouderengeneeskunde nauwelijks genoemd, terwijl zij een cruciale rol spelen in de zorg voor ouderen in verpleeghuizen. Patiëntendossiers die door meerdere partijen kunnen worden ingezien zijn een zeldzaamheid. Totaalbeeld Artsen en verpleegkundigen blijken weinig informatie naar elkaar over te dragen. “De informatieoverdracht tussen artsen onderling en verpleegkundigen onderling blijkt beter op orde dan tussen artsen en verpleegkundigen”, zegt NIVEL-onderzoeker Carolien de Blok, “terwijl alle betrokken zorgverleners eigenlijk een totaalbeeld moeten hebben van een patiënt. Het is dus goed als de IGZ de ontwikkeling van een standaard voor de gehele zorgketen stimuleert.” Regionale initiatieven De onderzoekers zochten in de literatuur naar breed gedragen standaarden. Die zijn er nauwelijks, maar er blijken wel regionale initiatieven te zijn – veelal met behulp van ICT – om de lokale informatieoverdracht op orde te krijgen. Bijvoorbeeld in Eindhoven, Amsterdam en Den Haag. Carolien de Blok: “Zeker gezien de groeiende groep ouderen is het belangrijk dat het veld ook zelf initiatief neemt om de informatieoverdracht te verbeteren. Hierin kunnen instellingen van bestaande initiatieven leren waardoor uiteindelijk alle ouderen in Nederland daarvan profiteren.

Mycobacterium tuberculosis lineages and anti-tuberculosis drug resistance in reference hospitals across Viet Nam.

Background Mycobacterium tuberculosis, the tuberculosis (TB) pathogen, despite a low level of genetic diversity, has revealed a high variety of biological and epidemiological characteristics linked to their lineages, such as transmissibility, fitness and propensity to acquire drug resistance. This has important implications for the epidemiology of TB. We conducted this first countrywide cross-sectional study to identify the prevalent M. tuberculosis lineages and to assess their epidemiological associations and their relation to drug resistance. The study was conducted among isolates acquired in reference hospitals across Vietnam. Isolates with drug susceptibility testing profiles were identified for their lineages by spoligotyping. Logistic regression was used to investigate the association of M. tuberculosis lineages with location, age and sex of the patients and drug resistance levels. Results Results showed that the most prevalent lineage was Beijing (55.4 %), followed by EAI (27.5 %), T (6.4 %), LAM (1.3 %), Haarlem (1 %) and Zero type (0.3 %). The proportion of Beijing isolates in the North (70.4 %) and the South (68 %) was higher than in the Centre (28 %) (OR = 1.7 [95 % CI: 1.4–2.0], p < 0.0001), whereas the proportion of EAI isolates in the North (7.1 %) and the South (17 %) was much lower compared with the Centre (59 %) (OR = 0.5 [95 % CI: 0.4–0.6], p < 0.0001). Overall, Beijing isolates were the most likely to be drug-resistant and EAI isolates were the least likely to be drug-resistant, except in the South of Vietnam where EAI is also highly drug-resistant. The proportion of Beijing isolates was significantly higher (p < 0.01), and the proportion of EAI isolates was significantly lower (p < 0.05) in younger patients. The proportion of drug-resistance was higher in isolates collected from male patients and from patients in the middle age groups. Conclusions The findings suggest ongoing replacement of EAI lineage, which is mainly more drug-susceptible with highly drug-resistant Beijing lineage in all studied regions of Vietnam. Male patients of working ages should be the focus for better control to prevent the emergence of drug-resistant TB