Prolonged Hypophosphatemia and Intensive Care After Curative Surgery of Tumor Induced Osteomalacia : A Case Report

Introduction Rare FGF23-producing mesenchymal tumors lead to paraneoplastic tumor-induced osteomalacia (TIO) presenting with phosphate wasting, hypophosphatemia, chronic hypomineralization of the bone, fragility fractures and muscle weakness. Diagnosis of TIO requires exclusion of other etiologies and careful search for a mesenchymal tumor that often is very small and can appear anywhere in the body. Surgical removal of the tumor is the only definitive treatment of TIO. Surgical complications due to chronic hypophosphatemia are not well recognized. Case Description The current case describes severe fragility fractures in a 58-year-old woman, who lost her ability to walk and was bedridden for two years. First, the initial diagnostic laboratory work-up did not include serum phosphorus measurements, second, the suspicion of adverse effects of pioglitazone as an underlying cause delayed correct diagnosis for at least two years. After biochemical discovery of hyperphosphaturic hypophosphatemia at a tertiary referral centre, a FGF23-producing tumor of the mandible was discovered on physical examination, and then surgically removed. Postoperatively, severe hypophosphatemia and muscle weakness prolonged the need for ventilation support, intensive care and phosphate supplementation. After two years of rehabilitation, the patient was able to walk short distances. The tumor has not recurred, and serum phosphate concentration has remained within normal limits during 3.5 years of follow-up. Conclusions The case report illustrates knowledge gaps in the diagnostic work-up of rare causes of low bone mass and fragility fractures. Compared to other low phosphate conditions, surgical recovery from TIO-induced hypophosphatemia warrants special attention. Increased alkaline phosphatase concentration may indicate impaired postsurgical recovery due to prolonged hypophosphatemia, underlining the need for proactive perioperative correction of hypophosphatemia.Peer reviewe

Effective implementation of relationship orientation in new product launches

The critical role of relationships in business performance is widely recognized in the business marketing literature. However, to date, the prevailing new product launch research has concentrated on firms&#39; general customer and competitor focus on predicting launch performance, and mainly applied a product centered or marketing mix perspective on considering effective strategic and tactical launch activities. Consequently, there is only scant knowledge on the relevance of a relational perspective when launching new products. The study contributes to this gap by examining the impact of firms&#39; relationship orientation on launch performance and the key activities through which it is transformed into performance in the new product launch context. A set of hypotheses is developed and tested with data collected from 109 new product launches in pharmaceutical companies. The results show that sales force management and relationship leveraging mediate relationship orientation&#39;s impact on launch performance through complexly intertwined relationships. From a theoretical perspective, this study highlights the role of the relational perspective in new product launch and fosters our understanding on how relationship-focused culture is effectively implemented in practice. From a managerial perspective, the results offer insights on how firms can effectively enhance the successful commercialization of new products through relationship-oriented sales and marketing activities.</p

Impact of Mesh and Fixation on Chronic Inguinal Pain in Lichtenstein Hernia Repair : 5-Year Outcomes from the Finn Mesh Study

Objective To find out the mesh fixation technique that minimises chronic pain in Lichtenstein hernioplasty. Summary background data Mesh fixation may affect chronic pain and recurrence after inguinal hernia surgery, but long-term results of comparative trials are lacking. Methods Lichtenstein hernioplasty was performed under local anaesthesia on 625 patients in day care units. The patients were randomised to receive either a cyanoacrylate glue (n = 216), self-gripping mesh (n = 202) or non-absorbable 3-0 polypropylene sutures (n = 216) for the fixation of mesh. A standardised telephone interview or postal questionnaire was conducted 5 years after the index operation. The patients with complaints suggesting recurrence or chronic pain (visual analogue scale >= 3, 0-10) were examined clinically. The rate of occasional pain, chronic severe pain, recurrence, re-operations, daily use of analgesics, overall patient satisfaction and sensation of a foreign object were recorded. Results A total of 82% of patients (n = 514) completed the 5-year audit including 177, 167 and 170 patients in the glue, self-fixation and suture groups, respectively. There were no significant differences in the incidence of pain (7-8%), operated recurrences (2-4%), overall re-operations (4-5%), need for analgesics (1-2%), patient's satisfaction (93-97%) or in the feeling of a foreign object (11-18%) between the study groups. Conclusion The choice of the mesh or fixation method had no effect on the overall long-term outcome, pain or recurrence of hernia. Less penetrating fixation (glue or self-gripping mesh) is a safe option for the fixation of mesh in Lichtenstein hernia repair.Peer reviewe

Fostering transformational teacher agency in Finnish teacher education

In this article, we studied how well teacher education in Finland is able to answer the changing needs of the contemporary world. More precisely, we focussed on the question of how well an alternative teacher education model guides teacher students’ agency towards a transformational view of the teaching profession, making it possible for schools to enable social change. This question was studied in the framework of critical social pedagogy. The data for this article was collected ethnographically by observing meetings in the Critical Integrative Teacher Education (CITE) programme at the University of Jyväskylä in 2015–2017. The analysis is based on a theoretical background in which we outline two different discourses on the concept of teachers’ agency. The first promotes schools’ role in conservation; teachers are expected to educate obedient and uncritical citizens to maintain steady economic growth. The second discourse is defined as critical and emancipatory, where the education pursues transformation in students’ underlying attitudes and a deeper understanding of education and society. The results showed that the CITE model fosters teacher students’ critical self-reflection and understanding of group phenomena considering education. The students’ ability to understand schools in a social context also develops. However, CITE seems to struggle in transforming the students’ thinking and understanding into actions. According to the data, feelings of inability, cynicism and a lacklustre ability to understand concretely how teachers can have an impact on society through their profession prevent a more complete transformation in the students’ everyday modes of action. A stronger community perspective, collaboration with institutions outside teacher education, the enabling of group-oriented action and the provision of real-life experiences regarding the transformation could better help to develop future teachers’ agency towards transformational views

Factors predicting chronic pain after open inguinal hernia repair : a regression analysis of randomized trial comparing three different meshes with three fixation methods (FinnMesh Study)

Correction: Volume: 22 Issue: 5 Pages: 819-819 DOI: 10.1007/s10029-018-1788-y WOS:000446065400016Chronic pain after inguinal hernioplasty is the foremost side-effect up to 10-30% of patients. Mesh fixation may influence on the incidence of chronic pain after open anterior mesh repairs. Some 625 patients who underwent open anterior mesh repairs were randomized to receive one of the three meshes and fixations: cyanoacrylate glue with low-weight polypropylene mesh (n = 216), non-absorbable sutures with partially absorbable mesh (n = 207) or self-gripping polyesther mesh (n = 202). Factors related to chronic pain (visual analogue scores; VAS ae 30, range 0-100) at 1 year postoperatively were analyzed using logistic regression method. A second analysis using telephone interview and patient records was performed 2 years after the index surgery. At index operation, all patient characteristics were similar in the three study groups. After 1 year, chronic inguinal pain was found in 52 patients and after 2 years in only 16 patients with no difference between the study groups. During 2 years' follow-up, three (0.48%) patients with recurrences and five (0.8%) patients with chronic pain were re-operated. Multivariate regression analysis indicated that only new recurrent hernias and high pain scores at day 7 were predictive factors for longstanding groin pain (p = 0.001). Type of mesh or fixation, gender, pre-operative VAS, age, body mass index or duration of operation did not predict chronic pain. Only the presence of recurrent hernia and early severe pain after index operation seemed to predict longstanding inguinal pain.Peer reviewe

Exploiting Sparse Representations for Robust Analysis of Noisy Complex Video Scenes

Abstract. Recent works have shown that, even with simple low level visual cues, complex behaviors can be extracted automatically from crowded scenes, e.g. those depicting public spaces recorded from video surveillance cameras. However, low level features as optical flow or fore-ground pixels are inherently noisy. In this paper we propose a novel unsupervised learning approach for the analysis of complex scenes which is specifically tailored to cope directly with features ’ noise and uncer-tainty. We formalize the task of extracting activity patterns as a matrix factorization problem, considering as reconstruction function the robust Earth Mover’s Distance. A constraint of sparsity on the computed basis matrix is imposed, filtering out noise and leading to the identification of the most relevant elementary activities in a typical high level behavior. We further derive an alternate optimization approach to solve the pro-posed problem efficiently and we show that it is reduced to a sequence of linear programs. Finally, we propose to use short trajectory snippets to account for object motion information, in alternative to the noisy optical flow vectors used in previous works. Experimental results demonstrate that our method yields similar or superior performance to state-of-the arts approaches.

Contact formulations for analysis of micropolar media with finite continuum beam elements

Microscale beam-like structures are standard components of micromechanical systems in many devices. However, the small dimensionality affects their deformation characteristics and leads to misinterpretations of the results. Presenting such size dependency is possible with advanced continuum descriptions via introducing additional variables compared to the classical one. Hence, the problems where contact occurs require the readjustment of boundary conditions considering these extra parameters. That burdens the already challenging task of contact problem calculations and restricts most demonstration examples to two-dimensional problems and geometrical linearity. The resolution of the imposed restrictions within finite element modeling further emphasizes the usage of advanced media in design and facilitates its application to various problems, which is the aim of this paper. The delivery of that task is as follows. Firstly, we present the kinematics and material descriptions for the micropolar media. The authors propose to use a newly developed continuum-based micropolar beam formulation to avoid an overwhelming computational burden and, at the same time, deal with nonlinear stress–strain relations. Secondly, the work develops a contact approach within the micropolar theory from two-dimensional to three-dimensional elasticity, although the contact is considered frictionless. Finally, it compares two existing contact formulations, including the developed one, for the contact beam problems, using the examples of two collinear sliding beams’ bending.Peer reviewe