Replantation of Nine Fingers in a Patient: A case report

Amputation of multiple fingers of both hands is a rare and serious injury. We report a case of a 41-year-old male patient who presented to Khoula Hospital, Muscat, Oman, in 2015 with the amputation of nine fingers due to a workplace injury. With two teams working in tandem, all the amputated fingers were re-attached. A total of seven fingers survived and the patient regained reasonable functionality of his hands. To the best of the authors’ knowledge, this is the first case of several finger amputations in Oman.Keywords: Fingers; Traumatic Amputation; Crush Injuries; Replantation; Case Report; Oman

Identification of Co-Existing Mutations and Gene Expression Trends Associated With K13-Mediated Artemisinin Resistance in Plasmodium falciparum

Plasmodium falciparum infects millions and kills thousands of people annually the world over. With the emergence of artemisinin and/or multidrug resistant strains of the pathogen, it has become even more challenging to control and eliminate the disease. Multiomics studies of the parasite have started to provide a glimpse into the confounding genetics and mechanisms of artemisinin resistance and identified mutations in Kelch13 (K13) as a molecular marker of resistance. Over the years, thousands of genomes and transcriptomes of artemisinin-resistant/sensitive isolates have been documented, supplementing the search for new genes/pathways to target artemisinin-resistant isolates. This meta-analysis seeks to recap the genetic landscape and the transcriptional deregulation that demarcate artemisinin resistance in the field. To explore the genetic territory of artemisinin resistance, we use genomic single-nucleotide polymorphism (SNP) datasets from 2,517 isolates from 15 countries from the MalariaGEN Network (The Pf3K project, pilot data release 4, 2015) to dissect the prevalence, geographical distribution, and co-existing patterns of genetic markers associated with/enabling artemisinin resistance. We have identified several mutations which co-exist with the established markers of artemisinin resistance. Interestingly, K13-resistant parasites harbor α-ß hydrolase and putative HECT domain–containing protein genes with the maximum number of SNPs. We have also explored the multiple, publicly available transcriptomic datasets to identify genes from key biological pathways whose consistent deregulation may be contributing to the biology of resistant parasites. Surprisingly, glycolytic and pentose phosphate pathways were consistently downregulated in artemisinin-resistant parasites. Thus, this meta-analysis highlights the genetic and transcriptomic features of resistant parasites to propel further exploratory studies in the community to tackle artemisinin resistance.</p

Modern cemented Furlong hemiarthroplasty: Are dislocations rates better?

BACKGROUND: Dislocation following hip hemiarthroplasty is a major complication with increased mortality and morbidity. Data looking at dislocation following contemporary bipolar stems are lacking in literature. METHODS: Retrospective review of our prospective national hip fracture database over a two-year period. Group 1 comprised of consecutive patients receiving bipolar Furlong prosthesis (N222) while Group 2 was made up of a historical cohort (uncemented; N254). Clinical and radiological records were reviewed to determine dislocation rates, causes and associative factors of dislocations. Data were analysed using SPSS. RESULTS: Following 476 hemiarthroplasties performed during the study period, 12 (2.5%) dislocations were reported (eight in Group 1; four in Group 2). There was no significant difference in dislocation rates (3.6% vs 1.6%) between groups (p = 0.159). Subgroup analysis of Group 1 demonstrated a significant difference in dislocations with Furlong cemented (6%) as compared with Furlong uncemented (0%) hemiarthroplasties (p = 0.024). Following dislocation, death rates increased to 8.3% from 1.7% in both groups. CONCLUSION: There is a statistically significant increase in dislocation rate following use of cemented Furlong prosthesis when compared to similar uncemented prosthesis at the same treatment period. However, when compared to traditional uncemented prosthesis, there is no difference in dislocation rates

Physiology of long pranayamic breathing: Neural respiratory elements may provide a mechanism that explains how slow deep breathing shifts the autonomic nervous system

Pranayamic breathing, defined as a manipulation of breath movement, has been shown to contribute to a physiologic response characterized by the presence of decreased oxygen consumption, decreased heart rate, and decreased blood pressure, as well as increased theta wave amplitude in EEG recordings, increased parasympathetic activity accompanied by the experience of alertness and reinvigoration. The mechanism of how pranayamic breathing interacts with the nervous system affecting metabolism and autonomic functions remains to be clearly understood. It is our hypothesis that voluntary slow deep breathing functionally resets the autonomic nervous system through stretchinduced inhibitory signals and hyperpolarization currents propagated through both neural and non-neural tissue which synchronizes neural elements in the heart, lungs, limbic system and cortex. During inspiration, stretching of lung tissue produces inhibitory signals by action of slowly adapting stretch receptors (SARs) and hyperpolarization current by action of fibroblasts. Both inhibitory impulses and hyperpolarization current are known to synchronize neural elements leading to the modulation of the nervous system and decreased metabolic activity indicative of the parasympathetic state. In this paper we propose pranayama’s physiologic mechanism through a cellular and systems level perspective,involving both neural and non-neural elements. This theoretical description describes a common physiological mechanism underlying pranayama and elucidate the role of the respiratory and cardiovascular system on modulating the autonomic nervous system. Along with facilitating the design of clinical breathing techniques for the treatment of autonomic nervous system and other disorders, this model will also validate pranayama as a topic requiring more research

Strategic innovation through outsourcing:the role of relational and contractual governance

There is growing evidence that client firms expect outsourcing suppliers to transform their business. Indeed, most outsourcing suppliers have delivered IT operational and business process innovation to client firms; however, achieving strategic innovation through outsourcing has been perceived to be far more challenging. Building on the growing interest in the IS outsourcing literature, this paper seeks to advance our understanding of the role that relational and contractual governance plays in achieving strategic innovation through outsourcing. We hypothesized and tested empirically the relationship between the quality of client-supplier relationships and the likelihood of achieving strategic innovation, and the interaction effect of different contract types, such as fixed-price, time and materials, partnership and their combinations. Results from a pan-European survey of 248 large firms suggest that high-quality relationships between clients and suppliers may indeed help achieve strategic innovation through outsourcing. However, within the spectrum of various outsourcing contracts, only the partnership contract, when included in the client contract portfolio alongside either fixed-price, time and materials or their combination, presents a significant positive effect on relational governance and is likely to strengthen the positive effect of the quality of client-supplier relationships on strategic innovation

HI in NGC 5433 and its Environment: High-Latitude Emission in a Small Galaxy Group

We present HI synthesis maps of the edge-on starburst NGC 5433 and its environment, obtained with the VLA in its C and D configurations. The observations and spectral model residuals of the main disc emission in NGC 5433 reveal 3 extraplanar features. We associate 2 of these features with coherent extraplanar extensions across multiple spectral channels in our data, including a complete loop in position-velocity space. Interpreting the latter as an expanding shell we derive a corresponding input energy of 2 x 10^54 ergs, comparable to that for the largest supershells found in the Galaxy and those in other edge-on systems. NGC 5433 is in a richer environment than previously thought. We confirm that KUG 1359+326 is a physical companion to NGC 5433 and find two new faint companions, both with Minnesota Automated Plate Scanner identifications, that we label SIS-1 and SIS-2. Including the more distant IC 4357, NGC 5433 is the dominant member of a group of at least 5 galaxies, spanning over 750 kpc in a filamentary structure. A variety of evidence suggests that interactions are occurring in this group. While a number of underlying mechanisms are consistent with the morphology of the high-latitude features in NGC 5433, we argue that environmental effects may play a role in their generation.Comment: 18 pages including 10 figures. Accepted for publication in MNRAS. For higher resolution Fig. 1, see http://www.astro.cornell.edu/~spekkens/papers/ v2: Proof-corrected cop

Exceptional AGN-driven turbulence inhibits star formation in the 3C 326N radio galaxy

We detect bright [CII]158μm line emission from the radio galaxy 3C 326N at z=0.09, which shows weak star formation (SFR⊙~yr−1) despite having strong H2 line emission and 2×109M⊙ of molecular gas. The [CII] line is twice as strong as the 0-0S(1) 17μm H2 line, and both lines are much in excess what is expected from UV heating. We combine infrared Spitzer and Herschel data with gas and dust modeling to infer the gas physical conditions. The [CII] line traces 30 to 50% of the molecular gas mass, which is warm (70−3. The [CII] line is broad with a blue-shifted wing, and likely to be shaped by a combination of rotation, outflowing gas, and turbulence. It matches the near-infrared H2 and the Na D optical absorption lines. If the wing is interpreted as an outflow, the mass loss rate would be larger than 20M⊙/yr, and the depletion timescale shorter than the orbital timescale (108yr). These outflow rates may be over-estimated because the stochastic injection of turbulence on galactic scales can contribute to the skewness of the line profile and mimic outflowing gas. We argue that the dissipation of turbulence is the main heating process of this gas. Cosmic rays can also contribute to the heating but they require an average gas density larger than the observational constraints. We show that strong turbulent support maintains a high gas vertical scale height (0.3-4kpc) in the disk and can inhibit the formation of gravitationally-bound structures at all scales, offering a natural explanation for the weakness of star formation in 3C 326N. To conclude, the bright [CII] line indicates that strong AGN jet-driven turbulence may play a key role in enhancing the amount of molecular gas (positive feedback) but yet can prevent star formation on galactic scales (negative feedback)

Gestion del conocimiento y orientacion al marketing interno en el desarrollo de ventajas competitivas en el sector hotelero

Internal marketing orientation (IMO) can be used as a tool for managing employees’ knowledge that allows companies to develop a competitive advantage to the extent that generates information, communicates it internally and facilitates to articulate a response to their needs. IMO through proper management of human capital facilitates more effective competition and a more agile response to market demands. This study analyzes the three dimensions that make up IMO and involve knowledge management with regard to gathering intelligence concerning employees’ needs, the transmission of these needs and the subsequent response. Then, an empirical research has been carried out to analyze the IMO in Spanish hotels and it had led to the classification of three clearly defined groups. Moreover, the results indicate IMO as a source of competitive advantage as higher levels of job satisfaction and organizational commitment are found in the groups with higher IMO

Influence of organic molecules on the aggregation of TiO2 nanoparticles in acidic conditions

Engineered nanoparticles released into the environment may interact with natural organic matter (NOM). Surface complexation affects the surface potential, which in turn may lead to aggregation of the particles. Aggregation of synthetic TiO2 (anatase) nanoparticles in aqueous suspension was investigated at pH 2.8 as a function of time in the presence of various organic molecules and Suwannee River fulvic acid (SRFA), using dynamic light scattering (DLS) and high-resolution transmission electron microscopy (TEM). Results showed that the average hydrodynamic diameter and ?-potential were dependent on both concentration and molecular structure of the organic molecule. Results were also compared with those of quantitative batch adsorption experiments. Further, a time study of the aggregation of TiO2 nanoparticles in the presence of 2,3-dihydroxybenzoic acid (2,3-DHBA) and SRFA, respectively, was performed in order to observe changes in ?-potential and particle size over a time period of 9 months. In the 2,3-DHBA-TiO2 system, ?-potentials decreased with time resulting in charge neutralization and/or inversion depending on ligand concentration. Aggregate sizes increased initially to the micrometer size range, followed by disaggregation after several months. No or very little interaction between SRFA and TiO2 occurred at the lowest concentrations tested. However, at the higher concentrations of SRFA, there was an increase in both aggregate size and the amount of SRFA adsorbed to the TiO2 surface. This was in correlation with the ?-potential that decreased with increased SRFA concentration, leading to destabilization of the system. These results stress the importance of performing studies over both short and long time periods to better understand and predict the long-term effects of nanoparticles in the environment

Parental diet, pregnancy outcomes and offspring health:metabolic determinants in developing oocytes and embryos

The periconceptional period, embracing the terminal stages of oocyte growth and post-fertilisation development up to implantation, is sensitive to parental nutrition. Deficiencies or excesses in a range of macro- and micronutrients during this period can lead to impairments in fertility, fetal development and long-term offspring health. Obesity and genotype-related differences in regional adiposity are associated with impaired liver function and insulin resistance, and contribute to fatty acid-mediated impairments in sperm viability and oocyte and embryo quality, all of which are associated with endoplasmic reticulum stress and compromised fertility. Disturbances to maternal protein metabolism can elevate ammonium concentrations in reproductive tissues and disturb embryo and fetal development. Associated with this are disturbances to one-carbon metabolism, which can lead to epigenetic modifications to DNA and associated proteins in offspring that are both insulin resistant and hypertensive. Many enzymes involved in epigenetic gene regulation use metabolic cosubstrates (e.g. acetyl CoA and S-adenosyl methionine) to modify DNA and associated proteins, and so act as 'metabolic sensors' providing a link between parental nutritional status and gene regulation. Separate to their genomic contribution, spermatozoa can also influence embryo development via direct interactions with the egg and by seminal plasma components that act on oviductal and uterine tissues