Rectal Small Cell Carcinoma: A Case Report and Review of the Literature

We present a rare case of small cell carcinoma of the rectum presenting with rectal bleeding and discomfort in a fit 51-year-old gentleman. Our patient was treated with a combination of chemotherapy and radiotherapy and remains alive and free of disease 6 years after diagnosis. Our patient experience and review of the literature is presented highlighting the uncertainties regarding the biological behaviour and management

Pain associated with pressure injury: A qualitative study of community-based, home-dwelling individuals

© 2017 John Wiley & Sons Ltd. Aims: The aim of this study was to provide deep insights into the pain associated with pressure injuries in home-dwelling individuals using narrative accounts. Background: Pressure injuries or pressure ulcers are burdensome and costly. Prevalence data, surveys and systematic reviews demonstrate that pain associated with pressure injury is widespread, but voices of home-dwelling patients have remained largely unheard. Design: Concurrent mixed methods case study of a UK community of approximately 50,000 adults. Methods: Qualitative interviews, conducted in 2016, of 12 home-dwelling adult participants with a current pressure injury (n = 10), or a recently healed pressure injury (n = 2). Findings: Pain had an adverse impact on activities of daily living, mobility and sleep. Participants described days that were clouded in pain; a pain they felt was poorly understood and often out of control. Thematic content analysis revealed two major themes; these are: Poorly controlled pain: “I just want the pain to go away”; and, Uncertainty for the future: “it almost seems insurmountable.”. Conclusion: Findings of our study support the need to develop an appropriate assessment tool for pressure injury patients in the community to enable healthcare professionals and patients to recognize and manage pressure injury-related pain effectively

Health service provision and the use of pressure-redistributing devices: mixed methods study of community dwelling individuals with pressure injuries

© 2017 Informa UK Limited, trading as Taylor & Francis Group. Background: Health care within the home setting is a vital and growing component of pressure injury (PI) prevention and management. Objectives: To describe the use of health services and pressure-redistributing devices in community dwelling patients with PI’s. Design: Mixed-methods collective case study of a defined, diverse geographic postcode area in the United Kingdom. Methods: Quantitative retrospective analysis of electronic and paper medical records of adult PI patients from 2015 district nursing reports. Qualitative semi-structured interviews of community dwelling adult patients receiving, or received, treatment for PI in 2016. Results: Mandatory reports (n = 103) revealed that 90 patients were supplied with a variety of pressure-redistributing devices but only one-third of patients used the equipment as recommended. Qualitative interviews (n = 12), reported to COREQ guidelines, revealed that patients felt reliant on community health services, and were concerned about the consistency of their care. Conclusions: Authentic patient involvement is required to provide care and interventions that are acceptable to PI patients and can be incorporated into self-care strategies and effectively monitored

Developing ecosystem service indicators: experiences and lessons learned from sub-global assessments and other initiatives

People depend upon ecosystems to supply a range of services necessary for their survival and well-being. Ecosystem service indicators are critical for knowing whether or not these essential services are being maintained and used in a sustainable manner, thus enabling policy makers to identify the policies and other interventions needed to better manage them. As a result, ecosystem service indicators are of increasing interest and importance to governmental and inter-governmental processes, including amongst others the Convention on Biological Diversity (CBD) and the Aichi Targets contained within its strategic plan for 2011-2020, as well as the emerging Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES). Despite this growing demand, assessing ecosystem service status and trends and developing robust indicators is o!en hindered by a lack of information and data, resulting in few available indicators. In response, the United Nations Environment Programme World Conservation Monitoring Centre (UNEP-WCMC), together with a wide range of international partners and supported by the Swedish International Biodiversity Programme (SwedBio)*, undertook a project to take stock of the key lessons that have been learnt in developing and using ecosystem service indicators in a range of assessment contexts. The project examined the methodologies, metrics and data sources employed in delivering ecosystem service indicators, so as to inform future indicator development. This report presents the principal results of this project

A novel causal mechanism for grey squirrel bark stripping: The Calcium Hypothesis

AbstractGrey squirrels, Sciurus carolinensis, damage trees in the UK by stripping bark and eating the underlying phloem; squirrel motivation for damage is, however, unknown. Damage can result in deterioration of timber quality and a significant economic toll on the forestry industry. Prediction of severe damage followed by targeted killing of squirrels is the current recommended management option. However, the use of warfarin (an anticoagulant poison) is now restricted in the UK and other more humane methods of killing are labour-intensive, so an alternative solution is needed. A better understanding of what motivates grey squirrels to strip bark may enable a preventive approach to be developed. Whilst the bark stripping literature has explored predictive factors affecting the likelihood of damage, causal understanding is lacking. The aim of this review is to introduce the Calcium Hypothesis as a possible explanation for bark stripping, with a view to informing the prevention of damage. The Calcium Hypothesis states that grey squirrels damage trees to ameliorate a calcium deficiency. The main predictive factors of bark stripping behaviour each inform and lend support to the Calcium Hypothesis. Calcium is stored in tree phloem, and damage increases with phloem width, providing squirrels with more calcium per unit area ingested. Calcium levels increase in trees as active growth resumes after winter dormancy, this occurs immediately prior to the main bark stripping season of May–July, and trees growing most vigorously are at increased risk of damage. It is likely grey squirrels also have a requirement for calcium during the bark stripping season. Adult females will be under post-parturition pressures such as lactation, and juveniles will be going through their main period of bone growth, both of which likely represent a requirement for calcium – which supports an observed positive correlation between juvenile abundance and bark stripping. A high autumnal seed crop increases juvenile recruitment the following spring, and could also induce a requirement for calcium to a population due to the high phosphorus to calcium ratio of seeds. To further investigate the hypothesis, the extent to which grey squirrels can utilise calcium oxalate, as calcium occurs in bark, should be determined, and also the extent to which grey squirrels undergo seasonal periods of calcium deficiency. Increasing our causal understanding of bark stripping could inform the future development of preventive measures to aid forest management

Amylase α-2A Autoantibodies: Novel Marker of Autoimmune Pancreatitis and Fulminant Type 1 Diabetes

OBJECTIVE— The pathogenesis of autoimmune pancreatitis (AIP) and fulminant type 1 diabetes remains unclear, although it is known that immune-mediated processes severely compromise the endocrine and exocrine functions in both diseases

Overexpression of CALNUC (Nucleobindin) Increases Agonist and Thapsigargin Releasable Ca2+ Storage in the Golgi

We previously demonstrated that CALNUC, a Ca2+-binding protein with two EF-hands, is the major Ca2+-binding protein in the Golgi by 45Ca2+ overlay (Lin, P., H. Le-Niculescu, R. Hofmeister, J.M. McCaffery, M. Jin, H. Henneman, T. McQuistan, L. De Vries, and M. Farquhar. 1998. J. Cell Biol. 141:1515–1527). In this study we investigated CALNUC's properties and the Golgi Ca2+ storage pool in vivo. CALNUC was found to be a highly abundant Golgi protein (3.8 μg CALNUC/mg Golgi protein, 2.5 × 105 CALNUC molecules/NRK cell) and to have a single high affinity, low capacity Ca2+-binding site (Kd = 6.6 μM, binding capacity = 1.1 μmol Ca2+/μmol CALNUC). 45Ca2+ storage was increased by 2.5- and 3-fold, respectively, in HeLa cells transiently overexpressing CALNUC-GFP and in EcR-CHO cells stably overexpressing CALNUC. Deletion of the first EF-hand α helix from CALNUC completely abolished its Ca2+-binding capability. CALNUC was correctly targeted to the Golgi in transfected cells as it colocalized and cosedimented with the Golgi marker, α-mannosidase II (Man II). Approximately 70% of the 45Ca2+ taken up by HeLa and CHO cells overexpressing CALNUC was released by treatment with thapsigargin, a sarcoplasmic/endoplasmic reticulum calcium ATPase (SERCA) (Ca2+ pump) blocker. Stimulation of transfected cells with the agonist ATP or IP3 alone (permeabilized cells) also resulted in a significant increase in Ca2+ release from Golgi stores. By immunofluorescence, the IP3 receptor type 1 (IP3R-1) was distributed over the endoplasmic reticulum and codistributed with CALNUC in the Golgi. These results provide direct evidence that CALNUC binds Ca2+ in vivo and together with SERCA and IP3R is involved in establishment of the agonist-mobilizable Golgi Ca2+ store