One-stage lingual augmented urethroplasty in repair of distal penile hypospadias

AbstractObjectivesTo evaluate the outcome of augmentation of shallow urethral plate by lingual graft in repair of distal penile hypospadias.Patients and methodsBetween June 2008 and May 2011, the procedure was performed on 23 patients with mean age 2.3 years (range 1–3). All patients had distal penile hypospadias; 11 sub coronal and 12 coronal. The urethral plate was less than 8mm in all patients and 3 of them had history of previous hypospadias surgery. All procedures were carried out under general anesthesia using 4× magnifying loupe. After penile degloving and dorsal incision of the urethral plate, the lingual graft was harvested and sutured to the edges of the incised urethral plate from the hypospadias opening to the tip of the penis. The neourethra was closed and an intervening flap was fixed over the neourethra as a barrier against fistula formation.ResultsSuccess rate was 87% as 20/23 patients were cured without any permanent complication throughout the follow up period. None of patients suffered meatal stenosis or required regular urethral dilatation. Three patients developed urethrocutaneous fistula, of which two closed spontaneously and one required surgical repair 6 months later. Two patients had failed procedures and delayed re-intervention was performed due to complete loss of the graft in one of them and repair disruption following infection in the other. Two patients had post-operative pain in the graft harvesting site which disappeared within days.ConclusionThe one-stage lingual augmented urethral plate urethroplasty offers promising outcomes for repair of distal penile hypospadias with narrow urethral plate

Efficacy and safety of azithromycin maintenance therapy in primary ciliary dyskinesia (BESTCILIA): a multicentre, double-blind, randomised, placebo-controlled phase 3 trial.

BACKGROUND Use of maintenance antibiotic therapy with the macrolide azithromycin is increasing in a number of chronic respiratory disorders including primary ciliary dyskinesia (PCD). However, evidence for its efficacy in PCD is lacking. We aimed to determine the efficacy and safety of azithromycin maintenance therapy for 6 months in patients with PCD. METHODS The Better Experimental Screening and Treatment for Primary Ciliary Dyskinesia (BESTCILIA) trial was a multicentre, double-blind, parallel group, randomised, placebo-controlled phase 3 trial done at 6 European PCD clinics (tertiary paediatric care centres and university hospitals in Denmark, Germany, Netherlands, Switzerland, and UK). Patients with a confirmed diagnosis of PCD, aged 7-50 years old, and predicted FEV1 greater than 40% were recruited. Participants were randomly assigned (1:1), stratified by age and study site, via a web-based randomisation system to azithromycin 250 mg or 500 mg as tablets according to bodyweight (</≥ 40 kg) or identical placebo, three times a week for 6 months. The random allocation sequence was a permuted block randomisation, with a block size of four, generated by an external consultancy. Participants, investigators, and care providers were masked to treatment allocation. The primary endpoint was the number of respiratory exacerbations over 6 months. Analysis was by intention to treat. This study is registered in the EU Clinical Trials Register, EudraCT number 2013-004664-58. FINDINGS Between June 24, 2014, and Aug 23, 2016, 102 patients were screened, of whom 90 were randomly assigned to either azithromycin (n=49) or placebo (n=41). The study was ended without having included the planned number of participants due to recruitment difficulties. The mean number of respiratory exacerbations over 6 months was 0·75 (SD 1·12) in the azithromycin group compared with 1·62 (1·64) in the placebo group, and participants receiving azithromycin had significantly lower rate of exacerbations during the individual treatment periods (rate ratio 0·45 [95% CI 0·26-0·78]; p=0·004). Four serious adverse events were reported, occurring in one (2%) of 47 participants in the azithromycin group and in three (7%) of 41 participants in the placebo group. Loose stools or diarrhoea were more common in the azithromycin group than in the placebo group (11 [23%] vs two [5%]). INTERPRETATION This first multinational randomised controlled trial on pharmacotherapy in PCD showed that azithromycin maintenance therapy for 6 months was well tolerated and halved the rate of respiratory exacerbations. Azithromycin maintenance therapy is an option for patients with PCD with frequent exacerbations potentially leading to reduced need for additional antibiotic treatments and preventing irreversible lung damage. FUNDING European Commission Seventh Framework Programme and Children's Lung Foundation (Denmark)

Synthesis of some nucleosides derivatives from L- rhamnose with expected biological activity

Practical procedures for production of variously blocked compounds from L-rhamnose have been developed. These compounds are highly useful as indirect β-L-rhamnosyl donors. This approach represents a new method for the synthesis of aromatic nucleoside analogues and the synthesis of (3S, 4S, 5S, 6R) 3, 4, 5-triacetoxy-2-methyl-7,9-diaza-1-oxa-spiro [4,5]decane-10-one-8-thione (7)

Angiogenesis in urinary bladder carcinoma as defined by microvessel density (MVD) after immunohistochemical staining for Factor VIII and CD31

Background: Among the patients with bladder cancer, a group is still at risk of disease recurrence, progression, and death from their cancer after curative treatment. Angiogenesis is a crucial pathogenic mechanism for this type of urothelial carcinoma and is a potential therapeutic target. Objectives: To quantify tumor angiogenesis in bladder cancer and determine whether it correlates with tumor stage and grade. Patients and methods: A series of 42 archival samples from carcinomas of the urinary bladder were graded, staged, and analyzed for microvessel density (MVD) by a double immunohistochemical technique using Factor VIII (FVIII) and CD31 antibodies. The correlation between MVD and histopathological grade and tumor stage was evaluated. Results: FVIII and CD31 immunoreactivity was observed in 100% of cases and more intensely with CD31. Significantly higher MVD was determined in invasive tumors than in superficial tumors (p&#60;0.05). MVD increased with tumor grade and stage (p&#60;0.05); MVD was not affected by age or sex of the patients. Conclusion: These data demonstrate that MVD in bladder carcinoma correlates with the tumor grade and stage. Quantification of tumor angiogenesis may allow selection of the type of treatment for bladder cancer patients

Direct observation of incommensurate magnetism in Hubbard chains

The interplay between magnetism and doping is at the origin of exotic strongly correlated electronic phases and can lead to novel forms of magnetic ordering. One example is the emergence of incommensurate spin-density waves with a wave vector that does not match the reciprocal lattice. In one dimension this effect is a hallmark of Luttinger liquid theory, which also describes the low energy physics of the Hubbard model. Here we use a quantum simulator based on ultracold fermions in an optical lattice to directly observe such incommensurate spin correlations in doped and spin-imbalanced Hubbard chains using fully spin and density resolved quantum gas microscopy. Doping is found to induce a linear change of the spin-density wave vector in excellent agreement with Luttinger theory predictions. For non-zero polarization we observe a decrease of the wave vector with magnetization as expected from the Heisenberg model in a magnetic field. We trace the microscopic origin of these incommensurate correlations to holes, doublons and excess spins which act as delocalized domain walls for the antiferromagnetic order. Finally, when inducing interchain coupling we observe fundamentally different spin correlations around doublons indicating the formation of a magnetic polaron

Observation of mesoscopic crystalline structures in a two-dimensional Rydberg gas

The ability to control and tune interactions in ultracold atomic gases has paved the way towards the realization of new phases of matter. Whereas experiments have so far achieved a high degree of control over short-ranged interactions, the realization of long-range interactions would open up a whole new realm of many-body physics and has become a central focus of research. Rydberg atoms are very well-suited to achieve this goal, as the van der Waals forces between them are many orders of magnitude larger than for ground state atoms. Consequently, the mere laser excitation of ultracold gases can cause strongly correlated many-body states to emerge directly when atoms are transferred to Rydberg states. A key example are quantum crystals, composed of coherent superpositions of different spatially ordered configurations of collective excitations. Here we report on the direct measurement of strong correlations in a laser excited two-dimensional atomic Mott insulator using high-resolution, in-situ Rydberg atom imaging. The observations reveal the emergence of spatially ordered excitation patterns in the high-density components of the prepared many-body state. They have random orientation, but well defined geometry, forming mesoscopic crystals of collective excitations delocalised throughout the gas. Our experiment demonstrates the potential of Rydberg gases to realise exotic phases of matter, thereby laying the basis for quantum simulations of long-range interacting quantum magnets.Comment: 10 pages, 7 figure

Economic impact of infections and antibiotics

In this chapter, we review several aspects with respect to the burden of infectious diseases, its impact in morbidity and mortality, and its economic burden. Furthermore, we referenced the actual situation with relation to the use of antimicrobial, the resistance problem and misuse of antibiotic, and the economic impact in the health systems

The epidemiological transition in Antananarivo, Madagascar: an assessment based on death registers (1900–2012)

Background: Madagascar today has one of the highest life expectancies in sub-Saharan Africa, despite being among the poorest countries in the continent. There are relatively few detailed accounts of the epidemiological transition in this country due to the lack of a comprehensive death registration system at the national level. However, in Madagascar's capital city, death registration was established around the start of the 20th century and is now considered virtually complete. Objective: We provide an overview of trends in all-cause and cause-specific mortality in Antananarivo to document the timing and pace of the mortality decline and the changes in the cause-of-death structure. Design: Death registers covering the period 1976–2012 were digitized and the population at risk of dying was estimated from available censuses and surveys. Trends for the period 1900–1976 were partly reconstructed from published sources. Results: The crude death rate stagnated around 30‰ until the 1940s in Antananarivo. Mortality declined rapidly after the World War II and then resurged again in the 1980s as a result of the re-emergence of malaria and the collapse of Madagascar's economy. Over the past 30 years, impressive gains in life expectancy have been registered thanks to the unabated decline in child mortality, despite political instability, a lasting economic crisis and the persistence of high rates of chronic malnutrition. Progress in adult survival has been more modest because reductions in infectious diseases and diseases of the respiratory system have been partly offset by increases in cardiovascular diseases, neoplasms, and other diseases, particularly at age 50 years and over. Conclusions: The transition in Antananarivo has been protracted and largely dependent on anti-microbial and anti-parasitic medicine. The capital city now faces a double burden of communicable and non-communicable diseases. The ongoing registration of deaths in the capital generates a unique database to evaluate the performance of the health system and measure intervention impacts

Geometric frustration in compositionally modulated ferroelectrics

Geometric frustration is a broad phenomenon that results from an intrinsic incompatibility between some fundamental interactions and the underlying lattice geometry1-7. Geometric frustration gives rise to new fundamental phenomena and is known to yield intriguing effects, such as the formation of exotic states like spin ice, spin liquids and spin glasses1-7. It has also led to interesting findings of fractional charge quantization and magnetic monopoles5,6. Geometric frustration related mechanisms have been proposed to understand the origins of relaxor behavior in some multiferroics, colossal magnetocapacitive coupling and unusual and novel mechanisms of high Tc superconductivity1-5. Although geometric frustration has been particularly well studied in magnetic systems in the last 20 years or so, its manifestation in the important class formed by ferroelectric materials (that are compounds exhibiting electric rather than magnetic dipoles) is basically unknown. Here, we show, via the use of a first-principles-based technique, that compositionally graded ferroelectrics possess the characteristic "fingerprints" associated with geometric frustration. These systems have a highly degenerate energy surface and exhibit original critical phenomena. They further reveal exotic orderings with novel stripe phases involving complex spatial organization. These stripes display spiral states, topological defects and curvature. Compositionally graded ferroelectrics can thus be considered as the "missing" link that brings ferroelectrics into the broad category of materials able to exhibit geometric frustration. Our ab-initio calculations allow a deep microscopic insight into this novel geometrically frustrated system.Comment: 14 pages, 5 Figures; http://www.nature.com/nature/journal/v470/n7335/full/nature09752.htm

Metabolic control in a nationally representative diabetic elderly sample in Costa Rica: patients at community health centers vs. patients at other health care settings

<p>Abstract</p> <p>Background</p> <p>Costa Rica, like other developing countries, is experiencing an increasing burden of chronic conditions such as diabetes mellitus (DM), especially among its elderly population. This article has two goals: (1) to assess the level of metabolic control among the diabetic population age ≥ 60 years old in Costa Rica, and (2) to test whether diabetic elderly patients of community health centers differ from patients in other health care settings in terms of the level of metabolic control.</p> <p>Methods</p> <p>Data come from the project CRELES, a nationally representative study of people aged 60 and over in Costa Rica. This article analyzes a subsample of 542 participants in CRELES with self-reported diagnosis of diabetes mellitus. Odds ratios of poor levels of metabolic control at different health care settings are computed using logistic regressions.</p> <p>Results</p> <p>Lack of metabolic control among elderly diabetic population in Costa Rica is described as follows: 37% have glycated hemoglobin ≥ 7%; 78% have systolic blood pressure ≥ 130 mmHg; 66% have diastolic blood pressure ≥ 80 mmHg; 48% have triglycerides ≥ 150 mg/dl; 78% have LDL ≥ 100 mg/dl; 70% have HDL ≤ 40 mg/dl. Elevated levels of triglycerides and LDL were higher in patients of community health centers than in patients of other clinical settings. There were no statistical differences in the other metabolic control indicators across health care settings.</p> <p>Conclusion</p> <p>Levels of metabolic control among elderly population with DM in Costa Rica are not that different from those observed in industrialized countries. Elevated levels of triglycerides and LDL at community health centers may indicate problems of dyslipidemia treatment among diabetic patients; these problems are not observed in other health care settings. The Costa Rican health care system should address this problem, given that community health centers constitute a means of democratizing access to primary health care to underserved and poor areas.</p