Presentation and management outcome of children with intussusception at Tenwek Hospital, Kenya

Background: Intussusception, a common cause of Intestinal obstruction in infants and young children, occurs when one segment of the bowel invaginates into a distal segment. While non-operative reduction has been well described, surgery remains the predominant mode of therapy in many developing countries due to delayed presentation. This study aimed to describe the presentation, management and outcome of children with intussusception at a single institution.Method: A retrospective review of patients aged 16 years and below with intussusception managed at Tenwek hospital from January 2009 through December 2014 was undertaken. Diagnosis was based on the presenting signs, symptoms, physical findings and plain upright or supine abdominal X-rays, and confirmed via ultrasonography, barium enema or at surgery.Results: A total of 45 cases (24 boys, 21 girls) of intussusception were noted, with a mean age of 2.6 years (range 1 month-15 years).  The mean duration between symptom onset and presentation was 4.4 days (range 1-14), and the classic triad (vomiting, bloody mucoid stools and abdominal pain/distension) was noted in 27 (60%) cases. Abdominal ultrasound was diagnostic in 7 of the 11 cases ordered, with the rest diagnosed clinically. Non-operative reduction was undertaken in 4 cases and successful in 3. Surgery was performed in 42 cases with bowel gangrene and perforation noted in 20 (47.6%) and 15 (35.7%) cases respectively.  The main types of intussusception were ileocolic (23, 51.1%), colocolonic (10, 22.2%) and ileoceacal (7, 15.6%). Five (11.1%) mortalities and 4 (8.8%) morbidities were noted at discharge, most commonly being surgical site infection in three cases.Conclusion: Intussusception, in this series, was primarily diagnosed clinically and managed surgically, with a majority of the patients having gangrenous or perforated bowel at laparotomy.Keywords: Intussusception, children, management, outcome, Keny

The balance of power: accretion and feedback in stellar mass black holes

In this review we discuss the population of stellar-mass black holes in our galaxy and beyond, which are the extreme endpoints of massive star evolution. In particular we focus on how we can attempt to balance the available accretion energy with feedback to the environment via radiation, jets and winds, considering also possible contributions to the energy balance from black hole spin and advection. We review quantitatively the methods which are used to estimate these quantities, regardless of the details of the astrophysics close to the black hole. Once these methods have been outlined, we work through an outburst of a black hole X-ray binary system, estimating the flow of mass and energy through the different accretion rates and states. While we focus on feedback from stellar mass black holes in X-ray binary systems, we also consider the applicability of what we have learned to supermassive black holes in active galactic nuclei. As an important control sample we also review the coupling between accretion and feedback in neutron stars, and show that it is very similar to that observed in black holes, which strongly constrains how much of the astrophysics of feedback can be unique to black holes.Comment: To be published in Haardt et al. Astrophysical Black Holes. Lecture Notes in Physics. Springer 201

The role relationship between victim and perpetrator as a predictor of characteristics of intrafamilial sexual abuse

It is hypothesized that the closeness of the relationship between the perpetrator of sexual abuse and the victim will determine the number of instances of sexual abuse, the duration of the sexually abusive relationship, the level of coercion necessary to gain compliance, and how long it takes the victim to tell. Differences for cases where the perpetrator is the victim's father and married to the victim's mother, the victim's stepfather or victim's mother's live-in boyfriend, and the victim's noncustodial father are explored. It is argued that in the first case type, the relationship is the closest, the second case type falls in the middle, and in the third, the relationship is the most distant. Hypotheses regarding number of instances of sexual abuse, its duration, and the delay in telling are supported by the data.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44245/1/10560_2004_Article_BF00755849.pd

Differences in the pattern and regulation of mineral deposition in human cell lines of osteogenic and non-osteogenic origin

Bone marrow-derived mesenchymal stem cells (MSCs) are widely used as a cellular model of bone formation, and can mineralize in vitro in response to osteogenic medium (OM). It is unclear, however, whether this property is specific to cells of mesenchymal origin. We analysed the OM response in 3 non-osteogenic lines, HEK293, HeLa and NTera, compared to MSCs. Whereas HEK293 cells failed to respond to OM conditions, the 2 carcinoma-derived lines NTera and HeLa deposited a calcium phosphate mineral comparable to that present in MSC cultures. However, unlike MSCs, HeLa and NTera cultures did so in the absence of dexamethasone. This discrepancy was confirmed, as bone morphogenetic protein inhibition obliterated the OM response in MSCs but not in HeLa or NTera, indicating that these 2 models can deposit mineral through a mechanism independent of established dexamethasone or bone morphogenetic protein signalling

History of clinical transplantation

How transplantation came to be a clinical discipline can be pieced together by perusing two volumes of reminiscences collected by Paul I. Terasaki in 1991-1992 from many of the persons who were directly involved. One volume was devoted to the discovery of the major histocompatibility complex (MHC), with particular reference to the human leukocyte antigens (HLAs) that are widely used today for tissue matching.1 The other focused on milestones in the development of clinical transplantation.2 All the contributions described in both volumes can be traced back in one way or other to the demonstration in the mid-1940s by Peter Brian Medawar that the rejection of allografts is an immunological phenomenon.3,4 © 2008 Springer New York

Measurement of the View the tt production cross-section using eμ events with b-tagged jets in pp collisions at √s = 13 TeV with the ATLAS detector

This paper describes a measurement of the inclusive top quark pair production cross-section (σtt¯) with a data sample of 3.2 fb−1 of proton–proton collisions at a centre-of-mass energy of √s = 13 TeV, collected in 2015 by the ATLAS detector at the LHC. This measurement uses events with an opposite-charge electron–muon pair in the final state. Jets containing b-quarks are tagged using an algorithm based on track impact parameters and reconstructed secondary vertices. The numbers of events with exactly one and exactly two b-tagged jets are counted and used to determine simultaneously σtt¯ and the efficiency to reconstruct and b-tag a jet from a top quark decay, thereby minimising the associated systematic uncertainties. The cross-section is measured to be: σtt¯ = 818 ± 8 (stat) ± 27 (syst) ± 19 (lumi) ± 12 (beam) pb, where the four uncertainties arise from data statistics, experimental and theoretical systematic effects, the integrated luminosity and the LHC beam energy, giving a total relative uncertainty of 4.4%. The result is consistent with theoretical QCD calculations at next-to-next-to-leading order. A fiducial measurement corresponding to the experimental acceptance of the leptons is also presented

Search for strong gravity in multijet final states produced in pp collisions at √s=13 TeV using the ATLAS detector at the LHC

A search is conducted for new physics in multijet final states using 3.6 inverse femtobarns of data from proton-proton collisions at √s = 13TeV taken at the CERN Large Hadron Collider with the ATLAS detector. Events are selected containing at least three jets with scalar sum of jet transverse momenta (HT) greater than 1TeV. No excess is seen at large HT and limits are presented on new physics: models which produce final states containing at least three jets and having cross sections larger than 1.6 fb with HT > 5.8 TeV are excluded. Limits are also given in terms of new physics models of strong gravity that hypothesize additional space-time dimensions