Are patients willing participants in the new wave of community-based medical education in regional and rural Australia?

Community-based medical education is escalating to meet the increased demand for quality clinical education in expanded settings and patient participation is vital to the sustainability of this endeavour. This study aimed to investigate patients’ views on being used as an educational resource in medical student teaching, and whether they are being under- or over-used

Caudate lobe resections: a single-center experience and evaluation of factors predictive of outcomes

BACKGROUND: Despite the increasing frequency of liver resection for multiple types of disease, caudate lobe resection remains a rare surgical event. The goal of this study is to review our experience and evaluate possible predictors of adverse outcomes in patients undergoing caudate lobectomy. METHODS: We reviewed a 1,900-patient prospective hepato-pancreatico-biliary database from January 2000 to December 2011, identifying 36 hepatectomy patients undergoing caudate lobe resection. Clinicopathologic characteristic and outcome data were compared using chi-square, T-test, ANOVA, Kaplan-Meier, and Cox regression analysis. Primary endpoints were the incidence and severity of complications, and secondary endpoints were blood loss, hospital stay, and transfusion requirements. Patients were also divided in two groups with group A being patients operated on before December 2007 and group B after 2007. We compared the demographics, risk factors, complication rates, and operative details between the two groups. RESULTS: Thirty-six patients underwent caudate lobe resection for cholangiocarcinoma (47.2%), metastatic colorectal cancer (36.1%), hepatocellular carcinoma (8.3%), or benign disease (8.3%). Nine patients (29%) had additional liver resection. Median overall survival (OS) was 21 months. Complications occurred in 52.7% (19/36) of patients with a median grade of 2. Tobacco abuse was associated with an increased risk of operative complications (73.3% vs. 38.9%, p = 0.03). Prior history of cardiac disease was associated with a higher complication rate (87% vs. 42%, p = 0.03). Neoadjuvant chemotherapy, biliary procedures, hepatitis, and prior major abdominal surgery were not predictive of complications. Major complication was also predicted by the volume of RBC transfusion (2.7 vs. 4.1 units, p = 0.003). In our subgroup analysis of the patients undergoing surgery before and after 2007, the two groups were well matched based on age, comorbidities, and risk factors. The complication rates and rates of high-grade complications were similar, but blood loss (600 ml vs. 400 ml, p = 0.03), inflow occlusion time (Pringle time 12.6 vs. 6, p = 0.00), and hospital stay (9.5 vs. 7 days, p = 0.01) were significantly lower in group B. CONCLUSIONS: With appropriate patient selection, caudate lobe resection is an effective component of surgery for hepatic disease. Tobacco use and prior cardiac history increase the risk of complications

Engineering Proteinase Inihibitor Genes For Plant Defense Against Predators

Small proteinaceous inhibitors (Mr\u3c20,000) of the digestive serine proteinases of animals and microorganisms are found as moderately abundant proteins in storage organs and leaves of many plant genera. The proteins are powerful inhibitors of the digestive enzymes of plant predators and therefore are considered to be part of the array of defensive chemicals of plants. Proteinase inhibitor genes show excellent promise, using DNA technology, to manipulate plant genomes to express these biologically active proteins in order to improve natural defense systems. Members of two unrelated families of serine proteinase inhibitors found in tomato and potato plants, called Inhibitor I (monomer Mr 8000) and Inhibitor II (monomer Mr 12,300), are under both environmental and developmental regulation in different tissues of the plants. Genes coding for wound-inducible Inhibitors I and II have been isolated from both tomato and potato genomes and characterized. Tobacco plants have been transformed with the chimeric genes containing wound-inducible promoters fused with the reporter gene, chloramphenicol acetyl transferase, to assess promoter function and signal transmission. Transacting factors that regulate their expression in response to wounding are also being identified and purified. Intact genes are being employed to transform agriculturally important crop plants to determine their potential usefulness to enhance defensive capabilities of plants against herbivores and pathogens

Orientation of Vortices in a Superconducting Thin-Film: Quantitative Comparison of Spin-Polarized Neutron Reflectivity and Magnetization

We present a quantitative comparison of the magnetization measured by spin-polarized neutron reflectivity (SPNR) and DC magnetometry on a 1370 \AA\ -thick Nb superconducting film. As a function of magnetic field applied in the film plane, SPNR exhibits reversible behavior whereas the DC magnetization shows substantial hysteresis. The difference between these measurements is attributed to a rotation of vortex magnetic field out of the film plane as the applied field is reduced. Since SPNR measures only the magnetization parallel to the film plane whereas DC magnetization is strongly influenced by the perpendicular component of magnetization when there is a slight sample tilt, combining the two techniques allows one to distinguish two components of magnetization in a thin film.Comment: 12 pages, 8 figures, It will be printed in PRB, Oct. 200

Srebf1a is a key regulator of transcriptional control for adipogenesis

Adipogenesis is regulated by a complex cascade of transcriptional factors, but little is known about the early events that regulate the adipogenic program. Here, we report the role of the srebf1a gene in the differentiation of fibroblastic 3T3-F442A cells. We found that expression of srebf1a depended on GSK3β activity and that GSK3β activity was necessary for C/EBPβ phosphorylation at Thr188. Knockdown of srebf1a inhibited the adipogenic program because it blocked the expression of genes encoding PPARγ2, C/EBPα, SREBP1c and even FABP4, demonstrating that SREBP1a activation is upstream of these three essential adipogenic transcription factors. Kinetic analysis during differentiation illustrated that the order of expression of adipogenic genes was the following: cebpb, srebf1a, pparg2, cebpa, srebp1c and fabp4. Our data suggest that srebf1a acts as an essential link between the GSK3β-C/EBPβ signaling axis and the beginning of the adipogenic transcriptional cascade

Percutaneous radiofrequency lesions adjacent to the dorsal root ganglion alleviate spasticity and pain in children with cerebral palsy: pilot study in 17 patients

BACKGROUND: Cerebral palsy (CP) may cause severe spasticity, requiring neurosurgical procedures. The most common neurosurgical procedures are continuous infusion of intrathecal baclofen and selective dorsal rhizotomy. Both are invasive and complex procedures. We hypothesized that a percutaneous radiofrequency lesion of the dorsal root ganglion (RF-DRG) could be a simple and safe alternative treatment. We undertook a pilot study to test this hypothesis. METHODS: We performed an RF-DRG procedure in 17 consecutive CP patients with severe hip flexor/adductor spasms accompanied by pain or care-giving difficulties. Six children were systematically evaluated at baseline, and 1 month and 6 months after treatment by means of the Modified Ashworth Scale (MAS), Gross Motor Function Measure (GMFM) and a self-made caregiver's questionnaire. Eleven subsequent children were evaluated using a Visual Analogue Scale (VAS) for spasticity, pain and ease of care. RESULTS: A total of 19 RF-DRG treatments were performed in 17 patients. We found a small improvement in muscle tone measured by MAS, but no effect on the GMFM scale. Despite this, the caregivers of these six treated children unanimously stated that the quality of life of their children had indeed improved after the RF-DRG. In the subsequent 11 children we found improvements in all VAS scores, in a range comparable to the conventional treatment options. CONCLUSION: RF-DRG is a promising new treatment option for severe spasticity in CP patients, and its definitive effectiveness remains to be defined in a randomised controlled trial