Laryngeal spasm after general anaesthesia due to Ascaris Lumbricoides

Postoperative upper airway obstruction during recovery from general anaesthesia may have several causes. This is a report of a young girl who developed laryngeal spasm as a result of an ectopic roundworm Ascaris lumbricoides

Biopsy vs. Extensive Resection for First Recurrence of Glioblastoma: Is a Prospective Clinical Trial Warranted?

Background: Glioblastoma is an aggressive and almost universally fatal tumor. The prognosis at the time of recurrence has generally been poor, with overall survival typically in the range of 4-40 weeks. The merits of surgical resection (vs. open biopsy, to confirm recurrence via histology) in addition to conventional adjuvant chemotherapy have been the subject of longstanding debate. We wondered whether it would possible to conduct a trial at our institution to settle this question definitively with Class I evidence. Results: Initially, we had hoped to conduct a randomized, unblinded prospective clinical trial. However on closer inspection it appeared that such an undertaking would pose significant practical challenges. Thus we present our protocol in draft form. In keeping with recommended outcomes for these tumors, the primary endpoint would be median progression free survival. Secondary end points would be: median overall survival (mOS, from time of recurrence) and change in Karnofsky Performance Status over time. Patients would be eligible at the time of first recurrence if they had received conventional treatment until that point and at least 1 month had elapsed since the time of radiation. All patients would be considered potentially eligible for enrollment (unless the decision regarding resection was already clear-cut in view of other factors). Using Cox\u27s proportional hazards model, we estimate that at least 456 patients would be necessary to demonstrate an increase in the hazard ratio to 1.3 for those undergoing biopsy alone. This magnitude of benefit is estimated based on a review of retrospective studies. Discussion: If restricted to our Institution alone, which sees approximately 100-150 new cases of glioblastoma each year, a trial of this nature would be likely to take around 10 years. Furthermore, there may be significant reluctance on the part of patients and physicians to participate. There is also the opportunity cost of excluding patients from other trials to consider. We recognize that the estimate of the magnitude of effect may be conservative. As things stand, we feel that multi-institutional collaboration would almost certainly be required for an undertaking of this kind

Mechanical Design and Fabrication of Rotating Test Stand for Supersonic Wind Tunnel

This research project focuses on the design and manufacturing of a rotating test stand for the Cal Poly Supersonic Wind Tunnel (SSWT). In order to establish essential design parameters, the project employs compressible flow isentropic relationships to calculate the Mach number within the test section and determine static pressures. This comprehensive effort integrates preliminary design and manufacturing processes, utilizing CAD designs and a range of machinery for component fabrication, while also highlighting initial testing of the rotating test stand\u27s ability to withstand predicted aerodynamic loads. As part of the research\u27s future work, rigorous structural stability testing and the implementation of flow visualization techniques, such as shadowgraph imaging, are planned to validate the design and optimize aerodynamic performance. The project aims to not only advance our understanding of aerodynamics but also offer valuable educational opportunities for undergraduate students

Low levels of endogenous or X-ray-induced DNA double-strand breaks activate apoptosis in adult neural stem cells

The embryonic neural stem cell compartment is characterised by rapid proliferation from embryonic day (E)11 to E16.5, high endogenous DNA double-strand break (DSB) formation and sensitive activation of apoptosis. Here, we ask whether DSBs arise in the adult neural stem cell compartments, the sub-ventricular zone (SVZ) of the lateral ventricles and the sub-granular zone (SGZ) of the hippocampal dentate gyrus, and whether they activate apoptosis. We used mice with a hypomorphic mutation in DNA ligase IV (Lig4Y288C), ataxia telangiectasia mutated (Atm−/−) and double mutant Atm−/−/Lig4Y288C mice. We demonstrate that, although DSBs do not arise at a high frequency in adult neural stem cells, the low numbers of DSBs that persist endogenously in Lig4Y288C mice or that are induced by low radiation doses can activate apoptosis. A temporal analysis shows that DSB levels in Lig4Y288C mice diminish gradually from the embryo to a steady state level in adult mice. The neonatal SVZ compartment of Lig4Y288C mice harbours diminished DSBs compared to its differentiated counterpart, suggesting a process selecting against unfit stem cells. Finally, we reveal high endogenous apoptosis in the developing SVZ of wild-type newborn mice

An approach to the management of patients with residual Cushing’s disease

The evaluation and management of patients with residual Cushing’s disease is one of the more complex issues facing neurosurgeons and neuroendocrinologists in clinical practice. There is considerable controversy over several relevant issues such as the timing of the assessment of whether a patient is in remission, what biochemical parameters define remission, the most appropriate course of action to take after residual disease has been defined, etc. As a consequence of the controversies, treating physicians develop notions and fall into certain practice patterns based on evidence of varying levels, their anecdotal experiences, and information gleaned from scientific meetings. This practice pattern, we believe, constitutes the “art of medicine.” We conducted a PubMed literature search to identify manuscripts containing data relevant to Cushing’s disease, outcomes of various therapeutic modalities, and recurrences. Reference lists were used to identify additional relevant manuscripts. We focused our review on manuscripts that included reasonably large series of patients, those reflecting the experience of pituitary centers and physicians recognized as experts in the field, and those papers felt to represent seminal contributions to the literature. Furthermore, trends in the evaluation and management of relevant patients have been incorporated by the senior author who has seen and evaluated over 750 patients with documented Cushing’s syndrome over the past 18 years in clinical practice. An analysis of current evidence indicated that, despite advances in neurosurgical techniques and recent developments in adjuvant therapies, patients with residual Cushing’s disease present significant management challenges to treating physicians. In this era, however, it is indeed possible to gain control of the hypercortisolism in most patients. Despite the wide variability in research methodology designed to collect relevant data, a step-wise approach to the management of these patients can be achieved. A logical step-wise approach to the evaluation of postoperative patients with Cushing’s disease is essential. Patients with residual disease require the development of an individualized plan of management that takes into account numerous factors pertaining to status of disease, the experience of treating physicians, and available therapeutic modalities

Impacto del branding emocional en la fidelización de los clientes de la microempresa Vital Foods distrito de Trujillo, 2019

La presente investigación fue elaborada con el objetivo de determinar el impacto del branding emocional en la fidelización de los clientes de la microempresa Vital Foods distrito de Trujillo, 2019.El problema formulado fue: ¿De qué manera el branding emocional impacta en la fidelización de los clientes de la microempresa Vital Foods Distrito de Trujillo, 2019? La hipótesis que se planteo fue que El Branding Emocional impacta de manera positiva en la fidelización de los clientes de la microempresa Vital Foods en el distrito de Trujillo, 2019. Así mismo, se consideró una población de 3600 personas con una muestra de 347 clientes de la microempresa. El diseño de investigación empleada fue de tipo explicativo causal de corte transversal. Las técnicas utilizadas fueron la encuesta y la entrevista; mientras que, los instrumentos fueron el cuestionario y la guía de entrevista. Además, se aplicó la prueba estadística Chi-cuadrado para comprobar la hipótesis planteada. Por ello, se llegó a la conclusión que el branding emocional si tiene un impacto positivo en la fidelización de los clientes de la microempresa Vital Foods.The present investigation was prepared with the objective of determining the impact of emotional branding on the loyalty of customers of the Vital Foods microenterprise district of Trujillo, 2019.The problem formulated was: How does emotional branding impact on the loyalty of Vital Foods District Trujillo microenterprise customers, 2019? The hypothesis that was raised was that Emotional Branding positively impacts the loyalty of customers of the Vital Foods microenterprise in the district of Trujillo, 2019. Likewise, a population of 3600 people with a sample of 347 microenterprise customers was considered. The research design used was a causal explanatory type of cross-section. The techniques used were the survey and the interview; while, the instruments were the questionnaire and the interview guide. In addition, the Chi-square statistical test was applied to verify the hypothesis. Therefore, it was concluded that emotional branding does have a positive impact on customer loyalty of the Vital Foods microenterprise.Tesi

Optical-Sectioning Microscopy of Protoporphyrin Ix Fluorescence in Human Gliomas: Standardization and Quantitative Comparison With Histology

Systemic delivery of 5-aminolevulinic acid leads to enhanced fluorescence image contrast in many tumors due to the increased accumulation of protoporphyrin IX (PpIX), a fluorescent porphyrin that is associated with tumor burden and proliferation. The value of PpIX-guided resection of malignant gliomas has been demonstrated in prospective randomized clinical studies in which a twofold greater extent of resection and improved progression-free survival have been observed. In low-grade gliomas and at the diffuse infiltrative margins of all gliomas, PpIX fluorescence is often too weak to be detected with current low-resolution surgical microscopes that are used in operating rooms. However, it has been demonstrated that high-resolution optical-sectioning microscopes are capable of detecting the sparse and punctate accumulations of PpIX that are undetectable via conventional low-power surgical fluorescence microscopes. To standardize the performance of high-resolution optical-sectioning devices for future clinical use, we have developed an imaging phantom and methods to ensure that the imaging of PpIX-expressing brain tissues can be performed reproducibly. Ex vivo imaging studies with a dual-axis confocal microscope demonstrate that these methods enable the acquisition of images from unsectioned human brain tissues that quantitatively and consistently correlate with images of histologically processed tissue sections

d-Psicose Inhibits Intestinal α-Glucosidase and Suppresses the Glycemic Response after Ingestion of Carbohydrates in Rats

d-psicose is one of the rare sugars present in small quantities in commercial carbohydrates and agricultural products. In this study, we investigated the effects of d-psicose on the activities of α-amylases and α-glucosidases in vitro, and evaluated the effects of d-psicose on the in vivo postprandial glycemic response using rats. In the in vitro study, d-psicose potently inhibited the intestinal sucrase and maltase, however, slightly inhibited the intestinal and salivary α-amylase activities. Male Wistar rats (6 months old) were administrated 2 g/kg of sucrose, maltose or soluble starch together with 0.2 g/kg of d-psicose or d-fructose. The d-psicose significantly inhibited the increment of plasma glucose concentration induced by sucrose or maltose. The starch-induced glycemic response tended to be suppressed by d-psicose, however the suppression was not significant. These results suggest that d-psicose inhibits intestinal sucrase and maltase activities and suppresses the plasma glucose increase the normally occurs after sucrose and maltose ingestion. Thus, d-psicose may be useful in preventing postprandial hyperglycemia in diabetic patients when foods containing sucrose and maltose are ingested