Antibodies to Milk Antigens in Human Coronary Heart Disease

Milk protein has been implicated as a factor in the development of atherosclerosis. Significantly higher titers of antibodies (P \u3c 0.0002) toward milk antigens were observed in patients suffering from coronary heart disease as compared to age matched controls. These hemagglutination titers were not sex related but may have been related to age. Specificity of the antigen-antibody reaction was demonstrated by a hemagglutination inhibition test. The complement fixation test was evaluated and was less sensitive than the tanned hemaggIutination test. Treatment with 2-mercapto-ethanol resulted in reduced hemagglutination titers, indicating that significant antibody activity may be due to IgM. A special application of the Combs test detected specific antibodies on the surface of tanned and coated RBC which did not otherwise produce detectable agglutination

New Distributional Record for \u3ci\u3eBalcha Indica\u3c/i\u3e (Hymenoptera: Eupelmidae) in Eastern West Virginia Discovered During Emerald Ash Borer Parasitoid Recovery Surveys

Between 2010 and 2012, approximately 6,300 Spathius agrili Yang (Hymenoptera: Braconidae) and 9,500 Tetrastichus planipennisi Yang (Hymenoptera: Eulophidae) parasitoids were released for biological control of the invasive emerald ash borer, Agrilus planipennis Fairmaire, at Cacapon State Park and the Cool Front Development in Morgan County, West Virginia. The invasive beetle was first detected there in 2009, and extensive ash mortality is currently occurring. We conducted parasitoid recovery surveys in 2013 but did not recover either of the released parasitoid species. However, we did rear Balcha indica Mani and Kaul (Hymenoptera: Eupelmidae), which is native to Asia and is a documented parasitoid of A. planipennis, from bolts infested with A. planipennis. This is the first documented record of B. indica for West Virginia

Lean on Me: A Physician\u27s Fiduciary Duty to Disclose an Emergent Medical Risk to the Patient

This Article has two purposes. The first is to establish that physicians owe their patients a fiduciary duty. Courts and commentators have widely acknowledged that this duty exists because of the nature of the special relationship between a physician and a patient. Application of this duty has been sparse, however, in part because its jurisprudential foundation has received virtually no attention. This Article explores that foundation and establishes the strong basis for recognizing and applying this doctrine. The second purpose is to apply this doctrine to an issue that has generated considerable attention, both within and outside the medical profession: the concern that some physicians are failing to disclose medical errors and other emergent medical risks (collectively referred to as EMRs) to patients who are unaware of these developments. There is widespread recognition that patients want and need to trust their doctors and the hospitals to which they turn for help in times of sickness and injury. This Article asserts that physicians\u27 fiduciary duty to patients encompasses a duty to disclose EMRs to patients who are unaware of them. Although most physicians and professional organizations agree that such disclosures should be readily provided, these disclosures are not always forthcoming. Recognizing a fiduciary-based duty to disclose will encourage physicians to share crucial information with patients, which in turn will enable patients to avoid or mitigate potential harm. By routinely disclosing this information, physicians will deepen the trust of their patients in them and thereby facilitate the partnership between patients and physicians that should be the hallmark of health care

Intracranial and intraorbital extension of inverted papillomas: Treatment strategies

Εισαγωγή: Τα ανεστραμμένα θηλώματα (ΑΘ) είναι καλοήθεις όγκοι της ρινικής κοιλότητας εξωδερμικής προέλευσης. Παρόλο που έχουν σχετικά χαμηλή επίπτωση, πρόκειται για όγκους ενδιαφέροντος για τους ωτορινολαρυγγολόγους, καθώς παρουσιάζουν υψηλά ποσοστά υποτροπών (12-20%) κι έναν κίνδυνο κακοήθους εξαλλαγής της τάξεως του 10%. Επιπλέον, τείνουν να επεκτείνονται και να διεισδύουν σε γειτονικές δομές. Στόχοι: Η παρούσα διπλωματική εργασία στοχεύει στην παρουσίαση κι ανάλυση προοπτικά συλλεχθέντων δεδομένων μιας ομάδας ασθενών με ΑΘ που εκτείνονται ενδοκράνια/ ενδοκογχικά και που παρουσιάζουν μοναδικές χειρουργικές προκλήσεις, Επίσης, στοχεύει στον εντοπισμό όλων των περιστατικών ασθενών της βιβλιογραφίας που παρουσιάζουν ΑΘ που εκτείνονται ενδοκράνια/ ενδοκογχικά και στην σύγκριση χειρουργικής τεχνικής (ενδοσκοπικής έναντι ανοιχτής χειρουργικής επέμβασης) με γνώμονα τα ποσοστά υποτροπής. Μέθοδοι: Συλλέχθηκαν δεδομένα για τα δημογραφικά χαρακτηριστικά των ασθενών, την απεικόνιση, την ιστολογία των όγκων, τη χειρουργική τεχνική και τις υποτροπές από μια σειρά 14 ασθενών με ΑΘ που εκτείνονται ενδοκράνια/ ενδοκογχικά. Μια βιβλιογραφική ανασκόπηση (Pubmed) διεξήχθη προκειμένου να εντοπιστούν και να συλλεχθούν ανάλογα δεδομένα για όλους τους ανάλογους ασθενείς της βιβλιογραφίας. Τα δημογραφικά χαρακτηριστικά, ο αριθμός των προηγούμενων χειρουργείων και τα ποσοστά υποτροπής των ενδοσκοπικά χειρουργημένων ασθενών συγκρίθηκαν με εκείνα των ανοικτών χειρουργικών επεμβάσεων. Αποτελέσματα: Η ομάδα των 14 ενδοσκοπικά χειρουργημένων ασθενών είχε μέση ηλικία 52,9 ± SD 11,6 και αναλογία ανδρών προς γυναικών 10 προς 4. Ο μέσος αριθμός προηγούμενων εγχειρήσεων ήταν 3,1 (εύρος 0-16). Η χειρουργική τεχνική που ακολουθήθηκε σε αυτή τη σειρά κι οι δυσκολίες που αντιμετωπίστηκαν περιεγράφηκαν σε 2 από τους 14 ασθενείς. Το ποσοστό υποτροπής ήταν 1 στα 14 (7,1%) περιστατικά. Η βιβλιογραφική αναζήτηση ανέδειξε είκοσι-οκτώ ασθενείς (έτη 1981-2018) με ΑΘ που εκτείνονται ενδοκράνια/ ενδοκογχικά, εκ των οποίων 6 χειρουργήθηκαν ενδοσκοπικά και 20 ανοικτά. Η μέση ηλικία και ο λόγος ανδρών: γυναικών δεν διέφεραν μεταξύ ασθενών χειρουργημένων ανοικτά ή ενδοσκοπικά. Η παρούσα σειρά περιλαμβάνει έναν στατιστικά σημαντικό αριθμό (p <0,01) προηγουμένως χειρουργημένων ασθενών σε σχέση με παλαιότερα περιστατικά ενδοσκοπικής εκτομής που βρέθηκαν στη βιβλιογραφία. Η τάση για χαμηλότερα ποσοστά υποτροπής σε ασθενείς χειρουργημένων ενδοσκοπικά (5%) σε σχέση με εκείνους που χειρουργήθηκαν ανοικτά (20%) ήταν εμφανής, αλλά όχι στατιστικά σημαντική. Συζήτηση και συμπεράσματα: Οι ασθενείς με ΑΘ που εκτείνονται ενδοκράνια/ ενδοκογχικά αντιπροσωπεύουν μια σπάνια ομάδα ασθενών που συχνά υποβάλλεται σε πολλαπλές χειρουργικές επεμβάσεις. Οι νεότερες ενδοσκοπικές τεχνικές, όπως περιγράφονται στην παρούσα διατριβή, είναι πιθανό να μεγιστοποιήσουν την ακριβή εκτομή του όγκου, ελαττώνοντας τις δομές που αφαιρούνται στις απολύτως αναγκαίες και τα ακρωτηριαστικά χειρουργεία, ελαχιστοποιώντας τη μετεγχειρητική νοσηρότητα. Επιπλέον, ο σωστός σχεδιασμός του χειρουργικού πεδίου είναι αδιαπραγμάτευτο βήμα για την ορθή πλήρη εκτομή του όγκου. Η τάση για χαμηλότερα ποσοστά υποτροπής σε ενδοσκοπικά χειρουργημένους ασθενείς σε σύγκριση με την ανοικτή χειρουργική τεχνική παρατηρείται και στην σχετική βιβλιογραφία. Οι μελλοντικές μελέτες με μεγαλύτερες ομάδες ασθενών σίγουρα θα επιβεβαιώσουν την ανώτερη αποτελεσματικότητα της ενδοσκοπικής τεχνικής.Introducion: Sinonasal inverted papillomas (IP) are benign tumors of the nasal cavity of ectodermal origin. Although they have a relatively low incidence, these are tumors of high interest for the otorhinolaryncologists, as they present high recurrence rates (12-20%) and a lifetime malignant transformation risk of 10%. Furthermore, they tend to extend to and invade neighbouring structures. Aims: This thesis aims in presenting and analyzing prospectively collected data on a group of IP patients presenting with unique surgical challenges, namely those with IP extending intracranially/intraorbitally. It also aims in identifying all literature cases of patients presenting with IP extending intracranially/intraorbitally and in comparing surgical technique (endoscopic vs open surgery) in terms of recurrence rates. Methods: Data on patient demographic characteristics, imaging, pathology, surgical technique and recurrences from a series of 14 patients with IP extending intracranially and/or intraorbitally were collected. A literature review (Pubmed) was conducted in order to identify and collect analogous data on all operated patients. Demographic, characteristics, number of previous operations and recurrence rates of endoscopically operated patients were compared to those with open surgeries. Results: Our cohort of 14 endoscopically operated patients had a mean age ± standard deviation of 52.9 ± 11.6 and a male to female ratio of 10 to 4. Mean number of previous operations was 3.1 (range 0-16). Surgical technique and challenges were illustrated in 2 of 14 patients. Recurrence rate was 1 in 14 (7.1%). Literature searches identified twenty-eight patients (years 1981-2018) with IP extending intracranially and/or intraorbitally that were operated using an endoscopic (N= 6) or open technique (N=20). Mean age and male:female ratio did not differ between open or endoscopically operated patients. The present series included a significantly higher (p<0.01) number of revision cases compared to previous endoscopic resection cases found in the literature. A trend for lower recurrence rates in endoscopically operated patients (5%) compared to those with open surgeries (20%) was apparent, but did not reach statistical significance. Discussion and Conclusions: Patients with IP extending intracranially and/or intraorbitally represent a rare patient cohort that commonly undergoes multiple operations/revisions. Recent endoscopic techniques as illustrated in the present thesis are likely to maximize thorough excision by removing the pedicle of the tumor with high precision while minimizing surgical morbidity by reducing the structures resected to the absolute minimum. Moreover, correct planning and creation of the surgical field is non-negotiable for the complete excision of the tumor. A trend for lower recurrence rates in endoscopically operated patients compared to open surgery is consistent with salient literature. Future studies on larger patient cohorts are warranted to support the superior efficacy of the endoscopic technique in patients with IP extending intracranially and/or intraorbitally

Prevention of fish photobacteriosis. Comparison of the efficacy of intraperitoneally administered commercial and experimental vaccines

Two commercial multivalent vaccines against vibriosis, caused by Vibrio anguillarum serotype(s) and photobacteriosis, caused by Photobacterium damsela subsp. piscicida, one with oil adjuvant (AJ) and the other,being an aqueous solution (AV), and an experimental monovalent (Ph. damselae subsp. piscicida) vaccine inactivated with formalin or heat, namely EVF and EVH, were tested in laboratory trials on sea bass (Dicentrarchus labrax) in respect to their efficacy against experimentally induced photobacteriosis. The first trial aiming at high bacterial pressure was carried out 34 days post-vaccination and resulted in 90% mortalities in the control. The relative per cent survival (RPS) of vaccinated fish was calculated at 24, 3.7, 0 and 0 for the AJ, AV, EVF and EVH formulations, respectively. The second trial aiming at medium bacterial pressure was carried out 49 days post-vaccination and resulted in 45% mortalities in the control. The relative per cent survival (RPS) of vaccinated fish was calculated at 100, 92.7, 77.8 and 66.7 for the AJ, EVF, EVH and AV, formulations, respectively. Apparently, under both these high and medium bacterial pressure conditions, the commercial vaccine AJ performed better than the commercial vaccine AV, while under medium pressure there was no statistical difference between the performance of EVF and AJ. The measurement of specific antibody titers in sera collected from all fish groups 49 days post-vaccination, showed high levels in the fish vaccinated with the AJ vaccine, almost three times lower levels for the AV and EVF vaccines and even lower levels for the EVH vaccine. Results are discussed in respect to the choices mariculture companies have in selecting a commercial vaccine against photobacteriosis and possible alternatives, which, if commercially developed, may reduce vaccine cost

Different Nerve-Sparing Techniques during Radical Prostatectomy and Their Impact on Functional Outcomes

The purpose of this narrative review is to describe the different nerve-sparing techniques applied during radical prostatectomy and document their functional impact on postoperative outcomes. We performed a PubMed search of the literature using the keywords “nerve-sparing”, “techniques”, “prostatectomy” and “outcomes”. Other potentially eligible studies were retrieved using the reference list of the included studies. Nerve-sparing techniques can be distinguished based on the fascial planes of dissection (intrafascial, interfascial or extrafascial), the direction of dissection (retrograde or antegrade), the timing of the neurovascular bundle dissection off the prostate (early vs. late release), the use of cautery, the application of traction and the number of the neurovascular bundles which are preserved. Despite this rough categorisation, many techniques have been developed which cannot be integrated in one of the categories described above. Moreover, emerging technologies have entered the nerve-sparing field, making its future even more promising. Bilateral nerve-sparing of maximal extent, athermal dissection of the neurovascular bundles with avoidance of traction and utilization of the correct planes remain the basic principles for achieving optimum functional outcomes. Given that potency and continence outcomes after radical prostatectomy are multifactorial endpoints in addition to the difficulty in their postoperative assessment and the well-documented discrepancy existing in their definition, safe conclusions about the superiority of one technique over the other cannot be easily drawn. Further studies, comparing the different nerve-sparing techniques, are necessary

Design of an ogive-shaped beamstop

This paper addresses the evolution, design, and development of a novel approach for topping cw (continuous-wave), non-rastered proton beams. Capturing the beam in vacuo within a long, axisymmetric surface of revolution has the advantages of spreading the deposited energy over a large area while minimizing prompt neutron backstreaming and reducing shield size and mass. Evolving from a cylinder/cone concept, the ogive shape avoids abrupt changes in geometry that produce sharp thermal transitions, allowing the beam energy to be deposited gracefully along its surface. Thermal management at modest temperature levels is provided with a simple, one-pass countercurrent forced-convection water passage outside the ogive. Hydrophone boiling sensors provide overtemperature protection. The concept has been demonstrated under beam conditions in the CRITS (Chalk River Injector Test Stand) facility

Endoscopic enucleation of the prostate with Thulium Fiber Laser (ThuFLEP). A retrospective single-center study

Purpose: The aim of the present, retrospective study was to describe our initial experience and early outcomes of Thulium Fiber Laser enucleation of the prostate (ThuFLEP) with the use of the FiberDust™ (Quanta System, Samarate, Italy) in patients with benign prostate hyperplasia. Methods: From June 2022 to April 2023, all patients who underwent endoscopic enucleation of the prostate at Urology Department of the University Hospital of Patras were included. A single surgeon utilizing the same standardized operative technique performed all the surgeries. The primary endpoints included the uneventful completion of the operation, the surgical time and any minor or major complication observed intra- or post-operatively. Results: Twenty patients with benign prostate hyperplasia were treated with ThuFLEP. All the surgeries were completed successfully and uneventfully. The enucleation phase of the operation was completed in a mean time of 45 ± 9.1 min, while the average time needed for the morcellation was 17.65 ± 3.42 min. No significant complications were observed intra- or post-operatively. The average hemoglobin drop was calculated to be 0.94 ± 0.71 g/dL. Conclusions: All the operations were successfully and efficiently completed with the use of the FiberDust™ (Quanta System, Samarate, Italy) in ThuFLEP. Significant blood loss or major complications were not observed

Surgical Management of Cervical Spondyloarthropathy in Hemodialysis Patients

Dialysis-related spondyloarthropathy is a rare cause of spinal deformity and cervical myelopathy. Optimal management of cervical spine spondyloarthropathy often requires circumferential reconstructive surgery, because affected patients typically have both the anterior column and the facet joints compromised. The occasional presence of noncontiguous or "skip lesions" adds an additional level of complexity to surgical management, because decompression and fusion in an isolated segment of neural compression can worsen spine deformity by applying increased stress to adjacent cervical spine segments. We report two cases of hemodialysis patients who presented with cervical myelopathy and initially had anterior cervical discectomy or corpectomy. Because symptoms recurred due to hardware failure, both patients required posterior spine fusion as well. In retrospect, because of the hardware failure, both of these patients might have benefited from a circumferential (combined anterior and posterior) cervical spine reconstruction as their initial treatment

Pinna nobilis in the Greek seas (NE Mediterranean): on the brink of extinction?

The Mediterranean endemic fan mussel Pinna nobilis is suffering an ongoing basin-scale mass mortality event (MME) since 2016. As most Mediterranean populations have collapsed, the species has been declared as Critically Endangered in the IUCN Red List of threatened species. In an effort to track the progress of the MME and provide updated information on the status of the species in the Greek seas, data collected through dedicated surveys and opportunistic assessments during 2019 and 2020 have been compiled. During surveys conducted at 258 sites, a total of 14,589 fan mussels were recorded, of which 81.1% were dead. Of the remaining 2,762 live individuals, 256 were juveniles. Two marine areas that still sustain living populations were identified, namely Kalloni Gulf (Lesvos Island), and Laganas Bay (Zakynthos Island). The inner part of Kalloni Gulf appears to maintain the largest surviving population of the species in the eastern Mediterranean, with an abundance estimate of 684,000 individuals (95% confidence interval: 322,000-1,453,000). Solitary, potentially resistant, scattered individuals were recorded at several sites. Other previously abundant populations that had been assessed in the past, specifically those of Lake Vouliagmeni (Korinthiakos Gulf), Souda Bay (Crete) and Gera Gulf (Lesvos Island) with a total of ~350,000 individuals, have now been wiped out. Our results document the collapse of most P. nobilis populations throughout the Greek seas. The MME has progressed substantially between early 2019 and mid-2020, as indicated by the increase in mortality at sites consecutively monitored multiple times. This work highlights the urgent need for continuous monitoring of surviving populations and calls for immediate implementation of an effective protection and management strategy that will ensure the persistence of surviving individuals and the production of resistant offspring