Portland\u27s Changing Landscape

Occasional Papers in Geography Publication No. 4 What is the nature and character of Portland? What are the conditions, changes and developments that have made it what it is? How does Portland compare with other places? What makes it unique? These are some of the question pursued in this volume. This book contains thirteen chapters discussing various facets of Portland\u27s environmental, economy, and character. It is an up-to-date and comprehensive analysis of dynamics and change in the landscape. An overview is provided of Portland as a city and place to live, as well as its functional significance on a national and international basis. Two threads are woven through the tapestry of these essays. One is that Portland is a big city but with many attributes of a small town. The other is the closeness and accessibility of city and nature. The challenge is how to nurture and maintain both - to have our cake and eat it too. The evidence is clear that most American cities have not been able to achieve this. Only the future can tell how Portland will fare. The authors are all professional geographers or work in closely related fields. All have been involved with the Portland scene for a number of years and are uniquely qualified to write about these topics. While each approaches problems from his or her own perspective, the net result is a summing up, a taking stock of where we have been and where we are going. When considered as a whole the book should provide a better view than we have had of the nature and character of this special place.https://pdxscholar.library.pdx.edu/geog_occasionalpaper/1000/thumbnail.jp

Somatic and germline CACNA1D calcium channel mutations in aldosterone-producing adenomas and primary aldosteronism

Adrenal aldosterone-producing adenomas (APAs) constitutively produce the salt-retaining hormone aldosterone and are a common cause of severe hypertension. Recurrent mutations in the potassium channel KCNJ5 that result in cell depolarization and Ca(2+) influx cause ~40% of these tumors(1). We found five somatic mutations (four altering glycine 403, one altering isoleucine 770) in CACNA1D, encoding a voltage-gated calcium channel, among 43 non-KCNJ5-mutant APAs. These mutations lie in S6 segments that line the channel pore. Both result in channel activation at less depolarized potentials, and glycine 403 mutations also impair channel inactivation. These effects are inferred to cause increased Ca(2+) influx, the sufficient stimulus for aldosterone production and cell proliferation in adrenal glomerulosa(2). Remarkably, we identified de novo mutations at the identical positions in two children with a previously undescribed syndrome featuring primary aldosteronism and neuromuscular abnormalities. These findings implicate gain of function Ca(2+) channel mutations in aldosterone-producing adenomas and primary aldosteronism

Use of fluorescence imaging and indocyanine green during colorectal surgery:Results of an intercontinental Delphi survey

info:eu-repo/semantics/inPres

Use of fluorescence imaging and indocyanine green during colorectal surgery: Results of an intercontinental Delphi survey

BACKGROUND: Fluorescence imaging with indocyanine green is increasingly being used in colorectal surgery to assess anastomotic perfusion, and to detect sentinel lymph nodes. METHODS: In this 2-round, online, Delphi survey, 35 international experts were asked to vote on 69 statements pertaining to patient preparation and contraindications to fluorescence imaging during colorectal surgery, indications, technical aspects, potential advantages/disadvantages, and effectiveness versus limitations, and training and research. Methodological steps were adopted during survey design to minimize risk of bias. RESULTS: More than 70% consensus was reached on 60 of 69 statements, including moderate-strong consensus regarding fluorescence imaging's value assessing anastomotic perfusion and leak risk, but not on its value mapping sentinel nodes. Similarly, although consensus was reached regarding most technical aspects of its use assessing anastomoses, little consensus was achieved for lymph-node assessments. Evaluating anastomoses, experts agreed that the optimum total indocyanine green dose and timing are 5 to 10 mg and 30 to 60 seconds pre-evaluation, indocyanine green should be dosed milligram/kilogram, lines should be flushed with saline, and indocyanine green can be readministered if bright perfusion is not achieved, although how long surgeons should wait remains unknown. The only consensus achieved for lymph-node assessments was that 2 to 4 injection points are needed. Ninety-six percent and 100% consensus were reached that fluorescence imaging will increase in practice and research over the next decade, respectively. CONCLUSION: Although further research remains necessary, fluorescence imaging appears to have value assessing anastomotic perfusion, but its value for lymph-node mapping remains questionable