Bilateral isolated C5 paralysis of the shoulder: Atypical presentation of a transdiscal C4-C5 cervical spine fracture.

After a low-energy fall, an 83-year-old man presented with bilateral weakness of the upper arms without loss of sensation associated with a rigid cervical spine (ankylosing spinal disorder, ASD). Because of an atypical presentation during history, examination and initial imaging, a late diagnosis of a transdiscal C4-C5 fracture was made by dynamic radiographs. Anterior cervical discectomy and fusion were performed with delay. Strength improved from grade C to D (American Spinal Injury Association classification) after surgery. To our knowledge, this is the first description of a bilateral, isolated upper limb C5 paralysis without any loss of sensation caused by a transdiscal C4-C5 fracture. A high clinical and diagnostic index of suspicion is mandatory to make the diagnosis. We present three clinical 'Awareness Criteria' (1: recognition of ASD; 2: high index of fracture suspicion; 3: necessary imaging) helping clinicians to safely and promptly diagnose occult spinal fractures in ASD

Seasonal inputs of polyethoxylated compounds to a Mediterranean coastal lagoon through surface watercourses

Synthetic surfactants are among the chemicals that are produced and consumed in the largest volumes in the world (more than 10 million tons per year), due to their variety of applications, mainly as key ingredients in detergents and cleaners but also as additives in paints, pesticides, personal care products, etc. In spite of the high removal efficiences of surfactant residues in sewage treatment plants (STP), significant amounts of these chemicals reach aquatic ecosystems via direct discharges of treated or non-treated wastewaters, or indirect discharges through rivers, where they are present dissolved or associated with particulate material. Therefore, particular attention has been given to the environmental analysis of anionic and non-ionic surfactants (90% of the overall production. Our main objective in this work was to detect the presence and compare the distribution of the most world-wide used non-ionic (alcohol polyethoxylates, AEOs, and nonylphenol polyethoxylates, NPEOs) surfactants, and an important group of nonionic synthetic water-soluble polymers of ethylene oxide, polyethylene glycols (PEGs), which are also used in a wide range of applications (e.g., antifreeze agents, cosmetics) as well as the main precursors / degradation products of AEOs, in waters and sediments from Mar Menor Lagoon (SE Spain). Under our knowledge, some of the data shown here are among the first even reported on the environmental distribution of PEGs in aquatic systems

Computer-aided detection systems to improve lung cancer early diagnosis: state-of-the-art and challenges

Lung cancer is one of the most lethal types of cancer, because its early diagnosis is not good enough. In fact, the detection of pulmonary nodule, potential lung cancers, in Computed Tomography scans is a very challenging and time-consuming task for radiologists. To support radiologists, researchers have developed Computer-Aided Diagnosis (CAD) systems for the automated detection of pulmonary nodules in chest Computed Tomography scans. Despite the high level of technological developments and the proved benefits on the overall detection performance, the usage of Computer-Aided Diagnosis in clinical practice is far from being a common procedure. In this paper we investigate the causes underlying this discrepancy and present a solution to tackle it: the M5L WEB- and Cloud-based on-demand Computer- Aided Diagnosis. In addition, we prove how the combination of traditional imaging processing techniques with state-of-art advanced classification algorithms allows to build a system whose performance could be much larger than any Computer-Aided Diagnosis developed so far. This outcome opens the possibility to use the CAD as clinical decision support for radiologists

High precision dynamic alignment and gap control for optical near-field nanolithography

The authors demonstrate the use of interferometric-spatial-phase-imaging (ISPI) to control a gap distance of the order of nanometers for parallel optical near-field nanolithography. In optical near-field nanolithography, the distance between the optical mask and the substrate needs to be controlled within tens of nanometers or less. The ISPI technique creates interference fringes from checkerboard gratings fabricated on the optical mask, which are used to determine the gap distance between the mask and the substrate surfaces. The sensitive of this gapping technique can reach 0.15 nm. With the use of ISPI and a dynamic feedback control system, the authors can precisely align the mask and the substrate and keep variation of the gap distance below 6 nm to realize parallel nanolithography. (C) 2013 American Vacuum Society

Quality of Life and psychopathology in adults who underwent Hematopoietic Stem Cell Transplantation (HSCT) in childhood: a qualitative and quantitative analysis.

Background: Patients who undergo pediatric Hematopoietic Stem Cell Transplantation (HSCT) may experience long-term psychological sequelae and poor Quality of Life (QoL) in adulthood. This study aimed to investigate subjective illness experience, QoL, and psychopathology in young adults who have survived pediatric HSCT. Method: The study involved patients treated with HSCT in the Hematology-Oncology Department between 1984 and 2007. Psychopathology and QoL were investigated using the SCL-90-R and SF-36. Socio-demographic and medical information was also collected. Finally, participants were asked to write a brief composition about their experiences of illness and care. Qualitative analysis of the texts was performed using T-LAB, an instrument for text analysis that allows the user to highlight the occurrences and co-occurrences of lemma. Quantitative analyses were performed using non-parametric tests (Spearman correlations, Kruskal-Wallis and Mann-Whitney tests). Results: Twenty-one patients (9 males) participated in the study. No significant distress was found on the SCL-90 Global Severity Index, but it was found on specific scales. On the SF-36, lower scores were reported on scales referring to bodily pain, general health, and physical and social functioning. All the measures were significantly (p < 0.05) associated with specific socio-demographic and medical variables (gender, type of pathology, type of HSCT, time elapsed between communication of the need to transplant and effective transplantation, and days of hospitalization). With regard to the narrative analyses, males focused on expressions related to the body and medical therapies, while females focused on people they met during treatment, family members, and donors. Low general health and treatment with autologous HSCT were associated with memories about chemotherapy, radiotherapy, and the body parts involved, while high general health was associated with expressions focused on gratitude (V-Test \ub1 1.96). Conclusion: Pediatric HSCT survivors are more likely to experience psychological distress and low QoL in adulthood compared with the general population. These aspects, along with survivors' subjective illness experience, show differences according to specific medical and socio-demographic variables. Studies are needed in order to improve the care and long-term follow-up of these families

Simple battery armor to protect against gastrointestinal injury from accidental ingestion

Inadvertent battery ingestion in children and the associated morbidity and mortality results in thousands of emergency room visits every year. Given the risk for serious electrochemical burns within hours of ingestion, the current standard of care for the treatment of batteries in the esophagus is emergent endoscopic removal. Safety standards now regulate locked battery compartments in toys, which have resulted in a modest reduction in inadvertent battery ingestion; specifically, 3,461 ingestions were reported in 2009, and 3,366 in 2013. Aside from legislation, minimal technological development has taken place at the level of the battery to limit injury. We have constructed a waterproof, pressure-sensitive coating, harnessing a commercially available quantum tunneling composite. Quantum tunneling composite coated (QTCC) batteries are nonconductive in the low-pressure gastrointestinal environment yet conduct within the higher pressure of standard battery housings. Importantly, this coating technology enables most battery-operated equipment to be powered without modification. If these new batteries are swallowed, they limit the external electrolytic currents responsible for tissue injury. We demonstrate in a large-animal model a significant decrease in tissue injury with QTCC batteries compared with uncoated control batteries. In summary, here we describe a facile approach to increasing the safety of batteries by minimizing the risk for electrochemical burn if the batteries are inadvertently ingested, without the need for modification of most battery-powered devices.National Institutes of Health (U.S.) (Grant DE013023)National Institutes of Health (U.S.) (Grant EB000244)National Institutes of Health (U.S.) (Grant GM086433)National Institutes of Health (U.S.) (Grant T32 DK 7191-38

Comparison between Two Different Two-Stage Transperineal Approaches to Treat Urethral Strictures or Bladder Neck Contracture Associated with Severe Urinary Incontinence that Occurred after Pelvic Surgery: Report of Our Experience

Introduction. The recurrence of urethral/bladder neck stricture after multiple endoscopic procedures is a rare complication that can follow prostatic surgery and its treatment is still controversial. Material and Methods. We retrospectively analyzed our data on 17 patients, operated between September 2001 and January 2010, who presented severe urinary incontinence and urethral/bladder neck stricture after prostatic surgery and failure of at least four conservative endoscopic treatments. Six patients underwent a transperineal urethrovesical anastomosis and 11 patients a combined transperineal suprapubical (endoscopic) urethrovesical anastomosis. After six months the patients that presented complete incontinence and no urethral stricture underwent the implantation of an artificial urethral sphincter (AUS). Results. After six months 16 patients were completely incontinent and presented a patent, stable lumen, so that they underwent an AUS implantation. With a mean followup of 50.5 months, 14 patients are perfectly continent with no postvoid residual urine. Conclusions. Two-stage procedures are safe techniques to treat these challenging cases. In our opinion, these cases could be managed with a transperineal approach in patients who present a perfect operative field; on the contrary, in more difficult cases, it would be preferable to use the other technique, with a combined transperineal suprapubical access, to perform a pull-through procedure

Advanced Glycation End-Products and Hyperglycemia Increase Angiopoietin-2 Production by Impairing Angiopoietin-1-Tie-2 System

The angiopoietin-Tie-2 system plays a crucial role in the maintenance of endothelial integrity. Hyperglycemia and advanced glycation end-products (AGEs) are involved in endothelial cell dysfunction responsible of the pathogenesis of microvascular complications of diabetes. Here, we investigated whether glycated serum (GS) or hyperglycemia (HG) affect the angiopoietin-Tie-2 system in the microvascular endothelial cells HMEC-1. We found that culture for 5 days in the presence of AGEs and HG (alone or in combination) decreased cell proliferation, increased reactive oxygen species (ROS) production, and reduced ratio between the oxidized and the reduced form of glutathione. Since angiopoietin-1 (Ang-1) signaling regulates angiopoietin-2 (Ang-2) expression through inactivation of the forkhead transcription factor FoxO1, we investigated intracellular signaling of Ang-1 and expression of Ang-2. HG and AGEs reduced phosphorylation of Akt and abrogated phosphorylation of FoxO1 induced by Ang-1 without affecting neither Tie-2 expression nor its activation. Furthermore, AGEs and/or HG induced nuclear translocation of FoxO1 and increased Ang-2 production. In conclusion, we demonstrated that both hyperglycemia and AGEs affect the angiopoietin-Tie-2 system by impairing Ang-1/Tie-2 signaling and by increasing Ang-2 expression. These results suggest that therapeutic strategies useful in preventing or delaying the onset of diabetic vascular complications should be aimed to preserve Ang-1 signaling

Life Cycle Assessment of Luminescent Solar Concentrators Integrated into a Smart Window

The main goal of this paper is to assess the life cycle environmental impacts of a multifunctional smart window luminescent solar concentrator (SW-LSC) prototype through the application of the Life Cycle Assessment methodology. To the authors' knowledge, this is one of the first studies on the topic. The analysis followed a cradle to gate approach, considering the assembly and maintenance phase as well as the end of life, examined separately through a recycling/landfill scenario. A comparison of the impacts of LSC modules with those of some building-integrated photovoltaic technologies was carried out. Results showed that the global warming potential (100 years) for SW-LSC was 5.91 x 10(3) kg CO2eq and the manufacturing phase had the greatest impact (about 96%). The recycling/landfill scenario results showed the possibility to reduce impacts by an average of 45%. A dominance analysis of SW-LSC components showed that the aluminum frame was the main hotspot (about 60% contribution), followed by the light-shelf (about 19%). Batteries and motors for the shading system were the biggest contributors in the abiotic depletion potential category (36% and 30%, respectively). An alternative scenario, which involved the use of 75% recycled aluminum for the window frame, highlighted the possibility to reduce environmental impacts from 3% to 46%. Finally, the comparison results showed that the LSC modules' impacts were on average 870% lower than that of various PV technologies when compared on the basis of m(2); on the contrary, LSC modules had the highest impacts in all categories (from 200% to 1900%) when compared with other PV technologies on the basis of 1 kWh of energy generated. The results could be used for the definition of eco-design strategies for the examined device, in order to support the scaling-up process and to put "greener" systems onto the market