Some Implications of Outdoor Recreation Desires for Urban Redevelopment

Author Institution: Department of Geography, Miami UniversityThe significance of four attributes of outdoor recreation relative to a consideration of urban redevelopment forms the focus of this paper. Data on the public's desires for specific recreational facility qualities and activities and the socio-economic characteristics of households are used to develop implications for urban redevelopment policy. Some effects of household income level, car availability, and place of residence are examined as examples. Conclusions are based on a possible set of public responses and emphasize the need for a fuller appreciation of the role of outdoor recreation in policy determination

Peroxisome proliferator-activated receptors as stimulants of angiogenesis in cardiovascular disease and diabetes

The incidence of diabetes is directly related to the incidence of obesity, which is at epidemic proportions in the US. Cardiovascular disease is a common complication of diabetes, which results in high morbidity and mortality. Peroxisome proliferator-activated receptors (PPARs) are a group of nuclear hormone receptors that regulate lipid and glucose metabolism. PPAR-α agonists such as fenofibrate and PPAR-γ agonists such as the thiozolidinediones have been used to treat dyslipidemia and insulin resistance in diabetes. Over the past few years research has discovered the role of PPARs in the regulation of inflammation, proliferation, and angiogenesis. Clinical trials looking at the effect of PPAR agonists on cardiovascular outcomes have produced controversial results. Studies looking at angiogenesis and proliferation in various animal models and cell lines have shown a wide variation in results. This may be due to the differential effects of PPARs on proliferation and angiogenesis in various tissues and pathologic states. This review discusses the role of PPARs in stimulating angiogenesis. It also reviews the settings in which stimulation of angiogenesis may be either beneficial or harmful

Clinicopathological study of benign ovarian tumuors

Background: The incidence of ovarian tumor amongst gynecological admissions have been reported to vary from 1-3 %. About 75% of these tumors have been found to be benign. Ovarian malignancies represent the greatest clinical challenge of all the gynecological malignancies. During the reproductive years most of the ovarian tumors encountered are benign. About 2/3 of the ovarian tumors are encountered in this group only. The chance that an ovarian tumor is malignant in a patient younger than 45 years is 1 in 15. The differentiation of the benign from malignant tumors can go wrong even with imaging modalities.CA125 along with ultrasound are useful in differentiating benign from malignant tumors. Histopathological examination is gold standard for diagnosis of ovarian neoplasm.Methods: The present study includes consecutive cases of histopathologically proven ovarian tumors of 3 years from June 2010 to May 2013 reported by the Department of Pathology of our tertiary care center. It includes total 150 cases. After careful study of gross findings, appropriate bits were taken from received ovarian specimen, followed by routine paraffin processing to make H and E stained slides. Special stains were used wherever needed.Results: Majority of the cases 91 (60.67%) were benign, 53 (35.33%) were malignant and 6 (4.0%) were borderline. Surface epithelial tumours were the most common type (68.13%) of ovarian neoplasm in this study. Most of tumours in our study occurred in the age group of 21-40 years. Mucinous cystadenomas were most common benign surface epithelial tumour and most common benign tumors overall. There were 22 cases of benign germ cell tumor, all were mature teratoma. All the sex-cord stromal tumours were diagnosed in women older than 40 years. Most common benign lesion in our study is surface epithelial tumour and in age group of 21-40 years. 84% patients studied had symptoms at presentation, out of which 26% of patient presented with dull/dragging pain. Pan hysterectomy was the most common procedure for surgical management.Conclusions: Most of ovarian neoplasm are benign with mucinous cystadenoma being commonest entity. Commonest age group is 21-40 years. Commonest benign germ cell tumor is Mature cystic teratoma. Commonest clinical symptom is dull/dragging pain. Pan hysterectomy was the most common procedure for surgical management.

Use of Laparoscopy in Trauma at a Level II Trauma Center

Although laparoscopy is little used in trauma, it may have a significant role in a select subset of patients

Fatigue life prediction of pedicle screw for spinal surgery

This paper is dedicated to fatigue estimation of implants for spinal surgery. This article deals especially with special case of hollow pedicle screw. Implant systems utilizing specially designed spinal instrumentation are often used in these surgical procedures. The most common surgical procedure is spinal fusion, also known as spondylodesis, is a surgical technique used to join two or more vertebra. Implants are subjected to many loading cycles during their life, especially in the case of other degenerative changes in the skeleton, there are often changes in loading conditions, which often cannot be accurately determined. These changes often lead to further bending load in the thread. Hollow screws studied in this work show higher fatigue resistance than other types of implants

Acute myeloid leukemia arising from a donor derived premalignant hematopoietic clone: A possible mechanism for the origin of leukemia in donor cells

AbstractDuring recent years, it has become increasingly evident that donor leukemia following allogeneic transplant may be more common then realized in the past. We identified five cases of potential donor leukemia cases during past five years. The precise mechanism of the origin of such leukemias, however, remains poorly defined. In this short communication, we report a well documented case of donor-derived de novo acute myeloid leukemia (AML) that developed fourteen years after allogeneic stem cell transplantation for treatment induced AML for his primary malignancy Immunoblastic lymphoma. This case allows us to postulate a possible mechanism of the origin of donor leukemia. The de novo AML clone contained a distinct cytogenetic abnormality, trisomy 11, which was simultaneously detected in preserved peripheral blood obtained at the time of transplantation as well as in the current bone marrow from an otherwise clinically and phenotypically normal donor. The findings from this unique case, provides insight into the process of leukemogenesis, and suggests that the sequence of events leading to leukemogenesis in this patient involved the senescence/apoptosis of normal donor hematopoietic cells due to telomere shortening resulting in the selective proliferation and transformation of this clone with MLL (mixed-lineage leukemia) gene amplification

Alveolar ridge preservation reduces the need for ancillary bone augmentation in the context of implant therapy.

BACKGROUND There is limited information on the need for bone augmentation in the context of delayed implant placement whether alveolar ridge preservation (ARP) is previously performed or not. The primary aim of this retrospective cohort study was to evaluate the efficacy of ARP therapy after tooth extraction compared with unassisted socket healing (USH) in reducing the need for ancillary bone augmentation before or at the time of implant placement. METHODS Adult subjects that underwent non-molar single tooth extraction with or without simultaneous ARP therapy were included in this study. Cone beam computed tomography scans obtained before tooth extraction and after a variable healing period were used to record the baseline facial bone thickness and to virtually plan implant placement according to a standard method. A logistic regression model was used to evaluate the effect of facial alveolar bone thickness upon tooth extraction and baseline therapy (USH or ARP) on the need for additional bone augmentation, adjusting for several covariates (i.e., age, sex, baseline KMW, and tooth type). RESULTS One hundred and forty subjects that were equally distributed between both baseline therapy groups constituted the study population. Implant placement was deemed virtually feasible in all study sites. Simultaneous bone augmentation was considered necessary in 60% and 11.4% of the sites in the USH and ARP group, respectively. Most of these sites (64.2% in the USH group and 87.5% in the ARP group) exhibited a thin facial bone phenotype (<1 mm) at baseline. Logistic regression revealed that the odds of not needing ancillary bone augmentation were 17.8 times higher in sites that received ARP therapy. Furthermore, the need for additional bone augmentation was reduced 7.7 times for every 1 mm increase in facial bone thickness, regardless of baseline therapy. CONCLUSIONS Based on a digital analysis, ARP therapy, compared with USH, and thick facial alveolar bone largely reduce the need for ancillary bone augmentation at the time of implant placement in non-molar sites

MAVIDOS Maternal Vitamin D Osteoporosis Study: study protocol for a randomized controlled trial. The MAVIDOS Study Group.

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.UNLABELLED: MAVIDOS is a randomised, double-blind, placebo-controlled trial (ISRCTN82927713, registered 2008 Apr 11), funded by Arthritis Research UK, MRC, Bupa Foundation and NIHR. BACKGROUND: Osteoporosis is a major public health problem as a result of associated fragility fractures. Skeletal strength increases from birth to a peak in early adulthood. This peak predicts osteoporosis risk in later life. Vitamin D insufficiency in pregnancy is common (31% in a recent Southampton cohort) and predicts reduced bone mass in the offspring. In this study we aim to test whether offspring of mothers supplemented with vitamin D in pregnancy have higher bone mass at birth than those whose mothers were not supplemented. METHODS/DESIGN: Women have their vitamin D status assessed after ultrasound scanning in the twelfth week of pregnancy at 3 trial centres (Southampton, Sheffield, Oxford). Women with circulating 25(OH)-vitamin D levels 25-100 nmol/l are randomised in a double-blind design to either oral vitamin D supplement (1000 IU cholecalciferol/day, n = 477) or placebo at 14 weeks (n = 477). Questionnaire data include parity, sunlight exposure, dietary information, and cigarette and alcohol consumption. At 19 and 34 weeks maternal anthropometry is assessed and blood samples taken to measure 25(OH)-vitamin D, PTH and biochemistry. At delivery venous umbilical cord blood is collected, together with umbilical cord and placental tissue. The babies undergo DXA assessment of bone mass within the first 14 days after birth, with the primary outcome being whole body bone mineral content adjusted for gestational age and age. Children are then followed up with yearly assessment of health, diet, physical activity and anthropometric measures, with repeat assessment of bone mass by DXA at age 4 years. DISCUSSION: As far as we are aware, this randomised trial is one of the first ever tests of the early life origins hypothesis in human participants and has the potential to inform public health policy regarding vitamin D supplementation in pregnancy. It will also provide a valuable resource in which to study the influence of maternal vitamin D status on other childhood outcomes such as glucose tolerance, blood pressure, cardiovascular function, IQ and immunology.Published versio

Role of gastric per-oral endoscopic myotomy (G-POEM) in post-lung transplant patients: a multicenter experience

Background and study aims: Gastroparesis post-lung transplant (LTx) can lead to increased risk of gastroesophageal reflux (GER) and accelerated graft dysfunction. We aimed to evaluate the efficacy and safety of gastric per-oral endoscopic myotomy (G-POEM), a promising tool in patients with refractory gastroparesis, for managing refractory gastroparesis and GER in post-LTx patients. Patents and methods  This was a multicenter retrospective study on post-LTx patients who underwent G-POEM for management of gastroparesis and GER that were refractory to standard medical therapy. The primary outcome was clinical success post-G-POEM. Secondary outcomes included the rate of post-G-POEM objective esophageal pH exam normalization, rate of gastric emptying scintigraphy (GES) normalization, technical success, and adverse events. Results: A total of 20 patients (mean age 54.7 ± 14.1 years, Female 50 %) underwent G-POEM at a median time of 13 months (interquartile range 6.5-13.5) post-LTx. All G-POEM procedures were technically successful. Clinical success was achieved in 17 (85 %) patients during a median follow-up time of 8.9 (IQR: 3-17) months post-G-POEM. Overall GCSI and two of its subscales (bloating and postprandial fullness/early satiety) improved significantly following G-POEM. Two patients (10 %) developed post-procedural AEs (delayed bleeding 1, pyloric stenosis 1, both moderate in severity). Post-G-POEM GES improvement was achieved in 12 of 16 patients (75 %). All 20 patients were on proton pump inhibitors pre-G-POEM, as opposed to five post-G-POEM. Post-G-POEM PH study normalization was noted in nine of 10 patients (90 %) who underwent both pre- and post-G-poem pH testing. Conclusions: G-POEM is a promising noninvasive therapeutic tool for management of refractory gastroparesis and GER post-LTx