Presentation, diagnostic assessment and surgical outcomes in primary hyperparathyroidism:a single centre's experience

Objective: Primary hyperparathyroidism (PHPT) is a common reason for referral to endocrinology but the evidence base guiding assessment is limited. We evaluated the clinical presentation, assessment and subsequent management in PHPT. Design: Retrospective cohort study. Patients: PHPT assessed between 2006 and 2014 (n = 611) in a university hospital. Measurements: Symptoms, clinical features, biochemistry, neck radiology and surgical outcomes. Results: Fatigue (23.8%), polyuria (15.6%) and polydipsia (14.9%) were associated with PHPT biochemistry. Bone fracture was present in 16.4% but was not associated with biochemistry. A history of nephrolithiasis (10.0%) was associated only with younger age (P = 0.006) and male gender (P = 0.037). Thiazide diuretic discontinuation was not associated with any subsequent change in calcium (P = 0.514). Urine calcium creatinine clearance ratio (CCCR) was <0.01 in 18.2% of patients with confirmed PHPT. Older age (P < 0.001) and lower PTH (P = 0.043) were associated with failure to locate an adenoma on ultrasound (44.0% of scans). When an adenoma was identified on ultrasound the lateralisation was correct in 94.5%. Non-curative surgery occurred in 8.2% and was greater in those requiring more than one neck imaging modality (OR 2.42, P = 0.035). Conclusions: Clinical features associated with PHPT are not strongly related to biochemistry. Thiazide cessation does not appear to attenuate hypercalcaemia. PHPT remains the likeliest diagnosis in the presence of low CCCR. Ultrasound is highly discriminant when an adenoma is identified but surgical failure is more likely when more than one imaging modality is required

Monocytes mediate homing of circulating microvesicles to the pulmonary vasculature during low-grade systemic inflammation

Microvesicles (MVs), a plasma membrane-derived subclass of extracellular vesicles, are produced and released into the circulation during systemic inflammation, yet little is known of cell/tissue-specific uptake of MVs under these conditions. We hypothesized that monocytes contribute to uptake of circulating MVs and that their increased margination to the pulmonary circulation and functional priming during systemic inflammation produces substantive changes to the systemic MV homing profile. Cellular uptake of i.v.-injected, fluorescently labelled MVs (J774.1 macrophage-derived) in vivo was quantified by flow cytometry in vascular cell populations of the lungs, liver and spleen of C57BL6 mice. Under normal conditions, both Ly6Chigh and Ly6Clow monocytes contributed to MV uptake but liver Kupffer cells were the dominant target cell population. Following induction of sub-clinical endotoxemia with low-dose i.v. LPS, MV uptake by lung-marginated Ly6Chigh monocytes increased markedly, both at the individual cell level (~2.5-fold) and through substantive expansion of their numbers (~8-fold), whereas uptake by splenic macrophages was unchanged and uptake by Kupffer cells actually decreased (~50%). Further analysis of MV uptake within the pulmonary vasculature using a combined model approach of in vivo macrophage depletion, ex vivo isolated perfused lungs and in vitro lung perfusate cell-based assays, indicated that Ly6Chigh monocytes possess a high MV uptake capacity (equivalent to Kupffer cells), that is enhanced directly by endotoxemia and ablated in the presence of phosphatidylserine (PS)-enriched liposomes and β3 integrin receptor blocking peptide. Accordingly, i.v.-injected PS-enriched liposomes underwent a redistribution of cellular uptake during endotoxemia similar to MVs, with enhanced uptake by Ly6Chigh monocytes and reduced uptake by Kupffer cells. These findings indicate that monocytes, particularly lung-marginated Ly6Chigh subset monocytes, become a dominant target cell population for MVs during systemic inflammation, with significant implications for the function and targeting of endogenous and therapeutically administered MVs, lending novel insights into the pathophysiology of pulmonary vascular inflammation

The Evolution of Private Equity: Corporate Restructuring in the UK, c.1945-2010

The paper analyses the role of private equity in restructuring the UK corporate economy. It develops a theoretical synthesis to show that the evolution of the PE industry and firms in which it invested were governed by the relations of corporate governance between investor and investee companies. Effective governance relations were a necessary condition for success and complement firm specific resources to create competitive advantage. Four case studies are used to show the contrasting effects of these determining factors, ICFC and Slater Walker, and the two waves of buy-out centred restructuring that developed with the maturity of the PE industry after 1980. In contrast to the evolutionary approach, the periodisations utilised in this study show that structural breaks associated with points of institutional reform are also necessary to make firm specific resource and governance determinants of competitive advantage operable

The martian dust chronicle: Eight years of reconstructed climatology from spacecraft observations

We have reconstructed the climatology of airborne dust from Martian years (MY) 24 to 31 using multiple datasets of retrieved or estimated column optical depth. The datasets are based on observations of the Martian atmosphere from March 1999 to July 2013 by different orbiting instruments: the Thermal Emission Spectrometer (TES) on board Mars Global Surveyor, the Thermal Emission Imaging System (THEMIS) on board Mars Odyssey, and the Mars Climate Sounder (MCS) on board Mars Reconnaissance Orbiter (MRO). The procedure we have adopted consists in gridding the available retrievals of column dust optical depth (CDOD) from TES and THEMIS nadir observations, as well as the estimates of this quantity from MCS limb observations. Our gridding method calculates weighted averages on a regular but likely incomplete spatial grid, using an iterative procedure with weights in space, time, and retrieval uncertainty. The derived product consists of daily synoptic gridded maps of CDOD at a resolution of 6 degree longitude x 3 degree latitude for MY 24-26, and 6 degree longitude x 5 degree latitude for MY 27-31. We have statistically analyzed the gridded maps to present an overview of the dust climatology on Mars over eight years, specifically in relation to its intraseasonal and interannual variability. Finally, we have produced complete daily maps of CDOD by spatially interpolating the available incomplete gridded maps using a kriging method. These complete maps are used as dust scenarios in the Mars Climate Database (MCD) version 5, and should be useful for many other applications. The maps for the eight available Martian years are publicly available and distributed with open access, under Creative Commons Attribution-ShareAlike 3.0 Unported License. The current version and future updates can be downloaded from the MCD website at the Laboratoire de Meteorologie Dynamique: http://wwwmars. lmd.jussieu.fr/mars/dust_climatology

Erdheim‐Chester disease in bone marrow

No abstract available

The effect of high dose antibiotic impregnated cement on rate of surgical site infection after hip hemiarthroplasty for fractured neck of femur : a protocol for a double-blind quasi randomised controlled trial

Background: Mortality following hip hemiarthroplasty is in the range of 10-40% in the first year, with much attributed to post-operative complications. One such complication is surgical site infection (SSI), which at the start of this trial affected 4.68% of patients in the UK having this operation. Compared to SSI rates of elective hip surgery, at less than 1%, this figure is elevated. The aim of this quasi randomised controlled trial (RCT) is to determine if high dose antibiotic impregnated cement can reduce the SSI in patients at 12-months after hemiarthroplasty for intracapsular fractured neck of femur. Methods: 848 patients with an intracapsular fractured neck of femur requiring a hip hemiarthroplasty are been recruited into this two-centre double-blind quasi RCT. Participants were recruited before surgery and quasi randomised to standard care or intervention group. Participants, statistician and outcome assessors were blind to treatment allocation throughout the study. The intervention consisted of high dose antibiotic impregnated cement consisting of 1 gram Clindamycin and 1 gram of Gentamicin. The primary outcome is Health Protection Agency (HPA) defined deep surgical site infection at 12 months. Secondary outcomes include HPA defined superficial surgical site infection at 30 days, 30 and 90-day mortality, length of hospital stay, critical care stay, and complications. Discussion: Large randomised controlled trials assessing the effectiveness of a surgical intervention are uncommon, particularly in the speciality of orthopaedics. The results from this trial will inform evidence-based recommendations for antibiotic impregnated cement in the management of patients with a fractured neck of femur undergoing a hip hemiarthroplasty. If high dose antibiotic impregnated cement is found to be an effective intervention, implementation into clinical practice could improve long-term outcomes for patients undergoing hip hemiarthroplasty

Geostationary Coastal and Air Pollution Events (GeoCAPE) Filter Radiometer (FR)

The GeoCAPE Filter Radiometer (FR) Study is a different instrument type than all of the previous IDL GeoCape studies. The customer primary goals are to keep mass, volume and cost to a minimum while meeting the science objectives and maximizing flight opportunities by fitting on the largest number of GEO accommodations possible. Minimize total mission costs by riding on a commercial GEO satellite. For this instrument type, the coverage rate, km 2 min, was significantly increased while reducing the nadir ground sample size to 250m. This was accomplished by analyzing a large 2d area for each integration period. The field of view will be imaged on a 4k x 4k detector array of 15 micrometer pixels. Each ground pixel is spread over 2 x 2 detector pixels so the instantaneous field of view (IFOV) is 2048 X 2048 ground pixels. The baseline is, for each field of view 50 sequential snapshot images are taken, each with a different filter, before indexing the scan mirror to the next IFOV. A delta would be to add additional filters

Mapeando Dificuldades e Intervenções no Cotidiano das Organizações de Cultura Popular em Caruaru-PE

Neste texto, o objetivo é refletir sobre o cotidiano de organizações de culturas populares em Caruaru-PE, a partir de duas vivências: a primeira, referente ao mapeamento das principais dificuldades vividas por mestres(as), e a segunda, referente às intervenções realizadas. Partimos da noção de cotidiano de Michel de Certeau, para compreender as práticas táticas (ou microrresistências), e a premissa filosófica das práticas para a compreensão da realidade social. Realizamos conversas informais e entrevistas semiestruturadas com doze mestres(as) de onze diferentes segmentos da cultura popular e observações não participantes. Destacamos que as dificuldades mapeadas são expressões dos conflitos existentes no cotidiano dos(as) mestres(as), levando-os a realizar práticas táticas. Ademais, ressaltamos as ações de intervenção como possíveis microrresistências às práticas acadêmicas instituídas, capazes de se relacionar com as práticas das próprias organizações de culturas populares, criando “espaços” nos “lugares” instituídos, e constituindo o cotidiano