Laparoscopic Surgical Management and Clinical Characteristics of Ovarian Fibromas

Ovarian fibromas may be misdiagnosed as uterine myoma or ovarian malignant tumor. Laparoscopic examination appears to be an effective and safe surgical approach for managing ovarian fibromas

Isolated fracture of the ceramic head after third-generation alumina-on-alumina total hip arthroplasty

BACKGROUND: While most reports of component fracture following alumina-on-alumina total hip arthroplasty have involved the acetabular liner, few have involved fracture of the alumina femoral head. In the present multicenter study, we investigated ceramic head fractures in a cohort of patients who underwent third-generation alumina-on-alumina total hip arthroplasty. METHODS: We performed a retrospective study of 312 patients (367 hips) who underwent alumina-on-alumina total hip arthroplasty without cement at four participating centers with the use of a 28-mm BIOLOX forte femoral head and a BIOLOX forte liner from July 2001 to October 2003. Three hundred and five patients (359 hips) were evaluated at a mean of forty-five months postoperatively. Clinical follow-up with use of the Harris hip score and radiographic evaluation were performed at six weeks; at three, six, and twelve months; and every six months thereafter. Retrieved ceramic implants were examined by means of visual inspection. RESULTS: Five hips (1.4%) in five patients were revised because of a ceramic head fracture during the follow-up period. The ceramic head fractures occurred during normal daily activities at a mean of 22.6 months postoperatively. A short neck had been used in all five hips in which a fracture occurred, compared with 121 (34.2%) of the 354 hips in which a fracture did not occur (p = 0.009). The fracture involved a circular crack along the circumference of the thinnest portion of the head component at the proximal edge of the bore. The fracture also involved multiple vertical cracks extending radially along the longitudinal axis from the circumference of the circular crack line to the lower edge of the head component. CONCLUSIONS: In the present study, the rate of ceramic head fracture associated with one design of a short-neck modular alumina femoral head was 1.4% (five of 359). The extent to which these findings are generalizable to other designs that utilize this type of femoral head is unknown

Anesthetic consideration for patients with severe tracheal obstruction caused by thyroid cancer -A report of 2 cases-

To achieve safe airway management, it is essential first to predict whether there will be difficulties in intubating or ventilating the patient's airway. An enlarged thyroid mass can produce a tracheal obstruction by compression or intraluminal invasion or both. We report two patients with thyroid cancer that obstructed the trachea by compression or invasion. There was no difficulty in endotracheal intubation of the patients with marked thyroid enlargement or in securing passage of the endotracheal tube through the compressed or narrowed portion of the trachea

Extrahepatic Biliary Schwannomas: A Case Report

Benign schwannomas arise in neural crest-derived Schwann cells. They can occur almost anywhere in the body, but their most common locations are the central nervous system, extremities, neck, mediastinum, and retroperitoneum. Schwannomas occurring in the biliary tract are extremely rare and mostly present with obstructive jaundice. We recently experienced a case of extrahepatic biliary schwannomas in a 64-yr-old female patient who presented with intra- and extrahepatic bile duct and gallbladder stones during a screening program. To the best of our knowledge, extrahepatic biliary schwannomas associated with bile duct stones have not been reported previously in the literature

Elevated red cell distribution width is associated with advanced fibrosis in NAFLD

Background/AimsThe red-blood-cell distribution width (RDW) is a newly recognized risk marker in patients with cardiovascular disease, but its role in nonalcoholic fatty liver disease (NAFLD) has not been well defined. The aim of the present study was to determine the association between RDW values and the level of fibrosis in NAFLD according to BARD and FIB-4 scores.MethodsThis study included 24,547 subjects who had been diagnosed with NAFLD based on abdominal ultrasonography and questionnaires about alcohol consumption. The degree of liver fibrosis was determined according to BARD and FIB-4 scores. The association between RDW values and the degree of fibrosis in NAFLD was analyzed retrospectively.ResultsAfter adjusting for age, hemoglobin level, mean corpuscular volume, history of hypertension, history of diabetes, and high-sensitivity C-reactive protein, the RDW values were 12.61±0.41% (mean±SD), 12.70±0.70%, 12.77±0.62%, 12.87±0.82%, and 13.25±0.90% for those with BARD scores of 0, 1, 2, 3, and 4, respectively, and 12.71±0.72%, 12.79±0.66%, and 13.23±1.52% for those with FIB-4 scores of <1.30, 1.31-2.66, and ≥2.67, respectively (P<0.05). The prevalence of advanced fibrosis (BARD score of 24 and FIB-4 score of ≥1.3) increased with the RDW [BARD score: 51.1% in quartile 1 (Q1) vs. 63.6% in Q4; FIB-4 score: 6.9% in Q1 vs. 10.5% in Q4; P<0.001]. After adjustments, the odds ratio of having advanced fibrosis for those in Q4 compared to Q1 were 1.76 (95%CI=1.55-2.00, P<0.001) relative to BARD score and 1.69 (95%CI=1.52-1.98, P<0.001) relative to FIB-4 score.ConclusionsElevated RDW is independently associated with advanced fibrosis in NAFLD

Nulägesanalys och förbättringar inom Veidekkes anläggningsprojekt : Veidekkes fortsatta utveckling av anläggningsprojekt

Byggbranschen står i nuläget för utsläpp av cirka 11 miljoner ton koldioxidekvivalenter per år och av dem står anläggningsbranschen för 6 miljoner ton koldioxidekvivalenter per år. Alla aktörer i branschen står inför en tuff uppgift att minska de totala utsläppen tills 2050 då målet i Sverige är att minska energianvändningen med 50%.  Genom att certifiera anläggningsprojekt fås en positiv utveckling av branschens miljöarbete. Då CEEQUAL är det enda certifieringssystem som finns översatt till svenska och att de har mest erfarenhet i branschen är CEEQUAL det populäraste valet för att certifiera anläggningsprojekt. I CEEQUAL bedöms beställarens, projektörens och entreprenörens miljöarbete i projekten. De delar som bedöms är projektstrategi, projektledning, människor och lokalsamhälle, markanvändning och landskapsutformning, kulturhistorisk miljö, ekologi och biologisk mångfald, vattenmiljö, fysiska resurser- användning och hantering samt transporter. Examensarbetes syfte och mål var att undersöka skillnaderna i arbetet med hållbarhet inom verksamhetsområdena Anlägg och Bygg i Veidekke genom en nulägesanalys av arbetssättet i projekten, samt bidra till ökad förståelse för hur certifieringssystem förbättrar ett projekt.  Genom att visa hur hållbarhetsarbetet mellan anlägg och bygg skiljer sig åt, visa vad man förbättrar genom att införa ett certifieringssystem samt ta fram alternativa metoder för att utföra delmoment i projekten på ett hållbarare vis. Undersökningen genomfördes med en litteraturstudie, nulägesanalys med tre olika projekt som jämfördes samt att förbättringsförslag presenterades och där CEEQUAL fokuserades mest på.   Resultatet från undersökningen visade att grundidén i Veidekke Bygg och Anlägg är lika och i detta fall var enda skillnaden att bygg har kommit längre med certifieringssystem än anlägg samt att dokumentera projektet digitalt.  Förbättringsområden som föreslogs var enligt följande:        1.           All dokumentation bör vara digital        2.           Storstadskraven ska uppfyllas        3.           Bör vara krav på användning av biodiesel        4.           Byte till energisnålare personalbodar        5.           Dokument för att få en bättre CEEQUAL bedömning        6.           Bör använda hjälpsystem för grävmaskiner        7.           Bör använda Eco asfalt Resultatet av CEEQUAL bedömningen visade att projekt Edsvalla VA skulle klara bedömningen ”Pass” med 27% vilket är precis på gränsen för att bli godkänt. De främsta förbättringar som bör ske för en klassning av CEEQUAL kapitel 4 och 8, anses vara: Livscykelanalys av området Vattenresursanalys Analys av omkringliggande landskap

Piperine Ameliorates Trimellitic Anhydride-Induced Atopic Dermatitis-Like Symptoms by Suppressing Th2-Mediated Immune Responses via Inhibition of STAT6 Phosphorylation

Atopic dermatitis (AD) is a common inflammatory skin disease predominately related to Type 2 helper T (Th2) immune responses. In this study, we investigated whether piperine is able to improve AD symptoms using a trimellitic anhydride (TMA)-induced AD-like mouse model. Topical treatment with piperine reduced ear swelling (ear thickness and epidermal thickness) induced by TMA exposure. Furthermore, piperine inhibited pro-inflammatory cytokines such as TNF-&alpha; and IL-1&beta; in mouse ears, compared with the TMA-induced AD group. In measuring allergic immune responses in draining lymph nodes (dLNs), we found that IL-4 secretion, GATA3 mRNA level, and STAT6 phosphorylation were suppressed by piperine treatment. In an ex vivo study, piperine also inhibited the phosphorylation of STAT6 on the CD4+ T cells isolated from splenocytes of BALB/c mice, and piperine suppressed IL-4-induced CCL26 mRNA expression and STAT6 phosphorylation in human keratinocytes resulting in the inhibition of infiltration of CCR3+ cells into inflammatory lesions. These results demonstrate that piperine could ameliorate AD symptoms through suppression of Th2-mediated immune responses, including the STAT6/GATA3/IL-4 signaling pathway. Therefore, we suggest that piperine is an excellent candidate as an inhibitor of STAT6 and may help to improve AD symptoms

Oral Administration of Achyranthis radix Extract Prevents TMA-induced Allergic Contact Dermatitis by Regulating Th2 Cytokine and Chemokine Production in Vivo

Allergic contact dermatitis (ACD) remains a major skin disease in many countries, necessitating the discovery of novel and effective anti-ACD agents. In this study, we investigated the preventive effects of Achyranthis radix extract (AcRE) on trimellitic anhydride (TMA)-induced dermatitis and the potential mechanism of action involved. Oral administration of AcRE and prednisolone (PS) significantly suppressed TMA-induced increases in ear and epidermal thickness, and IgE expression. In addition, abnormal expression of IL-1β and TNF-α protein and mRNA was also significantly attenuated by oral administration of AcRE. Treatment with AcRE also significantly suppressed TMA-induced IL-4 and IL-13 cytokines and mRNA expression in vivo. Moreover, AcRE strongly suppressed TMA-induced IL-4 and IL-5 production in draining lymph nodes, as well as OVA-induced IL-4 and IL-5 expression in primary cultured splenocytes. Interestingly, AcRE suppressed IL-4-induced STAT6 phosphorylation in both primary cultured splenocytes and HaCaT cells, and TMA-induced GATA3 mRNA expression ex vivo. AcRE also suppressed TMA-mediated CCL11 and IL-4-induced CCL26 mRNA expression and infiltration of CCR3 positive cells. The major compounds from AcRE were identified as gentisic acid (0.64 ± 0.2 μg/g dry weight of AcRE), protocatechuic acid (2.69 ± 0.1 μg/g dry weight of AcRE), 4-hydroxybenzoic acid (5.59 ± 0.3 μg/g dry weight of AcRE), caffeic acid (4.21 ± 0.1 μg/g dry weight of AcRE), and ferulic acid (14.78 ± 0.4 ± 0.3 μg/g dry weight of AcRE). Taken together, these results suggest that AcRE has potential for development as an agent to prevent and treat allergic contact dermatitis

Evaluation of a hydrology and run-off BMP model in SUSTAIN on a commercial area and a public park in South Korea

Adapting best management practices (BMPs) is influenced by target reduction efficiency BMP size, and BMP type. The System for Urban Storm water Treatment and Analysis INtegration (SUSTAIN) model was evaluated to determine optimal size and type of BMP with monitoring results from a commercial area and a public park in Korea. The hydrology model in SUSTAIN was tested in a commercial area (impervious area: 85%) and a public park (impervious area: 36%) in South Korea. A sensitivity analysis revealed that the significant parameters for total flow were impervious area Manning&apos;s roughness (IMPN) and saturated hydraulic conductivity (HYDCON); and those for peak flow were IMPN, Manning&apos;s roughness of conduit (ROUGH) and HYDCON. The observed average run-off ratios of the two study sites were 0.59 and 0.30 for the commercial area and the public park, respectively. In contrast, the simulated average run-off ratios were 0.53 and 0.22, respectively. The SUSTAIN hydrology model was also evaluated statistically by comparing observed and simulated run-off. In a commercial area, R2, root mean square error, and Nash-Sutcliffe efficiency were 0.68, 10.98, and 0.46, respectively, whereas the public park yielded 0.74, 1.97, and 0.62, respectively. After calibrating the model, the BMP options of SUSTAIN (i.e. bioretention, dry pond, and wet pond) were utilized to test run-off reduction capability with 11 mm of retaining run-off depth from the commercial area and 3 mm from the public park. Monitoring data showed that 11 and 3 mm run-off storage ensured about a 50% reduction of run-off from the commercial area and the public park, respectively. In the commercial area, average reduction rates were identically all 43.0% for bioretention, dry pond, and wet pond, respectively, and those for the public park were 49.6, 57.6, and 53.5%, respectively. Overall, the BMP function of SUSTAIN seemed to be reasonable for reducing run-off and could be used to design BMP to meet a target reduction goal where monitoring data does not exist.close