Persistent vaginal granulation tissue of a large size on the episiotomy scar

Although persistent granulation tissue continues to be a well-recognized complication of wound healing, the incidence of episiotomy scar granulation tissue is unknown, and reports are rare. Herein, we present a case of multiple hypertrophied and polypoidal granulation tissue of a large size at the site of episiotomy scar treated with surgical excision and the recovery was uneventful with excellent results

Effect of types of fibres on the shear behaviour of deep beam with opening

This paper discusses experiments on the behaviour of deep beams with and without opening in the styles of stainless-steel fibres under a two-point load test. Triple varieties of stainless steel fibre used (constant fibre fraction (1 percent) by volume of concrete, (straight, hooked and corrugated steel fibre)). In this analysis, the key parameters were the fibre forms and the influence of the opening on the behaviour. The results show that the steel fibres raise the first crack and final loads in both groups (first group without opening the second group with opening). Besides, an increase of (20.6 to 40.5) % in first cracking load for the first group and (36.4 to 56.7) % for the second group and an increase of (59.5 to 110.1) % and (20.2 to 28.8) % in ultimate load for first and second groups respectively

Outcome of patients with osteosarcoma over 40 years of age: Is angiogenesis a marker of survival?

BACKGROUND: Osteosarcoma predominantly afflicts young people in their second and third decades of life. When osteosarcoma arises in patients older than 40 years, the prognosis is usually poorer compared to their younger counterparts. Although the clinical, histopathologic features and prognostic indicators are well defined for young patients, much less is known about affected adults. The purpose of this study is to describe our institution's experience with the management of osteosarcoma in patients greater than 40 years and also evaluate, by immunohistochemical analysis, the prognostic significance of microvessel density, as a marker of intratumoural angiogenesis. METHODS: A retrospective clinicopathological analysis was performed on 11 patients over the age of 40 years that were treated at our institution between 1996 and 2004. Archival pre-treatment biopsy tissue was retrieved for immunohistochemical staining against two endothelial cell markers (CD31 and CD34) and also against VEGF. Angiogenesis was assessed by determining the intratumoural microvessel density (MVD) and the degree of VEGF expression in these specimens. This was correlated with patient outcome in terms of local recurrence, metastasis and death. Histological results were also compared to a group of patients less than 40 years of age. RESULTS: Of the 11 patients, 9 were male and 2 were female and the mean age was 58 years (range, 42–85). In 7 patients, osteosarcoma arose secondarily from Paget's disease of the bone. The most common site involved was the humerus (7) followed by the femur (2) then pelvis (1) and ulna (1). At the time of diagnosis, 4 patients had metastatic disease. Preoperative chemotherapy was given to 4 patients, with a good response in 3 patients. Six patients underwent limb-sparing surgery, 4 had amputations and 1 was treated with radiotherapy alone. The mean follow up time was 31.5 months (range, 8–81). At this time, 4 patients (36%) had developed lung metastases and 5 patients (46%) had died. Overall survival was 54.5%. Intratumoural MVD was higher in patients over 40 years, although not statistically significant (p = 0.111, CD31; p = 0.134, CD34). VEGF was uniformly expressed in all sections, however no relationship was found between the degree of expression and patient age. CONCLUSION: The prognosis for older patients with osteosarcoma is generally poor. Initial presentation is commonly associated with metastatic disease and neoadjuvant chemotherapy is often avoided because of its side effects. Increased intratumoural vascularity may contribute to the poorer prognosis in these patients, however further studies are needed

Structural behavior of two-way slabs cast with different fiber types and contents

This paper presents an experimental investigation on the effects of incorporating Stainless-Steel Fibers (SSF) on the flexural behavior of reinforced concrete two-way slabs. For this deal, three types of steel fiber (straight, hooked, and corrugated steel fiber) are used. Each type of steel fiber was added in four different volume fractions. Each steel fiber shape was added separately by proportions (0, 0.5, 1, 1.5) % of the total concrete volume. Subsequently, ten 800 × 800 mm × 100 reinforced concrete slabs (three slabs for each type of fibers, one for each proportion, and the remaining one slab was the control) were cast and subjected to flexural tests. The effect of type and amount of SSF on flexural behavior of two-way slabs were studied. That, where 0.5% of steel fibers was added, the straight fibers were acknowledged in comparison to the others whereas the improvement to the stiffness was better and the ultimate load increased by 22.58%. At 1% of steel fibers, the ultimate load increased by (35, 43, and 29) % for straight, hooked, and corrugated fibers respectively which at this addition ratio the hooked fibers were the notable contributor as opposed to other types, and this observation was apparent in improving splitting and flexure strength for hardened concrete. Adding 1.5% of steel fibers to the concrete degrade the workability severely by (83-92)% for all types of steel fibers in parallel with little improvement on slabs behavior is contrary to 1% ratio, thus, the 1% is the recommended addition

The Helicobacter pylori HrcA repressor: Study of the Global Transcriptional Response during Heat Shock.

The ability to respond quickly to environmental changes and thus modulate gene expression is a crucial skill exploited by bacteria for their survival. In this context, the widespread human pathogen Helicobacter pylori, under stress conditions induces the synthesis of a class of highly conserved proteins, called Heat Shock Proteins. In this bacterium, the major heat-shock genes are negatively regulated by two transcriptional repressors, HspR and HrcA. Although the heat-shock regulatory circuit is well-studied, not enough is known about the global heat shock response in H. pylori. In order to identify other potential cellular process regulated by HrcA, we performed differential transcriptional analysis of heat shock regulation by RNA-seq, comparing the transcriptome of the H. pylori G27 wild type strain subjected and not subjected to heat shock stress versus the HrcA isogenic G27 mutant strain. This analysis showed that most of the differentially expressed genes were deregulated only under heat shock treatment. Moreover, several non-heat shock responsive genes were deregulated in the HrcA mutant. To further characterize the HrcA regulon in H. pylori we attempted setting up a ChIP-seq experiment. However, the HrcA protein appears to be poorly immunogenic, for this reason we used a strategy in which an epitope (3XFLAG), recognized by commercial antibodies, was fused to the N-terminal region of the HrcA protein. In addition, three levels of expression (weak, intermediate and strong) of the 3XFLA-HrcA were obtained by using three known H. pylori promoters. The immunoprecipitation assays performed showed a poor enrichment of DNA fragments bound by HrcA and hindered the identification of novel in vivo HrcA binding sites. Thereafter, we further analyzed the HrcA-DNA interactions on some putative targets through DNaseI footprinting assays on novel putative target promoters binding of the regulator could not be detected and possibly transcriptional regulation by HrcA of these genes is indirect

Evidence based models for evaluating opertaing room performance

The operating room (OR) within a hospital environment is one of the most expensive functional areas, yet the use of the OR also provides hospitals with an essential source of income. However, at present, there are variations on how to evaluate the performance of ORs, since there is no clear and full explanation of the concept and methods used for evaluation. The overall aim of this thesis is to develop an evidence based Operating Room Assessment Framework (ORAF) to evaluate Operating Room performance with clear and complete guidelines that can be used by operating room managers, directors or any other medical professionals to evaluate operating room performance, determine OR planning and scheduling efficiency, OR workload and OR utilization. The resulting Operating Room Assessment Framework will assist targeted healthcare professionals in their quest to evaluate, monitor and improve overall Operating Room efficiency. The OR management systems of eight tertiary and teaching hospitals in three countries (Japan, Canada and Saudi Arabia) have been examined from 2010 to 2012, which include more than 98,500 procedures. The Operating Room Assessment Framework (ORAF) involves three important elements of Operating Room performance, namely: OR scheduling level, the type of OR workload, and OR utilization. These elements can simply be read to reach the end result, which includes three types of scheduling levels: under scheduling, ideal scheduling and over scheduling; five types of OR workload: OR total workload (the gross workload), OR actual workload, over workload, unnecessary workload and unexpected workload; and three types of OR utilization: underutilization, ideal utilization, and 100% utilization with over workload. Through the validation process in different hospital contexts, the ORAF has proven its ability to perform satisfactorily, with accuracy, in line within the research’s objectives

Genome Sequence of Borrelia chilensis VA1, a South American Member of the Lyme Borreliosis Group

Borrelia chilensis strain VA1 is a recently described South American member of the Borrelia burgdorferi sensu lato complex from Chile. Whole-genome sequencing analysis determined its linear chromosome and plasmids lp54 and cp26, confirmed its membership in the Lyme borreliosis group, and will open new research avenues regarding its pathogenic potential

Glucose-6-phosphate dehydrogenase-derived NADPH fuels superoxide production in the failing heart.

In the failing heart, NADPH oxidase and uncoupled NO synthase utilize cytosolic NADPH to form superoxide. NADPH is supplied principally by the pentose phosphate pathway, whose rate-limiting enzyme is glucose 6-phosphate dehydrogenase (G6PD). Therefore, we hypothesized that cardiac G6PD activation drives part of the excessive superoxide production implicated in the pathogenesis of heart failure. Pacing-induced heart failure was performed in eight chronically instrumented dogs. Seven normal dogs served as control. End-stage failure occurred after 28 +/- 1 days of pacing, when left ventricular end-diastolic pressure reached 25 mm Hg. In left ventricular tissue homogenates, spontaneous superoxide generation measured by lucigenin (5 microM) chemiluminescence was markedly increased in heart failure (1338 +/- 419 vs. 419 +/- 102 AU/mg protein, P < 0.05), as were NADPH levels (15.4 +/- 1.5 vs. 7.5 +/- 1.5 micromol/gww, P < 0.05). Superoxide production was further stimulated by the addition of NADPH. The NADPH oxidase inhibitor gp91(ds-tat) (50 microM) and the NO synthase inhibitor L-NAME (1 mM) both significantly lowered superoxide generation in failing heart homogenates by 80% and 76%, respectively. G6PD was upregulated and its activity higher in heart failure compared to control (0.61 +/- 0.10 vs. 0.24 +/- 0.03 nmol/min/mg protein, P < 0.05), while superoxide production decreased to normal levels in the presence of the G6PD inhibitor 6-aminonicotinamide. We conclude that the activation of myocardial G6PD is a novel mechanism that enhances NADPH availability and fuels superoxide-generating enzymes in heart failure