Paroxysmal supraventricular tachycardia managed with acupressure of Nei-Guan (PC6): the report of a case in the emergency department

Background: We described a 75-year-old man with a history of recurrent attacks of paroxysmal supraventricular tachycardia (PSVT). The patient presented to the emergency department (ED) with complaints of palpitations and chest tightness. Vagal stimulation maneuvers failed to convert the rhythmMaterials and Methods: Acupressure was applied on Nei-Guan (PC6).Results: Acupressure applied on PC6 immediately converted the tachycardia to a normal sinus rhythm, thus successfully terminated an episode of PSVT complicated with hypotension and chest pain in the patient reportedConclusion: Acupressure of PC6 is easy to perform and safe, and can be done when other resuscitative measures are ongoing the same time. It is harmless and appropriate for certain groups of patients such as the elderly, children and pregnant women and worth trying before the administration of medication.Keywords: Paroxysmal supraventricular tachycardia (PSVT), Nei-guan (PC6

Robot-assisted versus standard laparoscopic partial nephrectomy: comparison of perioperative outcomes from a single institution

OBJECTIVE: To evaluate the perioperative outcomes of robot-assisted laparoscopic partial nephrectomy and standard laparoscopic partial nephrectomy in a teaching hospital. DESIGN: Retrospective study. SETTING: Division of Urology, Department of Surgery, Queen Mary and Tung Wah hospitals, Hong Kong. PATIENTS: The first 10 consecutive patients who had robot-assisted laparoscopic partial nephrectomy for renal tumours between January 2008 and September 2009 with prospective data collection were evaluated. Their outcomes were compared with the last 10 consecutive patients in our database, who had standard laparoscopic partial nephrectomy between November 2004 and October 2007. MAIN OUTCOME MEASURES: Demographics, tumour characteristics, perioperative outcomes, renal function, and pathological outcomes. RESULTS: There were no differences between the groups with regard to age (63 vs 56 years; P=0.313) and tumour size (2.7 vs 2.8 cm; P=0.895). No significant difference was found between the two groups with respect to the operating room time (376 vs 361 min; P=0.722), estimated blood loss (329 vs 328 mL; P=0.994), and length of hospital stay (7 vs 14 days; P=0.213). A statistically significant shorter mean warm ischaemic time for the robot-assisted group was noted (31 vs 40 minutes; P=0.032). Respective renal functional outcomes as shown by the difference between day 0 and day 60 serum creatinine levels were comparable (+10 vs +7 mmol/L; P=0.605). In both groups, there were no intra-operative complications or instances of surgical margin tumour involvement. Three patients endured postoperative complications in the standard laparoscopic group (a perinephric haematoma, urine leakage, and lymph leakage) compared with one in the robot-assisted group (a perinephric haematoma). These complications all resolved with conservative treatment. CONCLUSIONS: Robot-assisted laparoscopic partial nephrectomy is a technically feasible alternative to standard laparoscopic partial nephrectomy, and provides comparable results. Robot-assisted laparoscopic partial nephrectomy appears to offer the advantage of decreased warm ischaemic time. Longer follow-up is required to assess renal function and oncological outcomes. Further experience and randomised trials are necessary to compare robot-assisted with standard laparoscopic partial nephrectomy.published_or_final_versio

How Do Biological Characteristics of Primary Intracranial Tumors Affect Their Clinical Presentation in Children and Young Adults?

We demonstrated the pattern in presentation of primary intracranial tumors in a population-based cohort of patients aged 0-24 years identified from the National Cancer Registry for England, using linked medical records from primary care and hospitals. We used generalized additive models to estimate temporal changes in presentation rates. Borderline and malignant tumors presented at a similar rate in primary care (6.4 and 6.6 consultations per 100 patients each month) and in hospital (3.4 and 3.6). Benign tumors presented earlier but less frequently (rate = 4.4 and rate ratio = 0.75, 95% CI = 0.60-0.93, in primary care; rate = 2.6 and rate ratio = 0.83, 95% CI = 0.77-0.89, in hospital). Many tumors began presenting shortly before their diagnosis, but less aggressive tumors were likely to present earlier in primary care. Earlier detection of less aggressive tumors in primary care may reduce the risk of complications and morbidity among survivors

Pattern of symptoms and signs of primary intracranial tumours in children and young adults: a record linkage study.

OBJECTIVE: To describe the age pattern and temporal evolution of symptoms and signs of intracranial tumours in children and young adults before diagnosis. DESIGN AND SETTING: A record linkage study using population-based data from the National Cancer Registry, linked to Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES). PATIENT COHORT: Patients aged 0-24 years when diagnosed with a primary intracranial tumour between 1989 and 2006 in England. METHODS: Linked records of relevant symptoms and signs in primary care and hospitals were extracted from CPRD (1989-2006, 181 patients) and HES (1997-2006, 3959 patients). Temporal and age-specific changes in presentation rates before diagnosis of an intracranial tumour, for each of eight symptom groups, were estimated in generalised additive models. RESULTS: All symptoms presented with increasing frequency until eventual diagnosis. The frequency of presentation of raised intracranial pressure (ICP) to hospitals rose rapidly to 36.4 per 100 person-months (95% CI 34.6 to 38.4) in the final month before diagnosis in the entire cohort. Clinical features in primary care were less specific: the main features were visual disturbance (rate: 0.49 per 100 person-months; 95% CI 0.33 to 0.72) in newborns to 4-year-olds, headache in 5-year-olds to 11-year-olds (0.64; 0.47 to 0.88), 12-year-olds to 18-year-olds (1.59; 1.21 to 2.08) and 19-year-olds to 24-year-olds (2.44; 1.71 to 3.49). The predominant features at hospital admission were those of raised ICP: between 1.17 per 100 person-months (95% CI 1.08 to 1.26) in newborns to 4-year-olds and 0.77 (0.67 to 0.88) in 19-year-olds to 24-year-olds. CONCLUSIONS: Non-localising symptoms and signs were more than twice as common as focal neurological signs. An intracranial tumour should be considered in patients with relevant symptoms that do not resolve or that progress rapidly

Carcinoid tumour of the kidney in a Chinese woman presenting with loin pain

Renal carcinoid tumours are uncommon. The aetiology is not yet fully understood and there is still no useful diagnostic tool for detecting them. We report our experience managing a Chinese woman with a primary renal carcinoid tumour.published_or_final_versio

Alterations in Gastric Microbiota After H. Pylori Eradication and in Different Histological Stages of Gastric Carcinogenesis

The role of bacteria other than Helicobacter pylori (HP) in the stomach remains elusive. We characterized the gastric microbiota in individuals with different histological stages of gastric carcinogenesis and after receiving HP eradication therapy. Endoscopic gastric biopsies were obtained from subjects with HP gastritis, gastric intestinal metaplasia (IM), gastric cancer (GC) and HP negative controls. Gastric microbiota was characterized by Illumina MiSeq platform targeting the 16 S rDNA. Apart from dominant H. pylori, we observed other Proteobacteria including Haemophilus, Serratia, Neisseria and Stenotrophomonas as the major components of the human gastric microbiota. Although samples were largely converged according to the relative abundance of HP, a clear separation of GC and other samples was recovered. Whilst there was a strong inverse association between HP relative abundance and bacterial diversity, this association was weak in GC samples which tended to have lower bacterial diversity compared with other samples with similar HP levels. Eradication of HP resulted in an increase in bacterial diversity and restoration of the relative abundance of other bacteria to levels similar to individuals without HP. In conclusion, HP colonization results in alterations of gastric microbiota and reduction in bacterial diversity, which could be restored by antibiotic treatment.published_or_final_versio

瑪麗醫院進行腹腔鏡腎臟切除術的早期經驗

OBJECTIVE: To report our early experience of laparoscopic nephrectomy. DESIGN: Prospective data collection. SETTING: Queen Mary Hospital, Hong Kong. PATIENTS: Transperitoneal laparoscopic nephrectomies were performed on 40 patients between July 1997 and December 2002. MAIN OUTCOME MEASURES: Demographic and perioperative data including operating time, blood loss, postoperative pain score, analgesic requirement, complications, time to resume oral intake, ambulatory state, and length of hospital stay. RESULTS: Laparoscopic nephrectomy was performed for 21 solid renal masses, five transitional cell carcinomas, and 14 non-functioning kidneys. Seven (17.5%) patients had previous abdominal surgery. The mean body mass index of the patients was 23.9 kg/m(2) and the mean operating time was 229 minutes. The mean estimated blood loss was 370 mL, and two patients required conversion to open surgery because of intra-operative bleeding. Other complications include diaphragmatic injury, port-site bleeding, chyle leakage, bleeding peptic ulcer, and myocardial ischaemia. The postoperative mean analgesic requirement was 26 mg of morphine sulphate equivalent. The mean time for patients to resume oral diet and full ambulation was 1.3 and 2.8 days, respectively, and the mean length of hospital stay was 6.7 days. The mean diameter of the solid renal tumour was 4.1 cm and the surgical margins of all resected specimen for malignant tumours were negative. CONCLUSION: Laparoscopic nephrectomy is a safe and efficacious approach for resection of benign non-functioning kidneys and malignant renal tumours.published_or_final_versio

Gluon Scattering Amplitudes in Finite Temperature Gauge/Gravity Dualities

We examine the gluon scattering amplitude in N=4 super Yang-Mills at finite temperature with nonzero R-charge densities, and in Non-Commutative gauge theory at finite temperature. The gluon scattering amplitude is defined as a light-like Wilson loop which lives at the horizon of the T-dual black holes of the backgrounds we consider. We study in detail a special amplitude, which corresponds to forward scattering of a low energy gluon off a high energy one. For this kinematic configuration in the considered backgrounds, we find the corresponding minimal surface which is directly related to the gluon scattering amplitude. We find that for increasing the chemical potential or the non-commutative parameter, the on-shell action corresponding to our Wilson loop in the T-dual space decreases. For all of our solutions the length of the short side of the Wilson loop is constrained by an upper bound which depends on the temperature, the R-charge density and the non-commutative parameter. Due to this constraint, in the limit of zeroth temperature our approach breaks down since the upper bound goes to zero, while by keeping the temperature finite and letting the chemical potential or the non-commutative parameter to approach to zero the limit is smooth.Comment: 30 pages, 16 figures, minor corrections (plus improved numerical computation for the non-commutative case

Cryotomography of budding influenza a virus reveals filaments with diverse morphologies that mostly do not bear a genome at their distal end

Influenza viruses exhibit striking variations in particle morphology between strains. Clinical isolates of influenza A virus have been shown to produce long filamentous particles while laboratory-adapted strains are predominantly spherical. However, the role of the filamentous phenotype in the influenza virus infectious cycle remains undetermined. We used cryo-electron tomography to conduct the first three-dimensional study of filamentous virus ultrastructure in particles budding from infected cells. Filaments were often longer than 10 microns and sometimes had bulbous heads at their leading ends, some of which contained tubules we attribute to M1 while none had recognisable ribonucleoprotein (RNP) and hence genome segments. Long filaments that did not have bulbs were infrequently seen to bear an ordered complement of RNPs at their distal ends. Imaging of purified virus also revealed diverse filament morphologies; short rods (bacilliform virions) and longer filaments. Bacilliform virions contained an ordered complement of RNPs while longer filamentous particles were narrower and mostly appeared to lack this feature, but often contained fibrillar material along their entire length. The important ultrastructural differences between these diverse classes of particles raise the possibility of distinct morphogenetic pathways and functions during the infectious process