[Impact of glucagon-like peptide-1 receptor agonists on nasopharyngitis and upper respiratory tract infection among patients with type 2 diabetes: a network meta-analysis].

[Impact of glucagon-like peptide-1 receptor agonists on nasopharyngitis and upper respiratory tract infection among patients with type 2 diabetes: a network meta-analysis].

Beijing Da Xue Xue Bao. 2016 Jun 18;48(3):454-459

Authors: Li ZX, Wu SS, Yang ZR, Zhan SY, Sun F

Abstract
OBJECTIVE: To systematically review the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on two common respiratory system adverse events (RSAE: nasopharyngitis and upper respiratory tract infection) among type 2 diabetes (T2DM).
METHODS: Medline, Embase, Clinical trials and Cochrane library were searched from inception through May 2015 to identify randomized clinical trials(RCTs) assessed safety of GLP-1RAs versus placebo or other anti-diabetic drugs in T2DM. Network meta-analysis within a Bayesian framework was performed to calculate odds ratios for the incidence of RSAE.
RESULTS: In the study, 50 RCTs were included, including 13 treatments: 7 GLP-1RAs (exenatide, exenatide-long-release-agent, liraglutide, lixisenatide, taspoglutide, albiglutide and dulaglutide), placebo and 5 traditional anti-diabetic drugs(insulin, metformin, sulfonylureas, sitagliptin and thiazolidinediones ketones). Compared with insulin, taspoglutide significantly decreased the incidence of nasopharyngitis (OR=0.67, 95%CI: 0.46-0.96). Significant lowering effects on upper respiratory tract infection were found when taspoglutide versus placebo (OR=0.57, 95%CI: 0.34-0.99) and insulin (OR=0.39, 95%CI: 0.23-0.73). The result from the network meta-analysis based on Bayesian theory could be used to rank all the treatments included, which showed that taspoglutide ranked last with minimum risk on nasopharyngitis and upper respiratory tract infection.
CONCLUSION: Taspoglutide was associated with significantly lowering effect on RSAE.

PMID: 27318907 [PubMed - as supplied by publisher]

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The development of immunotherapy in older adults: New treatments, new toxicities?

The development of immunotherapy in older adults: New treatments, new toxicities?

J Geriatr Oncol. 2016 Jun 15;

Authors: Helissey C, Vicier C, Champiat S

Abstract
Monoclonal antibodies targeting immune checkpoint molecules CTLA-4, PD-1 or PD-L1 are emerging as promising anticancer therapeutics in multiple cancer subtypes resulting in remarkable and long-lasting clinical responses. These immune checkpoint blockers (ICBs) have already obtained approval for the treatment of patients with metastatic melanoma, advanced/refractory non-small cell lung cancer and renal cell cancer. ICBs enhance immune responses against cancer cells but can also lead to inflammatory side effects called immune-related adverse events (irAEs). Such toxicities are distinct from those associated with traditional chemotherapeutic agents or molecularly targeted therapies. Although severe irAEs remain rare (~10% of cases under monotherapy), they can become life-threatening if not anticipated and managed appropriately. As malignancies are frequently diagnosed in older patients, ICB treatment of elderly presents a unique challenge. However, the knowledge about efficacy and toxicity of these molecules in this specific population is limited, as most of the studies have involved a low number of older patients. In this review, we will discuss about the different ICB efficacy data available for older patients. We will then highlight the specific spectrum of immunotherapy toxicities and talk about their management in the context of older adults.

PMID: 27318796 [PubMed - as supplied by publisher]

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Double minute chromosomes in acute myeloid leukemia, myelodysplastic syndromes, and chronic myelomonocytic leukemia are associated with micronuclei, MYC or MLL amplification, and complex karyotype.

Double minute chromosomes in acute myeloid leukemia, myelodysplastic syndromes, and chronic myelomonocytic leukemia are associated with micronuclei, MYC or MLL amplification, and complex karyotype.

Cancer Genet. 2016 May 27;

Authors: Huh YO, Tang G, Talwalkar SS, Khoury JD, Ohanian M, Bueso-Ramos CE, Abruzzo LV

Abstract
Double minute chromosomes (dmin) are small, paired chromatin bodies that lack a centromere and represent a form of extrachromosomal gene amplification. Dmin are rare in myeloid neoplasms and are generally associated with a poor prognosis. Most studies of dmin in myeloid neoplasms are case reports or small series. In the current study, we present the clinicopathologic and cytogenetic features of 22 patients with myeloid neoplasms harboring dmin. These neoplasms included acute myeloid leukemia (AML) (n = 18), myelodysplastic syndrome (MDS) (n = 3), and chronic myelomonocytic leukemia (CMML) (n = 1). The AML cases consisted of AML with myelodysplasia-related changes (n = 13) and therapy-related AML (n = 5). Dmin were detected in initial pre-therapy samples in 14 patients with AML or CMML; they were acquired during the disease course in 8 patients who had AML or MDS. The presence of dmin was associated with micronuclei (18/18; 100%), complex karyotype (17/22; 77.3%), and amplification of MYC (12/16; 75%) or MLL (4/16; 25%). Immunohistochemical staining for MYC performed on bone marrow core biopsy or clot sections revealed increased MYC protein in all 19 cases tested. Except for one patient, most patients failed to respond to risk-adapted chemotherapies. At last follow up, all patients had died of disease after a median of 5 months following dmin detection. In conclusion, dmin in myeloid neoplasms commonly harbor MYC or MLL gene amplification and manifest as micronuclei within leukemic blasts. Dmin are often associated with myelodysplasia or therapy-related disease, and complex karyotypes.

PMID: 27318442 [PubMed - as supplied by publisher]

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Late pneumolabyrinth after stapedectomy.

Late pneumolabyrinth after stapedectomy.

Eur Ann Otorhinolaryngol Head Neck Dis. 2016 Jun 15;

Authors: Ziade G, Barake R, El Natout T, El Natout MA

Abstract
INTRODUCTION: Pneumolabyrinth is defined as the presence of air within the inner ear causing cochleovestibular signs and symptoms. Twenty-seven cases of pneumolabyrinth are published in the literature of which only two were described as delayed pneumolabyrinth as a complication of stapes surgery.
CASE REPORT: A 45-year-old male patient presented with vertigo after Valsalva maneuver 12 years after stapedectomy. He was diagnosed with delayed pneumolabyrinth on high resolution computed tomography and underwent an exploratory tympanotomy with surgical repair.
DISCUSSION: Delayed pneumolabyrinth is a rare complication of stapes surgery and should be considered in patients presenting with vestibulocochlear symptoms even many years later. An exploratory tympanotomy is recommended for patients diagnosed with pneumolabyrinth and having a sensorineural hearing loss and/or persistent vertigo.

PMID: 27318888 [PubMed - as supplied by publisher]

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Reply to letter: The association of postural sensory deficit with freezing of gait in Parkinson's disease.

Reply to letter: The association of postural sensory deficit with freezing of gait in Parkinson's disease.

Parkinsonism Relat Disord. 2016 Jun 15;

Authors: Huh YE, Hwang S, Kim K, Chung WH, Youn J, Cho JW

PMID: 27318705 [PubMed - as supplied by publisher]

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Human Papilloma Virus as a Biomarker for Personalized Head and Neck Cancer Radiotherapy.

Human Papilloma Virus as a Biomarker for Personalized Head and Neck Cancer Radiotherapy.

Recent Results Cancer Res. 2016;198:143-161

Authors: Eriksen JG, Lassen P

Abstract
A dramatic increase in the incidence of HPV-related oropharyngeal cancer has been reported in some parts of the western world over the past 30 years. They constitute a clinically distinct subgroup of cancers in terms of molecular biology, patient characteristics, and treatment outcome. This chapter describes the molecular characteristics, epidemiology, and demographics of the HPV-related head and neck cancers and discuss available methods to detect HPV-related tumours. The impact of HPV-related biomarkers in clinical studies on radiotherapy only, altered fractionation, modulation of hypoxia, and concurrent chemo- or bio-radiotherapy are reviewed as well as the perspectives of de-escalation and immune-modulation are discussed.

PMID: 27318685 [PubMed - as supplied by publisher]

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Hypoxia as a Biomarker and for Personalized Radiation Oncology.

Hypoxia as a Biomarker and for Personalized Radiation Oncology.

Recent Results Cancer Res. 2016;198:123-142

Authors: Vordermark D, Horsman MR

Abstract
Tumor hypoxia is a clinically relevant cause of radiation resistance. Direct measurements of tumor oxygenation have been performed predominantly with the Eppendorf histograph and these have defined the reduced prognosis after radiotherapy in poorly oxygenated tumors, especially head-and-neck cancer, cervix cancer and sarcoma. Exogenous markers have been used for immunohistochemical detection of hypoxic tumor areas (pimonidazole) or for positron-emission tomography (PET) imaging (misonidazole). Overexpression of hypoxia-related proteins such as hypoxia-inducible factor-1α (HIF-1α) has also been linked to poor prognosis after radiotherapy and such proteins are considered as potential endogenous hypoxia markers.

PMID: 27318684 [PubMed - as supplied by publisher]

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DNA Repair.

DNA Repair.

Recent Results Cancer Res. 2016;198:1-24

Authors: Borgmann K, Köcher S, Kriegs M, Mansour WY, Parplys AC, Rieckmann T, Rothkamm K

Abstract
Cellular chromosomal DNA is the principal target through which ionising radiation exerts it diverse biological effects. This chapter summarises the relevant DNA damage signalling and repair pathways used by normal and tumour cells in response to irradiation. Strategies for tumour radiosensitisation are reviewed which exploit tumour-specific DNA repair deficiencies or signalling pathway addictions, with a special focus on growth factor signalling, PARP, cancer stem cells, cell cycle checkpoints and DNA replication. This chapter concludes with a discussion of DNA repair-related candidate biomarkers of tumour response which are of crucial importance for implementing precision medicine in radiation oncology.

PMID: 27318679 [PubMed - as supplied by publisher]

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Peripheral component of laryngeal and pharyngeal motor evoked potentials.

Peripheral component of laryngeal and pharyngeal motor evoked potentials.

Neurophysiol Clin. 2016 Jun 15;

Authors: Celik Gokyigit M, Ercan I, Seker S, Gundogdu Celebi L, Ertekin C

Abstract
In this study, the responses of thyroarytenoid (TA) and cricopharyngeus (CP) muscles were simultaneously recorded to peripheral magnetic stimulation of the vagus nerve. Recordings were performed in 13 subjects by means of concentric needle EMG electrodes inserted in the TA and CP. Magnetic shocks were delivered to the vagus nerve with a round coil placed occipitally, while EMG was silent in the TA. In all subjects, clear-cut responses were obtained simultaneously in both muscles. In TA compared to CP, the maximum amplitude of the responses were higher, whereas the onset latency was shorter. Our results revealed that simultaneous recordings of TA and CP motor responses to occipital magnetic stimulation enabled a reliable evaluation of their peripheral innervation by the vagus nerve.

PMID: 27318611 [PubMed - as supplied by publisher]

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Management of penetrating abdominal and thoraco-abdominal wounds: A retrospective study of 186 patients.

Management of penetrating abdominal and thoraco-abdominal wounds: A retrospective study of 186 patients.

J Visc Surg. 2016 Jun 15;

Authors: Barbois S, Abba J, Guigard S, Quesada JL, Pirvu A, Waroquet PA, Reche F, Risse O, Bouzat P, Thony F, Arvieux C

Abstract
This is a single center retrospective review of abdominal or abdomino-thoracic penetrating wounds treated between 2004 and 2013 in the gastrointestinal and emergency unit of the university hospital of Grenoble, France. This study did not include patients who sustained blunt trauma or non-traumatic wounds, as well as patients with penetrating head and neck injury, limb injury, ano-perineal injury, or isolated thoracic injury above the fifth costal interspace. In addition, we also included cases that were reviewed in emergency department morbidity and mortality conferences during the same period. Mortality was 5.9% (11/186 patients). Mean age was 36 years (range: 13-87). Seventy-eight percent (145 patients) suffered stab wounds. Most patients were hemodynamically stable or stabilized upon arrival at the hospital (163 patients: 87.6%). Six resuscitative thoracotomies were performed, five for gunshot wounds, one for a stab wound. When abdominal exploration was necessary, laparotomy was chosen most often (78/186: 41.9%), while laparoscopy was performed in 46 cases (24.7%), with conversion to laparotomy in nine cases. Abdominal penetration was found in 103 cases (55.4%) and thoracic penetration in 44 patients (23.7%). Twenty-nine patients (15.6%) had both thoracic and abdominal penetration (with 16 diaphragmatic wounds). Suicide attempts were recorded in 43 patients (23.1%), 31 (72.1%) with peritoneal penetration. Two patients (1.1%) required operation for delayed peritonitis, one who had had a laparotomy qualified as "negative", and another who had undergone surgical exploration of his wound under general anesthesia. In conclusion, management of clear-cut or suspected penetrating injury represents a medico-surgical challenge and requires effective management protocols.

PMID: 27318585 [PubMed - as supplied by publisher]

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[Vestibular disorders and nausea during head and neck intensity-modulated radiation therapy].

[Vestibular disorders and nausea during head and neck intensity-modulated radiation therapy].

Cancer Radiother. 2016 Jun 15;

Authors: Berta É, Righini CA, Chamorey E, Villa J, Atallah I, Reyt É, Coffre A, Schmerber S

Abstract
PURPOSE: We studied whether there is a relationship between nausea and vestibular disorders in patients treated with intensity modulated radiation therapy (IMRT) for head and neck cancer.
PATIENTS AND METHODS: We performed a prospective single-centre study that enrolled 31 patients. A videonystagmography was carried out before and within 15 days after radiation therapy for each patient. Nausea was assessed at baseline, every week, and at the post-radiotherapy videonystagmography visit.
RESULTS: Twenty-six patients had benefited from a complete interpretable videonystagmography. For 14 of these patients vestibular damage was diagnosed post-radiotherapy. During irradiation, six patients felt nauseous, but without dizziness. In univariate analysis, we found a relationship statistically significant between the average dose received by the vestibules and vestibular disorder videonystagmography (P=0.001, odds ratio [OR]: 1.08 [1.025-.138]), but there was no relationship between vestibular disorder videonystagmography and nausea (P=0.701).
CONCLUSIONS: Irradiation of the vestibular system during IMRT does not seem to explain the nausea.

PMID: 27318553 [PubMed - as supplied by publisher]

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The need for supportive care among head and neck cancer patients: psychometric assessment of the Dutch version of the Supportive Care Needs Survey Short-Form (SCNS-SF34) and the newly developed head and neck cancer module (SCNS-HNC).

The need for supportive care among head and neck cancer patients: psychometric assessment of the Dutch version of the Supportive Care Needs Survey Short-Form (SCNS-SF34) and the newly developed head and neck cancer module (SCNS-HNC).

Support Care Cancer. 2016 Jun 18;

Authors: Jansen F, Witte BI, van Uden-Kraan CF, Braspenning AM, Leemans CR, Verdonck-de Leeuw IM

Abstract
PURPOSE: The purpose of this study is to assess the psychometric properties of the Dutch version of the 34-item Short-Form Supportive Care Needs Survey (SCNS-SF34) and the newly developed module for head and neck cancer (HNC) patients (SCNS-HNC).
METHODS: HNC patients were included from two cross-sectional studies. Content validity of the SCNS-HNC was analysed by examining redundancy and completeness of items. Factor structure was assessed using confirmatory and exploratory factor analyses. Cronbach's alpha, Spearman's correlation, Mann-Whitney U test, Kruskall-Wallis and intraclass correlation coefficients (ICC) were used to assess internal consistency, construct validity and test-retest reliability.
RESULTS: Content validity of the SCNS-HNC was good, although some HNC topics were missing. For the SCNS-SF34, a four-factor structure was found, namely physical and daily living, psychological, sexuality and health system and information and patient support (alpha = .79 to .95). For the SCNS-HNC, a two-factor structure was found, namely HNC-specific functioning and lifestyle (alpha = .89 and .60). Respectively, 96 and 89 % of the hypothesised correlations between the SCNS-SF34 or SCNS-HNC and other patient-reported outcome measures were found; 57 and 67 % also showed the hypothesised magnitude of correlation. The SCNS-SF34 domains discriminated between treatment procedure (physical and daily living p = .02 and psychological p = .01) and time since treatment (health system, information and patient support p = .02). Test-retest reliability of SCNS-SF34 domains and HNC-specific functioning domain was above .70 (ICC = .74 to .83), and ICC = .67 for the lifestyle domain. Floor effects ranged from 21.1 to 70.9 %.
CONCLUSIONS: The SCNS-SF34 and SCNS-HNC are valid and reliable instruments to evaluate the need for supportive care among (Dutch) HNC patients.

PMID: 27318479 [PubMed - as supplied by publisher]

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Clicks as a Healthy Alternative to Bricks: How Online Grocery Shopping Reduces Vice Purchases

Although consumers are concerned about their health, obesity statistics suggest that contextual factors often lead them to choose unhealthy alternatives (i.e., vices) rather than healthy ones (i.e., virtues). Noting the increasing prevalence of online grocery shopping, the authors focus on shopping channels as one such contextual factor and investigate how food choices made online differ from food choices made in a traditional brick-and-mortar store. A database study and three lab experiments demonstrate that consumers choose relatively fewer vices in the online shopping environment. Moreover, this shopping channel effect arises because online channels present products symbolically, whereas offline stores present them physically. A symbolic presentation mode decreases the products' vividness, which in turn diminishes consumers' desire to seek instant gratification and ultimately leads them to purchase fewer vices. These findings highlight several unexplored differences between online and offline shopping, with important implications for consumers, public policy makers, and retailers.

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Experimental assessment of tree diversity-ecosystem functioning relationships in young forest plantations

Mixed forest plantations, delivering multiple ecosystem services, are generally recognized as more sustainable than monocultures. Mixing different tree species in forest plantations can increase the stand productivity, provide resistance to pests and diseases, and improve nutrient cycling processes. The more heterogeneous habitat created by mixed forests also provides diverse niches for associated biodiversity, such as arthropods. Although numerous studies looked into diversity effects in mature forest, mixing effects in the early stages of mixed forest plantations are still poorly understood. Tree species diversity experiments, such as the FORBIO experiment in Belgium, are a model platform to study the effects of tree species diversity and composition on forest ecosystem functioning throughout the different stages of forest development. The design of FORBIO allows unequivocally exploring the effects of tree species identity and diversity on three ecosystem functions. The main objective of this thesis was to study early effects of tree species diversity and composition on three related groups of functions: primary production (tree growth), resistance to crown damage (crown damage and crown arthropod community composition), and nutrient cycling (litter decomposition). We focused on 9 different tree species in two study sites of FORBIO, which were planted in 2009 and 2010. We measured the saplings' increment between 2 years, assessed crown damage in 2 seasons, captured crown arthropods in 1 season, and studied litter decomposition rates by using litterbags for 60 weeks. In our results, tree species identity explained the highest amount of variance in each function. A sapling's growth was additionally related with the characteristics of its local neighbourhood (notably phylogenetic diversity, relative size asymmetry, and ground vegetation cover). The crown damage of a sapling was influenced by the site characteristics and the timing of the assessment. The crown arthropod community differed between the landscapes, sites, and was related to sapling apparency and the phylogenetic diversity of the sapling's local neighbourhood. The decomposition rates of mixed litter were affected more by the identity of the litter species within the mixture than by the diversity of the litter per se, but the variability in litter decomposition rates decreased as the litter diversity increased. We expect that the diversity effects will become more apparent as the trees start to interact and develop a closed canopy. Interesting patterns were already developing and some management guidelines can be formulated.

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The role of parental achievement goals in predicting autonomy-supportive and controlling parenting

Although autonomy-supportive and controlling parenting are linked to numerous positive and negative child outcomes respectively, fewer studies have focused on their determinants. Drawing on achievement goal theory and self-determination theory, we propose that parental achievement goals (i.e., achievement goals that parents have for their children) can be mastery, performance-approach or performance-avoidance oriented and that types of goals predict mothers' tendency to adopt autonomy-supportive and controlling behaviors. A total of 67 mothers (aged 30-53 years) reported their goals for their adolescent (aged 13-16 years; 19.4 % girls), while their adolescent evaluated their mothers' behaviors. Hierarchical regression analyses showed that parental performance-approach goals predict more controlling parenting and prevent acknowledgement of feelings, one autonomy-supportive behavior. In addition, mothers who have mastery goals and who endorse performance-avoidance goals are less likely to use guilt-inducing criticisms. These findings were observed while controlling for the effect of maternal anxiety.

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Shared Structuring Resources across Domains: Double task effects from linguistic processing on the structural integration of pitch sequences

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Emerging trends and future directions for the field of motivation psychology: a special issue in honor of Prof. Dr. Willy Lens.

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Interactions between obsessional symptoms and interpersonal dynamics: an empirical single case study

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The contribution of start-ups and young firms to industry-level efficiency growth

This article examines the impact of start-ups (active for 1 up to 5 years) and young firms (active for 6 up to 10 years) on industry-level efficiency growth in six EU countries, covering the period 2002–2009. Using semi-parametric estimates of meta-frontier efficiency, it is found that surviving entrants gradually raise their efficiency level in all countries considered. Firm-level efficiency growth decreases with firm age, whereas reallocation towards efficient firms contributes more to industry-level growth as firms mature. The relative contribution of start-ups appears to have been important as they actually contributed positively to overall efficiency growth which, over the period under consideration, was negative in most countries, even before the 'Great Recession'. There are indications of 'cleansing', due to the exit of less efficient firms, during the 'Great Recession'.

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Molecular diversity and quantitative trait loci related to drought tolerance in lentil (Lens culinaris Medik., Fabaceae)

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The impact of vocal warm-up exercises on the objective vocal quality in female students training to be speech language pathologists

Purpose. The purpose of this study was to determine the impact of a specific vocal warm-up (WU) program-focused on the improvement of the dynamics of the extrinsic and intrinsic laryngeal muscles-on the objective vocal quality in Dutch female students who are getting trained to be speech language pathologists (SLPs). Hypothetically, one can assume that the objective vocal quality will increase after vocal WU exercises in SLPs in comparison with the matched control group that receives no WU program. Methods. This was a pretest-posttest control group design study, in which 45 female future SLPs were randomly assigned into two groups. The experimental group received a well-defined vocal WU program, whereas the control group took 30 minutes of vocal rest. Objective assessment techniques (aerodynamic, vocal range, acoustic measurements, and Dysphonia Severity Index [DSI]) were used. Results. After vocal WU, a significant increased DSI value, increased vocal performance (with lower intensity and higher frequency), and increased fundamental frequency (F-0) were measured. Conclusions. Clinically, there is clear evidence that warming up the vocal mechanism is beneficial to the objective vocal quality and the vocal performance in future SLPs. To what extent the repetition of these vocal WU exercises has the possibility to maintain increased objective vocal quality in these future professional voice users is subject to further research.

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Transmasculine People's Voice Function: A Review of the Currently Available Evidence.

Transmasculine People's Voice Function: A Review of the Currently Available Evidence.

J Voice. 2016 Jun 15;

Authors: Azul D, Nygren U, Södersten M, Neuschaefer-Rube C

Abstract
OBJECTIVES: This study aims to evaluate the currently available discursive and empirical data relating to those aspects of transmasculine people's vocal situations that are not primarily gender-related, to identify restrictions to voice function that have been observed in this population, and to make suggestions for future voice research and clinical practice.
METHODS: We conducted a comprehensive review of the voice literature. Publications were identified by searching six electronic databases and bibliographies of relevant articles. Twenty-two publications met inclusion criteria. Discourses and empirical data were analyzed for factors and practices that impact on voice function and for indications of voice function-related problems in transmasculine people. The quality of the evidence was appraised.
RESULTS: The extent and quality of studies investigating transmasculine people's voice function was found to be limited. There was mixed evidence to suggest that transmasculine people might experience restrictions to a range of domains of voice function, including vocal power, vocal control/stability, glottal function, pitch range/variability, vocal endurance, and voice quality.
CONCLUSIONS: More research into the different factors and practices affecting transmasculine people's voice function that takes account of a range of parameters of voice function and considers participants' self-evaluations is needed to establish how functional voice production can be best supported in this population.

PMID: 27318608 [PubMed - as supplied by publisher]

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Freedom in the free world: The extimate becomes the law.

Freedom in the free world: The extimate becomes the law.

Int J Law Psychiatry. 2016 Jun 15;

Authors: Aristodemou M

Abstract
My article takes Robert Burt's piece as a starting point to highlight how a lacanian analysis of law differs from the one Robert Burt (rightly) rejected and from the alternative psychotherapeutic scenario Burt develops. I focus on what I consider to be the novel characteristics of a lacanian analysis, particularly its insistence on the castration of the human subject by language, a castration that problematizes our understanding of "freedom" and "free speech", and, in turn, on Law's own castration. The gradual peeling away of the claims made on behalf of the subject by ego psychologists, enables us to arrive at what a lacanian analysis would ideally uncover, that is the subject's extimate core. I illustrate this with the film The Act of Killing, a documentary which displays not only the extimate core at the heart of the subject but the extimate as the Law itself. The encounter between law and psychoanalysis, I conclude, far from leading to mutual understanding, leads to the dissolution of the analysand's pretenses, and, in turn, to the withdrawal of psychoanalysis from the scene altogether.

PMID: 27318511 [PubMed - as supplied by publisher]

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PGC-1α-Dependent Mitochondrial Adaptation Is Necessary to Sustain IL-2-Induced Activities in Human NK Cells

Human Natural Killer (NK) cells are a specialized heterogeneous subpopulation of lymphocytes involved in antitumor defense reactions. NK cell effector functions are critically dependent on cytokines and metabolic activity. Among various cytokines modulating NK cell function, interleukin-2 (IL-2) can induce a more potent cytotoxic activity defined as lymphokine activated killer activity (LAK). Our aim was to determine if IL-2 induces changes at the mitochondrial level in NK cells to support the bioenergetic demand for performing this enhanced cytotoxic activity more efficiently. Purified human NK cells were cultured with high IL-2 concentrations to develop LAK activity, which was assessed by the ability of NK cells to lyse NK-resistant Daudi cells. Here we show that, after 72 h of culture of purified human NK cells with enough IL-2 to induce LAK activity, both the mitochondrial mass and the mitochondrial membrane potential increased in a PGC-1α-dependent manner. In addition, oligomycin, an inhibitor of ATP synthase, inhibited IL-2-induced LAK activity at 48 and 72 h of culture. Moreover, the secretion of IFN-γ from NK cells with LAK activity was also partially dependent on PGC-1α expression. These results indicate that PGC-1α plays a crucial role in regulating mitochondrial function involved in the maintenance of LAK activity in human NK cells stimulated with IL-2.

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Automated Data Abstraction of Cardiopulmonary Resuscitation Process Measures For Complete Episodes of Cardiac Arrest Resuscitation

Abstract

Introduction

Cardiopulmonary resuscitation (CPR) process measures research and quality assurance has traditionally been limited to the first five minutes of resuscitation due to significant costs in time, resources and personnel from manual data abstraction. CPR performance may change over time during prolonged resuscitations, which represents a significant knowledge gap. Moreover, currently-available commercial software output of CPR process measures are difficult to analyze.

Objective

The objective was to develop and validate a software program to help automate the abstraction and transfer of CPR process measures data from electronic defibrillators for complete episodes of cardiac arrest resuscitation.

Methods

We developed a software program to facilitate and help automate CPR data abstraction and transfer from electronic defibrillators for entire resuscitation episodes. Using an intermediary Extensible Markup Language export file, the automated software transfers CPR process measures data (electrocardiogram number, CPR start time, number of ventilations, number of chest compressions, compression rate per minute, compression depth per minute, compression fraction, and end-tidal CO2 per minute). We performed an internal validation of the software program on 50 randomly selected cardiac arrest cases with resuscitation durations between 15-60 minutes. CPR process measures were manually abstracted and transferred independently by two trained data abstractors and by the automated software program, followed by manual interpretation of raw electrocardiogram tracings, treatment interventions, and patient events. Error rates and the time needed for data abstraction, transfer and interpretation were measured for both manual and automated methods, as compared to an additional independent reviewer.

Results

A total of 9826 data points were each abstracted by the two abstractors and by the software program. Manual data abstraction resulted in a total of six errors (0.06%) compared to zero errors by the software program. The mean time ± SD measured per case for manual data abstraction was 20.3 ± 2.7 minutes compared to 5.3 ± 1.4 minutes using the software program (p=0.003).

Conclusions

We developed and validated an automated software program that efficiently abstracts and transfers CPR process measures data from electronic defibrillators for complete cardiac arrest episodes. This software will enable future cardiac arrest studies and quality assurance programs to evaluate the impact of CPR process measures during prolonged resuscitations.

This article is protected by copyright. All rights reserved.

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Causes of elevated cardiac troponins in the emergency department and their associated mortality

Abstract

Study Objective

Cardiac troponins (cTn) are structural components of myocardial cells and are expressed almost exclusively in the heart. Elevated cTn levels indicate myocardial cell damage/death but not reflect the underlying etiology. The 3^rd Universal Definition of myocardial infarction (MI) differentiates MI into various types. Type 1 (T1MI) is due to plaque rupture with thrombus, while type 2 (T2MI) is a result of a supply: demand mismatch. Non-MI cTn elevations are also common. We determined the causes of elevated cTn in a tertiary care ED and the associated in-hospital mortality.

Methods

We performed a structured, retrospective review of all consecutive adult ED patients with elevated troponin I (defined as >99^th %ile of the normal population, as run on the ADVIA Centaur^® platform; Siemens USA, Malvern, PA) during 1 year. Causes of elevated cTn were classified based on the 3^rd Universal Definitions. Comparisons between groups were performed using Χ² and Mann-Whitney U tests.

Results

Of 96,612 ED patients presenting from 5/12-4/13, 13,502 (14%) had cTn measured, of which 1,310 (9.7%) were elevated. Of these, 340 (26.5%, 95% CI, 24.2-29.0) were T1MI, 452 (35.2%, 95% CI, 32.7-37.9) T2MI, 458 (35.7%, 95% CI, 33.1-38.4) multifactorial and 33 (2.5%, 95% CI, 1.8-3.5) due to non-ischemic injury. Non-T1MI patients were slightly older, more likely female, and had higher BUN and creatinine. Comorbidities were more common in non-T1MI while cardiac risk factors were more common in T1MI. Non-T1MI patients were less likely to have diagnostic ECGs and had lower initial and subsequent cTn levels. In hospital mortality rates were similarly high for T1MI and non-T1MI (11% [95% CI 8-15%] vs. 10% [95% CI 8-12%], P=0.48).

Conclusions

Of all ED patients with elevated cTn, ~75% have a non-T1MI. The mortality of patients with non-T1MI is similar to the mortality in patients with T1MI.

This article is protected by copyright. All rights reserved.

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Biological availability and efficacy of folates from bioengineered rice

The basic concept of folate rice is to develop a means for rural areas to combat folate deficiency. Folate deficiency is of concern given the relation between folate status and birth defects, ranging in severity from mild back ache to stillbirth, due to a malformation of the neural tube. While western populations benefit from diverse and nutrient rich diets, even these populations are at risk for folate deficiency. One method to alleviate the health burden associated with folate deficiency is to add synthetic folic acid to commonly consumed food items such as breakfast cereals or bread. However, remote, mostly rural communities, do not have free access to folic acid fortification. As such, a rice variety with a high natural folate content that could be grown locally may serve to achieve an adequate folate status. However, since folate rice is a genetically engineered rice variety, public and governmental acceptance depends on scientific evidence that the folates contained within these rice grains are released into the bloodstream when consumed. This is because some genetically engineered food items have been criticized as a result of their limited influence on nutrient status. It is therefore of paramount importance to evaluate the impact of folate rice consumption on folate status. Given the need for strict control of nutrient intake and regulatory constraints, a rodent feeding trial was devised to evaluate the efficacy of folate rice as a dietary folate source. Due to the complexity of folate metabolism and body distribution, a long term study was performed including regular evaluation of folate status, folate related clinical parameters and general health. These results were compared between groups receiving no folate, a small amount of folate present in 'normal' rice, a larger amount of folate in either folate rice or folic acid fortified rice or ample folate as an optimal scenario. To quantify the biological outcome of folate rice consumption, an analytical method was developed to measure the amount of folates in 2 separate blood fractions, i.e. plasma and red blood cells. Given the low concentrations in which folates are present, a sensitive method using liquid chromatography coupled to tandem mass spectrometry was used. Since the term folate signifies several different molecules with different chemical and biological properties, the developed method required the measurement of individual folate species. Also, to exclude the influence of folates which might be present in the rodent diets used during the rodent trial, a separate method was developed to determine the folate concentration in the rodent diets used. Due to the necessity of folates for DNA-synthesis in white blood cells, the influence of folate concentration and speciation on the functioning of the immune system was investigated as well.

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Mondialisation et Internet: Belgique

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Unraveling the biology of juvenile myelomonocytic leukemia using transcriptomics

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A good or a bad transition from school to work: who is responsible?

Purpose - The purpose of this paper is to analyse the determinants of the quality of the first job in Flanders (Belgium). The authors differentiate between circumstances on the one hand - individual characteristics beyond the control of the individuals such as gender or the unemployment rate at labour market entry - and efforts on the other hand - characteristics that are at least partly under the individuals' control such as their educational attainment or labour motivation. The authors specifically take into account the fact that the former might influence the latter. A better understanding of the effects of these determinants can help to formulate (labour market) policy proposals (to ameliorate the school-to-work transition) that are responsibility-sensitive. The authors use the distance function to construct a one-dimensional measure of job quality - based on a list of job characteristics - and explain the variation in job quality in terms of circumstances and efforts. The empirical analysis is based on the 1978 birth cohort of the Flemish SONAR data. The results show that the quality of the first job is to a large extent depending on personal efforts and that circumstances have a considerable influence on the efforts. For this reason circumstances influence job quality twice. This is especially the case for gender and for the educational attainment of the individual's mother. The labour market situation at labour market entry also plays a considerable role. Design/methodology/approach - The authors use the distance function to construct a one-dimensional measure of job quality - based on a list of job characteristics - and explain the variation in job quality in terms of circumstances and efforts. The empirical analysis is based on the 1978 birth cohort of the Flemish SONAR data. Findings - The results show that circumstances have a considerable influence on the efforts and for this reason circumstances influence job quality twice. This is especially the case for gender and for the educational attainment of the individual's mother. The labour market situation at labour market entry also plays a considerable role. Originality/value - The paper contributes to the literature in several ways. First, it analyses the quality of the first job individuals get after leaving school and uses an equality of opportunity framework. This approach differs from an approach based on search duration or job satisfaction. Second, job quality is evaluated in a multidimensional way using the distance function. Third, the relation between job quality and circumstances - issues for which the individual is not responsible - and efforts - issues for which the individual is at least partly responsible - is investigated. The authors specifically take into account the fact that circumstances might influence efforts and investigate the consequences for labour market policy.

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Student’s perception of mind mapping in Problem-based learning

2016-06-20T02-24-29Z
Source: Journal of Contemporary Medical Education
Sneha Ravindranath, Warnakula Kusum de Abrew, Vishna Devi Nadarajah.
Background: Problem based learning enables active learning but an inherent disadvantage is that the knowledge is perceived to be unorganized. The use of concept maps and flow charts has been suggested to enhance reflection in PBL. The objective of the study was to determine if the PBL experience can be enhanced using a mind map for summary writing. Methods: Semester 2 medical students were briefed on the process of mind mapping for summarizing the PBL group discussion. Students who consented to participate in the study completed a pre intervention questionnaire on the perception of PBL learning process. Each student constructed a mind map at the end of every PBL session for three consecutive triggers. The students completed a post intervention questionnaire on the perception of PBL learning process at the end of the module. Data analysis of the pre and post intervention questionnaires was carried out using Independent t-test. Results: Students perception of the PBL learning process continued to be positive after the intervention of summary writing with mind map and there was a difference in the ranking of the PBL learning processes with summarizing and structuring concepts at the top after mind mapping. Students comments indicated that the mind mapping exercise was useful although it was time consuming. Conclusions: Mind mapping can help in summarizing the PBL discussion however, not all students may find that it enhances the PBL learning process. The findings of this study support the use of mind maps only as an optional tool for summarizing PBL discussion and may be used to complement the learning process in PBL based on students learning needs.


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The role of antimullerian hormone in the hormonal workup of women with persistent acne

Summary

Background

In persistent female acne, PCOS (polycystic ovarian syndrome) is a common finding. To diagnose PCOM (polycystic ovarian morphology), transvaginal – USG is required, which is not possible in virginal women. Also, hyperandrogenemia is not consistently reported.

Objectives

The aim of the study was to compare the hormonal profile of persistent acne patients with or without PCOS and to assess the role of AMH (antimullerian hormone) in persistent acne patients.

Methods

A cross-sectional retrospective study of persistent acne patients was undertaken and detailed hormonal assessment and USG was undertaken and patients were divided into two group, those with and without PCOS. The various clinical parameters, AMH and other hormonal levels were compared between the two groups of patients. The predictive value of serum AMH level was evaluated using the receiver operating characteristic (ROC) curve analysis.

Results

Of the 112 patients of persistent acne, 40 (34.7%) were described as PCOS. Mean menstrual cycle length, hirsutism, and PCOM (polycystic ovarian morphology) were significantly more in the PCOS group (P < .0001). AMH was significantly higher in the PCOS group of acne patients as compared to the group without PCOS (6.79 ± 2.79 vs. 2.69 ± 1.23, P < 0.001), and an AMH value of 3.6 ng/mL was predictive of PCOM. Apart from the SHBG levels which were low in both groups (normal range 34.3–147 nmol/L), no other hormonal level was deranged. The total testosterone levels were in the high-normal range.

Conclusions

AMH is a good tool to diagnose PCOM in persistent acne patients and can be used as a replacement for TV-USG, although it does not correlate with hyperandrogenemia. Low SHBG levels were the most common finding in persistent acne patients and could explain the hyperandrogenism seen in patients.

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Comparison between the efficacy and safety of platelet-rich plasma vs microdermabrasion in the treatment of striae distensae: clinical and histopathological study

Summary

The article entitled "Comparison between the efficacy and safety of platelet-rich plasma vs microdermabrasion in the treatment of striae distensae: clinical and histopathological study" (Zeinab Abd El-Samad Ibrahim, et al.) is very interesting but the methodology is not robust. Our mains comments concerned the count of the cells, the activation of the PRP and the method of assessment.

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Do dermatologists have cosmetic procedures?

Summary

Background

Current approach and ideas of dermatologists about undergoing MICPs themselves are unknown.

Objective

The aim of this study was to reveal current situation and thought of dermatologists about undergoing minimally invasive cosmetic procedures (MICPs) themselves.

Methods

This study was planned as a cross-sectional, descriptive study and performed between December 2014 and July 2015. A questionnaire comprising 11 questions was sent to dermatologists via electronic mail.

Results

Of the 318 dermatologists, 233 (73.3%) were female and 85 (26.7%) were male. It was established that 56 percent (n = 178) of the dermatologists underwent MICPs. There was a statistical difference between the gender and having MICPs (female = 66.1% vs. male = 28.2%; P < 0.001). They selected dermatologists (91%) as a performer and private settings (67.2%). To be young and beautiful (77%), they had MICPs after medical residency (75.3%). Physicians' experience (66.9%) was the most important criterion. Of the dermatologists who did not have MICPs were planning to have MICPs (76.4%). The most frequent reason that stopped them from having MICPs was "not need yet" (62.1%).

Conclusion

There are some tendencies among the dermatologists while selecting a physician for the procedures. They usually have MICPs after dermatology residency to seem younger and more beautiful by an experienced dermatologist in private setting. Male Turkish dermatologists have MICPs more frequently than the general population. Their satisfaction level with MICPs is very high. Most of dermatologists who do not have MICPs are planning to have MICPs.

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An anatomic variant causing a previously unreported complication of transcutaneous treatment of trigeminal neuralgia

This case report describes a patient with an anatomic variant of the foramen ovale that was encountered during an attempted glycerol rhizolysis for trigeminal neuralgia. Various complications have been reported during transcutaneous trigeminal neuralgia treatment. We report an adult female on whom transcutaneous cannulation of the foramen ovale was not possible. Subsequent imaging revealed a causative elongation of the spine of the sphenoid that distorted the foramen ovale and effectively blocked it. Variations in bony anatomy may complicate transcutaneous approaches to the foramen ovale for the treatment of trigeminal neuralgia.

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The impact of self-efficacy beliefs on learning strategies: towards learning Human Anatomy at College of Medicine

2016-06-20T02-24-29Z
Source: Journal of Contemporary Medical Education
Lackson Harrison Tembo, Flemmings Fishani Ngwira.
Objective: The study was designed first, to find out from the medical students if their perceived self-efficacy is related to their use of cognitive learning strategies; second, to asses if, in terms of gender and parent education, differences do exist in their levels of self-efficacy and their use of the cognitive strategies. Method: This was a cross section study which employed a pre-tested questionnaire, Motivated Strategies for Leaning Questionnaire (MSLQ), scored on a Likert Scale. The study population was made up of first year medical students after consenting to take part in the study. There was an 86% response rate. Results: Self-efficacy positively predicted both learning strategies of shallow [β = 0.47] and deep [β = 0.42]. There were no significant differences between male and female students on both shallow and deep learning strategies, and self-efficacy beliefs (p

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Flipping the switch: The feasibility of a “think aloud” flipped-classroom approach to clinical reasoning instruction

2016-06-20T02-24-29Z
Source: Journal of Contemporary Medical Education
Roy E Strowd, Charlene E Gamaldo, Anthony B Kwan, Tiana E Cruz, Rachel Marie E Salas.
Background: Clinical reasoning is a fundamental skill in medical and allied health professions. Implementation of the evidence-based think aloud method (i.e. describing cognitive processes through verbalization) for teaching clinical reasoning has been variable due to time and resource constraints in healthcare education. Materials & Methods: To explore the feasibility of implementing the think aloud method for teaching clinical reasoning, we piloted a flipped-classroom model of instruction to free live-synchronous educational time in a medical school clerkship. Two asynchronous web-based videos were implemented prior to synchronous case-based discussion applying the think aloud method. Performance was assessed by baseline and end-of-clerkship examination and NBME shelf exam; clinical skills by clinical evaluation; satisfaction and student learning styles by survey. Results: The flipped-curriculum was piloted in 38 students; mean age 25+2.2 years; 63% male. Baseline knowledge was low (mean baseline score 43+21%) and improved significantly (mean final score 70+23%; increase 29%, 95%CI 20-37%, p


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Final year medical students’ satisfaction with clinical education and family medicine module. Suez Canal University. Egypt

2016-06-20T02-24-29Z
Source: Journal of Contemporary Medical Education
Hend Mikhail Salama, Hebatallah Nour-Eldein.
Background: Satisfaction is an indirect performance measure to the effectiveness of a curriculum. Faculties which provide professional education should be concerned with students satisfaction as an educational process outcomes. Objective 1- to evaluate medical students satisfaction with clinical education and factors in the organizational domain that could influence their satisfaction. Objective 2- to evaluate the students satisfaction with family medicine module. Methods: This was a cross sectional descriptive analytic study carried out between September and October, 2015. Convenience sampling was used and It included all 136 final year medical students in Suez Canal University. The first questionnaire was used to evaluate the medical students satisfaction with clinical education. Student Perception of Module (SPOM) questionnaire with 18 items was used to evaluate the students perception of family medicine (FM) module. Results: The study included 136 students and the mean age was 23.5 (0.45) years. Overall satisfaction with clinical education was 86.8%. The majority of study sample (85.3%) was satisfied with outpatient training. Most of the study sample was satisfied with bedside and theoretical training (76.5% & 77.9 %) respectively. Students satisfaction with family medicine modules revealed that across 80% of the 18 items, strong satisfaction ranged from 61.8% to 42.6%. Conclusion: Future reevaluation of clinical education in Suez Canal University is recommended with consideration of the variety of diseases and improving instructor experience in bedside teaching. Reviewing FM module is recommended with special concern to make the students look the profession in positive way and to be intellectually more stimulating.


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Music medicine course for medical students in Hungary

2016-06-20T02-24-29Z
Source: Journal of Contemporary Medical Education
Janos Kollar, Pal Kovago, Edit Czegledi.
Objective: In 2006 a Music Medicine credit course was initiated on Medical and Health Science Centre of University of Debrecen, Hungary for helping the medical students to gain more knowledge about Music Medicine and to dissolve prejudices and misbeliefs about the topic. The aims of the study besides the introduction of the course was thematic quantitative and qualitative analysis of the students evaluation about the course (n=150). Methods: A short, six-item questionnaire concerning the evaluation of the course was constructed for the purpose of this study. We used both qualitative and quantitative analysis. All of the participants (n=150) in the cross sectional survey were 1th to 6th year medical university students Medical and Health Science Centre of University of Debrecen, (Hungary). Data were collected between the years 20062012. Results: Evaluation of the course proved to be especially favourable regarding every measured aspects. The most favourable score showed the evaluation of the teacher and the least one was the individual participation. Content analysis resulted in four content categories, namely group cohesion, self-awareness, practical focus, and new perspective. Conclusions: Besides transferring useful information regarding the possibilities of applying music in medical practice a new as a side-effect the course improved the group cohesion between students, and helped them to overcome their shyness, and be more open to their fellow students.


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Retrotransverse foramen in atlas vertebrae of the late 17th and 18th centuries

Anatomical variations of the atlas vertebra are of particular importance because of their possible repercussions on the vertebral vessels. In view of the extensive articular mobility of the atlas, any anomaly where the vertebral artery and veins run through the transverse foramen could impair blood flow. However, in spite of the possible effect of this anomaly on the vertebral artery and veins, there are few data on the presence of an abnormal accessory transverse foramen, termed retrotransverse foramen, which is smaller and located behind the transverse foramen of the atlas. The aim of this research was to analyse the prevalence of retrotransverse foramen in a sample of 88 dry C1 vertebrae from a Spanish rural population of the late 17th and the early 18th centuries, as well as to study the possible repercussions of the presence of this anatomical variant on the size of the transverse foramen. The anteroposterior diameter and the lateral diameter of the transverse foramen of all the atlas vertebrae and retrotransverse foramina were measured using digital calibres. Two atlases with retrotransverse foramina (2.27%) were found in which the presence of the anatomical variant caused a larger anteroposterior diameter and a smaller lateral diameter than those of the transverse foramina of the normal 86 C1 vertebrae that were analysed. Our results show that a thorough study should be performed on the prevalence of this anatomical variant in the current population, as well as its possible clinical repercussion on the vertebral artery.

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Students’ opinion towards the Pernkopf atlas: are the Italian students ready to know the history?

The debate around Pernkopf's atlas, the origin of bodies used to create its plates and the person of Eduard Pernkopf has involved with time academic authorities and university professors, and has shaken the anatomical scenario. However, no study has been so far performed concerning the opinion of students towards this sensitive and problematic issue. This article aims at exposing the results of an interview performed on 42 Italian medical students, after a self-chosen course of history of human anatomy, in order to ascertain the students' opinion towards this important debate in the anatomic scenario. Results showed that 91% of students did not know the existence of Pernkopf's atlas: 51% stated they would not use it, whereas for 65% it should be preserved for didactic purposes. Subjects who preferred the atlas to be banished justified their position mainly on the base of ethical reasons (25%); however, in a third of cases students were not able to give an answer. Twenty-two percent of students who agree with a preservation of the atlas would limit its use to historical studies. In 11% ethical issues were not considered important. In 52% of cases no opinion was given. Results show that the debate concerning Pernkopf's atlas, at least among students, is at the very beginning: more efforts need to be performed in order to let the medical students know the history of the atlas and its importance in the scientific debate around the ethics in anatomy.

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Description of an optic spine on the sphenoid bone of camels and dromedaries

Objective To describe the presence of an intraorbital cylindrical osseous structure (a spine) in two animal species: camel (Camelus bactrianus) and dromedary (Camelus dromedaries). A homologous osseous structure was previously observed in the large fruit-eating bat (Artibeus lituratus).
Procedures The bony anatomy of the orbital cavity was studied and quantified on macerated skulls of 3 camels and 2 dromedaries. Additionally, one macerated skull of a large fruit-eating bat (Artibeus lituratus) was used for comparative purposes.
Results The anatomic description of these unique intraorbital spine was made while studying the bony orbit of macerated skulls, and was considered homologous to that of the bat based on the same anatomic position (at the bone bridge that separates the optic canal and the sphenorbital fissure) and similarities in shape. We suggest the name optic spine of the sphenoid bone.
Discussion The novel observation of an optic spine on the sphenoid bone in camels and dromedaries (Artiodactyla), when combined with the previous finding of a similar anatomic structure in a bat (Chiroptera) suborder Microchiroptera, may provide further support to the close proximity of these two apparently very distinct animal orders in the phylogenetic tree, and may contribute to the understanding of bat evolution and provide new directions for future research. The function of this osseous spine remains to be investigated, although we hypothesize that the optic spine of the camelids may serve as an attachment site for extraocular muscles.

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The patellofemoral joint alignment in patients with symptomatic accessory navicular bone

Quadriceps angle (Q angle) provides useful information about the alignment of the patellofemoral joint. The aim of the present study was to assess a possible link between malalignment of the patellofemoral joint and symptomatic accessory navicular (AN) bone as an underlying cause in early adolescence using Q angle measurements. This study was performed on patients presenting to the Foot and Ankle Clinic at the Jordanian Royal Medical Services because of pain on the medial side of the foot that worsened with activities or shoe wearing, with no history of knee pain, between September 2013 and April 2015. The Q angle was measured using a goniometer in 27 early adolescents aged 10-18 years diagnosed clinically and radiologically with symptomatic AN bone, only seven patients had associated pes planus deformity; the data were compared with age appropriate normal arched feet without AN. Navicular drop test (NDT) was used to assess the amount of foot pronation. The mean Q angle value among male and female patients with symptomatic AN with/without pes planus was significantly higher than in controls with normal arched feet without AN (p<0.05). Symptomatic AN feet were also associated with higher NDT values (p<0.001). The present findings suggest an early change in patellofemoral joint alignment in patients with symptomatic AN bone with/without arch collapse. Therefore, it is recommended that Q angle assessment should be an essential component of the examination in patients with symptomatic AN bone.

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Caspar Bauhin (1560-1624): Swiss anatomist and reformer of anatomical nomenclature

Caspar Bauhin (1560-1624) was a Swiss anatomist, physician and botanist. He commenced the study of medicine at a young age in Basel but had to move to Padua after an outbreak of plague in his native place. In Padua, he was privileged to study under Fabricius ab Aquapendente, an accomplished anatomist of his time, and other pioneers in the field of medicine, surgery and botany. He travelled extensively through Italy, France and Germany before finally returning to Basel, where he started to conduct public anatomy dissections and in due course was appointed to the Chair of Anatomy and Botany at the University of Basel. His treatise, Theatrum anatomicum (1605), was considered as the finest comprehensive text in anatomy during that period. Theatrum was highly appreciated as it followed a systemic approach with focus on anatomical anomalies and had a useful set of illustrations. His major contribution to Anatomy was the introduction of a descriptive terminology which replaced the prevalent trend of naming the structures with ordinal numbers and cleared the confusion among anatomists in relation to identification of structures. He was the first to describe the anterior lingual glands (Bauhin's gland), which are seromucous glands located near the tip of tongue. He is presumed to be the first to report the ileocecal valve, which is also known as Bauhin's valve. Bauhin's contributions are a true testimony of his legacy in the domain of anatomical sciences.

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Morphometric study of variations of sacral hiatus among West Bengal population and clinical implications

The study was conducted on one hundred and seventeen human sacra to categorize the sacral hiatus of West Bengal population to improve the accuracy of caudal epidural block for anesthesia and analgesia. Various contours of hiatus were observed in this study which included inverted U (70.09%), inverted V (14.53%), irregular (12.82%), bifid (1.71%) and dumbbell (0.85%).The most frequently observed positions of apex and base of the hiatus were fourth and fifth sacral vertebrae respectively (74.36% and 95.73%). The average length, width and depth of hiatus were 20.21 mm, 12.10 mm and 6.02 mm with standard deviation of 7.7 3mm, 3.13 mm and 2.43 mm respectively. All the measurements were taken by Vernier calipers. Only in 27.35% cases the points on the lateral sacral crests at the level of first sacral foramina formed an equilateral triangle with the apex of the hiatus and thus could be used as an important landmark to locate sacral hiatus.

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Abnormal branching of the axillary artery: an axillo-hepatic artery

The axillary artery is a continuation of the subclavian at the outer border of first rib. Reports of anatomic variations of the axillary artery encountered during cadaveric dissection are not uncommon. However, abnormal branching patterns of the axillary artery identified on imaging studies are rare. We encountered an abnormal branch of the right axillary artery, which descended along the lateral thoraco-abdominal wall and gave off branches to the liver capsule before terminating at the level of the ipsilateral iliac crest. Knowledge of this variation, which we term the axillo-hepatic artery, will be of interest to anatomists, radiologists and adult- and pediatric- surgeons operating on the upper chest and abdominal regions. To our knowledge, such a vessel has not been reported previously in the extant medical literature.

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Unilateral duplication of parotid duct – a rare cadaveric case report

The parotid gland is drained by the parotid duct which normally measures 50 mm in length and 3 mm in width. The parotid duct emerges at the anterior border of the gland and runs horizontally across the masseter muscle to pierce the buccinator and open into the vestibule of the mouth. The occurrence of double parotid duct is 7% and there are only very few literature references. The parotid gland develops as an epithelial bud arising from the oral ectoderm and invaginating into the underlying mesenchyme. The proximal part canalises to form the duct and the distal end differentiates to form the acini. An early division of the parotid duct with acini from both ducts intermingling with each other results in the formation of double parotid duct. The cytodifferentiation and morphogenesis of parotid gland are influenced by cell specific gene expression and cell-matrix interactions that produce collagen responsible for branching and hyaluronidase responsible for acini formation. The awareness of presence of a double parotid duct is significant in ductal endoscopic procedures and in performing surgery in the parotid region.

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The anatomy of the medial collateral ligament of the knee and its significance in joint stability

The medial collateral ligament (MCL) is the most important stabilizer of the medial side of the knee together with the capsuloligamentous complex. As such, it has a distinctive role in joint stability, as far as its biomechanics are concerned, and major joint stability issues onset when it is injured or deficient. One of the main functions of the medial collateral ligament is mechanical as it passively stabilizes the knee and help in guiding it through its normal range of motion when a tensile load is applied. It exhibits nonlinear anisotropic mechanical behaviour, like all ligaments, and under low loading conditions it is relatively compliant, perhaps due to recruitment of "crimped" collagen fibres as well as to viscoelastic behaviours and interactions of collagen and other matrix materials. Continued ligament-loading results in increasing stiffness until a stage is reached where it exhibits nearly linear stiffness and beyond this it continues to absorb energy until it is disrupted. In addition, the function of the MCL has to do with its viscoelasticity which assists the maintainance of joint congruity and homeostasis. The treatment of grade III medial collateral ligament injuries (with gross valgus instability at 0° of flexion) is still controversial. The most severe injuries (especially with severe valgus alignment, intra-articular medial collateral ligament entrapment, large bony avulsions, or multiple ligament involvement) may require acute operative repair or augmentation. In addition, surgical reconstruction is indicated for isolated symptomatic chronic medial collateral ligament laxity. The optimal surgical treatment remains controversial. More studies with evidence of level I and II are required in order to clarify the pros and cons of any solution.

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A rare anomaly of the human spleen with nine notches associated with multiple accessory spleens. A case study, hypothesis on origin and review of clinical significance

In humans, the spleen is the body's largest secondary lymphoid organ and filterer of blood. The trabeculated structure of the spleen, which is formed in its early embryonic development, provides its three-dimensional framework designed to remove senescent erythrocytes and eliminate blood-borne microorganisms and/or dubious antigens. At a later date this lobulated framework can develop into notches which usually manifest along its anterior (superior) border. This study addresses the clinical significance and developmental basis of both numerous notches and multiple accessory spleens observed in a male human cadaver. The nine notches were all observed on the anterior and inferior borders, whilst the accessory spleens numbered four, with two localized at the splenic hilum and the other two upon the splenorenal and splenocolic ligaments respectively. In the present study, we propose an aetiological origin for the anomalous multi-notches and accessory spleens, which will provide primary benefit for surgeons and radiologists because of clinical significance.

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Formation of suprascapular foramen as a result of ossification of superior transverse scapular ligament: a case report and short review of the literature

Ossification of superior transverse scapular ligament resulting in a bony suprascapular foramen is of fundamental anatomical and clinical importance. In this case report, we describe a special case of a suprascapular foramen. Its specificity lies in foraminal dimensions, resulting in a unique morphometrical pattern in comparison with reported similar cases. This pattern is of great anatomical and clinical importance, because ossification of suprascapular foramen leads to limitation of suprascapular notch, over which suprascapular nerve passes. Ossification can consequently constitute a major predisposing factor for suprascapular nerve entrapment and subsequent neuropathy. Therefore, this anatomic variation should be considered from surgeons and other healthcare professionals.

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