A previously healthy, fully immunized 10-year-old girl from Minnesota presented in July with a 1-week history of headaches, dizziness, myalgias, pharyngitis, and fever and a 1-day history of double vision, unsteady gait, and slurred speech. Her symptoms began approximately 4 days after returning from a family vacation to northern Wis- consin, where she had spent signiﬁcant time outdoors and had exposure to mosqui- toes.
Surgical treatment definitely represents the preferred options for BCC, with conventional excision being suf- ficient in most primary BCCs and Mohs micrographic surgery being the most effective in high risk or recur- rent BCCs of the face, where it is associated with 5- and 10-year recurrence rates of 2.1–5.2% and 3.9–4.4%, respectively [41–43]. Among non-surgical options, radi- otherapy represents a consolidated and effective alter- native [3, 4, 34, 35], although logistical barrier may be a limitation. In selected cases, ECT may be a rapid, easy to apply treatment, although the broad spectrum of BCC presentation poses peculiar challenges to its applica- tion. In order to maximize the efficacy to toxicity ratio, clinicians should aim to select the most appropriate ECT treatment modality (type of anaesthesia, route of drug administration and electrode geometry). In theory, sys- temic chemotherapy, coupled with use of a large needle electrode (i.e., the hexagonal array, Fig. 1a) allows homo- geneous tumor tissue exposure to chemotherapy and complete tumor electroporation. However, this should be weighed against possible side effects. Systemic bleo- mycin can be associated, although in very rare cases, with lung toxicity (especially in patients >70 years of age) , and the application of a large needle electrode can increase skin injury due to its greater invasiveness . Furthermore, clinician and patients could be reluctant to systemic chemotherapy for the treatment of a localized, slow growing tumor. ECT proved to be effective in BCCs located on the midface, where treatment could be poten- tially challenging due to the presence of aesthetic and functional structures. According to a well-documented series of three patients with BCC of 0.5–1.0 cm 2 affecting
We report our 10-year experience with penile injuries. We ret- rospectively reviewed the records of 156 cases of male external genitalia injuries between May 2002 and December 2012. Of these, only 26 patients presented without urethral injuries and were included in this study. Patients were divided into 4 groups: Group 1 (n = 12) with patients with penile fractures injuries; Group 2 (n = 5) with patients with penile amputation injuries; Group 3 (n = 2) with patients with penile penetrating injuries; and Group 4 (n = 7) with patients with penile soft tissue injuries. Grading of injury was done using the American Association for the Surgery of Trauma (AAST)-Organ injury scale of penile injury. Penile injuries without urethral injuries are urological emergencies which require immediate attention.
All the data were reported as means ± standard deviation (SD). The differences in mean values among three groups were examined using an analysis of variance (ANOVA) and those between two groups were evaluated using the unpaired t-test. The categorical variables were compared using the chi- squared test. The associations between the three TC groups (a high-TC group [n = 69], with TC of $209 mg/dL; an inter- mediate-TC group [n = 69], with TC of 176–208 mg/dL; and a low-TC group [n = 67], with TC of #175 mg/dL) or serum concentrations of TC, LDL-C, HDL-C, or TG, and time with 10-year mortality were assessed using the multivari- ate Cox proportional hazards regression analysis, in which only gender was adjusted or both gender and other various confounding factors (smoking, alcohol intake, history of stroke or heart disease, serum albumin concentration, BMI, and systolic BP) were adjusted. A comparison of the survival rates among the three TC groups was also assessed by the Kaplan–Meier method, followed by a logrank test to assess
The differences in mean values among the three global MMSE groups were examined using an analysis of variance (ANOVA) and those between two groups were evaluated using the unpaired Student’s t-test. Unpaired Student’s t-test was done between men and women, or survivor and non- survivor for comparing MMSE scores. The categorical variables were compared using the chi-squared test. The associations between the three global MMSE groups and 10year mortality rates were assessed using multivariate Cox proportional hazards regression analyses in which no adjust- ment was made, or only adjustment for sex was made, both
However, there was no study about therapeutic abor- tion in Siriraj Hospital, therefore this research was per- formed. The study is hypothesized that indications of therapeutic abortion 24 weeks or less are mostly related with fetus and those with after 24 weeks are related with mother. The objective of this study was to examine the trend of therapeutic abortion, indications and methods of therapeutic abortion during 10-year period.
Background: The Israeli National and Ethnic Mutation database (http://server.goldenhelix.org/israeli) was launched in September 2006 on the ETHNOS software to include clinically relevant genomic variants reported among Jewish and Arab Israeli patients. In 2016, the database was reviewed and corrected according to ClinVar (https://www.ncbi. nlm.nih.gov/clinvar) and ExAC (http://exac.broadinstitute.org) database entries. The present article summarizes some key aspects from the development and continuous update of the database over a 10-year period, which could serve as a paradigm of successful database curation for other similar resources.
Whilst biosensor was not specified in , I have in- cluded it as a major topic since JBE has published a sub- stantial number of papers on biosensors. I have classified all published JBE articles (from volumes 1 to 9, i.e. years 2007 to 2015; note that JBE publishes one volume per year) into the above six areas, and summarized the re- sults in Fig. 1. I have to admit that such classification was not always easy, since biological engineering is inherently interdisciplinary. It was also difficult to draw a clear borderline between synthetic biology and biopro- duction. While I tried my best to make such classifications, there may exist a certain degree of misin- terpretation. Also in some rare cases, two different top- ical areas were equally addressed in a single paper, thus I counted such paper twice over two topical areas.
2.3.1 Launched in 2003 Modernising Medical Careers sought to implement programmes in response to, Unfinished Business, the Chief Medical Officers report. Widespread consultation was undertaken before the four UK health departments embarked upon the initiative, though in hindsight this may not have been as wide as originally thought. 2005 saw the introduction of a new two year foundation training programme “that forms the bridge between medical school and specialty or general medical practice training“(MMC website 2011). The programme sought to provide a transparent and efficient career path, which had previously been not been apparent with the Senior House Officer (SHO) posts as they lacked; educational definition, structured career pathways, time limits, and vague dissemblance between training and service. Foundation Year 1 (F1) and foundation Year 2 (F2) training posts replaced the House Officer (HO) and SHO positions. The replacement speciality training was introduced in 2007 and split into two strands; Core Training (CT), offered two to three years of core training in competitive fields of clinical medicine before applying for advanced training in specialities through an open competition system. Speciality Training (ST), offered automatic progression through the training dependant on satisfactory completion of competency requirements.
sensitivities to qualitative and some quantitative policy initiatives, and omissions. Some further work was done on these for the Ten Year Transport Plan, but it was not the DETR’s view that they had been (or, perhaps, could be) completely solved in the time, or with this method 5 . The central issue is whether the forecasts give an unbiased assessment of the sensitivity of traffic, congestion etc to changes in the speeds, costs, regulation and conditions of travel that are subject to policy influence. This is much more important than calculation of the ‘base’ case from which the effects of the changes are calculated, since the sensitivities it embodies to changes in costs or speeds, brought about by different policies, will determine which policies are judged more or less effective. A powerful test of a model is therefore to compare the sensitivities it uses with other evidence, or a priori expectations. At first sight, the
cold weather causes vasospasm followed by ischemia which forms part of the pathogenesis of preeclampsia (25). The preconceptional factors, especially the plasma volume and vascular tonicity, have been raised in this regard. It is assumed that the onset of the preeclampsia is secondary reduction of placental uterine perfusion to abnormal cytotrophoblastic invasion of spiral arterioles. Thus, placental hypoxia/ischemia causes extensive dysfunction/activation of maternal vascular endothelium followed by formation of endothelia, thromboxane and superoxide, vascular hypersensitivity to angiotensin II, Reduction in prostacyclin production and the result of this abnormal vascular changes is increased peripheral resistance and hypertension. Researchers who have found the higher risk of preeclampsia in pregnancies with fertilization in the cold seasons, have discussed about numerous possible mechanisms such as changes in climate, temperature and humidity, infection and seasonal variation in food intake (25-27). Accordingly, vasoconstriction in cold seasons (28), fluctuations in the prevalence of seasonal infections which cause inflammatory responses in pregnancy, or changes in maternal diet during different seasons such as antioxidants and calcium, and low intake of vitamin D in cold seasons (29), have been discussed. On the other hand, studies that reported a high risk of preeclampsia in pregnancies with fertilization during the summer, have suggested changes in blood plasma volume influenced by climate changes (9) or heat- affected vascular damage in the primary stages of pregnancy and placenta implantation process (30). Zahirisoroori et al. in Guilan (the North of Iran) did not find a significant relationship between preeclampsia / eclampsia, and seasons (29). They stated that it was not possible to confirm the study results due to the lack of sufficient distinction between seasons (for example, relative similarity between spring and summer or autumn and winter) and lack of temperature and humidity differentiation throughout the year in this area. (29) It should be noted that though Hamadan is regarded as one of the cold region in Iran, it has four distinct and separate seasons which puts the present study in a unique situation in this regard. In our study, the risk of developing preeclampsia was significantly higher in blood group O + than other blood groups. Different
A number of interesting and effective message design strategies have appeared in the literature over the past 10 years, and this trend will likely continue. Counterbalan- cing this is the fact that message design was not addressed in many of the published studies examined here, however, and Table 2 suggests that only a limited number of formalized message design approaches are appearing in this literature. While com- munication scholars are well aware of message design principles and theories, those from other disciplines may be less aware of such approaches. In addition to better dissemination of message design frameworks and theories, campaign scholars should strive for continued innovation in this area. For instance, communication scholars might collaborate with those in advertising and social marketing who have signifi- cant experience developing messages and in that manner develop new and creative approaches to message design (e.g., Evans et al., 2002; Zimmerman et al., in press). Finally, much of the work conducted in this area may not be fully reported in evalu- ation articles, even though such reporting would be useful.
15 patients had right, 3 patients left, and two patients bilateral diaphragmatic eventration. 18 patients undef\vent operation (plication), while two patients with small and asymptomatic eventration were not operated. Operative repair was performed with no mortality. Hospital stay was 14.5 days. 12/20 patients had come for follow-up and they were evaluated from 5 months to 10 years. All showed good results from diaphragmatic plication without respiratory distress or infection and gained weight from below the 3rd percentile to above the 10th percentile. Surgical correction is strongly recommended in patients with eventration of the diaphragm and failure to thrive or other clinical manifestations.
OALibJ | DOI:10.4236/oalib.1101393 5 March 2015 | Volume 2 | e1393 diography was done to all patients with ARM in Clinic of Neonatology. Their incidence in our study matches the reported incidence of 12% - 27% for cardiovascular anomalies     . The reported inci- dence of gastrointestinal anomalies ranges between 10% and 24%  . In this study, they comprise 15.79% of all associated anomalies, represented by 8 patients with esophageal atresia (14.04%) and one patient with Meckels Diverticula. Esophageal atresia is also the most frequent anomaly throughout this study.
10 often very sensitive ones. As Fishman says, “If you try to move the mountain it may be too much for you to do and in that weakened condition you cannot afford too many more defeats”. The history of language loss is normally one of defeats and therefore the patience involves taking on only that which you can accomplish, taking on the minor or less threatening goals and less threatening opponents. Sometimes that’s a very difficult thing to do when there’s an element of frustration but there is only so much you can undertake, particularly in a weakened condition, but patience.
Peter’s asthma has always been a concern to his parents. Since his diagnosis of asthma at 2 years of age during his first hospitalization for pneumonia, his mother often reminds doctors that “they said he was very sick—that if we hadn’t taken him to the hospital that night, he may have died.” Now 10 years old, Peter has had 5 subsequent brief hospitalizations for status asthmaticus. His pattern of illness is pre- dictable: an upper respiratory illness followed by wheezing not completely controlled by inhalation home medication; he spends not more than 2 days in the hospital. He has had only one other episode of pneumonia. Emergency room visits seemed clus- tered around moments of family disruption. His par- ents’ separation and divorce when he was 5 years old, his mother’s loss of her job when he was 7, and his older sister’s auto accident when he was 8 were each accompanied by 1 to 3 emergency room visits for asthma. At other times, asthma exacerbations were managed at home. Peter’s pediatrician, and subsequently an allergist, provided his mother with a written plan for maintenance and acute treatment medications, as well as attention to household aller- gen elimination, with limited success. Recently, Peter refused to take his inhaler to school. He resisted going to the school nurse for medication as needed. In the 4th grade, his behavior in class was on occa- sion disruptive, and he demonstrated less interest in school work. His teacher reported that Peter was often short of breath after playing at recess. Peter now lives with his mother and older sister. His mother works full time as a medical assistant. Since the divorce 5 years ago, Peter spends 1 weekend each month with his father, who lives in a nearby town.