Impaired Hypercarbic and Hypoxic Responses from Developmental Loss of Cerebellar Purkinje Neurons: Implications for Sudden Infant Death Syndrome

Impaired responsivity to hypercapnia or hypoxia is commonly considered a mechanism of failure in sudden infant death syndrome (SIDS). The search for deficient brain structures mediating flawed chemosensitivity typically focuses on medullary regions; however, a network that includes Purkinje cells of the cerebellar cortex and its associated cerebellar nuclei also helps mediate responses to carbon dioxide (CO2) and oxygen (O2) challenges and assists integration of cardiovascular and respiratory interactions. Although cerebellar nuclei contributions to chemoreceptor challenges in adult models are well described, Purkinje cell roles in developing models are unclear. We used a model of developmental cerebellar Purkinje cell loss to determine if such loss influenced compensatory ventilatory responses to hypercapnic and hypoxic challenges. Twenty-four Lurcher mutant mice and wild-type controls were sequentially exposed to 2% increases in CO2 (0-8%) or 2% reductions in O2 (21-13%) over 4 min, with return to room air (21% O2/79% N2/0% CO2) between each exposure. Whole body plethysmography was used to continuously monitor tidal volume (TV) and breath frequency (f). Increased f to hypercapnia was significantly lower in mutants, slower to initiate, and markedly lower in compensatory periods, except for very high (8%) CO2 levels. The magnitude of TV changes to increasing CO2 appeared smaller in mutants but only approached significance. Smaller but significant differences emerged in response to hypoxia, with mutants showing smaller TV when initially exposed to reduced O2 and lower f following exposure to 17% O2. Since cerebellar neuropathology appears in SIDS victims, developmental cerebellar neuropathology may contribute to SIDS vulnerability.

Management of renal arteriovenous malformations: A pictorial review

Arteriovenous malformations (AVMs) are communications between an artery and a vein outside the capillary level. This pathologic communication may be either a fistula, a simple communication between a single artery and a dilated vein, or a more complex communication, a nidus of tortuous channels between one or more arteries/arterioles and one or more draining veins. The latter type of lesion is most frequently seen in the extremities; in the kidney they tend to appear more rarely. The most common clinical presentation of renal arteriovenous malformations (RAVMs) is haematuria. Percutaneous treatment with selective endovascular techniques offers a minimally invasive, nephron-sparing option in comparison to the more invasive surgical approaches. The purpose of this pictorial review is to highlight the general lines of management and to show the range of imaging findings of the percutaneous treatment of RAVMs.

The SIC-GIRCG 2013 Consensus Conference on Gastric Cancer

The topic chosen by the Board of the Italian Society of Surgery for the 2013 annual Consensus Conference was gastric cancer. With this purpose, under the direction of 2 chairmen, 36 experts nominated by the Regional Societies of Surgery and by the Italian Research Group for Gastric Cancer (GIRCG) participated in an experts consensus exercise, preceded by a questionnaire and mainly held by telematic vote, in accordance with the rules of the Delphi method. The results of this Consensus Conference, presented to the 115th National Congress of the Italian Society of Surgery, and approved in plenary session, are reported in the present paper.

Acknowledgment of Reviewers

Aaslid, Rune Abbas, Mohammed Abbott, Anne Abdullah, Abdul Abe, Tatsuya Abhayaratna, Walter Abilleira, Sonia Abiodun, Akinwuntan Abou-Chebl, Alex Abu-Omar, Yasir AbuRahma, Ali Acharya, Aninda Acker III, Joe Ackerman, Robert Ada, Louise Adachi, Hisashi Adair, John Adame, Isabel Maria Adams, David Adams, Harold Adler, John Agarwal, Sachin Agrawal, Devendra Aguilar, Maria I. Ahmad, Arshia Ahmed, Ejaz Aibiki, Mayuki Aichner, Franz Ainslie, Philip Aiyagari, Venkatesh Aizpuru, Felipe Ajmo Jr, Craig Akai, Yasuhiro Akins, Paul Al Shafaee, Mohammed Aladro, Yolanda Alano, Conrad Alaraj, Ali Albers, Greg Albert, Martin Alberts, Mark Alberts-Grill, Noah Alecu, Cosmin Aleil, Boris Aleksic, Ivan Alevizaki, Maria Alexander, G. Caleb Alexandrov, Andrei Algra, Ale Alhenc-Gelas, Francois Alkayed, Nabil Allison, Matthew Almawi, Wassim Almeida, Osvaldo Al-Qasmi, Mohammed Al-Rawi, Pippa Al-Rawi, Yasir Al-Shahi, Rustam Alsop, David Altaf, Nishath Altay, Tamer Altieri, Marta Alvarez-Sabin, José Amar, Jacques Amarenco, Pierre Amberger, Nicola Ameriso, Sebastian Amin-Hanjani, Sepideh Amiri, Masoud An, Hongyu Ancliffe, Jacqui Andersohn, Frank Anderson, Craig Andjelkovic, Anuska Andre, Charles Andreasson, Katrin Andreone, Vincenzo Andresen, Jon Annunziato, Lucio Anrather, Josef Antonello, Michele Anzola, Gian Paolo Apfalter, Petra Appelros, Peter Arauz, Antonio Arboix, Adriý Arcieri, Romano Ardelt, Agnieszka Arenillas, Juan Arif, Hiba Armijo, Adriana Armstead, William Arnold, Marcel Aro, Antti Aronow, Herbert Aronow, Wilbert Aronowski, Jaroslaw Arrich, Jasmin Ashmaui, Aly Aslanyan, Stella Asplund, Kjell Asselbergs, Folkert Athanasios, Benetos Atkinson, Richard Auburger, Georg Audebert, Heinrich Auer, Dorothee P. Aukrust, Pål Aulchenko, Yurii Au-Yeung, Stephanie Avendano, Mauricio Aviv, Richard Awad, Issam Ay, Hakan Ayata, Cenk Azhar, Salman Azouvi, Philippe

On the sizing of a flat-panel ground heat exchanger

Ground-source heat pumps are a reliable technology and may represent an efficient and cost-effective option for space heating and cooling, when the investment for ground heat exchangers is reasonable. New advanced ground exchangers have been recently proposed, showing high performances also in shallow ground; their shape has not yet been investigated in literature. In the present study, an analytical solution based on the line-source method is applied for sizing a novel shape. This so-called flat-panel shape is assumed to be an equivalent slinky-coil having the same heat transfer surface per unit of trench length. As overall benchmarks, two other configurations of straight pipe disposed vertically and horizontally have been sized; all devices are supposed to work in a four lined geothermal field. The building heating requirement has been evaluated assuming a simplified lumped system and three different climate zones, defined by 2000, 2500 and 3000 degree days. Then, a 2D finite-element model has been implemented to solve the transient heat conduction problem in the ground. The results of the analytical formulation and numerical simulations have been compared in terms of average temperature at the wall surface of the heat exchanger. The design minimum temperature considered by the analytical method in sizing the two straight pipe configurations and the flat-panel are accurately reproduced by the numerical model. Therefore, the slinky-coil equivalent approach followed in the analytical method for sizing the flat-panel seems to be a reliable and suitable approximation

Dysphagia Management in Acute and Sub-acute Stroke

Swallowing dysfunction is common after stroke. More than 50% of the 665 thousand stroke survivors will experience dysphagia acutely of which approximately 80 thousand will experience persistent dysphagia at 6 months. The physiologic impairments that result in post-stroke dysphagia are varied. This review focuses primarily on well-established dysphagia treatments in the context of the physiologic impairments they treat. Traditional dysphagia therapies including volume and texture modifications, strategies such as chin tuck, head tilt, head turn, effortful swallow, supraglottic swallow, super-supraglottic swallow, Mendelsohn maneuver and exercises such as the Shaker exercise and Masako (tongue hold) maneuver are discussed. Other more recent treatment interventions are discussed in the context of the evidence available.

Misclassification in Administrative Claims Data: Quantifying the Impact on Treatment Effect Estimates

Misclassification is present in nearly every epidemiologic study, yet is rarely quantified in analysis in favor of a focus on random error. In this review, we discuss past and present wisdom on misclassification and what measures should be taken to quantify this influential bias, with a focus on bias in pharmacoepidemiologic studies. To date, pharmacoepidemiology primarily utilizes data obtained from administrative claims, a rich source of prescription data but susceptible to bias from unobservable factors including medication sample use, medications filled but not taken, health conditions that are not reported in the administrative billing data, and inadequate capture of confounders. Due to the increasing focus on comparative effectiveness research, we provide a discussion of misclassification in the context of an active comparator, including a demonstration of treatment effects biased away from the null in the presence of nondifferential misclassification. Finally, we highlight recently developed methods to quantify bias and offer these methods as potential options for strengthening the validity and quantifying uncertainty of results obtained from pharmacoepidemiologic research.

Children and adults varicocele: diagnostic issues and therapeutical strategies

Varicocele is defined as abnormally dilated scrotal veins. It is present in 15 % of normal males and in 40 % of males with infertility. This disorder is a challenge for the physicians involved in the diagnosis and treatment, as the pathophysiology of varicocele is not yet completely understood. For this reason, accurate diagnostic criteria and clear indications for treatment in asymptomatic adolescents or adults with clinical or subclinical varicocele are still not defined. Ultrasonography (US) is considered the best method for calculating the volume of the testicles, measuring vein diameter and monitoring the growth of the testis in adolescent patients. Color-Doppler US is the method of choice for detecting spermatic vein reflux and for classifying the grade of varicocele. Various classification systems have been published with recommendations on how to perform US imaging of the scrotum. Currently, color-Doppler US and spectral analysis are the most effective, non-invasive diagnostic procedures as they allow detection of subclinical varicocele associated with infertility. Various techniques are used in the treatment of varicocele including open surgery, laparoscopic procedures and interventional radiology. However, there is no consensus among physicians on which technique is the most effective in terms of outcome and complication rates. This review shows that color-Doppler US is currently the most widely employed diagnostic method for detection and classification of varicocele caused by venous reflux, as it is reliable and easily performed. The review also highlights the role of varicocelectomy in the management of adult male infertility.

Italian Association of Clinical Endocrinologists (AME) position statement: a stepwise clinical approach to the diagnosis of gastroenteropancreatic neuroendocrine neoplasms

Caratteristiche della miastenia grave associata con l’autoimmunità tiroidea a Taiwan

In questo rimarchevole studio, condotto su di una casistica estremamente ampia, veniva esaminata la frequenza di autoimmunita tiroidea in pazienti con miastenia grave e venivano valutate le caratteristiche della miastenia stessa in relazione all’associazione o meno con l’autoimmunita tiroidea. Tra il 1999 e il 2009 venivano studiati 1482 pazienti con miastenia grave. Di questi, 121 (8,2%) presentavano un’associazione con malattie autoimmuni della tiroide conclamate (5,7% morbo di Basedow e 1,1% tiroidite autoimmune) o con la positivita degli anticorpi anti-tiroide circolanti (1,4%). I pazienti con associata autoimmunita tiroidea presentavano una maggior frequenza di miastenia oculare rispetto ai pazienti che non presentavano tale associazione. Questi ultimi presentavano piu spesso la forma generalizzata di miastenia grave. Inoltre, la frequenza di timoma e quella degli autoanticorpi anti-recettore dell’acetilcolina circolanti erano significativamente piu basse nei pazienti con miastenia oculare, che invece presentavano piu spesso un’iperplasia timica.