Use of glass beads and CF 11 cellulose for removal of leukocytes from malaria-infected human blood in field settings

Passage of malaria infected blood through a two-layered column composed of acid-washed glass beads and CF 11 cellulose removes white cells from parasitized blood. However, because use of glass beads and CF 11 cellulose requires filtration of infected blood separately through these two resins and the addition of ADP, the procedure is time-consuming and may be inapropriate for use in the field, especially when large numbers of blood samples are to be treated. Our modification of this process yields parasitized cells free of contaminating leukocytes, and because of its operational simplicity, large numbers of blood samples can be processed. Our procedure also compares well with those using expensive commercial Sepacell resins in its ability to separate leukocytes from whole blood. As a test of usefulness in molecular biologic investigations, the parasites obtained from the blood of malaria-infected patients using the modified procedure yield genomic DNA whose single copy gene, the circumsporozite gene, efficiently amplifies by polymerase chain reaction.

Surgical treatment of ingrown toenail without matricectomy.

BACKGROUND: Partial excision of the nail matrix (matricectomy) is generally considered necessary in the surgical treatment of ingrown toenail. Recurrences may occur, however, and poor cosmetic results are frequently observed. OBJECTIVE: The objective is to present a new surgical procedure for ingrown toenail with complete preservation of the nail matrix. METHODS: Twenty-three patients with ingrown toenail were included in this study. The surgical excision was performed 1 week after the completion of treatment of the initial infection. A large volume of soft tissue surrounding the nail plate was removed under local anesthesia. No matrix excision was performed. RESULTS: Short-term results were excellent. No recurrences or severe complications were observed during the minimum 12-months follow-up period. Cosmetic results were remarkable. CONCLUSIONS: Ingrown toenail results from the compression of the lateral nail folds on the nail plate. This study shows that ingrown toenail can be surgically treated without matricectomy. A large volume of soft tissue surrounding the nail plate should be removed to decompress the nail and reduce inflammation. Cosmetic results are excellent and superior to the classical Emmert plasty. Postoperative nail dystrophies and spicule formation are not observed. The main advantage of this surgical approach is the complete preservation of the anatomy and function of the nail to improve both therapeutic and cosmetic results.

The "help" question doesn't help when screening for major depression: external validation of the three-question screening test for primary care patients managed for physical complaints.

BACKGROUND: Major depression, although frequent in primary care, is commonly hidden behind multiple physical complaints that are often the first and only reason for patient consultation. Major depression can be screened by two validated questions that are easier to use in primary care than the full DSM-IV criteria. A third question, called the "help" question, improves the specificity without apparently decreasing the sensitivity of this screening procedure. We validated the abbreviated screening procedure for major depression with and without the "help" question in primary care patients managed for a physical complaint. METHODS: This diagnostic accuracy study used data from a cohort study called SODA (for SOmatisation Depression Anxiety ) conducted by 24 general practitioners (GPs) in western Switzerland that included patients over 18 years of age with at least one physical complaint at index consultation. Major depression was identified with the full Patient Health Questionnaire. GPs were asked to screen patients for major depression with the three screening questions one year after inclusion. RESULTS: Out of 937 patients with at least one physical complaint, 751 were eligible one year after index consultation. Major depression was diagnosed in 69/724 (9.5%) patients. The sensitivity and specificity of the two-question method alone were 91.3% (95% confidence interval 81.4-96.4%) and 65.0% (95% confidence interval 61.2-68.6%), respectively. Adding the "help" question decreased the sensitivity (59.4% ; 95% confidence interval 47.0-70.9%) but improved the specificity (88.2% ; 95% confidence interval 85.4-90.5%) of the three-question method. CONCLUSIONS: The use of two screening questions for major depression was associated with high sensitivity and low specificity in primary care patients presenting a physical complaint. Adding the "help" question improved the specificity but clearly decreased the sensitivity; when using the "help" question; four out of ten patients with depression will be missed, compared to only one out of ten with the two-question method. Therefore, the "help" question is not useful as a screening question, but may help discussing management strategies.

A new training set-up for trans-apical aortic valve replacement.

Trans-apical aortic valve replacement (AVR) is a new and rapidly growing therapy. However, there are only few training opportunities. The objective of our work is to build an appropriate artificial model of the heart that can replace the use of animals for surgical training in trans-apical AVR procedures. To reduce the necessity for fluoroscopy, we pursued the goal of building a translucent model of the heart that has nature-like dimensions. A simplified 3D model of a human heart with its aortic root was created in silico using the SolidWorks Computer-Aided Design (CAD) program. This heart model was printed using a rapid prototyping system developed by the Fab@Home project and dip-coated two times with dispersion silicone. The translucency of the heart model allows the perception of the deployment area of the valved-stent without using heavy imaging support. The final model was then placed in a human manikin for surgical training on trans-apical AVR procedure. Trans-apical AVR with all the necessary steps (puncture, wiring, catheterization, ballooning etc.) can be realized repeatedly in this setting.

Isokinetic rotator muscles fatigue in glenohumeral joint instability before and after Latarjet surgery: a pilot prospective study.

We aimed to analyze the changes in isokinetic internal (IR) and external (ER) rotator muscles fatigue (a) in patients with non-operated recurrent anterior instability, and (b) before and after shoulder surgical stabilization with the Bristow-Latarjet procedure. Thirty-seven patients with non-operated unilateral recurrent anterior post-traumatic instability (NG) were compared with 12 healthy subjects [control group (CG)]. Twenty patients with operated recurrent anterior instability group (OG) underwent isokinetic evaluation before and 3, 6, and 21 months after Bristow-Latarjet surgery. IR and ER muscles strength was evaluated with Con-Trex® dynamometer, with subjects seated and at a 45° shoulder abduction angle in scapular plane. IR and ER muscle fatigue was determined after 10 concentric repetitions at 180° · s(-1) through the fatigue index, the percent decrease in performance (DP), and the slope of peak torque decrease. There were no differences in rotator muscles fatigue between NG and CG. In OG, 3 months post-surgery, IR DP of operated shoulder was significantly (P < 0.001) higher than presurgery and 6 and 21 months post-surgery. Rotator muscles fatigability was not associated with recurrent anterior instability. After surgical stabilization, there was a significantly higher IR fatigability in the operated shoulder 3 months post-surgery, followed by recovery evidenced 6 months post-surgery and long-term maintenance over 21 months.

Nuclear scaffold proteins are differently sensitive to stabilizing treatment by heat or Cu++.

The distribution of three nuclear scaffold proteins (of which one is a component of a particular class of nuclear bodies) has been studied in intact K562 human erythroleukemia cells, isolated nuclei, and nuclear scaffolds. Nuclear scaffolds were obtained by extraction with the ionic detergent lithium diidosalicylate (LIS), using nuclei prepared in the absence of divalent cations (metal-depleted nuclei) and stabilized either by a brief heat exposure (20 min at 37C or 42C) or by Cu++ ions at 0C. Proteins were visualized by in situ immunocytochemistry and confocal microscopy. Only a 160-kD nuclear scaffold protein was unaffected by all the stabilization procedures performed on isolated nuclei. However, LIS extraction and scaffold preparation procedures markedly modified the distribution of the polypeptide seen in intact cells, unless stabilization had been performed by Cu++. In isolated nuclei, only Cu++ treatment preserved the original distribution of the two other antigens (M(r), 125 and 126 kD), whereas in heat-stabilized nuclei we detected dramatic changes. In nuclear scaffolds reacted with antibodies to 125 and 126-kD proteins, the fluorescent pattern was always disarranged regardless of the stabilization procedure. These results, obtained with nuclei prepared in the absence of Mg+2 ions, indicate that heat treatment per se can induce changes in the distribution of nuclear proteins, at variance with previous suggestions. Nevertheless, each of the proteins we have studied behaves in a different way, possibly because of its specific association with the nuclear scaffold.

Eyes wide shut - unusual two stage repair of pectus excavatum and annuloaortic ectasia in a 37 year old marfan patient: Case report

We report about a 37 year old male patient with a pectus excavatum. The patient was in NYHA functional class III. After performed computed tomography the symptoms were thought to be related to the severity of chest deformation. A Ravitch-procedure had been accomplished in a district hospital in 2009. The crack of a metal bar led to a reevaluation 2010, in which surprisingly the presence of an annuloaortic ectasia (root 73 × 74 mm) in direct neighborhood of the formerly implanted metal-bars was diagnosed. Echocardiography revealed a severe aortic valve regurgitation, the left ventricle was massively dilated presenting a reduced ejection fraction of 45%. A marfan syndrome was suspected and the patient underwent a valve sparing aortic root replacement (David procedure) in our institution with an uneventful postoperative course. A review of the literature in combination with discussion of our case suggests the application of stronger recommendations towards preoperative cardiovascular assessment in patients with pectus excavatum.

Carcinome de Merket: (r)évolution [Merkel cell carcinoma: (r)evolution].

Merkel Cell Carcinoma (CCM) is an aggressive cutaneous tumor of the elderly, which has become the second cause of mortality linked to skin cancer. This has led clinicians and scientists to devote more time to the study of this rare tumor, announcing to a revolution in our understanding, diagnosis and therapy of this cancer. We present here these recent advances, which illustrate the exponential growth of knowledge in the medical field, drawing comparisons with more frequent cancers such as melanoma and squamous cell carcinoma.

Transmyocardial laser revascularisation in acutely ischaemic myocardium.

OBJECTIVE: Although recent experience suggests that transmyocardial laser revascularisation (TMLR) relieves angina, its mechanism of action remains undefined. We examined its functional effects and analysed its morphological features in an animal model of acute ischaemia. METHODS: A total of 15 pigs were randomised to ligation of left marginal arteries (infarction group, n = 5), to TMLR of the left lateral wall using a holmium:yttrium-aluminium garnet (Ho:YAG) laser (laser group, n = 5), and to both (laser-infarction group, n = 5). All the animals were sacrificed 1 month after the procedure. Haemodynamics and echocardiography with segmental wall motion score were carried out at both time intervals (scale 0-3: 0, normal; 1, hypokinesia; 2, akinesia; 3, dyskinesia). Histology of the involved area was analysed. RESULTS: Laser group showed no change of the segmental wall motion score of the involved area 30 min after the laser channels were made (score: 0 +/- 0). Infarction and laser infarction groups both showed a persistent and definitive increase of the segmental wall motion score (at 30 min: 1.6 +/- 0.3 and 2 +/- 0, respectively; at 1 month: 1.8 +/- 0.2 and 1.8 +/- 0.4, respectively). These increases were all statistically significant in comparison with baseline values (P < 0.5), however comparison between infarction and laser-infarction groups showed no significant difference. On macroscopic examination of the endocardial surface, no channel was opened. On histology, there were signs of neovascularisation around the channels in the laser group, whereas in the laser-infarction group the channels were embedded in the infarction scar. CONCLUSIONS: In this acute pig model, TMLR did not provide improvement of contractility of the ischaemic myocardium. To the degree that the present study pertains to the clinical setting, the results suggest that mechanisms other than blood flow through the channels should be considered, such as a laser-induced triggering of neovascularisation or neural destruction.

Sex differences in hospital readmission among colorectal cancer patients.

Background: While several studies have analysed sex and socioeconomic differences in cancer incidence and mortality, sex differences in oncological health care have been seldom considered. Objective: To investigate sex based inequalities in hospital readmission among patients diagnosed with colorectal cancer. Design: Prospective cohort study. Setting: Hospital Universitary in L¿Hospitalet (Barcelona, Spain). Participants: Four hundred and three patients diagnosed with colorectal between January 1996 and December 1998 were actively followed up until 2002. Main outcome measurements and methods: Hospital readmission times related to colorectal cancer after surgical procedure. Cox proportional model with random effect (frailty) was used to estimate hazard rate ratios and 95% confidence intervals of readmission time for covariates analysed. Results: Crude hazard rate ratio of hospital readmission in men was 1.61 (95% CI 1.21 to 2.15). When other significant determinants of readmission were controlled for (including Dukes¿s stage, mortality, and Charlson¿s index) a significant risk of readmission was still present for men (hazard rate ratio: 1.52, 95% CI 1.17 to 1.96). Conclusions: In the case of colorectal cancer, women are less likely than men to be readmitted to the hospital, even after controlling for tumour characteristics, mortality, and comorbidity. New studies should investigate the role of other non-clinical variable such as differences in help seeking behaviours or structural or personal sex bias in the attention given to patients.

Reactive rise in blood pressure upon cuff inflation: cuff inflation at the arm causes a greater rise in pressure than at the wrist in hypertensive patients.

OBJECTIVE: Cuff inflation at the arm is known to cause an instantaneous rise in blood pressure, which might be due to the discomfort of the procedure and might interfere with the precision of the blood pressure measurement. In this study, we compared the reactive rise in blood pressure induced by cuff inflation when the cuff was placed at the upper arm level and at the wrist. PARTICIPANTS AND METHODS: The reactive rise in systolic and diastolic blood pressure to cuff inflation was measured in 34 normotensive participants and 34 hypertensive patients. Each participant was equipped with two cuffs, one around the right upper arm (OMRON HEM-CR19, 22-32 cm) and one around the right wrist (OMRON HEM-CS 19, 17-22 cm; Omron Health Care Europe BV, Hoofddorp, The Netherlands). The cuffs were inflated in a double random order (maximal cuff pressure and position of the cuff) with two maximal cuff pressures: 180 and 240 mmHg. The cuffs were linked to an oscillometric device (OMRON HEM 907; Omron Health Care). Simultaneously, blood pressure was measured continuously at the middle finger of the left hand using photoplethysmography. Three measurements were made at each level of blood pressure at the arm and at the wrist, and the sequence of measurements was randomized. RESULTS: In normotensive participants, no significant difference was observed in the reactive rise in blood pressure when the cuff was inflated either at the arm or at the wrist irrespective of the level of cuff inflation. Inflating a cuff at the arm, however, induced a significantly greater rise in blood pressure than inflating it at the wrist in hypertensive participants for both systolic and diastolic pressures (P<0.01), and at both levels of cuff inflation. The blood pressure response to cuff inflation was independent of baseline blood pressure. CONCLUSIONS: The results show that in hypertensive patients, cuff inflation at the wrist produces a smaller reactive rise in blood pressure. The difference between the arm and the wrist is independent of the patient's level of blood pressure.

Tytäryhtiöiden konserniohjaus ja -valvonta kuntakonsernin riskienhallinnassa Case: Imatran kaupunki

Tutkimuksen päätavoitteena olianalysoida Imatran kaupungin konserniohjausta ja -valvontaa tytäryhtiöihin liittyvien riskien hallitsemiseksi. Tavoitteen saavuttamiseksi tutkittiin tytäryhtiöiden konserniohjausta ja sisäistä valvontaa sekä tytäryhtiöihin liittyviä riskejä Imatran kaupunkikonsernissa. Jotta tutkimustavoite saavutettiin alatavoitteina selvitettiin konsernin, konserniohjauksen, sisäisen valvonnan, riskin ja riskienhallinnan käsitteitä sekä yleisesti että kuntaympäristössä. Lisäksi selvitettiin tutkimuksen teoreettisena viitekehyksenä käytettävää COSO-mallia. Tutkimusaineisto jakautui teoreettiseen ja empiiriseen aineistoon. Tutkimuksen teoreettista osuutta varten käytettiinaiheeseen liittyvää kirjallisuutta ja tutkimuksia. Empiirinen aineisto kerättiin haastatteluin ja organisaation tuottamia dokumentteja tutkien. Haastattelut toteutettiin teemahaastatteluina. Tutkimusstrategialtaan tutkimus oli tapaustutkimus (case study), joka tutkii olemassa olevan Imatra-konsernintytäryhtiöiden konserniohjausta ja - valvontaa. Tutkimuksessa analysoitiin yksityiskohtaista ja intensiivistä tietoa konsernin emon näkökulmasta. Todellista elämää kuvaavana tutkimus voidaan luokitella myös kvalitatiiviseksi eli laadulliseksi tutkimukseksi. Tutkimuksen perusteella voin todeta, että kaupunginhallituksen asettamat päämäärät ja tavoitteet ovat Tiian yleisiä ja jäävät konsernitasolle, joten niiden ohjausvaikutus tytäryhtiöihin ei ole kovin suuri. Tytäryhtiöiden heikosta tavoitteiden muotoilusta johtuen myös tytäryhtiöidentarkoituksenmukaisuuden ja tehokkuuden valvonta on vähäistä. Sen sijaan tytäryhteisöjen taloudellisten raporttien luotettavuus, lakien ja sääntöjen noudattaminen tulee valvottua tilintarkastusten yhteydessä. Lisäksi sisäisen tarkastuksen resurssien vähäisyyden vuoksi yksikön suorittama tytäryhtiöiden sisäisen valvonnan ja riskienhallinnan arviointi on olematonta. Myös riskienhallinnan kannalta tavoitteiden asettaminen on ollut liian suurpiirteistä ja irrallaan tytäryhtiöiden toiminnasta. Lisäksi haastattelujen mukaan sekä riskikäsite että riskienhallinnan käsite nähdään aivan liian suppeina. Ohjauksen, valvonnan sekä riskienhallinnan kannalta olisi tärkeää, että konsernin tavoitteiden asettamisen jälkeen myös tytäryhtiöille asetettaisiin selkeät mitattavat tavoitteet, joilla on yhteys kaupungin strategioihin. Tulisi myös varmistaa, että konsernissa ja sen tytäryhtiöissä on jatkuva riskien tunnistamistoiminto. Suositeltavaa on, että Imatra-konsernissa käynnistetään kokonaisvaltainen riskienhallintaprosessi.

Correcting for the bias due to expression specificity improves the estimation of constrained evolution of expression between mouse and human.

MOTIVATION: Comparative analyses of gene expression data from different species have become an important component of the study of molecular evolution. Thus methods are needed to estimate evolutionary distances between expression profiles, as well as a neutral reference to estimate selective pressure. Divergence between expression profiles of homologous genes is often calculated with Pearson's or Euclidean distance. Neutral divergence is usually inferred from randomized data. Despite being widely used, neither of these two steps has been well studied. Here, we analyze these methods formally and on real data, highlight their limitations and propose improvements. RESULTS: It has been demonstrated that Pearson's distance, in contrast to Euclidean distance, leads to underestimation of the expression similarity between homologous genes with a conserved uniform pattern of expression. Here, we first extend this study to genes with conserved, but specific pattern of expression. Surprisingly, we find that both Pearson's and Euclidean distances used as a measure of expression similarity between genes depend on the expression specificity of those genes. We also show that the Euclidean distance depends strongly on data normalization. Next, we show that the randomization procedure that is widely used to estimate the rate of neutral evolution is biased when broadly expressed genes are abundant in the data. To overcome this problem, we propose a novel randomization procedure that is unbiased with respect to expression profiles present in the datasets. Applying our method to the mouse and human gene expression data suggests significant gene expression conservation between these species. CONTACT: marc.robinson-rechavi@unil.ch; sven.bergmann@unil.ch SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Mentorointi liiketoiminnan kehittämisen ja henkilökohtaisen kehittymisen välineenä. Case: Stora Enso Oyj Imatran tehtaat

Tämän tutkimuksen tavoitteena on teemahaastatteluin ja kyselytutkimuksen avulla selvittää Stora Enso Oyj:n Imatran tehtaiden edellytyksiä ja tavoitteita mentorointiohjelmaan siirtymisessä. Tavoitteena on myös selvittää miten mentorointiohjelma tulisi Imatran tehtailla käytännön tasoilla toteuttaa. Empiirisen osan lopussa ehdotetaan erästä vaihtoehtoa mentorointimalliksi. Parhaimmillaan mentorointi mahdollistaa nopeutetun, mutta samalla laaja-alaisen ja syvällisen omaksumisen, työuralla etenemisen ja tuen saamisen. Mentorointi voi olla myös keino siirtää ikääntyneiden työntekijöiden hiljaista tietoa, organisaatiokulttuuria ja yhteisiä toimintatapoja. Tutkimuksen mukaan Imatran tehtailla on sekä tarpeita ja halua että edellytyksiä siirtyä mentorointiin. Mentorointiohjelman toteuttaminen vaatii huolellista paneutumista ohjelman kriittisiin kohtiin, kuten mentorin valintaan, parien muodostukseen, tiedotukseen, koulutukseen ja ohjelman ”myymiseen” organisaatiolle.

Strategian toimeenpanon haasteet - case SPY

Tutkimuksen tarkoituksensa oli luoda kokonaiskuva strategian toimeenpanoprosessista ja tuoda esiin case –yrityksen strategian toimeenpanon haasteet. Case –yritys toimii tietoliikennepalvelujen toimialalla, joka on ollut jatkuvassa muutoksessa. Yritys käynnisti strategiaprosessin vuonna 2002, jonka seurauksena liiketoiminnan painopistettä muutettiin palveluliiketoimintaan. Strategian toimeenpano ei sujunut haasteitta. Yritys on käynnistämässä uutta strategiaprosessia. Jotta edellisen strategian toimeenpanon ongelmat vältettäisiin, haluttiin tutkia, mikä on case –yrityksen strategian toimeenpanon taso tällä hetkellä ja tunnistaa case -yrityksen strategian toimeenpanemisen kehittämiskohdat. Tutkimus oli luonteeltaan kvalitatiivinen case –tutkimus, joka toteutettiin teemahaastatteluin. Tulokset osoittivat, että case –yrityksessä strategian toimeenpanoa voidaan kehittää erityisesti selkeyttämällä visio, lisäämällä johtajuutta ja visionäärisyyttä. Strategian toimeenpanossa johdolta vaaditaan myyntitaitoja: selkeää päämäärää, viestintää, luottamuksen tunteen luomista ja herkkyyttä kuunnella henkilöstön tuntoja. Johdon on itse omalla esimerkillään tehtävä tämä myyntityö. Hyvä visio poistaa muutosvastarintaa ja ohjaa oikeisiin päätöksiin. Ilman hyvää visiota, strategiasta voi tulla toimeenpanokelvoton. Strateginen johtaminen jatkuvana oppimisprosessina antaa hyvät mahdollisuudet tunnistaa toimintaympäristön muutokset. Strategiaprosessi kasvattaa koko yrityksen visionäärisyyttä samalla sitouttaen strategian toimeenpanoon. Lisäksi strategiaprosessi auttaa luomaan yritykseen joustavan oppivan organisaation kulttuurin, joka on edellytys kilpailukyvyn säilymiseen muuttuvassa toimintaympäristössä.