Data,information, knowledge,wisdom, and understanding

The digital age commenced in the mid-20th century and since we have seen approximately exponential growth in information. This period has also seen the rapid growth of computer technology that has facilitated, for instance, the derivation of whole genomes and automated drug discovery. Data, information, knowledge and wisdom lay the foundations for understanding how experience is formed from evidence and observations. When data are put into context, the resultant information can drive growth and further contribute to increased knowledge. Appreciating the source of data enables us to recognize and hopefully correct for inherent error and bias. Ultimately knowledge discovery can be automated to gain information from data and so on, enhancing our understanding of a given subject and expanding collective wisdom.     

Nephrology, Hypertension, Dialysis, Transplantation

Th. Andreoli, E. Ritz and L. Rosivall, Hungarian Kidney Foundation,Budapest, 2006. Total pages: 655. This monograph is a compilation of lectures given in recentcourses of the Budapest Nephrology School, a yearly educationalprogramme organized under     

Zyste, Endometriose, Borderlinetumor, CUP

Symptomatic renal cysts are not uncommon and can be treated by puncture, sclerotherapy, or laparoscopic fenestration. We report the case of a female patient in whom the diagnosis of a supposedly simple symptomatic renal cyst changed over endometriosis and borderline malignancy to a CUP. This case shows that in spite of all diagnostic measures and care the final diagnosis can be a surprise.     

Leak,fistula, sepsis,sinus, portal vein thrombosis

The creation of an ileal pelvic pouch is a complex procedure. While many perioperative complications are possible, surgery specific complications may include a pouch leak, fistula, abscess with sepsis, anastomotic sinus, and portal vein thrombosis. In this chapter, each of these are individually discussed along with evaluation and treatment options.     

Minimally invasive, nonlaparoscopic, preperitoneal, and sutureless, inguinal herniorrhaphy

BACKGROUND: Recent efforts at development of an ideal method for herniorrhaphy have resulted in a number of tremendous advances. The keen interest in hernia surgery and newer methods of repair, however, suggests that most surgeons are not fully satisfied with the methods currently available. METHODS: This repair involves a preperitoneal approach accomplished under regional or local anesthesia, with limited instrumentation and expense. It is performed in both a tension-free and sutureless fashion through a very small incision. It is effective in the treatment of primary and recurrent direct and indirect hernias as well as femoral hernias using the same approach in each case. RESULTS: With 808 hernia repairs performed over a 54-month period of time there have been only five recurrences identified. There were only two wound infections. No specific restrictions with regard to activity were placed on these patients after surgery. In almost all cases the patients were able to return to regular activities, including work, within a few days after surgery. CONCLUSIONS: The results with this procedure suggest that it may be a more effective method of hernia repair when cost, ease of performance, and rapid recovery are important considerations.     

MRSA: Resistenzmechanismen,Epidemiologie, Risikofaktoren,Prophylaxe, Therapie

Zusammenfassung Methicillin-resistente Staphylococcus aureus-Stämme (MRSA) sind inzwischen in vielen Ländern verbreitete Erreger, denen eine besondere Aufmerksamkeit geschenkt wird. In der vorliegenden Übersichtsarbeit werden der Resistenzmechanismus, die Epidemiologie der Verbreitung im Krankenhaus (H-MRSA) bzw. in Einrichtungen des Gesundheitswesens (HCA-MRSA) und außerhalb des Krankenhauses (C-MRSA), Ursachen der Zunahme des Nachweises, Besiedlungsdynamik, Erkrankungsrisiko und Letalität, das Vorgehen bei MRSA-Nachweis, Methoden zur Dekolonisierung, Überwachungskulturen sowie therapeutische Optionen diskutiert.     

Mechanics: force,mass, acceleration energy,work, power

Mechanics is the branch of physics that deals with the effect of energy and forces on objects. Newton's laws of motion are three physical laws that together describe the relationship between an object and the forces acting upon it, and its motion in response to these forces. Motion can be mathematically described by magnitude, displacement, velocity and acceleration. Work is done when a force acts on an object resulting in its motion. Energy is required for doing work. Power is the rate at which work is done.     

Laparotomy, laparoscopy, cancer, and beyond

The fate of laparoscopic methods for the treatment of cancer remains uncertain. Published middle-range oncologic results from nonrandomized studies demonstrate that laparoscopic methods are associated with an outcome comparable with results after open resection. The world awaits the 3- and 5-year oncologic results of the ongoing randomized and prospective trials. There is a possibility that laparoscopic methods may be associated with a survival benefit. Port tumors remain a concern. However, results at this writing suggest that these recurrences take place at a frequency similar to that of incisional recurrences following open cancer resection. Port tumors currently are viewed as local recurrences. Traumatization of the tumor at the time of resection is thought to be the most important surgery-related risk factor. The demonstration of a survival benefit in a randomized trial would likely have a tremendous impact on the surgical world. Avoidance of laparotomy-related immunosuppression and tumor stimulation, both of which have been well demonstrated in animal studies, theoretically, might account for differences in cancer outcome. The early postoperative period may be a critical time during which the fate of many cancer patients is determined. It is possible that this may be an ideal time frame for antitumor immunotherapy because the tumor burden is at its lowest, and because immunotherapy, unlike conventional chemotherapy, is unlikely to have a negative impact on wound and anastomotic healing. Perioperative nonspecific upregulation of immune function via pharmacologic means may improve long-term oncologic results. Similarly, preoperative tumor vaccines might provide patients with a specific means of combating any remaining tumor cells after curative resection. The results of several recently completed murine studies support both of these ideas. Finally, early postoperative administration of monoclonal antitumor antibodies might provide patients with specific means of combating any remaining tumor cells after curative resection. The introduction of advanced minimally invasive techniques nearly a decade ago has led to new methods of approaching malignant tumors that have the potential to have an impact on the oncologic outcome of cancer patients. This decade-long journey also has led to new insights regarding the impact of surgery on the patient. It also has alerted us concerning the importance of the immediate postoperative period in the patient's ongoing struggle against the tumor. These insights hopefully will lead to better surgical methods and new perioperative adjuvant therapies that will increase the rate of survival and reduce the recurrence rates for cancer patients.     

Stroke: epidemiology, classification, risk factors, complications, diagnosis, prevention, and medical and dental management.

Cerebrovascular accident, or stroke, refers to an acute onset of neurologic deficits lasting more than 24 hours or culminating in death caused by a sudden impairment of cerebral circulation. Stroke is the third leading cause of death and a major cause of long-term disability in the United States. This article provides the dental community with an up-to-date understanding of the epidemiology, classification, risk factors, complications, diagnosis, prevention, and medical and dental management issues pertaining to stroke.     

Distribution, elimination, and action of d-tubocurarine in neonates, infants, children, and adults

The relation of plasma concentration of d-tubocurarine (dTc) to neuromuscular blockade, and the distribution and urinary excretion of dTc was determined in neonates (n = 4), infants (n = 6), children (n = 8), and adults (n = 8). The plasma concentration-time course curves to 24 hr are best described for all groups by three-compartment models. Both neonates and infants exhibit decreased plasma clearance (CLP), 1.1 +/- 0.08 and 1.0 +/- 0.06 ml X kg-1 X min-1, and in addition a prolonged t1/2 terminal phase, 311 +/- 44 and 306 +/- 35 (mean +/- SEM, min). The neonates' 24-hr urinary excretion, 27 +/- 2 (mean +/- SEM, % total dose) is significantly less than the adult value, 45 +/- 4% total dose. There was no significant difference seen in the log plasma concentration-evoked compound electromyogram (ECEMG) response between 20-80% paralysis for adults, children, infants, and five of the seven neonates studied. Two of the neonates had a significant shift of their log concentration-response curve to the right. There was also no significant difference between any of the groups in the time for 50% return of ECEMG stimulus height or the time required for recovery of the ECEMG from 25 to 75% of control value. for recovery of the ECEMG from 25 to 75% of control value.     

Music,Musicians, Medicine,and the Kidney

The relationship between music, medicine and nephrology is ancient; ranging from musicians afflicted with kidney disease, contributors to nephrology who were musicians, and the use of music to treat renal maladies. Musicians have long been afflicted by diseases of the kidney, particularly nephrolithiasis, for which Marin Marais in 1725 composed a unique piece for the viol detailing the harrowing experience of ‘cutting for stone.’ Beethoven and Mozart were afflicted by kidney disease, as are several current musicians. Where past musicians succumbed to their failing kidneys, the advent of renal replacement therapy has given today's musicians, such as James DePreist and Natalie Cole, the opportunity to continue performing and composing. Several notable physicians of old have excelled as musicians; one example is Jacob Henle (1809–1885), for whom the loop of Henle is named, another is Robert Christison, a contemporary of Richard Bright, who is considered a ‘founder of nephrology’. Importantly, music therapy, as used in the times of Hippocrates and King David, has evolved from an empiric to a well‐established scientific discipline. Given the recent enlarging body of scholarly studies of music therapy, its rudimentary role in nephrology deserves further exploration.     

Pancreatic D-cell recognition of D-glucose: studies with D-glucose, D-glyceraldehyde, dihydroxyacetone, D-mannoheptulose, D-fructose, D-galactose, and D-ribose

To investigate how the D-cell recognizes the glucose stimulus, the hormone response to (1) glucose, (2) the trioses glyceraldehyde and dihydroxyacetone, (3) the metabolic blocker, mannoheptulose, and (4) the low- or nonmetabolized sugars galactose, fructose, or ribose were studied using the isolated dog pancreas. We found (1) a sigmoidal relationship between extracellular glucose concentrations and the somatostatin release. The threshold concentration was around 5 mM and the largest increase in somatostatin release occurs between 5 and 10 mM of glucose. (2) Glyceraldehyde at concentrations ranging between 1.25 and 5 mM stimulated the release of somatostatin, whereas the higher concentrations of 10 and 20 mM were suppressive. Dihydroxyacetone (11 mM), also initiated somatostatin release in the absence of glucose. Both of the trioses stimulated B- and inhibited A-cell secretion. (3) Mannoheptulose (5 mM) attenuated somatostatin and insulin secretion to 8.3 mM glucose, while it augmented glucagon output. In contrast, mannoheptulose (5 mM) did not affect D-, A-, or B-cell responses to glyceraldehyde (5 mM) in the absence of glucose. (4) The somatostatin, insulin, and glucagon release remained unchanged when 8.3 mM of either galactose, fructose, or ribose was added. The results suggest that the initiation of glucose-mediated D- as well as A- and B-cell responses depends on the metabolism of the sugar.     

Author Index EPOS, 2016, Rome,Italy

Purpose

In 1992, Georges Charpak invented a new type of X-ray detector, which in turn led to the development of the EOS^® 2D/3D imaging system. This system takes simultaneous anteroposterior and lateral 2D images of the whole body and can be utilized to perform 3D reconstruction based on statistical models. The purpose of this review is to present the state of the art for this EOS^® imaging technique, to report recent developments and advances in the technique, and to stress its benefits while also noting its limitations.

Methods

The review was based on a thorough literature search on the subject as well as personal experience gained from many years of using the EOS^® system.

Results

While EOS^® imaging could be proposed for many applications, it is most useful in relation to scoliosis and sagittal balance, due to its ability to take simultaneous orthogonal images while the patient is standing, to perform 3D reconstruction, and to determine various relationships among adjacent segments (cervical spine, pelvis, and lower limbs). The technique has also been validated for the study of pelvic and lower-limb deformity and pathology in adult and pediatric populations; in such a study it has the advantage of allowing the measurement of torsional deformity, which classically requires a CT scan.

Conclusions

The major advantages of EOS^® are the relatively low dose of radiation (50–80 % less than conventional X-rays) that the patient receives and the possibility of obtaining a 3D reconstruction of the bones. However, this 3D reconstruction is not created automatically; a well-trained operator is required to generate it. The EOS^® imaging technique has proven itself to be a very useful research and diagnostic tool.

     

Decency, honor, integrity, and the law

In its guidelines for hand care professionals, the American Society for Surgery of the Hand has set the following criteria as guidelines for the ethical hand surgeon in the 21st century: decency, honor, and integrity. This article reviews these criteria in detail, relates how they apply in practice, and describes how they interact with state and federal law in both legislative and judicial aspects. Matters pertaining to informed consent, privacy issues, patient autonomy, shared decision making, and conflict of interest are described, and recent developments in this area are examined. Are hand surgeons ready for an enforceable system of ethics to be handed down by the ASSH or by the government?     

Ageing,hormones, body composition,metabolic effects

The age-associated, progressive changes in body composition are paralleled by a progressive decrease in hormone levels, among which there are testosterone (T) and growth hormone (GH). Moreover, the age-associated changes are rather similar to the changes in body composition seen in hypogonadism or hyposomatotropism, respectively. These age-associated changes in body composition are rather important: a decline in muscle mass by 20%-40% between the ages of 25 and 75, a doubling of fat mass and a decrease in bone mineral density by 0.3% per year after age 35. They have important functional and metabolic consequences. Most studies show a significant positive correlation between muscle mass and bone mineral density, respectively, and plasma T or GH levels, whereas abdominal fat mass is generally negatively correlated with T and GH levels. Whether, however, the hormone levels play a causal role or are the consequence of the changes in body composition is still an unsettled problem. The beneficial effects of hormone substitution on body composition suggest, nevertheless, that T and GH are at least co-determinants of the observed age-associated changes.     

骨密度没量中精密度的重要性

骨密度测定,不论采取何特殊技术,即使严格地按照厂家建议的操作程序,也常常不能达到完美的重复性.必须确定每台骨密度仪不同骨骼部位的精确度.精密度,如标准差平均方根或变异系数平均方根,被用来确定骨密度的变化,即精密度决定最小显著性变化值和随访需要的至少时间间隔.除非确定了精密度,否则就不能确定任何水平的统计可信度最小显著性变化值,使得随访的研究结果难以解释.     

Bewusstlosigeit, Koma, Somnolenz, Stupor und Sopor

Background

In German the terms unconsciousness, coma, somnolence, stupor and sopor are used to describe a state of impaired consciousness partly due to historical reasons. In parallel the Glasgow Coma Scale (GCS) introduced in 1974 provides a better definition for the state of consciousness.

Material and methods

In this study two different groups were evaluated: active emergency physicians and emergency medicine trainees. Using a questionnaire both groups were asked to describe the impaired consciousness terms and indicate a corresponding GCS value. In addition they were asked to define a predescribed state of consciousness justifying the need for intubation.

Results

The active emergency physicians assigned coma and unconsciousness median GCS levels of 7 (5–8, interquartile range, IQR) and 9 (7–10 IQR), respectively, whereas trainees assigned mean GCS levels of 6.5 (5–8 IQR) and 8 (8–10 IQR), respectively. Of the participants 60% assumed that an unconscious patient, in contrast to the definition, does not show any defence signs to pain. Somnolence was assigned higher GCS values (median 11, 10–13 IQR) and 12, 10–13.5 IQR). Stupor and sopor were assessed to having GCS scores covering almost the complete range of values.

Conclusions

The results showed that most participating physicians were not aware that coma and unconsciousness are synonyms. Moreover, this demonstrates that much uncertainty is associated with the terms somnolence, sopor and stupor. In order to describe altered levels of consciousness, particularly in trauma patients, restrictions should be placed on the terms impaired consciousness and unconsciousness with a parallel use of the numerical GCS scale.     

Age, race, diabetes, blood pressure, and mortality among hemodialysis patients

Observational studies involving hemodialysis patients suggest a U-shaped relationship between BP and mortality, but the majority of these studies followed large, heterogeneous cohorts. To examine whether age, race, and diabetes status affect the association between systolic BP (SBP; predialysis) and mortality, we studied a cohort of 16,283 incident hemodialysis patients. We constructed a series of multivariate proportional hazards models, adding age and BP to the analyses as cubic polynomial splines to model potential nonlinear relationships with mortality. Overall, low SBP associated with increased mortality, and the association was more pronounced among older patients and those with diabetes. Higher SBP associated with increased mortality among younger patients, regardless of race or diabetes status. We observed a survival advantage for black patients primarily among older patients. Diabetes associated with increased mortality mainly among older patients with low BP. In conclusion, the design of randomized clinical trials to identify optimal BP targets for patients with ESRD should take age and diabetes status into consideration.