Effects of dietary saturated,monounsaturated and polyunsaturated fats on plasma lipids and lipoproteins in diabetic rats*

The effects of altering the type of dietary fat on plasma lipid and lipoprotein levels were investigated in streptozotocin‐diabetic rats fed non‐purified diets containing corn oil, olive oil, cod‐liver oil, sheep tallow and lard. After 32 days of experimental feeding, plasma levels of glucose, triglycerides, total cholesterol, low density and high density lipoprotein cholesterol were determined. Body weights and food intake were also measured. In neither animal group did the type of fat in the diet affect significantly the plasma levels of lipids and lipoproteins and their calculated ratios, and plasma glucose, body weight change or accumulative food intakes. In all studied diabetic rats, significant correlations were observed between body weight change and the following plasma variables: total cholesterol level (r = —0.37, P < 0.03), low density lipoprotein cholesterol level (r = —0.38, P<0.03) and triglycéride concentration (r = —0.36, P < 0.04). A significant positive correlation (r = 0.60, P < 0.0003) was also found between plasma levels of glucose and triglycérides. No significant correlations were noticed between accumulative food intakes and any of the studied variables. It is concluded that, in uncontrolled hyperglycemia in diabetes, the type of fat in the diet exerts little or no influence on plasma lipid and lipoprotein concentrations.     

A Belief Rule Based Expert System to Assess Tuberculosis under Uncertainty

The primary diagnosis of Tuberculosis (TB) is usually carried out by looking at the various signs and symptoms of a patient. However, these signs and symptoms cannot be measured with 100 % certainty since they are associated with various types of uncertainties such as vagueness, imprecision, randomness, ignorance and incompleteness. Consequently, traditional primary diagnosis, based on these signs and symptoms, which is carried out by the physicians, cannot deliver reliable results. Therefore, this article presents the design, development and applications of a Belief Rule Based Expert System (BRBES) with the ability to handle various types of uncertainties to diagnose TB. The knowledge base of this system is constructed by taking experts’ suggestions and by analyzing historical data of TB patients. The experiments, carried out, by taking the data of 100 patients demonstrate that the BRBES’s generated results are more reliable than that of human expert as well as fuzzy rule based expert system.     

Anatomic mapping and evaluation of the esophagus in relation to the cervical vertebral body

The relationship of the esophagus to the cervical vertebral body (CVB), disc space and longus colli (LC) muscles, to our knowledge, has not been previously studied. The purpose of this study was to quantify the relationship of the esophagus to the CVB, disc space and LC. 30 patients were selected for a retrospective review of computed tomography (CT) scans. Measurements between the esophagus and the C5, C6, and C7 vertebral bodies as well as the C5/6 and C6/7 disc spaces were performed in the midline, 3 mm right and left of midline, and at the edge of the LC on both sides. The closest distance of the esophagus to the CVB and disc space occurs at the midline (range 1.02–1.31 mm at each level). The furthest distance occurred at the edge of the right LC (range 2.67–3.30 mm at each level). The mean distance from the edge of the right LC to the midline was significantly greater (P < 0.01) than mean distance from the edge of the left LC to the midline. No statistical significant differences were observed when comparing measurements at the individual vertebral bodies and disc spaces. The results of the study demonstrate that the esophagus lies in closest proximity to the CVB and disc space in the midline. A larger potential space exists between the esophagus and the CVB and disc space at the edge of the LC. These results may provide insight into a potential cause of post-operative dysphagia. Furthermore, it may help guide the future design of cervical plates to better utilize the potential space between the esophagus and the CVB and disc space at the edge of the LC.     

Aspiration of breast abscess under ultrasound guidance: outcome obtained and factors affecting success

OBJECTIVE: To assess ultrasonographically (US) guided needle aspiration of breast abscesses as an alternative to surgical incision and drainage. METHODS: In our prospective study, 30 patients with 31 breast abscesses (one patient had bilateral breast abscess) underwent percutaneous breast abscess drainage under US guidance with local anaesthesia and oral antibiotics between 1 January 2004 and 31 March 2005. These patients consisted of 16 (53.3%) non-lactating and 14 (46.7%) lactating women, with ages ranging from 18 to 68 years (median, 28 years). The racial distribution comprised 26 (86.7%) Malays, three (10%) Chinese and one (3.3%) Indian. All patients had the chief complaint of breast swelling and 25 (83.3%) had breast pain. Clinically, 28 (93.3%) were found to have a palpable mass. Nine (30%) lesions were in the upper outer quadrant of the left breast. US diameters ranged from 1 to 15 cm (median, 4 cm). The pus volumes varied from 1 to 200 mL (median, 14 mL). RESULTS: Fifteen (50%) patients required only a single aspiration, 10 required multiple aspirations and five required incision and drainage. Those patients in whom needle aspiration failed had multiloculated lesions irrespective of abscess volume and size. CONCLUSION: Needle aspiration with ultrasound guidance is an effective treatment for breast abscess irrespective of abscess volume and size.     

Differentiating benign from malignant cardiac tumors with cardiac magnetic resonance imaging

Background

The purpose of this analysis is to describe the differences in cardiac magnetic resonance characteristics between benign and malignant tumors, which would be helpful for surgical planning.

Use of the Heartmate 3 for biventricular support as a bridge to heart transplant‐first US implant

Right ventricular failure continues to be the Achilles heel in the management of heart failure patients. Traditionally, either high doses of inotropes and inhaled nitric oxide or jerry‐rigged temporary mechanical devices have been used to support failing right ventricles. No durable implantable right ventricular assist device has been developed to address this long‐standing concern. Because of this vacuum of innovation, surgeons have started using the third‐generation LVADs to support the right ventricle. The HeartMate 3 (Abbott) LVAD is a safe and effective therapy for the management of biventricular failure.     

Incidence,Cost, and Risk Factors for Readmission After Coronary Artery Bypass Grafting

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A systems-based modelling approach using transurethral resection of the prostate (TURP) specimens yielded incremental prognostic significance to Gleason when predicting long-term outcome in men with localized prostate cancer

Study Type – Prognosis (individual cohort) Level of Evidence 2a What's known on the subject? and What does the study add? Systems models have been successfully utilised to accurately define risk in men with prostate cancer. This study addresses the challenges when using TURP specimens to yield predictive models.

OBJECTIVE

? To develop a systems‐based model for predicting prostate cancer‐specific survival (PCSS) using a conservatively managed cohort with clinically localized prostate cancer and long‐term follow‐up.

PATIENTS AND METHODS

? Transurethral prostate (TURP) specimens in tissue microarray format and medical records from a 758 patient cohort were obtained. ? Slides were stained with haematoxylin and eosin (H&E), imaged and digitally outlined for invasive tumour. ? Additional sections were analysed with two multiplex quantitative immunofluorescence (IF) assays for cytokeratin‐18 (epithelial cells), 4′‐6‐diamidino‐2‐phenylindole(nuclei), p63/high‐molecular‐weight keratin (basal cells), androgen receptor (AR) and α‐methyl CoA‐racemase, Ki67, phosphorylated AKT (pAKT)and CD34. ? Images were acquired with spectral imaging software. H&E and IF images were evaluated with image analysis algorithms; feature data were integrated with clinical variables to construct prognostic models for outcome.

RESULTS

? Using a training set of 256 patients with 24% events, one clinical variable (Gleason score) and two tissue‐specific characteristics (H&E morphometry and tumour‐specific pAKT levels) were identified (concordance index [CoI] 0.79, sensitivity 76%, specificity 86%, hazard ratio [HR] 6.6) for predicting PCSS. ? Validation on an independent cohort of 269 patients with 29% events yielded a CoI of 0.76, sensitivity 59%, specificity 80% and HR of 3.6. ? Both H&E and IF features were selected in a multivariate setting and added incremental prognostic value to the Gleason score alone (CoI 0.77 to CoI 0.79). ? Furthermore, global Ki67 expression and AR levels in Gleason grade 3 tumours were both univariately associated with outcome; however, neither was selected in the final model.

CONCLUSION

? A previously validated prostate needle‐biopsy systems modelling approach that integrates clinical data with reproducible methods to assess H&E morphometry and biomarker expression, provided incremental benefit to the TURP Gleason score for predicting PCSS. ? Ki67 and AR, known to be associated with outcome in the prostate needle biopsy, were not associated with PCSS in multivariate models using TURP specimens.     

Mammary tuberculosis: analysis of thirty-eight patients

Thirty-eight patients with mammary gland tuberculosis were evaluated over a 5-year period presenting to the surgical unit of our institution. Unilateral involvement of the breast in a woman presenting at an average age of 29 years was the commonest observation. A lump in the breast with or without discharging sinuses was the most common clinical presentation. Ten (26%) of these patients had breast pain with or without increased breast nodularity. Axillary lymph nodal involvement was evident in 14 (36%) of our patients. Only five patients had associated pulmonary tuberculosis, the rest having an isolated involvement of the breast. Fine-needle aspiration cytology was the most reliable diagnostic modality. Medical therapy with antitubercular drugs ranging from 6 to 9 months was the mainstay of treatment. Surgical intervention was reserved for selected refractory cases.     

Unplanned return to operating room after lower extremity endovascular intervention is an independent predictor for hospital readmission

Objective

Hospital readmissions after surgical operations are preventable and are now counted as a quality metric. Patients with peripheral arterial disease often have several serious medical comorbidities. With advancements in endovascular technology and increasing comfort level of vascular surgeons, more and more patients with peripheral arterial disease are being treated with endovascular therapy. Most of these interventions are done as same-day operations. This study retrospectively reviewed the factors associated with hospital readmission after lower extremity endovascular interventions.