Pelvic floor anatomy and applied physiology

Pelvic floor muscles have two major functions: they provide support or act as a floor for the abdominal viscera including the rectum; and they provide a constrictor or continence mechanism to the urethral, anal, and vaginal orifices (in females). This article discusses the relevance of pelvic floor to the anal opening and closure function, and discusses new findings with regards to the role of these muscles in the vaginal and urethra closure mechanisms.     

Patching fellow eyes during subjective night does not prevent disruption to minus lens compensation in constant light-reared chicks

PURPOSE: This study re-examined an earlier claim that monocular patching during subjective night (i.e. patched at the usual time that night would occur) in the chicks reared in continuous lighting (CL), offered unpatched eyes some protection from the ocular effects of CL. It also examined whether this monocular patching protected unpatched eyes against the disruptive effect of CL on compensation to minus lenses. METHODS: Hatchling White-Leghorn chicks were reared in either constant or diurnal lighting conditions (n=28) for 2 weeks. Some CL chicks had their right eyes patched every night during the entire study. Lenses of either +10 or -10D power were fitted to the unpatched eyes of some patched chicks at the beginning of the second week. Retinoscopy, IR photo-keratometry and high-frequency A-scan ultrasonography were used to track refractions, corneal radius of curvature and ocular axial dimensions respectively; data were collected on experimental days 0, 7, 9 and 14. RESULTS: The patched eyes were completely protected from the ocular growth effects of CL, i.e. accelerated posterior segment (vitreous chamber) growth and inhibited anterior segment growth. Although the unpatched eyes showed no protection from the anterior chamber effects of CL, they were completely protected from the effects of CL on vitreous chamber growth. Nonetheless, the response to the -10D lenses was disrupted in unpatched eyes, which responded in the wrong direction for compensation (+5.5+/-0.25D more hyperopic than no lens-unpatched eyes). The response to the +10D lenses was preserved (+9.25+/-0.25D more hyperopic than no lens-unpatched eyes). CONCLUSION: These data provide further support for local control of emmetropization, as reflected in compensatory lens responses, but point to additional influences on eye growth as reflected in CL-induced ocular changes.     

Role of autophagy in resistance to oxaliplatin in hepatocellular carcinoma cells

In spite of an initially promising anti-tumor activity, oxaliplatin-based combinatorial treatments can eventually result in a tumor resistance response. In this study we aimed to understand the role of autophagy in HCC cell resistance to oxaliplatin and to discuss its potential therapeutic implication. We found that exposure to oxaliplatin induced a significant increase in LC3 lipidation and subsequent LC3 puncta formation. While the proliferation of HCC cells was inhibited upon oxaliplatin exposure, inhibition of autophagy by ATG7 interference and chloroquine pre-treatment further increased the sensitivity to chemotherapy. Meanwhile, the oxaliplatin-induced apoptotic cell death was significantly enhanced. These results suggest that autophagy may function importantly in HepG2 cell resistance to oxaliplatin. Intriguingly, the resistance could be recovered apparently by inhibition of autophagy. This also points to the potential therapy for hepatoma by perturbing autophagy.     

Liver transplantation in patients over 60 and 65 years: an evaluation of long-term outcomes and survival.

With increased demand for liver transplantation (LT), outcomes of older recipients have been subjected to greater scrutiny, as previous studies have demonstrated poorer survival outcomes. Outcomes of 77 patients aged>65 yr (group 1) who underwent transplantation between 1988 and 2003 at King's College Hospital, London, were compared with all recipients aged between 60 and 64 yr (group 2, n=137) and 202 time-matched control patients with chronic liver disease aged between 18-59 yr (group 3). Patient survival at 30-days for groups 1, 2, and 3 were 99%, 94%, and 94%, respectively (P=not significant [NS]). At 1-yr, survival in the 3 groups was 82%, 86%, and 83%, respectively (P=NS), and at 5-yr patient survival was comparable (73%, 80%, and 78%, respectively) (P=NS). Episodes of acute cellular rejection (ACR) were fewer in the older cohorts (43% vs. 45% vs. 61%, P=0.0016), although there was no significant difference identified in the numbers of patients in each group who experienced ACR (P=0.16). A similar but nonsignificant trend was identified for rates of chronic rejection among the groups. In conclusion, these data suggest that survival of patients over 60 and 65 yr undergoing LT is satisfactory, at least in the first 5-yr posttransplantation. In addition, patients over 65 yr experience less rejection, with good graft survival. Thus, LT should not be denied to patients>65 yr on the basis of age alone, once a comprehensive screen for comorbidity has been undertaken.     

Satisfaction and adherence of patients with amputations to physiotherapy service at public hospitals in KwaZulu-Natal,South Africa

Background

Individuals who have undergone a lower limb amputation require comprehensive rehabilitation from the multidisciplinary team to ensure optimal treatment outcomes and social integration. Physiotherapists play a pivotal role within the multidisciplinary team and offer patients physical and psychosocial rehabilitative care. Determining patients'' satisfaction levels and exploring factors affecting adherence to physiotherapy interventions can inform practice and improve service delivery of rehabilitation within resource poor settings such as South Africa.

Objectives

To determine the level of satisfaction with physiotherapy services rendered to acute and sub-acute in-patients with lower limb amputations and to explore factors affecting adherence to physiotherapy intervention.

Methods

A prospective survey of 35 patients with lower limb amputations from four public hospitals in South Africa was undertaken. A modified version of the Hampstead rehabilitation centre patient satisfaction questionnaire was utilised.

Results

Majority of participants were satisfied with the physiotherapy services whilst a few reported dissatisfaction. Three themes emerged whilst exploring the patients'' experience relating to adherence to physiotherapy programmes. Themes included service delivery, patient-therapist interaction and participation barriers and facilitators.

Conclusion

Recommendations aimed to improve quality of care and healthcare outcomes thereby enhancing the participants'' adherence to the physiotherapy programme.     

Giant right coronary artery aneurysm – A rare presentation

Coronary artery aneurysm (CAA) is focal dilatation of a coronary artery 1.5 times or more its normal size (Res Cardiovasc Med, 2016; 5: e32086). Coronary artery aneurysm is found in 1.2–4.9% of diagnostic coronary angiography and 1.4% at post‐mortem (Heart Views, 2014; 15: 13; Clin Cardiol, 2015; 29: 439). The proximal and middle segments of the right coronary artery (RCA) are most commonly involved, followed by the proximal left anterior descending (LAD) and the left circumflex arteries. The left main stem rarely develops aneurysms (Clin Cardiol, 2015; 29: 439). A giant aneurysm is a CAA> 2 cm. Giant coronary artery aneurysms (GCAA) are rare (incidence 0.02%) although cause serious complications. [4] Given the rarity of this disease, there is limited information in the literature on its presentation and there is no consensus on its optimal management option. We report a case of a GCAA with an atypical presentation and describe its management. This will add to the current small database on CAA to provide clinicians a better insight on the disease.