ATP increases head volume in capacitated human sperm via a purinergic channel.

Scanning ion-conductance microscopy allowed us to document an external Ca2+ dependent ATP driven volume increase (ATPVI) in capacitated human sperm heads. We examined the involvement of purinergic receptors (PRs) P2X2R and P2X4R in ATPVI using their co-agonists progesterone and Ivermectin (Iver), and Cu2+, which co-activates P2X2Rs and inhibits P2X4Rs. Iver enhanced ATPVI and Cu2+ and 5BDBD inhibited it, indicating P2X4Rs contributed to this response. Moreover, Cu2+ and 5BDBD inhibited the ATP-induced acrosome reaction (AR) which was enhanced by Iver. ATP increased the concentration of intracellular Ca2+ ([Ca2+]i) in >45% of individual sperm, most of which underwent AR monitored using FM4-64. Our findings suggest that human sperm P2X4R activation by ATP increases [Ca2+]i mainly due to Ca2+ influx which leads to a sperm head volume increase, likely involving acrosomal swelling, and resulting in AR.

Can virtual reality technology be considered as a part of the surgical care pathway?

INTRODUCTION: Virtual reality (VR) is emerging as a new technology in the healthcare sector. It has been shown to enhance the patient's experience and satisfaction in various settings. This review aims to give a brief description of the use of VR and establish validity of its applications to improve the patient's pathway through surgery. METHODS: A literature search was conducted using the PubMed and Embase™ databases to identify fields in which VR technology has been trialled in relation to surgery. The search terms 'virtual reality' and 'surgery' were employed. RESULTS: Although benefits relating to VR use have been identified in mental health, obesity management, and physical and cognitive rehabilitation, those in surgery have been less well documented. There are, however, some important but limited benefits reported in managing surgery related stress and improving preoperative patient education as well as VR being an adjunct to some level of postoperative analgesia. CONCLUSIONS: The current applications of VR in relation to surgical care fall into four main categories: preoperative education, supporting mental health, postoperative pain management, and pre and postoperative patient optimisation. Future studies and validation of VR applications should be carried out so the technology can be utilised throughout the entire patient pathway as VR surgical care bundles.

Somatic yolk sac differentiation in tumors of the gynecologic tract: A report of two cases and review of the literature.

•Somatic yolk sac tumor differentiation associated with malignant neoplasms is uncommon and associated with poor outcome.•In the gynecologic tract, somatic yolk sac differentiation most often arises in postmenopausal patients.•Somatic yolk sac differentiation shares driver mutations with and likely differentiates from the corresponding carcinoma.•This is the first report of somatic yolk sac differentiation in the gynecologic tract from a non-epithelial malignancy.

Zirconium retention for minimizing environmental risk: Role of counterion and clay mineral.

Zr(IV) together with U(IV) are the major components of high-level radionuclide waste (HLRW) and spent nuclear fuel (SNF) from nuclear power plants. Thus, their retention in the waste disposal is of great importance for the environmental risk control. Here, the influence of clay minerals on the retention of Zr(IV), as component of the nuclear waste and as chemical analogues of U(IV), has been evaluated. Three clay minerals, two bentonites and one saponite, were hydrothermally treated with three zirconium salts. A structural study at long-range order by X-ray diffraction and short-range order by NMR was performed to evaluate the generation of new zirconium phases and degradation of the clay minerals. Three immobilization mechanisms were observed: i) cation exchange of ZrO2+ or Zr4+ by clay minerals, ii) the precipitation/crystallization of ZrO2, and, iii) the chemical interaction of zirconium with the clay minerals, with the formation of zirconium silicates.

23-hour/next day discharge post-laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery is safe.

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is well established, yet practice varies as to when patients should be discharged post operation. After noting that many LRYGB patients met our unit's discharge criteria sooner than anticipated, we implemented a policy of aiming for 23-h inpatient stay post LRYGB in January 2012. This retrospective study aimed to assess the safety of this policy. We reviewed data of all patients undergoing LRYGB at our unit from September 2010 to October 2013. We compared the lengths of inpatient stay, complication rates and re-admission rates of patients treated before and after the introduction of the 23-h length of stay policy. Of 161 LRYGB procedures, 38 patients (29 female) underwent LRYGB from September 2010 to December 2011 (pre-policy change) and 123 (107 female) underwent operation after this date (post-policy change). The two groups were similar in terms of mean age (46.5 vs. 46.7 years, p = 0.932), mean BMI (46.8 vs. 46.6 kg/m(2), p = 0.868) and median number of pre-operative comorbidities (3 vs. 3, p = 0.9). There were significant reductions in median length of inpatient stay (2 vs. 1 day, p < 0.0001), re-admission rate (21.1 to 6.5 %, p = 0.025) and complication rate (18.4 vs. 3.3 %, p = 0.004) after the policy change. There were seven complications pre-policy change: pulmonary embolus (n = 1), chest infection (n = 1), constipation and anal fissure (n = 1), umbilical hernia requiring operation (n = 2), adhesional obstruction (n = 1) and persistent food intolerance (n = 1). Post-policy changes, there were four complications: adhesional obstruction (n = 2), staple line bleeding (n = 1) and persistent dysphagia (n = 1). There were no deaths. Patients undergoing LRYGB can be safely discharged on the first post-operative day. This reduction in length of inpatient stay offers significant cost savings.

The usefulness of cone beam computed tomography for treatment of complex odontoma.

BACKGROUND: Odontomas are odontogenic tumours, resulting from epithelial growth and differentiated mesenchymal cells, clinically asymptomatic, and often associated with changes to the eruption of the permanent dentition. In recent years, cone beam computed tomography (CBCT) has been used in the diagnosis and treatment planning of this condition. CASE REPORT: A 9-year-old male patient, with an unerupted permanent maxillary right central incisor (tooth 11) presented to our clinic. The panoramic radiograph showed impaction of tooth 11 with incomplete root development and the suspicion of an odontome and supernumerary tooth. CBCT was performed and enabled the visualisation of a radiopaque image compatible with an odontome, confirming the presence of an impacted supernumerary tooth on the palatal surface of tooth 11. TREATMENT: Surgical excision of the odontome and the supernumerary tooth was performed. FOLLOW-UP: Clinical and radiographic evaluations 2 months after the removal of the lesion showed lack of space for the eruption of tooth 11. The patient was referred for orthodontic treatment and a Hyrax appliance was fitted. The patient has been followed for 12 months. CONCLUSION: CBCT is an important auxiliary tool, aiding in both correct diagnosis and accurate treatment planning. It is currently a technology accessible to most paediatric dentists and should be beneficial considering the diagnostic information provided as well as the cost-benefit ratio for the patient.

Need for standardization of the measurement of preoperative weight in bariatric surgical patients in the UK: A survey of British Obesity and Metabolic Surgery Society (BOMSS) members.

BACKGROUND: Weight loss is the most commonly used metric in comparing outcomes after bariatric surgery. This is frequently presented in the form of percentage of excess weight loss (%EWL). Patients' weight is measured at several time points prior to surgery. The time point selected as the preoperative weight can have significant effects upon the measurement of %EWL. This study aimed to investigate whether there was any standardization in the selection of preoperative weight amongst UK bariatric surgery healthcare professionals. METHODS: A questionnaire survey was conducted among the delegates at the British Obesity and Metabolic Surgery Society (BOMSS) meeting in January 2011. RESULTS: A total of 54 delegates (consultant & trainee surgeons, bariatric specialist nurses, dieticians and psychologists) responded to the survey. A wide variation was noted in which preoperative weight was used in the calculation of %EWL, both among various disciplines and also among the same disciplines. The majority (61%) used the preoperative weight recorded at the bariatric surgical assessment clinic prior to surgery. 20% of delegates used the highest recorded preoperative weight. The remainder of delegates used weight recorded on the day of surgery (17%) or the weight recorded during the first visit to a medical physician led weight management clinic (2%). CONCLUSION: Variation in the measurement of the preoperative weight will lead to variations of calculated %EWL between different bariatric units or even between different disciplines in the same unit. This will make comparison of published outcome data difficult. This study highlights the urgent need for standardization.

Elective versus ruptured abdominal aortic aneurysm repair: a 1-year cost-effectiveness analysis.

Abdominal aortic aneurysm (AAA) is a life-threatening condition with an overall mortality of 80%. It predominantly affects men 65-74 years of age and is caused by focal distension of the main blood vessel in the abdomen. Most patients go undetected until their aneurysm ruptures. Controversy surrounds the most appropriate form of screening for AAA. Currently, screening is only carried out selectively in patients with peripheral vascular disease. Some patients have their AAA detected incidentally, whilst ultrasound examination of the abdomen is carried out for other indications. These patients have the opportunity to undergo surveillance or elective surgery. The mortality rate of emergency surgical intervention following rupture (50%) is far worse in comparison to that of patients undergoing planned intervention under specialist vascular surgeons (5%). Despite improvements in outcomes from elective intervention for AAA as a result of specialisation, the overall mortality from this condition remains very high (80%) as the commonest presentation of an AAA is rupture. Screening all men aged 65-74 years is considered too costly in the current economic climate. However the cost difference between elective repair and emergency repair of AAA must be considered given that the outcome from elective AAA repair is far superior to that following ruptured AAA repair. Our objective was to retrospectively collect costs and outcomes of elective and emergency AAA repair in order to carry out a cost-effectiveness analysis. Four multiprofessional teams in accident and emergency, operation theatres, intensive care, and surgical wards at the Kent and Canterbury Hospital were selected from health-care professionals including doctors, managers, nurses, and clerical staff with the purpose of obtaining costs. Detailed cost data collection sheets were prepared to calculate costs, which included staff costs, consumables including drugs, intravenous fluids, equipment, investigations, laundry, catering, and stationery. An inventory of costs per item was obtained, and the total cost was calculated from the number of items used. Outcomes were measured in terms of survival. The total costs of emergency AAA repair were pounds sterling 96,700.69, with a cost per life saved of pounds sterling 24,175.17. The total cost of elective AAA repair was pounds sterling 76,583.22, with a cost per life saved of pounds sterling 5,470.23. Emergency intervention for AAA was found to cost five times more than a planned intervention per life saved per year.

Audit of local recurrence rates following 'ultra'-conservative surgery for invasive breast cancer--a boost to the breast?

BACKGROUND: Conservative breast surgery with postoperative radiotherapy and appropriate systemic therapy is associated with similar outcomes when compared with mastectomy. The reported 5 year local recurrence rate varies between 3% and 15%. We prefer a more conservative 'complete' local excision rather than 'wide' local excision combined with post-operative radical radiotherapy and tumour bed boost with the aim of achieving optimal cosmesis. AIMS: Our review was undertaken to assess whether or not this 'ultra' conservative approach was compromising long-term local control. METHODS: Case notes and pathology reports of patients who underwent conservative surgery for breast cancer from January 1983 to February 2001 were accessed for this audit. Patient demographic data and tumour characteristics were noted. The primary outcome data were the number of local recurrences following invasive breast cancer at 5 and 10 years and the distance from the tumour to the closest margin of excision. RESULTS: At 5 and 10 years there were 16/451 and 5/124 local recurrences, with a local recurrence rate of 3.5% (95% CI, 1.7-4.7%) and 4.1% (95% CI, 0.47-6.5%), respectively. Complete data with regards to the closest histological margin of excision were available in 423 patients. One hundred and sixty-five patients (39%) had their tumours excised with a distance of less than 1 mm to the closest margin. Nearly, all tumours (97.8%) were excised with the distance to the closest margin less than 1 cm and 81% with 5 mm or less. CONCLUSION: It is possible to achieve low local recurrence rates after very conservative surgery for breast cancer when this is combined with radical radiotherapy and an additional tumour bed boost.

Using and misusing factor analysis to explore group cohesion.

Group cohesion is an important construct in understanding the behavior of different types of groups. However, controversy exists about how to conceptualize and measure cohesion, and a central issue is its dimensionality. Consequently, researchers have used factor analysis to examine the structure of the construct of cohesion and measures of it. Our goals in writing this article were to review critically how factor analysis has been used to understand group cohesion, make some recommendations for future factor analytic work, and point out some weaknesses and strengths in using factor analysis to explore cohesion.

Sodium-retaining activity of some natural and synthetic 21-deoxysteroids.

The effect of progesterone and six other C21-deoxysteroids on renal sodium retention by male adrenalectomized rats was compared with the effect exerted by the natural corticoids aldosterone, 11-deoxycorticosterone, and corticosterone. Steroids were active in the following order: aldosterone > 11,19-oxidoprogesterone > 5 alpha H-3,20-pregnanedione > or = 5 beta H-3,20-pregnanedione > progesterone = 11-ketoprogesterone > 6,19-oxidoprogesterone = 11-keto-6,19-oxidoprogesterone > or = corticosterone. All C21-deoxysteroids, except 11,19-oxidoprogesterone, exhibited parabolic log dose-response functions, indicating an effect that opposes renal sodium retention at high doses. 11,19-Oxidoprogesterone and the natural corticoids exhibited normal, exponential, log dose-response curves. Diverse geometric parameters related to molecular planarity were calculated and their correlation with biopharmacological properties was attempted. The best linear regression was obtained for correlation of the concavity of log dose-response parabolas (second-order coefficients) of C21-deoxysteroids with the C3 = O/ring D angle of these molecules. A good linear regression could also be obtained for correlation of the affinity of C21-deoxysteroids, except 11,19-oxidoprogesterone, for purified type I mineralocorticoid receptors with those angles. The latter correlation deteriorated upon incorporation of the affinity data for the three natural corticoids, due to similar affinities of these hormones for type I mineralocorticoid receptors, but could be restored when the binding data for the unpurified, corticosterone-binding globulin-containing stage of the receptors were considered. In vivo binding data followed the same trend as that for unpurified receptors.

A Regression Equation for the Parallel Analysis Criterion in Principal Components Analysis: Mean and 95th Percentile Eigenvalues.

Monte Carlo research increasingly seems to favor the use of parallel analysis as a method for determining the "correct" number of factors in factor analysis or components in principal components analysis. We present a regression equation for predicting parallel analysis values used to decide the number of principal components to retain. This equation is appropriate for predicting criterion mean eigenvalues and was derived from random data sets containing between 5 and 50 variables and between 50 and 500 subjects. This relatively simple equation is more accurate for predicting mean eigenvalues from random data matrices with unities in the diagonals than a previously published equation. Moreover, given that the parallel analysis decision rule may be too dependent on chance, our equation is also used to predict the 95th percentile point in distributions of eigenvalues generated from random data matrices. Multiple correlations for all analyses were at least .95. Regression weights for predicting the first 33 mean and 95th percentile eigenvalues are given in easy-to-use tables.