Minor surgery in primary care has reduced minor surgery waiting lists: a 12-month review.

BACKGROUND: To investigate minor procedures performed in general practice, to alleviate the burden on the economy, patients and secondary care physicians. AIMS: To determine the range of minor surgical procedures performed in a single group general practice, subsequent referrals made to secondary care, follow-up surgical procedures required and post-operative complications within a patient group. METHODS: Retrospective data collection from the electronic records of a single group general practice consisting of 5101 active patients within the previous 12 months. Through use of Socrates software program and statistical analysis, patients were stratified into demographics, including, age, gender, the cost of the procedure, the type of procedure being carried out, the post-operative referral rate to secondary care and any subsequent procedures required. The patients were excluded if their minor procedure was classified as a joint injection. RESULTS: 133 procedures were carried out over the 12-month period. Of these patients, the majority were male, and the mean age was 44 years old. The most common procedures included the removal of ingrown toenails, lesion excisions and punch biopsies. Histological analysis was done on biopsies, with a low rate of misdiagnosis pre-operatively. Additionally, there were minimal referrals and no complications recorded. CONCLUSIONS: This study has demonstrated the ability for minor surgery to be safely carried out in primary care. The integration of general practice, general surgery and plastic surgery could provide a higher level of patient care and exchange of skills to help reduce waiting lists and alleviate the burden secondary care.

Kikuchi Disease: A Case Report.

BACKGROUND: Kikuchi disease, also known as Kikuchi-Fujimoto disease, is a rare, benign cause of cervical lymphadenitis. It is characterized by painful cervical lymphadenopathy with fevers, leukopenia, and an elevated erythrocyte sedimentation rate. It is diagnosed by obtaining a biopsy specimen from a lymph node that shows characteristic histopathologic findings. CASE REPORT: We highlight a 42-year-old Japanese man who presented with persistent fevers and cervical lymphadenopathy who was misdiagnosed at multiple urgent care facilities and emergency departments. He was eventually diagnosed with Kikuchi disease after a biopsy specimen was obtained from a lymph node 1 month after his symptoms began. He was treated with hydroxychloroquine and prednisone with resolution of his symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although Kikuchi disease has been previously described in various specialty medical journals, the published literature on Kikuchi disease in emergency medicine is relatively scarce. Given that cervical lymphadenopathy is a common presentation to emergency departments, it is important for emergency physicians to be cognizant of Kikuchi disease in the differential diagnosis of cervical lymphadenopathy to prevent misdiagnoses and unnecessary treatments.

Visual and verbal learning and memory in cystinosis.

Cystinosis is a rare genetic lysosomal storage disorder characterized by the accumulation of cystine in lysosomes. Many organ systems are vulnerable to this cystine accumulation including the CNS. A past study demonstrated that children with cystinosis have deficits in visual learning and memory while their verbal learning and memory and global intellectual function are spared (Spilkin, Ballantyne, & Trauner, 2009). However, no related study has been performed to assess the dissociation between visual and verbal learning and memory in adults with cystinosis who have had the benefit of longterm treatment with the cystine-depleting agent, cysteamine. In this study we assessed visual and verbal learning and memory in 15 adults with cystinosis, with a mean age of 30.2 years. The results indicate that adults with cystinosis have no significant deficits in either verbal or visual learning and memory. However, the individuals did perform better on the verbal assessment. The results suggest that if early and continued treatment is given to individuals with cystinosis there is a relative sparing of visual learning and memory that might have otherwise declined. This emphasizes the essential nature of the proper clinical management of cystinosis.

Discharging dynamics in an electrolytic cell.

We analyze the dynamics of a discharging electrolytic cell comprised of a binary symmetric electrolyte between two planar, parallel blocking electrodes. When a voltage is initially applied, ions in the electrolyte migrate towards the electrodes, forming electrical double layers. After the system reaches steady state and the external current decays to zero, the applied voltage is switched off and the cell discharges, with the ions eventually returning to a uniform spatial concentration. At voltages on the order of the thermal voltage V_{T}=k_{B}T/q≃25 mV, where k_{B} is Boltzmann's constant, T is temperature, and q is the charge of a proton, experiments on surfactant-doped nonpolar fluids observe that the temporal evolution of the external current during charging and discharging is not symmetric [V. Novotny and M. A. Hopper, J. Electrochem. Soc. 126, 925 (1979)JESOAN0013-465110.1149/1.2129195; P. Kornilovitch and Y. Jeon, J. Appl. Phys. 109, 064509 (2011)JAPIAU0021-897910.1063/1.3554445]. In fact, at sufficiently large voltages (several V_{T}), the current during discharging is no longer monotonic: it displays a "reverse peak" before decaying in magnitude to zero. We analyze the dynamics of discharging by solving the Poisson-Nernst-Planck equations governing ion transport via asymptotic and numerical techniques in three regimes. First, in the "linear regime" when the applied voltage V is formally much less than V_{T}, the charging and discharging currents are antisymmetric in time; however, the potential and charge density profiles during charging and discharging are asymmetric. The current evolution is on the RC timescale of the cell, λ_{D}L/D, where L is the width of the cell, D is the diffusivity of ions, and λ_{D} is the Debye length. Second, in the (experimentally relevant) thin-double-layer limit ε=λ_{D}/L≪1, there is a "weakly nonlinear" regime defined by V_{T}≲V≲V_{T}ln(1/ε), where the bulk salt concentration is uniform; thus the RC timescale of the evolution of the current magnitude persists. However, nonlinear, voltage-dependent, capacitance of the double layer is responsible for a break in temporal antisymmetry of the charging and discharging currents. Third, the reverse peak in the discharging current develops in a "strongly nonlinear" regime V≳V_{T}ln(1/ε), driven by neutral salt adsorption into the double layers and consequent bulk depletion during charging. The strongly nonlinear regime features current evolution over three timescales. The current decays in magnitude on the double layer relaxation timescale, λ_{D}^{2}/D; then grows exponentially in time towards the reverse peak on the diffusion timescale, L^{2}/D, indicating that the reverse peak is the results of fast diffusion of ions from the double layer layer to the bulk. Following the reverse peak, the current decays exponentially to zero on the RC timescale. Notably, the current at the reverse peak and the time of the reverse peak saturate at large voltages V≫V_{T}ln(1/ε). We provide semi-analytic expressions for the saturated reverse peak time and current, which can be used to infer charge carrier diffusivity and concentration from experiments.

Dynamics of a self-diffusiophoretic particle in shear flow.

Colloidal particles can achieve autonomous motion by a number of physicochemical mechanisms. For instance, if a spherical particle acts as a catalyst with an asymmetric surface reactivity, a molecular solute concentration gradient will develop in the surrounding fluid that can propel the particle via self-diffusiophoresis. Theoretical analyses of self-diffusiophoresis have mostly been considered in quiescent fluid, where the solute concentration is usually assumed to evolve solely via diffusion. In practical applications, however, self-propelled colloidal particles can be expected to reside in flowing fluids. Here, we examine the role of ambient flow on self-diffusiophoresis by quantifying the dynamics of a model Janus particle in a simple shear flow. The imposed flow can distort the self-generated solute concentration gradient. The extent of this distortion is quantified by a Peclet number, Pe, associated with the shear flow. Utilizing matched asymptotic analysis, we determine the concentration gradient surrounding a Janus particle in shear flow at a small, but finite, Peclet number and the resulting particle motion. For example, when the symmetry axis of the particle is aligned with the imposed flow, the Janus particle experiences an O(Pe) cross-streamline drift and an O(Pe(3/2)) reduction in translational velocity along the flow direction. We then analyze the in-plane trajectory of the Janus particle in shear. We find that the particle performs elliptical orbits around its initial position in the flow, which decrease in size with increasing Pe.

Computational and experimental investigations of mono-septanoside binding by Concanavalin A: correlation of ligand stereochemistry to enthalpies of binding.

Structure-energy relationships for a small group of pyranose and septanose mono-saccharide ligands are developed for binding to Concanavalin A (ConA). The affinity of ConA for methyl "manno"ß-septanoside 7 was found to be higher than any of the previously reported mono-septanoside ligands. Isothermal titration calorimetry (ITC) in conjunction with docking simulations and quantum mechanics/molecular mechanics (QM/MM) modeling established the specific role of binding enthalpy in the structure-energy relations of ConA bound to natural mono-saccharides and unnatural mono-septanosides. An important aspect in the differential binding among ligands is the deformation energy required to reorganize internal hydroxyl groups upon binding of the ligand to ConA.