Going to war on COVID-19: Mobilizing an academic nephrology group practice.

AIM: The COVID-19 pandemic poses unprecedented operational challenges to nephrology divisions in every country as they cope with COVID-19-related kidney disease in addition to regular patient care. Although general approaches have been proposed, there is a lack of practical guidance for nephrology division response in a hospital facing a surge of cases. Here, we describe the specific measures that our division has taken in the hope that our experience in Singapore may be helpful to others. METHODS: Descriptive narrative. RESULTS: A compilation of operational responses to the COVID-19 pandemic taken by a nephrology division at a Singapore university hospital. CONCLUSION: Nephrology operational readiness for COVID-19 requires a clinical mindset shift from usual standard of care to a crisis exigency model that targets best outcomes for available resources. Rapid multi-disciplinary efforts that evolve flexibly with the local dynamics of the outbreak are required.

The slings and arrows of comparative linguistics.

In this Formal Comment the authors respond to objections to their previous Essay, reiterating that comparative linguistics is not an easy undertaking.

Meaningful syntactic structure in songbird vocalizations?

The faculty of language is thought to be uniquely human. Recently, it has been claimed that songbirds are able to associate meaning with sound, comparable to the way that humans do. In human language, the meaning of expressions (semantics) is dependent on a mind-internal hierarchical structure (syntax). Meaning is associated with structure through the principle of compositionality, whereby the meaning of a complex expression is a function of the meaning of its constituent parts and the mode of composition. We argue that while recent experimental findings on songbird call sequences offer exciting novel insights into animal communication, despite claims to the contrary, they are quite unlike what we find in human language. There are indeed remarkable behavioral and neural parallels in auditory-vocal imitation learning between songbirds and human infants that are absent in our closest evolutionary relatives, the great apes. But so far, there is no convincing evidence of syntax-determined meaning in nonhuman animals.

Structures, Not Strings: Linguistics as Part of the Cognitive Sciences.

There are many questions one can ask about human language: its distinctive properties, neural representation, characteristic uses including use in communicative contexts, variation, growth in the individual, and origin. Every such inquiry is guided by some concept of what 'language' is. Sharpening the core question--what is language?--and paying close attention to the basic property of the language faculty and its biological foundations makes it clear how linguistics is firmly positioned within the cognitive sciences. Here we will show how recent developments in generative grammar, taking language as a computational cognitive mechanism seriously, allow us to address issues left unexplained in the increasingly popular surface-oriented approaches to language.

Psychosocial aspects of botox in aesthetic surgery.

BACKGROUND: The human preoccupation of experimenting with potentially toxic substances at sublethal doses to enhance beauty spans the ages. The Botox injection is the fastest growing cosmetic procedure, and its physiologic safety profile is considered to be excellent. The psychosocial consequences of Botox have been largely ignored in the literature. METHODS: This cross-sectional study investigated the psychosocial issues that can arise as either an antecedent to the treatment or a consequence of it. RESULTS: Significant differences between clients and control subjects were observed in the four major areas of psychosocial functioning implicated in this study: (a) distress arising from the procedure (anxiety/phobia), (b) worry about the facial changes after the procedure, (c) expectations, involving the discrepancy between expected and actual outcomes of treatment; and (d) dependence, involving the desire for repetitive administration. CONCLUSIONS: The impact of Botox on the psychosocial functioning of individuals was investigated in this study from a psychosocial and clinical perspective in an effort to pave the way for the formulation of national standardized guidelines for the use of Botox. This study empowers the clinician to understand the basis for the relative contraindications of Botox, which are largely psychological in nature, and thus to ensure its administration in a safe and responsible manner.

Changing face of gestational trophoblastic tumor.

During the years there have been many advances in the diagnosis and treatment of gestational trophoblastic tumor (GTT) with marked improvement in the outcome. At the same time in Korea there have been many social and economic changes which also have had a marked influence on the outcome. The purpose of this study was to review the changes that have occured among patients admitted to Il Sin Christian Hospital, Pusan, Korea over the past four decades.

Changes in gestational trophoblastic tumors over four decades. A Korean experience.

OBJECTIVE: To review changes that occurred in gestational trophoblastic tumor (GTT) patients treated over four decades and to identify factors leading to the changes. STUDY DESIGN: A retrospective study of 287 cases treated during 1961-1967, 1975-1979, 1980-1986 and 1990-1994. The method of diagnosis, incidence and outcome in each decade and factors that may have had an influence, on incidence, outcome or both, were reviewed. RESULTS: Diagnosis shifted from pathologic (1960s) to clinical (1990s). The incidence per 1,000 births decreased from 4.4 (1960s) to 1.6 (1990s). The incidence showed a 26-fold increase in women aged 40 and over and 13.4-fold increase in women para 3 and over. The obstetric population showed a decrease in the high-risk group of greater age and higher parity. Assessment by the 1983 World Health Organization prognostic score showed an increase in low-risk and decrease in high-risk disease. Prognostic score changes are related to a decrease in GTT in older women, increase in GTT with a short interval and increase in nonmetastatic disease. Overall mortality decreased from 32.6% to 2.6%. CONCLUSION: The decreased incidence and improved outcome of GTT in Korea are related to improved medical care and to social, economic and educational changes.

Changing face of gestational trophoblastic tumor.

During the years there have been many advances in the diagnosis and treatment of gestational trophoblastic tumor (GTT) with marked improvement in the outcome. At the same time in Korea there have been many social and economic changes which also have had a marked influence on the outcome. The purpose of this study was to review the changes that have occured among patients admitted to Il Sin Christian Hospital, Pusan, Korea over the past four dccades.

[Brain abscess complicating dental caries in children]. / Abcès cérébraux de l'enfant compliquant des caries dentaires.

Brain abscess following dental or periapical infection is rare in childhood. This report describes brain abscesses found in two children with dental caries. Case 1.--A 12 year-old boy was admitted because he had suffered from acute meningitis for 3 days. Clinical examination showed symptoms of meningitis plus palsy of the right third and fourth cranial nerves and of the left facial nerve, and a defect in the left temporal field. Funduscopic examination showed papilledema; CT scan and MRI showed a ring-shaped lesion in the right occipital area. The patient was given cefotaxime and thiamphenicol. The abscess was drained; bacteriological examination showed Actinomyces viscosus and Peptostreptococcus magnus. The neurological condition and the CT scan lesion improved, but intracranial pressure increased again on the 17th day after the onset, requiring replacement of the antibiotics by rifampicin and ampicillin plus clavulanic acid for 2 months. This brain abscess appeared to be metastatic, derived from the infection of a large dental cyst due to a dental infection that had been treated 6 months earlier. Case 2.--A 8 1/2 year-old girl was admitted because she was suffering from palsy of the left facial nerve and left arm. She had had headaches and fever for a few days. Clinical examination showed the palsies and drowsiness. CT scan showed two brain abscesses. The patient was given ceftriaxone, fosfocin and metronidazole. She had been treated for a gingival abscess 1 month earlier, and had two infected teeth extracted. Improvement of the intracranial pressure was transient and the antibiotics were changed on the 12th day of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

An evaluation of the prognostic factors in metastatic gestational trophoblastic disease.

A retrospective evaluation of prognostic factors in 55 patients suffering from metastatic gestational trophoblastic disease (MGTD) treated by modified Bagshawe's CHAMOCA regimen was done. The prognostic significance of the eight prognostic factors in the WHO scoring system, number of sites of metastasis and FIGO staging were evaluated by univariate analysis using Chi-square test with Yates' correction and odds ratio and by multivariate analysis using Cox proportional hazard analysis and logistic regression analysis. In the univariate analysis, the intervals between antecedent pregnancy and the diagnosis of GTD, (P = 0.004) the level of hCG (P = 0.02) and the number of metastatic sites (P = 0.046) were significantly associated with death. In the multivariate analysis, only the interval between the antecedent pregnancy and the diagnosis and the level of hCG were significantly associated with death. Thus, it seems that the interval between antecedant pregnancy and the diagnosis and the level of hCG were the two most significant factors in predicting mortality in high risk MGTD. The WHO staging was more predictive of poor outcome than that of the FIGO staging in this group of patients.

Instrumentation for salivary duct cannulation.

The use of lacrimal probes to locate and dilate the ducts of major salivary glands is described. This technique greatly facilitates cannulation for sialography.