Androgen Receptor CAG Repeat Length in Relation to Phenotype Among Females with Nonclassical 21-Hydroxylase Deficiency.

Nonclassical 21-hydroxylase deficiency (NC21OHD) manifests with various degrees of post natal virilization. The length of CAG repeats of the androgen receptor gene (AR) is inversely correlated to activity of the human androgen receptor (AR) and affects phenotype of several androgen-dependent disorders. The aim of the study was to investigate the associations between CAG repeat length and the phenotype of females with NC21OHD. CAG repeat length and AR inactivation were assessed in females with NC21OHD, and related to their clinical presentation. CAG repeat length and AR inactivation were assessed in 119 females with NC21OHD. Biallelic mean (BAM) of the CAG repeat length and the weighted BAM (WBAM) were related to various clinical parameters. Age at diagnosis and age of menarche positively correlated with BAM (r=0.22, p=0.02, and r=0.23, p=0.01, respectively). A shorter (<25) BAM was associated with younger age at diagnosis (14.8 vs. 21.4 years, p<0.01), at adrenarche (8.1 vs. 10.2 years, p<0.01) and gonadarche (9.9 vs. 11.2 years, p<0.01), and higher corrected height standard deviation score at diagnosis (0.77 vs. 0.15, p=0.01). Precocious pubarche and precocious puberty were more frequent in these with the shorter BAM. Results of WBAM were similar. The CAG repeat length of the AR gene contributes to the clinical diversity of the phenotype in females with NC21OHD.

An examination of retention factors among registered practical nurses in north-eastern Ontario, Canada.

INTRODUCTION: Literature from the past two decades has presented an insufficient amount of research conducted on the nursing practice environments of registered practical nurses (RPNs). The objective of this article was to investigate the barriers and facilitators to sustaining the nursing workforce in north-eastern Ontario (NEO), Canada. In particular, retention factors for RPNs were examined. METHODS: This cross-sectional research used a self-administered questionnaire. Home addresses of RPNs working in NEO were obtained from the College of Nurses of Ontario (CNO). Following a modified Dillman approach with two mail-outs, survey packages were sent to a random sample of RPNs (N=1337) within the NEO region. Logistic regression analyses were used to determine intent to stay (ITS) in relation to the following factor categories: demographic, and job and career satisfaction. RESULTS: Completed questionnaires were received from 506 respondents (37.8% response rate). The likeliness of ITS in the RPNs' current position for the next 5 years among nurses aged 46-56 years were greater than RPNs in the other age groups. Furthermore, the lifestyle of NEO, internal staff development, working in nursing for 14-22.5 years, and working less than 1 hour of overtime per week were factors associated with the intention to stay. CONCLUSIONS: Having an understanding of the work environment may contribute to recruitment and retention strategy development. The results of this study may assist with addressing the nursing shortage in rural and northern areas through improved retention strategies of RPNs.

[One stage combined endoscopic and per-oral buccal fat pad approach for large oro-antral-fistula closure with secondary chronic maxillary sinusitis].

There are numerous surgical approaches for oro-antral-fistula (OAF) closure. Secondary sinus disease is still considered by many experts a relative contra indication for primary closure. To describe a single-stage combined endoscopic sinus surgery and per-oral buccal fat pad (BFP) flap approach for large OAF causing chronic maxillary sinusitis. The records of all the patients with OAF and chronic manifestations of secondary rhinosinusitis that were treated between 2010 and 2013 in our tertiary care medical center were reviewed. The exclusion criteria were: OAF 5 mm, resolved sino-nasal disease, OAF secondary to malignancy, recurrent fistula, medical history that included radiotherapy to the maxillary bone and age <18 years. Each procedure was performed by a team consisting of a rhinologist and a maxillofacial surgeon. The surgical approach included an endoscopic middle antrostomy with maxillary sinus drainage, and a per-oral BFP regional flap for OAF closure. Total OAF closure, complications and need for revision surgeries. Forty-five patients that underwent OAF closure together with sinus surgery using a combined endoscopic sinus surgery (ESS) and BFP flap approach met the inclusion criteria. There were 28 males and 17 females with a mean ± SD age of 53.5 ± 14.9 years (range 22-80 years). The presenting signs and symptoms included purulent rhinorrhea (n = 22, 48.9%), foreign body in sinus (n = 10, 22.2%) nasal congestion (n = 7, 15.5%), halitosis (n = 6, 13.3%) and pain (n = 5, 12.2%). Surgical complications included local pain (n = 2, 4.4%), persistent rhinitis (n = 2, 4.4%) and synechia (n = 1, 2.2%). One patient required revision surgery due, to an unresolved OAF. The OAF of all the other 44 patients (97.8%) was closed after the first procedure and the paranasal sinuses on the treated side were completely recovered. The mean follow-up time for the group was 7.6 ± 4.3 months (7-21 months), and no untoward sequelae or recurrence were reported. Combined, one step, endoscopic Maxillary sinus drainage together with per-oral BFP flap approach is an efficacious surgical approach for safe closure of OAFs that are complicated with secondary chronic maxillary sinusitis.

Bioinspired peptide nanotubes: deposition technology, basic physics and nanotechnology applications.

Synthetic peptide monomers can self-assemble into PNM such as nanotubes, nanospheres, hydrogels, etc. which represent a novel class of nanomaterials. Molecular recognition processes lead to the formation of supramolecular PNM ensembles containing crystalline building blocks. Such low-dimensional highly ordered regions create a new physical situation and provide unique physical properties based on electron-hole QC phenomena. In the case of asymmetrical crystalline structure, basic physical phenomena such as linear electro-optic, piezoelectric, and nonlinear optical effects, described by tensors of the odd rank, should be explored. Some of the PNM crystalline structures permit the existence of spontaneous electrical polarization and observation of ferroelectricity. The PNM crystalline arrangement creates highly porous nanotubes when various residues are packed into structural network with specific wettability and electrochemical properties. We report in this review on a wide research of PNM intrinsic physical properties, their electronic and optical properties related to QC effect, unique SHG, piezoelectricity and ferroelectric spontaneous polarization observed in PNT due to their asymmetric structure. We also describe PNM wettability phenomenon based on their nanoporous structure and its influence on electrochemical properties in PNM. The new bottom-up large scale technology of PNT physical vapor deposition and patterning combined with found physical effects at nanoscale, developed by us, opens the avenue for emerging nanotechnology applications of PNM in novel fields of nanophotonics, nanopiezotronics and energy storage devices.

Endoscopic sinus surgery for dental implant displacement into the maxillary sinus-a retrospective clinical study.

The aims of this retrospective clinical study were to present our management protocol for the retrieval of impacted dental implants that have become displaced into the maxillary sinus cavity and to define the role of endoscopic sinus surgery in this setting. All 24 patients (25 implants) who underwent surgical retrieval of dental implants displaced into the maxillary sinus between 2012 and 2019 were included. Data on surgical interventions and complications were collected retrospectively. Eleven patients (46%) had chronic sinusitis associated with the migrated implant. All implants were successfully retrieved via transnasal endoscopic approach alone: 80% via a middle meatal antrostomy and 20% via a combined middle and inferior meatal antrostomy. Five patients required a concomitant transoral approach for oro-antral fistula repair. None required a transoral approach for displaced implant retrieval. All patients healed uneventfully without complications. Transnasal endoscopic sinus surgery via a middle meatal antrostomy or a combined middle and inferior antrostomy is recommended as the primary choice for dental implant retrieval from the maxillary sinus. A transoral approach should be performed simultaneously only for oro-antral fistula repair. This surgical protocol proved to be safe and efficient, and it obviated the need for osteotomies of the anterolateral maxillary wall.

Mass casualty incident management, triage, injury distribution of casualties and rate of arrival of casualties at the hospitals: lessons from a suicide bomber attack in downtown Tel Aviv.

BACKGROUND: Terrorist attacks in Israel cause mass events with varying numbers of casualties. A study was undertaken to analyse the medical response to an event which occurred on 17 April 2006 near the central bus station, Tel Aviv, Israel. Lessons are drawn concerning the management of the event, primary triage, evacuation priorities and the rate and characteristics of casualty arrival at the nearby hospitals. METHODS: Data were collected both during and after the event in formal debriefings. Their analysis refers to medical response components, interactions and main outcomes. The event is described according to the DISAST-CIR methodology (Disastrous Incidents Systematic AnalysiS Through--Components, Interactions and Results). RESULTS: 91 casualties were reported in this event; 85 were evacuated from the scene including 3 already dead on arrival, 9 severely injured, 14 moderately injured and 59 mildly injured. Six were declared dead at the scene. Emergency medical service (EMS) vehicle accumulation was rapid. The casualties were distributed between five hospitals (three level 1 and two level 2 trauma centres). The first evacuated casualty arrived at the hospital within 20 min of the explosion and the last urgent victim was evacuated from the scene after 1 h 14 min. Evacuation occurred in two phases: the first, lasting 1 h 20 min, in which most of the patients with evident trauma were evacuated and the second, lasting 8 h 15 min, in which most patients presented with tinnitus and symptoms of somatisation. The most common injuries were upper and lower limb injuries, diagnosed in 37% of the total injuries, and stress-related disturbances (anxiety, tinnitus, somatisation) diagnosed in 41%. CONCLUSION: Rapid accumulation of EMS vehicles, effective primary triage between urgent and non-urgent casualties and primary distribution between five hospitals enabled rapid conclusion of the event, both at the scene and at the receiving hospitals.

Type 1 diabetes in Jewish Ethiopian immigrants in Israel: HLA class II immunogenetics and contribution of new environment.

The interrelationship between human leukocyte antigen immunogenetics and environmental factors and their contribution to the emergence of type 1 diabetes (T1D) were studied in Jewish immigrants from Ethiopia in Israel. This community displays high incidence of T1D, and is unique both by its ethnic segregation and its rapid exposure to a new environment after the immigration. The study population consisted of 152 Ethiopian Jews living in Israel, 33 with T1D and 119 unrelated controls. Human leukocyte antigen class II susceptible and protective alleles in the Jewish Ethiopian patients were similar to those in patients of other ethnic groups in Israel and in non-Jewish Ethiopian patients, with a few exceptions. Three haplotypes were markedly associated with diabetes in Jewish Ethiopian patients: DRB1*0301 DQA1*05 DQB1*02 (OR 4.4, p < 0.001); DRB1*0404 DQA1 03 DQB1*0302 (OR 19.2, p = 0.006), and DRB1*0405 DQA1*03 DQB1*0302 (OR 87.8, p < 0.001). The highly susceptible allele DRB1*0301 was more common in the general Ethiopian population (25.2%) than in all other ethnic groups in Israel, which may render this community prone to the disease. The age at onset of disease in patients with two susceptible haplotypes was negatively correlated with the duration of living in Israel (r = -0.621, p = 0.04). We concluded that ongoing exposure of genetically predisposed immigrants from Ethiopia to diabetogenic environmental factors eventually leads to a high incidence of overt diabetes in this ethnic group.

Severe pulmonary disease in association with Crohn's disease in a 13-year-old girl.

Pulmonary manifestations of Crohn's disease are infrequent in adults and even less common in children. Our literature search found only a few cases of Crohn's disease causing pulmonary manifestations in children. We report on the case of a 13-year-old girl in whom severe pulmonary disease was found four years after the onset of Crohn's disease. Open lung biopsy uncovered bronchiolitis obliterans and granulomatous lung disease. Aggressive treatment has yielded gradual improvement. This case emphasizes the importance of recognizing the association, the differential diagnosis, and treatment implications.

Coping with the Gulf war: subculture differences among ischemic heart disease patients in Israel.

The purpose of this study was to assess short term effects of the Gulf war on ischemic heart disease patients of different ethnic origin. Three dimensions of patients' reactions to the war situation were studied: psychological, physical and behavioral. The study first focused on changes in patients' responses on these dimensions over three stages of the war, differentiated according to degree of threat. Second, differences stemming from ethnic origin were examined among patients who live in the same geographical region, use the same health services and were exposed to the same threatening life event. One hundred ischemic heart disease patients were interviewed while waiting in outpatient hospital clinics for a regular examination at the end of the war. The results of intrapersonal comparisons showed that the intensity of responses, as expected, increased significantly on the three dimensions from the week before the war started to the first week of the war, which was the most stressful period for Israelis. During the last week of the war, however, when stress was significantly reduced, the expected change was found primarily with regard to psychologic responses. That is, worries were significantly reduced, but no significant reduction in frequency of anginal pain and in drug consumption followed, indicating differences in the adjustment process on the psychologic and physical levels. Subcultural differences were found in the studied responses: Patients of Asian or North African countries of origin reported having more frequent anginal pains, and consuming more drugs than patients from Western countries.(ABSTRACT TRUNCATED AT 250 WORDS)

Endoscopic transnasal transsphenoidal microsurgery versus the sublabial approach for the treatment of pituitary tumors: endonasal complications.

OBJECTIVE: To evaluate the nasal complications after transnasal transsphenoidal operations for pituitary tumors, comparing two surgical techniques: traditional sublabial transseptal and endoscopic transseptal techniques. STUDY DESIGN: We retrospectively evaluated by self-reported questionnaire and endoscopic examination the nasal condition of 40 consecutive patients with pituitary tumors: 20 patients had endoscopic surgery and 20 had surgery with the traditional sublabial technique. RESULTS: Compared with the traditional technique, the endoscopic approach was associated with a shorter operative time (about 40 min), shorter hospitalization time (about half), absence of recurrent epistaxis snoring and denture problems, and lower incidence of septal perforation, synechia, and crust formation. Furthermore, loss of nasal tip projection was found only in the group that had surgery with the sublabial technique. CONCLUSIONS: Endoscopically guided transseptal transsphenoidal surgery is simple to perform and time-saving, and it results in fewer nasal and denture complications than the sublabial technique. At the same time, it allows the surgeon all the benefits of the binocular microscopic surgical field that are associated with the traditional approach.

Complete and partial fault tolerance of feedforward neural nets.

A method is proposed to estimate the fault tolerance (FT) of feedforward artificial neural nets (ANNs) and synthesize robust nets. The fault model abstracts a variety of failure modes for permanent stuck-at type faults. A procedure is developed to build FT ANNs by replicating the hidden units. It exploits the intrinsic weighted summation operation performed by the processing units to overcome faults. Metrics are devised to quantify the FT as a function of redundancy. A lower bound on the redundancy required to tolerate all possible single faults is analytically derived. Less than triple modular redundancy (TMR) cannot provide complete FT for all possible single faults. The actual redundancy needed to synthesize a completely FT net is specific to the problem at hand and is usually much higher than that dictated by the general lower bound. The conventional TMR scheme of triplication and majority voting is the best way to achieve complete FT in most ANNs. Although the redundancy needed for complete FT is substantial, the ANNs exhibit good partial FT to begin with and degrade gracefully. The first replication yields maximum enhancement in partial FT compared with later successive replications. For large nets, exhaustive testing of all possible single faults is prohibitive, so the strategy of randomly testing a small fraction of the total number of links is adopted. It yields partial FT estimates that are very close to those obtained by exhaustive testing. When the fraction of links tested is held fixed, the accuracy of the estimate generated by random testing is seen to improve as the net size grows.

Connectivity and performance tradeoffs in the cascade correlation learning architecture.

The cascade correlation is a very flexible, efficient and fast algorithm for supervised learning. It incrementally builds the network by adding hidden units one at a time, until the desired input/output mapping is achieved. It connects all the previously installed units to the new unit being added. Consequently, each new unit in effect adds a new layer and the fan-in of the hidden and output units keeps on increasing as more units get added. The resulting structure could be hard to implement in VLSI, because the connections are irregular and the fan-in is unbounded. Moreover, the depth or the propagation delay through the resulting network is directly proportional to the number of units and can be excessive. We have modified the algorithm to generate networks with restricted fan-in and small depth (propagation delay) by controlling the connectivity. Our results reveal that there is a tradeoff between connectivity and other performance attributes like depth, total number of independent parameters, and learning time.

Giant adrenal cyst in the newborn: perinatal diagnosis and management.

Routine ultrasound examination in a pregnant 20-year-old woman at 32 weeks demonstrated a cystic structure in the fetal abdomen. Follow-up till term showed no substantial change in size. After birth the cyst could easily be palpated as an epigastric mass. Ultrasonography followed by a barium meal suggested, among other things, the diagnosis of gastric duplication. At exploratory laparotomy the cyst proved to be of adrenal origin. The diagnosis and therapeutic options are discussed.

Combined mother and baby care: does it meet the needs of families?

Combined mother/baby care is thought to be an effective way to prepare a family for the changing roles and added responsibilities that the arrival of a new baby entails, but few studies have evaluated this care delivery system. Therefore, the postpartum staff at Sudbury General Hospital conducted a post-test control group study design with a self-selected sample of postpartum mothers when the unit was changing from traditional to combined mother/baby care. One hundred and three mothers who received traditional care and 102 who had combined mother/baby care completed a questionnaire to assess perceptions of their own competence and satisfaction with the type of care administered. There were no significant differences between the two study groups. Factors that may have confounded the results include: insufficient time between institution of the program and its evaluation, and the quality of prenatal education received. Multiparous mothers scored higher on self care, infant care, and maternal competence than did primiparous mothers regardless of the care delivery system. Maternal concerns related to immediate needs. Future research should take the differences between primiparas and multiparas into account, and focus on the less immediate needs of mothers.

Perceived mood and exercise behaviors of cardiac rehabilitation program referrals.

The objective of this study was to examine how 65 clients referred to a cardiac rehabilitation program perceived their current mood, severity of illness, exercise behaviors, and hence, quality of life. The theoretical perspective for this study was derived from King's (1981) theory of goal attainment. The individual's perceptions are a fundamental element of goal attainment. A telephone survey was developed to gather data on demographics, exercise intensity and participation, severity of illness at time of hospital discharge and time of interview as well as responses to a mood adjective check list (Lubin, 1981). Analysis indicated that exercise was a valued behavior for the majority of subjects. All subjects perceived that the severity of their heart condition had changed from more to less severe. Furthermore, those who exercised felt healthy and merry, while those who did not exercise felt miserable.

Hassles, uplifts, and anxiety reported by Post-RN students in a BScN programme.

This study examined the daily hassles, uplifts and anxiety of registered nurse students (Post-RN) during a Community Health Nursing challenge examination in a baccalaureate nursing programme. The objectives of the first phase of this study were 1) to identify the daily hassles, uplifts and anxiety experienced by distance education and on-campus students and 2) to examine relationships among these variables and selected sociodemographic factors. Spielberger's (1983) State and Trait Anxiety Inventory (STAI) and Folkman and Lazarus' (1989) Hassles and Uplifts questionnaire were utilised. State anxiety levels were found to be higher than those of female working adults (Spielberger 1983). As well, on-campus students had higher state anxiety levels than distance education students. Trait anxiety differed significantly by age. Except for employment status, sociodemographic factors had no impact on hassles or uplifts. Unemployed subjects experienced significantly greater intensity of uplifts than subjects employed in a hospital setting. Hassles contributed significantly to the anxiety expressed by registered nurse students. As anticipated for women fulfilling multiple family, work and student roles, time pressure emerged as the most important hassle factor. Future research is planned to further explore hassles, uplifts and anxiety as Post-RN students progress through a baccalaureate nursing programme.

Family-centered care in Ontario general hospitals: the views of pediatric nurses.

Registered nurses and registered practical nurses working on pediatric units in 35 Ontario general hospitals participated in a study that examined their perceptions and practices of family-centered care (FCC). The Family-Centered Care Questionnaire-Revised (FCCQ-R) was used to collect the data. The participants were asked to rate their level of agreement regarding necessary elements (perceptions) of family-centered care and whether these elements are part of their current work (practice). The participants had a reasonable knowledge of the necessary elements of family-centered care, but were not consistently including these in their every day work. A number of barriers to the implementation of family-centered care were also identified. Perception and practice scores were higher among those who had participated in continuing education on family-centered care than those who had not. The findings suggest that some nurses may be having difficulties shifting from a medical helping model of care to an enabling helping model of care, which is considered the foundation of family-centered care. Difficulties in implementing family-centered care appear to be systemic, both at the unit and organizational level. Based on the findings, implications for practice, education and research are suggested.

[Preservation of the great posterior auricular nerve during superficial parotidectomy].

Sensory loss in the operative area after superficial parotidectomy is one of the complications which disturbs the patient. The greater auricular nerve, which stems from the cervical plexus, supplies sensation to the area. Sacrifice of the nerve during superficial parotidectomy causes sensory loss in the area. We investigated the degree of sensory loss in the operative area after superficial parotidectomy in 10 patients in whom the posterior branch of the greater auricular nerve was preserved and compared the results with those in whom it was not, a year after operation. There was more sensory loss when the greater auricular nerve was sacrificed. We therefore suggest preserving the posterior branch of the greater auricular nerve during superficial parotidectomy if at all possible.

[Type 2 diabetes among adolescents in Israel].

Type 2 diabetes has been considered rare in children and adolescents. Recently, increase in the incidence of type 2 diabetes has been reported among adolescents in various parts of the world. We report the occurrence of type 2 diabetes among adolescents in Israel. A boy of 14 and girls of 16.5 and 17 were pubertal and extremely obese, with a body mass index (BMI) between 39-47 kg/m2. Acanthosis nigricans, elevated diastolic blood pressure, and hirsutism with menstrual disorders, were associated with insulin resistance, and should raise suspicion of type 2 diabetes. Significant obesity and strong family histories of type 2 diabetes appeared to be important risk factors. Since type 2 leads to long-term morbidity and mortality, its early identification and appropriate treatment are crucial.