The carotid body can transduce hypoxia and other blood-borne stimuli, perhaps including hypoglycaemia, into afferent neural discharge that is graded for intensity and which forms the afferent limb of a cardiorespiratory and neuroendocrine reflex loop. Hypoxia inhibits a variety of K(+) channels in the type I cells of the carotid body, in a seemingly species-dependent manner, and the resultant membrane depolarisation is sufficient to activate voltage-gated Ca(2+) entry leading to neurosecretion and afferent discharge. The ion channels that respond to hypoxia appear to do so indirectly and recent work has therefore focussed upon identification of other proteins in the type I cells of the carotid body that may play key roles in the oxygen sensing process. Whilst a role for mitochondrial and/or NADPH-derived reactive oxygen species (ROS) has been proposed, the evidence for their signalling hypoxia in the carotid body is presently less than compelling and two alternate hypotheses are currently being tested further. The first implicates haemoxygenase 2 (HO-2), which may control specific K(+) channel activation through O(2)-dependent production of the signalling molecule, carbon monoxide. The second hypothesis suggests a role for the cellular energy sensor, AMP-activated protein kinase (AMPK), which can inhibit type I cell K(+) channels and increase afferent discharge when activated by hypoxia-induced elevations in the AMP: ATP ratio. The apparent richness of O(2)-sensitive K(+) channels and sensor mechanisms within this organ may indicate a redundancy system for this vital cellular process or it may be that each protein contributes differently to the overall response, for example, with different O(2) affinities. The mechanism by which low glucose is sensed is not yet known, but recent evidence suggests that it is not via closure of K(+) channels, unlike the hypoxia transduction process.
AMP-Activated Protein Kinases ; metabolism ; Animals ; Carotid Body ; physiology ; Chemoreceptor Cells ; physiology ; Heme Oxygenase (Decyclizing) ; metabolism ; Humans ; Hypoxia ; physiopathology ; Potassium Channels ; metabolism ; Reactive Oxygen Species ; metabolism

With the advent of newer technologies, the management of small renal masses has shown a paradigm shift.This has resulted in preferring partial nephrectomy over radical nephrectomy, emphasizing the concept of nephronsparing surgery. Various lasers have been used in few cases. We prospectively evaluated the use of thuliumlaser in open partial nephrectomy over last 1 year. The aim is to study thulium laser as an energy source forpartial nephrectomy for peripheral tumor. The role of partial nephrectomy and zero ischemia time in renalpreservation is already proven. Outcomes of total of 4 patients who underwent open partial nephrectomy wereanalyzed prospectively. We used Quanta Cyber TM laser at setting of 30 W both for cutting and coagulation.Preoperative characteristics and outcomes were analyzed. Four patients underwent open partial nephrectomy withzero ischemia. The mean tumor size was 5.26 cm, mean RENAL nephrometry score was 4.5, mean operativetime was 67.5 minutes, active laser time was 2 minutes, mean blood loss related to partial nephrectomy perse was 65 mL. Mean preoperative hemoglobin was 11.12 g% and mean postoperative hemoglobin was 10.05g%. Mean duration of stay was 6 days. Histologically all lesions were renal cell carcinoma pT1/T2, with marginsnegative for tumor and no deterioration in renal function during follow-up. The thulium laser at 2013 nm wavelengthdemonstrates excellent hemostasis and precise cutting capabilities of the renal cortex during open partialnephrectomy for peripheral tumors without requiring renal artery clamping.

Acute Kidney Injury ; chemically induced ; Aged ; Anti-Bacterial Agents ; administration & dosage ; adverse effects ; Arthroplasty, Replacement, Knee ; Bone Cements ; adverse effects ; Drug-Related Side Effects and Adverse Reactions ; complications ; Female ; Humans ; Surgical Wound Infection ; prevention & control ; Treatment Outcome

No abstract available.
Herpesvirus 4, Human ; Lymphoproliferative Disorders ; Primary Myelofibrosis

No abstract available.
Drug-Induced Liver Injury ; Ribavirin

Thoracic impalement injuries are very rare and the majority of patients do not survive to reach a medical care facility. In this case report, we describe the successful outcome of a case of double thoracic impalement by two steel tors, of which one steel tor had impaled two patients simultaneously. The case report highlights all aspects of managing such rare and complex cases right from prehospital care; extrication process which happened under controlled environment at the trauma centre itself, till the definitive management of the impaled thoracic objects. Thoracic impalement injuries are dramatic and appear very challenging. However presence of mind of the managing team, coordinated team effort and availability of adequate facilities can lead to a successful outcome.
Humans ; Thoracic Injuries ; Wounds, Penetrating

Arthroscopy ; Follow-Up Studies ; Humans ; Rotator Cuff/surgery* ; Treatment Outcome

Although studies of the sacral corridor dimension have been reported in the European population, little attention has been paid to this issue in the Asian population. The purpose of the study is to estimate the safe dimension of the corridor to avoid neurovascular damage during the fixation of the sacral fracture. The study aimed to examine the cephalocaudal (vertical) and the anteroposterior diameter of the bony passage in the upper three sacral segments. The study further examines the effect of age and sex on corridor dimensions at different sacral levels. Three-dimensionally reconstructed sacra from computed tomography of normal subjects were included in the study. Cephalocaudal and anteroposterior diameters were measured in coronal and axial sections using Geomagic Freeform Plus software. Anteroposterior diameter of the sacral corridor at the first, second, and third sacral segments are significantly higher in males (P=0.013, 0.0011, and <0.0001, respectively). The length of the sacrum also revealed sexual dimorphism (P<0.00016). The anteroposterior diameter of the second sacral segment (ap-S2c) correlated moderately with the first sacral anteroposterior diameter (ap-S1c) (R=0.519, P<0.001). The ap-S2c exhibited a moderate correlation to the third sacral segment (ap-S3c) (R=0.677, P<0.001). The sacral corridor at the level of S1 has the largest cephalocaudal (18.25 mm) and anteroposterior diameter (17.11 mm). Placement of the screw in the first sacral corridor may avoid damage to the neurovascular bundle during the fixation of the sacral fracture.

Purpose::Tibial stress fracture associated with knee osteoarthritis is an unusual and difficult clinical scenario. There is no clear existing treatment guideline for this uncommon clinical disease. The aim of this study is to review the impact of various treatment options for patients with advanced knee osteoarthritis associated with proximal tibial stress fracture.Methods::The study was performed using the databases of PubMed and Scopus. Methodological index for non-randomized studies score was used to evaluate the included studies’ bias. The concluded data included the treatment approach, reported outcome measure, and time to fracture union. The literature search was started in December 2021 and accomplished in January 2022. A narrative description of the different methods and comparison of their results were done.Results::Out of total assessed 69 studies, 9 studies were included in our review. The commonest treatment approach used was total knee arthroplasty by long tibial stem extension. The mean preoperative knee society score and knee functional score were 30.62 and 23.17, respectively. The mean postoperative knee society knee score was 86.87, while the functional score was 83.52. The average reported time to achieve fracture union was 4 months (a range of 2.07 - 5.50 months).Conclusion::The optimal clinical outcome for treating either acute or mobile tibial stress fracture in patients with advanced knee osteoarthritis can be achieved with long stem total knee arthroplasty. However, due to heterogeneity of data, comparison of different treatment options for chronic proximal tibial stress fracture mal-union/non-union coexisting with knee osteoarthritic and such inferences need to be judged cautiously.

INTRODUCTIONThe purpose of this study is to compare the sensitivities and positive predictive values (PPV) of the anterior apprehension test and magnetic resonance imaging (MRI) in the diagnosis of anterior labral tears in young patients with shoulder instability and to determine if surgery could be carried out without this investigation in selected patients.

MATERIALS AND METHODSWe undertook a retrospective study of 168 patients aged between 15 and 30 years with a history of shoulder dislocation and compared the sensitivities and the PPV of the apprehension test with both MRI and magnetic resonance arthrograms (MRA) in the diagnosis of a Bankart lesion. The radiological investigations were interpreted by general practice radiologists and specialised musculoskeletal radiologists. All patients had their diagnosis confirmed by shoulder arthroscopy.

RESULTSOur results showed that the apprehension test was highly reliable when it was positive with a PPV of 96%. It was more sensitive than MRI in the diagnosis of a Bankart lesion. The clinical test was significantly better when a musculoskeletal radiologist interpreted the MRI. The MRA interpreted by a musculoskeletal radiologist had the highest rates of sensitivity in detecting Bankart lesions. The figure was similar to that for the apprehension test. There was no difference in the PPVs among the clinical test, the MRI and the MRA read by the 2 categories of radiologists.

CONCLUSIONWe conclude that a routine MRI may be unnecessary in evaluating a young patient with clinically evident anterior shoulder instability if the apprehension test is positive. A MRA that can be interpreted by a musculoskeletal radiologist will be the next best investigation if the clinical test is negative or equivocal.

Adolescent ; Adult ; Arthroscopy ; Female ; Humans ; Joint Instability ; diagnosis ; etiology ; surgery ; Magnetic Resonance Imaging ; Male ; Physical Examination ; methods ; Predictive Value of Tests ; Retrospective Studies ; Sensitivity and Specificity ; Shoulder Dislocation ; complications ; diagnosis ; surgery ; Shoulder Joint ; surgery ; Young Adult