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Background Encapsulated pancreatic fluid collection (PFC) is a requisite for endoscopic drainage procedures. The 4-week threshold for defining walled-off necrosis does not capture the dynamic process of encapsulation. We aim to investigate the changes in the wall characteristics of PFC in acute necrotizing pancreatitis (ANP) by comparing baseline contrast-enhanced computed tomography (CECT) with follow-up CT scans.

Background The role of dual-modality drainage of walled-off necrosis (WON) in patients with acute pancreatitis (AP) is established. However, there are no data on the association of clinical outcomes with the timing of percutaneous catheter drainage (PCD). We investigated the impact of the timing of PCD following endoscopic drainage of WON on clinical outcomes in AP.

Summary: Brain metastasis cancer-associated fibroblasts (bmCAFs) are emerging as crucial players in the development of breast cancer brain metastasis (BCBM), but our understanding of the underlying molecular mechanisms is limited. In this study, we aim to elucidate the pathological contributions of fucosylation (the post-translational modification of proteins by the dietary sugar L-fucose) to tumor-stromal interactions that drive the development of BCBM. Here, we report that patient-derived bmCAFs secrete high levels of polio virus receptor (PVR), which enhance the invasive capacity of BC cells. Mechanistically, we find that HIF1α transcriptionally upregulates fucosyltransferase 11, which fucosylates PVR, triggering its secretion from bmCAFs. Global phosphoproteomic analysis of BC cells followed by functional verification identifies cell-cell junction and actin cytoskeletal signaling as modulated by bmCAF-secreted, -fucosylated PVR. Our findings delineate a hypoxia- and fucosylation-regulated mechanism by which bmCAFs contribute to the invasiveness of BCBM in the brain.

Abstract Introduction Aggressive cancers commonly ferment glucose to lactic acid at high rates, even in the presence of oxygen. This is known as aerobic glycolysis, or the “Warburg Effect.” It is widely assumed that this is a consequence of the upregulation of glycolytic enzymes. Oncogenic drivers can increase the expression of most proteins in the glycolytic pathway, including the terminal step of exporting H+ equivalents from the cytoplasm. Proton exporters maintain an alkaline cytoplasmic pH, which can enhance all glycolytic enzyme activities, even in the absence of oncogene-related expression changes. Based on this observation, we hypothesized that increased uptake and fermentative metabolism of glucose could be driven by the expulsion of H+ equivalents from the cell. Results To test this hypothesis, we stably transfected lowly glycolytic MCF-7, U2-OS, and glycolytic HEK293 cells to express proton-exporting systems: either PMA1 (plasma membrane ATPase 1, a yeast H+-ATPase) or CA-IX (carbonic anhydrase 9). The expression of either exporter in vitro enhanced aerobic glycolysis as measured by glucose consumption, lactate production, and extracellular acidification rate. This resulted in an increased intracellular pH, and metabolomic analyses indicated that this was associated with an increased flux of all glycolytic enzymes upstream of pyruvate kinase. These cells also demonstrated increased migratory and invasive phenotypes in vitro, and these were recapitulated in vivo by more aggressive behavior, whereby the acid-producing cells formed higher-grade tumors with higher rates of metastases. Neutralizing tumor acidity with oral buffers reduced the metastatic burden. Conclusions Therefore, cancer cells which increase export of H+ equivalents subsequently increase intracellular alkalization, even without oncogenic driver mutations, and this is sufficient to alter cancer metabolism towards an upregulation of aerobic glycolysis, a Warburg phenotype. Overall, we have shown that the traditional understanding of cancer cells favoring glycolysis and the subsequent extracellular acidification is not always linear. Cells which can, independent of metabolism, acidify through proton exporter activity can sufficiently drive their metabolism towards glycolysis providing an important fitness advantage for survival.

This study was completed in effort to characterize the notch sensitivity of additively manufactured (AM) Inconel 718 produced by laser powder bed fusion (L-PBF). Three different root radii on V-notched test specimens and smooth specimens were evaluated under tensile conditions for specimens built in vertical and horizontal orientations. Both the total axial strain and localized notch diametral strain were measured. Finite element analysis (FEA) was completed on each specimen geometry to confirm the actual strain measurements near the notch. Test results showed the tensile strength of the notched specimens were larger than the tensile strength values of the smooth specimens. These tensile results equate to a notch-sensitivity ratio (NSR) greater than one, indicating that the L-PBF Inconel 718 material is a notch-strengthened material. It is suspected that the notch strengthening is a result of increased triaxial stress produced near the notch tip causing added material constraints, resulting in higher strength values for the notched specimens. Fractography analysis was completed on the various fracture surfaces and identified a dominate ductile failure mode within all of the specimens; however, the amount of ductility reduced with smaller notch root radii. While this study provides the initial notch responses of the L-PBF Inconel 718, further research must be completed in regard to the impact of notches on more complex loading behaviors, such as fatigue and stress-rupture conditions.

Purpose Chronic pelvic pain (CPP) in women is often associated with marked emotional distress and disability, with particular impairments in sexual functioning. Research supports the efficacy of interdisciplinary chronic pain rehabilitation programs (ICPRPs) in treating chronic pain, however less is known about their utility in CPP. Methods This retrospective study examined pain-related sexual impairment, emotional symptoms, and pain severity in CPP patients before and after completing a 3–4 week ICPRP. Predictors of post-treatment sexual impairment were also investigated. Participants included 58 female CPP patients and 58 age-matched females with non-pelvic chronic pain (NPCP). Results All participants reported robust improvements across outcome measures. Women with CPP reported greater pre- and post-treatment impairment in sexual function than NPCP patients, despite significant treatment-related improvements. In contrast, CPP patients also reported higher levels of depression at baseline but showed greater treatment related-improvements. In participants with CPP, treatment-related improvements in depression, alexithymia, and pain severity significantly explained decreases in pain-related sexual impairment following treatment, whereas none of these variables explained sexual impairment outcomes in women with NPCP. Conclusion Results demonstrate that ICPRPs can effectively treat CPP, particularly through changes in depression and alexithymia. Future research should examine whether specific interventions can be added in ICPRPS to address CPP-related sexual impairment.

Many cancer cell lines are aneuploid and heterogeneous, with multiple karyotypes co-existing within the same cell line. Karyotype heterogeneity has been shown to manifest phenotypically, thus affecting how cells respond to drugs or to minor differences in culture media. Knowing how to interpret karyotype heterogeneity phenotypically would give insights into cellular phenotypes before they unfold temporally. Here, we re-analyzed single cell RNA (scRNA) and scDNA sequencing data from eight stomach cancer cell lines by placing gene expression programs into a phenotypic context. Using live cell imaging, we quantified differences in the growth rate and contact inhibition between the eight cell lines and used these differences to prioritize the transcriptomic biomarkers of the growth rate and carrying capacity. Using these biomarkers, we found significant differences in the predicted growth rate or carrying capacity between multiple karyotypes detected within the same cell line. We used these predictions to simulate how the clonal composition of a cell line would change depending on density conditions during in-vitro experiments. Once validated, these models can aid in the design of experiments that steer evolution with density-dependent selection.

Abstract Growing tumors are dynamic and nonlinear ecosystems, wherein cancer cells adapt to their local microenvironment, and these adaptations further modify the environment, inducing more changes. From nascent intraductal neoplasms to disseminated metastatic disease, several levels of evolutionary adaptations and selections occur. Here, we focus on one example of such an adaptation mechanism, namely, “niche construction” promoted by adaptation to acidosis, which is a metabolic adaptation to the early harsh environment in intraductal neoplasms. The avascular characteristics of ductal carcinoma in situ (DCIS) make the periluminal volume profoundly acidic, and cancer cells must adapt to this to survive. Based on discovery proteomics, we hypothesized that a component of acid adaptation involves production of collagen by pre‐cancer cells that remodels the extracellular matrix (ECM) and stabilizes cells under acid stress. The proteomic data were surprising as collagen production and deposition are commonly believed to be the responsibility of mesenchymally derived fibroblasts, and not cells of epithelial origin. Subsequent experiments in 3D culture, spinning disk and second harmonic generation microscopy of DCIS lesions in patients’ samples are concordant. Collagen production assay by acid‐adapted cells in vitro demonstrated that the mechanism of induction involves the RAS and SMAD pathways. Secretome analyses show upregulation of ECM remodeling enzymes such as TGM2 and LOXL2 that are collagen crosslinkers. These data strongly indicate that acidosis in incipient cancers induces collagen production by cancer cells and support the hypothesis that this adaptation initiates a tumor‐permissive microenvironment promoting survival and growth of nascent cancers.

Abstract The Socioscientific Issue (SSI) framework was applied to explore how a team of two teachers navigated SSI cases as students in a STEM education graduate program. Using a case study approach, we found a connection between the specific SSI case and levels of scientific argumentation, as well as teachers’ plans for teaching. Our findings suggest successes and challenges for our teachers in incorporating scientific argumentation through SSI cases into his/her intended classroom practices. Specifically, our participating teachers displayed notably higher levels of claims, reasoning, and ability to question the sources of information, but lower levels of evidence and rebuttals. They had difficulty in connecting claims to evidence and reasoning in discussing the SSI cases. Moreover, their intended classroom implementation considered how to connect the lessons to their students’ lives, build scientific knowledge, and provide meaningful context to engage their students in the study of SSI.

Abstract Friedreich ataxia is an autosomal recessive, neurodegenerative disease characterized by the deficiency of the iron‐sulfur cluster assembly protein frataxin. Loss of this protein impairs mitochondrial function. Mitochondria alter their morphology in response to various stresses; however, such alterations to morphology may be homeostatic or maladaptive depending upon the tissue and disease state. Numerous neurodegenerative diseases exhibit excessive mitochondrial fragmentation, and reversing this phenotype improves bioenergetics for diseases in which mitochondrial dysfunction is a secondary feature of the disease. This paper demonstrates that frataxin deficiency causes excessive mitochondrial fragmentation that is dependent upon Drp1 activity in Friedreich ataxia cellular models. Drp1 inhibition by the small peptide TAT‐P110 reverses mitochondrial fragmentation but also decreases ATP levels in frataxin‐knockdown fibroblasts and FRDA patient fibroblasts, suggesting that fragmentation may provide a homeostatic pathway for maintaining cellular ATP levels. The cardiolipin‐stabilizing compound SS‐31 similarly reverses fragmentation through a Drp1‐dependent mechanism, but it does not affect ATP levels. The combination of TAT‐P110 and SS‐31 does not affect FRDA patient fibroblasts differently from SS‐31 alone, suggesting that the two drugs act through the same pathway but differ in their ability to alter mitochondrial homeostasis. In approaching potential therapeutic strategies for FRDA, an important criterion for compounds that improve bioenergetics should be to do so without impairing the homeostatic response of mitochondrial fragmentation.

Early ducts of breast tumors are unequivocally acidic. High rates of glycolysis combined with poor perfusion lead to a congestion of acidic metabolites in the tumor microenvironment, and pre-malignant cells must adapt to this acidosis to thrive. Adaptation to acidosis selects cancer cells that can thrive in harsh conditions and are capable of outgrowing the normal or non-adapted neighbors. This selection is usually accompanied by phenotypic change. Epithelial mesenchymal transition (EMT) is one of the most important switches correlated to malignant tumor cell phenotype and has been shown to be induced by tumor acidosis. New evidence shows that the EMT switch is not a binary system and occurs on a spectrum of transition states. During confirmation of the EMT phenotype, our results demonstrated a partial EMT phenotype in our acid-adapted cell population. Using RNA sequencing and network analysis we found 10 dysregulated network motifs in acid-adapted breast cancer cells playing a role in EMT. Our further integrative analysis of RNA sequencing and SILAC proteomics resulted in recognition of S100B and S100A6 proteins at both the RNA and protein level. Higher expression of S100B and S100A6 was validated in vitro by Immunocytochemistry. We further validated our finding both in vitro and in patients' samples by IHC analysis of Tissue Microarray (TMA). Correlation analysis of S100A6 and LAMP2b as marker of acidosis in each patient from Moffitt TMA approved the acid related role of S100A6 in breast cancer patients. Also, DCIS patients with higher expression of S100A6 showed lower survival compared to lower expression. We propose essential roles of acid adaptation in cancer cells EMT process through S100 proteins such as S100A6 that can be used as therapeutic strategy targeting both acid-adapted and malignant phenotypes.

Abstract Background Forty years ago the actin cytoskeleton was determined to be disrupted in fibroblasts from persons with DNA repair-defective, hereditary colon cancer, with no clear connection between the cytoskeleton and DNA repair defects at that time. Recently, the large number of sequenced genomes has indicated that mammalian mutagenesis has a large stochastic component. As a result, large coding regions are large mutagen targets. Cytoskeletal protein-related coding regions (CPCRs), including extra-cellular matrix proteins, are among the largest coding regions in the genome and are indeed very commonly mutated in cancer. Methods To determine whether mutagen sensitivity of the actin cytoskeleton could be assessed experimentally, we treated tissue culture cells with 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone and quantified overall cytoskeleton integrity with rhodamine-phalloidin stains for F-actin. Results The above approach indicated cytoskeletal degradation with increasing mutagen exposure, consistent with increased mutagenesis of CPCRs in TCGA, smoker samples, where overall mutation rates correlate with CPCR mutation rates (R2 = 0.8694; p

Teacher candidates are called on to create effective lesson plans to implement during their student teaching semester, and certain components of lesson plans are recognized as particularly significant. Viewing lesson plans as the foundation for impactful instruction, it is necessary for teacher candidates to have skills in evaluating their plans before implementing them in the classroom. This article seeks to provide a set of questions teacher candidates may use to self-evaluate their lesson plans based on three major methods to assess lesson plans.

Category: Trauma Introduction/Purpose: Pilon and unstable ankle fractures are often treated initially with an external fixator (ex-fix) due to soft tissue concerns. Typically, the second stage involves open reduction internal fixation of the fracture as the definitive management. Ex-fix application in the emergency department (ED) has been described previously. We aimed to determine if an ex-fix applied in the ED would have any difference in rate of ex-fix revision, deep infection, and hospital length of stay when compared to an ex-fix that is applied in the operating room (OR). Methods: This is a retroscpective, case-cohort study performed at an urban, level-1 trauma center. Using CPT codes in our billing database, we identified all patients from 2011-2015 who had operative fixation of pilon (AO classification 43B or 43C) or unstable ankle fractures (AO classification 44C) and had application of an ex-fix (either ED or OR) prior to definitive fixation. Patients with open injury, those placed in ex-fix at outside institutions and those treated definitively with ex-fix were excluded. Results: Ninety-six patients met the inclusion criteria. Average age was 47 years and 54 (56%) were male. Thirty-three patients had ex-fix placed in the OR and 63 patients had ex-fix placed in the ED. Post-surgical complications (prominent implant, nonunion, deep infection, DVT, loss of reduction) were seen in 6/33 in the ED and 8/63 in the OR group (χ 2 =0.44, p=0.51). Deep infections occurred in 2/33 OR ex-fix and 5/63 ED ex-fix patients (χ 2 =0.137, p=0.71, OR= 1.4 [95% CI = 0.25 to 7.5]). Revision ex-fix for loss of reduction was performed 4/33 in the OR group and 10/63 in the ED ex-fix group (χ 2 =0.296, p=0.59). Mean length of stay was 14 days for the OR and 13 days for the ED group (p=0.35). Conclusion: We found no significant difference in post-surgical complications (surgical or infectious) or ex-fix revision rates for an ex-fix placed in ED compared to one placed in the OR. Total hospital days were similar in both groups. Prospective studies are needed to validate this method of provisional stabilization in the ED; however, these results indicate that the ED ex-fix is equally efficacious to an OR ex-fix.

Piezoelectric sensing is of increasing interest for high-temperature applications in aerospace, automotive, power plants and material processing due to its low cost, compact sensor size and simple signal conditioning, in comparison with other high-temperature sensing techniques. This paper presented an overview of high-temperature piezoelectric sensing techniques. Firstly, different types of high-temperature piezoelectric single crystals, electrode materials, and their pros and cons are discussed. Secondly, recent work on high-temperature piezoelectric sensors including accelerometer, surface acoustic wave sensor, ultrasound transducer, acoustic emission sensor, gas sensor, and pressure sensor for temperatures up to 1,250 °C were reviewed. Finally, discussions of existing challenges and future work for high-temperature piezoelectric sensing are presented.

This study explores the experiences of two teachers participating in professional development workshops focused on supporting implementation of SocioScientific Issues (SSI) and aspects of social justice into STEM classrooms. SSI are ill-defined problems, with a basis in science, but necessarily include moral and ethical decisions that cannot be resolved through science alone. These debatable issues can enhance learning of STEM by engaging students in real-world and authentic problems. The "USTRIVE project" was developed to foster STEM learning through integrated professional development workshops and the development of professional learning communities to support teachers in the use of SSI and incorporation of aspects of social justice in their STEM classrooms. Two research questions were investigated: (a) To what extent did teachers implement SSI into their lesson planning during the project and (b) In what ways did teachers' designed lessons change from the beginning of the workshop?

Introduction: Birth weight and placental weight are good indicators of new born growth parameters. Maternal complications are seen in both lean and obese women. The available studies shows correlations of placental parameters with baby anthropometric variables but limited relationship to maternal BMI which will help very much to anticipate the neonatal outcome and complications. Aim: To find out correlation of maternal BMI and neonatal BMI with placental weight in rural South Kerala. Study Design: Prospective cohort study in a rural medical college in South Kerala. Materials and Methods: All singleton neonates 28 weeks of gestational age and above delivered in the institution and their mothers from January 2015 to October 2015. Neonatal BMI, Maternal BMI and placental weight were calculated. Means (x), standard deviation (SD) and frequency (%) was calculated for the statistical analysis. Student’s ‘t’ test was used to compare the mean results of the continuous variables. Pearson correlation was used to find out the correlation between different anthropometric variables. Results: Out of the 920 live single births 463 (50.3%) were male and 457(49.7%) were females. Among the mothers (86.2%) were between the age group of 25-29 years, about 87.7% of the mothers were unemployed. Mean birth weight was 3000gm (SD=500) Mean baby length was 48.9 (SD=2). The mean placental weight was 499gm (SD=78). Mean maternal BMI was 27 (SD 3.9) and the mean neonatal BMI was 12.5 (SD=1.9). It was found that both maternal BMI (r=0.143 p

Retained placenta is a common complication of the third stage of labor. Most literature has focused on management of a trapped placenta or placenta accreta. The most common source of a trapped placenta is from a partial closure of the cervix and/or a contracted lower uterine segment. We present an unusual case of a retained placenta trapped in a septate uterus. The management included unsuccessful conservative measures that resulted in delivery of the placenta by laparotomy with hysterotomy.

Background and Aims: Substitutional urethroplasty with buccal mucosal grafting for urethral stricture is associated with significant pain, and thus inappropriate perioperative pain management could delay postoperative recovery. The objective of our research was to determine the effects of analgesia with systemic or epidural or intrathecal morphine on quality of recovery (QoR) in patients undergoing substitutional urethroplasty with buccal mucosal grafting. Material and Methods: This prospective, double-blinded, randomized control trial was conducted over 2 years in ASA I and II patients who underwent substitutional urethroplasty with buccal mucosal graft. Patients were randomized into three groups, and Group A received systemic morphine (0.1 mg/kg), Group B received epidural morphine (3 mg), and Group C received intrathecal morphine (150 μg). The QoR between the groups were compared postoperatively using the 40-item QoR questionnaire, and the hemodynamic variations, time taken for ambulation, resumption of oral intake, and incidence of complications were also compared. Results: Out of the recruited 93 patients, 88 patients were analyzed. The QoR score for each domain was comparable between the three groups. The total QoR score for systemic, epidural, and intrathecal morphine groups were 189 (185–191), 189 (187–191), and 185 (183–189), respectively. Additionally, the hemodynamic variations, time taken for ambulation, and resumption of oral intake were comparable between all three groups except the incidence of postoperative nausea and vomiting (PONV) and pruritis, which were higher in the intrathecal group. Conclusion: All three modalities, namely systemic morphine (0.1 mg/kg), epidural morphine (3 mg), and intrathecal morphine (150 μg), offer similar QoR after substitutional urethroplasty. However, the incidence of PONV and pruritis was higher with the administration of intrathecal morphine. [ABSTRACT FROM AUTHOR]

Objective: Undescended testis (UDT) increases the risk of testicular cancer (TCa) development. Historical evidence suggests that malignant transformation of uncorrected UDT primarily results in seminomas, whereas mixed germ cell tumours predominate in corrected UDT; however, the risk of malignancy in the 'normal' contralateral testis is unclear. We investigated the contemporary Oxford TCa cohort to report the frequency of prior UDT and types of tumours developing in the prior UDT and normal contralateral testis. Patients and Methods: A 607 patient contemporary TCa cohort within the Thames Valley Testicular Cancer database. Results: Of men with new TCa, 8% had a history of UDT. Of men with TCa and prior UDT, 61% developed seminomas, whereas 56% of men with TCa without previous UDT developed this subtype. Among men with prior UDT, 77% developed tumours in the UDT, whilst 23% developed TCa in the contralateral normal testis. Conclusion: Seminoma was the most frequent malignancy following UDT, with a greater frequency than without prior UDT. Around one in four TCa patients with UDT developed contralateral tumours, emphasising the need for self-examination of both testes. Advice should be given to any patient with a history of UDT stressing the importance of ongoing self-examination of both testes. Level of evidence: Level 4. [ABSTRACT FROM AUTHOR]

This article examines the long-term academic consequences of childhood language impairment. The authors, analyzing the results from a sample of children at 5 years of age and then again at 19 years of age, conclude language impairment is associated with academic problems which continue into adulthood.

Bleomycin, a cytotoxic chemotherapy agent, forms a key component of curative regimens for lymphoma and germ cell tumours. It can be associated with severe toxicity, long-term complications and even death in extreme cases. There is a lack of evidence or consensus on how to prevent and monitor bleomycin toxicity. We surveyed 63 germ cell cancer physicians from 32 cancer centres across the UK to understand their approach to using bleomycin. Subsequent guideline development was based upon current practice, best available published evidence and expert consensus. We observed heterogeneity in practice in the following areas: monitoring; route of administration; contraindications to use; baseline and follow-up investigations performed, and advice given to patients. A best-practice clinical guideline for the use of bleomycin in the treatment of germ cell tumours has been developed and includes recommendations regarding baseline investigations, the use of pulmonary function tests, route of administration, monitoring and patient advice. It is likely that existing heterogeneity in clinical practice of bleomycin prescribing has significant economic, safety and patient experience implications. The development of an evidence-based consensus guideline was supported by 93% of survey participants and aims to address these issues and homogenise practice across the UK. [ABSTRACT FROM AUTHOR]

Objective: To investigate the pathology of excised testicular lesions <10 mm in size. Patients and Methods: The pathological reports of 2 681 patients with testicular lesions from Barts Health NHS Trust and Oxford University Hospitals NHS Foundation Trust were reviewed as part of a service evaluation audit from January 2003 to May 2016. Cases in which the lesion had a maximum diameter of <10 mm were selected. Clinical features were also accessed, where available, to examine patient demographics, prediagnostic levels of serum markers, ultrasonographic findings and clinical details. Results: A total of 81 patients with a lesion size <10 mm on histology were identified and, of these, 16 (20%) had a lesion diameter <5 mm. Of the 81 patients, 56 (69%) had benign lesions. Of 16 patients with a benign lesion <5 mm in diameter, 15 underwent orchidectomy and just one underwent partial orchidectomy. Preoperative tumour markers were available in 47/81 patients. None of the 16 malignant tumours in these 47 patients were associated with raised tumour markers, while seven of 31 remaining patients with benign lesions had raised α‐fetoprotein and lactate dehydrogenase levels. In total there were 25/81 malignant cases (31%), which were all germ cell tumours (GCTs): 15 seminomas (60%) and 10 non‐seminomatous GCTs (40%). Only one GCT had a diameter of <5 mm, and this was a regressed tumour within an 18‐mm area of granulomatous inflammation. Only one GCT relapsed: a clinical stage I, embryonal carcinoma of 6 mm in maximum diameter. The 56 ‘benign’ cases included 34 sex cord stromal tumours, including 23 Leydig cell tumours (41%), eight Sertoli cell tumours (14%) and three mixed sex cord stromal tumours (5%). None showed any malignant features. The remaining 22/56 lesions (40%) were lesions with no further follow‐up. Benign lesions seemed to be associated with a small diameter, and we found <5 mm to be the best threshold for predicting benign vs malignant lesions (P = 0.002). Conclusion: The majority of testicular lesions <10 mm, identified by radiology, were benign, although approxmiately one‐third were malignant. In the present study, 100% of lesions <5 mm in diameter were benign. Tumour markers appear to be unhelpful in the distinction of these small tumours. We suggest that regular ultrasound surveillance be more widely used for testicular lesions of this size. Testicular tumours now have a very high cure rate and changes in size of lesions may be monitored prospectively with minimal risk of increased morbidity. Patients who undergo an orchidectomy for lesions <5 mm are ‘victims of modern imaging technology’. If surgery is undertaken in lesions 5–10 mm, patients should be counselled that two‐thirds of cases are benign. [ABSTRACT FROM AUTHOR]

Background and Aims: Substitutional urethroplasty with buccal mucosal grafting for urethral stricture is associated with significant pain, and thus inappropriate perioperative pain management could delay postoperative recovery. The objective of our research was to determine the effects of analgesia with systemic or epidural or intrathecal morphine on quality of recovery (QoR) in patients undergoing substitutional urethroplasty with buccal mucosal grafting. Material and Methods: This prospective, double-blinded, randomized control trial was conducted over 2 years in ASA I and II patients who underwent substitutional urethroplasty with buccal mucosal graft. Patients were randomized into three groups, and Group A received systemic morphine (0.1 mg/kg), Group B received epidural morphine (3 mg), and Group C received intrathecal morphine (150 μg). The QoR between the groups were compared postoperatively using the 40-item QoR questionnaire, and the hemodynamic variations, time taken for ambulation, resumption of oral intake, and incidence of complications were also compared. Results: Out of the recruited 93 patients, 88 patients were analyzed. The QoR score for each domain was comparable between the three groups. The total QoR score for systemic, epidural, and intrathecal morphine groups were 189 (185–191), 189 (187–191), and 185 (183–189), respectively. Additionally, the hemodynamic variations, time taken for ambulation, and resumption of oral intake were comparable between all three groups except the incidence of postoperative nausea and vomiting (PONV) and pruritis, which were higher in the intrathecal group. Conclusion: All three modalities, namely systemic morphine (0.1 mg/kg), epidural morphine (3 mg), and intrathecal morphine (150 μg), offer similar QoR after substitutional urethroplasty. However, the incidence of PONV and pruritis was higher with the administration of intrathecal morphine.

Introduction: Metabolic disorders like hypoglycaemia and hyperglycaemia are much common in neonates as compared to any other age groups. Infants are born with a blood glucose concentration of 60 to 70% of the maternal levels and it falls during the first 24 hours. Transient low blood glucose levels are common after birth as the glucose supply to neonates changes from a continuous transplacental supply from the mother to an intermittent supply from feeds. Aim: To find out the correlation between glucose levels in cord blood and capillary blood of neonates using glucometer soon after birth and to determine the prevalence of hypoglycaemia and hyperglycaemia among the study population. Materials and Methods: The study was a hospital based cross-sectional study and the study population included 1100 newborns who satisfied inclusion criteria. The glucose measurements were obtained using standard equipments and procedures. Data coded and entered into Microsoft excel, then analysed using SPSS software. Results: Results showed that there was a significant correlation between cord blood glucose and capillary blood glucose values (Pearson correlation coefficient r=0.894, p

Randall Sandke’s Where the Dark and Light Folks Meet is a very personal, but seriously flawed, consideration of racial issues in jazz. In Where the Dark and Light Folks Meet Sandke attempts to tackle a large number of race related topics and claims about the jazz discourse with uneven results. His targets include activist jazz writers, “radical” racial politics, claims of discriminatory practices in business, pay, and intellectual property, and neo-conservative music trends. Although sometimes the act of troubling can be a good thing, Sandke’s book is troubling in ways that undermine his best arguments about the music’s lack of innovative vitality, and for expanding its history beyond iconic musical figures. He sets out to, in the words of George E. Lewis, “trouble the settled” of the dominant narrative-an altogether worthy ambition-but sometimes Sandke merely comes off as feeling personally left out of jazz’s past and present, a not uncommon frustration for many jazz musicians. He initially describes his project as one of inclusion. When the smoke clears, Sandke is dissatisfied with racial discourse that binds concepts of jazz authenticity and blackness. (In early jazz writing blackness was often used as an indicator of primitivity and therefore “realness;” from the ’60s onward jazz’s perceived authenticity has factored into a larger project of re-claiming black identity and pride.) This is not an altogether unreasonable point of view for a non-black jazz practitioner. But rather than wage a direct assault on fragile and cliched notions of authenticity that permeate jazz history and continue to dominate its discourse, Sandke makes sweeping claims about the motives of historical and recent jazz writers that seem designed to create ill will.