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Contemplating individual ideals and therapy choices enhances affected individual participation inside rectal cancer malignancy therapy decisions.
This paper addresses ethical, legal and psychosocial aspects of Global Kidney Exchange (GKE). Concerns have been raised that GKE violates the non-payment principle, exploits donors in low and middle-income countries, and detracts from the aim of self-sufficiency. We review the arguments for and against GKE. We argue that while some concerns about GKE are justified based on the available evidence, others are speculative and do not apply exclusively to GKE but to living donation more generally. We posit that concerns can be mitigated by implementing safeguards, by developing minimum quality criteria and by establishing an international committee that independently monitors and evaluates GKE's procedures and outcomes. H 89 Several questions remain however that warrant further clarification. What are the experiences and views of recipients and donors participating in GKE? Who manages the escrow funds that have been put in place for donor and recipients? What procedures and safeguards have been put in place to prevent corruption of these funds? What are the inclusion criteria for participating GKE-centers? GKE provides opportunity to promote access to donation and transplantation but can only be conducted with the appropriate safeguards. Patients' and donors' voices are missing in this debate. This article is protected by copyright. All rights reserved.Testosterone aromatization into estrogens in the preoptic area (POA) is critical for the activation of male sexual behavior in many vertebrates. Yet, cellular mechanisms mediating actions of neuroestrogens on sexual behavior remain largely unknown. We investigated in male and female Japanese quail by dual-label fluorescent in situ hybridization (FISH) whether aromatase-positive (ARO) neurons express glutamic acid decarboxylase 67 (GAD67), the rate-limiting enzyme in GABA biosynthesis. AROcells and ARO cells double labeled with GAD67 (ARO-GAD67) were counted at standardized locations in the medial preoptic nucleus (POM) and the medial bed nucleus of the stria terminalis (BST) to produce three-dimensional distribution maps. Overall, males had more ARO cells than females in POM and BST. The numberof double-labeled ARO-GAD67 cells was also higher in males than in females and greatly varied as a function of the specific position in these nuclei. Significant sex differences were however present only in the most caudal part of POM.Although both ARO and GAD67 were expressed in the VMN, no colocalization between these markers was detected.Together, these data show that a high proportion of estrogen synthesizing neurons in POM and BST are inhibitory and the colocalization of GAD67 with AROexhibits a high degree of anatomical specificity as well as localized sex differences. The fact that many preoptic ARO neurons project to the periaqueductal gray in male quail suggests possible mechanisms through which locally produced estrogens could activate male sexual behavior. This article is protected by copyright. All rights reserved.OBJECTIVE The main objective was to describe the effect of bowel preparation (BP) prior to transvaginal ultrasound scan (TVUS) in detecting bowel involvement and describing rectosigmoid nodules of deep infiltrating endometriosis (DIE). The secondary objective was to describe the tolerance of BP. METHODS A prospective study of paired data was designed. A cohort of women referred for the first time to the Endometriosis Unit in a tertiary university hospital from September 2015 to March 2016 was included. In all patients, the wall of the rectum and lower sigmoid colon was evaluated by 2 TVUS the first ultrasound was performed without previous BP and the second was done after a three-day low-residue diet and two 250 ml enemas 12h and 3h before TVUS. Number and size of rectosigmoid nodules, deepest layer of the rectum affected, circumference of the bowel affected and distance from anal verge were determined. Tolerance to BP was also recorded using a five-point Likert scale. RESULTS The mean age of the patients included in the study was 36.8 ± 5.07 years. Up to 55% of thepatients identified with adherences to the serosa layer in the first TVUS without BP were evaluated as having real rectosigmoid nodules after TVUS with BP, and up to 22 additional nodules were observed in TVUS with BP. These newly detected rectosigmoid nodules, first assessed as adherences, were smaller and more superficial. Finally, the overall tolerance to BP was 1.81 in a 5-point Likert scale, being 1 "very well tolerated" and 5 "very poor tolerated". CONCLUSIONS BP is well tolerated by patients. When BP is performed before TVUS, it improves the detection of small and superficial nodules and those in the anterior sigmoid wall, and allows a better detailed description of them in patients with suspected endometriosis. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.Dextrocardia with situs solitus is a rare congenital anomaly, often associated with intra- or extracardiac malformations. A clear understanding of the spatial orientation of the chambers of the heart for planning surgical approach, is imperative. Access to the right side of the heart, especially for repair of the tricuspid valve can be challenging. We describe a case of dextrocardia, situs solitus, inlet ventricular septal defect (VSD) with iatrogenic tricuspid regurgitation (TR) in an adult patient, highlighting the surgical aspects essential for a successful outcome. © 2020 Wiley Periodicals, Inc.Hypertensive leg ulcer (HLU) is a painful chronic ulcer of the leg with necrotic and livedoid margins that develops rapidly.1,2, It mainly affects patients with diabetes mellitus or arterial hypertension.3 The pathophysiology involves microvascular ischemia.2 Management of HLU involves control of comorbidities, wound debridement, dressings and analgesics (morphine). Surgical management with grafts is recommended to control pain and promote healing.4,5 However, with treatment failure, there are unmet therapeutic needs. This article is protected by copyright. All rights reserved.The term CAPE was first introduced by Craiglow et al1 to define a papulosquamous eruption due to mutations in CARD14 in patients that display characteristics of both psoriasis and pityriasis rubra pilaris (PRP). Heterozygous mutations in CARD14 have been described in psoriasis2 and PRP3,4 patients, indicating that these disorders share a common underlying pathophysiology. This article is protected by copyright. All rights reserved.
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