Caecal diverticulitis: Presentation and management

While left sided colonic diverticular disease is common in Western countries, right sided colonic diverticular disease is rare. With increasing migration from Asia, many western countries including Australia, are now seeing more right sided diverticular disease, of which caecal diverticulitis is the commonest. This study aims to determine the incidence of caecal diverticulitis in patients presenting with colonic diverticulitis, as well as identify the symptoms and clinical features that may aid in making a pre-operative diagnosis. Methods: Data was collected using the Queen Elizabeth II Hospital medical records database identifying patients diagnosed with colonic diverticulitis and, more specifically, those with caecal diverticulitis from January 2007 to December 2013. Only those patients who had confirmed caecal diverticulitis on imaging studies or at laparoscopy on their first admission were included in this study. Results: A total of 632 patients with colonic diverticulitis were admitted to our institution over a seven-year period, of which 13 patients had caecal diverticulitis (2.06%). Of the 13 patients, twelve were of Asian background and ten were considered young (≤50 years of age). The main complaints were right sided abdominal pain (n=11, 84.6%) and diarrhoea (n=5, 38.5%). Nine were diagnosed using computed tomography (n=9/10, 90%), three on laparoscopy and one using ultrasound (n=1/2, 50%). Ten patients were treated successfully by conservative means. Discussion: A high index of suspicion in Asian patients with atypical symptoms of appendicitis, especially diarrhoea, may provide the diagnosis of caecal diverticulitis

Teatro Praga’s Omission of Shakespeare – An Intercultural Space

Teatro Praga’s (a Portuguese theatre company) adaptations of A Midsummer Night’s Dream and The Tempest omit what is usually considered crucial to a Shakespearean adaptation by giving primacy to neither text nor plot, nor to a stage design that might highlight the skill and presence of the actors, a decision arguably related to what the company perceives as a type of imprisonment, that of the lines themselves and of the tradition in which these canonical plays have been staged. Such fatigue with a certain way of dealing with Shakespeare is deliberately portrayed and places each production in a space in-between, as it were, which might be described as intercultural. “Inter,” as the OED clarifies, means something “among, amid, in between, in the midst.” Each of Teatro Praga’s Shakespearean adaptations, seems to exist in this “in-between” space, in the sense that they are named after Shakespeare, but are mediated by a combination of subsequent innovations. Shakespeare then emerges, or exists, in the interval between his own plays and the way they have been discussed, quoted, and misquoted across time, shaping the identities of those trying to perform his works and those observing its re-enactments on stage while being shaped himself. The fact that these adaptations only use Shakespeare’s words from time to time leads critics to consider that Teatro Praga is working against Shakespeare (or, to admirers of Henry Purcell, against his compositions). This process, however, reframes Shakespeare’s intercultural legacy and, thus, reinforces its appeal

Vitamin D, vitamin D receptor and the importance of its activation in patients with chronic kidney disease

El déficit de vitamina D se asocia a distintas patologías, siendo especialmente significativa con la morbimortalidad en pacientes con enfermedad renal crónica (ERC). La pérdida progresiva de la función renal conduce a una reducción de calcitriol y alteración de la homeostasis de calcio, fósforo, FGF-23 y PTH, entre otros, los cuales influyen a su vez sobre la activación del receptor de vitamina D (RVD) y el desarrollo de hiperparatiroidismo secundario (HPS). El RVD media las acciones biológicas tanto de la vitamina D como de sus análogos sintéticos, actuando sobre distintos genes; existe una estrecha asociación entre niveles bajos de calcitriol y la prevalencia del HPS. Así, la activación de los RVD y la restricción de fósforo, entre otros, desempeñan un papel importante en el tratamiento de la «alteración óseo-mineral asociada a la ERC». La Sociedad Española de Nefrología, dada la uniforme e importante asociación con mortalidad y niveles altos de fósforo, aconseja su normalización, así como la de los niveles de calcidiol. Igualmente considera que, aparte de la utilización de activadores selectivos/no selectivos de RVD para la prevención y tratamiento del HPS, se podría asegurar la activación de los RVD en pacientes en diálisis, con vitamina D nativa o incluso bajas dosis de paricalcitol, independientemente de la PTH, dado que algunos estudios de cohortes y un metaanálisis reciente han observado una asociación entre el tratamiento con vitamina D activa y la disminución de la mortalidad en pacientes con ERC. En general, se considera que es razonable utilizar toda esta información para individualizar la toma de decisionesVitamin D deficiency has been linked to many different pathologies, especially with morbimortality in patients with chronic kidney disease. The progressive loss of renal function leads to calcitriol deficiency and homeostatic changes in calcium, phosphorus, FGF- 23 and PTH, among others. All these changes can also influence vitamin D receptor (VDR) activation and the development of secondary hyperparathyroidism (SHPT). The biologic actions of both vitamin D and its synthetic analogues are mediated by binding to the same VDR, acting on different genes. There is a narrow relationship between low levels of calcitriol and SHPT. The combined approach of VDR activation and phosphate restriction, among others, plays an important role in the early treatment of the chronic kidney disease-mineral and bone disorder (CKD-MBD). The Spanish Society of Nephrology, in order to reduce the uniform and significant association with CKD-associated mortality, calcidiol and high phosphate levels suggests normalization of phosphate as well as calcidiol levels in both CKD and dialysis patients. Moreover, it considers that, in addition to selective/non selective activation of VDR for the prevention and treatment of SHPT, VDR could be activated in dialysis patients by native vitamin D or even low paricalcitol doses, independently of PTH levels, as some cohort studies and a recent metaanalysis have found an association between treatment with active vitamin D and decreased mortality in patients with CKD. In general it is considered reasonable to use all this information to individualise decision makin

Challenges to the development of antigen-specific breast cancer vaccines

Continued progress in the development of antigen-specific breast cancer vaccines depends on the identification of appropriate target antigens, the establishment of effective immunization strategies, and the ability to circumvent immune escape mechanisms. Methods such as T cell epitope cloning and serological expression cloning (SEREX) have led to the identification of a number target antigens expressed in breast cancer. Improved immunization strategies, such as using dendritic cells to present tumor-associated antigens to T lymphocytes, have been shown to induce antigen-specific T cell responses in vivo and, in some cases, objective clinical responses. An outcome of successful tumor immunity is the evolution of antigen-loss tumor variants. The development of a polyvalent breast cancer vaccine, directed against a panel of tumor-associated antigens, may counteract this form of immune escape

“To Be a Yardstick”: Individual Rebellion and Social Conformity in Cathy Park Hong’s Engine Empire

[Abstract] This Master’s thesis engages in a multidisciplinary humanistic analysis of Cathy Park Hong’s triptych Engine Empire. Said analysis is divided into three parts, each one corresponding to one of the poem’s sections. Following Sigmund Freud’s anthropological ideas on the origin and development of civilization, every chapter deals with the struggles of individuals who refuse to abide by the social norms imposed on them. Freud’s theory is complemented with the works of Michel Foucault regarding the means by which the ruling power exerts control over its subjects. Together with the analysis of the poem proper, the aim of this paper is to show how a literary work, namely a work of poetry, can elicit critical thinking.Traballo fin de mestrado (UDC.FIL). Estudos ingleses avanzados e as súas aplicacións. Curso 2018/201

Ways of Remembering: Musical Reveries Over Childhood and Youth

In this paper we aim to analyze three different works – The Dead,The Butcher Boy and The Speckled People – and to show the capacity ofmusic to activate memory and to act as a catalyst for nostalgia. Ballads and songs create in these works a landscape of its own, functioning both as a barrier and as a link between different characters and different worlds. An instrument or a song can become an objective correlative to the characters‘broken dreams or truncated hopes, synchronizing with their life’s rhythm, their emotional shades and accurately echoing their passions and frustrations, since the music that interweaves in the text is by no means accidental. Quite the opposite, it emanates from a carefully selected repertoire that sounds at the crucial moments and that operates as a sort of musical variation on a threefold theme: a failed love experience, a truncated sentimental journey and an intense feeling of otherness

Friel, Brian: Traducciones. Translated and edited by Mª Yolanda Fernández Suárez.

Friel, Brian: Traducciones. Translated and edited by Mª Yolanda FernándezSuárez. Madrid: Publicaciones de la Asociación de Directores de Escena deEspaña, 2016

Eibhear Walshe. Kate O´Brien. A Writing Life

Eibhear Walshe. Kate O´Brien. A Writing Life. Dublin: Irish Academic Press,2006,194 pages

Haematuria increases progression of advanced proteinuric kidney disease

Background Haematuria has been traditionally considered as a benign hallmark of some glomerular diseases; however new studies show that haematuria may decrease renal function. Objective To determine the influence of haematuria on the rate of chronic kidney disease (CKD) progression in 71 proteinuric patients with advanced CKD (baseline eGFR <30 mL/min) during 12 months of follow-up. Results The mean rate of decline in eGFR was higher in patients with both haematuria and proteinuria (haemoproteinuria, HP, n=31) than in patients with proteinuria alone (P patients, n=40) (-3.8±8.9 vs 0.9±9.5 mL/min/1.73m2/year, p<0.05, respectively). The deleterious effect of haematuria on rate of decline in eGFR was observed in patients <65 years (-6.8±9.9 (HP) vs. 0.1±11.7 (P) mL/min/1.73m2/year, p65 years (-1.2±6.8 (HP) vs. 1.5±7.7 (P) mL/min/1.73m2/year). Furthermore, the harmful effect of haematuria on eGFR slope was found patients with proteinuria >0.5 g/24 h (-5.8±6.4 (HP) vs. -1.37± 7.9 (P) mL/min/1.73m2/year, p<0.05), whereas no significant differences were found in patients with proteinuria < 0.5 g/24 h (-0.62±7.4 (HP) vs. 3.4±11.1 (P) mL/min/1.73m2/year). Multivariate analysis reported that presence of haematuria was significantly and independently associated with eGFR deterioration after adjusting for traditional risk factors, including age, serum phosphate, mean proteinuria and mean serum PTH (β=-4.316, p=0.025) Conclusions The presence of haematuria is closely associated with a faster decrease in renal function in advanced proteinuric CKD patients, especially in younger CKD patients with high proteinuria levels; therefore this high risk subgroup of patients would benefit of intensive medical surveillance and treatmentThis work was supported by grants from FIS (Programa Miguel Servet: CP10/00479, PI13/ 00802 and PI14/00883) and Spanish Society of Nephrology to Juan Antonio Moreno. Fundacion Lilly, FRIAT (Fundación Renal Iñigo Alvarez de Toledo) and ISCIII fund PI14/00386 to Jesus Egid