Gallbladder torsion is a rare but potentially catastrophic presentation to an acute surgical unit. It was first described by Wendel in 1898 where this presentation was labelled as a ‘floating gallbladder’, with a high propensity for perforation1. Since then approximately 500 cases have been reported in the literature2. Anatomically, gallbladder torsion occurs where the gallbladder rotates along its mesentery causing vascular compromise and obstruction to biliary drainage. This leads to subsequent necrosis and perforation3. Shaikh A. et al have reiterated that the entire aetiological sequence of gallbladder torsion continues to remains a debated topic although, generally, a redundant mesentery is required for torsion to occur4. In most reported cases, the gallbladder has been shown to undergo a clockwise rotation 5. As described later, this presentation has predominantly been reported in elderly females suggesting that age plays a role in anatomically predisposing to torsion. Factors hypothesised for this include decrease in visceral fat and liver atrophy making free movement of the gallbladder and ultimately volvulus more likely to occur6. The symptoms of gallbladder torsion are in keeping with those of cholecystitis, typically presenting with right upper quadrant pain, nausea and vomiting 2. Clinical examinations of previously reported cases have documented abdominal distention, right upper quadrant pain and localised peritonitis2. These non-specific signs can make this specific phenomenon a challenge to diagnose in clinical practice. It has been documented that a partial volvulus can present with intermittent symptoms, similar to those seen in biliary colic, although the majority of cases will present acutely with signs described above 3. Due to the relatively low numbers reported in the literature it is difficult to determine the most appropriate investigations in patients where this is expected. Classically, patients presenting with right upper quadrant pain will likely receive an abdominal ultrasound on admission. From the cases…
Effect of Aerobic Exercise Training Programme on Blood Cholesterol Profile in Prevention of Cardiovascular Diseases among Young Adults
This study investigated the effects of aerobic exercise training programme on blood cholesterol profile as cardiovascular disease risk factor among adolescents. The study employed the true experimental of pretest post test design with one experimental and control group. The population consisted of 745 students of Ekiti State University, Ado-Ekiti. The participants for the study were 32 students comprising 22 participants for the experimental and 10 for the control groups with equal number of male and female in each case. The instruments used for sample and data collection for the study were; stadiometer, vacutainer needles, plastic vacuum tubes, vacutainer holder, tourniquet, disinfection swabs, microspore tape, adhesive dressing, rubber gloves, lithium heparin bottles and spectrophotometer. The training programme consisted of graded activities lasting for 25-40 minutes, administered three times a week for 12 weeks. The blood samples collected were subjected to chemical analysis generated for the study. The data were subjected to descriptive statistics of mean, standard deviation and range and inferential statistics of Analysis of Covariance (ANCOVA). Multiple Classification Analysis (MCA) was employed to determine how much effect the treatment had on the cholesterol profile of the students. Statistical analysis showed significant reduction of total cholesterol, low density lipoproteincholesterol, and increase high density lipoprotein cholesterol. Aerobic exercise training programme had positive effects on total cholesterol, low density lipoprotein cholesterol, and high density lipoprotein cholesterol levels of the adolescents. It is therefore recommended that behavioural counseling will goal on way re-orientating the adolescents towards aerobic exercise training programme which will help in preventing cardio vascular diseases in adult population.
Residue trials of deltamethrin in black pepper (Piper nigrum) were conducted to estimate the maximum residue limit (MRL). Five residue trials were conducted at three commercial growers’ plots in Johor, Perak and Sarawak (Malaysia). The study plots contained 120 mature pepper vines which were selected and treated with deltamethrin using the manufacturer’s recommended rate (0.01 kg a.i./ha). The insecticide was applied with a motorized sprayer on monthly intervals. Green pepper berries samples (500g) were randomly collected from the plots at 1, 3, 5 and/or 7 days after the last spray. Analytical procedure of deltamethrin extraction was validated prior to actual analysis. Satisfactory recoveries ranging from 86.2% to 110.2% were obtained for the fortified pepper berries samples. The limits of detection and limits of quantification for deltamethrin were 0.521 μg kg−1 and 1.63 μg kg−1, respectively. Results showed that deltamethrin residues were at the low level with the residue value ranging between
Assessment of Football Cooperation Performance Based on Evaluation Model: a Case Study of the Everton Team
To comprehensively measure the effect of football team cooperation, this paper established a football team performance evaluation model and takes the performance of Everton F.C. in 2017 to 2018 season as an example. We selected 12 indicators from three aspects and use hierarchical clustering to divide the performance into four levels: very successful, relatively successful, unsuccessful and very failed. Then, we evaluated the performance of the team’s changes and focus on the opponent’s strategy indicators to analyze its impact. It is found that the reason for most of the failed games is that the team is affected by the away effect, the intra-team cooperation is not dominant and the opponent’s ability is strong, resulting in low CPI scores. At the end of the season, the influence of the opponent strategy on team performance becomes stronger and stronger.
Background: Schwannoma is a rare mesenchymal tumor, that arise from the Schwan cells of the nerve sheath. Schwannoma in the gastrointestinal tract is a very uncommon finding, with the stomach being the most common location. Preoperative diagnosis is difficult due to the wide variety of other mesenchymal tumors, definitive diagnosis is after histopathological examination and immunohistochemical staining of the specimen. Case presentation: We are presenting a rare case of stomach schwannoma, in a 50-year-old male who presented with urological complaints. He had a CT scan that incidentally showed a polypoidal gastric mass. Discussion: Schwannomas generally present asymptomatically; however, in some cases they can cause abdominal discomfort, pain or digestive symptoms. The definitive diagnosis of gastric schwannomas is determined by pathological examination of the surgically removed specimen. Conclusion: Schwannoma usually runs a benign course with excellent prognosis, yet there are very few reported cases of Malignant GI schwannoma. Benign or malignant, until now the treatment of choice is surgical excision with free margin.
Recently, with the popularity of the TV program THE SOUND and the similar voice competition TV performance , dubbing actors and this industry are coming into the public notice gradually. Dating back to the pre-Qin dynasty, the theory of “Language”, “Image” and “Meaning” has appeared in the traditional Chinese art. For instance, “Language” cannot convey “Meaning” entirely; form “Image” to complete “Meaning”; gain “Meaning” and ignore “Image”. The relationship among them is the dialectical unity. Artists are required to integrate the three things organically in the artistic creation, creating excellent works of art. Film dubbing art is a kind of artistic creation, so this paper will take the TV program THE SOUND as an example to analyze how the dubbing actors use the three aspects of “Language”, “Image” and “Meaning” flexibly.
We present a case of an 81-year-old asthmatic female with a left foot drop and an incidental finding of hypereosinophilia with an initial differential diagnosis of Eosinophilic Granulomatosis with Polyangiitis (EGPA). However, after extensive investigations, all causes of hypereosinophilia were excluded and the left foot drop was secondary to a radiculopathy. This led to a diagnosis of Idiopathic Hypereosinophilic Syndrome (IHES), a diagnosis of exclusion. This is the first case report where hypereosinophilia and a left foot drop where unrelated conditions occurring simultaneously thus posing a diagnostic dilemma. Therefore, this case report aims to highlight the importance of a systematic approach in the investigation of hypereosinophilia, to ascertain the cause and to rule out organ damage as this will affect the management and the outcome.
Maternal obesity and first trimester iodine levels are associated with the risk of congenital malformations in Assam, Northeast India
Purpose of the study: To assess body mass index (BMI) and trimester specific iodine status among pregnant women of Assam and study their association with congenital malformations (CM). Methods: Anthropometric, obstetric and socioeconomic data was obtained from pregnant women and apparently healthy women attending Assam Medical College and Hospital, Dibrugarh. Urinary iodine (UI) level was estimated in each trimester. BMI was classified based on Asian criteria suggested by WHO and the iodine intake was classified using WHO reference medians. Student’s t-test and univariate logistic regression analysis were used to determine the risk factors. Results: 156 pregnant women (age 18-35 years) and 160 controls were enrolled in the study. 55.8% pregnant women were underweight and 3.8% were overweight. Malformations were observed in 16 babies. The median urinary iodine concentration (MUIC) of pregnant women in their 1st trimester was 170 µg/l (IQR 100 µg/l) which increased to 275 µg/l (IQR 166 µg/l) during the 2nd trimester and decreased to 265 µg/l (IQR 160 µg/l) at the 3rd trimester. In the univariate analysis, maternal BMI > 23 kg/m2 (OR 3.67, 95% CI 0.20-67.65) and MUIC
To solve the problem of EMU maintenance planning time, we established a hybrid linear programming model based on adaptive genetic algorithm. According to the different levels of bullet train maintenance and the different arrival time, the constraint conditions are found, and the overall minimum maintenance time is taken as the objective function. Then the problem is transformed into a hybrid Flow-shop scheduling problem with unique process constraints, and an adaptive genetic algorithm is used to solve it again. It is concluded that the total maintenance takes 1125 minutes, and no blockage occurred in all EMU during the maintenance period. To provide a consistent basis for bullet train maintenance time and scheduling.
Morphofunctional changes of the placenta during the gestational period may be influenced by the pathological condition of Gestational Diabetes Mellitus. From this perspective, this chapter will address this theme as a way to evaluate the placental differences caused by this pathology.