Hypocalcaemia is a common complication after total thyroidectomy (TT). Treatment consists of calcium and active vitamin D supplementation. Low levels of vitamin D before surgery have been shown to be ...a risk factor for postoperative hypocalcaemia, yet studies examining routine preoperative vitamin D supplementation have shown conflicting results. This retrospective cohort study aims to investigate the potential benefit of preoperative active vitamin D supplementation on hypocalcaemia and its symptoms after TT.
This study included patients undergoing TT at Uppsala University Hospital from January 2013 to December 2020, resulting in a total of 401 patients after exclusion. Routine preoperative alfacalcidol treatment was initiated for all TT patients in January 2017 resulting in two groups for comparison: one group (pre-January 2017) that was prescribed preoperative alfacalcidol and one that was not. Propensity score matching was used to reduce bias. The primary outcome was early postoperative hypocalcaemia (serum calcium, S-Ca less than 2.10 mmol/l); secondary outcomes were symptoms of hypocalcaemia and length of stay.
After propensity score matching, there were 108 patients in each group. There were 2 cases with postoperative day one S-Ca less than 2.10 in the treated group and 10 cases in the non-treated group (P < 0.001). No patients in the treated group had a S-Ca below 2.00 mmol/l. Preoperative alfacalcidol was associated with higher mean serum calcium level day one (2.33 versus 2.27, P = 0.022), and reduced duration of hospital stay (P < 0.001). There was also a trend toward fewer symptoms of hypocalcaemia (18.9 per cent versus 30.5 per cent, P = 0.099).
Prophylactic preoperative alfacalcidol was associated with reduced biochemical hypocalcaemia and duration of hospital stay following TT. Also, with this protocol, it is suggested that routine day 1 postoperative S-Ca measurement is not required.
ERBB4 encodes the tyrosine kinase receptor HER4, a critical regulator of normal cell function and neurodevelopmental processes in the brain. One of the key ligands of HER4 is neureglin-1 (NRG1), and ...the HER4-NRG1 signalling pathway is essential in neural crest cell migration, and neuronal differentiation. Pharmacological inactivation of HER4 has been shown to hasten the progression of epileptogenesis in rodent models, and heterozygous ERBB4 null mice are shown to have cognitive deficits and delayed motor development. Thus far there is only a single case report in the literature of a heterozygous ERBB4 deletion in a patient with intellectual disability (ID). We identified nine subjects from five unrelated families with chromosome 2q34 deletions, resulting in heterozygous intragenic loss of multiple exons of ERBB4, associated with either non-syndromic ID or generalised epilepsy. In one family, the deletion segregated with ID in five affected relatives. Overall, this case series further supports that haploinsufficiency of ERBB4 leads to non-syndromic intellectual disability or epilepsy.
The goal of this thesis was to decide what environmental variables affected past SOF attempts at achieving interoperability with the conventional military, to examine the status of SOF and ...conventional forces interoperability as it exists today, and to explain why now is the time for SOP to engage in the reconfiguration of its forces to achieve an optimal level of interoperability. Five variables were used in the examination of SOFs organizational evolution toward interoperability with conventional forces. The interplay of these variables showed that environment changes combined with the sponsorship of civilian leadership had a dominant, yet, short-lived effect on SOF attempts at achieving interoperability with the conventional military, and that the incremental gains in structural and organizational aspects of SOF created conditions for achieving interoperability in the future. This window of opportunity is temporary, since SOF exists in an environment of competitive bureaucracies. Recommendations for SOF leaders in their pursuit of interoperability with conventional forces are presented. An opinion on how SOF might reconfigure itself to engage interoperability is provided.
Thesis. 1977. Ph.D.--Massachusetts Institute of Technology. Dept. of Electrical Engineering and Computer Science.
MICROFICHE COPY AVAILABLE IN ARCHIVES AND ENGINEERING.
Includes bibliographical ...references.
Ph.D.
Thesis (M.A. in National Security Affairs) Naval Postgraduate School, March 1996.
Thesis advisor(s): D.P. Eyre. "March 1996." Bibliography: p. 79-80. Also available online.
Chlorine(III) oxide, a new chlorine oxide McHale, Edward T; Von Elbe, Guenther
Journal of the American Chemical Society,
05/1967, Letnik:
89, Številka:
11
Journal Article
Preliminary greenhouse experiments involved acid metal-contaminated soil and different limestone types, calcitic limestone (Ca:Mg ratio = 53:1), dolomitic limestone (Ca:Mg ratio $\sim$ 2:1) and a ...50:50 mixture (Ca:Mg ratio = 8:1). Dolomitic limestone produced greater shoot and/or root dry weights than calcitic limestone in Vigna radiata (Mung bean) and Agrostis gigantea (Redtop). A solution based bioassay examining germination, early shoot and root growth of Agrostis gigantea and Lotus corniculatus revealed the nature of the relationship between heavy metals (Cu, Ni, & Al) and base cations (Ca & Mg). Agrostis gigantea was affected to a much greater degree than Lotus corniculatus by different metal-base combinations. Aluminum ameliorated both H$\sp{+}$ and nickel toxicity, but the amelioration was reduced at intermediate magnesium concentrations. In a greenhouse experiment, eight Ca:Mg ratios were created by mixing calcium carbonate with powdered dolomitic limestone (Ca:Mg ratio from 1:0 pure CaCO$\sb3$ to $\sim$2:1 dolomitic limestone). An extremely phytotoxic, a moderately toxic and an uncontaminated soil were used to grow Agrostis gigantea and Lotus corniculatus. Only Lotus at the low limestone application rate showed any significant treatment differences. Limestones with Ca:Mg ratios of $\le$4:1 gave greater shoot and root dry weights in the most toxic soil. A Ca:Mg ratio of 8:1 produced greater root dry weight in Lotus roots in the moderately toxic soil. In the most toxic soil the shoot and root dry weights increased as the proportion of dolomitic limestone increased. Tissue concentrations of calcium decreased and magnesium increased as the proportion of dolomitic limestone increased. Uptake of nickel is particularly sensitive to changes in the Ca:Mg ratio. By using a limestone with a low Ca:Mg ratio, the possibility of lime-induced magnesium deficiency is eliminated, and the uptake of toxic metals such as copper and nickel is also reduced. (Abstract shortened by UMI.)
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