Histological classification of laryngeal epithelial lesions is highly subjective, and methods of cytological detection are not well developed. Improved determination of aberrant cell cycle entry may allow increased objectivity in histological assessment and enable the development of less invasive diagnostic cytology tests. Sections of normal larynx (n ¼ 10), laryngeal dysplasia (n ¼ 20) and laryngeal squamous cell carcinoma (SCC) (n ¼ 10) were classified according to the Ljubljana classification and stained for markers of cell cycle entry, minichromosome maintenance protein-2 (Mcm-2) and Ki67. Expression patterns were compared using double labelling confocal microscopy. There was a correlation between Mcm-2 and Ki67 labelling indices (r ¼ 0.93; 95% CI [0.84, 0.97]) and both markers showed increased expression from normal epithelium to SCC (Mcm-2, P ¼ 0.001; Ki67, P ¼ 0.0002). Importantly, there was minimal expression of Mcm-2 or Ki67 in the most superficial layers of normal larynx and abnormal or atypical hyperplasia, in contrast to carcinoma in situ and SCC. Clusters of Mcm-2/5-positive cells were present in cytological preparations from SCC, but not from those showing atypical hyperplasia or inflammation in non-neoplastic tissue. Minichromosome maintenance protein-2 staining may increase the objectivity and reliability of histological grading of laryngeal epithelial lesions. Laryngeal brushings, combined with immuno-enhanced liquid-based cytology, could be useful, as a less invasive approach, to the detection of laryngeal malignant and premalignant lesions.

Sensory symptoms following radial artery procurement occur more frequently than previously reported, but are largely self-limiting and are usually clinically insignificant. Patients appear to have a good quality of life following CABG using the radial artery. Radial artery harvest may be associated with lower wound infection rates and greater patient satisfaction than LSV harvest, however, the presence of residual sensory symptoms may be of relevance when obtaining informed consent.

A Recovery filter (C.R. Bard, Tempe, AZ, USA) is a device for pulmonary embolism prophylaxis. There have been few case reports involving the migration of this particular filter or of a broken wire migrating to the heart. We report a case of right ventricular migration of a fractured wire from this filter in a patient who subsequently developed pericardial tamponade and required open heart surgery to extract the fractured wire. We discuss the current US Food and Drug Administration (FDA)-approved nonpermanent inferior vena cava filters and their reported complications. These complications can be life-threatening and may require immediate surgical intervention.

Objective:To determine the factors contributing to lack of interest in research activities among postgraduate residents in pediatric medicine.Methods:This cross-sectional survey was conducted at The Children’s Hospital Lahore, Pakistan in August 2017. The questionnaire was distributed to 105 postgraduate residents working in pediatric medicine department and 90 of them returned the completed proforma (response rate; 86%). Data was analyzed by SPSS version 22.Results:Out of 90 residents’ females were predominant (n=58/90; 64.4%). Mean age of the participants was 28.22 ± 2.092 years. Majority were unmarried (n=57; 63.3%). The highest mean score (2.31±0.697) was regarding “Lack of proper training for research”, followed by “lack of previous exposure” (2.26±0.728) and “over loaded curriculum” (2.13±0.753). “Uncooperative faculty” and “funding issues” as a barrier towards research (p=0.016 and 0.014 respectively) was mentioned by males more than females. “Social and family commitment” was a significant perceived barrier in married residents as compared to unmarried residents (p=0.001). The residents in the younger age group were more reluctant to do research due to “over loaded curriculum” (p=0.038).Conclusion:Lack of proper training of research, lack of previous exposure and time management are the major factors affecting resident’s research work, whereas married residents face more social/family constraints as compare to unmarried residents.

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We propose that immediate BMI-based preoperative dosing of LMWH along with postoperative prophylaxis is both safe and effective and should be standard for all patients undergoing Roux-en-Y gastric bypass surgery.