By N. Jesper. Yeshiva University. 2018.

It to the trunk or located more peripherally) also play a is very rare 15mg remeron with amex, but has an age and sex distribution pattern key role in the prognosis order 30mg remeron amex. Female patients appear to similar to that for the classical osteosarcoma generic remeron 15 mg overnight delivery. Of sis tends to be slightly worse since the chemotherapy is course discount remeron 15 mg on-line, tumor recurrence is a poor prognostic factor. Until recently the intra-arterial administration of the chemotherapeutic agents has not managed to produce Periosteal osteosarcoma any improvement in the results since the contact time A rare low- to intermediate-grade malignant tumor, is evidently too short. A more recent report challenges predominantly occurring between the ages of 10 and 20. The x-ray shows a fusiform elevation of the periosteum To sum up: the following factors are prognostically with erosion of the cortex and ossifying spicules. How- favorable (in decreasing order of importance): ever, the tumor does not penetrate into the medulla to ▬ good response to chemotherapy, any great extent and is usually located in the diaphysis. The ▬ tumor located more peripherally, appropriate treatment is wide resection of the tumor. If ▬ no metastases, this is performed in a correct and timely manner, the ▬ no »skip metastases«, prognosis is good. Chemotherapy is not particularly ef- ▬ female patient, fective and should be reserved for high-grade tumors. In a recent European multicenter study the 10-year survival rate The tumor resection also crucially affects the prognosis. The more advanced the tumor, the more radiopaque the os- sifications (⊡ Fig. Since it starts to grow at the periphery, a characteristic gap of brightness that is readily visible on the x-ray or CT scan develops between the cortex and the overlying developing mushroom-head-like osteosarcoma (⊡ Fig. By definition, no more than 25% of the medullary cavity should be affected. Lateral (a) and AP (b) x-rays and CT scan (c) of an 18- which must be treated as for a classical osteosarcoma year old girl with a parosteal osteosarcoma. Nor is it always easy to differentiate it from osteochondromas or secondary (epiexostotic) chon- drosarcomas. The Classical central chondrosarcoma spindly connective tissue cells show – occasionally > Definition only slight – atypia. At the periphery the cell content Low- to medium-grade malignant (rarely high-grade increases markedly, and the tumor can also infiltrate malignant) tumor with differentiated hyaline cartilage into the adjacent skeletal muscles. Cytogenetically, parosteal osteo- sarcomas are characterized by surplus ring chromo- Occurrence somes. After the osteosarcoma, the chondrosarcoma is the sec- ▬ The appropriate treatment is wide resection. If the also occurs in adolescents in less than 5% of cases, the tumor persists for a long time, or if there are multiple age peak is between the 5th and 7th decades (⊡ Fig. On the other hand, if the Site tumor is resected with a margin of healthy tissue, The chondrosarcoma is usually located in the metaphyses the prospects of a cure are good, since early metas- of the long bones, but can also occur in the diaphyses or tases almost never occur (resection and bridging in epiphyses. According to a British study, the cases, for example if a chondrosarcoma in the sacrum or average period between the onset of symptoms and di- spine cannot be resected with a margin of healthy tissue agnosis is 50 weeks. This slow-growing tumor does and recurs, particularly if neurological lesions occur. The prognosis for classical, usually low-grade malig- symptoms may be present. If an adequate resec- ▬ Radiographic findings: On the plain x-ray the tumor tion is implemented in good time, the survival rate appears osteolytic and shows marginal sclerosis of is over 90%, since the tumor grows slowly and only 4 varying severity depending on the rate of growth. A highly In around 10% of cases however the tumor can dediffer- typical feature of the tumor, though not necessar- entiate, usually after several recurrences, and transform ily present, are circular or arched (popcorn-like) and into a high-grade sarcoma.

Life phases (particularly at night) generic remeron 30mg without a prescription, which also affects mental expectancy is determined by the degree of respiratory performance during the day generic remeron 30 mg overnight delivery. A home ventilation program insufficiency and is between 40 and 60 years discount 30mg remeron with visa. The ortho- (assisted nocturnal ventilation) can significantly improve paedic and cardiac findings resemble those for Duchenne these symptoms remeron 30 mg with amex. More difficult is the treatment of the muscular dystrophy, but are less pronounced. The inci- heart failure, which is likewise progressive and a life-limit- dence of scolioses is not known, but spinal deformities ing factor. In the context of surgery, patients with Duch- must be expected in severe cases. Duchenne muscular dystrophy, the muscle biopsy shows a picture of degeneration and regeneration. The abnormal dystrophin level can be confirmed by laboratory tests and 4. The orthopaedic measures are essentially no different symptoms are less pronounced and progress less rapidly. Occurrence, etiology Becker muscular dystrophy has an incidence of 3/100,000 and is thus 10 times rarer than the Duchenne type. The onset of signs and symptoms can Clinical features and diagnosis occur from early childhood right through to adulthood. The disease manifests itself between the age of five and The condition manifests itself as a weakness of the afore- adolescence. In some cases, it does not appear until adult- mentioned muscles, and the pelvic muscles can also be af- 752 4. Deafness and changes in the fundus central-core myopathy, oculi may also be present. The muscle biopsy fiber type disproportion, shows a variable picture with focal fiber atrophy and other forms. Whereas the De Lange myopathy is a malignant condi- The course and prognosis differ, varying from a very slow tion, with death often occurring even during infancy, progression and a normal life expectancy to a loss of walk- the Batten-Turner type is benign, often with slow or ab- 4 ing ability in early adulthood. The aim of treatment is to sent progression, even though the overall clinical picture preserve mobility in the upper extremities. As Under histological examination, the cell nuclei in central- the dystrophy progresses, the muscle power is no longer core myopathy are located centrally in the muscle fibers. Corresponding clinical skeletal deformities (flatfoot, clubfoot: 21%, hip disloca- and radiological follow-up is indicated. Emery-Dreifuss muscular dystrophy The manifestation of nemaline myopathy (recessive or This X-linked recessive form of muscular dystrophy pri- dominant) is highly variable: some patients die during the marily affects older children, adolescents and adults. The neonatal period, whereas others are able to walk normally signs and symptoms consist of walking difficulties and and only show slight muscle weakness. The spine stiffens and fixed defor- problems arise from the development of scoliosis and mities occur in the extremities. As laboratory pa- The myotubular myopathy is variable with differing rameters the muscle enzymes are slightly to moderately modes of inheritance. The rare X-linked recessive vari- elevated, and the EMG shows myopathic changes. The muscle biopsy shows a dystrophic histological pattern, more common autosomal recessive type tends to produce partially mixed with muscular atrophies [4, 19, 21]. The clubfeet, lordoscolioses and winged scapula in the second condition can become life-threatening if it affects the decade of life. The orthopaedic management aims to preserve logically characterized by a predominance of excessively walking ability and prevent and treat skeletal deformities.

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If you want to 144 Review and editorial processes become an editor remeron 30 mg overnight delivery, it is probably best to ask a senior colleague for advice about how to get there discount remeron 30mg otc. Acknowledgements King quotes have been reprinted with the permission of Scribner generic remeron 15 mg visa, a Division of Simon & Schuster buy generic remeron 30 mg on-line, Inc. The Skinner Goldsmith, Bollingbrooke, Watson and Ochs quotes have been produced with permission from Collins Concise Dictionary of Quotations 3rd edn. Standard number: BS 5261C: 1976 2 Capital Community College, Hartford, CO, USA http://webster. An Adobe Acrobat version of these proofreading marks can be downloaded References 1 David A. The fate of papers presented at the 40th Society for Social Medicine Conference. Effect of open peer review on quality of reviews and on reviewers’ recommendations: a randomised trial. With practice, this discipline helps you learn how to craft your writing to suit your target audience. Irina Dunn1 The objectives of this chapter are to understand how to: • avoid duplicate publication • share data in large research teams • use the electronic media appropriately • assess the merit of journals and journal articles Duplicate publication A scientific paper is (1) the first publication of original research results, (2) in a form whereby peers of the author can repeat the experiments and test the conclusions, and (3) in a journal or other source document readily available with the scientific community. Infection and Immunity2 Redundant or duplicate publication occurs when results that are published in one paper substantially overlap with results published in another. Duplicate publication is unnecessary and is usually fraudulent since the authors have given a signed assurance that their work has not been published elsewhere. If you have any related information that is published in or has been submitted to another journal then you should include it when you submit your paper. In this way, it becomes the 147 Scientific Writing editor’s responsibility if the journal accepts a piece of work that proves to be duplicated. If more than 10% of a paper overlaps with another paper, the International Committee of Medical Journal Editors3 asks you to send in copies of the other paper so that the editorial panel can make an informed decision about the extent of any duplication of published data. No journal wants to publish papers that duplicate data that are already in press in another journal. If you want to include previous data analyses in your paper, the correct process is to cite them in the reference list. In some cases, secondary publication in another language is justifiable but only with the permission of the journal editor who may impose certain conditions. Most journals specifically ask authors to declare that their data are not published elsewhere and are not under consideration by another journal. These declarations help to prevent violation of copyright laws and to protect readers from being overwhelmed with information that is already in press. It is especially important not to present closely related analyses from the same study to two journals concurrently without disclosure to both journal editors. However, duplicate publication that comes to the notice of an editor will result in a prompt rejection and may result in disciplinary action from your institution or professional body. If the data are already in press, then a notice of duplicate publication may be published in the journal, perhaps without you as the author being given any prior notice. Such notices may also indicate withdrawal of the publication from the journal,5 which means that the article will be tracked by indexing services such as MEDLINE® as withdrawn. Most importantly, some editors have a strict policy of rejecting all future publications from authors who have submitted duplicate data to their journal. Most journals readily give permission for the reproduction of published figures and tables for which they have copyright, provided that the work is formally cited. However, you should be very careful when submitting data that are published in conference proceedings or in similar formats. However, the rules of duplicate publication do not preclude you from submitting a paper that contains data presented as an abstract or oral communication at a scientific meeting or a paper that has been rejected by another journal. It is generally accepted that results presented at scientific meetings in order to elicit peer review are from preliminary analyses and are not published in full. Scientific meetings are organised in order that researchers can exchange information with one other and are not primarily intended as a venue for releasing results to the public.

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Emphasis has been placed on clinical measures that could be conducted easily cheap 15 mg remeron otc, are time-efficient best remeron 15 mg, do not require costly technology discount remeron 30 mg free shipping, are readily understandable to the clinician 15mg remeron free shipping, and yield quantitative data at a minimum of ordinal level. The combination of measures comprising the BPR is also sensitive to posture in all of the three body planes and can provide separable information on the high, mid, and lower segments. As a result, the American Physical Therapy Society rated the development of a back function measurement as its third most important research goal. The aim of conducting this study was to test the reliability of a new Back Posture Rating (BPR) that is practical to administer in a clinic setting. Because this rating measures movement in all three planes, it is a sensitive measure of back posture and can provide separate information about the high, mid and lower back segments. The practice of saying something twice in one sentence is known as tautology and is described in the Oxford English Dictionary as “a fault of style”. For example, there is no need to say that you studied the subsequent development of infection. Since development can only be subsequent, the word subsequent is unnecessary. Also, do not describe something as being equally as important since the word equally is redundant. Similarly, in the sentence, There is no need to repeat the tests again, the word repeat can be replaced by conduct, or the word again can be deleted. In the first example, cross-sectional 205 Scientific Writing studies are large random population studies by definition, so only one of the two phrases is needed. The sentence also benefits from being rearranged so that the descriptor obese is not separated from its noun adults. In the second example, the word very is not needed because there are no degrees of inaccuracy. Moreover, the sentence is better written with the topic, which is the measurement of diet, as the subject. In the third example, time can only be a period so a considerable period of is redundant. It always pays to be precise in scientific writing so the more specific phrase for 12 years is even better. In the fourth and fifth examples, the tautologies can simply be removed. Elizabeth Murphy3 206 Writing style Short sentences are the crux of good scientific writing. Sentences with few words convey their meaning clearly at the first reading. If you are prone to writing long, snake-like sentences you will have to learn to chop them up. Long sentences quickly exhaust thinking capacity and are hard work to read. Snakes overload the reader who has to search for the main message while trying to remember and place all of the subtopics and asides. If a sentence has too many phrases and clauses, readers will not be able to maintain all the ideas until they reach the full stop. Long sentences may occasionally be needed but they should be the exception rather than the rule. One rule of thumb is that sentences that stretch to more than two printed lines and/or more than 30 words are too long. Sentences longer than this suddenly become tedious and difficult to read whereas sentences with less than 20 words are usually very readable. Simply by chopping up the snakes, you make your paragraphs more digestible. Cut long sentences into little ones, shorten verbs, delete unnecessary clauses, or put points in a list. Although we have no evidence, it is possible that indigenous children who have bronchitis in early life are more likely to be diagnosed with asthma. The long snaky sentence of 63 words can easily be cut into two sentences, one of 32 words and one of 25 words (total 57 words). Parallel structures To be easy to read, your text has to be clear and say what you mean in a simple and straightforward way.

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