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Globus pharyngeus is a relatively uncommon disorder of having the feeling of a lump or blockage in the throat. The condition has been associated with anxiety and obsessive traits, although the aetiology is still unclear. Hypnosis has become increasingly popular as a method for helping patients overcome anxiety in clinical settings, including during dental procedures. Anxiety towards dental treatment is not uncommon and is regularly a cause for missed or cancelled appointments. Twelve per cent of patients in the latest Adult Dental Health Survey reported extreme dental anxiety. This paper describes the case of a patient with an unusual presentation of globus pharyngeus whose symptoms were only kept at bay by the presence of food in the mouth. This presented barriers for treatment planning, which were heightened by the fact that the patient was also severely needle phobic and so prone to increased anxiety. This paper describes how inhalation sedation together with various hypnosis techniques, were used to facilitate tooth extraction in this difficult case. The paper highlights the importance of interdisciplinary teamwork and careful treatment planning in ensuring a safe and successful outcome for the patient. [ABSTRACT FROM AUTHOR]

Background: Many patients have a nasogastric feeding tube inserted during admission; however, misplacement is not uncommon. In this case report we present, to the best of our knowledge, the first documented fatality from pressure pneumothorax following nasogastric tube withdrawal.Case Presentation: An 84-year-old Caucasian woman with dysphagia and at risk of aspiration underwent routine insertion of a nasogastric feeding tube; however, shortly after insertion she developed respiratory distress. A chest X-ray showed the tube had been misplaced into our patient's right lung. The tube was removed, but our patient died less than an hour after withdrawal. The autopsy report stated that cause of death was tension pneumothorax, which developed following withdrawal of the misplaced feeding tube.Conclusions: The indications for insertion of nasogastric feeding tubes are many and the procedure is considered harmless; however, if the tube is misplaced there is good reason to be cautious on removal as this can unmask puncture of the pleura eliciting pneumothorax and, as this case report shows, result in an ultimately deadly tension pneumothorax. [ABSTRACT FROM AUTHOR]

• Minimal research has linked bicycling comfort to micro-scale urban design metrics. • Bicyclist physiology was obtained from a naturalistic investigation and GIS. • Elevated and reduced bicyclist comfortability were spatially autocorrelated. • Open urban spaces with no clear pathways decreased bicycling comfortability. • Highly integrated urban spaces increased bicycling comfortability. The current research set out to measure the moderating effect that urban design may have on bicyclist physiology while in transition. Focusing on the hilly City of Wuppertal, Germany, we harnessed bicyclists with mobile sensors to measure their responses to urban design metrics obtained from space syntax, while also adjusting for known traffic, terrain, and contextual factors. The empirical strategy consisted of exploratory data analysis (EDA), ordinary least squares (OLS), and a local regression model to account for spatial autocorrelation. The latter model was robust (R2 = 68%), and showed that two statistically significant (p < 0.05) urban design factors influenced bicyclist physiology. Controllability, a measure of how spatially dominated a space is, increased bicyclist responses (i.e., decreased comfortability); while integration, which is related to accessibility and connectivity, had the opposite effect. Other noteworthy covariates included one-way streets and density of parked automobiles: these exerted a negative influence on bicyclist physiology. The results of this research ultimately showed that nuanced urban designs have a moderate influence on bicycling comfort. These outcomes could be utilized by practitioners focused on implementing appropriate interventions to increase bicyclist comfort levels and this mode share. [ABSTRACT FROM AUTHOR]

Objective: Despite extensive research into the biological mechanisms behind obesity-related inflammation, knowledge of environmental and genetic factors triggering such mechanisms is limited. In the present narrative review we present potential determinants of adipose tissue inflammation and suggest ways ahead for future research in the field.Design: We searched the literature for potential determinants of obesity with inflammation through MEDLINE by applying the MeSH headings 'obesity' and 'inflammation' in combination with specific terms for a series of environmental and genetic factors.Results: Numerous articles reported on the association between environmental or genetic factors and respectively obesity and inflammation, whereas only a few studies assessed obesity and inflammation as a combined outcome. Among suggested determinants for obesity with inflammation were Adenovirus-36, the gut microbiota, trans-fatty acids, and the four genes FTO, MC4R, TNF-α and LEPR.Conclusions: We present a limited number of factors potentially contributing to the development of obesity with inflammation, while concluding that overall the area is indeed sparsely investigated. We present ideas for future studies that can identify relevant aetiological factors. This identification is essential for targeted prevention of obesity with inflammation and the clinical consequences thereof. [ABSTRACT FROM AUTHOR]