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tardive dystonia ( td ) , a rarer side effect after longer exposure to antipsychotics , is characterized by local or general , sustained , involuntary contraction of a muscle or muscle group , with twisting movements , generally slow , which may affect the limbs , trunk , neck , or face . td has been shown to develop in about 3 % of patients who have had long - term exposure to antipsychotics . . the low risk of td for atypical antipsychotics is thought to result from their weak affinity for dopamine receptors . compared with typical , atypical antipsychotic agents have a greater affinity for serotonin 5-ht2a than dopamine d2 receptors , with a low propensity to induce td . among this olanzapine is thought to have preferential action at mesolimbic over nigrostriatal dopaminergic pathways and is , therefore , associated with a very low incidence of extrapyramidal symptom ( eps ) . furthermore , a retrospective analysis of controlled multicentric trials suggested that olanzapine also improves preexisting symptoms of tardive movements .

tardive dystonia ( td ) is a serious side effect of antipsychotic medications , more with typical antipsychotics , that is potentially irreversible in affected patients . studies show that newer atypical antipsychotics have a lower risk of td . as a result , many clinicians may have developed a false sense of security when prescribing these medications . we report a case of 20-year - old male with hyperthymic temperament and borderline intellectual functioning , who developed severe td after low dose short duration exposure to atypical antipsychotic risperidone and then olanzapine . the goal of this paper is to alert the reader to be judicious and cautious before using casual low dose second generation antipsychotics in patient with no core psychotic features , hyperthymic temperament , or borderline intellectual functioning suggestive of organic brain damage , who are more prone to develop adverse effects such as td and monitor the onset of td in patients taking atypical antipsychotics .

syncope is caused by transient diffuse cerebral hypoperfusion and is characterized by transient loss of consciousness with a rapid onset followed by spontaneous and complete recovery . clinical features of syncope may include myoclonic jerks which are often multifocal and asynchronous , convulsions , and urinary incontinence , making it difficult to differentiate from epileptic seizure by clinical features alone . significant fluctuations in cerebral perfusion pressure are prevented by autoregulation of cerebral circulation , but there may be conditions where such mechanism may not compensate adequately . cough syncope , a rare form of syncope , may be a result of transient failure of the cerebral autoregulatory mechanism to cope with sudden decrease in cerebral blood flow . we present an unusual case of recurrent cough syncope , which was initially diagnosed and treated as seizures , in the context of a left - sided glomus jugulare tumor , a benign paraganglioma .

we present an unusual case of recurrent cough syncope in a 43-year - old woman , which was initially thought to be seizures . syncopal episodes were triggered by paroxysms of cough and were characterized by unresponsiveness and myoclonic jerks in her extremities . she had a left - sided glomus jugulare tumor that extended into the posterior cranial fossa with evidence of worsening communicating hydrocephalus on brain imaging . we postulate that bouts of cough produced increased intracranial pressure both by raising intrathoracic and intraabdominal pressures as well as by transient obstruction to cerebrospinal fluid flow secondary to intermittent tonsillar herniation during cough . this resulted in diffuse decrease in cerebral blood flow causing syncope . the patient 's syncopal episodes decreased in frequency once an external ventricular drain was placed followed by a ventriculoperitoneal shunt . search for factors that can increase intracranial pressure seems warranted in patients with recurrent cough syncope .

midwife - led primary delivery care for low - risk pregnant women during labor has been reported to have various advantages , such as increased odds of high maternal satisfaction and a decrease of unnecessary medical interventions [ 18 ] . although the maternity care system for low - risk pregnant women peculiar to one country can not easily be compared with those in other countries , consumer demands for the humanization of obstetric care have arisen in various countries [ 18 ] . to date , we have found no evidence that midwife - led primary obstetric care is unsafe for low - risk pregnant women in comparison with obstetric care with the favorable cooperation of obstetricians and midwives in japan [ 912 ] . in addition , about 85 % of low - risk pregnant women request that they give birth while receiving midwife - led primary delivery care . therefore , safe midwife - led delivery care with the backup of obstetricians may also be required for low - risk pregnant women in japan . if complications occur or threaten to occur during the primary midwife - led delivery care , the midwives have to refer the woman to obstetricians at the same or a neighboring hospital or private obstetric clinic as soon as possible . this is because , in deliveries managed by independent midwives in japan , many intervention measures , such as oxytocin infusion , epidural anesthesia , episiotomy , suture , and instrumental delivery , are not available based on japanese legal restrictions . in our institute , one of the main tokyo city perinatal centers , there are 3 japanese systems of midwife - led delivery care , as follows : ( 1 ) those intending to give birth at home managed by midwives who do not belong to our hospital , ( 2 ) those planning to give birth on futons ( i.e . , japanese - style bedding ) in japanese tatami mat delivery rooms in our hospital managed by the same midwives who do not belong to our hospital , and ( 3 ) those planning to give birth in japanese tatami mat delivery rooms managed by midwives who belong to our hospital . the objective of this study was to describe trends in transfers and perinatal outcomes among labors using these 3 japanese systems of midwife - led primary delivery care .

objective . the objective of this study was to describe the recent clinical characteristics of labor using 3 systems of japanese midwife - led primary delivery care , as follows : ( 1 ) those intending to give birth at home managed by midwives who do not belong to our hospital , ( 2 ) those planning to give birth in our hospital managed by the same midwives , and ( 3 ) those planning to give birth managed by midwives who belong to our hospital . methods . a retrospective cohort study was performed . results . there were no significant differences in the obstetric or neonatal outcomes among the 3 groups . the rate of transfers during labor with the system involving midwives belonging to our hospital was higher than those with the other 2 systems . in addition , the timing of transfers in the system with the midwives belonging to our hospital was earlier than with the other 2 systems . among the 3 groups , there were no significant differences in the rate of the main 2 indications for transfers : fetal heart rate abnormality and failure to progress . conclusion . there were no significant differences in perinatal outcomes among the 3 systems ; however , there were some differences in the status of transfers to obstetric shared care .

lipid apheresis provides a safe and effective means of treating patients with severe hyperlipidemia . it functions by first separating plasma from blood cells with a cell separator and then using either the adsorption of apolipoprotein b by affinity columns containing anti - apolipoprotein b antibodies or dextran sulphate , or their precipitation at low ph by heparin . lipid apheresis allows patients to attain lower levels of low - density lipoprotein ( ldl ) , which are usually not attainable with traditional drug therapy alone , while leaving high - density lipoprotein ( hdl ) levels generally unaffected . when used in conjunction with statins and other lipid - lowering drugs , lipid apheresis may also induce the regression of coronary atherosclerotic plaque in familial hypercholesterolemia ( fh ) patients . fh is a group of autosomal dominant genetic defects resulting in elevated serum ( ldl ) cholesterol levels . in the heterozygous state , fh is a relatively common but serious genetic disorder , with an incidence of about 1 in 500 persons in the general population . fh has been associated with an increased risk for atherosclerosis , premature coronary heart disease , and heart failure [ 3 , 4 ] . fh is caused by a mutation affecting apolipoprotein b , proprotein convertase subtilisin kexin type 9 ( pcsk9 ; an enzyme involved in ldl receptor degradation ) , or , most commonly , the ldl receptor gene , resulting in defective ldl receptors and/or a diminished number of ldl receptors [ 7 , 8 ] . these mutations cause ldl to be catabolized at a slower rate and thus accumulate in the circulation . currently , fh is treated using a variety of cholesterol - lowering drugs , most notably statins or hmg - coa reductase inhibitors . for many patients , however , statins are not a viable treatment option , because of either intolerance or ineffectiveness . lipid apheresis is an alternative form of treatment for these fh patients as well as those who have persistently elevated ldl levels despite treatment . because apheresis is performed at only a few highly specialized centers in relatively low volume , there is very little literature discussing the effectiveness of lipid apheresis on the reduction of lipid profiles and the prevention of future cardiac events . this study , therefore , reports the experience in a single metropolitan center of treating patients with hyperlipidemia with lipid apheresis .

lipid apheresis is used to treat patients with severe hyperlipidemia by reducing low - density lipoprotein cholesterol ( ldl - c ) . this study examines the effect of apheresis on the lipid panel and cardiac event rates before and after apheresis . an electronic health record screen of ambulatory patients identified 11 active patients undergoing lipid apheresis with 10/11 carrying a diagnosis of fh . baseline demographics , pre- and postapheresis lipid levels , highest recorded ldl - c , cardiac events , current medications , and first apheresis treatment were recorded . patients completed a questionnaire and self - reported risk factors and interest in alternative treatment . there were significant reductions in mean total cholesterol ( 58.4 % ) , ldl - c ( 71.9 % ) , triglycerides ( 51 % ) , high - density lipoprotein ( hdl ) cholesterol ( 9.3 % ) , and non - hdl ( 68.2 % ) values . thirty - four cardiac events were documented in 8 patients before apheresis , compared with 9 events in 5 patients after apheresis . our survey showed a high prevalence of statin intolerance ( 64 % ) , with the majority ( 90 % ) of participants indicating an interest in alternative treatment options . our results have shown that lipid apheresis primary effect is a marked reduction in ldl - c cholesterol levels and may reduce the recurrence of cardiac events . apheresis should be compared to the newer alternative treatment modalities in a randomized fashion due to patient interest in alternative options .

agriculture has been one of the primary economic avenues in the philippines contributing to about 20 % to the gross domestic product ( gdp ) . crops comprise about 47.56 % of the total agricultural sector and have contributed to about 510 billion pesos ( p510b ) to the country 's national income . benguet is a province in the northern portion of the philippines belonging to the cordillera administrative region . there are about 27.5 thousand farms covering 30 thousand hectares of agricultural land in benguet . it is also the largest producer of vegetables and fruits , supplying the capital cities in the philippines . the province is known as the salad bowl of the philippines as its major crops are tubers , roots , bulbs , leafy vegetables , stems , and flowers . in 2005 , benguet was the top producer of brocolli and carrots producing about 1.2 thousand and 13.7 metric tons contributing to 87.4 % and 81.4 % , respectively , to the national output . however , growing vegetables is considered a risk occupation in some areas in developing countries . soogarun et al . in 2003 found significantly low / abnormal mean blood cholinesterase levels among vegetable growers in thailand . health impacts of pesticide misuse on the other hand greatly affect the farming communities in the philippines questioning the economic advantages of its use . many researchers have correlated the extent of direct and indirect pesticide exposure and health hazards such as increased mortality , dermal contamination , depression in cholinesterase level , fetal abnormalities , and spontaneous abortion among pregnant women [ 36 ] . it is a discouraging fact though , that with knowledge of health risks , many filipino families still perceive that crop yield outweighs the health risks associated with pesticide use . pesticide poisoning is one of the most prevalent health problems in the philippines . in a study by the department of health ( doh ) from 19911995 , organophosphates accounted for the highest number of poisoning cases while organochlorines caused the most number of deaths . cheng in 1994 studied 2000 benguet vegetable farmers and found that the most common complaints were allergic reactions both in the skin and the eyes , abdominal pain , dizziness , chest pain , headache , and nose bleed . meanwhile , a study on pesticide poisoning in selected hospitals in four philippines regions in 2001 found that cases of acute poisoning were more prevalent than chronic cases . this study aimed to identify the pesticide exposure and risk factors among vegetable farmers . the data can be used as baseline data on the vegetable industry in the philippines .

this was a cross - sectional study that investigated pesticide exposure and its risk factors targeting vegetable farmers selected through cluster sampling . the sampling size calculated with p = .05 was 211 vegetable farmers and 37 farms . the mean usage of pesticide was 21.35 liters . risk factors included damaged backpack sprayer ( 34.7 % ) , spills on hands ( 31.8 % ) , and spraying against the wind ( 58 % ) . the top 3 pesticides used were pyrethroid ( 46.4 % ) , organophosphates ( 24.2 % ) , and carbamates ( 21.3 % ) . those who were exposed to fungicides and insecticides also had higher total pesticide exposure . furthermore , a farmer who was a pesticide applicator , mixer , loader , and who had not been given instructions through training was at risk of having higher pesticide exposure . the most prevalent symptoms were headache ( 64.1 % ) , muscle pain ( 61.1 % ) , cough ( 45.5 % ) , weakness ( 42.4 % ) , eye pain ( 39.9 % ) , chest pain ( 37.4 % ) , and eye redness ( 33.8 % ) . the data can be used for the formulation of an integrated program on safety and health in the vegetable industry .

primary diffuse leptomeningeal gliomatosis ( pdlg ) is diagnosed when a glioma is located in the subarachnoid space , while intraparenchymal tumor lesions are absent . pdlg must be distinguished from secondary meningeal gliomatosis resulting from a primary gliomatous cns tumor . pdlg , especially when caused by malignant astrocytic cells , is associated with very poor survival . we describe a patient with pdlg consisting of malignant astrocytic cells who underwent combined radio- and chemotherapy leading to the longest survival time described in the literature thus far .

objectiveprimary diffuse leptomeningeal gliomatosis ( pdlg ) is a rare neoplasm with a short survival time of a few months . there is currently no standardized therapeutic approach for pdlg.materials and methodswe report on a 53-year - old male patient who presented with epileptic seizures , gait disturbance , paraparesis and sensory deficits in the dermatomes t8-10.resultsmagnetic resonance imaging ( mri ) revealing numerous spinal and cranial gadolinium - enhancing nodules in the meninges and histopathology led us to diagnose primary diffuse leptomeningeal gliomatosis with who grade iii astrocytic cells . consecutively , the patient underwent craniospinal radiotherapy ( 30 gy ) and 11 sequential cycles of temozolomide . this regimen led to partial tumor regression . thirteen months later , spinal mri revealed tumor progression . second - line chemotherapy with 5 cycles of irinotecan and bevacizumab did not prevent further clinical deterioration . the patient died twenty - two months after diagnosis , being the longest survival time described thus far with respect to pdlg consisting of astrocytic tumor cells.conclusionsradiochemotherapy including temozolomide , as established standard therapy for brain malignant astrocytomas , might be valid as a basic therapeutic strategy for this pdlg subtype .

in past years , numerous studies have described the role of microalbuminuria ( mau ) as a predictor of cardiovascular disease ( cvd ) and death among subjects with type 2 diabetes ( t2d ) .13 mau is one of the earliest clinical signs for diabetic nephropathy and a significant risk factor for progression to proteinuria.1 additionally , hypertensive t2d individuals with mau have an increased risk of developing end - stage renal disease ( esrd ) .4 risk factors known to be associated with cvd and diabetic nephropathy are high blood pressure ( bp ) and elevated glycosylated hemoglobin ( a1c ) .5,6 achieving adequate bp and glycemic control ( gc ) plays an essential role in preventing renal and cvd events in individuals with t2d . a current secondary analysis from the hispanic health and nutritional examination survey ( hhanes ) 7 indicated that cuban americans have higher serum cholesterol and systolic bp than puerto ricans and mexican americans . furthermore , compared with other hispanic subgroups , cuban americans have the highest proportion of hypertension ( htn ) and mean serum creatinine levels.8 smith and barnett9 examined the national center for health statistics ( nchs ) from 1996 to 1997 and concluded that cuban americans 35 years of age and older have the highest percentage of diabetes - related deaths compared with other hispanics . although previous studies have shown significant differences and diversity within hispanics , further studies conducted in the cuban american population are scarce . over the past decade , the prevalence of t2d has increased , especially among cuban americans who have a higher incidence of diabetes ( 8.2 % ) compared with 6.6 % of non - hispanic whites.10 the high incidence of t2d combined with an increased risk for developing diabetes complications warrants further examination of the cuban american population . screening for mau can detect individuals at risk for renal dysfunction and cvd events and possibly reduce the burden associated with diabetes complications . therefore , the purpose of this study was to investigate to what degree the coexistence of htn and poor gc influences the likelihood of having mau among cuban americans with t2d . it was hypothesized that individuals with t2d , htn , and poor gc will have an increased likelihood to test positive for mau . it was further hypothesized that this association will be stronger after controlling for confounding variables .

purpose : to investigate to what degree the presence of hypertension ( htn ) and poor glycemic control ( gc ) influences the likelihood of having microalbuminuria ( mau ) among cuban americans with type 2 diabetes ( t2d ) .methods : a cross - sectional study conducted in cuban americans ( n = 179 ) with t2d . participants were recruited from a randomly generated mailing list purchased from knowledge - base marketing , inc . blood pressure ( bp ) was measured twice and averaged using an adult size cuff . glycosylated hemoglobin ( a1c ) levels were measured from whole blood samples with the roche tina - quant method . first morning urine samples were collected from each participant to determine mau by a semiquantitative assay ( immunodip ) .results : mau was present in 26 % of cuban americans with t2d . a significantly higher percentage of subjects with ma had htn ( p = 0.038 ) and elevated a1c ( p = 0.002 ) than those with normoalbuminuria . logistic regression analysis showed that after controlling for covariates , subjects with poor gc were 6.76 times more likely to have mau if they had hypertension compared with those without hypertension ( p = 0.004 ; 95 % confidence interval [ ci ] : 1.83 , 23.05 ) .conclusion : the clinical significance of these findings emphasizes the early detection of mau in this hispanic subgroup combined with bp and good gc , which are fundamentals in preventing and treating diabetes complications and improving individuals renal and cardiovascular outcomes .

cancer is the second leading cause of mortality and morbidity in both developed and developing countries . in india , cancer prevalence is estimated around 2.5 million , with over 0.8 million new cases and 0.5 million deaths occurring each year . there is an increase in the incidence of breast cancer and found to be gradually overtaking cancer of the cervix . breast self - examination ( bse ) is an important screening measure for detecting breast cancer . there is evidence that women who correctly practice bse monthly are more likely to detect a lump in the early stage of its development , and early diagnosis has been reported to influence early treatment , to yield a better survival rate . thus the present study aimed at identifying the level of knowledge and practice of bse among degree female students who are the citizen of the future and they can teach their family members , neighbors , friends and the community which helps the people to detect breast cancer in early stage . thus the morbidity or mortality can be reduced . in the current study only one participant was practicing bse occasionally so incorporating the bse concept in the degree education curriculum is very useful and helpful . the present study aimed at assessing the level of knowledge and the effectiveness of planned teaching program among degree female students on bse . it is a patient - centred , inexpensive and noninvasive method of screening for breast cancer . based on increased incidence of breast cancer and unawareness of bse among young women , researcher felt a need to provide awareness of bse among young women and can be reduced the incidence and prevalence of breast cancer in future . the objectives of the study were to : to assess the level of knowledge of degree college female students on bse.to determine the effectiveness of planned teaching program among degree college female students on bse.to find the association between pretest knowledge and selected demographical variables . to assess the level of knowledge of degree college female students on bse . to determine the effectiveness of planned teaching program among degree college female students on bse . the study attempted to test following hypotheses all the hypotheses were tested at 0.05 level of significance . there will be a significant difference between pretest and post - test score on knowledge of bse among degree college female students.there will be a significant association between pretest knowledge score and selected demographical variables . there will be a significant difference between pretest and post - test score on knowledge of bse among degree college female students . the study assumed that : the degree college female students will have some knowledge on bse.feel free to express their attitude toward bse.bse helps in early detection of breast cancer . the degree college female students will have some knowledge on bse . feel free to express their attitude toward bse . independent variables : teaching program on bse . selected variables : age , education , parent 's education and exposure to mass media .

introduction : breast cancer accounts for 19 - 34 % of all cancer cases among women in india . there is high mortality due to late stage diagnosis as patients usually present at an advanced stage because of lack of awareness and nonexistent breast cancer screening programs . early detection and prompt treatment offer the greatest chance of long - term survival and breast self - examination ( bse ) seems to be a important viable optional substitute for early detection of cancer.objectives:1 ) to assess the level of knowledge of degree college female students on bse . 2 ) to determine the effectiveness of planned teaching program among degree college female students on bse . 3 ) to find the association between pretest knowledge and selected demographic variables.materials and methods : pre - experimental one group pretestpost - test design was carried out among 40 degree female students by using cluster sampling method from selected colleges of udupi district.results : the data analyzed showed that majority ( 52 % ) of them was in the age group of 18 - 19 years and 72 % of them were had average knowledge on bse in the pretest score . out of 40 participants only one student was performing bse occasionally.conclusions : awareness regarding breast self examination among young generations is useful and it is the most important viable tool for early detection .

migraine is the leading neurological cause for seeking medical care , and is associated with significant disability in the sufferer . the greatest impact is on migraineurs with headaches on more days than not , a condition defined as chronic migraine ( cm ) . cm is defined as at least 15 days of headache per month in which at least eight of the days fulfill migraine criteria and/or are treated with specific migraine medications , in the absence of a diagnosis of medication overuse headache . patients with cm often had a history of episodic migraine that began in adolescence or early adulthood , reporting a process of transformation marked by headaches that become more frequent over years . among migraineurs , defining risk factors for cm , or for the progression of episodic migraine to cm , identified risk factors include medication overuse , obesity , sleep problems , and psychiatric comorbidity [ 712 ] . studies in both community and tertiary settings have demonstrated an association between migraine and several psychiatric conditions [ 8 , 9 ] . however , the frequency of psychiatric disorders in both setting has not been compared before in a single study . furthermore , differences in methods of studies based in community or tertiary centers prevent appropriate comparison . population studies fail to conduct face - to - face assessments , while clinic - based studies carry the potential for selection bias . studies focusing on best methods to address this gap are of interest , and one strategy is to compare data obtained from the community with those from specialty care , where methods of collection have been virtually identical , and that was the scope of this study . we compared demographic data and psychiatric comorbidity in a sample of individuals with cm from the community with another from a tertiary care clinic . in light of the fact that patients suffering from migraine and comorbid psychiatric disorders are greater health - care service users , we hypothesized that the frequency of psychiatric disorders , notably depression , is higher in patients followed in tertiary care .

although the association between episodic migraine and psychiatric comorbidities is well documented , few studies have focused on the comorbidity with chronic migraine ( cm ) and discrepancies exist between population - based and clinic - based data . the objective of this study is to compare demographic and psychiatric comorbidity correlates between cm samples drawn from the community and tertiary care . all inhabitants from a city borough were interviewed for the presence of headaches occurring 15 or more days per month . cm was diagnosed after subjects had been interviewed and examined by a headache doctor . participants were also assessed with a structured interview by a psychiatrist , who assigned diagnoses based on the dsm - iv . the same investigators assessed all patients consecutively seen in a university - based outpatient headache center over a 4-month period . the samples consist of 41 individuals from the community and 43 from the headache center . sociodemographic profiles were similar between groups with the exception of the mean number of years of formal education . among individuals from the community , psychiatric diagnoses were present in 65.9 % of cases , relative to 83.7 % in those from the headache center ( p = 0.06 ) . phobias ( 41.9 vs. 29.3 % ) and depression ( 32.6 vs. 29.3 % ) were more frequent in patients from the headache center , but this difference did not reach statistical significance . thus the frequency of psychiatric disorders in patients with cm was elevated in both settings , being higher in the specialty care clinic .

small bowel obstruction ( sbo ) is one of the most feared complications after a gastric bypass . it can be chronic or acute and can range from a nuisance to the patient to a life - threatening emergency sbos related to adhesions occur after laparoscopic roux - en - y gastric bypass ( lgb ) , but ih formation , secondary to the reconstruction of the small intestine , is also of concern to bariatric surgeons . multiple defects in the mesentery of the bowel can occur and may lead to ih and , in an antecolic bypass , a defect is associated with the roux limb passing over the transverse colon . the reported incidence of sbo after lgb varies widely , perhaps because the technique used in the operation also varies widely , not only in placement of the roux limb , but regarding closure or nonclosure of the mesenteric defects . the disparity in reports leads to confusion regarding the true incidence and even the causes of sbo after lgb . in addition , the closure of mesenteric defects is questioned in a substantial body of literature . the objective of this study was to examine the incidence and characteristics of sbo after antecolic antegastric bypass with nonclosure of the mesenteric defect of the jejunojejunal ( jj ) anastomosis .

background and objectives : there is a wide variation of reported incidence of small bowel obstruction ( sbo ) after laparoscopic roux - en - y gastric bypass ( lgb ) . there is also wide variation in technique , not only in placement of the roux limb , but also regarding closure or nonclosure of the mesenteric defects . the objective of this study was to examine the incidence and characteristics of sbo after antecolic antegastric bypass with nonclosure of the mesenteric defect of the jejunojejunal anastomosis.methods : this is a retrospective review of a series of consecutive lgbs over a 3-year period . all procedures were performed by the same surgeon using the same technique . in no case was the mesenteric defect closed . a prospectively maintained database was used for data collection . patients who returned with an sbo were the study group , and those who underwent revisional bariatric surgery or conversion to open operation were excluded.results : there were 249 primary lgbs performed during the study period ; 15 of the operations were followed by sbo , for an incidence of 6.0 % . four cases were caused by an internal hernia ( ih ) , for an incidence of 1.6 % , and 11 were caused by adhesions , which accounted for 73 % of the sbos.conclusions : sbo after lgb is a relatively common complication . the incidence of sbo from ih with nonclosure of the mesenteric defect is similar to that in other series where the defect is closed . regardless of the cause of the sbo , operative treatment of the patient who has a gastric bypass remains the definitive standard and should not be delayed .

ionic calcium ( ca ) controls multiple cellular signaling processes in all eukaryotic cells , including proliferation , gene expression , and neurotransmitter release . ca - binding proteins such as calmodulin play a pivotal role in ca signal transmission and amplification . increases in the concentration of intracellular ca activate specific protein targets , among which the ca / calmodulin - dependent protein kinase ii ( camkii ) is a critical signal mediator . in response to an increase in intracellular ca , thr-286 of camkii the coupling of ca - calmodulin to one of the camkii subunits allows for the phosphorylation of an adjacent subunit at thr . calmodulin trapping , confers ca - calmodulin - independent kinase activity to the complex and thus prolongs the ca signal . thus , calmodulin trapping represents a molecular mechanism of memory , which is defined as the capacity to acquire , store ( consolidate ) , and retrieve ( evocate ) information . camkii is a major synaptic protein that is activated during the induction of long - term potentiation ( ltp ) by ca influx through n - methyl - d - aspartate ( nmda ) receptors . calmodulin trapping allows camkii to remain activated long after the initial ca signal has dissipated , suggesting that camkii is a memory molecule crucial for ltp . consistent with this notion , camkii - null mice present with impaired memory formation , and camkii is essential for genesis and maintenance of ltp in postsynaptic neurons . following presynaptic stimulation , camkii is activated in postsynaptic neurons , which creates a physiological imprint of the initial ca signal , and increases translocation of nmda receptors to the plasma membrane . because of its capacity to remain activated long after the initial pulse of ca signaling , camkii perpetuates ca effects and modulates gene expression and the epigenetic profile of postsynaptic neurons . camkii also participates in glucose - stimulated insulin secretion ( gsis ) , as multiple insulin secretagogues increase camkii activity . in the perfused rat pancreas , the dynamics of camkii activation correlate with the amplitude of gsis , and camkii activation is temporally associated with insulin secretion . camkii is essential for appropriate gsis and is involved in several steps of this process , including the synthesis of insulin granules , the modulation of cytoplasmic content of atp , and the activation of synapsin . importantly , camkii also regulates transcription factors central for - cell function such as creb and mafa . here , we investigated whether pancreatic - cells , like neurons , acquire and store the information contained in calcium pulses as a form of metabolic memory . indeed , we find that - cells retain memory of prior activation , and describe the molecular mechanism that contributes to this memory .

ca2+/calmodulin - dependent protein kinase ii ( camkii ) functions both in regulation of insulin secretion and neurotransmitter release through common downstream mediators . therefore , we hypothesized that pancreatic - cells acquire and store the information contained in calcium pulses as a form of metabolic memory , just as neurons store cognitive information . to test this hypothesis , we developed a novel paradigm of pulsed exposure of - cells to intervals of high glucose , followed by a 24-h consolidation period to eliminate any acute metabolic effects . strikingly , - cells exposed to this high - glucose pulse paradigm exhibited significantly stronger insulin secretion . this metabolic memory was entirely dependent on camkii . metabolic memory was reflected on the protein level by increased expression of proteins involved in glucose sensing and ca2 + -dependent vesicle secretion , and by elevated levels of the key - cell transcription factor mafa . in summary , like neurons , human and mouse - cells are able to acquire and retrieve information .

the centers for disease control and prevention ( cdc ) and united states preventive services task force ( uspstf ) recommend universal hiv screening for all pregnant women entering prenatal care [ 1 , 2 ] . this screening enables hiv - infected women and their infants to benefit from appropriate and timely interventions such as antiretroviral medications . when the recommended antiretroviral and obstetric interventions are used , a woman who knows of her hiv infection early in pregnancy now has a less than 2 % chance of delivering an hiv - infected infant . without intervention , this risk is approximately 25 % in the united states [ 36 ] . testing for hiv began in 1985 with the introduction of the enzyme immunoassay ( eia ) . in order to account for false positive results using screening tests in a low - prevalence population , confirmatory testing has been implemented using a western blot or immunofluorescence assay . in a low - prevalence population , the false positive rate using the eia is increased compared to a high - prevalence population , and the positive predictive value of any test will always depend on the prevalence of the condition in the population tested . in testing performed by the cdc , the eia positive predictive value ranges from 71 to 83 % in populations with hiv prevalence from 0.5 to 1 % . some investigators believe that the presence of alloantibodies account for the increased false positive rate associated with pregnancy , transfusions , transplantation , and autoimmune diseases . however , risk factors specific to pregnancy that account for this are poorly understood . conversely , a recent large retrospective study found that the false positive hiv eia rate was lower in pregnant women compared to nonpregnant individuals ( 0.14 % versus 0.21 % ) . our objective was to determine if any maternal characteristics correlated with false positive hiv eia testing at delivery .

objective . to examine risk factors for false positive hiv enzyme immunoassay ( eia ) testing at delivery . study design . a review of pregnant women who delivered at parkland hospital between 2005 and 2008 was performed . patients routinely received serum hiv eia testing at delivery , with positive results confirmed through immunofluorescent testing . demographics , hiv , hepatitis b surface antigen ( hbsag ) , and rapid plasma reagin ( rpr ) results were obtained . statistical analyses included pearson 's chi - square and student 's t - test . results . of 47,794 patients , 47,391 ( 99 % ) tested negative , 145 ( 0.3 % ) falsely positive , 172 ( 0.4 % ) positive , and 86 ( 0.2 % ) equivocal or missing hiv results . the positive predictive value of eia was 54.3 % . patients with false positive results were more likely nulliparous ( 43 % versus 31 % , p < 0.001 ) and younger ( 23.9 5.7 versus 26.2 5.9 years , p < 0.001 ) . hiv positive patients were older than false positive patients and more likely positive for hbsag and rpr . conclusion . false positive hiv testing at delivery using eia is associated with young maternal age and nulliparity in this population .

infertility is one of the crucial and critical events in sex life which engages 1015 % of couples all over the world , and as one of the most distressful life experiences , exposes couples to social and psychological problems . couples , who are faced with this critical situation , are prone to depression , anxiety , loss of self - esteem and dissatisfaction with their sex life more than others . however , the intensity of psychological problems resulting from cultural - social circumstances varies in different societies , to the point that the frequency of anxiety in infertile couples has been reported in a wide range from 48 % to 96 % . although , the advances in assisted reproductive techniques have opened new doors for infertile couples , but studies have shown that these treatments are accompanied with stress , anxiety and depression . but the intensity of these disorders could be defined by the cause of the infertility . evaluating the related factors of depression and anxiety among iranian infertile couples showed that women who were infertile themselves showed higher levels of anxiety and depression than women with male factor infertility . however , in societies that define women as the main source of fertility , starting assisted reproductive treatments with limited successful outcomes could be harmful to these women 's mental health . utilization of assisted reproductive techniques requires processes such as daily injection to stimulate ovulation , vaginal ultrasound and painful processes such as oocyte aspiration which are all too expensive and alongside with the fear of failure could become a harmful condition . although , fertile women , who start assisted reproductive treatments due to their husband 's infertility have natural biological conditions to get pregnant , but they have to tolerate these critical processes due to male factor infertility . also , women are under more cultural and social pressures . these conditions could affect the vulnerability of fertile women during assisted reproductive treatment ; therefore the aim of this study was to evaluate the effect of assisted reproductive treatments on fertile women 's mental health .

introduction : the process of assisted reproductive treatment is a stressful situation in the treatment of infertile couples and it would harm the mental health of women . fertile women who started infertility treatment due to male factor infertility have reported to experience less stress and depression than other women before the assisted reproductive process but considering the cultural and social factors and also the etiology of the assisted reproductive process , it could affect the metal health of these women . therefore , this study was conducted to evaluate the mental health of fertile women who undergo assisted reproductive treatment due to male factor infertility.materials and methods : this study was a prospective study on 70 fertile women who underwent assisted reproductive treatment due to male factor infertility . the exclusion criterion was to stop super ovulation induction . to assess mental health , anxiety and depression dimensions of the general health questionnaire were used . before starting ovulation induction and after oocyte harvesting , the general health questionnaire was filled by women who were under treatment . data were analyzed using multi - variable linear regression , paired t - test , and chi-square.results : the results showed that the mean score of depression and anxiety before ovulation induction and after oocyte harvesting were not significantly different ; but the rate of mental health disorder in the depression dimension was significantly decreased after oocytes harvesting ( 31.7 % vs. 39.7 % ) . also , there was a significant relation between the level of anxiety and depression before ovulation induction and after oocyte harvesting ( p < 0.05 ) . the anxiety level after oocyte harvesting had a positive and significant correlation with the economic situation ( p < 0.05 ) .conclusion : this study revealed that the process of assisted reproductive treatment does not affect the mental health in fertile women independently , but these women start assisted reproductive process with high levels of depression and anxiety . therefore , prior to the assisted reproductive treatment mental health consultation is needed .

erg protein expression has been recently suggested to be reflective of erg gene rearrangements in prostate cancer ( pca ) documenting remarkable concordance between the two [ 16 ] . the rearrangements between the androgen receptor - regulated gene tmprss2 ( 21q22.3 ) and members of the ets family member of transcription factor gene , most commonly erg ( 21q22.2 ) , are among the most common genetic alterations detected in prostate cancer [ 711 ] . erg gene rearrangements have been detected in roughly half ( 4060 % ) of pca of surgical cohorts compared to a rate of 12 % 15 % in incidental or watchful waiting cohorts [ 7 , 1218 ] . previous studies investigating the prognostic significance of erg gene rearrangements have revealed mixed results [ 1922 ] . however , it is becoming more evident that erg gene rearrangements signify a molecular subtype of pca . some studies investigating the significance of erg protein expression in localized pca failed to show association with adverse clinical outcome [ 23 , 24 ] . however , a recent report by our group demonstrated an association of erg expression with lethal disease in patients with unsuspected and advanced / castrate resistant disease who were treated by transurethral resection of prostate . moreover , we documented significant association between erg expression and both gleason score and tumor volume . studies from our group and others have also linked erg status to responsiveness to hormonal therapy , and longer progression time to castration resistant disease , compared to men with no erg expression [ 24 , 25 ] . in the current study , we investigated the association of erg protein expression to clinical - pathological parameters in a cohort of men with localized prostate cancer .

background . the prognostic significance of erg expression in prostate cancer ( pca ) has generated mixed results . we sought to investigate the prognostic significance of erg expression in a localized cohort of men with pca . material and methods . we investigated erg protein expression in a cohort of 198 men with localized pca . erg expression was correlated with patients ' clinical outcome and several pathological parameters , including gleason score ( gs ) , pathological stage , surgical margin , and extra - capsular extension . results . erg expression was detected in 86/198 ( 43.4 % ) patients exclusively in neoplastic epithelium . overall , erg mean expression intensity was 1.01 1.27 versus 0.37 0.83 in acinar pca compared to foamy type pca ( p < 0.001 ) . in hgpin , erg intensity levels were comparable to those in foamy type pca ( 0.13 0.56 ) but significantly lower than those in acinar pca ( p < 0.001 ) . erg expression was significantly associated with extra - prostatic extension and higher pathological stage and showed a trend toward seminal vesicle invasion . herein , erg expression was documented in 50/131 ( 38.1 % ) patients with pt2 versus 30/55 ( 54.5 % ) patients with pt3 ( p = 0.04 ) . erg association with higher pathological stage was more pronounced in patients with gs > 7 . grouping patients into those with gs 7 versus > 7 , there was no significant association between erg expression and gs . similarly , no association was present in relation to either surgical margins or postsurgical serum psa levels . conclusion . we report significant association between erg protein levels and extra - prostatic extension and higher pathological stage . erg expression is not associated with adverse clinical outcome and is of limited prognostic value in localized pca .

the three main arteries of the leg , the anterior tibial artery ( ata ) , posterior tibial artery and peroneal artery , form a dense vascular network around the distal leg , ankle , and foot , which ramifies perforators as the basis of all kinds of pedicle flaps such as lateral or medial malleolar perforator flaps . there is plenty of literature describing the anatomy and clinical application of perforators of the peroneal artery and posterior tibial artery around the distal lower leg . however , literature regarding perforator flaps of ata or anterior supramalleolar artery ( asma ) , one of the major branches of distal ata , are scant . these papers either mention the existence of the perforators from ata or asma , or describe their communication with the medial and lateral supramalleolar arteries . none of them have a detailed anatomical study on asma . the objective of this study was to identify the anatomic parameters of the asma and its perforators that would enable microsurgeons to harvest potentially multi - paddle flaps or composite flaps from the foot and ankle region . we try to preserve the ata intact after we harvest the composite flaps around the ankle using asma . we also want to use the ata as the only one pedicle and harvest multi - paddle flaps , decreasing the microsurgical risk greatly and minimizing the sacrifice of the blood supply to the ankle and foot .

purpose : a further understanding of the anterior supramalleolar artery ( asma ) and its potential applications in reconstructive surgery.materials and methods : a total of 24 fresh lower limbs from fresh cadavers were injected with red latex for dissection . the type of origin , course , diameter of the pedicle , and the distance between the origin of the asma from the anterior tibial artery to the extensor retinaculum ( o - r ) were recorded . bi - foliate fasciocutaneous flaps were harvested using the branches of the asma.results : we found four types of origin of the asma , and we have accordingly classified them into four types . 10 of them were type a , 7 were type b , 6 were type c and 1 was type d. the mean o - r ( origin of asma to retinaculum ) distance was 2.0 0.8 cm . the diameter of the medial branch ( d1 ) , the diameter of the lateral branch ( d2 ) , and the diameter of artery stem ( d3 ) ( only in type a ) were 1.0 0.2 mm , 0.8 0.3 mm , 1.1 0.2 mm , respectively . the mean pedicle length of the lateral flap ( l1 ) and medial flap ( l2 ) were 5.1 1.0 cm and 3.7 0.6 cm , respectively.conclusions : the asma exists constantly with four different types of origin . its sizable diameter and lengthy pedicle make it suitable for bi - foliate fasciocutaneous flap transfer .

ankle dorsiflexion passive range of motion ( df prom ) measurements are performed in the field of physical therapy to estimate ankle motion during functional activities1 and to prevent lower extremity injuries2 . although in the clinical setting , ankle df prom is frequently measured under non - weight - bearing ( non - wb ) conditions1 , 3 , 4 , many researchers have stated that the wb position is more appropriate for estimating the amount of ankle df motion during functional activities5 , 6 . therefore , wb ankle df prom should be measured during interventions focused on increasing ankle df prom . limited ankle df prom with knee extended may result from gastrocnemius tightness and insufficient posterior talar glide7 . thus , gastrocnemius stretching and talocrural joint mobilization have been performed as intervention strategies to increase ankle df prom3 , 8 , 9 . previous studies have reported a significant increase in ankle df prom after these interventions3 , 8 , 9 ; however , to our knowledge , no study has demonstrated the combined effect of both interventions on wb ankle df prom . therefore , the aim of the present study was to examine the influence of gastrocnemius stretching combined with joint mobilization on wb ankle df prom .

[ purpose ] the purpose of this study was to investigate the effect of gastrocnemius stretching combined with talocrural joint mobilization on weight - bearing ankle dorsiflexion passive range of motion . [ subjects ] eleven male subjects with bilateral limited ankle dorsiflexion passive range of motion with knee extended participated in this study . [ methods ] all subjects received talocrural joint mobilization while performing gastrocnemius stretching . ankle dorsiflexion passive range of motion was measured using an inclinometer under weight - bearing conditions before and immediately after intervention . a paired t - test was used to analyze the difference between weight - bearing ankle dorsiflexion passive range of motion pre- and post - intervention . [ results ] a significant increase in weight - bearing ankle dorsiflexion passive range of motion was found post - intervention compared with pre - intervention . [ conclusion ] these findings demonstrate that gastrocnemius stretching combined with joint mobilization is effective for increasing weight - bearing ankle dorsiflexion passive range of motion .

dox is one of the key chemotherapeutic drugs for cancer treatment , but its use is limited by chronic and acute toxic side effects . dox is an antibiotic anthracycline that was isolated from a pigment of streptomyces peucetius in the early 1960s and it had been employed for more than 30 years in the battle against cancer , but it is now chemically synthesized . renal dox - induced toxicity may be part of a multiorgan damage mediated mainly through free radical formation eventually leading to membrane lipid peroxidation . induction of apoptosis and modulation of nox are mechanisms that are involved in toxic adverse effects associated with dox therapy . in addition , dox has a direct renal damaging effect as it accumulates preferentially in the kidney . dox has toxic effects on other organs such as heart and liver which may lead to modulation of blood supply to the kidney and alter xenobiotic detoxification processes , respectively , thus indirectly contributing to dox - induced nephropathy . dia is a new anti - inflammatory , analgesic , and antipyretic drug that was developed specially for the treatment of osteoarthritis . it is highly effective in relieving the symptoms of osteoarthritis and may be able to modify the course of the disease . interleukin 1 is a proinflammatory and proapoptotic agent that induces cytokine production by activating nfb and mitogen activated protein kinase signaling . a major cause of dox - induced nephrotoxicity is the production of reactive oxygen species which induce cytokines , including interleukin 1 [ 6 , 9 , 10 ] . the aim of the present study was to study the effect of the interleukin 1 receptor antagonist diacerein ( dia ) on dox - induced nephropathy .

nephrotoxicity is one of the limiting factors for using doxorubicin ( dox ) . interleukin 1 has major role in dox - induced nephrotoxicity , so we investigated the effect of interleukin 1 receptor antagonist diacerein ( dia ) on dox - induced nephrotoxicity . dia ( 25 and 50 mg / kg / day ) was administered orally to rats for 15 days , in the presence or absence of nephrotoxicity induced by a single intraperitoneal injection of dox ( 15 mg / kg ) at the 11th day . we measured levels of serum urea , creatinine , renal reduced glutathione ( gsh ) , malondialdehyde ( mda ) , total nitrites ( nox ) , catalase , and superoxide dismutase ( sod ) . in addition , caspase-3 , tumor necrosis factor alpha ( tnf ) , nuclear factor kappa b ( nfb ) expressions , and renal histopathology were assessed . our results showed that dox - induced nephrotoxicity was ameliorated or reduced by both doses of dia , but diacerein high dose ( dhd ) showed more improvement than diacerein low dose ( dld ) . this protective effect was manifested by significant improvement in all measured parameters compared to dox treated group by using dhd . dld showed significant improvement of creatinine , mda , nox , gsh , histopathology , and immunohistochemical parameters compared to dox treated group .

these tumors are classified as typical net ( tnet ) , goblet cell carcinoid ( gcc ) , and atypical gcc histologies . ex - goblet or composite - goblet are further classified into signet ring cell carcinoid ( srcc ) and poorly differentiated adenocarcinoid of the appendix . these tumors have a distinctive morphology showing tight clusters of cells with compact nuclei and abundant intracytoplasmic mucin resembling goblet or signet ring cells often with admixed enterochromaffin cells . pathologic features of gcc include presence of large mucin filled cells with crescent nuclei arranged in small clumps or rosettes mixed with cells of typical carcinoid appearance that stain positive for chromogranin a . patients with tnet have a 5-year survival ranging from 60 % to 84 % , with the most common site of metastasis being the liver . on the other hand , atypical gcc have a more aggressive clinical course with an increased incidence of lymph node and distant metastases , along with a lower 5-year survival ranging from 36 % to 56 % [ 5 - 7 ] . current management of gcc and atypical gcc is based on very limited data from small single institutional experiences . the rarity of appendiceal net , gcc , and srcc limits the ability to conduct appropriate randomized clinical trials to explore the optimal management . to assess the role of clinicopathologic features in survival of net , gcc , and srcc patients , the outcome of cases reported to the national cancer institute s surveillance epidemiology and end results ( seer ) program was evaluated . furthermore , to characterize the management of net , gcc , and srcc , a treatment strategy based on results of current analysis , published literature and institutional experience is suggested .

purposeappendiceal tumors are a heterogeneous group of diseases that include typical neuroendocrine tumors ( tnet ) , goblet cell carcinoids ( gcc ) , and atypical gcc . atypical gcc are classified into signet - ring cell cancers ( srcc ) and poorly differentiated appendiceal adenocarcinoids . the prognosis and management of these diseases is unclear because there are no prospective studies . the aim of this study is to assess the characteristics and outcome of appendiceal tnet , gcc , and srcc patients.materials and methodsappendiceal tnet , gcc , and srcc patients diagnosed between 1973 and 2011 were identified in the surveillance epidemiology and end results ( seer ) database . demographics , type of surgery , and clinicopathologic characteristics were collected . survival functions were estimated by the kaplan - meier method , and log - rank test was used to assess the difference in overall survival ( os ) among the three histologies.resultsthe seer database yielded 1,021 tnet patients , 1,582 with gcc , and 534 srcc patients . tnet presented at a younger age ( p < 0.001 ) . patients with srcc presented with advanced stage disease ( p < 0.001 ) . the median os ( mos ) for gcc and tnet patients was not reached ; mos for srcc was 24 months . multivariate analysis stratified for stage revealed significantly longer survival for tnet and gcc than srcc ( p < 0.001 ) .conclusionthis is the largest report to date for appendiceal neuroendocrine tumor patients , suggesting a spectrum of diseases with different characteristics and outcomes . in this report , we present a treatment approach for this complex spectrum of disease , based on the experience of ohio state and emory universities investigators .

an estimated 170 million people worldwide have hepatitis c virus ( hcv ) infection and over 20,000 new cases emerge every year . hcv infection frequently persists and may cause cirrhosis and hepatocellular carcinoma . in the us and most developed nations , where the prevalence of infection is 1 % 2 % , hcv is the leading cause of chronic liver disease.1 hcv infection is a serious public health problem in egypt , and is the country with the highest hcv prevalence , where 10 % 20 % of the general population is infected.2 interferons are a group of glycoproteins that modulate the activity of the immune system . recombinant alpha - interferon ( ifn ) has recently been approved as a therapy for chronic hepatitis c , for its antiviral effects and inhibition of cell proliferation.3 although interferon - based therapy is widely used for the treatment of chronic hcv , it is not without its disadvantages . treatment duration lasts for months , and is often fraught with potentially dangerous side effects . some of these side effects , such as influenza - like illness , myalgias , depression , and cytopenias can be intolerable resulting in premature treatment cessation , but have no lasting effects . ocular complications are among the complications of interferon therapy and include retinal hemorrhages , cotton wool spots , loss of color vision , cataracts , glaucoma , and occasionally retinal artery or vein obstruction . although the incidence of ophthalmological disorders while on interferon therapy is low , this can result in loss of vision.411

purposeto evaluate retinopathy associated with interferon therapy in patients with chronic hepatitis c.methodsone hundred patients with chronic hepatitis c undergoing interferon therapy were examined for the presence of cotton wool spots , retinal hemorrhages , cystoid macular edema , capillary non - perfusion , and arteriolar occlusion . complete ophthalmological examination including indirect ophthalmoscopic fundus examination was carried out for all patients and colored fundus photography and fluorescein angiography were carried out for the patients with positive fundus findings . the follow - up period was 9 months.resultssixteen percent of patients developed retinopathy in the form of cotton wool spots , retinal hemorrhages , cystoid macular edema , and capillary non-perfusion.conclusioninterferon therapy can lead to retinopathy which is mostly reversible and dose related . periodic fundoscopic examinations help in early detection and prevent progression to permanent visual loss .

women require special need - based health care programs as they pass through the menopausal transition . with this vision , a multisystem multispecialty health check - up and follow - up care program ( maitreyi health care program [ hcp ] ) was initiated by our team about a decade ago , and this has been continued at the medical research center , kasturba health society , mumbai . the comparative effects of three plant products on perimenopausal symptoms , quality of life ( qol ) and clinical biochemistry have been reported by our group earlier . our observation of frequent mood changes and sleep disturbances in women in the premenopausal group prompted us to undertake a study of cyclic symptoms in maitreyi hcp . in this communication , we describe the preliminary findings from the analysis of premenstrual symptoms in 200 consecutive women who underwent a comprehensive check - up in the maitreyi hcp . diagnosis of premenstrual tension syndrome ( pmts ) is based on the following criteria as per the american association of obstetricians and gynecologists : a 30 % increase in the intensity of symptoms of premenstrual syndrome ( measured using a standardized instrument ) from cycle days 510 as compared with the 6-day interval before the onset of menses and documentation of these changes for at least two consecutive cycles . at least one of the following affective and somatic symptoms during the 5 days before menses in previous cycles . affective symptoms : depression , angry outbursts , irritability , anxiety , confusion , social withdrawal . somatic symptoms : breast tenderness , abdominal bloating , headache , swelling of extremities ; symptoms relieved from days 4 through 13 of the menstrual cycle . to determine the prevalence of premenstrual cyclic symptoms in women who attended the maitreyi hcp .

objective : to determine the prevalence of premenstrual cyclic symptoms in perimenopausal age.subjects and methods : women attending bhavan 's sparc maitreyi 's health care programme ( hcp ) for women around 40 years of age were included in the study . last 200 women who attended from april 2002 to october 2004 are included for analysis . out of these 107 qualified for final analysis as others were post hysterectomy or post menopausal . thirty five symptoms listed under premenstrual tension syndrome were analysed.results : forty one women ( 38.3 % ) had 3 or more symptoms whilst 15 ( 14.0 % ) had 5 or more cyclic symptoms . five women ( 4.7 % ) reported that the symptoms were severe . eleven women had seeked treatment for premenstrual tension syndrome ( pmts ) . the commonest symptom was mastalgia or heaviness of breasts . next was whilst also was reported by several women . women reported anger attacks and reported depression.conclusion : pmts was common between 36 and 55 years . about half of them have experienced 3 more symptoms and 1 in 20 may require treatment .

according to the korean national statistical office , the main cause of death in korea was cancer in 2012 . the total number of deaths due to cancer in 2012 was 267,221 , which was increased by 9,825 ( 3.8 % ) compared to 2011.1 this was the all - time high since 1983 . currently , the treatment of cancer patients in the medical field consists mainly of surgery , radiation therapy , and chemotherapy . seventy to eighty percent of cancer patients in chemotherapy experienced side effects such as anemia , the decreased number of white blood cells and/or platelets , oral mucositis , vomiting , diarrhea , hair loss , and disabled generative functions as chemotherapy also affects the rapidly proliferating normal cells.2 most side effects are temporary and patients recover fully ; but , some side effects may take months or years to completely disappear . to decrease side effects from non - specific cytotoxicity , new drugs , such as targeted agents , are being developed to selectively destroy specific cancer cells . however , because of problems , such as tolerance manifestation , partly critical toxicity , decrease in sensitivity , and restriction in subjects , new drugs take only a small portion of the cancer treatment realm.3 chemoprevention is defined as the use of nontoxic or relatively safe chemical substances , such as vitamins , plant extracts , and pharmaceuticals to prevent cancer . it is effective in decreasing cancer risk and is helpful in early stages of cancer.4 hence , regular consumption of anticancer foods that display no or little toxicity to the body and boost efficacy of anti - tumor drugs or stop the development of tolerance would be beneficial in preventing cancer . thus , consumption of plant - derived natural foods to prevent cancer with few side effects and toxicity is crucial.5 recently , there has been a growing interest in probiotics due to the discovery of multidrug - resistant organisms that are tolerant to antibiotics . probiotics is derived from a greek word meaning for life and holds the opposite meaning from antibiotics which means against life . probiotics consist of microorganisms and substances , which modify the intestinal microflora , and when used as dietary supplement they have positive effects on health such as fortification of host immune function , suppression of diarrhea , and inhibition of carcinogenesis.6 kimchi , a korean traditional food , is fermented by probiotic lactic acid bacteria.7 kimchi lactic acid bacteria are known to suppress the activity of carcinogen - activating enzymes , such as azoreductase , nitroreductase , 7 -- dehydrogenase , -glucosidase , and -glucuronidase and inactivate or neutralize the cancer - causing agents and pathogenic microbes.8 in addition , the intake of lactic acid bacteria as part of kimchi improves bowel movement , strengthens immunity , ameliorates hepatocirrhosis , and decreases serum cholesterol levels.9,10 among lactic acid bacteria identified during the fermentation of kimchi , weissella , lactobacillus , leuconostoc and pediococcus species are known to play an important role in kimchi fermentation.1113 this commentary deals with anticarcinogenic effects of kimchi and lactic acid bacteria , weissella cibaria and lactobacillus plantarum separated from kimchi , which are known to be predominant in kimchi .

the number of death due to cancer has been increasing in korea . chemotherapy is known to cause side effects because it damages not only cancerous cells but healthy cells . recently , attention has focused on food - derived chemopreventive and anti - tumor agents or formulations with fewer side effects . kimchi , most popular and widely consumed in korea , contains high levels of lactic acid bacteria and has been shown to possess chemopreventive effects . this review focuses on weissella cibaria and lactobacillus plantarum , the representatives of kimchi lactic acid bacteria , in terms of their abilities to prevent cancer . further studies are needed to understand the mechanisms by which lactic acid bacteria in kimchi prevent carcinogenic processes and improve immune functions .

a glomangioma is a benign vascular tumor derived from the glomus body , a specialized neuromyoarterial structure involved in thermal regulation . it is a subtype of the more generalized category of glomus tumors and should not be confused with the head and neck paragangliomas , such as the glomus tympanicum or glomus jugulare . it should also be distinguished from the glomangiopericytoma , the sinonasal type hemangiopericytoma , which displays different ultrastructural and histochemical characteristics.1 glomangiomas are most commonly found subungually and are exceedingly rare in the head and neck.2 they account for only 0.6 % of all nonepithelial tumors of the nasal cavity , nasopharynx , and paranasal sinuses.3 glomangiomas that induce paraneoplastic osteomalacia are even more uncommon , with only one case reported to date.4 while there are several documented cases of oncogenic osteomalacia ( oo ) caused by glomangiopericytomas,5 we present the second reported case of glomangioma - induced osteomalacia and the first case documented in english .

oncogenic osteomalacia ( oo ) is an uncommon but treatable cause of osteomalacia related to tumor production of fgf23 , usually caused by benign mesenchymal neoplasms . paranasal sinus glomangiomas are a rare cause of oo , with only one previously reported case . here we describe a second case ( first reported in english ) of paranasal sinus glomangioma - induced osteomalacia in a 42-year - old man . he presented with weakness and multiple spontaneous fractures , and was found to have an ethmoid sinus glomangioma with intracranial extension . the tumor was removed via endoscopic endonasal approach to the anterior skull base , which resulted in complete resolution of symptoms and no further evidence of disease 1 year postoperatively .

invasive mole is penetration of molar tissue ( complete or partial mole ) into myometrium or uterine vasculature ( 1 , 16 , 19 ) . pathologists mention the existence of villi in trophoblastic tissue ( 8 , 12 ) . locally invasive gestational trophoblastic neoplasia develops in 15 % of patients and metastatic form in 4 % of patients after evacuation of complete mole and infrequently after partial mole ( 2 ) . hcg level ( > 100000 miu / ml ) , excessive uterine enlargement , theca lutein cyst size 6 cm are considered as high risks for developing post molar tumors ( high risk mole ) ( 3 ) . the most common symptom of invasive mole is persistent vaginal bleeding after evacuation of molar pregnancy ( sub involution of uterus and persistent theca lutein cyst is another symptom ) . the rise in hcg titer is a laboratory test for diagnosis of invasive mole in follow up of molar pregnancy . although definite diagnosis of invasive mole is based on pathology ( 8 ) , with hcg or radiologic diagnosis ( 9 ) , invasive mole is diagnosed as well . in rare cases , metastasis occurred and the most common sites were lungs ( 80 % ) ( 4 ) , vagina ( 30 % ) , pelvis ( 20 % ) , liver ( 10 % ) , brain ( 10 % ) , bowel and kidney and spleen ( < 5 % ) were other metastatic sites . metastasis can occur from direct extension of another pelvic neoplasm or by hematogenous or lymphatic spread or by transcelomic dissemination . possibility of metastasis to ovary is extremely rare which is even much lower than that of nongestational primary ovary choriocarcinoma with an incidence of 1 in 3.710 ( 5 ) . invasive mole is curable with chemotherapy but hysterectomy decreases the need for multiple courses of chemotherapy and in patients with heavy bleeding or sepsis for control of complication and stabilization , chemotherapy is needed ( 6 , 11 ) . here a case with invasive mole after evacuation of molar pregnancy , presented with acute abdomen and in surgery metastasis to ovary and omentum and parametrium was detected .

background : invasive mole is responsible for most cases of localized gestational trophoblastic neoplasia . gestational trophoblastic disease describes a number of gynecologic tumors that originate in trophoblastic layer including hydatidiform mole ( complete or partial ) , invasive mole , choriocarcinoma , placental site trophoblastic tumor and epitheloid trophoblastic tumor . invasive mole may arise from any pregnancy event although in most cases is diagnosed after molar pregnancy . overall cure rate in low risk patients is nearly 100 % and in high - risk patient 90 % . in rare cases , molar tissue traverses thickness of myometrium and leads to perforation and acute abdomen and invasive mole infrequently metastasis . the best treatment option is chemotherapy ( according to stage and score with single or multiple agent ) and in patients that fertility is not the matter , hysterectomy can be done.case presentation : a 41 years old g3p2ab1 woman referred to firouzgar hospital 2 months after curettage of molar pregnancy with vaginal bleeding and acute abdomen . in workup , hcg 224000 miu / ml and evidence of metastasis was detected . chemotherapy due to stage 3 and score 9 and surgery due to acute abdomen was done . this case was reported for its rarity.discussion : this case reported about ovarian metastasis and uterine rupture with acute abdomen and involvement of omentum in metastatic invasive mole . lack of surveillance led to extensive morbidity . management of this patient was successful . in follow up , she was free of disease without sequel of any kind for five years now .

temporary henna tattoos or pseudotattoo have become increasingly widespread among children and adolescent , as a safe and economic alternative to permanent tattoos . it is well - known that allergic skin reactions to natural henna are rare , due to its extremely low rate of sensitization . in india , north of africa , china , and egypt , it is used in weddings and religious ceremonies ; in occident , it is used to dye hair and cosmetics . paraphenylenediamine ( ppd ) , a powerful allergen , is added to the henna tattoo mixtures ( black henna tattoo ) to decrease application time and intensify the color .

temporary henna tattoos or pseudotattoos have become increasingly widespread among children and adolescent . a generalized skin reaction , type erythema multiforme - like reaction is unusual , and rarely reported . we describe the case of a 7-year - old boy who reported erythematous papular bulls - eye shaped lesions and consolidated edema primarily in the upper and lower extremities . these lesions were compatibles with erythema multiforme - like reaction . he also showed an erythematous - eczematous lesion on his leg , shaped like a dolphin . in this area , a temporary henna tattoo was painted 1-month earlier . patch test was positive for paraphenylenediamine ( ppd ) . skin reactions due to henna are rare . most of the reactions are due to additives , especially ppd , an aniline derivative , which is added to speed up the process of skin dyeing and to give a darker brown to black color ( black henna ) . as henna tattoos are becoming increasingly popular , prevention requires the annual provision of information to consumers , especially young people and their parents .

the relation between chronic subclinical low - grade inflammation and insulin resistance ( ir ) has long been known [ 1 , 2 ] . ir is the major contributor and mediating factor in the development of type 2 dm ( t2 dm ) along with concomitant hypertension ( ht ) and cardiovascular disease ( cvd ) [ 3 , 4 ] . the relationship between the development of dm and some markers of inflammation such as c - reactive protein ( crp ) , il-6 , fibrinogen , and pai-1 has been described previously . serum concentration of crp increases in both impaired glucose tolerance ( igt ) and overt t2 dm [ 3 , 510 ] . on the other hand , some studies reported that elevation of crp is an indicator of development of t2 dm . compared with the conventional ogtt ( 2-hpg ) as recommended by who as gold standard , fasting plasma glucose ( fpg ) and hba1c are more convenient , simpler , and cost - effective diagnostic methods that are currently in use for the diagnosis of t2 dm [ 5 , 1217 ] . however , each test recognizes people with different metabolic features and groups who may be diagnosed by different tests but do not overlap substantially . while high postchallenge plasma glucose is a strong predictor of cvd , fasting glucose is not an independent predictor of cvd . to the best of our knowledge , there is no previous report specifically comparing the role of hs - crp in people with newly diagnosed dm with the criteria based on the 2-hpg , fpg , and hba1c . therefore , the aim of this study was to identify the optimal cut - off points of hs - crp in new - onset ( previously undiagnosed ) people with dm diagnosed based on the current 2-hpg , fpg , and hba1c diagnostic criteria . in this study , hs - crp results obtained from a nationally representative population - based survey are being reported .

fasting plasma glucose ( fpg ) and hemoglobin a1c ( hba1c ) have been used to diagnose new - onset diabetes mellitus ( dm ) in order to simplify the diagnostic tests compared with the 2-hour oral glucose tolerance test ( ogtt ; 2-hpg ) . we aimed to identify optimal cut - off points of high sensitive c - reactive protein ( hs - crp ) in new - onset dm people based on fpg , 2-hpg , or hba1c methods . data derived from recent population - based survey in turkey ( turdep - ii ) . the study included 26,499 adult people ( 63 % women , response rate 85 % ) . the mean serum concentration of hs - crp in women was higher than in men ( p < 0.001 ) . the people with new - onset dm based on hba1c had higher mean hs - crp level than fpg based and 2-hpg based dm cases . in hba1c , 2-hpg , and fpg based new - onset dm people , cut - off levels of hs - crp in women were 2.9 , 2.1 , and 2.5 mg / l [ 27.5 , 19.7 , and 23.5 nmol / l ] and corresponding values in men were 2.0 , 1.8 , and 1.8 mg / l ( 19.0 , 16.9 , and 16.9 nmol / l ) , respectively ( sensitivity 6065 % and specificity 5464 % ) . our results revealed that hs - crp may not further strengthen the diagnosis of new - onset dm . nevertheless , the highest hs - crp level observed in new - onset dm people diagnosed with hba1c criterion supports the general assumption that this method might recognize people in more advanced diabetic stage compared with other diagnostic methods .

optimal treatment of cancers in children often requires combined - modality therapy , including : chemotherapy , surgery , and/or radiotherapy . chemotherapy is not always sufficient to achieve the cure of solid tumors in children ; either resection or radiation may be needed for local tumor control as well ( 1 ) . children with radiosensitive malignant tumors typically require radiation therapy for a number of sessions over a period of several weeks . although the procedure is painless , young children need to be sedated or anesthetised in order to provide a motionless state during the procedure . a short period of sedation , analgesia or general anaesthesia the patient and anaesthesia equipment are observed continuously by closed - circuit television , and monitors are mirrored to the remote observation site outside the treatment room . different anesthesia methods and anesthetics have been recommended to provide a safe and optimal situation of motionless with a short recovery period in children undergoing general anaesthesia or sedation for external beam irradiation ( 37 ) . this report describes the accidental detection of a missed complication by the anesthetist at the time of radiotherapy , from the previous chemotherapy , which was preliminarily and unduly attributed to anesthesia .

treatment of cancer in children often requires a combination of chemotherapy , surgery , and/or radiotherapy . radiotherapy and chemotherapy are not painful processes , but children undergoing these procedures must be made motionless through anesthesia or sedation . there are a few reports of complications during these procedures in relation to the procedures themselves or to the anesthesia given . this report describes an unexpected pulseless radial artery which was preliminarily and unduly attributed to anesthesia . a 2.5 year - old male pediatric patient with an acute lymphoblastic leukaemia was scheduled for radiotherapy . anesthesia with intramuscular ketamine was induced before starting radiotherapy . about 5 minutes after injection of ketamine we found the right radial pulse undetectable . there was no other manifestation of hypoxia or hypo - perfusion . carotid pulsation was normal . examination of the left radial pulse and other peripheral pulses showed normal pulsation . the procedure was continued uneventfully . the next follow - up after radiotherapy , showed a scar and swelling on the right antecubital area , caused by extravasation of chemotherapeutic agent in the prior period of chemotherapy . doppler ultrasonography of the antecubital vein confirmed the diagnosis . this case study therefore demonstrates that proper intravenous cannula establishment before chemotherapy is of great importance . furthermore , accurate history and physical examination before induction of anesthesia or sedation may be useful in preventing mismanagement in pediatric cancer procedures .

annually , more than 2.5 million muslims from about 140 countries go on the hajj pilgrimage , which is the largest mass gathering in the world . the presence of such a vast number of people in the holy places , especially in the cities of mecca and medina , and the massive pilgrim crowds in certain places at certain times , causes infectious diseases to spread more easily . racial , cultural and health differences , as well as the level of access to health , medical and welfare services at the time of stay in these places are important factors that increase the risk of communicable diseases . both , viral or bacterial respiratory tract infections are very common among pilgrims in all age and sex groups , and is regarded as the most common disease among pilgrims in some reports . some studies have also reported the prevalence of different types of these infections up to 85.3 % . to prevent these infections , some preventive measures have been recommended for the pilgrims , such as mandatory injection of tetravalent meningococcal meningitis vaccine , recommendation to inject seasonal flu vaccine , and using surgical masks . on the other hand , each country plans and implements some specific measures to prevent and control these diseases among pilgrims . more than 100,000 iranians in about 600 caravans undertook the hajj in 2010 . according to the current policies of the hajj medical center of iran , before traveling any caravan common diseases detected among pilgrims are treated in the caravan itself , or referred to the medical center , if needed . the reports show conflicting results about the effects of preventive measures for respiratory tract infections and in fact , a precise study on the effects of each one of these preventive measures has been rarely done . this research is trying to examine the effects of general preventive measures on respiratory tract infections through a nested case - control study , which is more precise design than ordinary case - control studies .

background : respiratory tract infections are very common among the hajj pilgrims . some preventive measures including influenza vaccination , using face mask and salt water gargling have been considered to control these infections and the reports show conflicting results about the effects of each one of these measures . this study is trying to assess the effects of these recommendations on respiratory tract infections.methods : according to nested case - control design , in a cohort consisting of 338 iranian pilgrims , the outcome examined , was all types of respiratory tract infections other than common colds . with occurrence of any patient in convoy , data collection form was completed for that person . on the same day , two people were randomly selected as control group from among pilgrims who have not affected so far.results : during hajj , 32 pilgrims ( 9.5 % ) were affected by respiratory tract infections other than common colds . in univariable logistic regression analysis , salt water gargling ( or = 2.4 , p = 0.08 ) , existence of other patient in the room ( or = 2.14 , p = 0.19 ) , age over 60 years ( or = 1.84 , p = 0.15 ) and the education more than or equal to 3 years ( or = 1.93 , p = 0.16 ) were effective in the respiratory tract infections ( p < 0.2 ) . however , multivariable logistic regression analysis showed that none of the above mentioned factors are significantly associated with these infections.conclusions : this study showed that measures such as seasonal influenza vaccination , use of face masks and personal prayer carpet have no effect on the incidence of respiratory tract infections . however , washing throat and mouth with salt water can be considered the most effective preventive measures .

the irrevocable aim of endodontics is a three - dimensional unblemished seal of the root canal system which is achieved by perfect designing of the canal diameter and canal form . the biomechanical preparation is one of the major steps for removal of bacteria and debris in the root canal so as to achieve a successful endodontic treatment . during root canal instrumentation there are complications such as perforations , ledge formation , transportation of canal , and formation of cracks in the root dentin . at times , in the zeal of biomechanical preparation of the canal we inevitably end up damaging the root dentin , which becomes a gateway to dentinal cracks and minute intricate fractures ; thereby , causing failure of treatment . as a result of craze lines or microcracks , there might be occurrence of root fracture that propagates due to repeated application of stress by the occlusal forces . shemesh et al . , observed more dentinal defects in teeth which were obturated with spreader than teeth obturated without spreader . in different degrees , dentinal damage can occur due to procedures like biomechanical preparation , obturation , and retreatment . complexities in the preparation of root canal may be attributed to variation in the design of the cutting instrument , taper , or composition of the material from which it is made . hand instrumentation the milestone of endodontic practice in the past though have lost popularity , still remain the integral part of canal preparation . rotary instrument by its innate behavior in the canal may result in more friction , which may increase dentinal defects and microcracks formation in comparison to hand instruments . possible relationship between the design of niti rotary instruments and the incidence of the vertical root fractures was found by kim et al . , and it was concluded that the design of the file affects strain concentration and the apical stress during instrumentation of root canal . recently , the protaper next ( ptn , dentsply , maillefer ) files were introduced in the family of niti rotary instruments with a completely new design comprising of unique swaggering movement , greater flexibility , the m - wire technology , the 5 generation of continuous improvement , and its offset design . whether it is rotary or hand files ( hfs ) , they are assumed to cause limited frictional forces within the canal , hence creating dentinal defects . so there is need to study the behavior of different niti rotary instruments and the newly developed rotary system , ptn , on root dentin .

introduction : the objective of this study was to evaluate dentinal defects formed by new rotary system protaper next ( ptn ) .materials and methods : sixty single - rooted premolars were selected . all specimens were decoronated and divided into four groups , each group having 15 specimens . group i specimens were prepared by hand k - files ( mani ) , group ii with protaper universal ( pt ; dentsply maillefer ) , group iii with hero shaper ( hs ; micro - mega , besancon , france ) , and group iv with ptn ( dentsply maillefer ) . roots of each specimen were sectioned at 3 , 6 , and 9 mm from the apex and were then viewed under a stereomicroscope to evaluate presence or absence of dentinal defects.results : in roots prepared with hand files ( hfs ) showed lowest percentage of dentinal defects ( 6.7 % ) ; whereas in roots prepared with pt , hs , and ptn it was 40 , 66.7 , and 26.7 % , respectively . there was significant difference between the hs group and the ptn group ( p < 0.05 ) .conclusion : all rotary files induced defects in root dentin , whereas the hand instruments induced minimal defects .

since the introduction of extra - oral implants in reconstruction of craniofacial defects , achieving proper prosthesis retention has become more promising . these problems include ulceration of hard and/or soft tissues used for retention , lack of retention due to prosthesis movement , and tissue irritation caused by adhesives . the ideal position and number of implants for restoring orbital defects would be three non - linear implants in lateral , supraorbital , and infra - orbital rims . however , such implant arrangement is not always conceivable considering the extension of the defect , and bone quality and quantity of defect s walls . two of the most common retention systems used in reconstruction of orbital defects include freestanding abutments with magnetic retention and bar - clip retention . magnetic abutments are more common because they resolve the potential problems associated with bar - clip attachment including difficulty in insertion and removal of prosthesis by the patient , difficulty in regular hygiene measurements , and rigidity of the attachment resulting in implant overloading . however , magnetic attachment might not provide sufficient retention if implants have been placed adjacently . the presence of implant in the defective area might complicate the usual impression - taking procedures used in fabrication of conventional craniofacial prostheses . accuracy of the impression is affected by defect shape , retention system , number , and divergence of the implants . moreover , anatomical undercuts in the defect , and proximity or remoteness of the implants could complicate the impression - taking procedure . use of multiple trays , elastomeric impression materials , and dual impression technique have been suggested to overcome such problems [ 2,1214 ] . the purpose of this article was to present a case treated with an implant - supported prosthesis to reconstruct a relatively large orbital defect using three adjacent implants in the lateral orbital rim .

implant - supported craniofacial prostheses are made to restore defective areas in the face and cranium . this clinical report describes a technique for fabrication of an orbital prosthesis with three adjacent implants in the left lateral orbital rim of a 60-year - old woman . selection of appropriate attachment system ( individual magnetic abutments versus bar - clip attachment ) for implant - supported orbital prostheses depends upon the position of implants . bar - magnetic attachment has been selected as the retention mechanism in the present case .

alcoholic liver disease ( ald ) represents a spectrum of clinical illness and morphological changes that range from fatty liver , hepatic inflammation , and necrosis ( alcoholic hepatitis ) to progressive fibrosis ( alcoholic cirrhosis ) . many of the toxic effects of ethanol in the liver have been associated with its metabolism . ethanol oxidation generates toxic products such as acetaldehyde , and reactive oxygen species result in oxidative stress that initiates apoptosis and cell injury [ 25 ] . it is activated by endotoxin , cytokines , and oxidative stress . in unstimulated cells , nf-b is a heterodimeric complex that is sequestered in the cytoplasm by its interaction with ib family of inhibitors . when these cells are stimulated , ib is phosphorylated with subsequent release of nf-b resulting in the translocation of nf-b from the cytoplasm to the nucleus where it activates the expression of target genes [ 7 , 8 ] . activation of nf-b increased expression of proinflammatory cytokines and chemokines that were key factors in ethanol - induced liver injury rats [ 912 ] . peroxisome proliferators activated receptors gamma ( ppar ) is a family of ligand - activated nuclear transcriptional factor which regulates cell differentiation , apoptosis , lipid metabolism , and inflammation . more recently , decreased expression of ppar has been found in rats with alcoholic liver fibrosis . these suggested that ppar may play an important role in the development of hepatocellular inflammation , necrosis , and fibrosis in rats with ethanol consumption . curcumin ( diferuloylmethane ) , an antiinflammatory and antioxidant compound , is isolated from the rhizomes of the plant curcuma longa linn . importantly , it has been showed that curcumin suppressed the activation of nf-b in ethanol - induced liver injury in rats . activation of ppar by curcumin resulted in inhibition of nf-b trans activating activity and increased expression of ppar at both the transcriptional and translational levels in activated hepatic stellate cells ( hscs ) . however , it is unclear whether curcumin had any effect in early stage of ethanol - induced liver injury . therefore , the present study determined the effect of curcumin on early stage of ethanol - induced liver inflammation and improved pathology in rats .

to study the mechanism of curcumin - attenuated inflammation and liver pathology in early stage of alcoholic liver disease , female sprague - dawley rats were divided into four groups and treated with ethanol or curcumin via an intragastric tube for 4 weeks . a control group treated with distilled water , and an ethanol group was treated with ethanol ( 7.5 g / kg bw ) . treatment groups were fed with ethanol supplemented with curcumin ( 400 or 1 200 mg / kg bw ) . the liver histopathology in ethanol group revealed mild - to - moderate steatosis and mild necroinflammation . hepatic mda , hepatocyte apoptosis , and nf-b activation increased significantly in ethanol - treated group when compared with control . curcumin treatments resulted in improving of liver pathology , decreasing the elevation of hepatic mda , and inhibition of nf-b activation . the 400 mg / kg bw of curcumin treatment revealed only a trend of decreased hepatocyte apoptosis . however , the results of sod activity , ppar protein expression showed no difference among the groups . in conclusion , curcumin improved liver histopathology in early stage of ethanol - induced liver injury by reduction of oxidative stress and inhibition of nf-b activation .

student perception of their dental school experience is an essential measure of the success of dental education . undergraduates ' feedback and suggestions are very important for improving the curriculum and learning process . this information also helps determine the students ' preferences regarding different elements of their educational experience . endodontics teaching can be considered complex , difficult , and stressful because of the complex anatomy of the root canal system , responsibility toward patients , and low self - confidence . however , teaching endodontics in recent years has improved as a result of the development of knowledge , techniques , and materials . dental students at taibah university , saudi arabia , take a preclinical full - year endodontic course in the 3 year of their 6-year bachelor of dental surgery degree . the course consists of 28 h of theoretical lectures and 28 3-h laboratory sessions , during which they perform technical aspects of root canal treatment on extracted single- and multi - rooted teeth . there is a one - semester clinical endodontic course in the 4 year that consists of 14 theoretical lectures and fourteen 3-h clinical sessions during which students treat single- and multi - rooted teeth . in the 5 year , endodontic treatments are performed as part of a comprehensive dentistry care course under the supervision of specialists . this study examined the endodontic experiences , perceptions of endodontic practice , and self - rated confidence of dental students enrolled in taibah university , saudi arabia .

objective : this study examined the endodontic experience , perceptions of endodontic practice , and self - rated confidence of dental students enrolled in taibah university , saudi arabia.materials and methods : a questionnaire was distributed to 41 undergraduate dental students registered in endodontic courses in the 2015 academic year . the questionnaire evaluated their confidence performing nonsurgical root canal treatment . the level of confidence was classified using a 5-point scale as very confident , confident , neutral , not very confident , or not at all confident . the data were analyzed using spss version 20.0 ( spss , chicago , il , usa ) .results : the participation rate was 93 % . the maxillary incisor was the most common first tooth treated . the students were relatively confident , but their confidence levels were lower regarding endodontic radiology , evaluation of root canal obturation , and determining the correct recall period for the patient.conclusion : the confidence of undergraduates in endodontics must be enhanced to increase their clinical competence when performing root canal treatment .

with the worldwide spread of mycobacterium tuberculosis ( mtb ) strains resistant to both isoniazid and rifampicin ( rif ) , multidrug - resistant ( mdr ) tuberculosis ( tb ) has become a major public health problem posing formidable challenges due to its complex diagnostic and treatment requirements . this highlights the need for having rapid molecular diagnostic techniques which could help facilitate early diagnosis and appropriate delivery of anti - tubercular therapy . xpert mtb / rif assay ( cepheid ) , a real - time automated nucleic acid amplification system is one such technique which detects mtb as well as mutations that confer resistance to rif in > 2 h. it was installed in our institute ( guru gobind singh medical college and hospital , faridkot ) in october 2013 under revised national tuberculosis control programme ( rntcp ) tb xpert project supported by who - stop tb partnership - unitaid . rif is a principle first line anti - tb drug and rif resistance is a surrogate marker for mdr - tb . the genetic basis of rif resistance ( in approximately 95 % cases ) is the presence of mutations in 81 bp rif resistance determining region ( rrdr ) of the rpob gene , corresponding to codons 507533 ( escherichia coli numbering system ) , which codes for a beta subunit of rna polymerase of mtb . studies conducted in diverse geographical areas have shown that the burden of mdr - tb and the mutations responsible for drug resistance vary from country to country and region to region . however , there is not enough of information about this important aspect from north india and the data from malwa region of punjab is almost lacking . therefore , this retrospective study was conducted to determine the frequency of rif resistance and rpob gene mutations among the suspected tb / mdr cases of malwa region of punjab ( districts : faridkot , fazilka , firozpur , moga , bathinda , and muktsar - area approximately 14,981 km ) , using xpert mtb / rif assay . knowledge of the pattern of mutations present in rif - resistant isolates could provide insight into the epidemiology of rif - resistant mtb isolates of this particular area .

background : xpert mtb / rif assay has revolutionized the diagnosis of tuberculosis ( tb ) by simultaneously detecting the bacteria and resistance to rifampicin ( rif ) , a surrogate marker for multidrug - resistant tb ( mdr - tb ) in < 2 h. the rif resistance pattern in malwa region of punjab , india , is not documented . here , we report the epidemiology of rif - resistant tb and mutations in rpob gene of mycobacterium tuberculosis ( mtb ) .materials and methods : a total of 1612 specimens received between october 2013 and february 2015 were tested by xpert mtb / rif assay following manufacturer 's instructions . the results thus obtained were analyzed using spss version 20.0.0 ( spss inc . , chicago , il , usa ) statistical software.result : rif resistance was statistically higher in previously treated patients in comparison to the new patients ( p = 0.006 ) and in patients with acid fast - bacilli ( afb ) positive smears to afb - negative smears ( p = 0.048 ) . rif resistance mutations in 130 specimens revealed frequency of e 73/130 ( 56 % ) , b 28/130 ( 21.5 % ) , d 18/130 ( 13.8 % ) , a 11/130 ( 8.4 % ) , and c 1/130 ( 0.7 % ) while in one specimen , mutation combination , i.e . , mutations associated with more than one probe ( a and b both ) was present.conclusion : xpert mtb / rif assay is a user - friendly screening tool for detection of mtb and rif resistance from suspected tb / mdr cases in a shorter period of time . it could also serve as a useful technique to have simultaneous preliminary information regarding the mutation pattern of rif resistance in mtb isolates .

the long - term use of immunosuppressive agents for prevention of allograft rejection increases the risk of malignancy approximately 100 times as high as that in the general population . the prevalence rate of post - transplant malignancies in total differs between geographical areas ; for example , in europe , that rate is 1.6 % and in australia is 24 % , with a mean of 6 % . skin cancers , mostly squamous cell carcinoma ( scc ) , are the most common tumors among persons have solid organ transplantation . but , however , iranian studies found that the most common malignancy after kidney transplantation was kaposi sarcoma ( ks ) among the iranian patients . ks is a skin tumor of multicentre origin , characterized histologically by endothelium - lined vascular spaces and spindle - shaped cells . ks presents as single or multiple lesions on mucosal surfaces , including the skin , lungs , gastrointestinal tract and lymphoid tissues . the etiopathogenes of ks is complex and poorly understood , but is almost certainly dependent on human herpes virus type 8 ( hhv -8 ) infection in immunosuppressed , immunogenetically susceptible individuals . although the treatment of ks is controversial , it should ideally address these pathogenic issues . the current guideline is reduction of immunosuppression as first - line treatment , but these recommendations are based on anecdotal experience or uncontrolled studies . perhaps the most fundamental controversy that has implications for all aspects of the disease surrounds the nature of ks : i.e . whet her it is a true malignancy or reversible hyperplasia . the aim of present study was to investigate the frequency of ks in patients with kidney transplantation in 21 years period .

introductionthe long - term use of immunosuppressive agents for prevention of allograft rejection increases the risk of malignancy approximately 100 times as high as that in the general population and kaposi 's sarcoma ( ks ) is a relatively common malignancy after kidney transplantation . the aim of present study was to investigate the frequency of ks in patients with kidney transplantation in 20 years period.material and methodsin this study charts and pathology reports of 1487 recipients for kidney allografts treated at imam reza hospital between 1991 and 2012 were reviewed . the spss software package version 16 ( spss inc . , chicago , illinois , usa ) was used for the statistical analysis.resultsthere were 17 of 1487 incident cases of ks kidney transplant population at our hospital in period of study . there is no significant difference between age and gender of patients . the mean time between transplantation and non - ks malignant tumors was 34.4 21.8 months ( range 12140 months ) , while in ks patients it was 18.7 25.2 months , which was statistically significantly different ( p < 0.05 ) . after detection of ks in 12 patients , we perform serum antibody detection against hhv . among them , 8 ( 66.6 % ) were seropositive.conclusionks is a common long - term complication in renal transplant recipients , with an increased incidence compared with the general population . given that candidates for organ transplantation who are seropositive for hhv-8 -and thus at risk for ks- can now be identified , chemoprevention should be available in this high - risk population .

forensic odontology has established itself as an important and often indispensible science in medicolegal matters and identification of the dead . the forensic importance of dental tissue has been well recognized because tooth is the hardest of all human tissues . they are well preserved for a long period even after death , hence dental remains are the most stable biological evidence encountered in crime cases and yield useful information . blood grouping has been one of the major factors for identification of biological materials in forensic investigations and is a widely used technique in forensic laboratories . the presence of abo blood group and rhesus factor is applied to inherited antigens detected on red cell surface by specific antibodies . once the blood group and rhesus factor are established , it remains unchanged throughout life . kind in 1960 discovered the presence of abo blood group in saliva by absorption - elution ( ae ) method . blood grouping from dried stain by elution procedure was described more than 50 years ago but not employed widely in forensic serology , until 1960 , when kind refined this technique . ae technique / procedure originally devised by siracusa is now employed in all forensic laboratories because it is proven to be most sensitive , reliable and reproducible . pulp tissue is one of the most protected tissues being surrounded from all sides by dental hard tissues . pulp contains numerous blood vessels and blood group antigens are certainly present in tooth pulp . the distribution of abo substances from the pulp cavity wall to the dentin edge and the enamel gradually reduces , because of fewer possibilities of diffusion of antigens from both blood and saliva . the existence of blood group antigens in tooth dentin and enamel and their nature has been substantiated by infusion sedimentation phenomena combined with inherently present antigens . this theory describes the infusion of water - soluble antigens from saliva into the tooth tissue . the presence of abo blood group and rhesus factor antigen in soft and hard dental tissues makes a possible contribution in human identification even in decomposed bodies . therefore , blood group and rhesus factor determination for biological evidence on tooth material is of great importance in forensic odontology . the aim of this study was to determine the abo blood grouping and rhesus factor from dentin and pulp of extracted teeth using ae technique at 0 , 3 , 6 , 9 and 12 months after extraction .

objective : the aim of the study was to determine blood groups and rhesus factor from dentin and pulp using absorption - elution ( ae ) technique in different time periods at 0 , 3 , 6 , 9 and 12 months , respectively.materials and methods : a total of 150 cases , 30 patients each at 0 , 3 , 6 , 9 and 12 months were included in the study . the samples consisted of males and females with age ranging 1360 years . patient 's blood group was checked and was considered as control . the dentin and pulp of extracted teeth were tested for the presence of abo / rh antigen , at respective time periods by ae technique.statistical analysis : data were analyzed in proportion . for comparison , chi - square test or fisher 's exact test was used for the small sample.results : blood group antigens of abo and rh factor were detected in dentin and pulp up to 12 months . for both abo and rh factor , dentin and pulp showed 100 % sensitivity for the samples tested at 0 month and showed a gradual decrease in the sensitivity as time period increased . the sensitivity of pulp was better than dentin for both the blood grouping systems and abo blood group antigens were better detected than rh antigens.conclusion : in dentin and pulp , the antigens of abo and rh factor were detected up to 12 months but showed a progressive decrease in the antigenicity as the time period increased . when compared the results obtained of dentin and pulp in abo and rh factor grouping showed similar results with no statistical significance . the sensitivity of abo blood grouping was better than rh factor blood grouping and showed a statistically significant result .

septic internal jugular vein - sigmoid sinus thrombosis is a rare condition that complicates local and regional infectious inflammatory processes occurring in the head and neck . these include deep neck infections , lemierre syndrome , and central venous catheterization ( cvc ) or cannulation17 ) . this is a life - threatening condition and prompt management is essential to decrease the potential for thrombosis - related morbidity and mortality . we report a case of internal jugular vein - sigmoid sinus thrombosis due to a misplaced central venous catheter .

septic internal jugular vein - sigmoid sinus thrombosis ( ijv - sst ) associated with a malpositioned central venous catheter is a rare condition . it is potentially life - threatening and necessitates early diagnosis and rapid administration of appropriate medications . unfortunately , it is difficult to diagnose due to vague clinical presentations . several studies such as ct , mri , and cerebral angiography should be performed and carefully examined to help make the diagnosis . we report a case of septic ijv - sst due to a malpositioned central venous catheter .

they are also used to treat multiple myeloma , bone metastases , and calcium disorders 2 . these patients reportedly often develop bisphosphonaterelated osteonecrosis of the jaw ( bronj ) that is caused by subsequent dental surgery 3 , 4 . in general , it is thought that nitrogencontaining bisphosphonates are much high risk of osteonecrosis than nitrogen notcontaining bisphosphonates . thus , medications for cancer , such as zoledronate ( zometa ) , are thought to have much high risk of osteonecrosis than medications for osteoporosis , such as alendronate ( bonalon ) 5 . besides bisphosphonates , other antiresorptive agents such as denosumab and antiangiogenic medications also cause osteonecrosis 6 . thus , the american association of oral and maxillofacial surgeons position paper published in 2014 and the committee recommended changing the nomenclature of bronj to the term medicationrelated osteonecrosis of the jaw ( mronj ) to accommodate the growing number of jaw osteonecrosis cases associated with other antiresorptive and antiangiogenic therapies 7 . according to the position paper , there are three categories of risk factors for mronj : ( 1 ) medicationrelated risk factors ( e.g . , bisphosphonate use ) , ( 2 ) local factors ( e.g . , dental surgery ) , and ( 3 ) demographic and systemic factors and other medication factors . in this case report , the patient developed mronj and died of sepsis , although he received shortterm oral bisphosphonate therapy and had not received any dental surgical treatment because he was completely edentulous . however , he had many systemic factors such as diabetes , cirrhosis , and steroid use for interstitial pneumonia . the presence of multiple systemic factors can be a very high risk for mronj , even though there are few medicationrelated factors and local factors 8 , 9 , 10 .

key clinical messagemedicationrelated osteonecrosis of the jaw ( mronj ) is developed even in the patients who are edentulous and treated with shortterm bisphosphonate therapy and oral administration . it sometimes causes lethal sepsis in patients who have multiple health problems such as diabetes , cirrhosis , steroid use for interstitial pneumonia , sepsis , and spinal disk herniation .

the function of sensory receptors ( nrec ) in the movement control , muscle coordination and perception of the space position of temporo - mandibular joint ( tmj ) is fundamental although the presence of nrec in the tmj is still debated : some authors have reported on the lack of nervous fibers in the articular disk 1,2 , while florid innervation of tmj has been reported in several studies on animal models and in human 3 - 6 which suggested that 6 the concentration of sensory receptors within tmj is higher in the areas supporting higher strong tensions during articular movements ( chewing , biting , speaking ) . in discordance , other authors disclosed the presence of mechanical nrec in the articular disk of human tmj 7,8 also distinguishing receptors in capsulated and uncapsulated on the bases of morphological features . the aim of this study is to ascertain the presence and the distribution of nrec in human tmj by using of immunohistochemical investigations in healthy and pathological tmj such as arthritis and arthrosis . the study was approved by the bioethics committee of the department of odontology and surgery of university of bari .

aim : a study was performed on the articular disk and periarticular tissues of the temporo - mandibular joint ( tmj ) with immunohistochemical techniques to give evidence to the presence of neuroreceptors ( nrec ) in these sites . methods : the study was carried out on tissue samples obtained from 10 subjects without tmj disease and from 7 patients with severe tmj arthritis and arthrosis . we use antibodies directed against following antigens : gliofibrillary acidic protein ( gfap ) , leu-7 , myelin basic protein ( mbp ) , neurofilaments 68 kd ( nf ) , neuron specific enolase ( nse ) , s-100 protein ( s-100 ) and synaptophysin ( syn ) . results : this study revealed that ruffini 's - like , pacini 's - like and golgi 's - like receptors can be demonstrated in tmj periarticular tissues and that free nervous endings are present in the subsynovial tissues but not within the articular disk . we observed elongated cytoplamic processes of chondrocytes that demonstrated strong s-100 immunoreactivity but they were unreactive with all other antibodies . these cytoplamic processes were more abundant and thicker in the samples obtained from patients with disease tmj . conclusion : the results of this study confirm that different nrec are detectable in tmj periarticular tissues but they are absent within the articular disk . in the latter site , only condrocytic processes are evident , especially in diseased tmj , and they might have been confused with nervous endings in previous morphological studies . nevertheless the absence of immunoreactivity for nf , nse and syn proves that they are not of neural origin .

milrinone , a phosphodiesterase iii inhibitor currently used to treat pediatric patients with cardiac diseases , increases the level of cyclic adenosine monophosphate in the myocardium and vascular smooth muscle . high levels of cyclic adenosine monophosphate enhance the contractility of the myocardium by increasing calcium influx and relaxing vascular smooth muscles,1 ) therefore increasing cardiac output and decreasing afterload . milrinone also has a lusitropic property , which improves myocardial relaxation.2 ) unlike other inotropes such as dopamine , dobutamine , and epinephrine , milrinone is not associated with an increase in myocardial oxygen consumption.3 ) milrinone is widely used due to its inotropic , vasodilatory , and lusitropic properties . it is frequently prescribed after cardiac surgery due to its efficacy in preventing low cardiac output syndrome.4 ) milrinone is also commonly administered to pediatric patients with myocarditis as a bridge therapy for patients with heart failure who are waiting for cardiac transplantation.5 ) 6 ) milrinone has been shown to improve heart contractility in patients with septic shock.7 ) milrinone is currently one of the most commonly used off - label cardiovascular medications in children.8 ) although a few reports showed the efficacy and safety of short - term milrinone treatment ( for about 35 hours ) in children with heart disease,9 ) 10 ) the safety and efficacy of long - term use of milrinone in children is limited due to a lack of sufficient evidence - based studies in pediatric populations . currently , milrinone is widely used for 3 days , which is usually based on extrapolation from studies in adults or clinical experience . therefore , the objective of this study was to evaluate the safety and efficacy of the current pattern of milrinone administration for 3 days in pediatric patients .

background and objectivesmilrinone is often used in children to treat acute heart failure and prevent low cardiac output syndrome after cardiac surgery . due to the lack of studies on the long - term milrinone use in children , the objective of this study was to assess the safety and efficacy of the current patterns of milrinone use for 3 days in infants and children with heart diseases.subjects and methodswe retrospectively reviewed the medical records of patients aged < 13 years who received milrinone for 3 days from january 2005 to december 2012 . patients ' characteristics including age , sex , height , weight , and body surface area were recorded . the following parameters were analyzed to identify the clinical application of milrinone : initial infusion rate , maintenance continuous infusion rate , total duration of milrinone therapy , and concomitantly infused inotropes . the safety of milrinone was determined based on the occurrence of adverse events such as hypotension , arrhythmia , chest pain , headache , hypokalemia , and thrombocytopenia.resultswe assessed 730 admissions ( 684 patients ) during this period . ventricular septal defects were the most common diagnosis ( 42.4 % ) in these patients . milrinone was primarily used after cardiac surgery in 715 admissions ( 97.9 % ) . the duration of milrinone treatment varied from 3 to 64.4 days ( 7 days in 149 admissions ) . ejection fraction and fractional shortening of the left ventricle improved in patients receiving milrinone after cardiac surgery . dose reduction of milrinone due to hypotension occurred in only 4 admissions ( 0.5 % ) . although diverse arrhythmias occurred in 75 admissions ( 10.3 % ) , modification of milrinone infusion to manage arrhythmia occurred in only 3 admissions ( 0.4 % ) . multivariate analysis indicated that the development of arrhythmia was not influenced by the pattern of milrinone use.conclusionmilrinone was generally administered for 3 days in children with heart diseases . the use of milrinone for 3 days was effective in preventing low cardiac output after cardiac surgery when combined with other inotropes , suggesting that milrinone could be safely employed in pediatric patients with heart diseases .

brown - squard syndrome ( bss ) , which occurs due to dysfunction of the spinothalamic tract , typically reflects the hemisection of the spinal cord at the cervical or thoracic level . the syndrome mainly occurs as a result of penetrating trauma , syringomyelia , hematomyelia , tumor , severe discs , or blunt trauma . among the multiple etiologies , the most common cause is penetrating trauma , such as a gunshot7,8 ) . therefore , most management guidelines focus on penetrating cervical injuries and/or vertebral artery ( va ) injury12 ) . non - missile penetrating spinal cord and va injuries are rare because of the bony structures that protect the spinal cord and va14 ) . thus , the treatment approach for wounds caused in non - missile penetrating spinal injuries such as a knife , a power drill bit , or even a pen could be different from common missile penetrating injuries5,6,13,17 ) .to our knowledge , there are few reports in the literature of complete obstruction of the va due to penetration of a foreign body through the neural foramen into the spinal canal . herein , the authors report on va dissection and bss caused by penetration of an electric screw driver bit .

there are few reports in the literature of complete obstruction of the vertebral artery ( va ) due to an electric screw driver bit penetration through the neural foramen into the spinal canal with brown - squard syndrome ( bss ) . a 25-year - old man was admitted to the emergency department with a penetrated neck injury by an electric screw driver bit after a struggle . the patient presented the clinical features of bss . computed tomography scan revealed that the electric screw driver bit penetrated through the right neural foramen at the level of c3 - 4 , and it caused an injury to the right half of the spinal cord . emergent angiography revealed va dissection , which was managed by immediate coil embolization at both proximal and distal ends of the injury site . after occlusion of the va , the electric screw driver bit was extracted under general anesthesia . bleeding was minimal and controlled without difficulties . no postoperative complications , such as wound dehiscence , csf leakage , or infection , were noted . endovascular approaches for occlusion of vertebral artery lesions are safe and effective methods of treatment .

vogt - koyanagi - harada disease ( vkh ) is a granulomatous inflammatory disorder affecting the eyes , auditory system , meninges , and skin [ 1 , 2 ] . it is one of the most common causes of uveitis in asia and accounts for approximately 16 % of all uveitis cases in china . clinically , vkh is divided into four stages : prodromal , acute , convalescent , and chronic recurrent . exudative retinal detachment is a common cause of visual function impairment among vkh patients , but secondary alterations in retinal morphology and function also occur [ 5 , 6 ] . due to advancements in retinal imaging , such as fundus autofluorescence ( faf ) [ 7 , 8 ] and optical coherence tomography ( oct ) [ 9 , 10 ] , important clinical insight into the pathophysiology of the retina can be achieved noninvasively . recent studies report a significant association of the inner segment ( is ) /os junction and the cone outer segment tips ( cost ) line in various retinal diseases with visual function [ 1113 ] . however , the majority of previous studies have used best corrected visual acuity ( bcva ) as a measure of visual function . recently , microperimetry was found to provide a more comprehensive assessment of macular sensitivity and functional changes in the macula [ 14 , 15 ] . we investigated the characteristics of late - stage vkh via oct , especially photoreceptor microstructure integrity and its potential correlation to visual function .

purpose . to characterize the optical coherence tomography ( oct ) findings in late - stage vogt - koyanagi - harada ( vkh ) disease and its correlation with visual function . methods . the records of patients with late - stage vkh disease ( defined as 12 months from disease onset ) were retrospectively reviewed . the analysis focused on the oct findings and microperimetry , in addition to the possible correlation between morphology and functional findings . results . twenty - nine patients ( 58 eyes ) were included . mean age at onset was 34.24 10.67 years . the oct revealed that the outer retina and retinal pigment epithelium ( rpe ) were mainly affected . these effects included rpe thickening and breakage or disappearance of the cone outer segment tip ( cost ) line and/or inner segment / outer segment ( is / os ) junction . the cost line and is / os results were related to macular function and the interval between symptom onset and initiation of high - dose corticosteroid treatment ( all p < 0.01 ) . eyes with intact cost lines demonstrated intact is / os and normal rpe layers as well as better visual function and normal retinal sensitivity . conclusions . the oct findings are strongly correlated with macular function , as well as other clinical findings in late - stage vkh . with respect to the cost line and retinal sensitivity especially , the oct and microperimetry findings may be useful for evaluating later - stage vkh .

the emergency department ( ed ) is known to be one of the most congested units in any hospital that faces greater pressure in terms of patient load and health care resources as compared to other departments of the health care system . studies across various countries reported that quality of care decreases when the ed is overcrowded . overcrowding can result in delayed treatment , long patient waiting time and stay , overburdened working staff , patient elopement , high medical error rate , low productivity and poor patient outcomes . an efficient patient flow system serves critical patient quickly minimizing unnecessary delay in treatment . on the other hand , a patient arriving in the ed encounters repeated waits as he / she progresses in different stages , which may last for hours or even days . waiting time has been often cited as the most important cause of patients dissatisfaction in the ed . cooke cited reduction of waits as the most important area for improvement in ed . delays in the process have been associated with adverse outcome and increased violence in eds . waiting time in turn depends on multiple factors including volume of patients and workload on existing staff . if the outflow of patients from ed ( either by means of transfer out or by discharge ) is obstructed , this upstream bottleneck will also cause delays in the treatment . the present study was conducted to assess the patient flow system by assessing the arrival time pattern and waiting time distribution of patient in the ed of a tertiary health care institute of india . by understanding flow trends , hospital administrators can streamline processes to minimize wait times , improve efficiency , reduce overcrowding in the emergency out patient department ( eopd ) and in turn improve patients satisfaction .

background : emergency department ( ed ) of tertiary health care institute in india is mostly overcrowded , over utilized and inappropriately staffed . the challenges of overcrowded eds and ill - managed patient flow and admission processes result in excessively long waits for patients.aim : the objective of the present study was to analyze the patient flow system by assessing the arrival and waiting time distribution of patients in an emergency out patient department ( eopd ) .materials and methods : this short cross - sectional descriptive study was conducted in the eopd of a tertiary level health care institution in north india in the month of may , 2011 . the data was obtained from 591 patients , who were present in the eopd during the month of may , 2011 . the waiting time , inter arrival time between two consecutive patients were calculated in addition to the daily census data ( discharge rate , admission rate and transfer out rates etc . ) of the emergency.results : arrival time pattern of patients in the eopd was highly stochastic with the peak arrival hours to be 9.00 - 12.00 h in which around 26.3 % patients arrived in the eopd . the primary waiting areas of patients included patients under observation ( 29.6 % ) ; waiting for routine diagnostic tests ( 16.4 % ) and waiting for discharge ( 14.6 % ) . around 71 % patients were waiting due to reasons within emergency complex.conclusion : the patient flow of the ed could only be addressed by multifaceted , multidisciplinary and hospital wide approach .

primary intracystic squamous cell carcinoma ( scc ) in the breast is an extremely rare neoplasm . primary sccs in the breast are quite rare , although scc mixed with ductal carcinoma is more common . it can arise from metaplastic epithelium associated with other primary malignancy of the breast , metastasis from primary elsewhere in the body or an extension of malignancy from the skin covering .

primary intracystic squamous cell carcinoma ( scc ) of the breast is an extremely rare entity and has a low incidence in comparison with other breast cancers . we report a rare case of primary intracystic scc in a 45-year - old woman who presented with a cystic lump in the right breast . cytological smears of the fluid aspirated from the breast tumor revealed malignant squamous cells dispersed in single and occasional groups along with numerous cyst macrophages , suggesting cystic scc . histological study of the mastectomy specimen confirmed the diagnosis of primary intracystic scc . although the presence of abundant foamy macrophages in the background of fine needle aspiration cytology smears of the breast suggest benign breast lesion , when associated with malignant squamous cells , these suggest cystic primary scc or metastatic scc . the primary scc should not be confused with metaplastic change in other breast carcinomas .

retinal vein occlusion ( rvo ) is an obstruction of the retinal venous system , it has an abrupt onset and is an important cause of visual morbidity . retinal vein occlusions constitute the second most common cause of retinal vascular disease after diabetic retinopathy , with a prevalence of between 1 % and 2 % in persons older than 40 years of age [ 25 ] . in the wisconsin beaver dam eye study , 12 % of eyes that developed severe visual impairment ( best corrected visual acuity 20/200 ) during a 15-year followup were due to rvo . although the exact etiology of rvo is not known , it is likely to follow a thrombotic event , possibly caused by external compression or disease of the vein wall [ 1 , 7 ] . rvo can be categorized as branch retinal vein occlusion ( brvo ) , if the obstruction is located in one of the branches of the central vein ; or central retinal vein occlusion ( crvo ) , if it is located in the central vein , at the level of the optic nerve . brvo encompasses a heterogeneous group of disorders with different clinical aspects and presents with dilated and tortuous retinal venous system in a particular quadrant or hemisphere of the retina and is often associated with macular edema . crvo is presented with hemorrhagic changes in all four quadrants of the retina and dilated and tortuous veins . in both brvo and crvo , cotton wool spots , disc edema , and neovascularization the incidence of rvo has been estimated to be 0.12 % /year in adults aged 45 years for brvo and 0.04 % /year in adults aged 45 years for crvo in caucasian populations [ 6 , 11 ] . however , the canadian incidence of visual impairment ( vi ) due to macular edema ( me ) secondary to rvo is unknown . this study aims to determine the annual incidence of vi and characteristics of patients with me secondary to brvo and crvo in a real - world canadian setting .

retinal vein occlusion ( rvo ) is an obstruction of the retinal venous system , and macular edema ( me ) is a complication of rvo that can lead to blindness . the canadian incidence of visual impairment ( vi ) due to me secondary to rvo is unknown . this observational , retrospective study used records from the southwestern ontario database to observe the annual incidence , demographics , and comorbidity characteristics of patients with vi due to me secondary to rvo . from 47,166 patients , 73 with rvo ( > 40 years old ) were identified : 53 with branch retinal vein occlusion ( brvo ) , 20 with central retinal vein occlusion ( crvo ) . the annual incidence of vi ( visual acuity < 20/40 in snellen equivalent ) due to me secondary to brvo was ( mean ( 95 % ci ) ) 0.056 % ( 0.0110.072 ) , and to crvo was 0.021 % ( 0.0080.081 ) . furthermore , a greater proportion of rvo patients had hypertension ( 68 % versus 14 % ) or dyslipidemia ( 16 % versus 10 % ) , when compared to a healthy control cohort of 76,077 subjects ( p < 0.05 ) . this study presents a description of the characteristics of patients with vi due to me secondary to rvo in a real - world canadian setting . the results demonstrate that brvo was more frequent than crvo , and that rvo in this patient population was associated with several vascular comorbidities .

the fontan procedure is used to separate the systemic and pulmonary circulations in patients with various forms of functionally univentricular hearts . in the fontan circulation , systemic venous return is sent to the pulmonary arteries without passage through a ventricle . the fontan procedure can result in various late complications , including central venous hypertension , diminished oxygen delivery , reduced cardiac output , venous thrombosis , and arrhythmia ( 1,2 ) . these complications caused by central venous hypertension lead to parenchymal injury , fibrosis , and cirrhosis of the liver ( 2,3 ) . cardiac cirrhosis is a serious late complication of congenital heart disease and can cause hepatocellular carcinoma ( hcc ) ( 4,5 ) . however , the prevalence and risk factors of cirrhotic changes and hccs have not been clearly identified . furthermore , non - invasive diagnostic tools for hepatic fibrosis and the management of hcc in patients after undergoing the fontan procedure have not yet been clearly established .

a 29-year - old woman who underwent the fontan procedure at 10 years of age had an incidental finding of liver masses on abdominal ultrasonography . subsequent gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid magnetic resonance imaging showed a 15 mm hypervascular mass with washout in the hepatobiliary phase in liver segment 4 ( s4 ) , and an 18 mm hypervascular mass without washout in the hepatobiliary phase in liver segment 2 ( s2 ) . the s2 liver mass was pathologically diagnosed to be a regenerative nodule by an ultrasound - guided needle biopsy , and the s4 liver mass was pathologically diagnosed as a poorly differentiated hepatocellular carcinoma after partial hepatectomy .

uterine prolapse is rare in the queen , usually occurring after delivery of kittens or abortion . we report uterine prolapse in a non - pregnant queen and in association with an unusual diffuse , polypoid , fibrosis of the perimetrium and parametrium . the perimetrium ( syn uterine tunica serosa ) is equivalent to the visceral peritoneal lining . it is composed of loose connective tissue containing nerves and smooth muscle cells covered by mesothelium . it blends in with the broad ligaments of the uterus , which is also covered by mesothelium and contains a core of connective tissue , the parametrium . while peritonitis in cats is frequently associated with feline infectious peritonitis , specific lesions unique to the perimetrium have not been documented .

case summarythis case describes a young non - pregnant cat that presented with uterine prolapse in association with an unusual diffuse , polypoid , fibrosing perimetritis and parametritis . following ovariohysterectomy the cat recovered fully . no intra - abdominal complications were seen on ultrasound examination 3 months postsurgery . at the time of writing , the cat remains healthy.relevance and novel informationuterine prolapse in the cat is relatively rare and usually associated with the periparturient period . inflammatory polypoid perimetritis and parametritis have not previously been documented in cats , and in dogs have only been reported in association with the administration of oestrogenic compounds . the polypoid inflammation affecting the uterus and parametrium may have contributed to increased laxity of the uterine ligaments and predisposed to the development of uterine prolapse .

high phosphorus ( p ) intake is known as one of the risk factors for impaired bone health . several researchers have investigated the adverse effects of a high p diet on bone metabolism . in human adults , a diet containing p additives increases urinary hydroxyproline excretion , a bone resorption marker . in growing male rats , elevation in parathyroid hormone ( pth ) secretion is considered one of the mechanisms by which a high p diet impairs bone metabolism . pth stimulates osteoblasts , which produce mediators of osteoclastic bone resorption such as macrophage colony - stimulating factor ( m - csf ) , interleukin-6 ( il-6 ) , or receptor activator of nf-b ligand ( rankl ) [ 46 ] . we previously reported that a high p diet increased rankl mrna expression and the osteoclast number in rats . it could therefore be deduced that high p diet - induced elevated pth secretion leads to an increase in rankl expression , which enhances osteoclastic bone resorption . overton and basu suggested that bone loss occurs with increasing age at a rate of approximately 1 % per year averaged over the age range of 2976 y . in a previous mouse study by ferguson et al . , bone mass and mechanical properties approached mature levels by 12 weeks of age while age - related osteopenia was observed after 42 weeks of age . we previously reported the effects of a high p diet on mechanical properties of the femur in 4- , 12- , 24- , and 80-week - old mice . the results showed that a high p diet decreased the breaking force of the femur in 80-week - old mice and the stiffness of the femur in 24- and 80-week - old mice . we also found that a high p diet increased serum pth concentration in 12- , 24- , and 80-week - old mice , and 80-week - old mice had a higher serum pth concentration than mice at other ages . therefore , it was thought that a high p diet strongly influences aged mice in terms of pth response . the purpose of this study was to clarify the mechanism by which a high p diet affects bone metabolism in older mice . we assessed the changes in bone metabolism in young and aged mice fed a high p diet by measuring the mrna expression of bone metabolism mediators using real - time polymerase chain reaction ( pcr ) .

in this study , the effects of high phosphorus ( p ) diet on bone metabolism - related gene expression were investigated in young and aged mice . twelve- and 80-week - old ddy male mice were divided into two groups , respectively , and fed a control diet containing 0.3 % p or a high p diet containing 1.2 % p. after 4 weeks of treatment , serum parathyroid hormone ( pth ) concentration was significantly higher in the high p groups than in the control groups in both young and aged mice and was significantly higher in aged mice than in young mice fed the high p diet . high p diet significantly increased receptor activator of nf-b ligand ( rankl ) mrna in the femur of both young and aged mice and significantly increased the rankl / osteoprotegerin ( opg ) mrna ratio only in aged mice . high p diet significantly increased mrna expression of transient receptor potential vanilloid type 6 , calbindin - d9k , and plasma membrane ca2 + -atpase 1b in the duodenum of both young and aged mice . these results suggest that high p diet increased rankl mrna expression in the femur and calcium absorption - related gene expression in the duodenum regardless of age . furthermore , the high p diet - induced increase in pth secretion might increase the rankl / opg mrna ratio in aged mice .

despite advancements in modern medical science and the health management industry , the incidence of cerebral palsy ( cp ) continues to rise1 . the most common features of cp are decreased muscle strength and abnormal muscle tone2 . cp sufferers lack theability to generate enough force to maintain antigravity postural control , which result in abnormal postures3 . the development of movement and posture may be altered by non - progressive damage to the brain and subsequent neurological impairments ( spasticity , muscle weakness , co - contractions and visual impairment ) 5 . studies indicate that children and adults with both mild and severe forms of cp have postural impairments6,7,8 . the emergence of sitting postural control in early infancy changes the way infants interact with the world . from the sitting position , looking , reaching , and interacting become functional and allow exploration that supports learning and further development of motor skills . therefore , independent sitting , defined as not needing support from a caregiver or pillow while sitting , is one of the first developmental goals for every child . individual differences are present between children , and characteristic signs of developmental disorders during infancy are relatively unspecific . therefore , why a specific child is not able to achieve sitting postural control is not always clear . one method of examining postural control in adults and children is to measure the center of pressure ( cop ) at the base of support using a force platform during the task of remaining upright . cop has frequently been used to investigate postural control during standing by young children who are healthy or have cp9 , 10 . the purpose of this study was to investigate the differences of the pressure distributions of the sitting postures of typical developmental ( td ) children and children with cp .

[ purpose ] the purpose of this study was to investigate the differences in symmetry of sitting posture between typical developmental ( td ) children and hemi - cerebral palsy ( cp ) children . [ subjects and methods ] a school chair mounted on a force platform was used to assess the quiet - sitting pressure distribution of 10 td and 10 cp children . [ results ] the symmetry index of the td children was significantly closer to zero than that of the cp children irrespective of the latter group s hemiparetic side . [ conclusions ] sitting posture on school chairs of cp children was more asymmetrical than that of td children .

bioethanol is one of the most employed liquid biofuels due to the easy adaptability of this fuel to existing engines and because this is a cleaner fuel with higher octane rating than gasoline . ethanol market grew from less than a billion liters in 1975 to more than 39 billion liters in 2006 and is expected to reach 100 billion liters in 2015 . among the widely used substrates for ethanol production are the molasses , the wastes byproduct of sugar industries from sugarcane and sugar beet . this is because they are cheap raw materials , readily available , and ready for conversion with limited pretreatments as compared with starchy or cellulosic materials , as all sugars are present in a readily fermentable form . ongoing research and development seeking to improve methods by minimizing the numbers of experiments provide information about the direct additive effects of the study variables and interaction effects using design of experiment methods . recently , this statistical technique has been successfully applied in many fields [ 58 ] . response surface methodology ( rsm ) is a combination of mathematical and statistical techniques and is used for the modeling and analysis of problems in which a response of interest is influenced by several variables , and the objective is to optimize this response . the most popular rsm design is the central composite design ( ccd ) for analysis of experimental data . the ccd is efficient and flexible , providing sufficient information about the effects of variables and overall experimental error with a minimum number of experiments . center points in ccd design are usually repeated 46 times to get a good estimate of experimental error ( pure error ) . five center points are created by default for each factor : alpha , with negative , zero and positive values ( 1 , 0 , and 1 ) . in this study , alpha value was taken as one resulting in 3 levels , lowest ( 1 ) , middle ( 0 ) , and highest ( + 1 ) which is more specifically known as central composite face centered design ( ccfd ) , in an attempt to optimize the variables : incubation period , initial ph , incubation temperature , and molasses concentration , which affect bioethanol production . the main goal of the present work was to maximize bioethanol production from sugarcane molasses in batch fermentation process using previously isolated saccharomyces cerevisiae y-39 . the application of ccfd and rsm assisted in designing , modeling , and optimizing the fermentation process by performing a series of controlled laboratory experiments .

a statistical model was developed in this study to describe bioethanol production through a batch fermentation process of sugarcane molasses by locally isolated saccharomyces cerevisiae y-39 . response surface methodology rsm based on central composite face centered design ccfd was employed to statistically evaluate and optimize the conditions for maximum bioethanol production and study the significance and interaction of incubation period , initial ph , incubation temperature , and molasses concentration on bioethanol yield . with the use of the developed quadratic model equation , a maximum ethanol production of 255 g / l was obtained in a batch fermentation process at optimum operating conditions of approximately 71 h , ph 5.6 , 38c , molasses concentration 18 % wt. % , and 100 rpm .

ectopic kidney is a relatively rare renal anomaly however , an endourologist does encounter stone disease in an ectopic kidney occasionally . factors such as anomalous blood vessels and tortuous ureter with high insertion can lead to poor drainage and predisposition to the formation of renal calculi in these patients . the common management option for such stones is laparoscopy or ultrasound guided percutaneous nephrolithotomy ( pcnl ) . we report our experience with the use the recently described micro - pcnl or microperc for two such cases .

management of stone disease in an ectopic kidney is challenging . laparoscopy or ultrasound guided percutaneous nephrolithotomy and retrograde intra - renal surgery are the preferred techniques for these stones . we performed ultrasound guided microperc using a 16 g needle for the management of renal calculi in pelvic ectopic kidneys in two patients . there was no intraoperative or post - operative complication . both patients had complete stone clearance and were discharged on the first post - operative day . ultrasound guided microperc is a safe and effective option for the management of small renal calculi in pelvic ectopic kidneys .

intra - radicular posts are commonly used to restore endodontically treated teeth if their remaining coronal tissue could no longer provide adequate support and retention for the restoration . although the use of prefabricated posts has gained popularity , for several years custom cast dowel and core has been used to retain restorations with clinical evidence of success . one important advantage of this post system is that the dowel will fit a flared or irregularly shaped canal more closely than prefabricated post systems do . however , although endodontic therapy has shown a high success rate , adverse situations that require endodontic retreatment are not rare . when signs , symptoms and radiographic images suggest the failure of endodontic treatment , an atraumatic and efficient post removal is essential for optimal non - surgical endodontic management . drills and extractors exert high force on the root and may result in root fractures . ultrasonic energy is transmitted to the post , causing cracks in the cement thus facilitating its removal . recent evidence suggests that ultrasonic vibration is a safe and fast method for post removal . however , several in vitro studies have evaluated post removal with ultrasonic devices by using roots of extract teeth included in resin cylinders . this procedure is used in order to facilitate handling and test application . however clinically , the root is enveloped by periodontal ligament ( pdl ) , which presents higher resiliency than resins used for root inclusion . this difference in resiliencies enables pdl to dissipate the ultrasonic energy more easily than when the root is included in a resin cylinder . thus , the facility found in some in vitro studies for post removal with ultrasound activation may not be consistent with the clinical reality . the simulation of the pdl in these tests would be important to bring the laboratory findings to clinical application . the aim of this in vitro study was to evaluate the effect of simulated periodontal ligament ( spdl ) on custom cast dowel and core removal using an ultrasonic device . the null hypothesis was that the spdl does not influence the action of the ultrasonic device used to remove the cast dowel and core from the root canal .

objectivethe aim of this study was to evaluate the effect of simulated periodontal ligament ( spdl ) on custom cast dowel and core removal by ultrasonic vibration.material and methodsthirty - two human maxillary canines were included in resin cylinders with or without spdl made from polyether impression material . in order to allow tensile testing , the roots included in resin cylinders with spdl were fixed to cylinders with two stainless steel wires . post - holes were prepared by standardizing the length at 8 mm and root canal impressions were made with self - cured resin acrylic . cast dowel and core sets were fabricated and luted with panavia f resin cement . half of the samples were submitted to ultrasonic vibration before the tensile test . data were analyzed statistically by two - way anova and tukey 's post - hoc tests ( p < 0.05 ) .resultsthe ultrasonic vibration reduced the tensile strength of the samples directly included in resin cylinders . there was no difference between the values , whether or not ultrasonic vibration was used , when the pdl was simulated . however , the presence of spdl affected the tensile strength values even when no ultrasonic vibration was applied.conclusionsimulation of pdl has an effect on both ultrasonic vibration and tensile testing .

human metapneumovirus ( hmpv ) is an rna virus in the pneumovirinae subfamily of the paramyxoviridae family that was first isolated in the netherlands in 2001 and has subsequently been identified worldwide . it has been implicated as a significant cause of hospitalization for young children , second only to respiratory syncytial virus ( rsv ) in infants hospitalized with acute respiratory infections ( aris ) . hmpv has been detected in 1.543.0 % of patients with aris . while it circulates predominantly in the winter , seroprevalence studies have shown that almost all children over five years of age have evidence of past infection . clinical syndromes associated with hmpv infection are similar to those of rsv infection , ranging from mild upper respiratory tract infections to wheezing and severe lower respiratory tract infections requiring mechanical ventilation . rare cases of fatalities have been associated with hmpv and it has been implicated in a handful of cases of encephalitis . although hmpv infections have been diagnosed in adults , their greatest impact occurs in children . a significant association with hmpv and wheezing is seen in young children , and hmpv has been linked to apparent life - threatening events in infants . hmpv has been associated with aris with super - infections as a result of staphylococcus aureus and streptococcus pneumoniae . to begin to understand the impact of hmpv on our institution , we analyzed children admitted to our tertiary care center in southeast michigan with respiratory symptoms during the respiratory season of 20062007 through an observational , retrospective study . the primary purposes of our study were to establish the utility of testing for hmpv in children who were admitted to our hospital during the respiratory virus season and to compare the impact of hmpv and rsv on the healthcare system .

human metapneumovirus ( hmpv ) is a recently discovered virus that causes respiratory illness in children that can lead to hospitalization . our study was undertaken to further understand hmpv - associated illness , compare clinical characteristics of hmpv and respiratory syncytial virus ( rsv ) , and establish the utility of routine screening for hmpv . we retrospectively identified hmpv - associated illnesses described among children with respiratory symptoms admitted to a tertiary care center in southeast michigan during the 20062007 respiratory viral season . a convenience sample of 256 nasopharyngeal specimens was subjected to nucleic acid extraction and amplification to identify those specimens positive for hmpv . a medical record review was undertaken to retrieve demographic and clinical data of patients with hmpv , comparing them to rsv - positive patients and patients evaluated for respiratory symptoms who were negative for hmpv and rsv . we found that hmpv was the second most commonly identified virus after rsv . hmpv - positive patients were older than rsv - positive patients . among hmpv - positive patients , pneumonia was diagnosed in 37.5 % and bronchiolitis in 31.2 % , peribronchial cuffing was present on chest radiographs of 37.5 % , antibiotic treatment was used in 81.2 % , and admission to the icu was seen in 37.5 % . finally , hmpv - positive patients were more likely to have fever than rsv - positive patients or patients negative for hmpv and rsv . we concluded that hmpv is a major pathogen associated with hospitalization of children and with the same severity of illness as rsv but in a slightly older population . because of the apparent prevalence and severity of illness , routine screening should be implemented .

ameloblastoma is a benign but locally aggressive neoplasm of the odontogenic epithelium.1 accounting for 11 % of all odontogenic tumors , ameloblastoma is the most common odontogenic neoplasm affecting the jaws , yet it only accounts for 1 % of all tumors of the maxilla and mandible.24 the average age of patients presenting with ameloblastoma is 36 years , with men and women being equally affected.5 ameloblastomas are classified as solid / multicystic , intraosseous , or unicystic , with peripheral subtypes.6,7 the radiographic appearance of ameloblastoma , dentigerous cysts , and odontogenic keratocysts is similar and for this reason a biopsy is recommended to obtain a precise diagnosis of ameloblastoma.8 although a benign tumor , ameloblastoma is aggressive because of the myeline nature of its growth and because its conservative treatment is associated with a high rate of recurrence ( 50 % 90 % ) . primary resection of this benign tumor is , therefore , considered the only predictable curative form of therapy.711 unfortunately , this treatment leaves the patient with a defect in the affected region of the jaw . a multi - disciplinary approach is needed for the patient s complete rehabilitation , including bone grafting , the planned placement of implant , and the prosthetic work . sometimes the orthodontist s role in this multidisciplinary approach is to create an optimum occlusal relationship and sufficient space to allow for successful reconstruction of the affected region of the jaw .

this case report describes the combined surgical , orthodontic and prosthodontic rehabilitation of an adult female patient with a previous history of follicular ameloblastoma , which was treated through partial mandibulectomy and an immediate replacement of missing bone with an autologous calvarial bone graft . orthodontic treatment was undertaken in order to restore occlusal disturbances and obtain sufficient space for two dental implants and an optimum prosthodontic rehabilitation .

biological membranes are mainly composed of phospholipids , sphingolipids , cholesterol , and membrane - associated proteins . these molecules are nonhomogeneously distributed in membranes and can rearrange , leading to the formation of membrane domains with highly differentiated molecular compositions and supramolecular architectures , which are stabilized by lateral interactions among the membrane components . although glycosphingolipids ( gsls ) were originally thought to be structural components of plasma membranes , several experiments suggested that gsls are involved in the regulation of numerous cellular functions . the membrane lipid bilayer is a stable structure , constituting a physical boundary between intra- and extracellular environments . gsls are expressed on the surface of cellular membranes . based on their physicochemical properties , especially their many hydroxyl and acetamide groups , which can act as hydrogen bond donors and acceptors , gsls form clusters through cis interactions . there is a general consensus on the roles played by the ceramide moiety of gsls in promoting the formation and stabilization of membrane lipid domains . in addition , ceramide was also shown to be involved in gsl - mediated functions and several biological activities [ 3 , 4 ] . we recently showed that very long fatty acid chains of ceramide , such as c24:0 and c24:1 , are responsible for the direct connection between lactosylceramide ( laccer , cdw17 ) and palmitoylated signal transducer molecules . moreover , the phosphorylated product of sphingosine , sphingosine-1-phosphate ( s1p ) , was shown to be important in immunological , especially inflammatory reactions [ 4 , 6 ] . this review describes the role of the fatty acid chains of ceramide in gsl - mediated outside - in signaling in promoting gsl - enriched domain - mediated cellular functions , as well as the activities of s1p in inflammatory reactions of keratinocytes in human .

glycosphingolipids ( gsls ) are composed of hydrophobic ceramide and hydrophilic sugar chains . gsls cluster to form membrane microdomains ( lipid rafts ) on plasma membranes , along with several kinds of transducer molecules , including src family kinases and small g proteins . however , gsl - mediated biological functions remain unclear . lactosylceramide ( laccer , cdw17 ) is highly expressed on the plasma membranes of human phagocytes and mediates several immunological and inflammatory reactions , including phagocytosis , chemotaxis , and superoxide generation . laccer forms membrane microdomains with the src family tyrosine kinase lyn and the gi subunit of heterotrimeric g proteins . the very long fatty acids c24:0 and c24:1 are the main ceramide components of laccer in neutrophil plasma membranes and are directly connected with the fatty acids of lyn and gi . these observations suggest that the very long fatty acid chains of ceramide are critical for gsl - mediated outside - in signaling . sphingosine is another component of ceramide , with the hydrolysis of ceramide by ceramidase producing sphingosine and fatty acids . sphingosine is phosphorylated by sphingosine kinase to sphingosine-1-phosphate , which is involved in a wide range of cellular functions , including growth , differentiation , survival , chemotaxis , angiogenesis , and embryogenesis , in various types of cells . this review describes the role of ceramide moiety of gsls and its metabolites in immunological and inflammatory reactions in human .

stimulated by the promise of mechanically interlocked molecular architectures with potential employment in future nanotechnological applications such as in the development of molecular machines and switches , the interest being shown in their construction is ever increasing . rotaxane and catenane species can also , however , be designed to function as selective host systems whereby the topologically unique interlocked three - dimensional cavities are exploited to selectively recognise specific guest species . in previous work , we have utilised anion templation to construct a range of rotaxanes and catenanes , which , upon removal of the template , bind anions strongly and selectively in competitive solvent mixtures . furthermore , selective anion binding can be exploited to bring about triggered motion within the interlocked supramolecular architectures , underlining the possible application of these systems in the preparation of molecular switches . to sense and monitor anion binding ( and/or binding - triggered motion ) , it is desirable to integrate a redox- or photoactive reporter group in proximity to the interlocked anion - binding site . examples of interlocked hosts with the capability of sensing anions by electrochemical or optical [ 3b , 4 , 6 ] methods are rare . herein , we report the preparation of the first anion - templated rotaxane incorporating an optically- and electro - active osmium ( ii ) tris ( bipyridine ) reporter group . after removal of the anion template , selective anion binding is investigated by monitoring the optical and electronic output from the osmium ( ii ) tris ( bipyridine ) reporter moiety . to develop and fabricate a prototype molecular sensory system , surface association removes complications associated with brownian motion , typically increases conformational rigidity , and will underpin potential applications of such molecular architectures and , ultimately , device integration . [ 1b ] to date , only a limited number of surface - bound interlocked structures have been reported . [ 5b , c , 7 ] hence , we additionally report the anion - templated assembly of these electrochemically active osmium ( ii ) bipyridyl rotaxane structures on gold substrates and , after template removal , the specific reporting of anion recruitment from solution ( figure 1 ) . schematic representation of the recognition and sensing of anions for a surface - bound rotaxane . axle in blue , macrocycle in green , with anion binding functionalities shown in red .

we report the preparation of [ 2 ] rotaxanes containing an electrochemically and optically active osmium ( ii ) bipyridyl macrocyclic component mechanically bonded with cationic pyridinium axles . such interlocked host systems are demonstrated to recognise and sense anionic guest species as shown by 1h nmr , luminescence and electrochemical studies . the rotaxanes can be surface assembled on to gold electrodes through anion templation under click copper ( i ) -catalysed huisgen cycloaddition conditions to form rotaxane molecular films , which , after template removal , respond electrochemically and selectively to chloride .

prediction of mandibular growth pattern ( mgp ) plays an important role in orthodontic treatment planning ; it is critical when managing the development of dentofacial structures . different methods have been introduced for predicting mgp and assessing , symphyseal morphology is one of them . ricketts and others stated that morphology of the symphysis may be used to predict the direction of mandibular growth . he found that forward inclination of the condylar head was associated with forward mandibular rotation , along with a greater curvature of the mandibular canal compared with mandibular contour . a tendency toward backward mandibular rotation was associated with a pronounced apposition below the symphysis with more overall concavity of the inferior mandibular border . jarabak 's cephalometric analysis predicted the direction of mandibular growth by a facial polygon , including the saddle angle ( n - s - ar ) , articular angle ( s - ar - go ) , and gonial angle ( ar - go - me ) ; a sum of these three angles greater than 396 is predictive of a posterior mgp while a sum less than 396 was associated with anterior mgp . also a ratio of posterior ( s - go ) to anterior face height ( n - me ) of 56 - 62 % indicated a posterior mgp , whereas a ratio of 65 - 80 % indicated an anterior growth tendency . although many cephalometric measurements have been introduced , it is still very difficult to accurately predict the direction of mandibular growth . although , skieller 's four variables accounted for 86 % of the variability of changes in the direction of mandibular growth ( mandibular inclination , intermolar angle , shape of the inferior border of the mandible , and inclination of the symphysis ) ; however , it accounted for only 8 % in lee 's study . thus , he concluded that predicting the direction of mandibular growth is very perplexing and problematic . assessed symphyseal height , depth ratio ( h / d ) and angle . in his study , the morphology of the symphysis was found to be associated with the direction of mandibular growth . a mandible with an anterior growth direction was associated with a small height , large depth , small ratio , and large angle of the symphysis . conversely , a posterior growth direction was associated with a large height , small depth , large ratio , and small angle of the symphysis . the purpose of this study was to evaluate symphyseal morphology ( height , depth , and height / depth ) in patients aged between 9 and 14 years with different sagittal and vertical mgps .

background : this study sought to assess symphyseal morphology in adolescents with different mandibular growth patterns ( mgps ) in order to see if a relation exists.materials and methods : in this study the symphyseal parameters ( height , depth , and ratio ) of normal subjects were compared with four groups with malocclusion ( cl iii vertical , cl ii vertical , cl iii horizontal , and cl ii horizontal ) . these groups ( 15 samples each ) were matched ( for sex and cervical maturation stage [ cvms ] ) based on their cephalograms and patient charts . growth patterns were differentiated by seven vertical parameters and the wylie analysis . after confirmation of normality of the groups and similarity of their variances the two - way analysis of variance ( anova ) was used for analysis of data assessed by adjusted chi - square ( p < 0.001 ) . the comparison of cases with the normal group was performed by the dunnett method . intraclass correlation coefficient ( icc ) was used for evaluation of intraobserver reliability.results : we found the symphyseal ratio to have a significant correlation with the mgp ( p < 0.001 ) . the symphyseal ratio ( height / depth ) was small in a mandible with vertical growth pattern cl ii or cl iii . conversely , a horizontal growth pattern of a cl ii or cl iii mandible was associated with a larger ratio of the symphysis in comparison with the normal group . the symphyseal ratio was also found to be greater in females.conclusion : the symphyseal ratio was found to be strongly associated with the mgp .

hearing loss is a significant public health concern given the deleterious effects that untreated hearing impairment may have on overall physical and cognitive wellbeing.1 , 2 the hearing health foundation reports that nearly 50 million americans have hearing loss.3 sensorineural hearing losses generally have a highfrequency component . this frequency region is essential for good speech understanding in complex listening environments , particularly in noise.4 , 5 individuals with substantial , bilateral highfrequency hearing loss experience hearing difficulties in most aspects of life : at home , on the phone , at work , and in social situations . they can be highly frustrated because existing hearing aid technology can not overcome the problems of reduced word understanding in quiet and noise.6 , 7 , 8 due to their communication problems , they may become isolated , withdrawing from family , colleagues , and friends . with severe hearing loss , areas of minimal or nonfunctioning hair cells or auditory neurons are often present , resulting in cochlear dead regions where vibrations of the basilar membrane are not detected via inner hair cells or neurons in that region . frequencies falling in a dead region are detected via apical or basal spread of vibrations to other cochlear places . therefore , hearing loss at a given frequency may be greater than indicated by the audiometric threshold.9 typically , acoustic amplification of dead regions does not improve speech understanding and may worsen it.10 , 11 individuals with this hearing loss profile may be candidates for electric plus acoustic stimulation in the same ear . treatment options for individuals with bilateral , severe skislope hearing loss have been limited to stateofthe art amplification , including frequency lowering,12 in an effort to improve speech intelligibility . these attempts often end with the rejection of hearing aids due to the lack of benefit , leaving the individual with no other alternatives . studies have shown that an implant with a shorter electrode array provides beneficial electric stimulation for high frequencies while preserving acoustic lowfrequency hearing , resulting in improved speech understanding.13 , 14 recently , lenarz et al . described results from a european multicenter study using the cochlear ltd . , sydney , australia , nucleus hybrid l24 implant.15 we report results of the clinical trial leading to u.s . food and drug administration approval of the firstofitskind combined electric and acoustic ( hybrid ) implant system to address the substantial hearing difficulties of individuals not benefitting from amplification and not eligible for a standard cochlear implant ( ci ) .

objectives / hypothesisto evaluate the safety and efficacy of acoustic and electric sound processing for individuals with significant residual lowfrequency hearing and severetoprofound highfrequency sensorineural hearing loss.study designprospective , singlearm repeated measures , singlesubject design.methodsfifty individuals , 18 years old , with lowfrequency hearing and severe highfrequency loss were implanted with the cochlear nucleus hybrid l24 implant at 10 investigational sites . preoperatively , subjects demonstrated consonantnucleusconsonant word scores of 10 % through 60 % in the ear to be implanted . subjects were assessed prospectively , preoperatively , and postoperatively on coprimary endpoints of consonantnucleusconsonant words , azbio sentences in noise , and selfassessment measures.resultssignificant mean improvements were observed for coprimary endpoints : consonantnucleusconsonant words ( 35.8 percentage points ) and azbio sentences in noise ( 32.0 percentage points ) , both at p < 0.001 . ninetysix percent of subjects performed equal or better on speech in quiet and 90 % in noise . eightytwo percent of subjects showed improved performance on speech in quiet and 74 % in noise . selfassessments were positive , corroborating speech perception results.conclusionthe nucleus hybrid system provides significant improvements in speech intelligibility in quiet and noise for individuals with severe highfrequency loss and some lowfrequency hearing . this device expands indications to hearingimpaired individuals who perform poorly with amplification due to bilateral highfrequency hearing loss and who previously were not implant candidates.level of evidence2b . laryngoscope , 126:175181 , 2016

canine visceral leishmaniasis ( cvl ) is an infectious disease transmitted by sand flies and caused by leishmania infantum ( 1 ) . it is a zoonotic endemic disease in most of the mediterranean area , asia , and latin america ( 2 , 3 ) . in iran the prevalence of cvl in various parts of iran is different and it is correlated by weather condition and humidity ( 4 ) . it is endemic in ardebil , east azerbaijan , fars and bushehr provinces ( 5 ) . domestic dogs ( canis familiaris ) are the main reservoir hosts of human visceral leishmaniasis in iran ( 6 ) and the prevalence of vl in human , in distinct area , is associated with amount of cvl in dogs ( 4 ) . in foci of canine leishmaniasis , symptomatic disease is low and due to the systemic nature of the disease , clinical manifestations are variable ( 68 ) . it seemed among different control strategies of the disease vaccination , if an efficient vaccine being accessible , is the best possible way for eradication of this disease in dogs ( 6 ) . immunization with naked dna is the latest method , which promote both cd4- and cd8-mediated responses ( 9 , 10 ) . in the past few years , studies focused on some antigens such as gp63 , cp , tsa , gp64 , lmsti1 , leif and p8 , p4 and lack ( 11 ) . among of these antigens , lack gene is one of the best candidates in other strains of this pathogen ( 12 ) lack ( leishmania homologue of receptors for activated c kinase ) is a 36 kda protein localized in cytosol and external surface of the membrane ( 13 ) . it is expressed in both promastigote and amastigote forms of the parasite ( 14 ) . the protective effect of the lack vaccine was mediated by il-12-dependent ifn - g production ( 15 ) . the objective of this study was to investigate of the quality of lack protein expression of iran strain of l. infantum .

background : there are several methods , such as vaccination , to control visceral leishmaniasis . although there is no efficient vaccine , it seem dna vaccination with stimulates both cellular and humoral immunity apparently is the best way . the aim of this study was cloning and expression of lack gene , a 36kd protein , as a candidate protein for vaccination against iranian l. infantum.methods : iranian strain of l. infantum [ mcan / ir/07/moheb - gh ] was used as a template for pcr to amplify lack gene . the lack gene was cloned in ptz57r / t vector and after confirmation it was digested by restriction enzymes ( bamh1 ) and cloned in pcdna3.1 expression vector . recombinant plasmid was extracted and analyzed by sequencing , restriction digestion analysis and pcr reaction . the pc- lack recombinant plasmid was purified from transformed e.coli ( dh5 ) and its expression was analyzed by sds - page and western blot.results : the results of sequencing , restriction digestion analysis and pcr reaction revealed that lack gene was cloned correctly in pcdna3.1 vector and the results of sds page and western blot emphasized that lack protein of iranian l. infantum is a well - expressed protein.conclusion : we amplified , cloned and expressed iranian l. infantum lack gene successfully .

arterial stiffness is increased in patients with type 2 diabetes mellitus ( t2 dm ) , which can potentially increase the risk of morbidity and mortality associated with cardiovascular diseases ( cvd ) . the brachial - ankle pulse wave velocity ( bapwv ) is a non - invasive technique often used clinically for assessment of arterial wall stiffness and evaluation of the state of atherosclerosis and prediction of cvd in t2 dm patients [ 2 , 3 ] . previous studies demonstrated that conventional risk factors for cvd , such as age , gender , body mass index ( bmi ) , duration of t2 dm , glycemic control , dyslipidemia , systolic blood pressure ( sbp ) , estimated glomerular filtration rate ( egfr ) , uric acid and albuminuria , are associated with increased arterial stiffness in patients with t2 dm [ 1 , 4 - 6 ] . however , life style - related problems were not fully taken into consideration in these studies , although the risk of cvd in patients with t2 dm correlates with numerous lifestyle problems [ 7 , 8 ] . in fact , we recently demonstrated that poor sleep quality in patients with t2 dm correlates with increased arterial stiffness ; however , in that study , we did not take conventional cardiovascular risk factors into full consideration . another study showed that low physical activity was associated with increased arterial stiffness in newly diagnosed patients with t2 dm . on the other hand , the association of other lifestyle habits , such as energy intake , morningness - eveningness , sleep duration and depressive state , with bapwv remains largely unknown in patients with t2 dm . the aim of the present study was to identify lifestyle habits that are associated with bapwv in t2 dm patients free of apparent cvd , using a model adjusted for numerous conventional cardiovascular risk factors and lifestyle habits .

backgroundwhile conventional cardiovascular risk factors and certain lifestyle habits are associated with arterial stiffness in patients with type 2 diabetes mellitus ( t2 dm ) , it is still unknown whether they are actually associated with arterial stiffness even after adjustment for conventional cardiovascular risk factors and lifestyle habits . the aim of this study was to identify variables that are associated with brachial - ankle pulse wave velocity ( bapwv ) .methodsthe study participants comprised 724 japanese t2 dm outpatients free of history of cardiovascular diseases . lifestyle habits were analyzed using self - reported questionnaires . the associations among conventional cardiovascular risk factors and lifestyle habits with bapwv were investigated by multivariable linear regression analysis.resultsthe mean age of the study subjects was 57.8 8.6 years , and 62.8 % of those were males . the mean hba1c was 7.01.0 % , and the estimated duration of t2 dm was 9.9 7.2 years . multiple linear regression analysis that included age and gender demonstrated that age and male sex were positively associated with bapwv . in a model adjusted for numerous conventional cardiovascular risk factors and lifestyle habits , age , duration of t2 dm , systolic blood pressure , serum uric acid , urinary albumin excretion and poor sleep quality were positively associated with bapwv , while body mass index was negatively associated with bapwv.conclusionsin japanese t2 dm , in addition to several conventional cardiovascular risk factors , poor sleep quality was associated with bapwv even after adjustment for numerous conventional cardiovascular risk factors and lifestyle habits .

paediatric age at the time of diagnosis represents a negative prognostic factor for keratoconus progression , with increased probability of corneal transplant . particularly younger patients represent a population at high risk for more rapid progression of the disease [ 1 , 2 ] . the long - term results reported in literature [ 35 ] have demonstrated the ability of cross - linking to slow the progression of keratoconus by a photo - polymerization reaction of stromal collagen fibres . cross - linking photodynamic reaction is induced by the combined action of a photosensitizing substance ( riboflavina o vitamin b2 ) and ultraviolet ( uv ) a light , allowing a corneal stiffening by increasing the number of intrafibrillar , interfibrillar covalent bonds , and corneal collagen resistance against enzymatic degradation [ 68 ] . the long - term effects of the technique are related also to a process of collagen neosynthesis with a different structure and higher molecular weight [ 912 ] which confers to the corneal stroma an increased resistance and lamellar compaction responsible of the variable functional modifications recorded after the treatment [ 1114 ] . according to international results [ 35 ] , cross - linking should be the primary choice in young patient with progressive keratoconus .

purpose . to report a comparative prospective long - term functional analysis after riboflavin uv a corneal cross - linking ( cxl ) in three different age groups of patients affected by progressive keratoconus ( kc ) . methods . functional analysis comprised paediatric patients ( 18 years ) included 152 eyes ( 29.5 % ) ; intermediate group ( 1926 years ) 286 eyes ( 55.4 % ) , and adults ( 27 years ) 78 eyes ( 15.1 % ) . cxl was performed according to the siena protocol by using the vega cbm ( caporossi - baiocchi - mazzotta ) x linker ( cso , florence , italy ) at siena university by the same authors . pre- and post - op examinations included ucva , bscva , corneal topography , and surface aberrometry ( cso eye top , florence , italy ) , at 48 months followup . results . at 48 months followup paediatrics , intermediate , and adult patients showed a mean gain in ucva of + 0.2 , + 0.14 and + 0.12 snellen lines . bscva gained by a mean of + 0.21 , + 0.2 , and + 0.1 snellen lines . kmax was reduced by a mean value of 0.9 d , 0.6 d , and 0.5 d , respectively . coma values improved by a mean of 0.45 m , 0.91 m , and 0.19 m , respectively . treatment ensured a long - term keratoconus stabilization in over 90 % of treated patients . conclusion . according to our long - term comparative results , epithelium - off riboflavin uv a cross - linking should be the first choice therapy of progressive kc , particularly in paediatric age and patients under 26 years .

obesity is not only a risk factor for cancer development but also a factor affecting treatment outcomes . endometrial cancer ( ec ) was the first malignancy to be recognized as related to obesity . it has been associated with lower quality of life values among ec survivors and higher body mass index ( bmi ) , measured before ec diagnosis , has been associated with higher all - cause and endometrial cancer specific mortality . early stage ec treatment involves surgery ( total abdominal hysterectomy and bilateral salpingo - oopherectomy with or without pelvic lymph node dissection ) followed by adjuvant radiotherapy in selected cases . randomized studies have shown that radiotherapy ( rt ) reduces the risk of pelvic relapse . vaginal cuff is the most common site of relapse and the postoperative radiation therapy for endometrial carcinoma 2 ( portec-2 ) trial demonstrated that patients with intermediate - risk ec can be treated safely with postoperative vaginal cuff brachytherapy ( vcb ) in the absence of whole pelvic external beam radiotherapy , thus decreasing toxicity . although vcb is one most commonly used adjuvant gynaecological treatments , there is a lack of studies analysing whether dosimetric factors are influenced by overweight . our aim , therefore , was to evaluate the effect of bmi and perivaginal fat on dose in organs at risk during fractionated vcb .

purposeassociation between body mass index ( bmi ) and doses in organs at risk during postoperative vaginal cuff brachytherapy ( vcb ) treatment has not been evaluated . the aim of this study was to analyse the impact of bmi on the dose delivered to bladder and rectum during high - dose - rate vcb using computed tomography ( ct ) scans at every fraction.materials and methodsa retrospective analysis of 220 planning ct sets derived from 59 patients was conducted . every planning ct was re - segmented and re - planned under the same parameters . rectum and bladder dose - volume histogram values ( d0.1cc , d1cc , and d2cc ) were extracted and evaluated . the mean values for all applications per patient were calculated and correlated with bmi , as well as other factors influencing rectal and bladder doses . multiple regression analysis performed to model organ at risk dose - volume parameters.resultsaccording to world health organization ( who ) , 6.8 % of patients were normal , 35.6 % were overweight , and 57.6 % were class i obese . median rectal doses were 133.5 % , 110.9 % , and 99.3 % for d0.1cc , d1cc , and d2cc , respectively . the corresponding median bladder doses were 96.2 % , 80.6 % , and 73.3 % , respectively . bmi did not show significant association with rectal doses . however , bmi did show a significant association with evaluated bladder dose metrics ( d0.1cc , r=0.366 , p=0.004 ; d1cc , r=0.454 , p < 0.001 ; d2cc , r=0.451 , p < 0.001 ) . bmi was retained in the multivariate regression models ( d0.1cc , p=0.004 ; d1cc , p < 0.001 ; d2cc , p=0.001 ) .conclusionin this group of mediterranean , overweight , and moderately obese patients , bmi showed association with lower bladder dose values , but not with rectal doses .

the incidence of splenic abscess is a clinically uncommon disease with current literature reporting a 0.140.7 % occurrence rate [ 1 , 2 ] . although splenic abscesses are a clinical rarity , they have the potential to be fatal . the presentation of this disease is often vague and insidious including left upper quadrant abdominal pain , fever and chills . additionally , these patients may present with leukocytosis , left upper quadrant mass and pleural effusion on chest x - ray . splenic abscesses generally occur in patients with underlying comorbidities , which commonly include neoplasia , immunodeficiency , trauma , metastatic infection , splenic infarct or diabetes . the best management of splenic abscesses is still debatable with the various modalities including antibiotics , percutaneous drainage or splenectomy . the current literature supports a 67100 % success rate with percutaneous drainage ; however , tung et al . states that the most optimal treatment for splenic abscess is splenectomy . of the 600 cases of splenic abscess documented in the current literature , most have been described as air confined to the left upper quadrant on chest x - ray . we report a young patient with a ruptured splenic abscess resulting in an acute abdomen and pneumoperitoneum . to our knowledge , there have only been four other reported cases of ruptured splenic abscess causing pneumoperitoneum [ 3 , 4 ] .

we encountered a case of ruptured splenic abscess presenting as peritonitis and pneumoperitoneum . our patient did not have an underlying neoplasm nor was she immunosuppressed . in our case , splenectomy was the treatment of choice in combination with antibiotics , which proved to be a good outcome for the patient . work - up for the cause of the abscess was negative , although bacteria predominately found in the oral flora were isolated from the abscess . we strongly encourage that splenic abscess be considered on the differential diagnosis of patients presenting with pneumoperitoneum and peritonitis , although a clinical rarity .

squamous cell carcinoma of the head and neck ( scchn ) is the fifth most common neoplasm with an estimated annual global incidence of more than 500,000 cases diagnosed worldwide . the treatment is usually interdisciplinary and mainly involves surgeons , radiation oncologists , medical oncologists , clinical nurse specialists , speech and language specialists , and dieticians . dependent on the situation , goals of the treatment can be to obtain ( i ) a high locoregional control and survival rates in patients with limited disease , ( ii ) an increased survival in patients with advanced disease ( improved locoregional control , reduced probability of distant metastasis , and second malignancies ) , ( iii ) an increased organ - function preservation in resectable and unresectable tumors , and ( vi ) an increased therapeutic ratio ( cure / toxicity ratio ) . single modality treatment is recommended for the patients with early - stage disease ( stage i or stage ii , approximately 40 % of the patients with scchn ) and combined modality treatment for patients with locally advanced disease . the combined modality treatment may include surgery followed by adjuvant radiotherapy or radiochemotherapy , concomitant radiochemotherapy ( using conventional or alternative fractionation regimen ) , and induction chemotherapy followed by radiotherapy or radiochemotherapy [ 3 , 4 ] . a precise understanding of prognostic factors is important to select the optimal treatment for the individual patient or to stratify patients for clinical trials or statistical analyses . in this retrospective single - institutional study , the role of potential prognostic factors was evaluated and compared in patients with squamous cell carcinoma of the oro- and hypopharynx after treatment with definitive radiotherapy / radiochemotherapy ( drt ) versus surgery followed by postoperative radiotherapy ( prt ) .

purpose . to compare the impact of prognostic factors of patients treated with definitive radio ( chemo ) therapy versus patients treated with surgery and postoperative radiotherapy for squamous cell carcinoma of the oro- and hypopharynx . patients and methods . 162 patients treated with definitive radiotherapy and 126 patients treated with postoperative radiotherapy were retrospectively analysed . the impact of the prognostic factors gender , age , total tumor volume ( ttv ) , pre - radiotherapy hemoglobin level ( hb - level ) , tumor site , t- and n - classification , radiotherapy interruptions > 5 days , radiotherapy versus simultaneous radiochemotherapy , r - status and time interval between surgery and radiotherapy were investigated . results . the median follow - up time for the censored patients treated with definitive radio ( chemo ) therapy was 28.5 months and for postoperative radiotherapy 36.5 months . on univariate analysis , the ttv , hb - level , and simultaneous radiochemotherapy had a significant impact on the survival of patients treated with definitive radio ( chemo ) therapy . for patients treated with postoperative radiotherapy , only the ttv showed a statistical trend for the survival ( p = 0.13 ) . on multivariate analysis , the ttv and simultaneous radiochemotherapy maintained their statistical significance for patients treated with definitive raditherapy , and the ttv , the statistical trend for patients treated with postoperative radiotherapy ( p = 0.19 ) . conclusions . the ttv was the predominant prognostic factor for both , patients treated with definitive or postoperative radiotherapy .

the purpose of this process is to destroy and remove the injurious agents and injured tissues , thereby promoting tissue repair . when this beneficial response occurs in an uncontrolled manner , the result is excessive cellular / tissue damage that results in chronic inflammation and destruction of normal tissue . moreover , inflammatory airway and lung diseases , such as asthma or chronic obstructive pulmonary disease ( copd ) , are characterized by chronic inflammation . many of the known inflammatory target proteins , such as matrix metalloproteinase-9 ( mmp-9 ) , intercellular adhesion molecule-1 ( icam-1 ) , vascular cell adhesion molecule-1 ( vcam-1 ) , cyclooxygenase-2 ( cox-2 ) , and cytosolic phospholipase a2 ( cpla2 ) , are associated with inflammatory signaling pathways induced by various stimuli , including tumor necrosis factor- ( tnf- ) , interleukin-1 ( il-1 ) , adenosine-5-triphosphate ( atp ) , cigarette smoke extract ( cse ) , lipoteichoic acid ( lta ) , or lipopolysaccharide ( lps ) [ 26 ] . airway smooth muscle is considered as an end - response effector regulating regional differences in ventilation by contracting in response to various proinflammatory mediators and exogenous substances released under homeostatic or pathologic conditions , such as asthma . lung cells , in particular alveolar epithelial type ii cells , are susceptible to the injurious effects of oxidants . it has been shown that lung cells release inflammatory mediators and cytokines / chemokines , such as il-1 , il-6 , il-8 , and tnf- in response to oxidative stress . moreover , the sfks , pkc , growth factor tyrosine kinase receptors , nadph oxidase / ros , pi3k / akt , and mapks are components of signaling cascades that respond to extracellular stimuli by targeting transcription factors , such as nf-b and ap-1 , resulting in the modulation of inflammatory gene expression . thus , this review will focus on some general aspects of inflammatory signaling regulation and summarize current knowledge regarding the presence and functional roles of these inflammatory signal molecules within the respiratory system , and their proposed involvement in the expression inflammatory target proteins in response to proinflammatory mediators during airway and lung inflammation . the pharmacological interventions protect against inflammation - induced airway and lung diseases will be discussed .

in respiratory diseases , there is an increased expression of multiple inflammatory proteins in the respiratory tract , including cytokines , chemokines , and adhesion molecules . chemokines have been shown to regulate inflammation and immune cell differentiation . moreover , many of the known inflammatory target proteins , such as matrix metalloproteinase-9 ( mmp-9 ) , intercellular adhesion molecule-1 ( icam-1 ) , vascular cell adhesion molecule-1 ( vcam-1 ) , cyclooxygenase-2 ( cox-2 ) , and cytosolic phospholipase a2 ( cpla2 ) , are associated with airway and lung inflammation in response to various stimuli . injuriously environmental stimuli can access the lung through either the airways or the pulmonary and systemic circulations . the time course and intensity of responses by resident and circulating cells may be regulated by various inflammatory signalings , including src family kinases ( sfks ) , protein kinase c ( pkc ) , growth factor tyrosine kinase receptors , nicotinamide adenine dinucleotide phosphate ( nadph ) /reactive oxygen species ( ros ) , pi3k / akt , mapks , nuclear factor - kappa b ( nf-b ) , activator protein-1 ( ap-1 ) , and other signaling molecules . these signaling molecules regulate both key inflammatory signaling transduction pathways and target proteins involved in airway and lung inflammation . here , we discuss the mechanisms involved in the expression of inflammatory target proteins associated with the respiratory diseases . knowledge of the mechanisms of inflammation regulation could lead to the pharmacological manipulation of anti - inflammatory drugs in the respiratory diseases .

polycystic liver disease is a condition characterized by the presence of multiple cysts in the liver , which may be inherited or sporadic , and most cases of adult polycystic liver disease ( apld ) are related to autosomal dominant polycystic kidney disease ( adpkd ) . in 1964 , there have been some reports , till date , that describe the association of malignant neoplasms with potter type iii cystic disease of the liver and kidney [ 2 , 3 , 4 , 5 , 6 , 7 , 8 ] ; however , most of these describe pancreatic and hepatobiliary neoplasms arising in patients with polycystic liver and kidney diseases including adpkd , and no report has described the association of gastric carcinoma with potter type iii cystic disease of the liver and kidney . this is the first case report of multiple gastric carcinomas associated with potter type iii cystic disease of the liver , mesenterium and kidney . although it is unclear whether the development of multiple gastric carcinomas is directly associated with the pathogenesis of multiple cysts in the liver , mesenterium and kidney , this case provides a perspective for etiology of gastric carcinoma with polycystic disease .

we report a case of multiple gastric carcinomas associated with potter type iii cystic disease of the liver , mesenterium and kidney . a 65-year - old man with chronic renal failure due to polycystic kidneys and under hemodialysis treatment 3 times a week for 2 years was admitted to our hospital because of anemia . he stated that his sister had suffered from polycystic kidney disease . gastrointestinal fiberscopy showed two lesions in the lesser curvature in the lower portion of the stomach , and histopathological analysis of the gastric tumor biopsies revealed that one of the tumors was a papillary adenocarcinoma and the other a poorly differentiated adenocarcinoma . helicobacter pylori infection was not detected in the stomach mucosa . abdominal computed tomography scan revealed polycystic lesions in the liver , mesenterium and both kidneys . these imaging findings and family history suggested that the patient suffered from multiple gastric carcinomas associated with potter type iii cystic disease of the liver , mesenterium and kidney . reports on the association of malignant neoplasm with potter type iii cystic disease are extremely rare . especially , no case of the association of gastric carcinoma with potter type iii cystic disease of the liver and kidney has been described previously . this is a first report of the association of gastric carcinoma with potter type iii cystic disease . we also review reports of other malignant neoplasms associated with polycystic disease .

diabetes imposes a large economic burden on the individual , national healthcare systems , and countries . [ 15 ] healthcare expenditures due to diabetes account for 11 % of the total healthcare expenditures in the world in 2011 . estimated global healthcare expenditures to treat diabetes and prevent complications totaled $ 465 billion in 2011 . by 2030 , this number is projected to exceed some $ 595 billion . on average , the estimated healthcare spending due to diabetes was $ 5,063 per person with diabetes in high - income countries compared with $ 271 in low- and middle - income countries . worldwide , the estimated number of adults living with diabetes has soared to 366 million , representing 8.3 % of the global adult population . this number is projected to increase to 552 million people by 2030 , or 9.9 % of adults , which equates to approximately three more people with diabetes every 10 or almost 10 million per year . [ 78 ] the kingdom of saudi arabia is not exception of this global pandemic . over the past four decades the ageing of populations , together with rapid socio - economic development ( progressive urbanization , decreasing infant mortality and increasing life expectancy ) and tremendous changes in lifestyle towards the westernized pattern reflected by changes in nutrition , less physical activity , tendency to increased obesity and more smoking , has resulted in the dramatic increase in the diabetes prevalence . [ 916 ] worldwide , the desire of many healthcare players ( governments , diabetes associations , health professionals , health economists , and people with diabetes themselves ) to reduce the economic burden of diabetes and its related complications costs makes the question of economic impact of diabetes an important component in : determining the present economic burden of diabetes and its related complications on government healthcare systempredicting the likely future economic burden of diabetes and its related complications , anddeveloping effective policies and strategies about treatment of diabetes and its related complications and the future public health spending related diabetes healthcare costs . determining the present economic burden of diabetes and its related complications on government healthcare system predicting the likely future economic burden of diabetes and its related complications , and developing effective policies and strategies about treatment of diabetes and its related complications and the future public health spending related diabetes healthcare costs . the purpose of this research study , therefore , is to determine the economic impact of diabetes mellitus ( dm ) on saudi arabia 's healthcare system , both now and in the future . this research study , however , focuses on the prevalence of diabetes and aims at estimating and predicting the total and per capita healthcare expenditure for people diagnosed with diabetes .

background : diabetes imposes a large economic burden on the individual , national healthcare systems , and countries.objective : to determine the economic impact of diabetes mellitus on saudi healthcare system , both now and in the future.materials and methods : this research study uses a prevalence - based approach that combines the demographics of the population ( classified by nationality , sex and age group ) with and without diagnosed diabetes in 1992 and 2010 . the economic impact of diabetes is estimated in this study , using secondary sources of information provided by ministry of health , ministry of finance and central department of statistics and information databases.results : people diagnosed with diabetes , on average , have medical healthcare expenditures that are ten times higher ( $ 3,686 vs. $ 380 ) than what expenditures would be in the absence of diabetes . over 96 % of all medical healthcare expenditures attributed to diabetes are incurred by persons of saudi nationality , with the remaining 4 % incurred by persons of non - saudi nationality . the population age 45 - 60 incurs 45 % of diabetes - attributed costs , with the remaining population under age 15 incurs 3.8 % , age 15 - 44 incurs 27.5 % , and age 60 and above incurs 23.8 % .conclusion : the actual national healthcare burden because of diabetes is likely to exceed the $ 0.87 billion estimated in this study , because it omits the indirect costs associated with diabetes , such as absenteeism , lost productivity from disease - related absenteeism , unemployment from disease - related disability , lost productivity due to early mortality by disease . the social cost of intangibles such as pain and suffering and care provided by non - paid caregivers as well as healthcare system administrative costs , cost of medications , clinician training programs , and research and infrastructure development is also omitted from this research study . further studies are needed to confirm the present findings and to improve our understanding of economic costs of diabetes and its related complications .

corneal perforation caused by small corneal punctures can sometimes be managed with a bandage soft contact lens , patching , and/or tissue adhesive [ 2 , 3 , 4 ] . however , surgical intervention is usually indicated when the anterior chamber does not reform within a short period of time . herein , we report the successful experience of managing a small paracentral corneal perforation without good apposition , which could not be tamponaded by a soft bandage lens only , with iatrogenic iris incarceration followed by cyanoacrylate tissue adhesive .

backgroundsurgical intervention for corneal perforation is indicated when the anterior chamber does not reform within a short period of time . herein , we report the successful management of a small paracentral corneal perforation using autologous iris incarceration and tissue adhesive.casea 41-year - old man developed a small paracentral corneal perforation ( 0.5 mm in size ) in the right eye , while the treating physician attempted to remove the residual rust ring after removal of a piece of metallic foreign body.observationsthe eye was initially managed with a bandage soft contact lens to ameliorate the aqueous leakage ; however , without success . iatrogenic iris incarceration of the wound was first induced , followed by application of cyanoacrylate tissue adhesive to the perforated site . as a result , the anterior chamber was immediately reformed and maintained . complete corneal epithelialization of the perforation was achieved in 2 months without visual compromises.conclusionscyanoacrylate tissue adhesive with iatrogenic incarceration of the autologous iris was effective in treating this type of small corneal perforation . this technique is simple and potentially useful for small paracentral corneal perforations outside the visual axis and without good apposition .

fever is a common reason for seeking medical attention and accounts for more than 20 % of emergency department visits.1 many mothers and caregivers have perceived phobia associated with their child 's fever for reasons that include serious infection , seizure , brain damage and death.2 paediatricians have regularly advised parents to seek immediate medical attention if their children developed a fever because fever is of great diagnostic importance especially in developing countries where infectious diseases such as malaria and pneumonia are very prevalent.3 in developing countries , because of the relatively low level of literacy and financial constraint of procuring reliable thermometers , many parents rely on palpation to assess if their children have fever.4 the objective use of the thermometer to detect the presence of fever is often limited to health care settings in most resource - poor settings . an accurate determination of the absence of fever in a child assures parents and saves cost by preventing unnecessary investigations and medication . ownership of thermometer seems poor , although no study in our environment was found to support that . in a study in new york , usa , of the 78 % of caregivers that owned thermometers , nearly half ( 48 % ) still utilised tactile method to assess fever.4 in another study , in india in contrast , only 15 % owned thermometer with 23.8 % of them not knowing how to use it.5 this underscores the fact that the use of palpation as a means of assessing fever by mothers is common and universal . majority of mothers and care givers in our environment still utilise tactile assessment to determine if their children have fever . controversies over the reliability of tactile assessment of fever have been variously reported ; while a study found it accurate enough , at least in younger infants,4 others reported that it overestimates the presence of fever.67 the reliability of the use of palpation to detect fever still remains uncertain . this study was carried out to determine the reliability of tactile assessment of fever by nigerian mothers in under-5 children and also to determine if the surface of the hand used influence the accuracy . the study further ascertained if palpation of a single or multiple anatomical sites influence the accuracy of tactile assessment of fever .

background : many mothers still rely on palpation to determine if their children have fever at home before deciding to seek medical attention or administer self - medications . this study was carried out to determine the accuracy of subjective assessment of fever by nigerian mothers in under-5 children.patients and methods : each eligible child had a tactile assessment of fever by the mother after which the axillary temperature was measured . statistical analysis was done using spss version 19 ( ibm inc . chicago illinois , usa , 2010 ) .result : a total of 113 mother / child pairs participated in the study . palpation overestimates fever by 24.6 % . irrespective of the surface of the hand used for palpation , the sensitivity , specificity , positive predictive value ( ppv ) and negative predictive value ( npv ) of tactile assessment were 82.4 % , 37.1 % , 51.9 % and 71.9 % , respectively . the use of the palmer surface of the hand had a better sensitivity ( 95.2 % ) than the dorsum of the hand ( 69.2 % ) . the use of multiple sites had better sensitivity ( 86.7 % ) than the use of single site ( 76.2 % ) .conclusion : tactile assessment of childhood fevers by mothers is still a relevant screening tool for the presence or absence fever . palpation with the palmer surface of the hand using multiple sites improves the reliability of tactile assessment of fever .

there is a critical need to develop potent and selective therapeutic agents capable of targeting malignant tissue without compromising normal cell viability . while chemotherapeutic agents ( e.g . , doxorubicin and docetaxel ) remain widely used in the clinic , they lack inherent selectivity desired to limit toxicity to normal cells . in addition , administration of chemotherapeutic agents can induce drug resistance , resulting in disease progression . thus , the development of more targeted therapies could circumvent nonspecific interactions and potentially overcome drug resistance in cancer therapy . intriguing studies are currently exploring new methods to engage biomolecular targets with high affinity and specificity , including the generation of multivalent and heterobifunctional constructs . advances in chemical synthesis techniques , such as cross - coupling and conjugation strategies , have enabled chemists to decorate a plethora of molecular species with targeting moieties , providing access to elaborate molecular architectures that can be tailored to occupy distinct binding sites within one or multiple biomacromolecules . although these types of compounds fall outside the molecular weight range of typical drug compounds ( 5003000 da ) , increasing interest in developing new chemical entities that can modulate biomolecular targets in novel ways and address selectivity requirements are emerging . to date , there have been only limited examples evaluating the potential for targeting the androgen receptor ( ar ) with steroidal conjugates . the ar is an important drug target for treatment of prostate cancer and has been the subject of research for several decades . a large number of bioactive compounds targeting ar have been identified via screening efforts . in this review , we begin by providing a rationale for continued studies in prostate cancer pharmacology targeting the ar . particular focus is placed on examining current approaches to specifically engage and modulate ar activity with steroid conjugates utilizing rational design principles .

the androgen receptor ( ar ) is a major therapeutic target in prostate cancer pharmacology . progression of prostate cancer has been linked to elevated expression of ar in malignant tissue , suggesting that ar plays a central role in prostate cancer cell biology . potent therapeutic agents can be precisely crafted to specifically target ar , potentially averting systemic toxicities associated with nonspecific chemotherapies . in this review , we describe various strategies to generate steroid conjugates that can selectively engage ar with high potency . analogies to recent developments in nonsteroidal conjugates targeting ar are also evaluated . particular focus is placed on potential applications in ar pharmacology . the review culminates with a description of future prospects for targeting ar .

for patients with acute coronary syndrome ( acs ) , the key to increased survival and the preservation of myocardial function is rapid diagnosis followed by appropriate early intervention , which will enable timely management strategies and intervention to be carried out . delays at any level of management , from the prehospital setting to the emergency department ( ed ) and , subsequently , to the cardiac catheterisation laboratory , must be minimised . the diagnosis of acute myocardial infarction requires the combination of a good and prompt clinical history , a 12-lead electrocardiogram ( ecg ) and also appropriate cardiac markers ( in cases of st - elevation ami [ stemi ] , the results of cardiac markers will not be required for decisions on management and intervention ) [ 15 ] . prehospital 12-lead ecgs are now being performed and transmitted to eds to save precious time in diagnosis . institutions set targets where the door - to - ecg time should not exceed 10 min , the door - to - needle time must be within 30 min and the door - to - intervention time should be within 90 min of arrival [ 611 ] . the acquisition of a 12-lead ecg is an important step to assess the cardiac status in routine and emergency situations . in a cardiac emergency , the time and accuracy of information are important elements that have a critical effect on patient outcomes . accurate ecg measurements are essential for diagnostic purposes , as well as serial comparison to evaluate changes in cardiac status and help in the prediction of future events . in clinical practice , the relevance of the ecg depends upon its reproducibility in an individual . with all of these points in mind the application of single - lead electrodes to the torso for standard 12-lead ecg acquisition takes time . a relatively new praecordial v1v6 , v - quick patch , has been developed and it provides a one - piece template for the placement of all six praecordial leads , which makes application easy . the person performing the 12-lead ecg need only to reach out for one single item to be applied to the patient s torso , instead of six separate pieces of items , as in the traditional case . the patch has characteristics that enable it to conform to variations in thoracic dimensions while retaining the ability of providing accurate electrode placement . training in the use of this new patch requires a minimal amount of time , as the template provides cues to the user on placement as it is being performed . the v - quick patch has the potential to be used anywhere and in any setting where a 12-lead ecg is carried out .

introductionthe v - quick patch template system is compared with the standard 12-lead electrocardiogram ( ecg ) acquisition technique in this paper . the objectives of the study were : ( a ) to study and compare the time taken to produce the printed 12-lead ecg and ( b ) to look at the level of agreement when the ecgs were compared by two blinded , independent assessors.methodsone hundred and fifty each of male and female volunteers signed an informed consent form to participate in the clinical study . nurses were put through a 4-h training session to familiarise themselves with the v - quick patch system . the timings were measured with a stopwatch with the specific start and end points defined . the final ecg printouts were then compared by two blinded , independent assessors for several set criteria.resultsthe v - quick patch system was proved to be significantly faster than the standard 12-lead system in the acquisition of the ecg in both male and female volunteers . the time taken in male volunteers was also noted to be significantly faster than in female volunteers.conclusionthe two assessors shared a 100 % agreement level when comparing the ecgs acquired by both techniques in the same individual ( intra - assessor agreement ) and when each ecg was read by the two assessors separately ( inter - assessor agreement ) .

phrynoderma , meaning toad skin , is a type of follicular keratosis coined and described by nocholls in 1933 . various nutritional deficiencies such as vitamin ( vit ) a , vit b - complex , vit e and essential fatty acid ( efa ) deficiency , as well as protein - calorie malnutrition have been suggested as possible etiological factors . most of the studies on phrynoderma were conducted in the early and middle of the last century . therefore , clinical features of phrynoderma and its association with nutritional deficiency signs were studied to elucidate the relationship between phrynoderma and nutritional status of patients .

background : phrynoderma is a type of follicular hyperkeratosis . various nutritional deficiency disorders have been implicated in the etiology of phrynoderma.aim : to determine clinical features of phrynoderma and its association with nutritional deficiency signs.materials and methods : a cross - sectional descriptive study of 125 consecutive patients with phrynoderma attending the outpatient department ( opd ) of dermatology was conducted in a tertiary care hospital . in all patients , a detailed history was taken and cutaneous examination findings such as distribution , sites of involvement , morphology of the lesions , and signs of nutritional deficiencies were noted.results : the proportion of patients with phrynoderma attending the opd was 0.51 % . there were 79 males and 46 females . age of the patients was in the range of 3 - 26 years with a mean of 10 4.3 years . the lesions were asymptomatic in 114 ( 91.2 % ) patients . the distribution of lesions was bilateral and symmetrical in 89 ( 71.2 % ) patients . the disease was localized ( elbows , knees , extensor extremities , and/or buttocks ) in 106 ( 84.8 % ) patients . the site of onset was elbows in 106 ( 84.8 % ) patients . the lesions were discrete , keratotic , follicular , pigmented or skin colored , acuminate papules in all patients . signs of vitamin a and vitamin b - complex deficiency were present in 3.2 % and 9.6 % patients , respectively . epidermal hyperkeratosis , follicular hyperkeratosis , and follicular plugging were present in the entire biopsy specimen.conclusion : phrynoderma is a disorder with distinctive clinical features and can be considered as a multifactorial disease involving multiple nutrients , local factors like pressure and friction , and environmental factors in the setting of increased nutritional demand .

dieulafoy lesion is an aberrant submucosal vessel that lies in close contact with the mucous membrane , which may lead to its exposure , causing massive gastrointestinal ( gi ) bleeding.1 it is the cause of approximately 6 % of upper gi bleeding.2 it is most commonly found in the proximal stomach and especially within 6 cm of the gastroesophageal junction , predominantly on the lesser curvature . however , it can occur anywhere in the gi tract , such as the small bowel.3 due to difficult access , diagnosis of small bowel bleeding is often delayed ; therefore , a multidisciplinary approach is needed to obtain its proper diagnosis and treatment . we experienced two cases of ileal dieulafoy lesion bleeding that presented with massive hematochezia and instability of vitals . the two cases were diagnosed and treated successfully using single balloon enteroscopy ( sbe ) with hemoclips . we discuss the clinical features as well as useful diagnostic and therapeutic modalities of ileal dieulafoy lesion through a computer - assisted search of the english language literature .

ileal dieulafoy lesion is an unusual vascular abnormality that can cause gastrointestinal bleeding . it can be associated with massive , life - threatening hemorrhage and requires urgent angiographic intervention or surgery . ileal dieulafoy lesion is hard to recognize due to inaccessibility and normal - appearing mucosa . with advances in endoscopy , aggressive diagnostic and therapeutic approaches including enteroscopy have recently been performed for small bowel bleeding . we report two cases of massive ileal dieulafoy lesion bleeding diagnosed and treated successfully by single balloon enteroscopy with a review of the literature .

obesity stigma and negative stereotypes of obese people are widespread and damaging to the health , dignity , human rights , and quality of life of obese individuals . standard media and biomedical depictions of obese individuals contribute to this stigmatization by positing that obesity incidence is nearly entirely dependent on individualistic actions . furthermore , obese individuals ' may occupy numerous intersecting social roles and identities based on their gender , class , race , and other social positions . biomedical and media depictions invariably refer to obesity as a crisis or epidemic . obesity 's multifactorial and multilevel etiology is reduced to an energy balance model of causation , which inadequately explains weight trajectories . despite the oft - reported inefficacy of weight loss dieting , public health interventions may be unsuccessful due to a narrow focus on weight loss , an overly simplistic notion of how obese individuals live ; experience their bodies ; the contexts they inhabit ; and the opportunities available to them in seeking wellness , happiness , and a full life . furthermore , while health is posited as the ultimate goal , these projects frequently focus on weight and deem fatness or higher weights as necessarily pathological . this is especially important given that the populations often targeted by such campaigns may differ culturally and socioeconomically from dominant groups . these diverse factors may affect their lifeways , priorities , and health conceptualizations in manners which may require in - depth exploration to produce truly beneficial and sensitive programming . qualitative social scientists , such as anthropologists or sociologists , trained in methods such as ethnography , may be uniquely suited to explore the lived experiences of obese individuals . they may aid in developing a public health strategy that is suited to the priorities and lifestyles of all individuals and is implemented in a manner consistent with a salutogenic , positive , and holistic understanding of health promotion . this paper discusses the potential for in - depth , qualitative social science research to concretely contribute to program delivery . even within the expanding fields of critical obesity research , as warin and gunson note , the compiling of actual obese people 's experiences and perspectives has been limited . through actual collaboration between disciplines , rather than public health researchers and programmers and qualitative social scientists operating in separate silos importantly , rather than reliance on stereotypes , such an approach would facilitate compassionate and evidence - based policy and programming .

obesity is viewed as a major public health concern , and obesity stigma is pervasive . such marginalization renders obese persons a special population . weight bias arises in part due to popular sources ' attribution of obesity causation to individual lifestyle factors . this may not accurately reflect the experiences of obese individuals or their perspectives on health and quality of life . a powerful role may exist for applied social scientists , such as anthropologists or sociologists , in exploring the lived and embodied experiences of this largely discredited population . this novel research may aid in public health intervention planning . through these studies , applied social scientists could help develop a nonstigmatizing , salutogenic approach to public health that accurately reflects the health priorities of all individuals . such an approach would call upon applied social science 's strengths in investigating the mundane , problematizing the taken for granted and developing emic ( insiders ' ) understandings of marginalized populations .

celiac disease ( cd ) is a common autoimmune disorder estimated to affect approximately 1 % of the us population . many studies have evaluated methods for identifying high - risk populations of patients in need of proactive screening for case identification . as with many chronic diseases , quality improvement approaches can be applied to populations of patients with cd to standardize care and track outcomes . effectively identifying and tracking outcomes of these cohorts of patients however , the development of cd patient registries often requires significant resources including practitioners , informatics teams , and administrative support . our center has developed and maintained a patient registry including all newly diagnosed patients since early 2012 . prior studies have evaluated the reliability of international classification of diseases-9 ( icd-9 ) searches to identify patients with cd with only moderate success yielding only 17 % of sensitivity . contrast experiments have been done using manually defined keywords to classify high - risk cd cases generating much more accurate results at 73 % of sensitivity . few efforts combining different aspects of available information to further improve classification accuracy including the use of data from visits , laboratory tests and pathology reports have been described . pathology reports have been previously used in building natural language processing ( nlp ) systems for automated chart review of patients . here , we define nlp broadly as methods to process textual data . one study found pathology reports to be insufficient for detecting breast cancer when using nlp approach compared with manual approaches while others found the use of nlp for analyzing pathology reports to be effective on detection of colon cancer and manifestation of prostatectomy details . currently , a lack of research exists on investigating the usefulness of pathology reports on automated cd detection . based on a subset of patients prescreened using icd-9 code 579.0 , we evaluated the effectiveness of using natural language features from pathology reports to improve the identification of cd patients . this paper was among the first to adopt a machine learning approach to further increase the accuracy of cd patient identification based on a combination of pathological and clinical metrics . in contrast to prior research , we conducted contrast experiments using both natural language features and clinical features under different machine learning configurations for celiac identification .

background : celiac disease ( cd ) is a common autoimmune disorder . efficient identification of patients may improve chronic management of the disease . prior studies have shown searching international classification of diseases-9 ( icd-9 ) codes alone is inaccurate for identifying patients with cd . in this study , we developed automated classification algorithms leveraging pathology reports and other clinical data in electronic health records ( ehrs ) to refine the subset population preselected using icd-9 code ( 579.0 ) .materials and methods : ehrs were searched for established icd-9 code ( 579.0 ) suggesting cd , based on which an initial identification of cases was obtained . in addition , laboratory results for tissue transglutaminse were extracted . using natural language processing we analyzed pathology reports from upper endoscopy . twelve machine learning classifiers using different combinations of variables related to icd-9 cd status , laboratory result status , and pathology reports were experimented to find the best possible cd classifier . ten - fold cross - validation was used to assess the results.results : a total of 1498 patient records were used including 363 confirmed cases and 1135 false positive cases that served as controls . logistic model based on both clinical and pathology report features produced the best results : kappa of 0.78 , f1 of 0.92 , and area under the curve ( auc ) of 0.94 , whereas in contrast using icd-9 only generated poor results : kappa of 0.28 , f1 of 0.75 , and auc of 0.63.conclusion : our automated classification system presented an efficient and reliable way to improve the performance of cd patient identification .

the possible presence of infection in cervical smear tests is usually reported by the cytologists based on cytological criteria . therefore , non - specific cervicitis or inflammatory changes in a smear report are common . these findings are usually unclear for clinical approaches and there is not an appropriate guideline for management of such patients . it is not known if these women should be recalled for cultures and treatment or inflammatory change should be considered as minor . changes in balance of normal vaginal flora can cause an overgrowth of pathogens that lead to discharge . although it is a common complain among sexually active women , there are still gaps in our knowledge about it . bacterial vaginosis ( bv ) , vaginal candidiasis ( vc ) and trichomoniasis are the three infections most commonly associated with vaginal discharge ( 1 ) . a number of studies have indicated the association of bv with postoperative complications after gynecologic surgery as well as pregnancy complications ( 25 ) . trichomonas vaginalis ( tv ) is also another common cause of vaginal discharge , but some studies have not found its association with pregnancy complications ( 3 ) or some other indicated that tv during pregnancy was a predisposing factor for preterm delivery and delivering low - birth weight infants ( 6 ) . the pap smear test for detection of bv has showed a sensitivity of 88.2 % , a specificity of 98.6 % , and a positive predictive value ( ppv ) of 96.8 % ( 7 ) . the sensitivity , specificity , and ppv of pap test for tv diagnosis has been reported 98 % , 96 % , and 88 % , respectively ( 8 ) . also , some recent studies have demonstrated the co - infection of vaginal pathogenic organisms in pap tests ( 2 , 9 , 10 ) . this study aimed to investigate the prevalence of pathogenic vaginal microorganisms and the presence of inflammation in pap smear among an iranian women sample and to evaluate the possible co - infection of these organisms .

objectivenon - specific cervicitis or inflammatory changes in a smear report are common which are usually unclear for clinical approaches . to investigate the frequency of inflammation and pathogenic vaginal microorganisms in cervical smears among an iranian population sample.materials and methodsthis cross - sectional study was carried out on pap smear samples of women referred to gynecological clinic of taleghani hospital in tehran , iran , between october 2008 and march 2009 . this study was conducted on 528 conventional papanicolaou cervical smears . the frequency and severity of inflammation and prevalence of bacterial vaginosis ( bv ) , trichomonas vaginalis ( tv ) , and vaginal candidiasis ( vc ) was determined in the samples . also co - infection of the microorganisms in pap samples was evaluated . percentage , meanstandard deviation of the outcome parameters were calculated . the comparison between data was performed with the pearson 's chi square or fisher 's exact test.resultsthe prevalence of bv , vc , and tv in pap samples was 17 % , 11 % , and 0.4 % respectively . overall , the prevalence of these microorganisms in women of reproductive age was higher than menopausal women . there was a significant association between vc and the presence of inflammation in our samples.conclusionbased on our results , inflammation in the pap smears can suggest an infection of vc and the patients should be considered for proper vc treatment .

behet 's disease ( bd ) is a chronic inflammatory disease that is characterized by recurrent oral and genital ulceration and uveitis1 ) , the other clinical manifestations include skin lesions , arthritis , thrombosis , neurologic symptoms and intestinal ulceration . polychondritis is known as a rare complication of bd and no case of bd combined with polychondritis had been reported on until firestein et al . reported on five patients with both bd and relapsing polychondritis ( rp ) in 19852 ) . we recently experienced a case of a 40-year - old male patient with both bd and polychondritis , and we report herein on this unusual case along with a review of the literature .

polychondritis is an inflammatory disorder that affects various catilagenous structures , and the clinical features include auricular , nasal and respiratory tract chondritis . it also involves the eyes , audiovestibular apparatus , joints and vascular structures . polychondritis can be associated with several rheumatologic diseases such as systemic lupus erythematosus , rheumatoid arthritis and systemic vasculitis . however , polychondritis is a rare complication of behet 's disease ( bd ) and only ten cases with combined bd and polychondritis have been reported on around the world . in this report , we describe a 40-year - old korean man with bd who suffered from polychondritis that manifested as bilateral auricular chondritis , conjunctivitis and arthritis .

disability prevalence increases with advanced age , and disability in the elderly population is a major public health problem . this is especially crucial for chinese : there are 88 million persons aged 65 and above in china alone , and the number is projected to increase to 341 million in 2050 ; importantly , disability prevalence in chinese elderly population has been increasing [ 35 ] in contrast to a declining trend in the developed countries [ 6 , 7 ] . there is a big gap between the scale of the problem and the quantity and quality of available information . the first population - based report from china was published 16 years ago , and countable number of publications [ 35 , 812 ] exist in the literature . in this study , with large population - based data from shanghai ( the biggest city in china ) and singapore ( a city country in southeast asia , with majority of the residents being descendents of immigrants from south china ) , we aimed to examine the independent contributions of physical and cognitive health to disability in chinese older adults and explore the potential influences of environment .

objective . we aimed to examine the independent contributions of physical health and cognitive function to disability among chinese older adults living in two asian metropolises and explore the potential influences of environment . design and participants . cross - sectional analysis based on data from two population - based studies : the shanghai survey of alzheimer 's disease and dementia ( n = 4639 ) and the singapore longitudinal ageing study ( n = 2397 ) . disability was defined as needing help in at least one activity of daily living . results . the prevalence of functional disability was higher in shanghai sample ( 5 % ) than that in singapore sample ( 1.8 % ) . number of chronic diseases , self - rated health status , cognitive function ( measured by the mini - mental state examination ) , and environment ( singapore versus shanghai ) significantly contributed to functional disability independent of each other . the adjusted odds ratio was 1.35 ( 95 % ci 1.221.50 ) , 2.85 ( 95 % ci 2.363.43 ) , 0.89 ( 95 % ci 0.850.94 ) , and 0.68 ( 95 % ci 0.480.96 ) , respectively . the strength of associations between health variables and disability appeared to be influenced by environment . conclusion . physical health and cognitive function independently contributed to functional disability . the associations are modulated by environmental factors .

often , a new physics faculty member is faced with the duty of renovating the introductory physics labs . we will provide a list of experiments and equipment needed to convert about half of the traditional labs on a 1-year introductory physics lab into microcomputer - based laboratories ( mbls ) . our student body consists mostly of science majors that take the algebra - based course . but , the lab renovation described here could be used for the calculus - based group as well . we would suggest adjusting the lab manuals . nowadays , mbls are usually the choice when thinking of a renovation . they have effectively demonstrated an advantage to the learning process over the years . [ 14 ] moreover , for our science students , the labs are important in reinforcing the concepts learned in class . it is very common to hear , during the lab sections , students commenting on their grasp of the concept learned in class due to the experiment being performed . the overall 1-year lab experience follows the guidelines provided by the american association of physics teachers .

nowadays , data acquisition software and sensors are being widely used in introductory physics laboratories . this allows the student to spend more time exploring the data that is collected by the computer hence focusing more on the physical concept . very often , a faculty is faced with the challenge of updating or introducing a microcomputer - based laboratory ( mbl ) at his or her institution . this article will provide a list of experiments and equipment needed to convert about half of the traditional labs on a 1-year introductory physics lab into mbls .

type 2 diabetes mellitus ( t2 dm ) is a growing epidemic : in the united states of america alone , nearly 25.8 million people ( approx 8.3 % of the total population ) have the disease.1 estimates have placed the global prevalence of the disease at around 217 million.2 the consequence to the individual of prolonged exposure to hyperglycemia is a marked increase in the risk of mortality and morbidity , with an associated reduction in life expectancy of around 1213 years.3 diagnosis usually occurs some time after development of the disease and they have often already experienced occult pathology by the time patients receive a diagnosis . early adoption of an aggressive approach to disease management improves patient outcome , with marked reductions in morbidity and mortality.46 the first line approach to treatment is through lifestyle modification.7 however , t2 dm is progressive in nature , and lifestyle changes sufficient to halt the disease are difficult to achieve . intense efforts by patients and the healthcare team frequently fail . similarly , most conventional antidiabetic drugs ( eg , metformin , sulfonylureas etc . ) often fail to slow the progression of t2 dm , despite the availability of a broad range of agents employing different mechanisms of action.79 the progressive nature of the disease and how it overwhelms available therapies was highlighted in the ukpds study ; suggesting that fewer than half of all patients actually achieve adequate levels of disease control.4,5 there is a recognized need for new treatment options for t2 dm . characterization of the mechanisms facilitating glucose resorption by the kidney has raised the possibility of a novel treatment for diabetes : inhibition of the type 2 sodium - glucose transporter ( sglt2 ) , a 672 amino - acid , high capacity , low affinity transmembrane protein that promotes reabsorption of glucose as the glomerular filtrate passes down the nephrons.10 several candidate molecules are currently in development and may soon be available for use in the treatment of diabetes . we provide a brief review of sglt2 inhibitors and their possible role in the treatment of t2 dm .

there is a recognized need for new treatment options for type 2 diabetes mellitus ( t2 dm ) . recovery of glucose from the glomerular filtrate represents an important mechanism in maintaining glucose homeostasis and represents a novel target for the management of t2 dm . recovery of glucose from the glomerular filtrate is executed principally by the type 2 sodium - glucose cotransporter ( sglt2 ) . inhibition of sglt2 promotes glucose excretion and normalizes glycemia in animal models . first reports of specifically designed sglt2 inhibitors began to appear in the second half of the 1990s . several candidate sglt2 inhibitors are currently under development , with four in the later stages of clinical testing . the safety profile of sglt2 inhibitors is expected to be good , as their target is a highly specific membrane transporter expressed almost exclusively within the renal tubules . one safety concern is that of glycosuria , which could predispose patients to increased urinary tract infections . so far the reported safety profile of sglt2 inhibitors in clinical studies appears to confirm that the class is well tolerated . where sglt2 inhibitors will fit in the current cascade of treatments for t2 dm has yet to be established . the expected favorable safety profile and insulin - independent mechanism of action appear to support their use in combination with other antidiabetic drugs . promotion of glucose excretion introduces the opportunity to clear calories ( 8090 g [ 300400 calories ] of glucose per day ) in patients that are generally overweight , and is expected to work synergistically with weight reduction programs . experience will most likely lead to better understanding of which patients are likely to respond best to sglt2 inhibitors , and under what circumstances .

the goal of defibrillation ( df ) testing is to verify the detection of ventricular tachyarrhythmias by implantable cardioverter - defibrillators ( icds ) , and to ascertain df efficacy . all clinical trials , which demonstrated the benefit of icd therapy , have included some kind of df testing . according to the food and drug administration , the instructions for use of icds include the recommendation with df testing at the time of implantation . the absence of df testing may have medico - legal implications whether a device fails to terminate ventricular fibrillation ( vf ) during follow - up . nevertheless , df testing has been deliberately omitted in the majority of patients enrolled in contemporary icd studies . despite the stochastic nature of df , ineffective shocks during vf induction result in system modifications in up to 5 % of patients . system modifications , such as repositioning of the electrode , reversal of polarity , use of a high - energy device , use of a dual instead of a single - coil electrode , or the implantation of an additional subcutaneous electrode , may be unnecessary or even harmful since many patients have a successful retesting with the original system configuration . no single system modification in itself has ever been shown to improve outcome . with current devices and programming , an inadequate safety margin occurs infrequently , and the incidence of ventricular tachyarrhythmias requiring shocks is low at 46 % per year . while df testing has never been shown to improve survival , it is associated with an increased , albeit small risk of major adverse events of 0.4 % . by omitting routine df testing , the approach to icd implantation will likely change considerably , as the procedures will be shorter and performed without technical support and anaesthesia . similar to the simple trial , we hypothesized that , with current high - energy icd devices , the omission of df testing during implantation will not result in an inferior shock efficacy during follow - up when compared with standard df testing . as opposed to the simple trial , which used the composite outcome of arrhythmic death or failed appropriate shock , the primary end point of our study was the shock efficacy of all true ventricular tachycardia ( vt ) and vf episodes occurring in any patient during follow - up .

aimsthis trial was designed to test the hypothesis that shock efficacy during follow - up is not impaired in patients implanted without defibrillation ( df ) testing during first implantable cardioverter - defibrillator ( icd ) implantation.methods and resultsbetween february 2011 and july 2013 , 1077 patients were randomly assigned ( 1 : 1 ) to first time icd implantation with ( n = 540 ) or without ( n = 537 ) df testing . the intra - operative df testing was standardized across all participating centres , and all icd shocks were programmed to 40 j irrespective of df test results . the primary end point was the average first shock efficacy ( fse ) for all true ventricular tachycardia and fibrillation ( vt / vf ) episodes during follow - up . the secondary end points included procedural data , serious adverse events , and mortality . during a median follow - up of 22.8 months , the model - based fse was found to be non - inferior in patients with an icd implanted without a df test , with a difference in fse of 3.0 % in favour of the no df test [ confidence interval ( ci ) 3.0 to 9.0 % , pnon - inferiority < 0.001 for the pre - defined non - inferiority margin of 10 % ) . a total of 112 procedure - related serious adverse events occurred within 30 days in 94 patients ( 17.6 % ) tested compared with 89 events in 74 patients ( 13.9 % ) not tested ( p = 0.095 ) .conclusiondefibrillation efficacy during follow - up is not inferior in patients with a 40 j icd implanted without df testing . defibrillation testing during first time icd implantation should no longer be recommended for routine left - sided icd implantation .

acute myeloid leukemia ( aml ) is a clinically , morphologically and genetically heterogeneous disease characterized by clonal expansion of myeloid blasts in peripheral bone marrow ( bm ) , blood or other tissues . the incidence of aml increases with age , particularly after 65 years old , and the median age at diagnosis is around 70 years . age in itself is one of the most powerful prognostic factors for survival in aml , , . elderly patients not only present more comorbidities and worse performance status but also have more adverse molecular features compared to younger patients , , . due to the presence of comorbidities and poor performance status , intensive chemotherapy ( ic ) or allogeneic stem cell transplant is often unsuitable for a large proportion of elderly patients with aml , resulting in early mortality and prolonged hospitalization , . however , when feasible , treatment is associated with better survival when compared to best supportive care only but the median overall survival achieved with ic in the elderly is only 513 months , . therefore , there is an increasing need for new treatment options for elderly patients with aml . the aza-001 phase iii trial has demonstrated effectiveness of azacitidine ( aza ) in a dose of 75 mg / m2 daily for 7 consecutive days in patients with high - risk myelodysplastic syndromes . a subset analysis of the aza-001 trial restricted to patients with 2030 % bm blasts , demonstrated superior efficacy of aza when compared with conventional care regimens , leading to aza international approval for the treatment of low bm blast count ( 2030 % ) who - defined aml . these results raise the question of the potential use of aza in aml irrespectively of the bm blast count . this is supported by the identification of somatic mutations of genes involved in epigenetic regulation in approximately 30 % of aml patients . consequently several groups have assessed and reported the efficacy of aza in patients with aml , , , . more recently a randomized phase iii trial comparing first - line aza to conventional therapies , including intensive chemotherapy , in elderly patients with aml revealed that aza achieved clinically meaningful survival benefit compared to conventional treatments . we present herein a multi - centre retrospective analysis of 77 aml patients who were treated with aza in first line or due to relapsed / refractory disease . the main aim was the characterization of the efficacy and safety of aza treatment in aml patients in portugal . we also conducted an exploratory comparison of overall survival between patients receiving 1st line treatment with aza and elderly aml patients treated with ic alone .

retrospective data was collected from 77 elderly acute myeloid leukemia ( aml ) patients treated with azacitidine ( aza ) and 50 elderly aml patients treated with intensive chemotherapy ( ic ) from 4 portuguese hospitals.median os was 10.6 months in those receiving aza as 1st line . response ( overall response rate 44 % ) had a significant impact on overall survival ( p= < 0.0001 ) . median os of the comparator ic cohort was significantly inferior to that observed in the cohort treated with aza in first line ( p=0.0104 ) .these results support the efficacy of aza in aml in the elderly in any line of treatment .

one of the most important organ systems is cardiovascular that it 's disorders specially ischemic heart diseases can cause disability or death . some people specially workers who work in special industries are more in the risk of same disorders . there were many studies work on workers health but there were some of them , study on cardiovascular system because these disorders have more than one etiology and one of the modifiable risk factors or etiology is work exposure . according to these realities ; cardiovascular disorders risk factors were assessed and measured such as triglyceride , total cholesterol , low density lipoprotein ( ldl ) , high density lipoprotein ( hdl ) , blood pressure , obesity , smoking , genetic . also shift work , stress , carboxi hemoglobin ( cohb ) , solvents , noise , vibration , temperature of environment , air pollution can find the high risk personnel with non occupational and occupational risk factors of cardiovascular disorders . exposure to fumes , solvents , additives and drugs , carbon monoxide , carbon disulfide , pesticides , heavy metals , cold or warm environment , air pollution , vibration and noise can cause occupational cardiovascular disorders had demonstrated work as a farmer , have a heavy and manual work , exposure to noise and some physical or chemical were cardiovascular disorders risk factors . ghiasvand et al . in their study had shown that work in rail road industry was a risk factor and can cause hyper low density lipoprotein , specially in workers who had shift work . in study of national heart , lung , and blood institute had been shown that the work in tunnel can cause exposure to carbon monoxide and other study on foundry workers can cause the same exposure . kim et al . in other study had demonstrated that work in refrigerated industry was not a risk factor but workers who work in cold place and environment had diastolic blood pressure in more amount , it was in comparison between exposure to cold and non exposure to it . had shown that work as a engine driver had cardiovascular risk factors , because they had more hypertension and hyperlipidemia than control group . kang et al . in their study had found that work in companies and related job mental stress specially in the background of decision making it was related to amount of cholesterol and triglyceride , in the background of demands of work these were related to systolic blood pressure . chin - ming lin et al . had demonstrated that medical technicians had more hypertensive disorders than other healthcare workers . also kim had shown the relationship between cold exposure and increasing of blood pressure or hypertension . the objective of this study was comparison of cardiovascular risk factors between workers in different industries of iran .

background : disorders of cardiovascular system can cause disability or death , screening is necessary specially in workers who maybe had risk factors . hypertension , hyperlipidemia , obesity , smoking , genetic , exposure to chemicals , fumes , solvents , coldness are non occupational and occupational risk factors . objective was comparison of cardiovascular disorders risk factors between workers in different industries of iran.methods : in a cross - sectional study , workers of automobile , food industries and light works had been selected and cardiovascular disorders risk factors had been gathered then data analyzed in spss with one - way anova , chi-2 and multi nominal logistic regression with p < 0.05.results:875 workers had been participated in the study , all of the cardiovascular disorders risk factors were in the normal range . mean of high density lipoprotein ( hdl ) in food industry workers was 63.83 17.42 mg / dl and it was protective , but in workers who work in automobile industry was 38.97 11.08 mg / dl and the lowest , also hypertension and hypertriglyceridemia were more prominent in this industry and after regression with p < 0.05 , the differences were significant.conclusions : screening of cardiovascular disorders risk factors were important and helpful in industries specially automobile industry , that might be preventive method for these disorders in the future .

vesicoureteral reflux ( vur ) occurs commonly in children , resulting in potentially serious complications . this could result in renal scarring , hypertension , and even end - stage renal failure . treatment options for children with vur include continuous antibiotic prophylaxis , endoscopic injections , and laparoscopic or open ureteroneocystostomy . since hutch introduced open ureteral reimplantation to correct vur in 1952 , many such techniques have been developed . in 1984 , endoscopic injections of tissueaugmenting material for the correction of vur were introduced ; since then , many urologists prefer this procedure . endoscopic injection is frequently used now as a firstline treatment because it involves less pain and a shorter hospitalization period and leaves no scar , in contrast to open reimplantation . however , when an injection treatment fails , open ureteral reimplantation should be considered for treating persistent vur . we aimed to test the usefulness of open reimplantations , which were performed primarily and after failed endoscopic injection procedures .

purposeas endoscopic treatment for vesicoureteral reflux ( vur ) has increased , secondary ureteral reimplantation ( ur ) after failure of endoscopic treatment has increased . we studied the clinical feature and efficacy of secondary ur after failure of endoscopic treatment compared with primary ur.materials and methodseighty - one children who had ur for vur were enrolled . charts were reviewed retrospectively for age , sex , grade of vur before surgery , operative time , hospitalization period , postoperative complication , and success rate . primary ur ( group a , n=64 ) was compared with secondary ur after failed endoscopic treatment ( group b , n=17 ) . in group b , telephone survey for the satisfaction of endoscopic treatment and surgery was done.resultsmean age of each group was 49.637.1 and 56.622.5 months ( p=0.236 ) . there was no significant difference between each group in sex , mean operative time , postoperative transfusion , complication rate , and success rate . as telephone survey in group b , eleven responders preferred endoscopic treatment as primary treatment of vur because it was a simple method and no hospitalization.conclusionssecondary ur after failure of endoscopic treatment was similar to primary ur . parents preferred endoscopic treatment as first line treatment for vur in spite of the need for secondary ur after failure of endoscopic treatment .

in all well developed societies there tend to be barriers between different organizations and different professions , even when those professions want to co - operate to help individuals to satisfy their needs . health and social services today face groups of patients who have composite problems and are often unstable . they include , very obviously , elderly persons with multiple problems , chronically ill children , and persons suffering mental ill - health . they have continuing need of care and in search of care they move between primary care , hospital care and municipality care , such as that provided for elderly persons . their situation demands some form of integration between health and social services [ 35 ] , the benefits of which have been identified as including reduced hospital use , a strong focus on prevention and keeping patients healthy , and the provision of care closer to home . from the perspective of the person seeking care , medical and social needs are connected . individuals do not see themselves as multi - ill , but as needing support for their needs as they know them . it must be said that from the 1970s onwards a number of integrative approaches have been tried out , not least in education . although there are exceptions to learn from , generally speaking european health and social services are fragmented and poorly equipped to take care of patients with composite needs . so far , and to a great extent , the task of integrating different delivery systems , of managing the transitions from one provider to another , has fallen on the shoulders of patients themselves or their relatives . much of the evidence indicates that the problem we face is a result of the prevailing mindset . how can we increase our understanding of health and social services that are located in different organizations ?

introductionorganizations can be regarded as systems . the traditional model of systems views them as machines . this seems to be insufficient when it comes to understanding and organizing complex tasks . to better understand integrated care we should approach organizations as constantly changing living organisms , where many agents are interconnected in so - called complex adaptive systems ( cas ) .theory and discussionthe term complex emphasizes that the necessary competence to perform a task is not owned by any one part , but comes as a result of co - operation within the system . adaptive means that system change occurs through successive adaptations . a cas consists of several subsystems called agents , which act in dependence of one another . examples would be the ant - hill , the human immune defence , the financial market and the surgical operating theatre team . studying a cas , the focus is on the interaction and communication between agents . although these thoughts are not new , the cas - approach has not yet been widely applied to the management of integrated care . this helps the management to understand why the traditional top down way of managing , following the machine model thinking , may meet with problems in interdependent organizations with complex tasks.conclusionwhen we perceive health and social services as cass we should gain more insight into the processes that go on within and between organizations and how top management , for example within a hospital , in fact executes its steering function .

we will introduce recent advances on the study of post - translational processing , modification , and targeting of cathepsins and cystatins . almost all the intracellular proteins are passed through principally similar processes from the synthesis to their degradation in general . therefore , i would like to introduce the general fate of intracellular proteins , from the post - translational processing , modification , and targeting to the ordered particles . as figure 1 shows , the intracellular proteins are synthesized as pre - promature complex in polysomes and prepart is removed cotranslationally , and then the promature parts are translocated into golgi - apparatus , and then glycosylated by mannose - rich sugar . the glycosylated mature part is translocated into target organelles and the degradation was started by the splitting from the ordered nicked bonds to make hydrophobic peptides . these hydrophobic peptides are secreted to cytoplasm and are incorporated into the phagosomes or proteosomes after ubiquitination . biological merit of post - translational processing and modifications of proteins are possible considerations . the capability to take variable forms on the way of biosynthesis is important to keep adaptability to the changing of biological requirements and intracellular translocation during the maturation must be regulated . pro - parts or bound sugar are the targeting signals in some cases . in the cases of carbamoyl phosphate synthetase ( cps ) and ornithine transcarbamylase ( otc ) , their pro - parts play the role of signals to be recognized by their receptors located on target organella membrane , such as lysosomes , as shown in figure 4 . the glycosylated cathepsins are targeted into lysosomes mediated by mannose-6 phosphate receptors which are located on the lysosomal .

cathepsins are an essential protease family in all living cells . the cathepsins play an essential roles such as protein catabolism and protein synthesis . to targeting to various organella and to regulate their activity , the post translational - processing and modification play an important role cathepsins are translated in polysome as the pre - pro - mature forms . the pre - peptide is removed cotranslationally and then translocated to golgi - apparatus and the pro - part is removed and the mature - part is glycosylated , and the mature - part is targeted into the lysosome mediated by mannose-6-phosphate signal and the mature - part is bound with their coenzymes . the degradation of the mature - part is started by the limited proteolysis of the ordered nicked bonds to make hydrophobic peptides . the peptides are incorporated into phagosome or proteasome after ubiquitinated and are degrade into amino - acids . cystatins are endogenous inhibitors of cathepsins . cystatin which is only located in skin is phosphorylated at the near c - terminus by protein kinase - c , and the phosphorylate - cystatin is incorporated into cornified envelope and conjugated with filaggrin - fiber by transglutaminase to form the linker - fiber of skin . the cystatin is modified by glutathione or make their dimmer , and they are inactive . those modifications are regulated by the redox - potential by the glutathione .

five of the world s most fatal work safety accidents in the past decade ( 20012010 ) occurred in china ( 1 ) . work safety accidents has become the first cause of deaths of chinese citizens below 44 yr old ( 2 ) . work safety accidents pose a great threat to people 's life , especially major accidents , defined as ones that result in at least 10 deaths . the chinese government has established a surveillance system for monitoring work safety accident since 2001 under state of saws ( 3 ) , which is the only authority system for work safety accidents inquiry in china . injuries related to transportation , mining , fire , explosion had the majority of occurrence ( 46 ) , and the most accidents occurred in construction on certain geographic regions of china ( 7 , 8 ) . previous researches had focused on the characteristics of work safety accidents , while there is very few research analyzing major accidents with mass casualties . there has no clear answer yet that whether accidents with mass casualties are a simple enlargement of general accidents , or there is inherent mechanism of accident cause and special risk factors or not . the in - depth research focused on cause mechanism of work accidents with at least 10 fatalities has important theoretical value and practical meaning to improve relevance and effectiveness of accident prevention . to examine the national profile of the extent and type of major accidents in work safety , which causes more than 10 fatalities per accident , we analyzed data from accident inquiry system on saws website for the period 2003 to 2012 and provide scientific basis for prevention measures and strategies to reduce major work safety accidents and deaths in china .

background : this study provides a national profile of major work safety accidents in china , which cause more than 10 fatalities per accident , intended to provide scientific basis for prevention measures and strategies to reduce major work safety accidents and deaths.methods : data from 20032012 census of major work safety accidents were collected from state administration of work safety system ( saws ) . published literature and statistical yearbook were also included to implement information . we analyzed the frequency of accidents and deaths , trend , geographic distribution and injury types . additionally , we discussed the severity and urgency of emergency rescue by types of accidents.results : a total of 877 major work safety accidents were reported , resulting in 16,795 deaths and 9,183 injuries . the numbers of accidents and deaths , mortality rate and incidence of major accidents have declined in recent years . the mortality rate and incidence was 0.71 and 1.20 per 106 populations in 2012 , respectively . transportation and mining contributed to the highest number of major accidents and deaths . major aviation and railway accidents caused more casualties per incident , while collapse , machinery , electrical shock accidents and tailing dam accidents were the most severe situation that resulted in bigger proportion of death.conclusion : ten years major work safety accident data indicate that the frequency of accidents and number of eaths was declined and several safety concerns persist in some segments .

the diagnosis and extent of resection in the management of hd depend on the sensitive and specific identification of ganglion cells . [ 13 ] however , documenting aganglionosis is often difficult and tedious on routine hematoxylin - eosin ( h and e ) stained sections . acetylcholinesterase ( ache ) has evolved as the gold standard in diagnosing hd ; however , this histochemical analysis is technically challenging , and to date , has not gained worldwide utilization and applicability . the aim of this study was to evaluate the efficacy of calretinin immunostaining in the ganglionic and aganglionic hd colon biopsy specimens and correlate with the h and e , thereby exploring its utility in suspicious cases of hd .

aim : to evaluate the efficacy of calretinin immunostaining in diagnosing hirschsprung 's disease ( hd ) .materials and methods : sixty cases were studied over a period of 1 year ( july 2010-june 2011 ) . there were 36 full - thickness biopsies and 24 resected specimens . calretinin processing was done on the paraffin - embedded blocks after routine histopathological examination.results : of the 36 biopsy specimens , in 19 cases hd was diagnosed by hematoxylin and eosin ( h and e ) staining earlier . in 2 patients , ganglion cells were seen and hd was ruled out . in 15 cases , there was a diagnostic dilemma and calretinin was used . ganglion cells were found in 3 specimens and nerve fibers in 5 . in all 24 resected specimens , calretinin correlated with the findings on h and e staining.conclusions : calretinin was extremely useful in solving the suspicious and indeterminate cases of hd . it can serve as a valuable cost - effective diagnostic aid in the centers where acetylcholinesterase enzyme histochemistry is not available .

q fever is a zoonotic disease that is caused by coxiella burnetii , a microorganism that frequently infects domestic ungulates , as well as wild mammals in many genera ( 1 ) . in animals , the disease is transmitted to humans incidentally by inhalation of aerosols from infected cattle and sheep ( 1 , 2 ) . in humans , c. burnetii infection may be asymptomatic , acute , or chronic . chronic q fever is rare , with endocarditis presenting as the most common complication ( 1 , 3 ) . q fever has been reported in almost every country , except new zealand ( 4 ) . in canada , burnetii antibodies ( 5 ) . in japan , 60 to 84 % of cattle with reproductive disorders are seropositive ( 6 ) . a study conducted in southern france showed that 5 to 8 % of endocarditis cases in humans were due to c. burnetii , and the prevalence of acute q fever was 50 cases per 100,000 inhabitants ( 7 ) . researchers have suggested that the incidence of q fever is chronically underestimated because clinical manifestations of the disease are often nonspecific or even absent . therefore , concerns with the disease focus on the importance of detection ( 1 , 3 , 8 ) . in korea , there is a little information concerning the epidemiology of c. burnetii infection in either animals or humans . a few cases of acute q fever in humans have been reported ( 9 , 10 ) . we examined the prevalence of antibodies to c. burnetii in dairy cattle nationwide and in people for health screening in a rural area of korea , and used the data to evaluate the impact of q fever in both animals and humans in korea .

we report results on the seroprevalence of antibodies to coxiella burnetii in cattle and healthy people in korea . upon agreement with dairy owners , serum samples from 414 dairy cattle were collected between march and june 2001 and samples from 205 people for health screening were collected between april and december 2002 . the sera were analyzed for the presence of anti - c . burnetii phase ii antibodies using an indirect microimmunofluorescence test ; strong fluorescence at a 1:32 dilution was regarded as positive . the overall seroprevalence of c. burnetii in cattle in korea was 25.6 % , with regional variation from 8.9 to 59.3 % . of the positive serum samples , 75.5 % had antibody titers 1:256 . by contrast , only 1.5 % of people in a rural area were seropositive , and most of the positive samples had low antibody titers . in conclusion , this study showed that relatively high seropositivity of c. burnetii in dairy cattle , accordingly , the studies on the high - risk groups are needed to evaluate the seroprevalence for this organism in korea .

proton magnetic resonance spectroscopy ( h mrs ) is a noninvasive technique that allows us to provide an in vivo assessment of brain tissue composition and this gives us an insight into the metabolic processes of neurologic disorders ( 1 , 2 ) . this technique 's ability to obtain good spatial localization and serial measurements with high resolution makes in vivo h mrs an ideal investigative tool of brain function , with respect to biochemical interactions ( 3 ) . the application of this technique creates the possibility of observing major brain metabolites that contributes to the major resonances seen in h mr spectra of the brain , such as n - acetylaspartate ( naa ) , creatine / phosphocreatine ( cr ) , choline - containing compounds ( cho ) , and myo - inositiols ( ins ) ( 1 - 3 ) . using current localization techniques , h mrs spectra can be obtained from regions of 1 - 10 l within the timescale of a clinical examination , and this allows for the definition of spectral changes specific to the motor cortex ( 3 ) . early studies of h mrs in stroke have mostly investigated ischemic stroke , and they have shown an increased lactate and decreased naa within the stroke lesion ( 4 - 6 ) . however , attempts to determine whether the magnitude of neuronal damage , as measured by naa loss , correlates with the disability and impairment in ischemic stroke patients have brought forth inconsistent results ( 7 - 10 ) . there has been no previous h mrs study that has investigated the metabolic changes in the higher motor cortex following intracerebral hematoma in hemiparetic humans . the aim of this study was to evaluate the local metabolic changes for the primary motor cortex ( m-1 ) and supplementary motor area ( sma ) in the affected hemisphere ( ah ) and unaffected hemisphere ( uh ) , according to their axonal injuries at the level of the internal capsule .

this study was conducted to investigate the metabolic changes in the motor and motor association cortices following axonal injury in the internal capsule that was caused by deep intracerebral hematoma . using proton magnetic resonance spectroscopy ( 1h mrs ) , the authors studied the primary motor cortices ( m-1 ) and sup - plementary motor areas ( sma ) of 9 hemiparetic patients with documentable hemi - paresis of varying severity , and we studied 10 normal volunteers as controls . to measure the m-1 and sma biochemical changes , 4 separate single volumes of inter - est ( vois ) were located bilaterally in the affected and unaffected hemisphere ( ah and uh ) . 1h mrs provided a neuronal and axonal viability index by measuring levels of n - acetylaspartate ( naa ) and creatine / phosphocreatine ( cr ) . the m-1/sma naa / cr ratios of the ah and uh in patients , and the ah and normal volunteers were com - pared . the naa / cr ratios of the m-1 and sma in ah , and the sma in uh were sig - nificantly lower than those of normal volunteers . these 1h mrs findings indicate that axonal injury in the descending motor pathway at the level of internal capsule could induce metabolic changes in the higher centers of the motor pathway .

conversion disorder has one or more symptoms that affect voluntary motor or sensory function suggesting a neurological or other medical condition , but they are inconsistent with known neurological or musculoskeletal pathologies . instead , the symptoms are due to an unconscious expression of a psychological conflict or need . the symptoms are often reinforced by social support from family and friends or by avoiding underlying emotional stress . the symptoms of patients with conversion disorder can be debilitating and include paralysis of one or more limbs , ataxia , tremors , tics , and dystonia . many other names are used to describe this disorder are functional gait disorder , hysterical paralysis , psychosomatic disorder , conversion reaction , and chronic neurosis . the disorder is more common in adolescence than in childhood . despite conversion disorders long - documented history , it is often confused with other psychological disorders conversion disorder , remain diagnostic challenges for the clinicians .

conversion disorders are more prevalent in childhood and adolescence , especially in females . they are usually associated with stressors and symptoms usually reflect a means to avoid the stressor , or also with a primary and secondary gain . this case report involves a similar situation where a young girl was treated successfully with diazepam , therapeutic nerve conduction study , and behavioral psychotherapy .

the use of dental implants to support and retain dental prostheses has been demonstrated to be clinically efficacious . a precise fit between an implant abutment and a superstructure , determining the absence of bone tension , without the occlusal load , is an important factor for the long - term success of implant - supported restorations . considering the fact that implants are completely surrounded by bone , and that the interface is not elastic , a minimum movement is observed due to bone deformation under loading . accordingly , it must be anticipated that stress introduced into the implant system as the result of prosthesis misfit may be present many years after placement because of the ankylotic nature of the osseointegration . the present findings support the concern for precision of frameworks with regard to various aspects of fatigue in the long - term perspective2,13 . a widely used solution in implant - anchored prosthesis this abutment is designed to directly engage the implant and thus allows the prosthodontist extending the porcelain subgingivally in areas with extremely limited gingival tissue height . the subgingival placement of the restoration not only improves esthetics but also helps in situations with interocclusal distance limitations20 . the use of such abutments allows correction in angulations for implants inserted at angles other than ideal . for single - tooth restorations , the provision of an antirotational device is necessary ; for fixed partial restorations , non - hexed castable ucla abutments present as a better alternative . there has been concern as to whether the use of these custom - made abutments would result in fit of the abutment to the implant that could be comparable to that achieved with use of premachined titanium abutments . an intermediate solution was developed , whereby premachined ucla abutments made of noble metal alloys could be cast onto directly to allow integration of the restoration with the abutment . these hand - operated devices have been developed to correct casting defects in the fitting surface and reduce the abutment / implant misfit . despite various prosthetic and technical improvements , laboratory procedures used in the fabrication of implant - supported prostheses , especially casting and porcelain baking , this study evaluated the effect of cast rectifiers on the misfit of cast ucla abutments compared to premachined ucla abutments . the influence of casting and porcelain baking on the marginal misfit of these components was also investigated .

objectives : this study assessed the effect of cast rectifiers on the marginal misfit of cast ucla abutments compared to premachined ucla abutments . the influence of casting and porcelain baking on the marginal misfit of these components was also investigated.methods : two groups were analyzed : test group 10 cast ucla abutments , finished with cast rectifier and submitted to ceramic application ; control group 10 premachined ucla abutments , cast with noble metal alloy and submitted to ceramic application . vertical misfit measurements were performed under light microscopy . in the test group , measurements were performed before and after the use of cast rectifiers , and after ceramic application . in the control group , measurements were performed before and after casting , and after ceramic application . data were submitted to statistical analysis by anova and tukey 's test ( = 5 % ) .results : the use of cast rectifiers significantly reduced the marginal misfit of cast ucla abutments ( from 25.68m to 14.83m ; p < 0.05 ) . after ceramic application , the rectified cylinders presented misfit values ( 16.18m ) similar to those of premachined components ( 14.3 m ) . casting of the premachined ucla abutments altered the marginal misfit of these components ( from 9.63 m to 14.6 m ; p < 0.05 ) . there were no significant changes after porcelain baking , in both groups.conclusion : the use of cast rectifiers reduced the vertical misfit of cast ucla abutments . even with carefully performed laboratory steps , changes at the implant interface of premachined ucla abutments occurred . ceramic application did not alter the marginal misfit values of ucla abutments .

diabetic neuropathy is a leading complication of diabetes mellitus , resulting in significant morbidity and mortality . although its exact pathogenesis is not fully understood , hyperglycemia does not appear to be the sole factor in the development of neuropathy in diabetic patients . enigmatically , recent reports have described that long - term tight glycemic control may be a major risk factor for the development of diabetic neuropathy [ 1 , 2 ] . neuropathy secondary to rapid normalization of chronic hyperglycemia in the setting of poorly controlled diabetes is also emerging as a new disease entity classified as an iatrogenic complication . symptoms in these patients are typically consistent with a distal sensory polyneuropathy which is appearing shortly after the initiation of intensive glycemic control and is referred to as insulin neuritis or treatment - induced neuropathy and is characterized by acute , severe pain . . however , the parallel worsening of neuropathy and retinopathy from a rapid tightening of glycemic control [ 4 , 5 ] suggests a common underlying pathophysiology . hypoglycemia , a potentially devastating neuronal insult , is usually the result of attempting tight control of blood glucose levels with insulin or other hypoglycemic agents [ 1 , 6 ] . currently , the only available method for preventing this hypoglycemia - induced neuronal injury in the clinical setting is the delivery of glucose , a treatment that paradoxically may exacerbate the insult . the objective of this present research was to study the molecular mechanisms of acute neuropathic pain induced by insulin and hypoglycemia in an animal model . the expression of c - fos protooncogene , a marker of nociceptive - induced neuronal activity in the spinal cord [ 7 , 8 ] , was also determined . additionally , the preventive effects of pretreatment with coenzyme q10 ( coq10 ) on hypoglycemia - induced neuropathic pain and stress - sensitive factor expression were explored .

diabetic neuropathic pain is reduced with tight glycemic control . however , strict control increases the risk of hypoglycemic episodes , which are themselves linked to painful neuropathy . this study explored the effects of hypoglycemia - related painful neuropathy . pretreatment with coenzyme q10 ( coq10 ) was performed to explore the preventive effect of coq10 on hypoglycemia - related acute neuropathic pain . two strains of mice were used and 1 unit / kg of insulin was given to induce hypoglycemia . mechanical sensitivity of hindpaw withdrawal thresholds was measured using von frey filaments . blood glucose levels were clamped at normal levels by joint insulin and glucose injection to test whether insulin itself induced hypersensitivity . results suggest that the increased mechanical sensitivity after insulin injection is related to decreased blood glucose levels . when blood glucose levels remained at a normal level by the linked administration of insulin and glucose , mice demonstrated no significant change in mechanical sensitivity . pretreatment with coq10 prevented neuropathic pain and the expression of the stress factor c - fos . these results support the concept that pain in the diabetic scenario can be the result of hypoglycemia and not insulin itself . additionally , pretreatment with coq10 may be a potent preventive method for the development of neuropathic pain .

obesity is considered a major health problem and its prevalence has increased dramatically in the last decades , corresponding to the 36.9 % of the men and the 38.0 % of women worldwide . obesity is usually accompanied by other diseases , the most common being type 2 diabetes mellitus ( t2d ) , insulin resistance ( ir ) , and cardiovascular complications . moreover , other metabolic consequences have been related , such as nonalcoholic fatty liver disease ( nafld ) or even many cancers . although obesity is not the unique problem in metabolic syndrome , this is becoming more common due to a rise in obesity rates among adults . over the last few years , the number of people with diabetes mellitus has increased massively , raising prevalence worldwide , and does not focus on the western societies . in the economically advanced countries , the increase will be about 50 % in 2030 , so it has become one of the most important public health challenges globally . although great advances have been made in understanding the mechanisms involved in the pathogenesis of t2d , these have still not been fully elucidated . currently , the only effective therapy is weight loss , including the lately accepted bariatric surgery , and last knowledge about the effectiveness of the physical activity , which is able to decrease specific visceral fat increasing the fat - free mass . adipose tissue is a key regulator of energy balance , playing an active role in lipid storage and buffering , synthesizing , and secreting a wide range of endocrine products into circulating blood that influence systemic metabolism . a classical paradigm has been the fact that the more adipose tissue , the higher the prevalence of metabolic diseases , and it is this relationship that has interested researchers . however , certain inconsistencies have been found ; for example , some extremely obese people are not diabetic , while other overweight people develop severe ir and diabetes . this suggests that the absolute amount of fat stored may not be the most important factor determining the relationship between obesity and diabetes . obesity - related adverse health consequences therefore appear to be related to fat distribution rather than the total amount of fat . there are many theories linked to obesity : from the simplest excess of energy / lipids intake to the most recent gut microbiota [ 15 , 16 ] . but a very interesting theory is focused on a limit to the functional capacity of adipose tissue . when this capacity is exceeded , metabolic disorders occur . this suggests that the factor linking obesity , diabetes , and associated comorbidities may not be the absolute amount of fat accumulated but the mismatch between energy surplus and storage capacity . this new vision places the adipose tissue at the same level as other vital organs . just as one can speak of heart , liver , or kidney failure the aim of this review is to better understand the adipose tissue organ , reviewing the influence of variables that govern its ability to expand and its influence on development of ir and diabetes associated with obesity , mainly based on the studies undertaken by our research team over the last few years .

obesity is considered a major health problem . however , mechanisms involved and its comorbidities are not elucidated . recent theories concerning the causes of obesity have focused on a limit to the functional capacity of adipose tissue , comparing it with other vital organs . this assumption has been the central point of interest in our laboratory . we proposed that the failure of adipose tissue is initiated by the difficulty of this tissue to increase its cellularity due to excess in fat contribution , owing to genetic or environmental factors . nevertheless , why the adipose tissue reduces its capacity to make new adipocytes via mesenchymal cells of the stroma has not yet been elucidated . thus , we suggest that this tissue ceases fulfilling its main function , the storage of excess fat , thereby affecting some of the key factors involved in lipogenesis , some of which are reviewed in this paper ( ppar , ror1 , fasn , scd1 , rab18 , brca1 , zag , and fabp4 ) . on the other hand , mechanisms involved in adipose tissue expandability are also impaired , predominating hypertrophy via an increase in apoptosis and a decrease in adipogenesis and angiogenesis . however , adipose tissue failure is only part of this great orchestra , only a chapter of this nightmare .

intestinal pseudo - obstruction ( ipso ) is defined as ineffective intestinal propulsion which occurs in the absence of mechanical or obstructive factors ( 1 ) . cases , in whom ipso is the primary clinical feature , are typically associated with connective tissue diseases . however , ipso presenting as the first manifestation in systemic lupus erythematosus ( sle ) is rare , and < 30 cases of ipso in patients with sle have been reported ( 14 ) . clinical features generally include severe abdominal symptoms , such as distension , pain , nausea and vomiting , while radiographic signs show gaseous small bowel distension with air - fluid levels . acute lupus pneumonitis ( alp ) is an uncommon pulmonary manifestation of sle , and lung involvement has only been reported in 3 % of sle patients ( 5,6 ) . alp is an unusual but life threatening complication of sle , and usually presents with the acute onset of fever , cough , tachypnea and hypoxia . the radiological sign of alp is consolidations in one or more areas , and is often associated with pleural effusion and pulmonary arterial hypertension . the majority of alp responds to steroids and some requires treatment with cyclophosphamide ; however , the rate of mortality remains high ( 5,7 ) . ipso and alp occurring in a single patient , described as co - manifestation with sle , has not been reported previously . herein , we report a case in which ipso was the initial presentation of sle , and secondary onset of alp occurred after emergency surgery .

intestinal pseudo - obstruction ( ipso ) and acute lupus pneumonitis ( alp ) are uncommon severe complications of systemic lupus erythematosus ( sle ) . the present study reports the case of a 26-year - old female who presented with abdominal pain , nausea and vomiting as initial symptoms . computed tomography ( ct ) scanning revealed the jejunal wall was thickened and streaky , mimicking the presentation of intestinal obstruction . following emergency surgery , the patient 's general condition was aggravated , with evident limb erythematous rashes . a series of laboratory examinations revealed sle , and combined with patient 's medical history ipso was diagnosed , with a disease activity index score of 10 . during the therapeutic period , high fever , dyspnea and oxygen saturation ( sao2 ) reductions were detected , and ct scans indicated lung infiltration , excluding other causes through a comprehensive infectious work - up and a bronchoalveolar lavage examination . alp was confirmed and treated with high - dose methylprednisolone and gamma globulin supplement . the patient responded well and was discharged in 2 weeks . in the one - year tapering period and after stopping corticosteroids , the patient recovered well with no relapse detected . in conclusion , the manifestation of ipso in sle is rare and represents a challenge for the surgeon to establish the correct diagnosis and avoid inappropriate surgical intervention . alp may be the consequence of emergency surgery , and immediate high - dose glucocorticoid therapy is recommended .

military personnel face multiple stressors in their lives.1,2 studies have reported that stress occurs from risky assignments or missions,35 the demand for physical fitness , problems in interactions with peers and those of higher rank,6 sleep deprivation from shift work,7,8 deployment and separation from family,9 and additional noncombat work assignments such as disaster relief , peacekeeping , and other humanitarian actions.10 home - front problems with spouses and children also have an impact on the lives of military personnel.9,11,12 global defense budget cuts and the downsizing of military manpower increase the workload and stress of the few remaining military personnel.1315 the world health organization s ( who ) definition of health includes physical , mental and social aspects.16 quality of life ( qol ) in the context of individual cultural and subcultural systems is associated with personal goals , expectations , standards and values.17 the who has advocated for the goals of promotion of quality of life , preservation of function and well - being as well as prolongation of peoples lives.18 the who quality of life instrument ( whoqol ) and its brief version ( whoqol - bref ) are commonly used scales for use among general populations , as well as among disease - specific populations.19 the mental and physical health of military personnel may vary as a result of different administrative , characteristic , and political factors.20 the identification of stressors in military life , as well as the factors that influence health , would enable us to provide proper care for military personnel . therefore , the relationship between quality of life ( qol ) and perceived health are crucial for the maintenance of the welfare of military personnel and troop strength . the aim of this study was to evaluate military personnel from select branches of ground forces in taiwan for their perceived health status and qol .

objectivethe mental health of military personnel varies as a result of different cultural , political , and administrative factors . the purpose of this study was to evaluate the psychological morbidity and quality of life of military personnel in taiwan.materials and methodsthis cross - sectional study utilized the world health organization quality of life instrument , brief version , taiwan version , the general health questionnaire-12 , chinese version , and the visual analog scale ( vas ) in several military units.resultsmore than half of the subjects ( 55.3 % ) identified themselves as mentally unhealthy on the general health questionnaire-12 , chinese version ; however , a higher percentage of officers perceived themselves as healthy ( 57.4 % ) than did noncommissioned officers ( 38.5 % ) or enlisted men ( 42.2 % ) . officers also had higher total quality of life ( qol ) scores ( 83.98 ) than did enlisted men ( 79.67 ) . scores on the vas also varied : officers : 72.5 ; noncommissioned officers : 67.7 ; and enlisted men : 66.3 . the vas and qol were positively correlated with perceived mental health among these military personnel.conclusionour subjects had higher rates of perceiving themselves as mentally unhealthy compared to the general population . those of higher rank perceived themselves as having better mental health and qol . improving mental health could result in a better qol in the military . the vas may be a useful tool for the rapid screening of self - reported mental health , which may be suitable in cases of stressful missions , such as in disaster rescue ; however , more studies are needed to determine the optimal cut - off point of this measurement tool .

cystic fibrosis ( cf ) is a fatal disorder characterized by chronic and progressive lung disease that determines morbidity and mortality of these patients . airways of cf patients show a chronic nonresolving neutrophilic inflammation , which increases upon infection and disease progression . neutrophil products , such as elastase , chitinase - like proteins and chemokines , have been identified as important risk factors of lung damage and lung function decline and are suggested as biomarkers based on both cross - sectional and longitudinal studies in patients with cf [ 27 ] and mice with cf - like lung disease . previous studies also provided evidence that free extracellular dna is highly increased in cf airway specimen , initially referred to as dna derived from necrotic cells . however , several studies have now established that cf airway secretions contain meshwork structures reminiscent of nets [ 1014 ] . traditionally , neutrophils have been known to combat pathogens intracellularly by phagocytosis , a paradigm that was extended and challenged by the finding that neutrophils can immobilize and kill pathogens extracellularly through net formation ( netosis ) [ 15 , 16 ] . these released nets consist of a nuclear dna backbone equipped with characteristic granule and cytoplasmic proteins . while netosis has been initially described as a novel form of cell death , recent studies demonstrated that also living neutrophils , eosinophils , and basophils can form extracellular traps ( ets ) by expelling their mitochondrial dna [ 1823 ] . viable / nonlytic rapid net formation has been further found in response to staphylococcus aureus infection , where phagocytosis , chemotaxis , and net formation worked in a collaborative manner [ 24 , 25 ] . in this study , we investigated cf airway inflammation with a focus on the abundance of free dna structures characteristic for nets in different airway specimen ( sputum and bal ) obtained from patients with cf and enac - transgenic ( enac - tg ) mice with cf - like lung disease [ 2628 ] and correlated dna levels with proinflammatory cxc chemokines , characteristic cf pathogens , and measurements of lung function . our results demonstrate that free airway dna levels correlate with obstructive lung disease and proinflammatory chemokines in cf patients and cf mice and could serve as therapeutic target and potential biomarker in cf lung disease .

chronic obstructive lung disease determines morbidity and mortality of patients with cystic fibrosis ( cf ) . cf airways are characterized by a nonresolving neutrophilic inflammation . after pathogen contact or prolonged activation , neutrophils release dna fibres decorated with antimicrobial proteins , forming neutrophil extracellular traps ( nets ) . nets have been described to act in a beneficial way for innate host defense by bactericidal , fungicidal , and virucidal actions . on the other hand , excessive net formation has been linked to the pathogenesis of autoinflammatory and autoimmune disease conditions . we quantified free dna structures characteristic of nets in airway fluids of cf patients and a mouse model with cf - like lung disease . free dna levels correlated with airflow obstruction , fungal colonization , and cxc chemokine levels in cf patients and cf - like mice . when viewed in combination , our results demonstrate that neutrophilic inflammation in cf airways is associated with abundant free dna characteristic for netosis , and suggest that free dna may be implicated in lung function decline in patients with cf .

parenting stress escalates at a much faster rate among mothers of disabled children in comparison to mothers of non - disabled children . the addition of a disabled child to a family requires parents to adopt new roles and responsibilities and , in turn , creates a change in the function of the family system . indeed , disabled children often demand more effort in daily activities and social integration than non - disabled children . for example , in terms of social integration , disabled children who rely on others for an extended period of time due to a lack of independence tend to cause long - term parenting stress in mothers . the personal growth and psychological development of children appear to be influenced by parental attitudes . specifically , parents mental stability and psychological traits have been found to significantly impact disabled children1 . further , the behavior and disposition of disabled children are largely affected by their social surroundings and thus , their parents stress3 . parents who experience repeated parenting stress typically react negatively to children and , due to their parents adverse reaction , children respond with behavior that , once again , evokes poor parenting behavior . not surprisingly then , higher levels of mother - reported parenting stress are associated with higher levels of denial and coercive parenting behavior . therefore , parenting stress is considered a salient predictor of inappropriate parenting behavior among mothers1 , 3 . parenting stress among mothers is elicited by psychological and child - related factors as well as environmental factors , such as family income , and supporting factors , including fathers parenting participation4,5,6,7 . previous studies focused on the role of fathers in reducing the experience of parenting stress among mothers , because , traditionally , they are mothers closest companions8 , 9 . by assuming the role of an androgynous father , fathers reduce the negative effects of gender roles by interacting at a deeper level with their children . therefore , the need to socially introduce a new concept regarding the role of family members through research on fathers parenting participation is being magnified8 . however , fathers parenting participation as a factor for parenting stress in mothers with disabled children has not been adequately studied . thus , the objective of this study was to examine a novel concept regarding the role of fathers by investigating the relationship between fathers parenting participation and the parenting stress experienced by mothers who are primary caregivers for disabled children . broadly , this research will examine traditional parenting approaches , which places responsibility on the mother , against more egalitarian parenting .

[ purpose ] the purpose of this research was two - fold : ( 1 ) to evaluate the effects of father s parenting participation on parenting stress among mothers with disabled children and ( 2 ) more specifically , to investigate the importance of fathers parenting participation in decreasing mothers parenting stress . [ subjects and methods ] to examine these relationships , this study recruited 82 mothers with disabled children from rehabilitation centers in the gwangju city . the common characteristics of parents and children , father s parenting participation , and mother s parenting stress were assessed using standard questionnaires . [ results ] based on mother reports , findings suggest that as fathers parenting participation increases mothers parenting stress decreases . [ conclusion ] the present study reveals a need for improvement in parenting education and in providing fathers of disabled children with a temporary leave of absence from work . specifically , this research highlights the importance of shared parenting responsibilities among family members . finally , our findings suggest that developing a standardized national program for assisting parents with disabled children may help decrease parenting stress in mothers .

progressive nodular histiocytosis ( pnh ) is a rare normolipemic macrophage disorder first described by taunton et al . , in 1978 . it belongs to a subgroup of non - langerhans cell histiocytosis ( lchs ) , the juvenile xanthogranuloma ( jxg ) family , which includes xanthoma disseminatum ( xd ) , benign cephalic histiocytosis ( bch ) , multiple adult xanthogranuloma ( maxg ) and generalized eruptive histiocytosis ( geh ) . according to weitzman and jaffee , they present positive reaction to factor xiiia , cd68 , cd14 and negative reactions to cd1a and s-100 proteins . these disorders are difficult to categorize , primarily because of the diverse pathological findings and due to overlapping clinical and microscopic features .

progressive nodular histiocytosis ( pnh ) is a rare normolipemic macrophage disorder and belongs to a subgroup of non - langerhans cell histiocytosis ( lchs ) which is characterized by a progressive course with no sign of spontaneous resolution but without systemic involvement . we report a 30-year - old gentleman who presented with skin lesions all over the body associated with gradual bilateral painless loss of vision . on examination , approximately 30 to 40 , skin - colored , firm , non - tender papules and nodules were noted over the body especially on the face and trunk . a skin biopsy revealed a cellular tumor in the dermis composed of oval to spindle - shaped cells , positive for cd68 but negative for s-100 , cd34 , cd21 , cd35 and hmb45 , supporting a diagnosis of spindle cell histiocytic tumor . ophthalmic examination revealed a generalized arteriolar attenuation in both eyes . he received tab imatinib 400 mg od for 5 months followed by tab pazopanib 800 mg od for 4 months and both the drugs were stopped due to lack of any response in the skin lesions . we report this case due to its rarity , characteristic clinical presentation , and its association with eale 's disease . primary treatment remains surgical excision of bothersome lesions and optimal systemic treatment is still unknown .

desmoplastic fibroma ( df ) , a benign locally aggressive lesion of the bone is recognized as an intra - osseous counterpart of soft tissue fibromatosis and is usually seen affecting the long bones , pelvis and only occasionally presents itself as a jaw lesion . mandible is most commonly affected when compared to the maxilla and the cranium in the head and neck region . a systematic literature search of the pubmed database of national library of medicine using df and mandible as keywords revealed a total of 57 published cases occurring in the mandible alone from the year 19692014 . the cause for df is unknown and is stipulated to have a varied pathogenesis ranging from genetic , endocrine and traumatic factors to an exuberant reactive proliferation . when differentiating it from other neoplasms that behave aggressively , a history of expansion or perforation of the cortical plates along with the histopathological confirmation would be a pointer in the right direction .

desmoplastic fibroma ( df ) is a benign intra - osseous neoplasm , that is , recognized as the intra - osseous counterpart of soft tissue fibromatosis in both gnathic and extra - gnathic sites . it has a propensity for locally aggressive behavior and local recurrence . an occurrence of intra - osseous lesion other than that of odontogenic origin is rare in the jaws . in this case report , we define the clinico - pathological and radiographic features of df of the mandible in a 35-year - old female , who presented to the outpatient department with a 3-year history of a slowly expanding painless mass in the left mandibular posterior region . thus , we present a classic case of df exhibiting characteristic features along with a review of the literature .

nasopharyngeal carcinoma ( npc ) is an endemic disease within specific regions in the world . the highest incidence is found among southern chinese people , especially those of cantonese origin , whereas among caucasians from north american and other western countries it is sporadic . radiation therapy ( rt ) , alone or combined with chemotherapy , is a paramount approach as initial treatment option for npc . distant metastasis , however , remains one of the major problems after radical treatment in patients with locally advanced disease . we report a case of a 68-year - old patient with advanced npc who developed intrathoracic endotracheal metastasis after rt . we believe this to be the first reported case of intrathoracic endotracheal metastasis in an npc patient .

intrathoracic endotracheal metastasis from a very distant site is extremely rare . we report the first case of such a disease in a 68-year - old man with nasopharyngeal carcinoma who presented with a cough and hemoptysis 34 months after finishing radiotherapy . prior to tracheal metastasis , he developed a solitary metastasis in the lung and underwent chemotherapy followed by radiotherapy . computed tomography showed the presence of an enlarged lymph node in the para - aortic arch . fiberoptic bronchoscopy revealed an endotracheal tumor 1 cm above the carina . histological and immunohistochemical analyses confirmed its nasopharyngeal origin . he was treated with conventional radiotherapy and three - dimensional conformal radiotherapy ; complete tumor remission was achieved . he died of nonmalignant disease with no signs of tumor recurrence 2 years after treatment completion . radiotherapy may be an appropriate management approach to achieve long - term tumor control for this disease .

though the exact incidence is unknown , it ranges from 3 - 10 % in nulliparous population . it is a significant public health threat globally contributing greatly to maternal and perinatal mortality and morbidity . extensive changes occur in the kidneys as part of the end - organ damage in preeclampsia . proteinuria occurs as a consequence of reduction in the integrity of glomerular barrier or reduced tubular reabsorption . it remains an important objective criterion for diagnosis of preeclampsia and has been used to classify the severity as well as to predict adverse fetomaternal outcomes in preeclampsia . among the various methods available to quantify proteinuria , alternative methods like a spot urine sample protein - creatinine ( p / c ) ratio avoid the influence of variations in urinary solute concentrations and can reduce the delay in diagnosis and management of preeclamptic patients . though , serum uric acid level is of limited use in the initial diagnosis of preeclampsia , many investigators have shown that it correlates well with the disease severity . in this study , we have tried to correlate spot urine p / c ratio with 24-h urine protein estimation and test its diagnostic accuracy for detecting significant proteinuria . we have also correlated spot urine p / c ratio with serum uric acid levels and tried to analyze the association between proteinuria and hyperuricemia with adverse fetomaternal outcomes in preeclamptic women .

background : it is well - known that estimation of 24-h urine protein and spot urine protein / creatinine ( p / c ) ratio are commonly performed investigations to assess proteinuria in preeclamptic women . serum uric acid has been shown to correlate well with disease severity in preeclampsia.materials and methods : a total of 24-h urine protein estimation , spot urine p / c ratio , and serum uric acid measurements were carried out in 75 pregnant preeclamptic women and the correlation between these investigations , as also the association between proteinuria and hyperuricemia with adverse fetomaternal outcomes were studied.results : pearson 's correlation test showed a positive correlation between 24-h urine protein and spot urine p / c ratio . a statistically significant and direct correlation was also found between serum uric acid and spot urine p / c ratio , while there was no statistically significant difference between proteinuria and hyperuricemia with respect to the various fetal and maternal outcome parameters studied.conclusion : in the present study , we found a moderate correlation between 24-h urine protein and spot urine p / c ratio . there was a moderate correlation between spot urine p / c ratio and uric acid , while there was no statistical significance of the association between proteinuria and uric acid with fetomaternal outcomes in preeclampsia .