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myiasis , the infestation of organs and tissues of human and animals with fly larvae , is a common phenomenon especially in people of tropical and subtropical areas . in spite of occasional reports of obligatory myiasis , the majority of reported cases are facultative myiasis and more than a dozen families of flies can cause this form ( gullan and durden 2009 ) . phoridae , commonly known as humpback or scuttle flies , is the most important family of dipteran that causes myiasis and various problems for human . in this family genus megaselia , perhaps the largest genera of living organisms , has a wide variety of life styles and polyphagus diet ( disney 2008 ) . among identified species of this genus , it has been unwittingly carried around the world by human ( disney 2008 ) and previously has been reported from alborz province in iran ( zamani 2009 ) . adults of scuttle flies which are very small ( 24 mm in length ) , can explore a large variety of environmental and ecological habitats . females of these flies are highly attracted to strong of foul odors and lay their eggs on different decomposing materials such as fruits , stole , meat , excrement and carrions ( disney 2008 ) . the scuttle flies which are important agent of human facultative myiasis , exhibit a greater diversity of larval habitat than other insects . these flies can explore a large variety of environmental and ecological niches ( disney 2008 ) . in spite of predation and parasitation of some arthropods by this species ( costa et al . 2007 ) , previous studies showed them as a cause of human myiasis ( francesconi lupi 2012 ) . moreover , they have already been a polyphagus species and may be harmful to health as they become vector of pathogens ( disney 2008 ) . 1978 , carpenter and chastain 1992 , hira et al . 2004 ) and intestinal ( kaneko et al . 1975 , sing et al . however , the urogenital form is rarely seen and all of reported cases are restricted to females . so the study of men clinical manifestation as well as morphology of third instars larvae of these flies seems to be important . the aim of this paper is to report a case of man urogenital myiasis involving and to discourse the importance of its diagnosis and management in clinical science .

myiasis is the infestation of organs and tissues of human and animals with fly larvae . this article reports an 18 year - old man with urogenital myiasis , the passing of live megaselia scalaris larvae in the urine , from zanjan city , northwest of iran . we discourse the importance of diagnosis and management of urogenital myiasis in medicine .

focal and diffuse mesangial proliferative glomerulonephritis reveal the most common histologic lesions observed on renal biopsies from patients with iga nephropathy ( igan ) . however , histologic variability is also observed in this disease , which is the same as with lupus nephritis . in some cases , endocapillary hypercellularity is accompanied by segmental duplication of the glomerular basement membrane , and there is rarely diffuse endocapillary proliferation with lobular accentuation and multiple double contours , resembling type i membranoproliferative glomerulonephritis ( mpgn ) . tanaka and waga have reported a biopsied patient with acute igan following the formation of keloid scars due to a burn injury . however , further reports regarding the correlation between igan and burn injury are rare .

iga nephropathy ( igan ) is the most common primary glomerulonephritis worldwide , accounting for approximately 3040 % of patients undergoing renal biopsy in asia . the characteristic and diagnostic lesion of igan is the deposition of glomerular iga . the morphological lesions observed by light microscopy are extremely variable . a causal relationship between igan and burn injury has not been established , and the correlation between them is not clear if they appear at the same time . we have explored the cause of severe proteinuria of a chinese patient with burns of 2nd or 3rd degree after a gas leakage accident 2 weeks ago . the diffuse proliferative glomerulonephritis of this patient revealed type i membranoproliferative glomerulonephritis - like symptoms . moreover , this patient showed a sensitive response to prednisone . this case report demonstrates the intrinsic relationship between kidney disease and burn injury , which will facilitate a feasible treatment strategy for proteinuria after burn injury .

ocular cicatricial pemphigoid ( ocp ) is an uncommon , chronic autoimmune disease that affects mucous membranes , particularly the conjunctiva.1 the disease typically results in chronic conjunctivitis and causes conjunctival and corneal scarring , which can result in limbal stem cell deficiency and blindness.2 adequate control of ocular inflammation usually requires systemic as well as topical immunosuppressants . commonly used systemic medications include prednisone , methotrexate , mycophenolate mofetil ( mmf ) , and cyclophosphamide.3 the porphyrias are metabolic disorders caused by defective enzymes within the heme synthetic pathway.4 these defective enzymes cause an accumulation of intermediates from the heme synthetic pathway that results in various clinical manifestations.4,5 porphyria cutanea tarda is the most common of the porphyrias and results from a deficiency in uroporphyrin decarboxylase , which is the fifth enzyme in the heme synthetic pathway.6 this deficiency results in the accumulation of porphyrins in the liver and plasma . on exposure to light with a wavelength near 400 nm , the porphyrins enter an excited state that can lead to the damage of proteins , lipids , and basement membranes.6 this process results in blisters , fibrosis , and scarring of the skin in areas of the body exposed to sunlight.6 park et al7 have reported a case of a 31-year - old with cicatricial conjunctivitis who was biopsy negative for ocp and was later diagnosed with porphyria cutanea tarda ; in this case the patient s clinical symptoms significantly improved after initiating phlebotomy treatments . the present authors report a similar case , in which pathology and direct immunofluorescence confirmed a diagnosis of ocp and where the patient s clinical condition also improved significantly upon the diagnosis and treatment of porphyria cutanea tarda .

a 64-year - old caucasian male complaining of redness and tearing for 3 years in both eyes was referred for evaluation of cicatricial conjunctivitis . ocular cicatricial pemphigoid was suspected and this diagnosis was confirmed through biopsy . the patient s condition showed moderate improvement following treatment with methotrexate and mycophenolate mofetil . the patient was later diagnosed with porphyria cutanea tarda and phlebotomy treatments were subsequently initiated . the patient s ocular symptoms improved further after he began receiving these phlebotomy treatments , and conventional treatment was discontinued . the authors hypothesize that circulating porphyrins activated by ultraviolet light could be the cause of the ocular cicatricial pemphigoid in this patient .

genetic analysis of phenotypes and diseases has traditionally followed two approaches : family - based linkage analysis and population - based association studies . while in linkage analysis it is the co - segregation of alleles in families that is measured , population - based studies use non - random associations between phenotypes and alleles in populations to identify causative genes . linkage analysis has proven to be immensely successful as a means of identifying genes for a number of single gene diseases with simple mendelian inheritance ( eg see omim database ) . complex diseases are multifactorial , polygenic and often characterised by late age of onset , incomplete penetrance , locus heterogeneity and environmental exposures and , despite significant efforts , have not been amenable to family - based mapping . linkage disequilibrium ( ld ) is an important aspect of genetic association studies and is generated in a population through mutation , selection , drift , non - random mating and admixture . allelic associations due to ld are significant and are correlated with physical distance within small genomic regions but decay over time due to recombination [ 2 - 4 ] . ld - based association studies have been successful in both fine scale mapping and initial disease gene mapping in homogeneous populations that have undergone recent bottlenecks ( eg hirschsprung disease in mennonites , bardet- beidle syndrome in bedouins ) . allelic associations can result either from direct functional effects of the alleles tested or indirectly through non - random associations between the allele measured and nearby functional alleles . since functional alleles in most genes are still unknown and are indeed an object of the research , ld is an important feature of how genes can be screened for alleles that alter disease risk . thus , there has been substantial focus on the extent of ld across the genome and the definition of statistical methods for disease gene mapping using ld [ 9 - 11 ] . in large cosmopolitan populations , however , ld may be difficult to detect when the mutation is old , since the amount of remaining ld may be small . additionally , false - positive associations due to population stratification are important confounders in ld - based association studies .

admixture is an important evolutionary force that can and should be used in efforts to apply genomic data and technology to the study of complex disease genetics . admixture linkage disequilibrium ( ald ) is created by the process of admixture and , in recently admixed populations , extends for substantial distances ( of the order of 10 to 20 cm ) . the amount of ald generated depends on the level of admixture , ancestry information content of markers and the admixture dynamics of the population , and thus influences admixture mapping ( am ) . the authors discuss different models of admixture and how these can have an impact on the success of am studies . selection of markers is important , since markers informative for parental population ancestry are required and these are uncommon . rarely does the process of admixture result in a population that is uniform for individual admixture levels , but instead there is substantial population stratification . this stratification can be understood as variation in individual admixtures and can be both a source of statistical power for ancestry - phenotype correlation studies as well as a confounder in causing false - positives in gene association studies . methods to detect and control for stratification in case / control and am studies are reviewed , along with recent studies showing individual ancestry - phenotype correlations . using skin pigmentation as a model phenotype , implications of am in complex disease gene mapping studies are discussed . finally , the article discusses some limitations of this approach that should be considered when designing an effective am study .

peritoneal dialysis ( pd ) therapy has increased in popularity since the end of the 1970s . the method was developed as an alternative to hemodialysis ( hd ) presenting a patient survival rate equivalent to hd and better preservation of residual renal function . currently , the two principal causes of technique failure in order of importance are ( a ) peritonitis , this important medical problem can also represent nearly 16 % of the causes of death ; ( b ) ultrafiltration failure , a multifactorial complication that can affect up to 40 % of patients after 3 years of therapy . these proinflammatory stimuli can induce lymphokine secretion by macrophages , which in turn , activate fibroblasts . fibroblast activation has been associated with structural alterations in the peritoneal membrane of varying intensity . these alterations can be seen in figure 1 which was extracted from a submitted study of our group . in this prospective controlled study in 20 nonuremic wistar rats , peritoneal fibrosis occurs after exposure to glucose - based pd solutions and regardless the use of simvastatin . eps is a clinical syndrome that leads to persistent or recurrent intestinal obstruction , with or without inflammatory parameters of peritoneal thickening , sclerosis , calcification , and encapsulation , and can be inferred by clinical symptoms and radiology , but confirmed only by direct visualization with laparotomy [ 2 , 3 ] . incidence of eps is heterogenous and has been reported to vary from 6 to 20 % in eight years depending on the region .

peritoneal dialysis therapy has increased in popularity since the end of the 1970s . this method provides a patient survival rate equivalent to hemodialysis and better preservation of residual renal function . however , technique failure by peritonitis , and ultrafiltration failure , which is a multifactorial complication that can affect up to 40 % of patients after 3 years of therapy . encapsulant peritoneal sclerosis is an extreme and potentially fatal manifestation . causes of inflammation in peritoneal dialysis range from traditional factors to those related to chronic kidney disease per se , as well as from the peritoneal dialysis treatment , including the peritoneal dialysis catheter , dialysis solution , and infectious peritonitis . peritoneal inflammation generated causes significant structural alterations including : thickening and cubic transformation of mesothelial cells , fibrin deposition , fibrous capsule formation , perivascular bleeding , and interstitial fibrosis . structural alterations of the peritoneal membrane described above result in clinical and functional changes . one of these clinical manifestations is ultrafiltration failure and can occur in up to 30 % of patients on pd after five years of treatment . an understanding of the mechanisms involved in peritoneal inflammation is fundamental to improve patient survival and provide a better quality of life .

spinal dural arteriovenous fistula ( sdavf ) is a rare neurological disease with an estimated frequency of 510 cases per million per year . it is caused by a subdural shunt between a radiculomeningeal artery and a radicular vein , leading to impaired venous drainage from the spinal cord and the arterialization of the vein due to increased venous pressure . the time to diagnosis is often delayed due to unspecific neurological complaints to as long as 1015 years after the onset of symptoms . therefore , 40 % of patients are severely disabled at the time of diagnosis . the most common location of an sdavf is in the lower thoracic and lumbar region and it is accompanied by complaints in the lower extremities . sdavf at cervical level ( c - sdavf ) is extremely rare , accounting for approximately 2 % of the sdavf patients and can lead to quadriplegia and respiratory insufficiency . early clinical features are nonspecific and include gait claudication , worsened by exercise . by the time of the diagnosis , the triad consisting of ( 1 ) motor deficits ( leg / arm weakness , muscle cramps ) , ( 2 ) sensory disturbances ( paresthesia , numbness , pins and needles sensation , back pain ) , and ( 3 ) cauda syndrome ( micturition problems , erectile dysfunction , anal sphincter disturbances ) are present in 70 % of the patients . characteristic mri features include ( 1 ) engorged perimedullary veins , ( 2 ) central medullary edema , and ( 3 ) swelling of the caudal segments of the spinal cord . in the absence of the findings , diagnosis is difficult to make solely based on clinical symptoms and is usually erroneous . differential diagnoses may include medullary pathology ( myelitis , medullary tumors , disc herniation ) or peripheral pathology ( sensory polyneuropathy , chronic inflammatory demyelinating polyneuropathy ) ( table 1 ) . evidence of bladder or bowel dysfunction which share no evident relation with the site of medullary pathology could be very useful in suggesting the diagnosis . the association of cauda symptoms should be considered a red flag in sdavf and can guide the physician toward the correct diagnosis . the treatment involves either superselective catheterization with endovascular embolization of the fistula or neurosurgical occlusion of the arterialized vein . if successful , the treatment usually stops the progression of symptoms or leads to an improvement of neurological deficits . therefore , it is of utmost importance that the diagnosis is established as soon as possible in order to avoid permanent handicap .

subdural arteriovenous fistula ( sdavf ) is a rare condition characterized by clinical manifestations ranging from mild bilateral sensory deficits to quadriplegia . the diagnosis is often delayed due to unspecific neurological symptoms , initially diagnosed as polyneuropathy or myelopathy . the diagnosis can be delayed for as long as 115 years . the following report describes a cervical sdavf case initially misdiagnosed as myelitis transversa and treated with intravenous steroids . a 56-year - old male presented with sensory deficits and mild leg and right arm weakness . cervical mri showed a central medullary hyperintense lesion with contrast enhancement . after metabolic , infectious , and malignant causes were excluded , myelitis transversa was presumed and the patient was treated intravenously with methylprednisolone . shortly after that , he developed quadriplegia . cervical mri imaging showed engorged cervical perimedullary vessels , which were not visible on the initial mri . the diagnosis was revised and a sdavf identified . prompt surgical treatment led to a complete recovery . the effect of intravenous steroids in sdavf is controversial . acute clinical worsening after steroid administration is previously reported in several publications ; however , due to the paucity of clinical studies on sdavf , this effect remains mostly overlooked or unknown . the findings in this patient support the causative relation between sdavf clinical worsening and steroid administration . we propose that acute clinical worsening under steroids in patients initially diagnosed with myelitis should raise suspicion of an sdavf .

the world health organization ( who ) has estimated that about 17 million people die annually from cardiovascular disease worldwide , which accounts for approximately 33 % of all deaths . in addition , 9.4 million deaths are attributed to complications of hypertension . according to who statistics in 2008 , hypertension was diagnosed in almost two - fifths of people aged 25 years and older worldwide . if current trends continue , the number of patients with hypertension will increse by 500 million and reach a total of 1.56 billion in 2025 . there are about 639 million hypertensive people , which equals almost 75 % of the population in developing countries with limited resources . these hypertensive persons also have a very low awareness of their condition , as well as poor blood pressure ( bp ) control . non - optimal bp control accounts for 66.6 % of all strokes and 50 % of coronary artery disease cases . furthermore , hypertension is known to be one of the main risk factor of deaths in south asia . according to a study conducted between december 2011 and march 2012 in kabul , afghanistan the prevalence of hypertension was 46.2 % for the age group of 40years and older . several epidemiological studies have reported an association between proteinuria and a poor prognosis in hypertensive patients . the burden of proteinuria and its association with hypertension have not been studied in the adult hypertensive population of afghanistan . therefore , this study was aimed at determining the prevalence of proteinuria , and the association of different variables with proteinuria , among adult hypertensive patients attending an outpatient clinic in afghanistan .

abstractproteinuria in hypertension is an early marker of renal disease and a predictor for the progression of end stage renal disease , and cardiovascular diseases . this study was designed to determine the prevalence of proteinuria and its association with cardiovascular risk factors among adult hypertensive patients in afghanistan . five hundred fifty - five patients with a high blood pressure recorded in an outpatient clinic in andkhoy , afghanistan from december 2014 to may 2015 , were included in this study . data obtained from each patient , included demographic characteristics , body mass index , blood pressure patterns , cardiovascular history , cardiovascular risk factors , comorbidity , and current drug - therapy . dipstick screening for proteinuria was performed with reagent test strips . the mean age of the patients was 57.9 13.3 years , and a female predominance was observed ( n = 333 , 60 % ) . the prevalence of proteinuria was 67.2 % . the predictors of proteinuria were found to be age 65 years ( odds ratio [ or ] 1.02 , 95 % confidence interval [ ci ] 1.001.04 ) , smoking ( or 1.88 , 95 % ci 1.173.02 ) , heart failure ( or 2.23 , 95 % ci 1.134.41 ) , and diabetes mellitus ( or 3.41 , 95 % ci 1.497.81 ) . in conclusion , this study shows that proteinuria is highly prevalent among hypertensive outpatients in an outpatient clinic in andkhoy , afghanistan , especially in those with high cardiovascular risk .

the vast majority of cancers in the oral cavity are squamous cell carcinomas ( scc ) its evolution is influenced by host immune response cells ( e.g . , cd8 t , cd4 t , natural killer cells - nk , dendritic cells - dc , macrophages , and eosinophils ) . the eosinophils are considered as destructive effector leukocytes with cytotoxic activities mainly implicated in parasitic infections ( e.g . , helminthic infections ) and allergic diseases ( e.g . , bronchial asthma , allergic dermatitis , etc . ) . however , studies have shown that they can also be involved in tissue remodelling and in innate and acquired immunity response modulation [ 2 , 3 ] ( figure 1 ) . under diverse stimuli ( e.g . , infections , tumours , etc . ) , the eosinophils are able to release different substances , such as , eosinophil cationic protein ( ecp ) , major basic protein ( mbp ) , eosinophil peroxidise ( epo ) , eosinophil - derived neurotoxin ( edn ) , il-1 , il-2 , il-4 , il-5 , il-6 , il-8 , il-10 , il-12 , il-13 , il-18 , interferon ( inf ) - , tumor necrosis factor ( tnf ) - , transforming growth factor ( tgf ) - , tgf- , chemokines ( rantes , endotaxin-1 ) , platelet - activating factor ( paf ) , leukotriene c4 ( ltc4 ) , neuromediators , and indoleamine 2,3-dioxygenase ( ido ) [ 4 , 5 ] . these substances may cause cell death and induction of inflammatory symptoms as well as contribute to tumour progression or regulation . furthermore , the eosinophils present membrane receptors ( e.g . , il-1 , 3 , 4 , 5 , 8 , 10 , 12 , 13 , granulocyte monocyte colony - stimulating factor gm - csf , ifn- , tnf- , and macrophage inflammatory protein-1 ) that confer a survival and recruitment capacity of eosinophils themselves . in oral scc , several studies have shown that eosinophils can be associated with an improved prognosis , but there are other studies however , showing their association with a poor prognosis as well [ 6 , 7 ] . in this short review , we summarize briefly the role of the eosinophils in the general context of immunoregulation and its relation with oral squamous cell carcinoma .

the eosinophil cell has been related as a prognostic indicator for cancers . however , its exact function in tumour behaviour is still not clearly defined . in the oral cavity the presence of eosinophils can be a favourable prognostic indicator as well as it may be associated with a poor prognosis . in this short review , we briefly summarize the role of the eosinophils in the general context of immunoregulation and its relation to oral squamous cell carcinoma .

pneumococcal infections are especially dangerous for children and adults with immunodeficiencies , such as hiv , or with illnesses such as chronic cardiac disease and diabetes.1 pneumococcal vaccination has therefore been recommended for persons at high risk of severe illness or complications . asthma was first identified as an independent risk factor for pneumococcal disease ( pd ) in 2005 when talbot et al2 reported that asthma was associated with a 2.4-fold increased odds of pd among persons 249 years old enrolled in tennessee s medicaid program between 1994 and 2002 . several studies conducted since then have provided additional evidence that asthma is associated with an increased risk of pd in adults,35 but no study has provided convincing evidence that asthma is associated with an increased risk of pd in children.6 currently , pneumococcal vaccination is recommended for asthmatic adults , but it is not specifically recommended for asthmatic children . asthma is the most common chronic disease in children,7 and the prevalence of asthma is increasing worldwide.812 as the prevalence of asthma increases , so does the importance of understanding whether children with asthma are at increased risk of pd . the aim of the current study was to evaluate the association between asthma and the development of pd among danish children born between 1994 and 2007 .

backgroundalthough asthma has recently been established as a risk factor for pneumococcal disease ( pd ) , few studies have specifically evaluated this association in children.methodswe conducted a nation - wide population - based cohort study of the effect of asthma on childhood pd among all singleton live births in denmark from 1994 to 2007 , before the introduction of the 7-valent pneumococcal conjugate vaccine . all data were abstracted from danish medical registries . because underlying comorbidity substantially increases the pd risk in children , standard methods were used to assess the evidence of biologic interaction between comorbidity and asthma on the risk of pd.resultsthere were 2,253 cases of childhood pd among 888,655 children born in denmark from 1994 to 2007 . the adjusted incidence rate ratio of the effect of asthma on childhood pd was 2.2 ( 95 % confidence interval [ ci ] : 2.0 , 2.5 ) . age - stratified incidence rate ratios were 2.1 ( 95 % ci : 1.8 , 2.9 ) in children 6 months to < 24 months , 4.1 ( 95 % ci : 3.3 , 5.1 ) in children 24 months to < 60 months , and 2.3 ( 95 % ci : 1.6 , 3.2 ) in children 60 months . evaluation of the biologic interaction between asthma and comorbidity in older children revealed that 55 % ( 24 months to < 60 months ) to 73 % ( 60 months ) of cases among asthma - exposed children can be accounted for by the interaction between asthma and comorbidity.conclusionthese results confirm that asthma is an important risk factor for pd in children and suggest that children with underlying comorbidities are more sensitive to the effect of asthma on pd than children without comorbidities .

in 2005 , cardiovascular disease ( cvd ) was the underlying cause of death in 864,480 of the approximately 2.5 million total deaths in the united states [ 1 , 2 ] . cvd is the leading cause of death and the most costly disease in america and is expected to increase in costs to $ 1.48 trillion by 2030 . although the focus has been to reduce the modifiable risk factors for cardiovascular disease ( such as lipid levels , diabetes , and sedentary lifestyle ) , the unmodifiable risk factor , aging , is a major risk factor for coronary disease , hypertension , congestive heart failure , and stroke . the number of the aged in the united states is projected to increase by more than 20 % by the year 2030 . this growth in the elderly population is expected to significantly test our already overloaded health care system . although years of research have been conducted in regard to aging , we are still a long way from understanding the intricacies of age - related changes in human physiology , in particular the cardiovascular system . whether aging in animal models mimics many of the cardiovascular changes seen in humans is not well understood . in addition , the process of delineating the effect gender has on aging provides yet another variable to be considered .

cardiovascular disease is the leading cause of death in women in the united states . aging is a primary risk factor for the development of cardiovascular disease as well as cardiovascular - related morbidity and mortality . aging is a universal process that all humans undergo ; however , research in aging is limited by cost and time constraints . therefore , most research in aging has been done in primates and rodents ; however it is unknown how well the effects of aging in rat models translate into humans . to compound the complication of aging gender has also been indicated as a risk factor for various cardiovascular diseases . this review addresses the systemic pathophysiology of the cardiovascular system associated with aging and gender for aging research with regard to the applicability of rat derived data for translational application to human aging .

the mycotoxic nephropathy ( mn ) is a renal disorder caused by alimentary ingestion of secondary fungal metabolites possessing nephrotoxic properties and encountered in feeds / foods / forages made mainly from cereals or fibrous plants , and kept in storehouse conditions and increased humidity . since its discovering the disease has been described using various names : nephrosis provoked by moulds , chronic interstitial fibrosis of kidneys , chronic interstitial nephritis , etc . recently , the terms ochratoxicosis and mycotoxic nephropathy are the most frequently used ones for describing this nephropathy . during the last years this kidney disease has gained high publicity in some countries with well developed stock - breeding ( especially pig - breeding ) as denmark , sweden , bulgaria , etc . in order to prevent human exposure to various nephrotoxic mycotoxins , mainly ochratoxin a ( ota ) , via consuming the meat of animals with nephropathy , the timely diagnosis of disease during the meat inspection at slaughterhouses is very important . in such a way the exposure of humans to this very hazardous and relatively heat stable toxin from chicken / pigs meat can be prevented . there are some variances in the manifestation of the disease , especially in the clinicomorphological picture , which in a lot of the cases is influenced by the secondary bacterial infections as a result of the pronounced immunosuppression in the affected animals [ 2 , 3 , 4 , 5 , 6 ] . therefore , this review paper could contribute to timely diagnostics of mycotoxic nephropathy in farm animals ( mnfa ) as well as could help the organization of the prophylactic measures against this disease . in addition , some information is given how to make an evaluation of human exposure to ota on the base of the found concentrations of ota in human serum via calculating the daily ota intake of humans in endemic areas .

various etiological factors contributing to the development of mycotoxic nephropathy in farm animals and humans are reviewed . the possible synergistic effect between ochratoxin a ( ota ) and other mycotoxins , as penicillic acid ( pa ) and fumonisin b1 ( fb1 ) , contributing to this nephropathy is also considered and discussed . the most convenient ways of prophylaxis and various preventive measures against ota contamination of feeds or foods are reviewed . a reference is made concerning the most successful methods of veterinary hygiene control in the slaughterhouses in order to prevent the entering of ota in commercial channels with a view to human health . the economic efficacy of these prophylactic procedures is also considered . an evaluation of human exposure to ota is made .

distal anterior cerebral artery aneurysms , also known as pericallosal artery ( pa ) aneurysms , are located on the anterior cerebral artery distal to the anterior communicating artery . these aneurysms represent approximately 6 % of all intracranial aneurysms and 4 % of those that rupture49 ) . furthermore , they were similarly represented in the international subarachnoid aneurysm trial ( isat ) study population , in which they accounted for 95 of the 2143 patients randomized ( 4.4 % ) 14 ) . pa aneurysms present several problems for direct surgical clipping , that is , difficult exposure via an interhemispheric approach , especially in a swollen brain after subarachnoid hemorrhage ( sah ) , sacrifice of a bridging vein for adequate surgical exposure ( thus increasing the risk of postoperative morbidity ) , difficult controlling the parent artery , and the unfavorable orientation of the aneurysm fundus . as a consequence , surgical morbidity has been reported to be relatively high , with incidences ranging from 0 to 25 % 141221 ) . advances in endovascular techniques and devices have led to the rapid evolution of coil embolization of ruptured and unruptured intracranial aneurysms , and it has now become an efficient treatment technique that is comparable to surgical clipping . however , because of their distal location and the small diameter of the parent vessel , pa aneurysms pose a technical challenge for endovascular therapy and , as is the case for most bifurcation cerebral aneurysms , have a potential high recurrence rate18 ) . a search of the literature revealed relatively few studies have been performed on the endovascular treatment of ruptured pa aneurysms , and that the studies performed involved relatively small numbers of patient . accordingly , it is evident that the effectiveness and safety of the endovascular treatment of ruptured pa aneurysms have not been well - defined . here , we present 30 patients that were treated endovascularly for a ruptured pa aneurysm and describe their clinical and radiologic outcomes .

objectiveaneurysms arising from the pericallosal artery ( pa ) are uncommon and challenging to treat . the aim of this study was to report our experiences of the endovascular treatment of ruptured pa aneurysms.methodsfrom september 2003 to december 2013 , 30 ruptured pa aneurysms in 30 patients were treated at our institution via an endovascular approach . procedural data , clinical and angiographic results were retrospectively reviewed.resultsregarding immediate angiographic control , complete occlusion was achieved in 21 ( 70.0 % ) patients and near - complete occlusion in 9 ( 30.0 % ) . eight procedure - related complications occurred , including intraprocedural rupture and early rebleeding in three each , and thromboembolic event in two . at last follow - up , 18 patients were independent with a modified rankin scale ( mrs ) score of 0 - 2 , and the other 12 were either dependent or had expired ( mrs score , 3 - 6 ) . adjacent hematoma was found to be associated with an increased risk of poor clinical outcome . seventeen of 23 surviving patients underwent follow - up conventional angiography ( mean , 16.5 months ) . results showed stable occlusion in 14 ( 82.4 % ) , minor recanalization in two ( 11.8 % ) , and major recanalization , which required recoiling , in one ( 5.9 % ) .conclusionour experiences demonstrate that endovascular treatment for a ruptured pa aneurysms is both feasible and effective . however , periprocedural rebleedings were found to occur far more often ( 20.0 % ) than is generally suspected and to be associated with preoperative contrast retention . analysis showed existing adjacent hematoma is predictive of a poor clinical outcome .

cardiac implantable electronic device ( cied ) implantation continues to grow with permanent pacemaker implantation in the usa increasing by 56 % between 1993 and 2009 . in europe , there has been a 75 and 115 % increase in implantable cardiac defibrillator ( icd ) and cardiac resynchronization therapy pacemaker / defibrillator ( crt - p / crt - d ) implants between 2004 and 2008 . as a result of increasing indications for complex pacing , there is an expanding need for patients with pre - existing devices to undergo system revision due to lead failure or upgrade to allow icd and/or crt implant . in a recent european survey , 28 % of crt implants were performed in patients with pre - existing devices , and recent lead advisories have necessitated an increase in lead extraction cases . the combination of such factors means that the need for system revision and upgrade is likely to increase in the future . a major obstacle to device revision and/or upgrade is the presence of asymptomatic ipsilateral central venous obstruction . older reports suggested obstruction occurred in up to 50 % of cases with symptoms affecting only 13 % , but more contemporary reports have demonstrated a lower incidence closer to 30 % . this perhaps reflects improvements in lead design over time , but it remains clear that asymptomatic venous obstruction is not infrequently encountered . various strategies to overcome venous occlusion exist including contralateral lead or device implantation , venoplasty , and surgical epicardial lead implantation . the addition of extra pacemaker and/or icd leads is not without its drawbacks . in a recent prospective us registry of pacemaker / icd generator replacements , the need for an additional lead increased the rate of major complications from 4.0 to 15.3 % . lead extraction may be an alternative option to overcome this problem , but it is not without risk and this should be weighed against the benefits of removing any leads and also the likelihood of symptom recurrence in cases where there are symptoms of venous occlusion . the practice of laser lead extraction to re - canalize venous obstruction has previously been described in a limited number of patients and the suitability of this technique on a larger scale has not been reported . we describe our experience using laser lead extraction to overcome venous occlusion to enable ipsilateral device revision and/or upgrade .

aimsthe number of procedures involving upgrade or revision of cardiac implantable electronic devices ( cieds ) is increasing and the risks of adding additional leads are significant . central venous occlusion in patients with pre - existing devices is often asymptomatic and optimal management of such patients in need of device revision / upgrade is not clear . we sought to assess our use of laser lead extraction in overcoming venous obstruction.methods and resultspatients in need of device upgrade / revision underwent pre - procedure venography to assess venous patency . in patients with venous occlusion or stenosis severe enough to preclude passage of a hydrophilic guide wire , laser lead extraction with retention of the outer sheath in the vasculature was performed with the aim of maintaining a patent channel through which new leads could be implanted . data were recorded on a dedicated database and patient outcomes were assessed . between july 2004 and april 2012 , laser lead extractions were performed in 71 patients scheduled for device upgrade / revision who had occluded or functionally obstructed venous anatomy . new leads were successfully implanted across the obstruction in 67 ( 94 % ) cases . there were two major complications ( infection ) and four minor complications with no peri - procedural mortality . device follow - up was satisfactory in 65 ( 92 % ) cases with mean follow - up up to 26 19 months.conclusionlaser lead extraction is a safe and effective option when managing patients with central venous obstruction in need of cied revision or upgrade .

foot and mouth disease ( fmd ) is one of the highly contagious diseases of domestic animals , caused by foot - and - mouth disease virus ( fmdv ) , a member of the family picornaviridae , which has a colossal global impact , due to the huge number of animals affected . the fmd endemic countries collectively contain three - quarters of the world 's population ( robinson et al . , 2011 ) , indicating the global economic significance of the disease . at the national level in india , annual total economic loss due to fmd ranges from rs 12,000 crore to rs 14,000 crore ( singh et al . , 2013 ) . in spite of all the control measures taken , fmd continues to be an economically important disease in india due to poor surveillance and inadequate control programs . understanding of the mechanism of foot - and - mouth disease virus ( fmdv ) infection and replication of this virus is important to the control of this worldwide menace ( alexandersen et al . , 2003 , longjam et al . , 2011 ) . a vital question that has yet to be addressed concerns the role of viral receptors in the pathogenesis of fmd . integrins are the biologically important set of proteins used by the cells to bind and respond to the extracellular matrix which belong to a large family of integral membrane receptors that is required for cell adhesion . functionally active integrins consist of two noncovalently bound transmembrane glycoprotein subunits viz , alpha ( ) and beta ( ) ( springer , 2002 ) . evidence suggested that virus binding and infection of the integrin 6 ( itgb6 ) transfected cells are mediated through an rgd - dependent interaction ( baxt and becker , 1990 , jackson et al . , 2000 , mason et al . , 1994 ) . considering the role of host itgb6 receptor gene , the aim of the present study was to screen genetic variation within a snp ( rs136500299 ) at exon 14 region among different indigenous cattle . the polymorphism t / c is located at position 2145 of the reference itgb6 mrna and produces a missense change phe / ser in the position 667 of the polypeptide . previously , this polymorphism has been reported at least ten times : ss250661448 , ss263658018 , ss415630763 , ss420604742 , ss422472086 , ss679762826 , ss752601716 , ss828200981 , ss907724252 , and ss942564461 . in this study , we describe an accurate method on the basis of competitive polymerase chain reaction ( pcr ) so called tetraplex arms pcr , for identification of the snp among different animals .

the present study was aimed to screen genetic variation within a snp ( rs136500299 ) located at exon 14 region of bovine itgb6 gene among different zebu cattle breeds . the genotyping method describe in the present study is a tetraplex arms pcr , which offers extremely fast , economical , and simple detection tool . the distribution of the itgb6 genotypes among the different breeds studied suggested that the populations were under hardy weinberg equilibrium . our findings revealed that tt genotypes are widely distributed among different zebu cattle breeds , which can be associated with the resistance to fmd virus , as the bos indicus are more resistant to fmd virus in comparison to bos taurus .

over the last 3 decades , population - based studies aiming to determine the true burden of neurological disorders have increasingly been acknowledged . nevertheless , in developing countries , the limited access of neurologists to rural areas and the logistic and economic limitations to perform neuroepidemiological studies have significantly complicated their implementation.1 however , a series of epidemiological studies was conducted in upper egypt in the last 2 decades . epidemiologic research has progressed in egypt , particularly over the last 6 years , through two major projects to evaluate the incidence and prevalence of different neurological disorders in al kharga district , new valley and al quseir city , red sea governorate , upper egypt . this project aimed to evaluate the incidence and prevalence of epilepsy and stroke ; the incidence of bell s palsy ; and the prevalence of dementia , chorea , athetosis , dystonia , parkinson s disease , cerebellar ataxia , multiple sclerosis , migraine , trigeminal neuralgia , cerebral palsy , and spinal cord disorders .

a door - to - door survey , including every household , was conducted for all inhabitants of al quseir city ( 33,283 ) , red sea governorate , egypt by three specialists of neurology as well as nine senior staff members of neurology and 15 female social workers to assess the epidemiology of major neurological disorders . over six phases , from july 1 , 2009 to january 31 , 2012 , screening of all eligible people in the population was carried out , by which case ascertainment of all major neurological disorders included in the study was done according to the accepted definitions and diagnostic criteria of the world health organization . the order of frequency of prevalence of the studied neurological disorders was dementia ( 3.83 % for those aged > 60 years ) , migraine ( 2.8 % for those aged > 8 years ) , stroke ( 6.2/1000 for those aged > 20 years ) , epilepsy ( 5.5/1000 ) , parkinson s disease ( 452.1/100,000 for those aged > 40 years ) , cerebral palsy ( 3.6/1000 among children < 18 years ) , spinal cord disorders ( 63/100,000 ) dystonia ( 39.11/100,000 ) , cerebellar ataxia ( 30.01/100,000 ) , trigeminal neuralgia ( 28/100,000 for those aged > 37 years ) , chorea ( 21.03/100,000 ) , athetosis ( 15/100,000 ) , and multiple sclerosis ( 13.74/100,000 ) . the incidence rates of stroke , epilepsy , and bell s palsy were 181/100,000 , 48/100,000 , and 98.9/100,000 per year , respectively .

middle ear cholesteatoma is characterized by keratinocytic hyperproliferation with bony destruction and granulation tissue by chronic inflammation . the pathogenesis of middle ear cholesteatoma has been debated for a century , but there are four basic theories : invagination , basal cell hyperplasia , epithelial ingrowth and squamous metaplasia . during last century , etiopathogenicity of middle ear cholesteatoma raised many controversies and still a unanimous concept does n't exist . from a histological point of view this pathological tissue the interaction between cellular components is essential for the major histopathological features of cholesteatoma - hyperproliferation and bone destruction . in 1964 , the american anatomist gray referred to middle ear cholesteatoma as `` skin in the wrong place `` ( 1 ) . this simplified misdefinition stuck into literature and has been cited profusely in many scientific papers . the metaplasia theory ( 2 ) and existence of so - called `` congenital `` cholesteatoma put into question the `` skin origin `` of middle ear cholesteatoma and gave etiopathogenetical evidences against the simplified definition `` skin in the wrong place `` . the list of histological differences includes the absence of cutaneous adnexa and specialized dermal structures . neither hypodermal structures , nor blood vessels , or nerve endings have been ever described in cholesteatoma . the only similarity that is left between them is the presence of multistratified squamous epithelium , but in cholesteatoma this epithelium is with hyperproliferative properties . experimental models are critical for studying pathogenesis of middle ear cholesteatoma . in vivo models were tried to establish by chemical injection into the middle ear ( 3 ) , ligation of external auditory canal ( 4 ) and transplantation of skin ( 5 ) . keratinocytes of middle ear cholesteatoma were cultured by tissue culture ( 6 ) , passaged subculture ( 7 ) and air - liquid interface system ( 8 ) . however , stable experimental models of middle ear cholesteatoma are not established until now . our study has aimed to create an `` adequate `` in vitro model , based on the cell - to - cell interaction between keratinocytes and fibroblasts and to assess the grade of homogeneity between cholesteatoma and skin keratinocytes by focusing on the cytokeratin profile .

objectivesexperimental models are of importance to study the pathogenesis of middle ear cholesteatoma , however , they were not established until now . we aimed to develop in vitro model of middle ear cholesteatoma using primary keratinocytes and fibroblasts isolated from cholesteatoma tissue . hacat cell line was used as a `` skin equivalent `` and to compare the grade of homogeneity between cholesteatoma keratinocytes and hacat cells.methodsprimary keratinocytes were isolated from cholesteatoma tissue , co - cultured with preliminary prepared feeder layer from cholesteatoma fibroblasts and subsequently air - exposed . the protein profile of cholesteatoma keratinocytes and hacat cells was evaluated by means of immunoblot using monoclonal antibody against cytokeratin ( ck ) 13 and 16 . tissue localization of ck 13 and 16 was accomplished with immunohistochemistry.resultsdifferent protein profile and stronger expression of ck 13 and 16 were demonstrated in cholesteatoma keratinocytes in comparison with hacat cells . bigger stratification was observed in the 3d - in vitro systems when both cholesteatoma keratinocytes and hacat cells were respectively co - cultured with fibroblasts in comparison with the corresponding control groups without fibroblasts.conclusion3d-model demonstrates the significance of intercellular interaction between components of cholesteatoma tissue .

allogeneic bone marrow transplantation ( bmt ) is widely used in the treatment of various hematologic disorders , such as leukemia and aplastic anemia , and the major complication of bmt is graft - versus - host disease ( gvhd ) . we discuss whether autologous melanocyte transplantation is an appropriate way as a treatment of the vitiligo after allogeneic bmt . in this report we describe a patient with hodgkin 's lymphoma who developed universal vitiligo after allogeneic bmt from his sister . he underwent four times melanocyte - keratinocyte transplantation ( mkt ) for the treatment of vitiligo ; all treated depigmented patches had a significant repigmentation .

the treatment of vitiligo is derisory since the pathogenesis of vitiligo is not clear at present . most conservative treatments are difficult to approach satisfactory therapy . so transplantation is the only way left when the disease becomes insensitive to those conservative treatments . here we describe an 18-year - old patient who developed vitiligo , which was triggered by graft - versus - host disease after a allogeneic bone marrow transplantation for the treatment of hodgkin 's lymphoma from his sister . in the following treatment to vitiligo , the patient successfully performed the transplantation of autologous uncultured melanocyte on the premise of poor reaction to other conservative methods . we infer that transplantation can be a treatment of the vitiligo after allogeneic bone marrow transplantation .

spondylolisthesis is defined as an anterior migration of a vertebral body in relation to the vertebra located immediately caudal . in 1930 junghanns was the first to describe anterior translation of a lumbar vertebra without any defect in the neural arch following this the term degenerative spondylolisthesis ( ds ) was introduced by newman in 1955 . five types of spondylolisthesis have been described including dysplastic , isthmic , traumatic , pathologic , and degenerative . there are many predisposing factors like sagittally - placed facet joint , a high iliac crest [ 4 - 6 ] , etc . ds which is characterized by an intact vertebral ring is presumed to result from degeneration of facet joints and intervertebral discs with aging and thus has traditionally been considered to represent instability of the vertebral segment .

introduction : degenerative spondylolisthesis ( ds ) is usually seen at l4-l5 level and less frequently at l5-s1 level . this is a rare case report of spondylolisthesis of s1 over s2 with lumbarization of s1 . lumbarization of s1 is seen in just 1 - 2 % of the population and to have spondylolisthesis in this segment is even rarer . the purpose is to report a rare case of ds at s1-s2 level.case report : this is a single case report of a 66-year - old gentleman who presented with complains of lower backache for 2 years and acute retention of urine to the emergency department . detailed clinical and radiological evaluation of the spine was done which revealed lumbarization of s1 with spondylolisthesis at s1-s2 and facetal hypertrophy at l5 , s1 , and s2 . he underwent decompression and stabilization at l5 , s1 , and s2 along with placement of autologous bone graft . the bladder symptoms disappeared after 3 weeks . at 1-year follow - up , patient s clinical symptoms were relieved , and he improved clinically.conclusion : to the best of our knowledge , this is probably the first case of ds of sacral vertebrae to be reported in english literature . the prevalence of complete lumbarization is around 1.8 % and to get spondylolisthesis in this segment is even rarer , hence the lack of literature in this regard . since this is the first of its kind of case , further case series or longitudinal studies of such cases may help understand better the pathomechanics related to spondylolisthesis at this level .

organic foreign bodies are generally associated with severe inflammatory reaction and infection , while the nature of reaction elicited by inorganic foreign bodies depends on the material of the foreign body . graphite , which is the major constituent of pencil lead , has been reported to remain inert in the eye for a long time . however , it has also been reported to cause severe endophthalmitis - like reaction in the eye . we report a rare case of retained graphite pencil tip in the anterior chamber of a six - year - old girl .

retained intraocular graphite foreign bodies are uncommon . although they are generally inert , they have been reported to cause severe inflammatory reaction and progressive damage to intraocular structures . we report a case of a six - year - old girl with a retained intraocular graphite pencil lead foreign body in the anterior chamber of the eye and discuss the various considerations in the management of such cases .

polyacrylonitrile ( pan ) are commercially important and used for the precursor for high - performance carbon fiber . in the fiber applications , pan is dissolved in a suitable solvent and spin to fibers by a wet or dry spinning process . the extensively used solvents are aqueous sodium sulfocyanate ( nascn ) , n , ndimethylformamide ( dmf ) , n , n - dimethylacetamide ( dmac ) , and n , n - dimethyl sulfone ( dmso ) . unfortunately , all the solvents mentioned above are unfriendly to the environment . to meet the requirements of green chemistry , scientists have been searching for a green solvent to be an alternative to these solvents . in recent years , room temperature ionic liquids ( rtils ) have received a lot of attention as the potential green and designable solvents . although the ionic liquids have been studied since the 1950s , but they can not to be handled under an inert atmosphere . these are not part of our studies until some kinds of water - stable and air - stable ionic liquids are found such as [ bmim ] cl . because of its extremely low volatility , some of the rtils are promising environment - friendly solvents instead of the volatile organic solvents in a range of science and technology applications such as media for organic and inorganic reactions , materials processing electrochemistry and chemical separation . during the copolymerization of an and mma in rtils our research group find that rtils are good solvents for pan copolymer , and pan copolymer could be precipitated from the rtils solutions by the addition of water . therefore rtils are promising to be green solvents for pan . understanding the rheological properties of a solution is a convenient and effective way to gain a fundamental knowledge of the spinnability and structure - property relationships for the spinning solution . thus , this paper investigates the rheological properties of pan copolymer / bmimcl concentrated solutions in some detail .

one of the room temperature ionic liquids ( rtils ) , 1-butyl-3-methylimidazolium chloride ( [ bmim ] cl ) was chosen to prepare the concentrated solutions of polyacrylonitrile ( pan ) . the rheological behaviors of the solutions were measured with rotational rheometry under different conditions , including temperatures , concentration , and molecular weight of pan . the solutions exhibited shear - thinning behaviors , similar to that of pan / dmf solutions . the viscosities decreased with the increasing of shear rates . however , the viscosity decreased sharply at high shear rates when the concentration was up to 16wt % . the dependence of the viscosity on temperature was analyzed through the determination of the apparent activation energy . unusually , the viscosity of solutions of higher concentration is lower than that of lower concentration . similarly , the viscosity of low molecular weight pan was higher than high molecular weight pan at high shear rates . the dynamic rheological measurement indicates the loss modulus is much higher than storage modulus . the trend of complex viscosity is similar with the result of static rheological measurement . the interaction between pan and ionic liquid [ bmim ] cl was discussed .

fistulae between the upper respiratory and gastrointestinal tracts are uncommon in adults . whereas developmental anomaly is the commonest cause in infancy and childhood , the etiology in adults is most frequently secondary to an esophageal malignancy . we report two cases of esophagobronchial fistulae one secondary to chronic chest tuberculosis and the other secondary to a squamous cell carcinoma of the upper esophagus diagnosed by multi - detector computed tomography ( mdct ) . traditionally , fluoroscopy with oral contrast swallow examination has been the mainstay radiological investigation for the diagnosis of these fistulae . however , it can be an inconvenient study with need for multiple projections to adequately demonstrate the fistula and its course . also , being a luminal study , the cause of the fistula is not adequately evaluated . use of the various post - processing features like thick maximum intensity projections ( mips ) and volume rendering techniques ( vrts ) enables better detection and depiction of these fistulae . use of virtual endoscopy also guides the clinician for the conventional endoscopy which would be needed for biopsy and treatment .

we report two cases of esophagobronchial fistulae diagnosed by multi - detector computed tomography ( mdct ) oral contrast swallow examination . it is helpful to supplement the ct study with an oral contrast swallow as it aids in confirmation of a suspected fistula and also demonstrates the fistula tract better . we present the clinical details and the imaging findings on mdct of two cases of esophagobronchial fistulae one secondary to chronic chest tuberculosis and the other secondary to a squamous cell carcinoma of the upper esophagus followed by discussion of the etiology , pathogenesis , and imaging of these fistulae .

patients treated with salvage chemotherapy had a response rate of only 9 % and a median time to tumor progression ( ttp ) of 9 weeks . although bevacizumab can offer a significantly higher response rate of 55 % and a period of clinical stabilization with a median ttp of 26 weeks , the tumor remains in the brain and continues to proliferate despite clinical and radiological appearances of improvement . as a result , bevacizumab has a questionable impact on the overall survival of patients [ 3 , 4 ] . therefore , new and novel treatments are needed for patients with recurrent glioblastoma who failed initial treatment with radiotherapy and temozolomide . the novottf-100a device is a new treatment approved by the united states food and drug administration ( fda ) for recurrent glioblastoma . the device emits alternating tumor treating electric fields ( ttfields ) via 2 pairs of transducer arrays placed orthogonally on the scalp . the ttfields work by interrupting tumor cells during mitosis , resulting in violent blebbing during cytokinesis , asymmetric chromosome segregation , and aneuploidy [ 5 , 6 ] . these cell biology effects ultimately result in apoptosis or slippage into a g0 state of the tumor cell , while simultaneously making it susceptible to immunogenic cell death . in the pivotal phase iii clinical trial , the novottf-100a device had a similar efficacy when compared to salvage chemotherapy , but without the toxicities associated with systemic chemotherapies [ 7 , 8 ] . here , we report a patient who had failed bevacizumab therapy for a recurrent cystic glioblastoma and , at the time of bevacizumab continuation , received add - on ttfields therapy by using the novottf-100a device . this treatment combination eventually resulted in the disappearance of cystic enhancement together with a marked reduction of the cyst size and the cerebral edema in the surrounding brain .

the novottf-100a device emits alternating tumor treating electric fields ( ttfields ) that interfere with cytokinesis and chromosome segregation during mitosis . because it has a similar efficacy to cytotoxic chemotherapy , the device has been approved by the united states food and drug administration for the treatment of recurrent glioblastoma . although bevacizumab has been in use for recurrent glioblastoma , patients who experience incomplete or no response to bevacizumab may be predisposed to early bevacizumab treatment failure . however , the addition of ttfields therapy may augment the efficacy from bevacizumab . we report a patient with recurrent cystic glioblastoma who received add - on ttfields therapy due to an incomplete response to single - agent bevacizumab . after 6 cycles of therapy , a resolution of cystic enhancement was noted , together with reduction of the tumor cyst and resolution of most of the cerebral edema in the surrounding brain . however , the patient also suffered from relapsed disease at locations distant from the original glioblastoma and the corresponding radiation fields received at initial diagnosis . we conclude that combination ttfields and bevacizumab therapy is safe and may be efficacious for patients with recurrent glioblastoma . a further study would be needed to determine the relapse pattern and the distribution of the electric fields in the brain .

plaque - induced gingivitis is one of the most frequent periodontal diseases , affecting more than 90 % of the population , regardless of age , sex or race20 . brazilian epidemiologic studies show a high prevalence of gingival inflammation , ranging from 74 % to 100 % , although the mean individual percentage of gingival bleeding varies from 28 % to 35 % 5 . however , the inability of the normal adult population to perform adequate toothbrushing has led to the search for chemotherapeutic agents in order to improve plaque control12 . these chemicals , mainly triclosan and chlorhexidine , have been used as mouthrinses or added to dentifrices to avoid plaque formation and development of gingivitis10,12,14,22 . as some of these substances may have undesirable side effects , such as tooth staining and taste alteration , phytotherapic agents with antimicrobial and antiinflammatory properties have been investigated7,16,17 . the use of natural products in the prevention and treatment of oral conditions has increased recently and could be of benefit to low - socioeconomic level urban and rural communities4 . among the various currently available herbal agents , aloe vera , popularly known as `` babosa `` , is a plant commonly found the northeast of brazil . its foliage , extract and resin present antimicrobial , antiinflammatory and healing properties and are indicated to hepatic and stomach diseases9 . the antimicrobial effect of a dentifrice containing aloe vera has been demonstrated in an in vitro study , in which this phytotherapic agent inhibited the growth of diverse oral microorganisms , such as s. mutans , s. sanguis , a. viscosus and c. albicans 7 . the only study available evaluating the clinical effects of aloe vera showed a significant reduction of gingivitis and plaque accumulation after use of a mouthrinse containing this natural product20 . to the present date , there is no reported controlled trial evaluating the efficacy of a dentifrice containing aloe vera in the control of plaque and gingivitis . therefore , the purpose of the present study was to assess the antiplaque and antigingivitis effects of this phytotherapic agent compared to a fluoridated dentifrice .

the effect of aloe vera on the reduction of plaque and gingivitis was evaluated in a randomized , parallel and double - blind clinical trial . subjects were randomly allocated to the test group ( n=15 ) dentifrice containing aloe vera - or the control group ( n=15 ) fluoridated dentifrice . plaque index ( pi ) and gingival bleeding index ( gbi ) were assessed at days 0 and 30 . subjects were asked to brush their teeth with the control or test dentifrice , three times a day , during a 30-day period . there was a significant reduction on plaque and gingivitis in both groups , but no statistically significant difference was observed among them ( p > 0.01 ) . the dentifrice containing aloe vera did not show any additional effect on plaque and gingivitis control compared to the fluoridated dentifrice .

incidental detection of small renal masses is increasing . this has led to an increase in biopsy of small renal masses , a proportion of which needle biopsy of small renal masses is controversial owing to the risk of seeding malignant cells along the needle tract . needle tract seeding is a rare event ; the incidence is estimated to be less than 1 in 10,000 cases of all biopsies . eight other cases of needle tract seeding in a renal mass biopsy have been described in the medical literature , two as recently as 2013 ( table 1 ) . we report our experience of a man with renal cell carcinoma ( rcc ) seeding along a biopsy tract and compare the circumstances and biopsy techniques with reported cases in the literature .

a 66-year - old man underwent computed tomography - guided needle biopsy of a suspicious renal mass . two months later he underwent partial nephrectomy . histology revealed a 30-mm clear cell renal cell carcinoma , up to fuhrman grade 3 . an area of the capsule was interrupted , which corresponded to a hemorrhagic area on the cortical surface . under microscopy , this area showed a tongue of tumor tissue protruding through the renal capsule . a tumor deposit was found in the perinephric fat . these features suggest that tumor seeding may have occurred during the needle biopsy .

the syndrome is named after french neurosurgeon octave crouzon , who described this rare genetic disorder first time in 1912 . although it is encountered rarely , crouzon syndrome constitutes almost 5 % of all craniosynostoses with an approximate birth prevalance of 1/25,000 - 1/50,000 . the syndrome is characterized by abnormal head shape , midfacial hypoplasia , maxillary hypoplasia , mandibular prognathism , ocular hypertelorism , proptosis , and airway obstruction due to premature fusion of multiple calvarial and skull base sutures within the first year of life . however , the clinical picture may vary greatly from mild to severe midfacial and orbital anomalies . the relationship between craniosynostosis and chiari malformation type i ( cm - i ) has been well - documented . cm - i has a tendency to accompany syndromic craniosynostosis more commonly than sporadic synostosis . the incidence of cm - i in crouzon syndrome is about 70 % . herein , we present a 16-year - old boy who admitted with symptoms related to cm - i and underwent suboccipital decompression . however , on physical examination his cruzonoid features drawed attention .

chiari malformation type i ( cm - i ) related to syndromic craniosynostosis in pediatric patients has been well - studied . the surgical management consists of cranial vault remodeling with or without posterior fossa decompression . there were also cases , in whom cm - i was diagnosed prior to the craniosynostosis in early childhood . we present a 16-year - old boy who admitted with symptoms related to cm - i . with careful examination and further genetic investigations , a diagnosis of crouzon syndrome was made , of which the patient and his family was unaware before . the patient underwent surgery for posterior fossa decompression and followed - up for crouzon 's syndrome . to our knowledge , this is the only case report indicating a late adolescent diagnosis of crouzon syndrome through clinical symptoms of an associated cm - i .

permanent postoperative hypoparathyroidism results from the unintentional removal or injury of parathyroid glands during thyroid and parathyroid surgery . permanent hypoparathyroidism is defined as persistent hypocalcemia requiring calcium and vitamin d supplementation 6 months after surgery . the risk is nominal during a minimally invasive parathyroidectomy for a single adenoma but is greatest after a subtotal or total parathyroidectomy , thyroid resection and nodal dissection for large and extensive thyroid cancers , and reoperative neck operations . even though the risk of transient hypocalcemia can be high during an extensive neck dissection , the permanent hypoparathyroidism rate is typically around 1 % in the hands of experienced endocrine surgeons at high - volume centers . the accidental onset of permanent hypoparathyroidism can be agonizing for the patient and the clinician alike . for the patient , its negative impact includes a reduced quality of life , expensive lifelong medication supplementation , frequent laboratory testing , and the potential for frequent hospital admissions . in addition , the persistent absence of parathyroid hormone ( pth ) has long - term systemic effects on the body , such as the development of osteoporosis ( due to the decreased function of osteocytes ) , premature cataracts , cardiac dysfunction , and neurologic dysfunction [ 1 , 2 ] . in the late 1960s and 1970s , several new techniques were introduced in an attempt to prevent the detrimental health and social consequences of permanent hypoparathyroidism . for example , intraoperative autotransplantation of parathyroid tissue into the sternocleidomastoid muscle or the brachioradialis muscle was recommended . however , not all patients at risk of permanent hypoparathyroidism actually develop it , nor do all patients require an immediate autotransplant . in fact , an unnecessary autotransplant , if performed during parathyroid surgery , could result in persistent hyperparathyroidism . additionally , the autograft could become autonomously hyperfunctional , posing a diagnostic and treatment dilemma in the future ; wells et al . overcame that limitation and transformed our approach to prevent hypoparathyroidism by introducing autotransplantation of cryopreserved parathyroid tissue . cryopreservation permits parathyroid tissue to be stored for potential reimplantation , thereby avoiding the risk of needlessly implanting parathyroid tissue during initial surgery . the clinician is able to accurately determine whether any residual parathyroid tissue will recover function or whether a delayed autotransplant will be needed . the disadvantages of cryopreservation of parathyroid tissue include the potential of graft failure and the risk of graft - dependent hypercalcemia . this paper provides an up - to - date , comprehensive review of the cryopreservation of parathyroid tissue and its current role in thyroid and parathyroid surgery .

the risk of permanent hypoparathyroidism following thyroid and parathyroid surgery is around 1 % in the hands of experienced endocrine surgeons . although this complication is rare , rendering a patient permanently aparathyroid has significant consequences on the health and quality of life of the patient . immediate autotransplantation of parathyroid glands that are injured or unintentionally removed offers the best possibility of graft viability and functionality . however , since the majority of cases of hypoparathyroidism are transient , immediate autotransplantation can complicate postoperative surveillance in certain patients , especially those with primary hyperparathyroidism . cryopreservation of parathyroid tissue is an alternate technique that was developed to treat patients with permanent hypoparathyroidism . this method allows for parathyroid tissue to be stored and then autotransplanted in a delayed fashion once permanent hypoparathyroidism is confirmed . this article provides a contemporary review on cryopreservation of parathyroid tissue and its current role in thyroid and parathyroid surgery .

a major feature of the movement toward hospital cost containment in the last decade has been the replacement of expensive inpatient care with less costly outpatient care . most discussions about the increasing reliance on outpatient care focus on utilization and revenue measures . a more important issue for hospital payment policy , however , is how actual costs have been affected by this shift from inpatient to outpatient services . trends in relative cost changes are not easily identified because hospital accounting systems do not easily disaggregate total cost into inpatient and outpatient components . cost - finding methodologies are complex , allowing hospitals considerable discretion in cost - allocation patterns . furthermore , an incentive was created by the prospective payment system ( pps ) to allocate costs to centers incurring outpatient charges because medicare pays a fixed amount per inpatient discharge but continues to pay for outpatients on the basis of reasonable cost . changes in relative costs have important implications in the current environment of changing methods of payment for hospital outpatient services . concern over increases in medicare outpatient expenditures led to congressional legislation in 1986 that mandated the implementation of a pps for outpatient care . an understanding of true cost increases is critical to the adoption of a plan that accurately reflects outpatient costs . in this article , we provide a methodology for disaggregating total cost into inpatient and outpatient components to examine relative changes . this is accomplished through estimation of a multiple - output total - cost function for a sample of acute care hospitals for the years 1984 - 88 .

in this article , the authors estimate a multiple - output cost function for a sample of 2,235 hospitals during the period 1984 - 88 to disaggregate total costs into inpatient and outpatient components . the results suggest that outpatient cost growth is roughly proportional to that of inpatient cost , despite much higher relative growth in revenues and utilization on the outpatient side . the stability in the outpatient / inpatient cost ratio implies that the increase in the outpatient - to - inpatient utilization ratio was offset by a decline in their relative unit costs .

autosomal dominant polycystic kidney disease ( adpkd ) , the most common heritable renal disease , with an estimated incidence of 1:800 live births , is a disorder characterized by the development and growth of cysts in the kidneys and other organs . this disease is genetically heterogeneous ; in 85 % of the cases , the disease is caused by a mutation localized on chromosome 16 ( pkd1 ) and in 15 % by a mutation localized on chromosome 4 ( pkd2 ) , while a few families have been identified in which the disease is caused by a mutation in an unmapped locus . however , within the two identified forms of the disease , there is a remarkable variability in clinical features . proteinuria and microalbuminuria ( ma ) also occur with a highly variable severity and are associated with a more progressive course of the disease [ 3 , 4 ] . mild proteinuria , usually < 2 g/24 h , is a common finding on routine examination in adpkd patients ; however , the association of nephrotic syndrome with adpkd is considered rare [ 4 , 5 ] and needs to be investigated further to exclude coexisting glomerular disease . among the anecdotal case reports of adpkd associated with nephrotic syndrome , we report the case of a 26-year - old male with adpkd and concomitant nephrotic syndrome , in which the renal biopsy showed a mesangioproliferative glomerulonephritis

backgroundautosomal dominant polycystic kidney disease ( adpkd ) is an inherited disorder characterized by the development and growth of cysts in the kidneys and other organs . in adpkd patients , nephrotic range proteinuria is unusual and needs to be investigated further to exclude coexisting glomerular disease . among the anecdotal case reports of adpkd associated with nephrotic syndrome , focal segmental glomerulosclerosis occurs most frequently.methodswe report the case of a 26-year - old male with adpkd and concomitant nephrotic syndrome , in which an ultrasound ( us ) -guided renal biopsy showed a mesangioproliferative glomerulonephritis . we treated the patient with prednisone 1 mg / kg / day , because of the failure of treatment with angiotensin - converting enzyme inhibitor / angiotensin receptor blocker association.resultsafter 6 months of steroid treatment , we observed a stability of his gfr and a reduction of proteinuria.conclusionthis case report and other cases of the literature underline the importance of a renal biopsy in patients with adpkd and nephrotic syndrome in order to make an accurate diagnosis and an appropriate treatment / prevention of renal function deterioration .

it consists of a pair of cylindrically shaped centrioles surrounded by fibrous pericentriolar material . before or during dna replication in s phase , the centrioles split , and each cylinder serves as a template for the assembly of a new daughter centriole . before mitosis , when cells contain two pairs of centrioles , each pair serves as a nucleation center for microtubules of the spindle apparatus . defects in centrosome assembly or in centrosome separation can result in defective nucleation of spindle microtubules , and in several cases , in the formation of monopolar spindles and mitotic arrest ( sunkel et al . several years ago , evidence was published that defective centrosome assembly can prevent cells from entering s phase . in particular , removal of the centrosome by microsurgery or by laser ablation resulted in a cell cycle arrest , as did inhibition or silencing of several centrosome - associated proteins , such as dynactin , parp-3 , centriolin , or akap450 ( hinchcliffe et al . , 2001 ; khodjakov and rieder , 2001 ; quintyne and schroer , 2002 ; augustin et al . , 2003 ; gromley et al . , 2003 ; keryer et al the mechanism leading to this centrosome - dependent cell cycle arrest in g1 phase has been unclear ; it was proposed that a checkpoint control would prevent those cells with imperfect centrosomes from continuing the cell cycle , to prevent the assembly of defective spindles later in mitosis ( murray , 2001 ) . in this study , we followed cell cycle progress after inhibition of centrosome assembly by depleting the pericentriolar proteins pericentriolar material 1 ( pcm-1 ) and pericentrin . these proteins have been shown to be necessary for the assembly of other centrosomal constituents ( dictenberg et al . , 1998 ; dammermann and merdes , 2002 ; kubo and tsukita , 2003 ) . we found that depletion of pcm-1 or pericentrin activates the p38-dependent stress pathway and the p53-dependent cell cycle checkpoint .

previous evidence has indicated that an intact centrosome is essential for cell cycle progress and that elimination of the centrosome or depletion of individual centrosome proteins prevents the entry into s phase . to investigate the molecular mechanisms of centrosome - dependent cell cycle progress , we performed rna silencing experiments of two centrosome - associated proteins , pericentriolar material 1 ( pcm-1 ) and pericentrin , in primary human fibroblasts . we found that cells depleted of pcm-1 or pericentrin show lower levels of markers for s phase and cell proliferation , including cyclin a , ki-67 , proliferating cell nuclear antigen , minichromosome maintenance deficient 3 , and phosphorylated retinoblastoma protein . also , the percentage of cells undergoing dna replication was reduced by > 50 % . at the same time , levels of p53 and p21 increased in these cells , and cells were predisposed to undergo senescence . conversely , depletion of centrosome proteins in cells lacking p53 did not cause any cell cycle arrest . inhibition of p38 mitogen - activated protein kinase rescued cell cycle activity after centrosome protein depletion , indicating that p53 is activated by the p38 stress pathway .

a male neonate born to g2 p1l1 mother at term by spontaneous vaginal delivery to iii degree consanguineous marriage was found to have proximal shortening of both upper and lower limbs [ figure 1 ] . the antenatal period was uneventful and antenatal ultrasound was reportedly not done during pregnancy and the mother was referred to our hospital after the onset of labor . apart from rhizomelic shortening , the neonate also had coronal clefts of thoracic vertebrae and stippled epiphysis of femur tibia and humerus on skeletal survey radiograph [ figure 2 ] . based on the above features a provisional diagnosis of rhizomelic chondro - dysplasia punctata ( rcdp ) was made and the prognosis was explained to the parents . the baby developed progressively severe respiratory distress and was discharged at request on day 3 of life as the parents were unable to come to terms with the diagnosis . rhizomelic shortening of upper limb punctate calcification and epiphyseal abnormalities chondrodysplasia punctata is a radiological diagnosis characterized by punctate or stippled calcifications in epiphyseal cartilage and seen in peroxisomal disorders such as zellweger syndrome , neonatal adrenoleukodystrophy , and infantile refsum disease . it may also be inherited as x - linked dominant , x - linked recessive , and autosomal recessive forms . it is classically associated with pex7 gene ( peroxin family of genes ) mutation and has been reported in indian patients too . rcdp is characterized by proximal shortening of the humerus and to a lesser degree the femur , punctate calcifications in cartilage with epiphyseal and metaphyseal abnormalities , radiolucent defects ( coronal clefts ) of the vertebral bodies which represents cartilage that are not ossified , cataracts , contractures , microcephaly , characteristic skin changes of icthyosis , facial dysmorphism ( depressed nasal bridge , hypertelorism , hypoplastic midface , anteverted nostrils , full cheeks ) , and developmental impairment . this condition is considered to be lethal and most of the affected fetuses die in utero or soon after birth . only few of them survive beyond infancy with severe physical disability and profound mental retardation in whom , death usually occurs in the first decade of life . diagnosis of rcdp is based on clinical findings and confirmed by clinically available biochemical or molecular genetic testing which includes biochemical tests of peroxisomal function like red cell plasmologen concentration , plasma phytanic acid , and very long chain fatty acid estimation . this case is presented due to its rarity and failure to detect such an abnormality in utero resulting in a wasted pregnancy . the lack of resources ( both money and manpower ) is probably responsible for this tragedy to the parents which could have been prevented by early diagnosis and appropriate counseling . establishing regional genetic labs which are connected with district level hospitals can be of immense help in reducing the burden of genetic diseases by appropriate prenatal diagnosis and counseling .

a male neonate was born with rhizomelic shortening of limbs . skeletal radiograph showed punctate calcification of epiphysis of humerus , femur , and tibia . the diagnosis and a brief review of literature pertaining to the condition with emphasis on antenatal diagnosis and counseling are being reported .

radioactive iodine thyroid ablation has been shown to be an inexpensive , safe , and effective treatment for hyperthyroidism . it is the most commonly used method for treating adult patients with graves ' disease . special precautions must be used in women of child - bearing age because of the possible detrimental side effects of fetal exposure . the american college of radiology ( acr ) practice guideline for the performance of therapy with unsealed radiopharmaceutical sources states that pregnancy should be ruled out using one of the following four criteria : ( 1 ) a negative hcg test obtained within 72 hours prior to administration of the radiopharmaceutical , ( 2 ) documented history of hysterectomy , ( 3 ) a postmenopausal state with absence of menstrual bleeding for two years , and ( 4 ) premenarche in a child age of 10 years or younger . the society of nuclear medicine ( snm ) procedure guideline for therapy of thyroid disease with i-131 states that females of child - bearing age should routinely be tested for pregnancy within 72 hours or less before i-131 treatment . when the patient 's history clearly indicates that pregnancy is impossible , the treating physician may omit the pregnancy test .

graves ' disease is a thyroid - specific autoimmune disorder in which the body makes antibodies to the thyroid - stimulating hormone receptor leading to hyperthyroidism . therapeutic options for the treatment of graves ' disease include medication , radioactive iodine ablation , and surgery . radioactive iodine is absolutely contraindicated in pregnancy as exposure to i-131 to the fetal thyroid can result in fetal hypothyroidism and cretinism . here we describe a case of a female patient with recurrent graves ' disease , who inadvertently received i-131 therapy when she was estimated to be eight days pregnant . this was despite the obtaining of a negative history of pregnancy and a negative urine pregnancy test less than 24 hours prior to ablation . at birth , the infant was found to have neonatal graves ' disease . the neonatal graves ' disease resolved spontaneously . it was suspected that the fetal thyroid did not trap any i-131 as it does not concentrate iodine until 10 weeks of gestation .

ischemic heart disease is the first leading cause of death among the world and caused 62.6 million disability adjusted life years in 2004 . cardiovascular diseases ( cvds ) accounts for 17.7 million annual deaths in world - wide . cvds are increasing in developing countries as they half of deaths and 80 % of the related global burden occur in these countries . cvds are the main cause of death and its covers 38 % of total mortality in iran as well . recent studies have indicated that primary prevention to reduce cvds death is four times more effective than other levels of prevention . knowledge of the magnitude of cvds related avoidable burden resulting from different risk factors regarding their own significance in codifying the prevention and priority setting by policy makers is absolutely essential . the contribution of every risk factor to the avoidable / attributable burden of diseases can be calculated by a measure entitled potential impact fraction ( pif ) . the pif ( also called the generalized attributable fraction ) was introduced by walter in 1980 and morgenstern and bursic in 1982 as a measure that generalizes the population attributable fraction ( attributable risk ) . it is defined as the fractional reduction of a disease resulting from changing the current distribution of a risk factor to some modified distribution or to incomplete elimination of exposure . the concept of avoidable / attributable burden and such modified levels , which considered to some alternative distribution of exposure in the counterfactual analysis have previously been reported elsewhere . there are according to the authors knowledge , few published studies that consider the joint effect of multiple risk factors on avoidable burden of cvds . accordingly , this study was aimed to estimate the joint effect of avoidable burden of multiple risk factors to cvds in iran .

background : there are few published studies that consider the joint effect of multiple risk factors on avoidable burden of cardiovascular diseases ( cvds ) . this study aimed to estimate the joint effect of avoidable burden of multiple risk factors to cvds.methods : estimates of avoidable burden to cvds were made using potential impact fraction ( pif ) . in order to calculate pif , data on the prevalence of the risk factors include diabetes , hypertension , central obesity , and hypercholesterolemia were obtained from 3rd national surveillance of risk factors of non - communicable diseases-2007 in iran and data on corresponding measures of effect were derived from a cohort study with multivariate adjusted hazard ratios . then , joint effect of risk factors was calculated.results : about 37 % ( 95 % uncertainty interval : 21.7 - 50.2 ) of attributable disability adjusted life years ( dalys ) to cvds in adult males and 59.4 % ( 95 % uncertainty interval : 30 - 76 ) in adult females due to selected risk factors are avoidable in theoretical minimum risk levels . after changing the current prevalence of these risk factors to the plausible minimum risk levels , 17.8 % ( 95 % uncertainty interval : 10.1 - 25.1 ) of cvds attributable dalys among adult males and 34 % ( 95 % uncertainty interval : 20 - 46.7 ) in adult females can be avoided.conclusions : to better priority setting as well as reporting the magnitude of avoidable dalys rather than the percentage of avoidable burden , pif should be applied to updated and revised burden of cvds .

cytoscape 1 , 2 provides an environment for the visualization and analysis of networks and associated annotations . the primary audience for cytoscape is the biological community and cytoscape supports a number of standard use cases for analyzing and visualizing biological data . many of these use cases involve the selection of a number of nodes or edges based on some analysis or annotation and either performing an action on that selection or comparing those nodes or edges to a different set of nodes or edges that resulted from alternative analyses or analyses based on alternative annotations . the core capabilities for cytoscape provide some tools to facilitate these types of comparisons but they can be counterintuitive or complicated to use . setsapp is a cytoscape 3 application that provides a general set of tools for users and developers to define and maintain sets of nodes or edges and compare those sets using the standard set operations of union , intersection , and difference . in this paper , we present the implementation of setsapp , in particular , how setsapp integrates with the cytoscape command system , and then present a sample biological workflow using setsapp .

setsapp ( http : //apps.cytoscape.org/apps/setsapp ) is a relatively simple cytoscape 3 app for users to handle groups of nodes and/or edges . it supports several important biological workflows and enables various set operations . setsapp provides basic tools to create sets of nodes or edges , import or export sets , and perform standard set operations ( union , difference , intersection ) on those sets . the sets functionality is also exposed to users and app developers in the form of a set of commands that can be used for scripting purposes or integrated in other cytoscape apps .

each year , 200 000 inhospital cardiac arrests ( ihca ) occur in the united states , with overall survival rates of 18 % to 20 % . however , the extent to which hospitals vary in survival rates for ihca remains poorly understood , as prior studies have largely reported aggregate survival rates at the patient level or have had a limited sample of hospitals , and most studies have lacked detailed information on patient factors to ensure adequate casemix adjustment . furthermore , the extent of sitelevel variation in neurologic status among survivors an outcome of great importance to many patients , their family members , and providers remains unknown . defining variability in survival rates , and examining the degree to which variation persists even after adjusting for patient casemix , would provide important insights into which hospitals could improve resuscitation care and offer opportunities to identify best practices at these hospitals . if significant variability in survival exists even after adjusting for patient casemix , this may suggest that resuscitation process factors ( eg , time to defibrillation , quality of cardiopulmonary resuscitation ) and quality improvement initiatives may be the primary reasons for substantially higher survival rates in topperforming hospitals . moreover , it would suggest a greater urgency to develop appropriate research methodology to identify which factors are associated with best practices at hospitals with the highest ihca survival . accordingly , within the american heart association 's get with the guidelinesresuscitation ( gwtgr ) , a large national inhospital cardiac arrest registry , we examined the extent to which hospitals varied in rates of survival to discharge among patients with ihca . gwtgr is an ideal data source , as it contains ihca data from over 400 us hospitals and collects detailed information on a number of patient and cardiac arrest characteristics to ensure robust casemix adjustment in a specific patient cohort .

backgroundinhospital cardiac arrest ( ihca ) is common and often fatal . however , the extent to which hospitals vary in survival outcomes and the degree to which this variation is explained by patient and hospital factors is unknown.methods and resultswithin get with the guidelinesresuscitation , we identified 135 896 index ihca events at 468 hospitals . using hierarchical models , we adjusted for demographics comorbidities and arrest characteristics ( eg , initial rhythm , etiology , arrest location ) to generate riskadjusted rates of inhospital survival . to quantify the extent of hospitallevel variation in riskadjusted rates , we calculated the median odds ratio ( or ) . among study hospitals , there was significant variation in unadjusted survival rates . the median unadjusted rate for the bottom decile was 8.3 % ( range : 0 % to 10.7 % ) and for the top decile was 31.4 % ( 28.6 % to 51.7 % ) . after adjusting for 36 predictors of inhospital survival , there remained substantial variation in rates of inhospital survival across sites : bottom decile ( median rate , 12.4 % [ 0 % to 15.6 % ] ) versus top decile ( median rate , 22.7 % [ 21.0 % to 36.2 % ] ) . the median or for riskadjusted survival was 1.42 ( 95 % ci : 1.37 to 1.46 ) , which suggests a substantial 42 % difference in the odds of survival for patients with similar casemix at similar hospitals . further , significant variation persisted within hospital subgroups ( eg , bed size , academic ) .conclusionsignificant variability in ihca survival exists across hospitals , and this variation persists despite adjustment for measured patient factors and within hospital subgroups . these findings suggest that other hospital factors may account for the observed sitelevel variations in ihca survival .

caregiver is an individual who has the responsibility of meeting the physical and psychological needs of the dependent patient . psychiatric patients need assistance or supervision in their daily activities and this often places a major burden on their caregivers , thereby placing the caregiver at a great risk of mental and physical health problems . the term caregiver burden is used to describe the physical , emotional and financial toll of providing care . as the disease progresses , it carries with it a tremendous increase of burden on the caregiver who does the caregiving . the burden perceived by caregivers of patients with psychiatric illness is a fundamental prognostic aspect as the caregiver burden is reportedly a critical determinant for negative caregiving outcomes . the burden upon caregivers for a mentally ill patient living at home was first acknowledged by grad and sainbury in the early 1960s . the most common mental health consequences identified are depression , anxiety and burnout which occurs when a caregiver slips beyond exhaustion or depression . studies conducted showed that caregivers reported burden in different areas including effects on family functioning , social isolation , financial problems , and health . most of the notable community - based studies proved that 1847 % of caregivers land in depression . it is also known that caring for someone with psychiatric illness is associated with a higher level of stress than caring for someone with functional impairment from other chronic medical illnesses . many authors opine that the level of burden does not correlate with the duration of illness , but has enough variability with age , gender and educational status . a previous study concluded that poor social support and severity of illness have major role in determining the amount of burden on a caregiver . the burden perceived by caregivers of patients with psychiatric illness is a fundamental prognostic aspect in the history of the disease , and the caregiver burden is reportedly a critical determinant for negative caregiving outcomes . caregiver burden is categorized in terms of objective burden ( ob ) , subjective burden ( sb ) and demand burden ( db ) . ob is defined as the extent of disruptions or changes in various aspects of the caregivers life and household . sb is defined as the caregivers attitude or emotional reactions to the caregiving experience . db measures the extent to which the caregiver feels the responsibilities are overly demanding . the assessment of burden has become a challenging task for most researchers because cultural , ethical , religious and other personal values may influence perceptions of meaning and consequences of burden . there is a paucity of data comparing the caregiver burden of psychiatric patients to that of chronic medical illness . the objective of this study is to evaluate the contrast between the caregiver burden of psychiatric and chronic medical illness patients and to study the association between demographic factors like age , gender , duration of care - giving and caregiver burden .

background : caregivers of individuals suffering from psychiatric illness are at risk of being subjected to mental health consequences such as depression , anxiety and burnout . community - based studies proved that 1847 % of caregivers land in depression . the caregiver burden can be quantified into objective , subjective and demand burdens . there is paucity of data comparing the caregiver burden of psychiatric patients and that of chronic medical illness patients.aims and objectives : ( 1 ) to compare the caregiver burden in psychiatric illness and chronic medical illness . ( 2 ) to study the association of caregiver burden with demographic factors like age , gender , duration of caregiving.materials and methods : the study included two groups of caregivers , each of 50 members . group 1 consisted of caregivers of psychiatric patients and group 2 consisted of caregivers of chronic medical illness patients . the montgomery borgatta caregiver burden scale was used to assess the burden in terms of objective , subjective and demand burdens.results and conclusion : the caregiver burden scores in the caregivers of psychiatric patients were significantly higher than that of chronic medical illness ( p < 0.0001 ) . the caregiver burden was found to increase with the duration of illness as well as with the age of caregiver . the caregiver burden in the sample population was less as the objective and demand burden did not cross the reference higher value in the given scale , whereas the emotional impact given by the subjective burden was on higher side .

anesthesia providers routinely care for patients undergoing magnetic resonance imaging ( mri ) , and the implications for patient care are well known . however , there is scant literature on the occupational hazards of mri for health care workers . it is well known in the radiology community that exposure to a magnetic field of sufficient strength from an mri scanner can cause vertigo , though the practical considerations for health care workers involved in direct patient care are not well established.1 in the 3 months following introduction of a 3 t mri scanner ( replacing a 1.5 t scanner ) at our institution , there were three incidents of vertigo reported by our anesthesia providers , unseen during years of standard mri anesthesia practice . herein , we describe one such case of an anesthetist experiencing acute vertigo while caring for a patient undergoing a scan in a 3 t mri machine . we then discuss the incidence , mechanism , risk factors , and practical implications of this phenomenon .

vertigo induced by exposure to the magnetic field of a magnetic resonance imaging ( mri ) scanner is a well - known phenomenon within the radiology community but is not widely appreciated by other clinical specialists . here , we describe a case of an anesthetist experiencing acute vertigo while providing sedation to a patient undergoing a 3 tesla mri scan . after discussing previous reports , and the evidence surrounding mri - induced vertigo , we review potential etiologies that include the effects of both static and time - varying magnetic fields on the vestibular apparatus . we conclude our review by discussing the occupational standards that exist for mri exposure and methods to minimize the risks of mri - induced vertigo for clinicians working in the mri environment .

this has caused widespread concern , considering the associations between obesity and a range of adverse health conditions . there is a widely held view that the increasing rates of obesity will lead to an epidemic of diabetes , other chronic conditions , and a subsequent reduction in life expectancy . however the picture is complicated . since the 1960s all - cause and cardiovascular - specific mortality rates have decreased steadily in most developed countries , and life expectancy has consistently increased . the aim of this paper is to suggest several reasons for the discrepancy between increasing levels of obesity and gains in life expectancy , and those factors may be masking the effects of obesity on life expectancy . a better understanding of the way in which obesity affects health and longevity will help determine the most appropriate response to increasing levels of excess body weight and assist our understanding of the likely impact of obesity on the health of individuals and the future burden on the health care system .

background . increasing levels of obesity over recent decades have been expected to lead to an epidemic of diabetes and a subsequent reduction in life expectancy , but instead all - cause and cardiovascular - specific mortality rates have decreased steadily in most developed countries and life expectancy has increased . methods . this paper suggests several factors that may be masking the effects of obesity on life expectancy . results . it is possible that health and life expectancy gains could be even greater if it was not for the increasing prevalence of extreme obesity . it is also possible that the principal impact of obesity is on disability - free life expectancy rather than on life expectancy itself . conclusion . if the principal impact of obesity were through disability - free life expectancy rather than on life expectancy itself , this would have substantial implications for the health of individuals and the future burden on the health care system .

digital intraoral radiographic systems have several advantages compared with conventional film - based radiography . these advantages , in endodontics , include the potential of a lower radiation exposure to the patient and faster image display . moreover , it was introduced the opportunity of evaluating the progression of periapical bone loss by digital tools as the pixel values . radiographs do not always reflect the extent of the destructive process in the periapical tissues and generally under - represent the size of a lesion . studies have suggested that pathologic involvement of the cortical plate , or at least junctional trabeculae , is a prerequisite for radiographic detection of periapical pathoses . nevertheless , periapical lesions confined to cancellous bone could be detected radiographically using pixel values using one of the tools of the digital image , the histogram . only a few studies employing animal models or human biopsies have compared the diagnostic and quantifying accuracy of radiographs to the gold standard represented by the histology . the aim of this study was to induce periapical disease in rats to assess the pixel values in different experimental periods to evaluate the bone loss progression .

objectivethis study evaluated experimentally - induced periapical bone loss sites using digital radiographic and histopathologic parameters . material and methodstwenty - seven wistar rats were submitted to coronal opening of their mandibular right first molars . they were radiographed at 2 , 15 and 30 days after the operative procedure by two digital radiographic storage phosphor plates ( digora ) . the images were analyzed by creating a region of interest at the periapical region of each tooth ( imagej ) and registering the corresponding pixel values . after the sacrifice , the specimens were submitted to microscopic analysis in order to confirm the pulpal and periapical status of the tooth . resultsthere was significant statistically difference between the control and test sides in all the experimental periods regarding the pixel values ( two - way anova ; p < 0.05 ) . conclusionsthe microscopic analysis proved that a periapical disease development occurred during the experimental periods with an evolution from pulpal necrosis to periapical bone resorption .

carcinoid tumors develop from stem cells of the bronchial epithelium known as kulchitsky cells , which have neuroendocrine activity . these neuroendocrine cells can develop tumors in many different organs with most common being the lungs , the appendix , the small intestine ( duodenum ) , the rectum and the pancreas.1 the most recent classification system from the world health organisation categorized neuroendocrine pulmonary tumors in four types : typical carcinoid ; atypical carcinoid ( atc ) ; large cell neuroendocrine carcinoma ; and small cell lung cancer.2 carcinoid bronchopulmonary tumors represent approximately 25 % of all carcinoid tumors and 1 % 2 % of all lung neoplasms.3 approximately 70 % of these tumors are located centrally in the large bronchial tubes leading to the lung , while 10 % 20 % , known as peripheral carcinoids , develop in the pulmonary periphery.4 typical carcinoid pulmonary tumors manifest nine to ten times more often than atc tumors . typical carcinoid tumors are seen in younger patients more often than atcs and appear to be the most frequent pulmonary neoplasms during childhood and puberty.5,6 atc lung tumors have a more aggressive histologic appearance and a greater tendency to metastasize than typical carcinoid lung tumors . these tumors are more frequent in males , and the average age of onset is 46 years.7 unlike most lung cancers , the development of carcinoid pulmonary tumors is not related to smoking or other environmental causes ( eg , tobacco smoke , air pollution , or asbestos ) . the detection of carcinoid tumorlets in lung biopsies led to speculation that carcinoid tumors may grow from these cells.1 however , further research needs to be conducted as this association has not been yet determined .

carcinoid bronchopulmonary tumors represent approximately 25 % of all carcinoid tumors and 1 % 2 % of all lung neoplasms . the most common symptoms are : persistent cough , asthma - like wheezing , chest pain , dyspnea , hemoptysis and obstructive pneumonitis . we present a case of a young adult diagnosed with a typical carcinoid tumor . the diagnosis was established on the basis of imaging examination and bronchoscopic biopsy . the patient was treated with bronchoscopic electrocautery therapy to relieve the obstructed airway , followed by surgical lobectomy in order to entirely remove the exophytic damage . this approach was not only a palliative management to bronchial obstruction but also avoided pneumonectomy . recent studies support the use of such interventional resection methods , as they may result in a more conservative surgical resection .

familial mediterranean fever ( fmf ) is a genetic , autosomal recessive disease affecting primarily non - ashkenazi jews , turks , arabs , and armenians . this disease is characterized by acute , short episodes of serosal membrane inflammation , and fever . the fmf gene , called as mediterranean fever ( mefv ) gene that encodes pyrin / marenostrin , is mapped to the short arm of chromosome 16 . although il-1 plays a fundamental role in pathogenesis of fmf , tumor necrosis factor - alpha ( tnf- ) , soluble il-2 receptor , il-6 , and il-8 have also been shown to stimulate this process . patients have an increased erythrocyte sedimentation rate ( esr ) , c - reactive protein ( crp ) , serum amyloid a ( saa ) , and fibrinogen levels during these attacks and usually , this increase returns to normal values in attack - free periods . however , it is now known that subclinical inflammation may continue in attack - free periods of fmf patients . this type of inflammation may lead to developing of amyloidosis , which is the most devastating complication of fmf . neutrophil to lymphocyte ratio ( nlr ) and mean platelet volume ( mpv ) were used to show the inflammation in both cardiac and noncardiac disorders before . , we aimed to investigate whether nlr and mpv could be used to indicate the subclinical inflammation in pediatric fmf patients .

background : blood neutrophil to lymphocyte ratio ( nlr ) and mean platelet volume ( mpv ) both have been used as a simple marker of inflammation in many disorders . here , we aimed to investigate the relationship between nlr , mpv , and familial mediterranean fever ( fmf ) .materials and methods : in this retrospective study , the files of fmf patients in pediatric rheumatology outpatient clinic were reviewed . there were 160 participants ( 68.4 % ) in the fmf patient group and 74 participants ( 31.6 % ) in the control group . ninety of patients were in attack - free period , and 70 were in attack period.results : the highest values of nlr were found in the patients at attack period . patients in attack - free period and the participants in control group had similar levels of nlr ( 1.71 0.83 and 1.91 1.86 respectively ) ( p = 0.457 ) , and they had lower ratios than the patients did at attack period ( 4.10 3.11 ) ( p < 0.001 for both ) . there was no significant difference between mpv values of attack patients ( 8.35 4.91 ) and attack - free patients ( 8.43 1.15 ) ( p = 0.074 ) . mpv values of attack patients and attack - free patients were significantly higher than control group ( 7.99 0.81 ) ( p < 0.001 for both ) .conclusion : nlr ratio may indicate fmf attack period . since there was no significant difference between attack - free patients and control groups , nlr ratio can not be used as a subclinical inflammation marker . however , nlr could be a useful predictor of inflammation in fmf patients . on the other hand , since our attack and attack - free patients have similar mpv values and both had greater mpv values than control group , we suggest that mpv may be used to show subclinical inflammation .

the posttraumatic immune response is characterized by a complex set of pro- and anti - inflammatory reactions in order to restore homeostasis and was shown to be organ and cell specific [ 2 , 3 ] . splenic immune response and cellular immunity are known to be depressed after trauma - hemorrhage leading to an increased susceptibility to infectious complications [ 4 , 5 ] . several studies have demonstrated that splenocyte functions , such as proliferative and cytokine production capacity as well as macrophage antigen presentation function are suppressed following trauma hemorrhage [ 69 ] . in regards to t - cell function , a posttraumatic shift from splenic th1 cytokine ( il-2 , ifn- , and tnf- ) to th2 cytokine ( il-4 , il-5 , il-10 ) production has been reported [ 1015 ] . these splenic immune alterations are well described in rodent trauma models consisting of laparotomy and hemorrhagic shock [ 3 , 1619 ] and appear already 2 hours after insult induction [ 12 , 15 , 2023 ] . simple hemorrhage and laparotomy alone were demonstrated to result in a marked depression of splenic immune function , and no differences were seen in the extent of depression in the early stage , if these two insults were combined . however , a prolonged splenic immunodepression of 7 days was seen after combined trauma hemorrhage , whereas splenic immune suppression only persists up to 3 days following isolated hemorrhage or laparotomy . with a later onset at day 7 , splenic immune alterations following femoral fracture and hemorrhage seem to differ from the aforementioned trauma models . however , results are inconsistent due to different study designs ( e.g . , animal gender , genetic strain , and protocol of fracture induction ) . data regarding the role of isolated femur fracture in early stage splenic immune alterations are lacking , but are of special clinical interest as femoral fracture itself as well as the stabilization by femoral nailing seems to have a significant impact on the inflammatory response and the susceptibility to infectious complications . furthermore , it is still controversially discussed whether interleukin ( il ) -6 , produced by many different cell types ( e.g . , macrophages , endothelial , and t cells ) , exerts pro- or anti - inflammatory effects in the posttraumatic immune response . il-6 seems to have both , pro- and inflammatory effects , depending on whether it is acting in a paracrine or endocrine manner . additionally , the effects of il-6 seem to be influenced by the stimulus and the model of inflammation used in experimental studies . the aim of the present pilot study was to investigate whether a femoral fracture with or without hemorrhagic shock has an impact on the splenic cytokine production capacity at an early posttraumatic stage ( 4 hours ) and to observe the effects of il-6 under these conditions .

splenic immune function is known to be depressed following hemorrhage . the present study investigates the effects of femoral shaft fracture , isolated or in combination with hemorrhage , on early stage cytokine production capacity of splenocytes and observes the role of il-6 under these conditions . male il-6 knockout ( il-6/ ) and wild - type mice ( wt ) were randomly divided into three groups : sham ( s ) , isolated femoral fracture ( fx ) , and femoral fracture + volume controlled hemorrhage ( th - fx ) ( n = 6 per group ) . animals were sacrificed four hours after induction of hemorrhage and fracture . cytokine release ( tnf- , il-6 , and il-10 ) of isolated and lps - stimulated splenocytes was determined by cytometric bead array . femoral fracture with or without hemorrhage caused a suppression of in vitro cytokine production capacity of splenocytes at an early posttraumatic stage in wt and il-6/ . in the absence of il-6 , the profile of splenic cytokine secretion is significantly altered , identifying this cytokine as a potential therapeutic target to modulate the posttraumatic immune response .

lipoma is the most common soft tissue mesenchymal neoplasm in adults , which is located in any part of the body . the majority occurs in the upper - half of the body , particularly the trunk , head , and neck region , and it is rarely described in the oral cavity . conventional lipoma has been divided into three forms according to the origin of the localization : superficial lipoma ( arise within subcutaneous tissue ) , deep lipoma ( arise within deep soft tissue ) and parosteal lipoma ( arise within the surfaces of bone ) . the histological characteristics and types vary , which include angiolipoma , angiomyolipoma , myolipoma , osteolipoma and chondrolipoma . both osteolipomas and chondrolipomas are rare entities . [ 24 ] however , occurrence of osteolipomas or in other term lipomas with oseous and cartilagenous metaplasia are less common than other subtypes of lipomas . the term of osteochondrolipoma has been used for the lipomas containing both cartilage and bone which , are very rarely seen and generally associated with a paraosteal localization . to our knowledge ,

osteochondrolipoma is a rare benign soft tissue neoplasm . it is occasionally considered to be a variant of adipose tissue neoplasm lipoma showing multiple differentiation pathways of pluripotent stem cells . as with the lipomas they can be seen at any location and show cartilagenous and osteoid differentiation when located parosteally . we present a case of osteochondrolipoma located at the symphysis of the mandible . to our knowledge , this is the first reported case of an oral osteochondrolipoma associated with parosteal localization .

anterior cervical spine fusion and stabilization is a well established procedure for cervical myelopathy , radiculopathy , neoplasms , and cervical trauma2 ) . although injuries to the pharynx and esophagus are known complications of anterior cervical spine surgery , delayed pharyngeal or esophageal perforation is rare7,9,10 ) . here , we describe a rare but potentially life - threatening complication after anterior cervical spine fusion and plating . the authors highlight this issue by presenting this case , which had no associated morbidity , and include a review of the relevant literature .

although anterior approaches to the cervical spine are popular and safe , they cause some of complications . esophageal perforation after anterior spinal fusion is a rare but potentially life - threatening complication . we present a rare case of delayed esophageal perforation caused by a cervical screw placed via the anterior approach . a 43-year - old man , who had undergone surgery for complete cord injury at another orthopedic department 8 years previously , was admitted to our institute due to painful neck swelling and dysphagia . radiological studies revealed a protruding screw and esophageal perforation . the perforation was found during surgery and was successfully repaired . this case emphasizes the need for careful long - term follow - up to check for delayed esophageal perforation in patients that have undergone anterior cervical spine plating .

huge economic losses have been seen in livestock production causing problems in animals and humans . the use of chemotherapeutic drugs to control internal and external parasites is a widespread practice in livestock production and several broad - spectrum anthelmintics are available in the market for the control of helminthosis . currently , failure of anthelmintics and reduced efficacy due to resistance of nematodes in sheep and goats are becoming a threat in some countries and are of increasing importance in certain african countries [ 2 , 3 ] . according to waller , most of the nematodes of domestic animals have shown resistance to common anthelmintics especially in warm and humid parts of the world and this has been suspected to be due to frequent dosing and poor therapeutic strategies [ 58 ] . drug resistance was first reported in the late 1950 's [ 9 , 10 ] and early 1960 's [ 1114 ] . by the nineties , recently , lots of works have been done on this within and outside of africa [ 1522 ] . this has led to the search for a more eco - friendly anthelmintic that can tackle the resistance issue . v. amygdalina has been shown to have potentials as an anthelmintic in some animal species and humans [ 2325 ] . adediran et al . worked on v. amygdalina as an anthelmintic on goats though it was the stalk and leaves that were fed raw to the goats . a comparison to establish the efficacy of this plant relative to well known and established synthetic anthelmintics to which resistance has been reported is therefore needed . we investigated the response of anthelmintic - naive goats that have acquired helminth infections naturally to treatment with three commonly used anthelmintics and v. amygdalina in southwest nigeria . faecal egg count reduction test ( fecrt ) , the commonest nematicide evaluation means [ 26 , 27 ] , has some shortcomings primarily due to the fact that egg count does not correspond to worm burdens . the fecrt can however be standardized by randomization of animals into treatment groups for even dispersion of egg counts and drug effectiveness , accurate dosing to make sure no administered drug is lost , and proper tagging of animals in each treatment group to ensure correct sampling . our study was conducted with strict adherence to the standardisation method to ensure accuracy of our data on the drugs we evaluated . the objective of this study was to evaluate resistance in west african dwarf goats to levamisole , albendazole , and ivermectin and v. amygdalina .

anthelmintic drug resistance has led to the search for alternatives in controlling helminth infections . fifty west african dwarf goats without history of anthelmintic treatment were divided equally into five groups . group a was treated with ivermectin injection subcutaneously , group b with levamisole subcutaneously , group c with albendazole orally , and group d with aqueous extract of vernonia amygdalina and group e was untreated control . faecal samples were collected before treatment from each animal and larval culture was carried out . faecal egg count reduction ( fecr ) test was carried out for each group and the data analysed using fecr version 4 to calculate percent reduction in faecal egg count . predominant helminth infections from larval culture were haemonchus contortus ( 70 % ) , trichostrongylus spp . ( 61 % ) , and oesophagostomum spp . ( 56 % ) . mixed infection was present in all the animals . from the fecr test vernonia amygdalina extract was more effective against helminths ( 100 % ) , compared to ivermectin 96 % , levamisole 96 % , and albendazole 99 % . the lower 95 % confidence limit was 89 for ivermectin and levamisole and 91 for albendazole . there is low resistance to ivermectin and levamisole and susceptibility to albendazole while v. amygdalina has great potentials that could be explored for the treatment of helminth diseases in goats .

maca ( lepidium meyenii walp . ) is an endemic highland crop of the central andes which is grown from central peru to bolivia and northwestern argentina [ 1 , 2 ] . this plant has great potential as an adaptogen and appears to be promising as a nutraceutical in the prevention of several diseases . maca roots have been traditionally used to increase the rate of fertility in both humans and livestock . over the past 20 years , commercial maca products have gained popularity as dietary supplements for aphrodisiac purposes and for increasing fertility and stamina . recently , maca industry develops fast in yunnan province , china . in yunnan , until the end of 2010 , maca growing and promotion areas reached 175 hm and maca yield achieved 780 t , taking up to 90 % and 93 % , nationwide . mineral elements in food are very important because the quality of many functional foods and medicines depends on the content and type of minerals . in the us , national surveys show that micronutrient inadequacies are widespread and mineral supplement helps fulfill micronutrient requirements in adults and children . up to now , only limited studies on selected elements in maca from different origins have been carried out [ 10 , 11 ] . moreover , in some studies , no reference material had been certified for elemental analysis , so there has been doubt about accuracy of the determination . in the present study , inductively coupled plasma optical emission spectroscopy ( icp - oes ) was used to determine the contents of eight elements ( b , co , cr , cu , li , na , ni , and zn ) in maca samples , and a comparison was made between the samples from china and peru .

contents of eight mineral elements in maca ( lepidium meyenii walp . ) from china and peru were determined by inductively coupled plasma optical emission spectroscopy . cu contents in maca samples from china ( 2.531 mg kg1 dry weight , dw ) were higher than the samples from peru ( < 2.1 mg kg1 dw ) . na in two samples from china was found to be significantly of high content ( 2400 and 2600 mg kg1 dw ) . the contents ( mg kg1 dw ) of b , co , cr , li , ni , and zn were , respectively , 8.121 , < 0.023 , < 1.1~3.5 , 0.0200.17 , 0.0854.5 , and 1039 for the samples from china , while being 6.612 , < 0.023 , < 1.1~2.3 , 0.0350.063 , 0.681.7 , and 2739 for the samples from peru .

myrtle ( myrtus communis l. ) is an evergreen shrub belonging to the family of mirtaceae that grows spontaneously throughout the mediterranean area . in italy it grows along the coast and in the inner hills , and it is spread especially in the islands , where it is one of the most characteristic species . myrtus communis had history in the popular and traditional medicine : the essential oil obtained from leaves and , sometimes , flowers and berries has been used for its tonic and balsamic properties , and it is used in flavour and fragrance industries . in sardinia natural formations are still the main source for the production of a traditional liqueur , that every year reaches 3 million bottles . essential oils are gaining remarkable interest for their potential multipurpose use as antioxidant , antibacterial , and antiseptic agent [ 14 ] ; the essential oil obtained from the leaves was used in the past for the treatment of lung disorders . the isolation of essential oils from myrtus communis leaves is usually obtained by hydrodistillation method with a clevenger - type apparatus , according to the italian official pharmacopoeia . the chemical composition of the essential oils , analysed by gas / cromatography ( g / c ) , generally exhibits -pinene , 11 % ; 1,8-cineole , 16 % ; linalool , 12 % ; -terpineol , 7 % ; and limonene , 5 % . the sardinian myrtle oil is characterized by the lack of myrtenyl acetate and by a higher content of limonene . . showed the biological activities of tannins , including anticancer and antioxidant . in our previous studies ( data not published ) the antimicrobial properties of myrtus essential oil against several clinical strains and in particular against helicobacter pylori were studied , and we obtained encouraging results . considering these results , in this study , we have used this essential oil towards strains of m. tuberculosis and strains of mycobacterium avium subsp .

mycobacterium tuberculosis is the etiological agent of tuberculosis . the world health organization has estimated that 8 million of people develop active tb every year and the situation is complicated by an increase of mycobacterium tuberculosis strains resistant to drugs used in antitubercular therapy : mdr and xdr - tb . myrtle leaf extracts , used as an antiseptic in sardinian traditional medicine , have strong antibacterial activity as several investigations showed . in this study we investigated the antimicrobial properties of the essential oil of myrtus communis against clinical strains of m. tuberculosis and m. paratuberculosis .

the mesenchymal tumors of the gastrointestinal ( gi ) tract have been called as various names including stromal tumor of unknown malignant potential ( stump ) , gastrointestinal stromal tumors ( gist ) , gastrointestinal autonomic nervous tumors ( gant ) and gastrointestinal pacemaker cell tumors ( gipact ) ( 1 , 2 ) . after stem cell kinase receptor cd117 ( c - kit ) was introduced , the gists presumed to derive from stem cells differentiating to the gi pacemaker cells , known as interstitial cells of cajal ( icc ) , because nearly all gists are implicated with c - kit gene abnormality and cd117 ( c - kit ) overexpression ( 1 ) . even though the new entity of gist were initially introduced from the ultrastructural observation , the number of ultrastructural studies on gists ( 3 - 5 ) have been limited , compared to the quite a few ultrastructural reports of gants ( 6 - 8 ) . gists can occur primarily in every intraabdominal site including omentum , mesentery or peritoneum in addition to gi tract . cd117 is being demonstrated increasingly in a wide variety of tumors including inflammatory myofibroblastic tumors , intraabdominal desmoids ( 9 ) , angiomyolipoma and perivascular epithelioid cell tumors ( 10 ) , and malignant peripheral nerve sheath tumor ( 11 ) , which give rise to quite confusion . we investigated the gist and gant ultrastructurally to identify the specific ultrastructure of these tumors , any clue of their histogenesis and the comparison of the gists and gants .

gastrointestinal stromal tumors ( gists ) are the most common mesenchymal tumors in the gastrointestinal tract ( git ) . although interstitial cells of cajal has been suggested as origin of this tumor , the cytological and ultrastructural features of gists are heterogeneous and unclear . a total 10 cases of normal gastrointestinal tissue ( control ) , 13 gists of the stomach ( 8 ) , small intestine ( 3 ) , mesocolon ( 1 ) and liver ( 1 ) , and 2 gastrointestinal autonomic nervous tumor ( gant ) of small intestine were ultrastructurally studied . normal interstitial cells of cajal ( icc ) were abundantly present around the myenteric plexuses or individually scattered through the wall of git . icc was characterized by slender cytoplasmic processes , well - developed endoplasmic reticulum ( er ) , mitochondria , golgi apparatus , caveolae and intermediate filaments . the gists and gants had overlapping ultrastructures . the most common and important ultrastructural features of gists were rich villous cytoplasmic processes , dispersed intermediate filaments and abundant ser , and those of gants were neurosecretory granules and skenoid fibers . compared with icc , the gists and gants had remarkably reduced caveolae and gap junctions . our study suggested that ultrastructural analysis gives much information to investigate lineage differentiation of neoplastic cells and make a differential diagnosis of these tumors from other mesenchymal tumors and between gists and gants .

the transposable element ( te ) was first described by mcclintock as a controlling element that jumps from one position to another in the maize chromosome in the mid-1940s , long before the discovery by watson and crick of the double helix structure of dna as a genetic element . it was a time when , after the rediscovery of mendel 's law of heredity in 1900 , the cytogenetic study of chromosomes was at the forefront of genetics and when genes were thought to be beads on a string located on the chromosome . it was in the late 1970s and early 1980s when insertion sequence ( is ) elements and transposons ( tn ) were discovered and found to be similar to mcclintock 's controlling elements , and her ac / ds elements were confirmed at the dna sequence level as a te . salient features of dna transposable elements ( dtes ) , including terminal inverted repeats ( tirs ) , target site duplication ( tsd ) , the transposase gene , and simple and replicative transposition mechanisms have been well established by extensive molecular biology and biochemistry studies . then , retrotransposable elements ( rtes ) , including long terminal repeat ( ltr ) -retrotransposons , non - ltr - retrotransposons , and other retro - elements , were being added to the repertoire since the 1980s to make the picture diverse and complicated . many new families of tes are being added , especially from eukaryotes , even by computational screening in the post - genome era , which has necessitated a new classification based on their structures and mechanisms of transposition . the presence of foldback intercoil ( fbi ) dna was first reported by kim in 1985 and shown by a space filling model to mediate intra - molecular homologous recombination of inversions and deletions . it was further shown in 1987 that fbi dna can mediate inter - molecular dna rearrangements , such as site - specific insertions , at the foldback tip and dna transpositional integration at the intercoil end of the detached dte . it will be examined in this review how fbi dna mediation of transposition can be extended to different classes and families of rtes . readers are suggested to refer to many good reviews available on the classification , structures , genetic contents , and function of the gene products and on the mechanisms of transposition with excellent diagrammatic illustrations [ 5 , 9 , 10 , 11 , 12 ] . this review will minimize duplicate descriptions and focus on the mechanistic features that are relevant to the application of fbi dna to the mechanisms of dna transposition .

foldback intercoil ( fbi ) dna is formed by the folding back at one point of a non - helical parallel track of double - stranded dna at as sharp as 180 and the intertwining of two double helixes within each other 's major groove to form an intercoil with a diameter of 2.2 nm . fbi dna has been suggested to mediate intra - molecular homologous recombination of a deletion and inversion . inter - molecular homologous recombination , known as site - specific insertion , on the other hand , is mediated by the direct perpendicular approach of the fbi dna tip , as the attp site , onto the target dna , as the attb site . transposition of dna transposons involves the pairing of terminal inverted repeats and 5 - 7-bp tandem target duplication . fbi dna configuration effectively explains simple as well as replicative transposition , along with the involvement of an enhancer element . the majority of diverse retrotransposable elements that employ a target site duplication mechanism is also suggested to follow the fbi dna - mediated perpendicular insertion of the paired intercoil ends by non - homologous end - joining , together with gap filling . a genome - wide perspective of transposable elements in light of fbi dna is discussed .

smoking is a major risk factor associated with the development and progression of a variety of cancers . smoking is estimated to account for approximately 4 - 5 million deaths worldwide and approximately 443,000 deaths each year in the united states alone [ 2 , 3 ] . sufficient evidence has accumulated to conclude that tobacco smoking caused cancers not only of the lung , but also of the lower urinary tract including the renal pelvis and bladder , upper aero - digestive tract including oral cavity , pharynx , larynx , and esophagus , and pancreas [ 2 , 4 ] . recent lines of evidence have showed that smoking tobacco can also cause cancers of the nasal cavity , paranasal sinus , nasopharynx , stomach , liver , kidney , cervix , uterus , breast , adenocarcinoma of the esophagus , and myeloid leukemia . of the thousands of chemicals in tobacco smoke , polycyclic aromatic hydrocarbons and nicotine - derived nitrosamines have been identified as the major and potent carcinogens [ 5 , 6 ] . the metabolites of these agents form dna adducts and cause mutations in vital genes like rb , p53 , and k - ras in smokers [ 79 ] . while the induction of these cancers is mediated by tobacco - specific nitrosamines as well as other carcinogens present in the tobacco smoke , it is becoming clear that signaling through the nicotinic acetylcholine receptors contribute to the growth , progression , and metastasis of a variety of cancers . nicotine , which is the major addictive component of tobacco smoke , acts through nicotinic acetylcholine receptors ( nachr ) [ 911 ] , but is not thought to be carcinogenic . the expression of nachrs in central and peripheral nervous system is associated with smoking dependence and addiction . it was generally believed that nachrs are only expressed in nervous system and at neuromuscular junctions ( muscle type nachrs ) . however , the discovery of widespread expression of nachrs in mammalian cells , including cancers , suggested its direct role in cancer progression [ 1315 ] . this paper deals with certain aspects of nicotinic receptor signaling in nonneuronal cells that lead to increased cell proliferation and survival , angiogenesis , tumor growth , and metastasis .

cigarette smoking is highly correlated with the onset of a variety of human cancers , and continued smoking is known to abrogate the beneficial effects of cancer therapy . while tobacco smoke contains hundreds of molecules that are known carcinogens , nicotine , the main addictive component of tobacco smoke , is not carcinogenic . at the same time , nicotine has been shown to promote cell proliferation , angiogenesis , and epithelial - mesenchymal transition , leading to enhanced tumor growth and metastasis . these effects of nicotine are mediated through the nicotinic acetylcholine receptors that are expressed on a variety of neuronal and nonneuronal cells . specific signal transduction cascades that emanate from different nachr subunits or subunit combinations facilitate the proliferative and prosurvival functions of nicotine . nicotinic acetylcholine receptors appear to stimulate many downstream signaling cascades induced by growth factors and mitogens . it has been suggested that antagonists of nachr signaling might have antitumor effects and might open new avenues for combating tobacco - related cancer . this paper examines the historical data connecting nicotine tumor progression and the recent efforts to target the nicotinic acetylcholine receptors to combat cancer .

a dna sequence contains six potential open reading frames ( orfs ) , three on one strand and three on the reverse strand . however , typically only one of the six is actually expressed because it is associated with appropriate genetic signals that specify the dna strand and the reading frame to be transcribed and translate . exceptions occur in which more than one open reading frame is translated into a protein , as has long been observed in the case of viral genes , where it was suggested that this property permitted a high packing density of information ( 1 ) . however , analysis of the coding potential of 481 prokaryotic genomes revealed the surprisingly high frequency of alternate orfs of annotated genes especially in high g + c rich genomes , where almost every annotated orf exhibits an alternative orf that could potentially encode a protein of 100 amino acids or more ( 2 ) . the frequency of alternate open reading frames in high g + c genomes gives rise to the possibility that this property could be exploited to evolve novel genetic information and it is important to be able to detect this potential . however , this high frequency also provokes serious problems of gene annotation , where the incorrect orf may inadvertently be mis - annotated as the coding sequence . this potential for error is especially problematic when automatic gene prediction programs are used to annotate genomes , but errors can also slip by human annotators . the problem is exacerbated if an alternative orf is mis - annotated and the error is propagated in subsequent genome annotations . alterorf provides a searchable database of all possible alternative orfs in sequenced prokaryotic genomes that are potentially capable of encoding proteins of 100 amino acids or more . the objectives are 2-fold : to improve genome annotation by indicating possible errors in orf identification and , perhaps more important in the long term , to predict instances of genes that potentially could give rise to more than one protein .

alterorf is a searchable database that contains information regarding alternate open reading frames ( orfs ) for over 1.5 million genes in 481 prokaryotic genomes . the objective of the database is to provide a platform for improving genome annotation and to serve as an aid for the identification of prokaryotic genes that potentially encode proteins in more than one reading frame . the alterorf database can be accessed through a web interface at www.alterorf.cl

cardiovascular disease is the leading cause of death in end - stage renal disease ( esrd ) patients receiving long - term peritoneal dialysis ( pd ) therapy . data from the canada and united states ( canusa ) peritoneal dialysis study showed that nearly half of the mortality in pd patients was due to cardiovascular disease . according to data from the united state renal data system ( usrds ) , this trend has remained more or less the same in the recent years . vascular / valvular calcifications are important and highly prevalent complications in esrd patients including those receiving pd therapy and very much contributed to the exceedingly high cardiovascular mortality in this population . numerous observational cohort studies demonstrated the prognostic importance of vascular / valvular calcification in esrd patients . using plain radiographs to estimate number of arterial sites with calcification including carotid artery , abdominal aorta , and iliofemoral axis , both the presence and extent of vascular calcifications are strong predictors of cardiovascular and all - cause mortality in the esrd patients . abdominal aortic calcification detected nonquantitatively using plain lateral abdominal radiographs has also been shown to be an independent predictor of all - cause mortality and cardiovascular death in hemodialysis patients . using multislice computed tomography ( msct ) that enables quantification of calcification , block et al . demonstrated a significant mortality effect of the severity of coronary artery calcium score in incident hemodialysis patients . cardiac valvular calcification , detected using echocardiography , also predicts all - cause mortality and cardiovascular death in chronic pd patients . notably , patients with both aortic and mitral valvular calcification showed the highest risk of mortality and cardiovascular death compared to those with either heart valve calcification or no valve calcification . these data suggest that the presence of vascular or valvular calcification , irrespective of the sites involved , is indicative of a poor prognosis in the dialysis population including patients on pd . in this paper , we reviewed the prevalence , significance , contributing factors , and emerging mechanisms for this important complication in the pd population . furthermore , we discussed therapeutic strategies that may be useful in retarding calcification burden in the pd patients .

cardiovascular disease accounts over half of the total mortality in peritoneal dialysis ( pd ) patients . in addition , there is an increasing recognition of a high prevalence of vascular and valvular calcification that may contribute to the increased all - cause and cardiovascular mortality in the pd patients . disturbed mineral metabolism in association with chronic kidney disease has been suggested as one of the major contributing factors to the increased vascular / valvular calcification in this population . in this paper , we provide an overview of the prevalence and importance of this complication in the pd patients . in addition , we review the contributing factors and some emerging mechanisms for this complication . furthermore , we discuss some therapeutic strategies that may be useful in limiting the progression of vascular / valvular calcification in the pd population .

with the development of chemotherapy , control of metastatic colorectal cancer has increased in recent years . aggressive resection of distant metastases , local recurrence , or peritoneal dissemination has been performed , and good results have been reported [ 1 , 2 ] . particularly , aggressive resection has been recommended for hematogenous metastasis ; however , in pulmonary resection , the presence of mediastinal lymph node recurrence has been reported as a poor prognostic factor . recommendations for the resection of distant lymph node metastasis are lacking , but it is thought that solitary metastatic lesions should be resected . the development of various diagnostic imaging such as pet / ct has contributed enormously to performing preoperative staging and detecting postoperative recurrence . here , we present the case of a patient who had a solitary swollen mediastinal lymph node with high accumulation on pet / ct after primary resection of rectal cancer . however , histopathological results showed no metastasis , and he was diagnosed with reactive lymphadenitis . we report 1 case study of false - positive diagnosis on pet / ct and compare our findings with previous literature .

18f - fluorodeoxyglucose ( fdg ) positron emission tomography and computed tomography ( integrated fdg pet / ct ) has been used to diagnose recurrence and differentiate postoperative changes from lymph node metastasis in colorectal cancer , although its accuracy is questionable . we report a prone thoracoscopic surgery for a rectal cancer patient in which false - positive mediastinal lymph nodes were found on fdg - pet / ct . a 60-year - old man underwent a laparoscopic high anterior resection and d3 lymph node dissection for rectal cancer . the histopathological diagnosis was moderately differentiated adenocarcinoma of the rectum , stage iiib ( pt3n1m0 ) , necessitating oral fluoropyrimidine agent s-1 . after the primary surgery , a solitary mediastinal lymph node measuring 30 mm in diameter was detected , and abnormal accumulation was confirmed by fdg - pet / ct ( suvmax , 11.7 ) . thoracoscopic resection was performed in the prone position , but histopathological results showed no metastasis . he was subsequently diagnosed with reactive lymphadenitis . the patient was discharged on postoperative day 4 in good condition and is alive without recurrence 12 months after surgery . pet / ct is useful for the detection of colorectal cancer recurrence ; however , it does have a high false - positive rate for mediastinal lymph nodes . there is a limit to its diagnostic accuracy , and one must determine the indication for surgical treatment carefully . surgery in the prone position is a useful and minimally invasive approach to the mediastinum and allows aggressive resection to be performed .

colistin belongs to the polymyxin class of antibiotics which is a group of cationic polypeptides . however , the popularity rapidly faded in 1970s because of significant renal and neurological toxicity and was replaced with less toxic antibiotics with a comparable or broader antibacterial spectrum such as aminoglycosides . with the recent emergence of multi drug - resistant ( mdr ) gram - negative organisms , in particular pseudomonas aeruginosa , acinetobacter baumannii , and klebsiella pneumonia , colistin has been reconsidered as a potential therapeutic agent for the past 10 - 15 years . this has not only increased the clinical usage of this ancient drug , but has also increased the prevalence of all the toxicities related to colistin . neurotoxicity is the second most common toxicity after nephrotoxicity following colistin therapy . among the various manifestations of its neurotoxicity , several cases of respiratory failure due to colistin were reported in the previous era . however ,

the emergence of multi - drug - resistant gram negative bacillary infections has regained popularity of ancient drugs such as polymyxins . we report a case of acute respiratory failure induced by use of intravenous colistimethate , which is one of the forms of polymyxin . the patient is a 31 year old female with paraplegia due to spina bifida who underwent excisional debridement of large lumbosacral decubitus ulcer with osteomyelitis infected with pan - resistant pseudomonas aeruginosa and mrsa . six days after initiation of intravenous colistimethate and vancomycin , she developed acute respiratory failure requiring mechanical ventilation . pan - culture was negative including a chest radiograph . v / q scan showed low probability for pulmonary embolism . echocardiogram showed normal right ventricle with no strain or pulmonary hypertension . colistimethate was discontinued . within 24 hours , she was extubated . in the early years after introduction of polymyxin , there were several reports of acute respiratory paralysis . the mechanism is thought to be noncompetitive myoneuronal presynaptic blockade of acetylcholine release . though a direct causal relationship for respiratory failure is often difficult to establish in current era with multiple co morbidities , the timeframe of apnea , acuity of onset as well as rapid recovery in our case clearly point out the causal relationship . in addition , our patient also developed acute renal failure , presumably due to colistimethate induced nephrotoxicity , a possible contributing factor for her acute respiratory failure . in summary , colistimethate can induce acute neurotoxicity including respiratory muscular weakness and acute respiratory failure . clinicians should consider its toxicity in the differential diagnosis of acute respiratory failure especially in critically ill patients .

deep brain stimulators ( dbs ) are increasingly used to treat carefully selected cases of movement disorders , pain , and psychiatric disorders that respond poorly to medical therapy . anaesthesiologist may be involved in the implantation procedure or more frequently when these patients present for non - related medical or surgical illnesses . patients with long standing parkinson disease ( pd ) with dbs for surgery pose significant challenges to the anaesthesiologist in view of primary pathology , multisystem involvement , potential drug interactions , and risk of dbs malfunction by interference with monitoring and therapeutic electromagnetic devices . on reviewing the literature , we did not find any published report of shoulder arthroscopic surgery in a patient of pd with dbs and report the same .

we describe the anaesthetic management of arthroscopic repair for complete rotator cuff tear of shoulder in a 59-year - old female with parkinson 's disease ( pd ) with deep brain stimulator ( dbs ) using a combination of general anaesthesia with interscalene approach to brachial plexus block . the dbs consists of implanted electrodes in the brain connected to the implantable pulse generator ( ipg ) normally placed in the anterior chest wall subcutaneously . it can be programmed externally from a hand - held device placed directly over the battery stimulator unit . in our patient , ipg with its leads was located in close vicinity of the operative site with potential for dbs malfunction . implications of dbs in a patient with pd for shoulder arthroscopy for anaesthesiologist are discussed along with a brief review of dbs .

the diagnoses of these disorders are primarily based on history , clinical features , and histopathology . the oral mucocutaneous lesions cause diagnostic problems , as these lesions resemble each other , and routine tissue biopsies may only offer a diagnosis of non - specific inflammation.1 for the past few years , immunofluorescence techniques emerged as an important tool in detecting the pathogenesis and diagnosis of oral mucocutaneous lesions ( and vesiculobullous disorders ) . two types of immunofluorescence techniques that commonly followed are direct immunofluorescence ( dif ) and indirect immunofluorescence ( iif ) . in some diseases , iif studies have revealed circulating autoantibodies2,3 whereas dif studies have revealed immunoglobulins , complement components and other protein substances within the affected tissue.4 these circulating and tissue - bound substances may have a role in the immunopathogenesis of these diseases . in addition detection of these immune reactive substances by dif aids in the diagnosis of many skin and mucosal diseases.1 the presence of characteristic fluorescent patterns in dif can definitely establish the diagnosis of pemphigus and pemphigoid and strongly indicate the likelihood of lichen planus ( lp ) and lupus erythematosus . the absence of these fluorescent patterns rules out these conditions , thereby strengthening the diagnosis of other oral mucosal diseases . the results of dif are sufficiently useful in the diagnosis of chronic ulcerative diseases of the oral mucosa.1 based on these facts , a prospective study of oral mucocutaneous lesions was designed to evaluate the consistency of the histopathology with dif . a retrospective analysis of the prevalence of oral mucocutaneous lesions namely oral lp ( olp ) , discoid lupus erythematosus ( dle ) , pemphigus vulgaris ( pv ) , and mucous membrane pemphigoid ( mmp ) were also studied with regards to demographic details and histopathological features ( hematoxylin and eosin stained sections ) that are characteristic of each disease were evaluated .

background : oral mucosa is often affected by many diseases including mucocutaneous disorders . the diagnoses of these disorders are primarily based on history , clinical features , and histopathology . for the past few years immunofluorescence techniques emerged as an important tool to study the pathogenesis and in the diagnosis of oral mucocutaneous and vesiculobullous disorders . the present study was designed to carry out retrospective and prospective analysis of oral mucocutaneous lesions to elucidate the clinicopathologic features and its immunofluorescence findings.materials and methods : a total of 70 subjects with oral mucocutaneous lesions were retrieved from the oral pathology files of tamil nadu govt . dental college and their clinical features were evaluated , and the histopathology was also evaluated with the help of hematoxylin and eosin stained sections . for the prospective study , biopsy from 12 subjects with oral mucocutaneous lesions was subjected to routine histopathological examination and dif to evaluate the consistency of the methods.results : in the retrospective analysis of 70 subjects with oral mucocutaneous lesions in relation to clinical features and histopathology , most of the findings were similar to the previous studies except for few criteria like male predilection in lichen planus and mucous membrane pemphigoid ( mmp ) and more prevalence of pemphigus vulgaris than mmp ( 2:1 ) . in the prospective analysis of 12 subjects , the histopathological diagnosis was consistent with dif study in 66 % of cases.conclusion : the diagnostic efficiency of oral mucocutaneous lesions can be improved by modern tools like dif studies in addition to traditional methods like clinical and histopathology .

the world health organization has made prevention of visual impairment ( vi ) an international priority . in order to prevent vi , , priorities for prevention , treatment , and management can be identified , and strategies and resources allocated appropriately . for many years , diabetes has been a leading cause of vi in many countries , and still takes a major toll on vi . in england and wales , the uk national screening committee for diabetic retinopathy has set 18 service objectives and quality assurance standards for diabetic retinopathy screening services.1,2 the first service objective is to reduce new blindness due to diabetic retinopathy ( dr ) .2 it stipulates that local services will need to prospectively audit both certifications of visual impairment ( cvi ) and incidence of vi predominantly due to dr in order to establish a baseline . the standard acceptable annual registration rate for severe vi and vi due to dr is 9.5 and 9.3 per million per year for england and wales , respectively . these figures have been derived from national data in 19901991.3 the minimum standard achievable is a 10 % reduction in severe vi and vi registration rate within 5 years of the start of the screening program . the desirable standard is 40 % reduction . from 2006 and annually thereafter , dr screening programmes in england and wales will be required to submit an annual report to the national screening programme , containing general information about the service offered and information to support an assessment against the service objectives and quality assurance standards for the programme . all programmes in england and wales will be required to use a report template in order to facilitate the collation and comparison of data.4 locally derived data on new vi should be included in the annual report submitted to the national screening programme . prior to 2005 , screening for dr in cambridgeshire was largely hospital - based , with patients being referred by their general practitioners , diabetic physicians , or optometrists directly to ophthalmologists at either addenbrookes or hinchingbrooke hospital . optometrists have recently been trained to perform optometric based screening , and to refer patients in a timely manner with maculopathy ( m1 ) , preproliferative retinopathy ( r2 ) , and proliferative retinopathy ( r3 ) . in november 2003 , these apply to the function of the better eye ; people with good vision in one eye are not eligible for certification . this is the first study to obtain the severe vi and vi registration rates predominantly due to dr in south cambridgeshire , cambridge city , and huntingdonshire . it was performed to establish a reference point of vi registration due to dr at the beginning of the screening program .

background / aims : the uk national screening committee ( nsc ) has set 18 standards for diabetic retinopathy ( dr ) screening services in england and wales , the first of which is to reduce new visual impairment ( vi ) due to dr by 10 % within 5 years . this study examined the incidence of vi due to dr in cambridgeshire ( city , south , and huntingdonshire ) in order to establish a baseline rate of vi registration.methods : a retrospective review of all certificates of visual impairment ( cvi ) for 2004 and 2005 was conducted . hospital records of patients registered due to dr were reviewed to ascertain conformity to nsc standards . the incidence of vi registration due to dr was calculated.results : the number of registrations predominantly due to dr was 18 ; 13 visually impaired and 5 with severe vi . the rates of vi and severe vi predominantly due to dr were 17.1 and 6.5 per million per year , respectively . the vi and severe vi registration rates in the diabetic population were 600 and 230 per million per year , respectively.conclusion : the severe vi registration rate due to dr lies within the national standard . the vi registration rate exceeds 19901991 national standards but lies within 19992000 national figures .

local anesthetics like lidocaine and bupivacaine , opioids like morphine , alpha2 adrenoceptor agonists like clonidine , dexmeditomidine , and magnesium sulphate have all been tried intra - articularly either as sole agents or in combination , to provide effective postoperative analgesia . studies have shown that dexamethasone increases the duration of regional blocks , when combined with local anesthetics . therefore , it is expected that such a beneficial effect of dexamethasone can be manifested when it is injected in combination with levobupivacaine to intra - articular spaces . this placebo - controlled , double - blind , prospective study is designed to assess the efficacy of intra - articular dexamethasone administered as adjuvant to local anesthetic levobupivacaine in patients undergoing arthroscopic knee surgery .

background and aims : in an attempt to improve the recovery and early rehabilitation after arthroscopic knee surgery , various medications have been administered via intra - articular route to prolong the duration and improve the quality of postoperative analgesia . among the potentially effective substances , steroids like dexamethasone could be of particular interest.materials and methods : fifty patients undergoing elective knee arthroscopy were randomly assigned to one of the following groups containing 25 patients each . group d patients received 8 mg ( 2 ml ) of dexamethasone added to 18 ml of 0.25 % levobupivacaine intra - articularly , ( total volume 20 ml ) . group l patients received 18 ml of 0.25 % levobupivacaine and 2 ml of isotonic saline ( 20 ml in total ) intra - articularly . analgesic effect was evaluated by measuring pain intensity visual analogue scale score and duration of analgesia.results : a longer delay was observed between intra - articular injection of study medication and first requirement of supplementary analgesic in group d ( 10.24 2.8 hours ) compared with group l ( 5.48 1.6 h ) . total consumption of diclofenac sodium in first 24 h in postoperative period was significantly less in group d. no significant side effects were noted.conclusion : dexamethasone , used as adjunct to levobupivacaine in patients undergoing arthroscopic knee surgery , improves the quality and prolongs the duration of postoperative analgesia .

the epidermal growth factor receptor ( egfr ) is over expressed in various solid malignancies including non small cell lung cancer ( nsclc ) . however , they are associated with a dermatologic side effects , which can occasionally be responsible for discontinuation of the egfr inhibitors . hence , we report a case of metastatic adenocarcinoma of lung who developed skin ulceration with gefitinib and responded to interruption of the drug and early intervention .

we report a case of gefitinib - induced skin ulceration in a 50-year - old female with metastatic adenocarcinoma of lung who developed this adverse effect 2 weeks following initiation of gefitinib at a dose of 250 mg / day . the ulcer improved with stopping gefitinib for 2 weeks and also addition of topical steroids and antibiotics . we are reporting this case to create awareness among treating oncologists of this adverse effect and also prompt interruption of therapy and topical steroids / antibiotics is useful to treat this adverse event .

acute quinine poisoning is a devastating ocular event that can result in severe loss of vision.1 quinine is an antimalarial agent that is often used for the treatment of restless legs syndrome . the drug has a narrow therapeutic range and carries the risk of multiple side effects such as cinchonism , hypoglycemia , arrhythmias , hemolysis , gastrointestinal intolerance , fever , and nephritis.2 in early 2007 , the us food and drug administration restricted the use of quinine solely to the treatment of malaria . quinine has long been known to be toxic to the eye even at therapeutic levels , causing symptoms such as loss of vision , reduced color vision , and reduced visual fields.3,4 most visual symptoms occur after a quinine dose greater than 4 g and death can occur with doses exceeding 8 g.5 we describe a patient with profound visual loss after acute quinine poisoning . at 72 hours postingestion , erg , stratus time - domain optical coherence tomography ( oct ) , fundus photography , and fluorescein angiography ( fa ) were performed on the patient . at 15 months postingestion , time - domain oct and fa were again performed on our patient . at the 28 months postingestion visit , cirrus spectral - domain and stratus time - domain oct , fa , and fundus autofluorescence ( faf ) were performed . to the best of our knowledge , this is the first documentation in the literature of the retinal changes in acute quinine toxicity as seen by oct and faf .

purposeto report a case of acute quinine poisoning , document acute and chronic macular changes with optical coherence tomography imaging and fluorescein angiography ( fa ) , and to review the literature on ocular toxicity of quinine.methodsa 32-year - old white female presented to our emergency department after ingesting over 7.5 g of quinine . she underwent a complete ophthalmologic examination , fluorescein angiography , stratus time - domain optical coherence tomography ( oct ) , and electroretinography at 72 hours and 15 months postingestion . stratus time - domain and cirrus spectral - domain oct , fundus autofluorescence , and fa were obtained at 28 months postingestion.resultsfluorescein angiography at 72 hours postingestion revealed normal filling times and vasculature . oct showed marked thickening of the inner retina bilaterally . at 15 and 28 months follow - up , fundus photography and fluorescein angiography demonstrated optic nerve pallor , severely attenuated retinal vessels while oct showed inner retinal atrophy . fundus autofluorescence did not reveal any retinal pigmentary abnormalities.conclusionsquinine toxicity as seen by oct reveals increased thickness with inner retinal hyperreflectivity acutely with development of significant retinal atrophy in the long - term . fundus autofluorescence reveals an intact retinal pigment epithelial layer at 28 months . these findings suggest that quinine poisoning may produce a direct toxic effect on the inner retina in the acute phase resulting in long - term retinal atrophy .

the diagnosed incidence of neuroendocrine tumors ( nets ) in the current decade has risen to 5/100,000 from about 1 to 2 cases per 100,000 , three decades ago . this can be attributed to advanced diagnostic radiological and pathological techniques available in medical science today . multi detector computed tomography ( ct ) techniques with dynamic scanning of the abdomen in the arterial phase to detect hypervascular lesions such as those found in net is routine protocol for patients who have a clinical suspicion of the tumor . similarly , functional imaging such as nuclear positron emission tomography ( pet ) scans with ga - dota - nai - octreotide ( ga - dotanoc ) has further narrowed the possibility of detecting these lesions . we present a perplexing case of a patient who presented with a solitary liver mass , mimicking hepatocellular carcinoma ( hcc ) , on imaging and cytopathology and was subsequently operated for the same . a fluorodeoxyglucose ( fdg ) pet scan done before the surgery did not detect the primary tumor . the patient was diagnosed to have a metastatic secondary in the liver from a primary net , only after histopathology and immunohistochemistry of the explanted liver was performed . further evaluation in the postoperative period with ga - dotanoc pet enabled the localization of the primary tumor in the midgut , which was then re - explored and excised with a follow - up surgery . this case highlights the importance of immunohistochemistry for suspected hypervascular mass lesions in the abdomen . in addition , it emphasizes the relevance of functional imaging with ga - dotanoc pet and pitfalls of fdg pet in the assessment of hypervascular tumors of the abdomen and gastrointestinal tract . the use of ga dotanoc pet in the first stage of evaluation of the liver mass , along with fdg pet could have pointed to the nature of the mass and thus saved the patient morbidity related to two consecutive major laparotomy procedures . on review of the literature , we came across only one case report , which showed a primary hcc metastasis to pancreas resembling a net , however no other such mimic cases have been reported .

neuroendocrine tumor metastases to the liver can mimic primary hepatocellular carcinoma ( hcc ) on imaging , cytology , and core biopsy . we present a case study along with the literature review of a patient who presented as a solitary liver mass mimicking hcc and subsequently underwent a partial hepatectomy . the histopathology and immunohistochemisrty of the resected specimen revealed metastatic neuroendocrine carcinoma . positron emission tomography ( pet ) scan with 68ga - dota - nai - octreotide ( 68ga - dotanoc ) localized the primary tumor in the ileum . a curative follow - up surgery for resection of the small bowel containing the primary tumor was carried out . this case illustrates the shortcomings of routine imaging methods , utility of immunocytochemistry and the importance of 68ga - dotanoc pet in determining the metastatic spread as well as the origin of neuroendocrine tumors ( nets ) . this case report attempts to highlight the current imaging paradigms and management strategy of midgut and other net 's at the point of detection , staging and follow - up .

crohn 's disease ( cd ) is an autoimmune inflammatory disorder that may involve different sites along the gastrointestinal tract . the disease tends to be more severe and widespread in children and young adults [ 1 , 2 ] . during the last 2 decades , the incidence of cd in childhood has considerably increased [ 2 , 3 ] . pulmonary involvement in cd is well described , and though it is rarely reported in pediatric patients , it may be more common than previously reported . pulmonary cd can be latent or symptomatic , with symptoms manifesting before , during or after the diagnosis of cd . down syndrome ( ds ) has been associated with increased frequency of malignancies , autoimmune diseases and infections . it has been hypothesized that this is due to abnormal precocious aging . however , recent evidence suggests that it is more likely that the immune system in ds is deficient from the very beginning , with immune dysregulation causing a tendency towards autoimmune diseases . in addition to other congenital defects , individuals with ds are also more likely to have structural and functional disorders of the gastrointestinal tract . associations between cd and ds have been reported , though very rarely [ 9 , 10 , 11 , 12 , 13 ] . in our search of the literature , we did not find any reported case of ds with pulmonary cd to date .

crohn 's disease ( cd ) is an autoimmune inflammatory disorder that primarily affects the gastrointestinal tract . it may have pulmonary involvement , which has been rarely reported in pediatric patients . down syndrome ( ds ) has been associated with increased frequency of autoimmune diseases . however , associations between cd and ds have been rarely reported . we present the case of a 5-year - old girl with known ds and a history of chronic intermittent abdominal pain who presented with persistent pneumonia . her workup included a chest computed tomography ( ct ) scan that showed multiple noncalcified pulmonary nodules . an extensive infectious workup was done that was negative . ct - guided needle biopsy of the lung nodules showed necrotizing granulomas . this raised concern for primary cd with extraintestinal pulmonary manifestation . an esophagogastroduodenoscopy and colonoscopy were performed , and colon biopsies showed scattered epithelioid granulomas . based on this information , there was consensus that her lung nodules were secondary to cd . she was started on standard therapy for cd , and her abdominal and respiratory symptoms gradually improved . however , she continues to have mild residual lung calcification and fibrosis . to our knowledge , this is the first reported case of pulmonary cd in a child with ds . the natural history of pulmonary cd in the pediatric population is not very well studied . furthermore , since ds has been well known to be associated with increased frequency of malignancies and autoimmune conditions due to immune dysregulation , it is difficult to predict the severity and possible complications in this patient .

there is considerable interest in understanding the role of vitamin d in cancer in general and in ovarian cancer in particular . experimental studies have shown that vitamin d administration reduces proliferation and promotes apoptosis in ovarian cancer cell lines and animal models [ 16 ] . ovarian cancer incidence and mortality rates are higher in northern latitudes , where sun exposure , which is required for the initiation of vitamin d synthesis in the skin , is lower [ 710 ] . an inverse association between dietary vitamin d intake and risk of ovarian cancer has been reported in one epidemiologic study , although others have not supported this finding [ 1216 ] . studies of the effect of dietary vitamin d intake are limited because estimation of dietary vitamin d intake does not capture cutaneous production of vitamin d. thus , circulating vitamin d , which reflects both cutaneous production and dietary / supplement intake [ 1720 ] , is considered the best indicator of overall vitamin d status . however , its concentration is about 1000 times lower than that of 25 ( oh ) d in circulation , due to its shorter half - life and local production in target tissues , such as the ovaries [ 21 , 22 ] . thus , 25 ( oh ) d is thought to better reflect overall vitamin d status than 1,25 ( oh ) 2 d [ 23 , 24 ] . to date , only one epidemiologic study has examined the relationship between prediagnostic levels of vitamin d and risk of ovarian cancer . did not find an association of ovarian cancer risk with the 25 ( oh ) d or 1,25-dihydroxyvitamin d ( 1,25 ( oh ) 2d ) plasma levels . polymorphisms in the vdr gene may influence the ability of 1,25 ( oh ) 2d to activate vitamin d target genes , including those involved in growth regulation and apoptosis . in a previous manuscript , we reported an overall null association between four common polymorphisms in the vdr gene ( bsm1 , apa1 , taq1 , and fok1 ) and risk of ovarian cancer , although a retrospective multiethnic study of 313 cases and 574 controls and a large pooled analysis including 1473 cases and 2006 controls from four studies ( one retrospective case - control study and three case - control studies nested in prospective cohorts ) found an association with the fok1 snp among caucasian women . mixed results for this and other vdr snps may be due to chance findings or limited power to detect associations . it is also possible that genetic variants influence ovarian cancer risk differently , depending on an individual 's vitamin d status . the objective of the present study was to examine the relationship between circulating levels of 25 ( oh ) d and risk of invasive epithelial ovarian cancer and to assess the combined effect of circulating 25 ( oh ) d and vdr polymorphisms on ovarian cancer risk .

we conducted a nested case - control study within two prospective cohorts , the new york university women 's health study and the northern sweden health and disease study , to examine the association between prediagnostic circulating levels of 25-hydroxy vitamin d ( 25 ( oh ) d ) and the risk of subsequent invasive epithelial ovarian cancer ( eoc ) . the 25 ( oh ) d levels were measured in serum or plasma from 170 incident cases of eoc and 373 matched controls . overall , circulating 25 ( oh ) d levels were not associated with the risk of eoc in combined cohort analysis : adjusted or for the top tertile versus the reference tertile , 1.09 ( 95 % ci , 0.592.01 ) . in addition , there was no evidence of an interaction effect between vdr snp genotype or haplotype and circulating 25 ( oh ) d levels in relation to ovarian cancer risk , although more complex gene - environment interactions may exist .

although perioperative mortality from tonsillectomy and submucosal uvulopalatopharyngoplasty ( smuppp ) with tonsillectomy has decreased significantly , postoperative bleeding is still an important complication . the incidence of bleeding after tonsillectomy is approximately 0.5 % -10 % , with death occurring in 1 in 20,000 patients . primary bleeding refers to that occurring within the first 24 h postoperatively , and bleeding occurring 5 - 10 days after surgery has been classified as secondary or delayed bleeding . factors such as age , gender , and surgical technique have been evaluated as risk factors for posttonsillectomy bleeding . to date , no study has specifically compared the rate of bleeding after tonsillectomy and smuppp . we reviewed the medical records of all patients at our institution who underwent unipolar cautery tonsillectomy alone or in conjunction with smuppp during the last 10 years to compare the incidence of secondary , delayed postoperative hemorrhage between the two procedures .

background : the aim of this study was to compare the incidence of postoperative secondary hemorrhage for tonsillectomy and submucosal uvulopalatopharyngoplasty ( smuppp ) .materials and methods : in this retrospective case series , the medical records of 404 patients who underwent tonsillectomy with unipolar electrocautery and smuppp at our institution between january 2001 and december 2010 were reviewed . the patients were divided into two groups : group 1 ( 198 patients ) underwent tonsillectomy ; group 2 ( 206 patients ) underwent smuppp . main outcome measures were incidence of bleeding or complications after tonsillectomy and smuppp and the need for revision surgery.results : the mean age of group 1 patients was 38.1 ( 2.58 ) years and that of group 2 was 37.7 ( 2.25 ) years . males were 51.3 % of group 1 and 46.7 % of group 2 . no statistically significant difference in age or gender distribution was found between groups 1 and 2 . the incidence of secondary , delayed hemorrhage was 5.05 % ( 10 patients ) in group 1 and 1.45 % ( three patients ) in group 2 ( p = 0.05 ) . the incidence of delayed hemorrhage requiring surgical treatment was 4.54 % ( nine patients ) in group 1 and 0.97 % ( two patients ) in group 2.conclusion : in adults , smuppp , which includes tonsillectomy , has a lower incidence of postoperative delayed hemorrhage than does tonsillectomy with unipolar cautery .

acute pancreatitis ( ap ) is an acute inflammatory process of the pancreas with variable severity . it can be severe and associated with systemic or local complications , especially those with infected pancreatic or peripancreatic necrosis ( ipn ) . gastrointestinal ( gi ) fistula is one of the well - recognized complications secondary to severe ap . depending on the sites of fistula , it may involve the stomach , duodenum , jejunum , ileum , and colon , either in combination or separately . it may result from direct erosion from digestive enzymes released by the inflamed pancreas on adjacent gi tract , or it could occur as a consequence of the intestinal necrosis due to vascular thrombosis in an area of inflammation and infection . although previous studies suggest the fistula of gi tract occurs infrequently in ap patients , ipn and the operative managements for ipn would increase the frequency . it has been reported gi fistulas may cause serious clinical consequences such as hemorrhage and exacerbation of infection with fatal outcome . in this retrospective study we aimed to evaluate the incidence and clinical outcome of gi fistulas in the setting of ap with ipn

abstractgastrointestinal ( gi ) fistula is a well - recognized complication of acute pancreatitis ( ap ) . however , it has been reported in limited literature . this study aimed to evaluate the incidence and outcome of gi fistulas in ap patients complicated with infected pancreatic or peripancreatic necrosis ( ipn ) .between 2010 and 2013 ap patients with ipn who diagnosed with gi fistula in our center were analyzed in this retrospective study . and we also conducted a comparison between patients with and without gi fistula regarding the baseline characteristics and outcomes.over 4 years , a total of 928 ap patients were admitted into our center , of whom 119 patients with ipn were diagnosed with gi fistula and they developed 160 gi fistulas in total . colonic fistula found in 72 patients was the most common form of gi fistula followed with duodenal fistula . all duodenal fistulas were managed by nonsurgical management . ileostomy or colostomy was performed for 44 ( 61.1 % ) of 72 colonic fistulas . twenty - one ( 29.2 % ) colonic fistulas were successfully treated by percutaneous drainage or continuous negative pressure irrigation . mortality of patients with gi fistula did not differ significantly from those without gi fistula ( 28.6 % vs 21.9 % , p = 0.22 ) . however , a significantly higher mortality ( 34.7 % ) was observed in those with colonic fistula.gi fistula is a common finding in patients of ap with ipn . most of these fistulas can be successfully managed with different procedures depending on their sites of origin . colonic fistula is related with higher mortality than those without gi fistula .

all forms of mercury viz . , organic , elemental , and mercury salts are toxic and manifestations depend on nature , intensity and the chemical form of mercury . most human exposure results from fish consumption ( organic mercury ) or dental amalgam ( metallic mercury ) . kidneys are the prime target of mercury toxicity as it is primarily excreted through them . here , we describe a patient who consumed mercuric chloride with suicidal intent , and presented with typical manifestation such as acute kidney injury ( aki ) and gastrointestinal erosion . in addition , he had disseminated intravascular coagulation ( dic ) , a rare complication of mercury poisoning .

mercury is a toxic heavy metal and occurs in organic and inorganic forms . inorganic mercury includes elemental mercury and mercury salts . mercury salts are usually white powder or crystals , and widely used in indigenous medicines and folk remedies in asia . inorganic mercury poisoning causes acute kidney injury ( aki ) and gastrointestinal manifestations and can be life - threatening . we describe a case with unknown substance poisoning who developed aki and disseminated intravascular coagulation ( dic ) . renal biopsy showed acute tubular necrosis . later , the consumed substance was proven to be mercuric chloride . his renal failure improved over time , and his creatinine normalized after 2 months .

eosinophilic granuloma ( eg ) , a benign local bone disease , is classified as the mildest form of langerhans ' cell histiocytosis ( lch ) . eg predominantly affects children , adolescents , and young adults , and the skull is the most common site of involvement.5 ) the pathologic diagnosis of eg can be confirmed by positive stains of cd1a antigen and protein s-100 or when intracytoplasmic organelles ( birbeck granules ) are detected using electron microscopy.11 ) the most common symptom of eg is a tender , growing scalp mass , but it can be asymptomatic and incidentally found on skull x - rays . the clinical course is benign with a tendency to spontaneous regress ; however , eg may also recur . it is common to prove the antecedent of a mild head trauma preceding clinical symptoms .

the authors present a case of rapidly progressing eosinophilic granuloma ( eg ) of the skull without hemorrhage after minor trauma . a 6-year - old boy presented with a soft mass on the midline of his forehead . he had a surgery for eg 19 months ago . one month earlier , computed tomography ( ct ) and bone scans were performed to evaluate the possible recurrence of eg , and there was no evidence of recurrence in ct . however , a slightly increased uptake in the bone scan was noted on the midline of the forehead . a rapid growing mass developed in a new spot after a minor trauma 7 days before the patient arrived at the clinic . his physical examination was unremarkable , except for a non - tender , soft , and immobile mass . a plain skull x - ray and ct showed a lytic bony defect on the midline of the frontal bone . magnetic resonance imaging showed a 1.4 cm sized enhancing mass . surgical resection and cranioplasty were done . the role of trauma in the development of eg is unclear . however , our case suggests that minor trauma is an aggravating factor for eg formation . careful observation with regular follow - up is necessary in patients with eg after minor trauma .

animal models with a human hematopoietic and immune system are now important tools for studying the human immune system as well as human - specific infections , such as hiv-1 [ 1 , 2 ] . recent approaches have involved the use of genetically immunodeficient mice that have been reconstituted using human - derived hematopoietic stem cells ( hscs ) ( known as humanized mice ) . several immunodeficient mice have been developed and nod / scid mice with nk defective genetically modified mice are mainly used for this approach [ 35 ] , because they exhibit deficiencies in macrophage and dendritic cell function , and complement as well as t and b lymphocyte deficiencies . rag-2c mice are also commonly used for establishing humanized mice [ 7 , 8 ] , and it is known that the genetic background of rag-2c mice is influenced by the efficiency of human cell engraftment . jak3 is a non - receptor - type tyrosine kinase crucial for mediating signaling from the common -chain of cytokine receptors , and jak3-deficient mice and common -chain - deficient mice show the same phenotype . based on these findings , we generated rag-2jak3 mice with c57/bl6 and balb / c genetic backgrounds . balb / c rag-2jak3 mice showed high efficiency of both human cd34 hematopoietic stem cell ( hsc ) and peripheral blood mononuclear cell ( pbmc ) transplantation compared with c57/bl6 rag-2jak3 mice . our data show that the genetic background of the mice influences human cell engraftment and balb / c rag-2jak3 mice are becoming an alternative source of humanized mice .

immunodeficient mice are becoming invaluable tools in human stem cell and tumor research . in this study , we generated rag-2/jak3 double - deficient ( rag-2/jak3/ ) mice with a c57/bl6 and balb / c genetic background and compared the human lymphohematopoietic cell engraftment rate . human cord blood - derived cd34 + hematopoietic stem cells were successfully engrafted into balb / c rag-2/jak3/ mice ; however , the engraftment rate was far lower in c57/bl6 rag-2/jak3/ mice . transplantation of human peripheral blood mononuclear cells resulted in the same tendency . thus , a balb / c background offers superior engraftment capacity than a c57/bl6 background and provides an attractive model for human hematopoietic cell engraftment .

infected dental plaque biofilm and the impaired host response remain the main causes of a wide range of gingival diseases . the ability of the patient to adhere to a proper oral care plan is also a critical factor that controls the tissue reaction and disease progression . the clinical manifestations of gingival inflammation differ according to the severity , distribution , and the response to treatment ranging between being localized and highly responsive to treatment to long standing lesions with persistent redness and massive bleeding on probing with variable degrees of swelling . the efficacy of treatment and the subsequent tissue response vary according to the etiology and idiopathic , local , or systemic cause . under healthy conditions , the neutrophils pass from the gingival connective tissue through the junctional epithelium into the gingival sulcus , providing a dynamic balance between continuously invading microorganisms and the immune response . the antioxidants , either enzymatic or nonenzymatic , play a crucial role in the tissue equilibrium via neutralizing such harmful agents ( ros ) [ 5 , 6 ] . under certain inflammatory conditions , the total amount of antioxidants decreases to its lowest levels , which necessities their supplementation by external source [ 7 , 8 ] . one of the most important antioxidant agents is vitamin c ( vit - c ) which has an important role in different body functions [ 7 , 8 ] . despite its mild acidity ( ph 4.2 ) , it requires an alkaline medium to perform its function as a reducing agent . to be activated , many changes in its structure occur in three successive cycles of oxidation ( figure 1 ) . vitamin c , being a strong reducing agent , can regulate the resolution of the inflammatory process and stimulate the tissue repair . it modulates the release of catabolic inflammatory cytokines [ 1012 ] , chemotaxis of the immune cells , and activation of the phagocytosis . the neutrophils and lymphocytes containing vitamin c show lower apoptotic potentiality and higher proliferation rate . furthermore , it enhances the synthesis of collagen type i , reduced by inflammatory process , keeps the balance between collagen i and collagen iii , and modifies the rate of fibroblast proliferation . it also reduces the potentiality of scaring via inhibiting cross - linking of collagen fibers and fibrosis . it acts as a cofactor in hydroxyproline synthesis to produce collagen type iv and improves endothelial cell vitality and function [ 1013 ] . the aim of the present study is to investigate the exact role and efficiency of the locally injected vitamin c in the treatment of persistent gingival inflammation after single or multiple dosing based on clinical and histopathological examination .

objective . the purpose of this study is to investigate the role and efficiency of the locally injected vitamin c in the treatment of persistent gingival inflammation . design . twenty adult patients with persistent chronic gingival inflammation were included in this study . the same dose of sterile vitamin c was injected in gingival tissues after the completion of phase i therapy . gingival biopsies were taken after total resolution of inflammation . the specimens were examined histologically , using h & e stain . results . clinical evaluation revealed great improvement of the injected sites with recall visits . histopathological results revealed marked decrease in inflammatory cells and epithelial thickness and a higher number of newly formed subbasal capillaries . conclusions . vitamin c is an effective adjunctive treatment in reducing various degrees of chronic gingival inflammation .

teneligliptin is a novel dipeptidyl peptidase4 ( dpp4 ) inhibitor belonging to the relatively novel pharmacological class of antihyperglycaemic agents that are now recommended as second or firstline agents in specific situations 1 , 2 , 3 . in a phase ii clinical trial , a 4week course of teneligliptin ( 20 mg ) monotherapy produced significant least squares ( ls ) mean reductions of 2.78 0.43 , 1.93 0.51 , and 2.08 0.42 mmol / l in 2h postprandial glucose level after breakfast , lunch and dinner , respectively , in japanese patients with type 2 diabetes ( t2 dm ) 4 . we therefore conducted the present phase iii , randomized , doubleblind , placebocontrolled study to assess the clinical efficacy and safety of teneligliptin in korean patients with t2 dm that was inadequately controlled with diet and exercise .

we assessed the 24week efficacy and safety of teneligliptin , a novel dipeptidyl peptidase4 inhibitor , in korean patients with type 2 diabetes mellitus ( t2 dm ) that was inadequately controlled with diet and exercise . the present study was designed as a multicentre , randomized , doubleblind , placebocontrolled , parallelgroup , phase iii study . patients ( n = 142 ) were randomized 2 : 1 into two different treatment groups as follows : 99 received teneligliptin ( 20 mg ) and 43 received placebo . the primary endpoint was change in glycated haemoglobin ( hba1c ) level from baseline to week 24 . teneligliptin significantly reduced the hba1c level from baseline compared with placebo after 24 weeks . at week 24 , the differences between changes in hba1c and fasting plasma glucose ( fbg ) in the teneligliptin and placebo groups were 0.94 % [ leastsquares ( ls ) mean 1.22 , 0.65 ] and 1.21 mmol / l ( 1.72 , 0.70 ) , respectively ( all p < 0.001 ) . the incidence of hypoglycaemia and adverse events were not significantly different between the two groups . this phase iii , randomized , placebocontrolled study provides evidence of the safety and efficacy of 24 weeks of treatment with teneligliptin as a monotherapy in korean patients with t2 dm .

atrophic gastritis ( ag ) is a histopathologic entity characterized by chronic inflammation of the gastric mucosa with loss of gastric glandular cells and replacement by intestinal - type epithelium , pyloric - type glands , and fibrous tissue . atrophy of the gastric mucosa is the endpoint of chronic processes , such as chronic gastritis associated with helicobacter pylori ( h. pylori ) infection , other unidentified environmental factors , and autoimmunity directed against gastric glandular cells . pepsinogen ( pg ) is precursors of pepsin , and consists of two biochemically and immunologically distinct types , namely , pg i and pg ii . serum pg levels are related to gastritis , gastric mucosal lesion , with a particular relationship to ag . decreased serum pg i levels and the pg i / ii ratio can be used to assess gastric atrophy . miki et al . reported that the pg i / ii ratio of more than 3 has a sensitivity of 93.3 % and specificity of 87.7 % for the diagnosis of normal fundic gland mucosa . h. pylori infection is the most common cause of ag , and at least 50 % of the world s population is infected with h. pylori . h. pylori infection can lead to variety of upper gastrointestinal disorders , including peptic ulcer disease , gastric mucosa - associated lymphoid tissue lymphoma , and gastric cancer . in addition , h. pylori infection has been linked to several extra - gastric disorders , such as atherosclerosis and coronary artery disease ( cad ) . some studies have shown a positive association between h. pylori infection and cad , while others have shown no significant association . recently , two studies have suggested that ag irrespective of h. pylori status was associated with atherosclerosis in general population . to the best of our knowledge , however , no previous reports have investigated the effects of ag on the prevalence of cad in general population . therefore , we investigated the relationship between ag , which is diagnosed based on serum pg levels , and cad in general japanese individuals .

atrophic gastritis is characterized by chronic inflammation of gastric mucosa by helicobacter pylori infection and other factors . helicobacter pylori infection has been linked to coronary artery disease . to our knowledge , however , no reports are available on the relationship between atrophic gastritis and coronary artery disease . in this study , we investigated the relationship between atrophic gastritis , which is diagnosed based on serum pepsinogen levels ( pepsinogen i 70 ng / ml and pepsinogen i / ii ratio 3.0 ) , and the prevalence of coronary artery disease in general japanese population . among 2,633 study subjects , 531 subjects ( 20.2 % ) were diagnosed as atrophic gastritis . the prevalence of coronary artery disease was higher in the atrophic gastritis - positive group than that in the atrophic gastritis - negative group ( 5.8 % vs 2.8 % , p = 0.0005 ) . multiple logistic regression analysis demonstrated that atrophic gastritis was independently associated with coronary artery disease ( odds ratio , 1.67 ; 95 % confidence interval , 1.032.72 ) , after adjustment for age , sex , obesity , hypertension , diabetes mellitus , dyslipidemia , hyperuricemia , and habits of smoking and drinking . these results suggest that atrophic gastritis is an independent risk factor for coronary artery disease . chronic inflammation of gastric mucosa may be associated with the prevalence of coronary artery disease .

transthyretin familial amyloid polyneuropathy ( ttrfap ) is an autosomaldominant , adultonset disorder associated with over 100 different mutations in the transthyretin ( ttr ) gene that cause transthyretin protein to deposit as amyloid in peripheral and autonomic nerves , heart , gastrointestinal ( gi ) tract , kidneys , eyes , and connective tissue of the transversal carpal ligament ( ando et al . , 2013 ; rowczenio et al . , 2014 ; sekijima , 2015 ) . this results in progressive organ dysfunction and death within an average of 10 years ( ando et al . , 2013 ) . ttrfap is a highly heterogeneous disease associated with a wide range of clinical manifestations that may present in varying degrees and combinations ( ando et al . , 2013 ; sekijima , 2015 ) . the disease can be difficult to recognize due to its variable clinical presentation and nonspecific symptoms . the age of onset ranges from the second to ninth decade of life ( ando et al . , 2013 ) , and incomplete penetrance of clinical disease can lead to sporadic cases without known affected relatives . accurate diagnosis of ttrfap is often delayed for years ( plantbordeneuve et al . , 2007 ; koike et al . , 2011 ; an accurate diagnosis is important to permit effective disease management , as tissue damage is largely irreversible , and available treatment options are most beneficial in early disease stages ( coelho et al . , 2013 ; plantbordeneuve , 2014 ; ericzon et al . , 2015

abstracttransthyretin familial amyloid polyneuropathy ( ttrfap ) is a rare , progressive , lifethreatening , hereditary disorder caused by mutations in the transthyretin gene and characterized by extracellular deposition of transthyretinderived amyloid fibrils in peripheral and autonomic nerves , heart , and other organs . ttrfap is frequently diagnosed late because the disease is difficult to recognize due to phenotypic heterogeneity . based on published literature and expert opinion , symptom clusters suggesting ttrfap are reviewed , and practical guidance to facilitate earlier diagnosis is provided . ttrfap should be suspected if progressive peripheral sensorymotor neuropathy is observed in combination with one or more of the following : family history of a neuropathy , autonomic dysfunction , cardiac hypertrophy , gastrointestinal problems , inexplicable weight loss , carpal tunnel syndrome , renal impairment , or ocular involvement . if ttrfap is suspected , transthyretin genotyping , confirmation of amyloid in tissue biopsy , large and smallfiber assessment by nerve conduction studies and autonomic system evaluations , and cardiac testing should be performed .

a cataract increases lens opacity and reduces visual acuity ( va ) , thus impairing the patient 's quality of life . various techniques for cataract surgery have been developed since h. ridley introduced intraocular lenses ( iols ) composed of polymethylmethacrylate in 1949 . the stability of iols allows cataract surgery to be commonly performed worldwide , and technological advancements such as multifocal and toric iols have increased the procedure 's popularity [ 6 , 7 ] . to improve quality of life , cataract surgery postoperative va , contrast sensitivity , and optical aberrations were measured as objective indices of surgical success [ 1116 ] . after cataract surgery , improvement in va is typically tested with a high - contrast ( 100 % ) chart under photopic and mesopic conditions . for example , visual inspection of human faces of the utmost importance in daily life involves a target of large size and low contrast . the change in va after cataract surgery has not been studied under various levels of contrast . the aim of this study was to assess the visual performance of pseudophakic eyes after cataract surgery at different contrast levels by using the oqas ( optical quality analysis system , visiometrics , terrassa , spain ) .

purpose . to assess visual function using optical quality analysis system ( oqas ) at varying levels of contrast in pseudophakic eyes . methods . the study included patients admitted to seoul st . mary 's hospital between january and february 2012 : 143 pseudophakic eyes with one of five intraocular lens types , examined 26 months after cataract surgery , and 93 normal eyes ( enhanced visual acuity ( va ) < 0.1 logmar ) in age - matched controls . subjects were examined at three contrast levels using the oqas . results . at 100 % , 20 % , and 9 % contrast , simulated mean va was 0.16 0.18 logmar , 0.30 0.18 logmar , and 0.52 0.17 logmar , in normal eyes , and 0.16 0.12 logmar , 0.33 0.20 logmar , and 0.56 0.21 logmar , respectively , in pseudophakic eyes . simulated va decreased significantly when contrast was reduced , regardless of ocular status , age group , and lens type ( p < 0.05 ) . there were no significant differences between normal and pseudophakic eyes among subjects aged 5069 ( p > 0.05 ) . among subjects aged 7079 , pseudophakic eyes showed improved simulated va ( p = 0.000 ) and objective scattering index values ( p = 0.008 ) . conclusions . patients with intraocular lenses have similar or superior visual function when compared to those with normal eyes at 26 months after cataract surgery , even under low - contrast conditions .

the process involves the removal of pulp cavity content and the consequent reduction of microorganism counts , especially in non - vital teeth with periapical lesion . with proper instrumentation , the cavity is enlarged and smoothened to fittingly receive the filling . as tooth and canal anatomies are equally important during canal preparation , the appropriate use of the endodontic instruments and the close contact with canal walls for pulp extirpation and cleaning purposes is likewise crucial to the treatment . several techniques and instruments have been suggested to achieve the desired efficiency in root canal preparation2,6,11,15,19,23 . the concomitant use of chemicals that promote the removal of microorganisms is widely accepted . as regards the cleaning and disinfection of root canals , current literature sets forward conflicting results for manual , mechanical and ultrasonic instrumentation techniques1,3,810,12,13,16,23 . therefore , considering that in the treatment of non - vital teeth with chronic periapical reaction the presence of bacteria inside the root canal system accounts for the development and persistence of periapical lesions , this study was designed to investigate quantitatively the in vitro ability to remove dye adhered to proximally flattened root canals . three techniques were investigated : crown - down technique with rotary instrumentation using nickel - titanium files ( k3 and protaper systems ) ; ultrasonic crown - down technique ; and progressive manual technique without apical pressure - modified oregon technique .

objective : the efficiency of rotary , manual and ultrasonic root canal instrumentation techniques was investigated in proximally flattened root canals.material and methods : forty human mandibular left and right central incisors , lateral incisors and premolars were used . the pulp tissue was removed and the root canals were filled with red die . teeth were instrumented using three techniques : ( i ) k3 and protaper rotary systems ; ( ii ) ultrasonic crown - down technique ; and ( iii ) progressive manual technique . roots were bisected longitudinally in a buccolingual direction . the instrumented canal walls were digitally captured and the images obtained were analyzed using the sigma scan software . canal walls were evaluated for total canal wall area versus noninstrumented area on which dye remained.results : no statistically significant difference was found between the instrumentation techniques studied ( p < 0.05 ) .conclusion : the findings of this study showed that no instrumentation technique was 100 % efficient to remove the dye .

coal - tar pitch is an important feedstock of carbochemical origin used for the production of i.a . carbon anodes , graphite electrodes , fireproof materials , carbon - carbon composites and carbon fibres , as coking additive and as binder in many insulating and sealing materials used in construction and road building [ 1 , 2 ] . bitumens originating from coal , similarly as petroleum asphalts can be treated as colloidal - dispersive systems . micelles composed of 2 components and partly of 1 components form dispersed phase while oils ( components ) and partly components are the dispersing phase . because of the presence of carcinogenic aromatic hydrocarbons in coal - tar pitch , there is a need for its modification to obtain material safe for natural environment . research on the preparation of modified bituminous substances originating from coal , carried out for many years in the institute of chemistry of warsaw university of technology in plock has led to the elaboration of method reducing the level of carcinogenicity of coal - tar pitch . modification of coal - tar pitch with polymers influences also significantly its group composition and properties . the direction and scale of changes depend on chemical structure of the modifier and its amount . chemical structure is a factor directly determining properties of each of the components of bitumen - polymer compositions and simultaneously has an impact on the possibility to form a specific structure of a given composition , on which in turn its properties depend [ 59 ] . because of profitable properties of pitch - polymer mixtures , it would be advisable to check the possibilities to use waste polymers for the modification of the pitch . it leads to the search for new techniques and methods of evaluation of their homogenicity and application properties . one of them are microscopic studies , which play significant role in the determination of the structure and colloidal stability of bitumens and bitumen - polymer systems , including pitch - polymer compositions . in the studies of bitumen - polymer systems , fluorescence microscope is used , particularly for the evaluation of polymer - asphalt materials [ 1113 ] . however , there is no significant development in the evaluation of pitch - polymer compositions with the use of such microscope . the aim of this work was to determine the utility of fluorescence microscope for the evaluation of the structure of coal - tar pitch compositions with selected waste polymers and to study their influence on pitch properties .

in this work , the results of studies on the evaluation of colloidal structure of coal - tar pitch compositions with selected waste polymers by fluorescence microscope . for pitch - polymer compositions containing 1050 wt % waste polymer , softening point , coking value and content of components insoluble in toluene and quinoline were carried out . the results indicate that pitch - polymer compositions can be treated as microheterogeneous systems , colloidal and biphase , generally exhibiting uniform dispersion of particles composed of polymer macromolecules and probably of components of coal - tar pitch .

current techniques in acl surgery have been associated with satisfactory long - term results in the majority of patients . however , there remains a considerable subset , up to 30 % of patients , with unsatisfactory outcomes [ 2 , 7 ] . specifically , patients report problems relating to rotational instability and return to previous level of activity [ 3 , 10 ] . it has been suggested that a more anatomical approach to restore the original acl anatomy may benefit these patients [ 4 , 17 ] . some authors have advocated placing a single graft in a position closer to the oblique femoral attachment of the acl [ 14 , 15 ] . however , it is not possible to fully restore normal knee kinematics with a single graft , regardless of the position [ 13 , 16 ] . the double bundle reconstruction technique ( dbt ) for acl reconstruction aims at restoring the acl anatomy with its two bundles and is gaining popularity [ 11 , 17 ] . anatomic studies have demonstrated the presence of two functional bundles within the acl , the anteromedial ( am ) and the posterolateral ( pl ) bundle [ 1 , 8 ] . although it is somewhat of a simplification , the double bundle description of the acl is generally accepted as an anatomic model for understanding the complex structure and function of the ligament [ 6 , 9 ] . the am bundle often obscures the pl bundle , and it may appear that only one bundle is present without careful inspection . the goal of this study was to describe the presence of the double bundle structure from an arthroscopic point of view , and to evaluate the value of different portals in knee arthroscopy .

in order to describe the arthroscopic presence of the double bundle structure and to evaluate the value of different portals in knee arthroscopy , we assessed the am and pl bundle anatomy . we prospectively examined the knees of 60 patients undergoing arthroscopic surgery for pathology unrelated to the acl . arthroscopy was performed in a two portal technique using an anterolateral ( alp ) and an anteromedial ( amp ) portal . with the arthroscope in the alp , we could distinguish an am and pl bundle in 28 % . switching the arthroscope to the amp , differentiation of the bundles was possible in 67 % . in all remaining cases visualization of the pl bundle was possible after retraction of the am bundle . use of amp increased visualization of the pl bundle . it seems reasonable to perform arthroscopy for acl reconstruction with the arthroscope in the amp and to establish an additional medial working portal to increase the visualization of the femoral acl insertion sites for optimal femoral tunnel placement .

many stroke patients with stroke have a balance problems while standing because they tend to put their weight on their non - paralyzed lower limb to increase swing of their upper body1 . falling accidents due to such decline in balance ability is on the increase annually . even when there is no injury from falling , frequent falling can sufficiently disrupt physical and social activities2 . because deterioration of muscular strength and balance ability increases the risk of falling , it is significantly important to perform exercises to promote upper limb muscular strength and training for balance3 . regular exercise of walking and for muscular strength and balance may increase muscular strength and balance to prevent falling of patients4 . walking , in particular , is known to be a safe type of aerobic exercise for patients , having the merit that it can be performed gradually by considering appropriate intensity , frequency , period , and phases of exercise for abilities of each patient5 . recently efficiency of walking training using a treadmill has attracted more attention as when such training has been reported to have better effects than walking on even ground . some researchers reported that walking on a treadmill is effective in improving balance and walking ability6 , 7 . with recent developments of relevant computer programs , new methods of rehabilitation exercise such exercises can increase interest and participation of patients in treatment and improve their significant functions by enabling them to perform various forms of tasks appropriate for goals of individual patients in virtual reality . virtual reality indicates a type of interactive simulation using computer hardware and software , in which users can have close - to - reality experiences8 . virtual reality training using visual feedback enables the participants to undergo the training while seeing their movements with their own eyes , a feature that helps them adjust their inaccurate body center caused by body image damage suffered by most stroke patients . in addition , training serves as a catalyst in active participation and performance of tasks by inducing interest and pleasure , providing immediately visual feedback on the result to enhance motor education ability9 . many recent researches of virtual reality games with higher accessibility reported that such games showed significant effects on voluntary control and coordination of children with cerebral palsy and increases in the motor ability of patients with parkinson disease10 . those types of games were also effective on recovery of upper limb functions and induced significant improvement in balance and walking of stroke patients , showing that the games can be used as an effective method of intervention11 , 12 . as a means of overcoming limitations of the existing intervention methods , virtual reality shows an availability it has to being applied in the rehabilitation of stroke patients . however , devices of virtual reality in previous studies are so large that they are difficult to be used in general social institutes or homes in terms of scale and cost . furthermore , they are targeted to a small number of patients . in this context , the purpose of this study was to perform treadmill exercise and virtual reality training exercise using nintendo wii , a device that can be easily used without regard to place or facility , in order to investigate the effects on balance and walking of stroke patients .

[ purpose ] the purpose of this study is to investigate the effects of virtual reality training using nintendo wii on balance and walking for stroke patients . [ subjects and methods ] forty stroke patients with stroke were randomly divided into two exercise program groups : virtual reality training ( n=20 ) and treadmill ( n=20 ) . the subjects underwent their 40-minute exercise program three times a week for eight weeks . their balance and walking were measured before and after the complete program . we measured the left / right weight - bearing and the anterior / posterior weight - bearing for balance , as well as stance phase , swing phase , and cadence for walking . [ results ] for balance , both groups showed significant differences in the left / right and anterior / posterior weight - bearing , with significant post - program differences between the groups . for walking , there were significant differences in the stance phase , swing phase , and cadence of the virtual reality training group . [ conclusion ] the results of this study suggest that virtual reality training providing visual feedback may enable stroke patients to directly adjust their incorrect weight center and shift visually . virtual reality training may be appropriate for patients who need improved balance and walking ability by inducing their interest for them to perform planned exercises on a consistent basis .

endovascular aortic aneurysm repair ( evar ) has developed into a feasible and successful alternative to open surgery for the treatment of abdominal aortic aneurysms . evar can be offered to many patients with a suitable anatomy of the aorta and iliac arteries , regardless of comorbid conditions [ 13 ] . despite the known excellent early results of evar in terms of the reduction in perioperative mortality , rate of complications and length of hospitalization , many patients require re - intervention during the middle and long - term follow - up because of procedure - related complications . for this reason , surveillance of these patients is crucial to determine the long - term performance of these devices [ 4 , 5 ] . because of the rapid diffusion of evar and the increased number of patients who undergo multidetector ct ( mdct ) follow - up , the radiologist should be familiar with the full spectrum of possible procedure - related complications in order to allow their early diagnosis and treatment . the purpose of this article is to present a spectrum of post - evar complications as seen with mdct .

backgroundmultidetector computed tomography ( mdct ) angiography represents the standard of reference in the follow - up of patients after endovascular abdominal aortic aneurysm repair ( evar ) , being effective in the detection of the full spectrum of possible complications on both axial and 3d images.methodsthe purpose of this article is to review the normal ct angiography findings of the different types of stent - grafts and to describe the radiological findings of early and late complications after evar on axial and reconstructed images . a selection of cases of post - evar mdct angiography is presented to learn the techniques most commonly used for endovascular treatment , the correct ct scanning technique to acquire the data , the full gamut of possible procedure - related complications and how these complications usually appear on ct images.conclusionmdct angiography is an effective and specific technique in both the pre- and postoperative settings of evar procedures . a better understanding of the procedure , the devices , the normal postoperative imaging features and the possible procedure - related complications ensures optimal planning and follow - up of patients undergoing an evar procedure .

women have relatively weak neck muscles , which can be a primary cause of chronic fatigue syndrome related to the muscular system , resulting in higher risk of chronic neck pain1 . in relation to pain a study by fisher found that 62 % of women wear heels that are over 5 cm , and the ones who enjoy wearing high heels are reported to suffer from foot , knee , and back pain , as well as an alteration of the normal gait patterns2 . according to previous studies , wearing high - heeled footwear can alter the static posture and dynamic movements of the body , and is regarded as a cause of musculoskeletal problems related to the spine3,4,5 . walking in high - heeled shoes changes the kinetic characteristics of the lower extremity joints , causing a reduction in ankle plantar flexor muscle moment , and power during stance phase and increases in forefoot peak pressure . walking in high heels produces an upward displacement of the center of mass of the body and possibly a more unstable posture compared to that producted by low - heeled walking6,7,8,9 . additionally , shock and ground reaction forces can lead to increased axial pressure onto the intervertebral discs , resulting in increased erector spinal muscle activation10 . walking in high - heeled shoes produce an increase in the ground reaction force compared to flat heeled shoes . in theory , the increase in ground reaction force with increased height may result from decreased subtalar joint pronation at heel strike and a lengthened tibiofemoral lever arm . as a result , trunk muscle activity increases with increasing heel height , which changes the posture and ground reaction force , leading to discomfort of the back muscle in women who wear high heels11 . in addition , the effects are magnified with increased activation of the erector spinae muscles , which contribute to compression of the spine . therefore , wearing high heels for an extended period can lead to an increase in paraspinal musculature activation of the lumbar and cervical spine , causing prolonged overload and fatigue in the trunk and neck muscles1 . a recent study reported that walking in heels induced a significant increase in the activation of cervical muscles in healthy subjects . this study was conducted in order to examine the effects of wearing high heels during gait on the cervical and lumbar musculature in patients with chronic neck pain and in healthy women .

[ purpose ] the purpose of this study was to investigate the effects of different height of high heels on muscle activation of the paraspinalis cervicis and erector spinae in healthy young women . [ subjects and methods ] thirteen healthy women were recruited in this study . to examine the effects of different heights of heels on muscle activation , the paraspinalis cervicis ( cervical spine ) and erector spinae ( lumbar spine ) were measured at the time of heel strike and toe off during gait on three different conditions ( barefoot , 4 cm high heels , and 10 cm high heels ) . there are no previous trials or reports that have evaluated this approach in patients with chronic neck pain . [ results ] a significant increase in muscle activation of the paraspinalis cervicis and erector spinae at heel strike and toe off ( except that of the paraspinalis cervicis at toe off in healthy subjects ) was observed in the under 10 cm high heel condition as , compared to that with barefoot condition , in all the subjects . [ conclusion ] the height of the high heels affects to the activation demand of the paraspinalis cervicis and erector spinae in patients with neck pain .

multiple sclerosis ( ms ) is a chronic , autoimmune , demyelinating disease of the central nervous system ( cns ) . presenting symptoms can vary greatly , but most commonly involve weakness , paresthesia , gait difficulty , or visual deficits . virtually any area of the cns white matter can be involved , though this most classically involves the periventricular white matter . brain stem involvement is common , though isolated cranial nerve palsies are rare signs in ms . previous studies have suggested that isolated cranial nerve palsies in ms are more commonly found as presenting symptoms than as relapsing symptoms . among isolated cranial nerve palsies in ms , the fifth nerve is most commonly involved ( 4.8 % ) , followed by the seventh nerve ( 3.7 % ) , and the sixth nerve ( 1.0 % ) . thus , abducens palsy is a rare isolated ms finding , either as a presenting sign or during disease exacerbation . patients with abducens palsy typically present with diplopia upon horizontal gaze , and examination can reveal a slow ipsilateral lateral rectus movement [ 4 , 5 ] . ms has been implicated as the cause of unilateral abducens palsy in 49 % of cases , though mri may not detect brain stem lesions in all cases . one 2002 study investigating nontraumatic causes of sixth nerve palsies in patients 2050 years of age found ms to be the cause in 24 % of cases . in addition to ms , the differential diagnosis for an abducens nerve palsy includes mass lesions , lyme disease , viral infection , syphilis , sarcoidosis , and vascular disease . here , we report a patient who presented with a unilateral isolated abducens palsy as the initial sign of ms .

while brain stem involvement in multiple sclerosis ( ms ) is relatively common , isolated cranial nerve palsies are rare , especially when they represent the initial presenting sign of a new diagnosis of ms . this report describes a patient with no prior history of ms whose sole presenting sign was an isolated abducens palsy . an enhancing pontine lesion was found on mri which correlated with his abducens palsy , and additional nonactive lesions on mri led to a diagnosis of ms . this case demonstrates the importance of considering ms as part of the differential diagnosis of patients with isolated cranial nerve palsies .

according to the world health organization ( who ) , a maternal death is defined as death of a woman while pregnant or within 42 days of termination of pregnancy , irrespective of the duration and site of pregnancy , from any cause related to or aggravated by pregnancy or its management ( icd-10 ) . about 99 % of these women are from developing world with over 90 % concentrated in africa and asia . the risk of a woman dying as a result of pregnancy and childbirth during her lifetime is about 1 in 6 in afghanistan compared with 1 in 30,000 in northern europe . united nation ( un ) report card on millennium development goal-5 concluded that little progress had been made in sub - saharan africa where half of all maternal deaths take place . the progress shown by the south asian countries including india which accounts for 25 % of all maternal deaths is also not impressive . most of the evidence for maternal mortality is obtained through hospital data and community based reports , which are situated mostly in urban areas , whereas most of the maternal deaths are from rural areas . this study was done to assess maternal mortality in a tertiary medical college hospital situated in semi urban part of western maharashtra where large numbers of patients are referred from rural parts of western maharashtra and north karnataka . this study was done to assess the local causes of maternal mortality and suggest remedial measures to reduce the same . to calculate the maternal mortality rate in our hospital.to assess the epidemiological aspects of maternal mortality.to assess the causes of maternal mortality.to suggest ways to reduce the mmr . to calculate the maternal mortality rate in our hospital . to assess the epidemiological aspects of maternal mortality . to assess the causes of maternal mortality . to suggest ways to reduce the mmr .

background : epidemiological data pertaining to maternal mortality is valuable in each set up to design interventional programs to favourably reduce the ratio . this study was done to evaluate the maternal mortality rate in our hospital , to assess the epidemiological aspects and causes of maternal mortality , and to suggest recommendations for improvement.methods : this was a 10 year retrospective study . epidemiological data was collected from the hospital register and maternal mortality ratio , epidemiological factors and causes affecting maternal mortality were assessed.results : a total of 120 maternal deaths occurred . most maternal deaths occurred in the age group of 2024 years , multiparous women ( 56.66 % ) , women from rural areas ( 69.16 % ) , illiterate women ( 65 % ) , unbooked patients ( 83.33 % ) , and patients of low socioeconomic status ( 83.33 % ) . direct causes accounted for 72.5 % of maternal deaths where as 27.5 % of maternal deaths were due to indirect causes.conclusion : there is a wide scope for improvement as a large proportion of the observed deaths are preventable .

non - hodgkin lymphomas ( nhls ) account for approximately 60 % of all lymphomas in children and adolescents . childhood nhls are subdivided into burkitt 's lymphoma , diffuse large b - cell lymphoma ( dlbcl ) , lymphoblastic lymphoma , and anaplastic large - cell lymphoma . dlbcl is characterized by relatively more frequent extranodal presentation , seen in upto 40 % of the cases . primary involvement of the lymphoma of the middle ear is rare , with only about 18 cases being reported in literature so far . here , we report a case of dlbcl , presented with features of facial palsy and otitis , who received initial symptomatic treatment and later chemotherapy after diagnosing dlbcl .

extra nodal presentation of non hodgkins lymphoma ( nhl ) is a rare entity , and data available about the nhl that primarily involves of middle ear and mastoid is limited . we report a case of diffuse large b cell lymphoma ( dlbcl ) , in a 2 year 8 month old boy , who developed otalgia and facial palsy . computed tomography revealed a mass in the left mastoid . mastoid exploration and histopathological examination revealed dlbcl . this case highlights the importance of considering malignant lymphoma as one of the differential diagnosis in persistent otitis media and / facial palsy .

diabetic retinopathy is the name given to the changes in the retina , which develop over a period of time in diabetics . it remains one of the major causes of new - onset visual loss in developed countries . if the central part of the retina ( i.e . , the macula ) is involved , it is referred to as diabetic maculopathy . the traditional approach to diagnosis of diabetic maculopathy includes fundus ophthalmoscopy and fluorescein angiography ( fa ) . the early treatment diabetic retinopathy study ( etdrs ) identified stereoscopic slit - lamp biomicroscopy and stereo colour fundus photography as standard methods of macular thickness assessment utilized in order to determine whether the treatment should be commenced as they defined the clinically significant macular oedema ( etdrs report number 10 , 1991 ) . however , these methods are subjective and relatively insensitive to small changes in retinal thickness and , therefore , may be unable to identify mild or localized macular thickening . they also do not provide any data on retinal morphology and blood flow . on the other hand , fa is a highly effective test of evaluating retinal blood vessels , macular perfusion , and pattern of leakage causing the oedema . although very useful clinically , it also does not contribute much to the evaluation of retinal morphology and its thickness profile . in 1991 the researchers from massachusetts institute of technology and harvard university patented the technique of optical coherence tomography ( oct ) , which was a major breakthrough in ophthalmic diagnostics ( us5321501 a , swanson ea , huang d , fujimoto jg , puliafito ca , lin cp , schuman js . method and apparatus for optical imaging with means for controlling the longitudinal range of the sample ) . the first paper to present the potential of the new diagnostic method four years later the first paper was published which described the use of oct in diagnosis of macular diseases . the purpose of this paper is to provide an overview of clinical utility of oct in retinal assessment of diabetic patients .

diabetic maculopathy ( dm ) is one of the major causes of vision impairment in individuals with diabetes . the traditional approach to diagnosis of dm includes fundus ophthalmoscopy and fluorescein angiography . although very useful clinically , these methods do not contribute much to the evaluation of retinal morphology and its thickness profile . that is why a new technique called optical coherence tomography ( oct ) was utilized to perform cross - sectional imaging of the retina . it facilitates measuring the macular thickening , quantification of diabetic macular oedema , and detecting vitreoretinal traction . thus , oct may assist in patient selection with dm who can benefit from treatment , identify what treatment is indicated , guide its implementing , and allow precise monitoring of treatment response . it seems to be the technique of choice for the early detection of macular oedema and for the followup of dm .

to our knowledge the most recent article on celiac dissection was published in 2015 and reported 24 known cases of spontaneous isolated celiac trunk dissection . in our literature review we did not identify a single case of isolated celiac artery dissection that presented during a hypertensive emergency . we present a case of hypertensive emergency induced spontaneous isolated celiac trunk dissection , which was managed nonoperatively with a labetalol drip . the definition of an arterial dissection is the cleavage of the arterial wall by an intramural hematoma located between two elastic layers , . as we are reporting the 25th known case of celiac artery dissection many of the other reported cases involve other arteries such as the common hepatic , splenic , superior mesenteric , and gastroduodenal , , , , , , . additionally , while some of those cases reported hypertension as a risk factor , no other case presents as hypertensive emergency with an isolated celiac artery dissection . the first case of visceral artery dissection involved the superior mesenteric artery ( sma ) and was reported in 1947 , while the first celiac artery dissection was not reported until 1959 . when they occur in the visceral arteries , the most common location is within the sma , . celiac artery dissection has been described in blunt abdominal trauma , but it only accounts for 12 percent of all visceral vascular lesions .

highlightsto the best of our knowledge , we present the 25th case of isolated celiac artery dissection.this is the first case of hypertensive emergency induced spontaneous isolated celiac trunk dissection in literature.visceral artery dissection is a rare commodity , and celiac artery dissection is less common than dissection in the sma.it is a difficult diagnosis to make on history and physical alone , necessitating contrast enhanced ct imaging.our patient was managed nonoperatively with a labetalol drip and did well .

primary cysts have a lined epithelium and secondary cyst could be secondary to trauma . epidermoid splenic cysts are example of primary congenital cysts that contain an epithelial lining , unlike secondary cysts , which are composed of fibrous tissues , when the cyst is large they have nonspecific abdominal symptoms like pain , nausea , or a palpable mass usually in the left upper quadrant . epidermoid cysts and parasitic cysts are examples of primary cysts and usually have a classic presentation on imaging . despite imaging modalities and the patient s history , it can be difficult to diagnose an epidermoid cyst without a histological examination . the purpose of this paper is to discuss variable and atypical radiological presentation of primary splenic cysts including epidermoid cysts .

highlightssplenic tumors are not common , many can have minimal to no symptoms , and they can be found incidentally.splenic tumors can be primary or metastatic . they can be benign or malignant.splenic cysts can be infectious , traumatic or congenital.epidermoid splenic cysts may not always present in a classic fashion on imaging , making diagnosis challenging.many splenic masses and complex cysts would require surgical pathological diagnosis .

fungal infections are well - recognized life threatening problems in solid organ transplant ( sot ) , namely in liver transplant recipients . host and environmental factors are critical and important determinants regarding the epidemiology of fungal infections in transplantation . the incidence and aetiology of fungal infections differ dramatically between hematopoietic stem cell transplantation and sot . in the last group , those receiving lung grafts have the highest incidence ( 7.9 % ) followed by heart ( 3.4 % ) , liver ( 3.1 % ) , kidney ( 1.1 % ) , and pancreas ( 0.7 % ) . in liver transplanted patients , the incidence of invasive fungal infections ranges from 4 to 50 % and candida spp . and aspergillus spp fungal cutaneous and subcutaneous infections are frequently associated with people with professional activities related to agriculture or forestry work and the entry of the fungus is facilitated by penetrating injuries caused by thorns , splinters , nails , etc . the limbs are the most affected , but other body parts can also be involved . alternaria general characteristics include the production of dark - coloured phaeodictyospores in chains , and a beak of tapering apical cells [ 6 , 7 ] . some species are recognized to cause cutaneous phaeohyphomycoses and are described as emerging pathogens in immunocompromised patients , being transplantation the most common risk factor and also associated to the use of prednisone .

fungal invasive infections are rare in general population but are an emergent cause of infection in the immunocompromized population , especially in the solid organ transplant recipients . herein the authors report a clinical case of a liver transplanted patient suffering a cutaneous co - existent infection with a. alternata as well as a. infectoria.to our knowledge this is the first case of cutaneous concomitant infection due to those two species reported not only in portugal but also worldwide . the patient was treated with surgical excision of the lesions and oral itraconazol without relapse .

prospective studies have shown the superiority of laparoscopic appendectomy in the treatment of acute appendicitis . however , this technique has not yet gained widespread acceptance because of its longer operative time and lower cost effectiveness when compared with the open approach . moreover , although recent retrospective studies have shown that laparoscopic appendectomy is associated with a significantly shorter hospital stay , other reports demonstrate no significant difference in hospital stay when the laparoscopic and the open approach were compared . the minilaparoscopic approach is associated with less abdominal wall trauma , a lower infection rate at the trocar site and abdominal wall hernia , and produces excellent cosmetic results . in this study , our goal was to confirm the safety and show the feasibility of the minilaparoscopic approach for the treatment of acute appendicitis .

background : minilaparoscopic appendectomy for appendicitis is not a well - established procedure . this approach provides less abdominal wall trauma , fewer complications , and excellent cosmetic results . our aim was to show the feasibility and safety of the minilaparoscopic approach.methods : minilaparoscopic appendectomy was performed in 37 patients . two 2.2-mm trocars were used to manipulate a 2.2-mm , 0-degree laparoscope and for grasper access . a 5-mm trocar was used for the ultrasonic scalpel.results : no deaths occurred . in 3 patients ( 8 % ) , appendectomy was aborted due to pathology of the ovary . conversion to the open approach occurred in 2.7 % of patients . the average operating time was 34 minutes ( range , 15 to 80 ) , and the median length of hospital stay was 1.2 day ( range , 1 to 5 ) .conclusions : the minilaparoscopic approach a ) has the same advantages as the conventional laparoscopic approach in terms of better diagnostic accuracy and safety ; b ) a low incidence of complications ; and c ) yields excellent cosmetic results .

mental health problems , such as depression and anxiety disorders , are often underrecognized and untreated . . showed that the prospect of being treated increases with the severity of the illness , but also that half of those affected by a serious mental illness remained untreated . it is easy to understand that a serious condition needs treatment to avoid complications such as suicide , need of inpatient care , and disability . however , studies have shown that the risk of such complications did not differ significantly between mild forms of mental illness compared to moderate forms . in several studies , around half of those affected by psychological distress or psychiatric diagnoses however , even if they seek , the detection rate of psychiatric symptoms is low . a recent meta - analysis of studies regarding general practitioners ability to recognize mild depression showed a detection sensitivity of 56.5 % . this emphasizes the importance of further increasing the awareness of mild cases of mental illness . in primary care , a vast majority of patients affected by depression and anxiety present with somatic symptoms [ 11 , 12 ] . somatic complaints include changes in appetite and libido , lack of energy , sleep disturbances , dizziness , palpitations , dyspnoea , and general aches , and pains such as headache , back and other musculoskeletal pain , and gastrointestinal disturbances . identifying persons affected by mental illness , but seeking care for somatic symptoms , is a major difficulty especially in the primary care setting , due to both patient - related issues as well as physician - related issues . it is of importance that somatic symptoms associated with mental health disorders are not confused with somatoform disorders ( i.e . , conversion , somatization , hypochondriasis , and somatization disorder ) . the knowledge of factors influencing care seeking in persons affected by depressive and anxiety disorders in the population is limited . hence , it is important to elucidate factors associated with care seeking in these groups , over all , and factors associated with not seeking care for psychological symptoms .

background . in primary care , a vast majority of patients affected with depression and anxiety present with somatic symptoms . detection rate of psychiatric symptoms is low , and knowledge of factors influencing care seeking in persons affected by depressive and anxiety disorders on a population level is limited . objective . this study aims to describe if persons , affected by depression and anxiety disorders , seek care and which type of care they seek as well as factors associated with care seeking . method . data derives from a longitudinal population - based study of mental health conducted in the stockholm county in 19982010 and the present study includes 8387 subjects . definitions of anxiety and depressive disorders were made according to dsm - iv criteria , including research criteria , using validated diagnostic scales . 2026 persons ( 24 % ) fulfilled the criteria for any depressive or anxiety disorder . results . forty - seven percent of those affected by depression and/or anxiety had been seeking care for psychological symptoms within the last year . a major finding was that seeking care for psychological symptoms was associated with having treatment for somatic problems . conclusions . as a general practitioner , it is of great importance to increase awareness of mild mental illness , especially among groups that might be less expected to be affected .

characterization of the bioactive constituents from the black pigmented ink has resulted in a handful of chemical elucidations . the ink from the molluscs has created a great interest towards its bioactive molecules with promising antibacterial , antitumour , antileukemic , and antiviral activities . the ink is ejected from the ink gland of the squid loligo duvauceli through the ink duct to escape from its predators . the black pigment was found to be melanin and the process of melanogenesis was explained in the ink gland of sepia sp . . the ink is a complex mixture of organelles , premelanosomes , melanosomes , granules , proteic material ( enzymes ) , glucosamine , and phospholipids in suspension . at the moment of extraction the ink gland has been also shown to contain a variety of melanogenic enzymes as tyrosinase , dopachrome tautomerase , and peroxidase . the ink has also various primary roles in the world of alternative medicine and has the widest range of therapeutic application . despite these reports there is no considerable interest shown towards the purification procedures of the l. duvauceli 's ink . potential chemical cues in squid ink have been identified and quantified using reverse - phase , high - performance , liquid chromatography ( rp - hplc ) . so this study is aimed at exploring the active bioconstituents of the ink by silica gel column chromatography and the gas chromatography - mass spectroscopic analysis ( gc - ms ) for its antimicrobial constituents .

chromatographic characterization and the gc - ms evaluation of the black pigmented ink of loligo duvauceli in the present study have yielded an array of bioactive compounds with potent antimicrobial property . facing an alarm of antimicrobial resistance globally , a need for elucidating antimicrobial agents from natural sources will be the need for the hour . in this view , this study is aimed at characterizing the black pigmented ink of the indian squid l. duvauceli . the squid ink was subjected to crude solvent extraction and was fractionated by silica gel column chromatography . tlc and hptlc profiles were recorded . antimicrobial bioassay of the squid ink fractions was done by agar well diffusion method . the antimicrobial fraction was then characterized using gc - ms analysis . the results showed that the n - hexane extract upon column fractionation yielded a total of 8 fractions with the mobile phase of hex / etoac in different gradients . tlc and hptlc profiles showed a single spot with a retention factor of 0.76 . fraction 1 showed significant antibacterial activity against escherichia coli , klebsiella pneumoniae , staphylococcus aureus , and lactobacillus acidophilus and a promising antifungal activity against candida albicans . the antimicrobial fraction upon gc - ms analysis of bis ( 2-ethylhexyl ) phthalate ( behp ) possesses the highest percentage of area normalisation ( 91 % ) with other few minor constituents . the study is concluded by stating that the antimicrobial efficacy of the squid ink might be due to the synergistic effects of the phthalate derivative and the other minor volatile compounds analysed in the squid ink .

abnormal knee kinematics are considered to be an important factor influencing the long - term outcomes after cruciate ligament injuries1,2,3 . in order to improve long - term outcomes of treatments for the patients with cruciate ligament injuries , therefore , it is important to precisely evaluate the kinematics of knees with cruciate ligament injuries . the motion of a knee joint with ligament injury is commonly evaluated by static methods such as the lachman test , posterior drawer test , valgus stress test , and arthrometric measurements , e.g . kt-1000 . however , patients with knee ligament deficiencies usually complain about their symptoms under dynamic conditions . therefore , there is a possibility that the instability of the knee joint evaluated in static conditions does not reflect the functional disabilities of its ligament injury1 , 3,4,5 . three - dimensional motion analysis using optical skin marker systems has been widely used as an evaluation method of body kinematics in dynamic conditions with muscular activations . this approach provides six - degrees - of - freedom motion of the kinematics of the knee during activities of daily living without restricted conditions in vivo . andriacchi et al . developed a point cluster technique ( pct ) , which employs an overabundance of markers ( a cluster ) placed on each segment to minimize the effects of skin movement artifacts6 . the pct can be extended to minimize skin movement artifact by optimal weighting of the markers according to their degree of deformation . the criteria of the normal range of three - dimensional knee kinematics during walking remain uncertain . side - to - side difference in the range of knee motion is widely used as a criterion of the normal range of knee motion1 . to detect an abnormal knee motion during walking , it is useful to determine the normal range of the side - to - side difference in knee kinematics during walking based on the data using the pct . to the best of our knowledge , however , no study has examined this ; therefore , the purpose of the present study was to determine the normal range of the side - to - side difference in knee kinematics using pct during walking based on three dimensional kinematics of the knee of healthy subjects .

[ purpose ] the purpose of this study was to determine the normal range of the side - to - side difference in three dimensional knee kinematics measured by the point cluster technique ( pct ) . [ subjects ] the subjects were twenty - one healthy normal volunteers without knee pain or an episode of injury to the legs . [ methods ] the subjects were tested bilaterally at a self - selected normal walking speed and six degrees of freedom knee kinematics were measured using the pct , and the 95 % confidence intervals of the average side - to - side differences in flexion - extension ( fe ) , adduction - abduction ( aa ) , internal - external ( ie ) rotation , and anterior - posterior ( ap ) , medial - lateral ( ml ) , superior - inferior ( si ) translation in each stage of the gait cycle were determined . [ results ] the average side - to - side differences and their 95 % confidence intervals in rotation / translation in each stage of the gait cycle were determined . the side - to - side differences in aa rotation and ap translation of the tibia were significantly larger in the swing phase than in the stance phase . [ conclusion ] the side - to - side differences in aa rotation and ap translation were highly dependent on the stage of the gait cycle . therefore , the normal ranges of the side - to - side differences in knee kinematics in each stage of the gait cycle , in particular aa rotation and ap translation of the tibia , is useful information for evaluating knee kinematics during walking .

osteoporosis is a systematic bone disease characterized by low bone mass and deterioration of microarchitecture of the bone , leading to bone fragility and eventually fractures 1 . the gold standard method recommended by the world health organization in the diagnosis of osteoporosis is dual - x - ray absorptiometry ( dxa ) . using this method , osteoporosis is defined by a bone mineral density ( bmd ) lower than -2.5 standard deviations ( sd ) of the reference bmd of caucasian women aged 20 - 29 years 2 . undeniably , this simplified definition of osteoporosis eases the physicians in diagnosing and initiating treatment for osteoporotic patients . however , there are several limitations of dxa which prevent it from being used in the mass screening of osteoporosis , which is currently a rising healthcare medical condition in the developing countries 3 . quantitative ultrasound ( qus ) is a bone health assessment technique which has gained much popularity in recent years since its introduction in 1984 . compared to dxa , qus offers wider accessibility to the public because it is portable , easier to handle , lower in cost and does not emit ionizing radiation 4 . this technology has been used to determine the bone health status in women 5 , men 6 , children 7 and in certain cases , infants 8 . the ultrasound is a type of sound wave with a frequency exceeding the normal auditory range of humans ( > 20 khz ) . the sound waves produced by unique piezoelectric probes are emitted and travelled longitudinally or horizontally through the bone under study . there are usually two probes on the qus device : the emission and receiver probes . the segment of bone under study will be placed between these probes and the ultrasound waves emitted from the emission probes through the bone will be sensed by the receiver probe 9 . there are two types of qus depending on the axis the ultrasound waves take to travel through the bone . horizontal transmission uses probes that measure the speed of sound on the cortical layer of the bone at a fixed distance . longitudinal transmission is more often used and the bone segment measured is the calcaneus 4 . according to the international society of clinical densitometry ( iscd ) , calcaneal qus is the only recognized measurement of qus as the determinant of bone health status because more research has been performed on the calcaneus as compared to the other bone segments 10 . besides , the calcaneus consists of 95 % trabecular bone and possesses two lateral surfaces 11 , which facilitates the movement of ultrasound through it . therefore , this discussion will emphasize on this measurement technique , which is the calcaneal qus .

quantitative ultrasound ( qus ) has emerged as a convenient and popular screening tool for osteoporosis . this review aimed to provide basic information on the principle of qus measurement and discuss the properties of bone reflected by qus indices . qus employed high frequency sound waves generated by the device to determine bone health status in humans . in vitro studies showed that qus indices were significantly associated with bone mineral density ( bmd ) , bone microarchitecture and mechanical parameters . in humans , qus indices were found to be associated with bmd as well . in addition , qus could discriminate subjects with and without fracture history and predict risk for future fracture . in conclusion , qus is able to reflect bone quality and should be used in the screening of osteoporosis , especially in developing countries where dual - x - ray absorptiometry devices are less accessible to the general population .

reflection is growing in importance as a means to promote a learner - centered environment where the learner is encouraged to learn through the practice of nursing with subsequent reflection . when students are in uncertain new situations , they are expected to use focused thought to apply learned principles to clinical situations and critically evaluate their performance and decisions , rather than focusing on technical knowledge in isolation . the national league for nursing has reiterated the importance of both reflective and critical thinking through their designation as core competencies for nurse educators . clinical journals are one of the strategies used throughout the undergraduate nursing curricula to facilitate and guide students ' reflective thinking processes . reflective journals are considered by ( most ) faculty members to be essential in fostering an understanding of course concepts and application of concepts to clinical practice ; however , students continually question their worth in their anecdotal comments and in formal student course evaluations . is student dissatisfaction based on reflective journaling in general , the format within an individual course or modality , or some other characteristic of the individual student ? it is possible that reflective journals are not consistently reaching the anticipated critical reflection / thinking outcomes that are desired for all students . the purposes of the study were to determine ( a ) the critical attributes of a reflective journal and relative levels of each attribute , ( b ) the relative importance of each attribute as perceived by the students , and ( c ) the perception of relative importance for student subgroups .

this study used a statistical technique , conjoint value analysis , to determine student perceptions related to the importance of predetermined reflective journaling attributes . an expert delphi panel determined these attributes and integrated them into a survey which presented students with multiple journaling experiences from which they had to choose . after obtaining irb approval , a convenience sample of 66 baccalaureate nursing students completed the survey . the relative importance of the attributes varied from a low of 16.75 % ( format ) to a high of 23.58 % ( time ) . the model explained 77 % of the variability of student journaling preferences ( r2 = 0.77 ) . students preferred shorter time , complete confidentiality , one - time complete feedback , semistructured format , and behavior recognition . students with more experience had a much greater preference for a free - form format ( p < .05 ) when compared to students with less journaling experience . additionally , the results of english as a second language students were significantly different from the rest of the sample . in order to better serve them , educators must consider the relative importance of these attributes when developing journaling experiences for their students .

mucormycosis , also known as zygomycosis , is an opportunistic and lethal mycological infection caused by a fungus of the order mucorales . it is mostly observed in immunocompromised patients such as those with hematological malignancy or those who have solid organ transplantation ( sot ) or bone marrow transplants . the infection usually starts in the middle nasal meatus and spreads to the paranasal sinuses , the orbit and the intracranial structures by direct extension or through blood vessels . early diagnosis , initiating prompt surgical and medical therapy and correcting the underlying conditions play a vital role in eliminating this infection , but mortality remains high . mucormycosis is uncommon in sot recipients and most cases have been reported after liver or renal transplantation .

mucormycosis is an opportunistic acute fungal infection with a high mortality rate seen in immunocompromised patients . it is extremely rare in heart transplant recipients . rhinocerebral mucormycosis ( rm ) is the most frequently observed presentation . we report a case of rm in a heart transplant recipient 5-month after the procedure , with a fatal outcome .

vitamin a deficiency is the leading cause of preventable childhood blindness in the developing world . although rare in the united states , vitamin a deficiency has been known to occur as a result of poor dietary intake , liver diseases , and gastrointestinal malabsorption [ 2 , 3 , 4 , 5 ] . vitamin a is a fat - soluble vitamin ingested in the diet in two forms : as retinol itself from animal sources , such as milk , meat , fish , liver , and eggs , or as the provitamin carotene from plant sources , such as green leafy vegetables , yellow fruits , and red palm oil . on the ocular surface , vitamin a deficiency has a wide range of ocular manifestations including conjunctival and corneal xerosis , keratomalacia , retinopathy , visual loss , and nyctalopia , also called night blindness , which is the earliest and most common symptom . we report a case of bilateral sequential corneal ulceration in a patient with severe vitamin a deficiency in the context of eosinophilic gastroenteropathy .

purpose : vitamin a deficiency is a very rare condition in the developed world and can lead to a variety of ocular changes from xerosis and xerophthalmia to corneal ulcer and perforation . the treatment of this devastating disease is simple and inexpensive . it is therefore important to recognize and treat accordingly , especially in the event of ulcers unresponsive to treatment or in the presence of severe malnutrition / malabsorption syndromes . the purpose of this case report is to remind physicians of the potentially devastating effects of vitamin a deficiency on the eyes and to demonstrate outcomes after vitamin a treatment . methods : single observational case report . results : a 29-year - old male with known eosinophilic gastroenteropathy was treated with oral steroids for peripheral ulcerative keratitis . two weeks after resolution , the patient suffered from peripheral ulcerative keratitis in his other eye , with a self - sealing perforation . vitamin a deficiency was confirmed and successfully treated , leading to subsequent resolution of signs and symptoms . conclusions : vitamin a deficiency can be present in patients with malabsorption and malnutrition syndromes and should be considered as cause of corneal ulceration .

grounding or earthing refers to direct skin contact with the surface of the earth , such as with bare feet or hands , or with various grounding systems . subjective reports that walking barefoot on the earth enhances health and provides feelings of well - being can be found in the literature and practices of diverse cultures from around the world.1 for a variety of reasons , many individuals are reluctant to walk outside barefoot , unless they are on holiday at the beach . various grounding systems are available that enable frequent contact with the earth , such as while sleeping , sitting at a computer , or walking outdoors . these are simple conductive systems in the form of sheets , mats , wrist or ankle bands , adhesive patches that can be used inside the home or office , and footwear . these applications are connected to the earth via a cord inserted into a grounded wall outlet or attached to a ground rod placed in the soil outside below a window . for the footwear applications , a conductive plug is positioned in the shoe sole at the ball of the foot , under the metatarsals , at the acupuncture point known as kidney 1 . from a practical standpoint , these methods offer a convenient and routine , user - friendly approach to grounding or earthing . they can also be used in clinical situations , as will be described in the section entitled summary of findings to date.1 recently , a group of about a dozen researchers ( including the authors of this paper ) has been studying the physiological effects of grounding from a variety of perspectives . this research has led to more than a dozen studies published in peer - reviewed journals . while most of these pilot studies involved relatively few subjects , taken together , the research has opened a new and promising frontier in inflammation research , with broad implications for prevention and public health . the findings merit consideration by the inflammation research community , which has the means to verify , refute , or clarify the interpretations we have made thus far . grounding reduces or even prevents the cardinal signs of inflammation following injury : redness , heat , swelling , pain , and loss of function ( figures 1 and 2 ) . rapid resolution of painful chronic inflammation was confirmed in 20 case studies using medical infrared imaging ( figure 3 ) .2,3 our main hypothesis is that connecting the body to the earth enables free electrons from the earth s surface to spread over and into the body , where they can have antioxidant effects . specifically , we suggest that mobile electrons create an antioxidant microenvironment around the injury repair field , slowing or preventing reactive oxygen species ( ros ) delivered by the oxidative burst from causing collateral damage to healthy tissue , and preventing or reducing the formation of the so - called inflammatory barricade . we also hypothesize that electrons from the earth can prevent or resolve so - called silent or smoldering inflammation . if verified , these concepts may help us better understand and research the inflammatory response and wound healing , and develop new information on how the immune system functions in health and disease .

multi - disciplinary research has revealed that electrically conductive contact of the human body with the surface of the earth ( grounding or earthing ) produces intriguing effects on physiology and health . such effects relate to inflammation , immune responses , wound healing , and prevention and treatment of chronic inflammatory and autoimmune diseases . the purpose of this report is two - fold : to 1 ) inform researchers about what appears to be a new perspective to the study of inflammation , and 2 ) alert researchers that the length of time and degree ( resistance to ground ) of grounding of experimental animals is an important but usually overlooked factor that can influence outcomes of studies of inflammation , wound healing , and tumorigenesis . specifically , grounding an organism produces measurable differences in the concentrations of white blood cells , cytokines , and other molecules involved in the inflammatory response . we present several hypotheses to explain observed effects , based on current research results and our understanding of the electronic aspects of cell and tissue physiology , cell biology , biophysics , and biochemistry . an experimental injury to muscles , known as delayed onset muscle soreness , has been used to monitor the immune response under grounded versus ungrounded conditions . grounding reduces pain and alters the numbers of circulating neutrophils and lymphocytes , and also affects various circulating chemical factors related to inflammation .

food chain information ( fci ) is one of the innovations introduced by the hygiene package to enhance the concept of food security and ensure welfare and animal health . food chain information can be used by the operator of the slaughterhouse within the haccp plan in order to organise the slaughtering and by the official veterinarian to take decisions on the carcass . information should cover what follows ( european commission , 2004 ) : i ) status of provenance or the regional animal health status ; veterinary medicinal products or other treatments administered within a relevant period and with a withdrawal period > 0 , together with their dates of administration and withdrawal periods ; ii ) occurrence of diseases that may affect the safety of the meat ; iii ) the results , if they are relevant to the public health , of any analysis carried out on samples taken from the animals or other samples taken to diagnose diseases that may affect the safety of the meat , including samples taken in a framework of the monitoring and control of zoonoses and residues ; iv ) relevant reports about previous ante- and post - mortem inspections of animals from the same holding of provenience , including reports from the official veterinarian production data when they may indicate the presence of diseases ; v ) name and address of the private veterinarian normally attending the holding of provenience . fci must be provided to the slaughterhouse operators at least 24 h before the arrival of the animals . it is also possible to send fci simultaneously in the following cases : for pigs , poultry or farmed game that have passed the antemortem inspection at the farm and are accompanied by a veterinary certificate declaring the animals as healthy ; for slaughtering of domestic solipeds or other animals subject to emergency slaughter if accompanied by a veterinary certificate attesting the successful antemortem inspection ; for animals that have not been sent directly from the holding of provenance to the slaughterhouse . within the council regulation ( ec ) n. 2076/2005 ( european commission , 2005 ) there is another exception to regulation ( ec ) n. 853/2004 ( european commission , 2004 ) , which provides for the simultaneous transmission of fci and animals regardless of species , subject to agreements between food business operator ( fbo ) and the official veterinary . if the veterinary decides for the slaughtering , even in the absence of fci , the document must be provided within 24 h , otherwise the entire carcass will be destroyed . several eu member states drafted guidelines for the correct application of the document . unfortunately in italy only few regions did it . the aim of the present work is to compare the different european guidelines and to analyse the situation in piedmont after few years of the entry into force of this provision in order to assess the presence of potential problems and propose solutions .

food chain information ( fci ) is an innovation of the new european regulation . its purpose is to enhance the concept of food security . fci includes specifications such as : health status , information on treatments and diseases , analytical reports on control plans , zoonoses or environmental contaminants , production performance , etc . the aim of this article is to compare the different european guidelines and analyse the situation in piedmont in order to assess potential problems and propose solutions . european guidelines are similar one another , but they have been tailored to the epidemiological situations of each state . except for spain and germany , fci models are different for each species and the poultry sector is the most detailed . unfortunately , italy has not provided guidelines yet , and this has generated considerable differences . overall , the number of fci models with incomplete information is the largest group compared to the models not completed for each entry . the main deficiencies are related to pharmacological treatments . the health status of the farm is listed consistently regarding the compulsory eradication plans , but other national voluntary or accreditation plans are rarely mentioned . the situation is similar in other european countries . in conclusion , fci is an effective tool if applied with consistency and reason . only in this way the collection of data will be effective and representative of the food chain .

abdominal pregnancies ( both primary and secondary ) have a reported incidence of 1 in 10,000 . worldwide , the incidence of ectopic pregnancies is increasing , with significant contribution from assisted reproductive technologies ( art ) . however , the incidence of abdominal pregnancies have remained constant or reduced , and maternal mortality reduced from 20 % to less than 5 % in last 20 years due to early diagnosis and management . early diagnosis has enabled laparoscopic management in many of these cases . in this study , we report a case of primary abdominal pregnancy following intra - uterine insemination ( iui ) managed laparoscopically .

primary abdominal pregnancy is an extremely rare type of extrauterine pregnancy . it has been reported from many unusual intra - abdominal sites . we report a case of primary abdominal pregnancy following intra - uterine insemination ( not reported earlier to our knowledge ) . implanted on the anterior surface of the uterus possibly related to an endometriotic foci . early diagnosis enabled laparoscopic management of this case .

gastroesophageal reflux disease ( gerd ) is a common gastrointestinal disease in asia as well as in the west ( 1 , 2 ) . studies have reported that 10 % -20 % of the adult western population experience typical gerd symptoms ( heartburn and/or regurgitation ) at least once per week ( 1 ) . the prevalence of gerd in adult koreans is reported to be 3.5 % -8.5 % ( 3 - 5 ) . this increase has been possibly attributed to changes in diet , an increasing aged population , the increasing frequency of endoscopic examinations , and the widely spreading knowledge on gerd . the montreal definition describes gerd as a condition that develops when the reflux of gastric contents causes troublesome symptoms and/or complications ( 6 ) . a number of regional and international guidelines and recommendations for the management of gerd have been published . the genval workshop report on reflux disease management , published in 1999 ( 7 ) , and the asia - pacific consensus on the management of gerd , published in 2008 ( 8 ) , previous studies show that proton pump inhibitors ( ppis ) are the most effective drug for patients with gerd ( 7 , 8 ) . actually , ppis are known to be most commonly prescribed for the treatment of gerd . however , the prescription pattern of ppis in patients with gerd may be different between countries , which is partly attributed to the economic situation or the health insurance system . in korea , national health insurance covers the cost for the medication prescribed in hospitals and clinics according to the insurance reimbursement guideline . accordingly , the prescription pattern of ppis used for the treatment of gerd is substantially influenced by the insurance reimbursement guideline . thus , the aim of this study was to document practice pattern of gastroenterologists for the management of gerd patients under the minimal influence of the insurance reimbursement guideline .

the objective of the study was to document practice pattern of gastroenterologists for the management of gastroesophageal reflux disease ( gerd ) under the minimal influence of the insurance reimbursement guideline . data on management for 1,197 consecutive patients with typical gerd symptoms were prospectively collected during 16 weeks . in order to minimize the influence of reimbursement guideline on the use of proton pump inhibitors ( ppis ) , rabeprazole was used for the ppi treatment . a total of 861 patients ( 72 % ) underwent endoscopy before the start of treatment . ppis were most commonly prescribed ( 87 % ) . at the start of treatment , rabeprazole 20 mg daily was prescribed to 94 % of the patients who received ppi treatment and 10 mg daily to the remaining 6 % . at the third visits , rabeprazole 20 mg daily was prescribed to 70 % of those who were followed and 10 mg daily for the remaining 30 % . continuous ppi treatment during the 16-week period was performed in 63 % of the study patients . in conclusion , a full - dose ppi is preferred for the initial and maintenance treatment of gerd under the minimal influence of the insurance reimbursement guideline , which may reflect a high proportion of gerd patients requiring a long - term treatment of a full - dose ppi .

the rapid improvement in quality , quantity , and cost of next generation sequencing ( ngs ) has resulted in commensurate improvements in analysis techniques . for bacteria , the availability of kits for library preparation , rapid and high content sequencing , and mature data analysis pipelines for genome resequencing and assembly had drastically reduced costs and improved reliability of these results . the commoditization of bacterial genome sequencing has led to more complex applications : clinical and agricultural diagnostics [ 14 ] , outbreak detection and monitoring [ 57 ] , human health studies [ 8 , 9 ] , biocatalysis [ 10 , 11 ] , environmental studies , and many others [ 13 , 14 ] . for ngs platforms , current sequencing technologies require that sequencing adapters be ligated to dna fragments before sequencing is possible . ligation of adapters to ( typically small ) dna fragments is an inefficient process , generating ligated hybrids from only a small fraction of targeted dna molecules . this limitation in turn increases the required dna input , with the only goal being to generate sufficient numbers of ligated fragments to allow sequencing . typical library preparation methods require large amounts ( ~1 g ) at high concentrations ( > 25 ng / ml ) of dna for successful library generation , limiting the types of samples that can be sequenced reliably . these include high variability of evenness and completeness of genome coverage as a function of % gc content , input dna quantities , and sequencing technology [ 1519 ] . these impact the amount of sequencing data required and the quality of genome assembly and analysis . several library preparation kits that require 1100 ng of input dna are now available ( new england biolabs ' nebnext , illumina 's truseq nano , bioo scientific 's nextflex , nugen 's ovation ultralow , etc . ) . this paper details the results of evaluation of the utility of the nebnext ultra library preparation kits for both resequencing and assembly of several bacterial genomes . we compare the evenness and completeness of coverage between nebnext ultra and illumina truseq kits for bacterial genomes of varying size and % gc content . our findings indicate that low dna input amounts are sufficient to generate high quality sequencing data that can be used for genome resequencing or de novo assembly ( if combined with long fragment data ) .

sequencing bacterial genomes has traditionally required large amounts of genomic dna ( ~1 g ) . there have been few studies to determine the effects of the input dna amount or library preparation method on the quality of sequencing data . several new commercially available library preparation methods enable shotgun sequencing from as little as 1 ng of input dna . in this study , we evaluated the nebnext ultra library preparation reagents for sequencing bacterial genomes . we have evaluated the utility of nebnext ultra for resequencing and de novo assembly of four bacterial genomes and compared its performance with the truseq library preparation kit . the nebnext ultra reagents enable high quality resequencing and de novo assembly of a variety of bacterial genomes when using 100 ng of input genomic dna . for the two most challenging genomes ( burkholderia spp . ) , which have the highest gc content and are the longest , we also show that the quality of both resequencing and de novo assembly is not decreased when only 10 ng of input genomic dna is used .

multiple sclerosis is a chronic demyelinating disease of the central nervous system , affecting any part of the cns , but mostly white matter tracts in the cerebral hemispheres , optic nerves , brainstem , cerebellum , and spinal cord . the prevalence of the disorder ranges between 2 and 150/100,000 depending on the country or specific population , affecting approximately 1 million people worldwide . psychiatric symptoms in the context of ms were first noted by charcot , who described mania , hallucinations , and depression among other manifestations of the disease . lifetime prevalence of major depression ranges from 19 to 54 % , depending on the population sample and diagnostic criteria used [ 68 ] . annual prevalence is estimated at 16 % , and point prevalence of clinically significant depressive symptoms is as high as 50 % . the rate of depressive disorders in a pediatric population with demyelinating disease has been estimated at 27 % . evidently , prevalence is considerably higher than in the general population or among patients with general medical conditions other than ms . etiologic factors seem to be both biological and psychosocial , and risk factors have been reported to be female sex , age < 35 years , family history of major depression , and a high level of stress . disease - modifying agents , interferon beta in particular , have also been suspected to induce depressive symptomatology [ 14 , 15 ] . however , subsequent well - designed studies failed to prove a depressogenic effect , and pretreatment depressed mood was found to be the best predictor of subsequent depression [ 16 , 17 ] . the importance of this clinical issue can not be underestimated , given its high frequency , the possible adverse effects of depression on disease course , cognitive functioning , treatment adherence , deleterious consequences on quality of life , and increased risk of suicide [ 22 , 23 ] . unfortunately , mental comorbidity and depression in particular are frequently underdiagnosed and undertreated , with reported rates of missed diagnosis around 2330 % [ 6 , 24 ] and rates of inadequate treatment around 20 % 36 % of those reporting depression [ 6 , 25 ] . in a cross - sectional community study of patients with ms by cetin et al . , 59 % of the patients who had significant symptoms of depression were not taking medication , possibly due to missed diagnosis , denial of symptoms , or false reporting , whereas the rest 41 % received inadequate treatment . in the whole sample ( n = 542 ) , 28 % of the patients were adequately treated for depression and therefore had achieved remission . in another study by mohr et al . , 65.6 % of depressed patients did not receive medication , 4,7 % received subthreshold treatment , 26,6 % received threshold , and only 3.1 % received overthreshold , indicating that in most cases , therapy is not in accordance with treatment guidelines for depression . given the fact that depression is a treatable condition , correct diagnosis and adequate treatment are issues of immense importance for the management of multiple sclerosis patients . the present paper is focused on current knowledge on diagnosis , assessment , and therapeutic interventions for depression in the context of multiple sclerosis .

multiple sclerosis is a chronic demyelinating disease affecting one million people worldwide , with a significant burden of psychiatric comorbidity . depression is the commonest psychiatric manifestation but still remains largely underdiagnosed and undertreated . the present work reviews current knowledge on diagnosis , assessment , and somatic and psychotherapeutic treatment interventions for depression in adult and pediatric populations of patients with multiple sclerosis .

variability in clinical response to standard therapeutic dosage regimen was reported in the 1950s by many pioneers in the field . since then , the association between monogenic polymorphisms and variations of drugs ' metabolism , transport , or target had been identified and the vision of personalized drug therapy in health care envisioned [ 1 , 2 ] . pharmacogenomic - guided drug therapy for patient is based on the premise that a large portion of interindividual variability in drug response ( efficacy and/or toxicity ) is genetically determined . despite the widespread recognition of the scientific rationale and the clinical implementation of pharmacogenomic tests at several major academic medical institutions [ 37 ] , most clinicians and researchers engaged in the discipline would agree that the early vision of achieving personalized therapy in the form of therapeutic regimens tailored to an individual 's genetic profile remains some years away . broadly speaking , the development and implementation pathways for pharmacogenomic tests consist of several stages ( figure 1 ) : first , discovery of pharmacogenomic biomarkers and validation in well - controlled studies with independent populations ; second , replication of drug - gene ( s ) association and demonstration of utility in at - risk patients ; third , development and regulatory approval of companion - diagnostic test ; fourth , assessing the clinical impact and cost - effectiveness of the pharmacogenomic biomarkers ; fifth , involvement of all stakeholders in clinical implementation . lessons learned in making pharmacogenomic - guided therapy useful to clinicians have identified multiple scientific challenges and implementation barriers existing within these stages , each of which is fueled by multitude of stakeholders with varied goals and interests . this paper will provide a perspective on these existing challenges and barriers in the complex process of implementing pharmacogenomics in clinical practice , as well as incorporating pharmacogenomics into the drug development process .

the mapping of the human genome and subsequent advancements in genetic technology had provided clinicians and scientists an understanding of the genetic basis of altered drug pharmacokinetics and pharmacodynamics , as well as some examples of applying genomic data in clinical practice . this has raised the public expectation that predicting patients ' responses to drug therapy is now possible in every therapeutic area , and personalized drug therapy would come sooner than later . however , debate continues among most stakeholders involved in drug development and clinical decision - making on whether pharmacogenomic biomarkers should be used in patient assessment , as well as when and in whom to use the biomarker - based diagnostic tests . currently , most would agree that achieving the goal of personalized therapy remains years , if not decades , away . realistic application of genomic findings and technologies in clinical practice and drug development require addressing multiple logistics and challenges that go beyond discovery of gene variants and/or completion of prospective controlled clinical trials . the goal of personalized medicine can only be achieved when all stakeholders in the field work together , with willingness to accept occasional paradigm change in their current approach .