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cardiovascular disease ( cvd ) and diabetic nephropathy ( dn ) are the major causes of mortality in individuals with type 1 diabetes ( 13 ) , and a growing body of evidence from basic and clinical studies ( 47 ) supports the relationship between cvd and renal function in health and disease . cvd and dn have been proposed to be manifestations of the same underlying pathology and also exist as interrelated risk factors ( 8,9 ) . the increased mesangial matrix associated with dn is similar to the pathophysiology of coronary atherosclerosis ( 8 ) . while atherosclerosis tends to remain subclinical until adulthood in individuals with type 1 diabetes ( 10 ) , adolescents with type 1 diabetes demonstrate reduced peak exercise capacity and decreased cardiac function compared with nondiabetic adolescents ( 11 ) . although the mechanisms underlying the reduced peak exercise capacity are poorly understood , we have previously shown that insulin resistance and elevated ldl cholesterol ( ldl - c ) were associated with low peak volume of oxygen ( vo2peak ) ( 11 ) . elevated albumin - to - creatinine ratio ( acr ) and glomerular filtration rate ( gfr ) , which are early manifestations of dn , are also increasingly recognized in children and adolescents with type 1 diabetes ( 1,12 ) . increased gfr was shown to be associated with increased cardiovascular mortality in adults ( 13 ) . little is known , however , about the possible associations between early renal health and exercise capacity in adolescents with type 1 diabetes , and whether this relationship is independent of insulin sensitivity . accordingly , we sought to examine the associations between markers of renal health and peak exercise capacity in adolescents with type 1 diabetes . we hypothesized that cardiopulmonary fitness would be directly associated with acr and inversely related to estimated gfr ( egfr ) in adolescents with type 1 diabetes .

objectivediabetic nephropathy and cardiovascular disease are strongly related in adults with type 1 diabetes , yet little is known about this relationship in adolescents prior to the onset of detectable clinical disease . we hypothesized that cardiopulmonary fitness would be directly associated with albumin - to - creatinine ratio ( acr ) and inversely related to estimated glomerular filtration rate ( egfr ) in adolescents with type 1 diabetes.research design and methodssixty - nine adolescents with type 1 diabetes and 13 nondiabetic control subjects of similar pubertal stage and bmi had insulin sensitivity ( glucose infusion rate [ gir ] ) , measured by hyperinsulinemic - euglycemic clamp , and lean body mass , measured by dexa . cardiopulmonary fitness was measured by cycle ergometry to obtain peak volume of oxygen ( vo2peak ) , and renal function was measured by egfr using the bouvet equation ( measuring creatinine and cystatin c levels ) and acr.resultsadolescents ( 15.5 2.2 years of age ) with type 1 diabetes ( 6.3 3.8 years diabetes duration ) had reduced vo2peak ( 31.5 6.3 vs. 36.2 7.9 ml / kg min , p = 0.046 ) and vo2peak / lean kg ( 43.7 7.0 vs. 51.0 8.6 ml / lean kg min , p = 0.007 ) compared with nondiabetic control subjects . egfr was inversely associated with vo2peak and vo2peak / lean kg after adjusting for sex , tanner stage , gir , hba1c level , systolic blood pressure , and ldl cholesterol level ( se , vo2peak : 0.19 0.07 , p = 0.02 ; vo2peak / lean kg : 0.19 0.09 , p = 0.048 ) . moreover , participants in the highest tertile for egfr had significantly lower sex- and tanner - adjusted vo2peak and vo2peak / lean kg compared with participants in the lowest tertile.conclusionsadolescents with type 1 diabetes had reduced exercise capacity , which was strongly associated with renal health , independent of insulin sensitivity . future studies should examine the underlying interrelated pathophysiology in order to identify probable targets for treatment to reduce cardiovascular and renal complications .

specific developmental disturbances due to various insults , brain damage , toxic influences , or psychological stress may determine higher levels of neurocognitive integration dysfunction that typically occur in children with attention - deficit and hyperactivity disorder ( adhd ) .13 one of the most important postnatal developmental deficits which may have various etiological causes influencing higher motor and cognitive functions is the persistence of several primitive reflexes that occurs in some neuropsychiatric disorders , such as the symmetric tonic neck reflex ( stnr ) and asymmetric tonic neck reflex ( atnr ) .46 these findings are in agreement with basic neurological concepts discovered by hughlings jackson , who proposed that certain functions developed later during the ontogenesis of the central nervous system ( cns ) tend to replace older ones.7 although hughlings jackson mainly focused on epilepsy in his works , he later discovered certain basic developmental rules describing cns development that were characterized by hierarchical ontogenetic stages.8 when the higher stages of cns development are not successfully achieved or are damaged , lower neural functions may be disinhibited and their release from control may lead to the dysregulation of later - developed adaptive functions.7 in principle , these findings agree with data indicating hypofrontality in adhd,9,10 which suggests that attentional and executive dysfunctions related to reduced activation in the right inferior frontal cortex , anterior cingulate cortex , supplementary motor area , and other regions are linked to inhibitory deficits.3 according to current findings and the best of our knowledge , there are few reported findings of persisting reflexes in dyslexia11,12 and preliminary findings suggesting that adhd symptoms could be related to persistence of the primitive reflexes in later developmental stages than is usual.12,13 these studies suggest that further detailed research examining developmental conditions in adhd is warranted and that such research might have significant consequences for understanding adhd , dyslexia , and other neurodevelopmental disorders.1113 most recent studies examining atypical development in adhd have predominantly studied boys , while studies of girls are very rare . however , the studies examining developing children have shown specific patterns mainly characterized by the girls earlier brain maturation compared with that of boys.14 at this time , as far as we are aware , there is no reported study that has assessed whether adhd symptoms are related to persistence of the primitive reflexes in medication - nave children with a focus on sex - specific assessment . as such , in the study reported here we examined the extent to which the persistence of the primitive atnr and stnr is related to adhd symptoms in 35 medication - nave girls of school age ( 811 years ) .

background and objectivesrecent and historical findings suggest that later - developed functions during brain ontogenesis related to higher levels of cognitive and motor integration tend to replace the older , more primitive , ones , and the persistence of the older functions may be linked to specific neuropsychiatric disorders . currently , there is growing evidence to suggest that persisting primitive reflexes may be related to developmental and neurodegenerative disorders . preliminary data also suggest that persisting primitive reflexes may be specifically linked to attention - deficit and hyperactivity disorder ( adhd ) .methodsin the study reported here , we tested to what extent the persisting primitive asymmetric tonic neck reflex and symmetric tonic neck reflex are related to adhd symptoms measured by conners parent questionnaire in 35 medication - nave girls of school age ( 811 years ) with adhd . the results were compared with those of a control group of 30 girls of the same age.resultsthis study showed that persisting primitive reflexes are closely linked to adhd symptoms.conclusionthe data suggest that adhd symptoms may be linked to more primitive neural mechanisms interfering with higher brain functions due to insufficiently developed cognitive and motor integration .

community - acquired pneumonia ( cap ) is acquired during the course of everyday life by patients who do not have a known immune deficiency . despite advancements in antibiotic treatment , cap continues to negatively affect morbidity and mortality . cap is also the sixth most common infectious cause of death in hospitals.1 previous studies have shown that the mortality rate of pneumonia varies from 1 % to 60 % and is related to the weight of the patient.2 studies have found that the mortality rate in cap outpatient cases is 15 % ; the mortality rate is 12 % in inpatient cases and 40 % in intensive care patients.3,4 d - dimer ( dd ) is a metabolic substance produced during the catabolization of fibrin by plasmin . dd levels have been shown to increase in patients who have disorders that trigger fibrin production and catabolization ; these disorders include pulmonary emboli ( pe ) , deep vein thrombosis ( dvt ) , solid tumors , leukemia , severe infections , trauma or a post - operative state , disseminated intravascular coagulation ( dic ) , pregnancy , acute stroke , sickle - cell anemia , congestive heart failure and chronic kidney failure.58 while the measurement of plasma dd levels is a well - known test for venous thromboemboli , the relationship between plasma dd and other diseases is still unclear . a limited number of studies have examined the relationship between cap and plasma dd levels . some of these studies suggest that an increase in dd is directly related to the intra- and extra - vascular coagulation that occurs in acute and chronic lung damage in cap cases.9 the present study investigated the relationship between the severity of cap and serum dd levels , as well as the potential correlation among plasma dd levels , the radiological extent of the disease and hospital mortality rates . the ultimate goal of this study was to determine whether plasma dd levels can be used to develop prognoses in cap cases .

background : plasma d - dimer levels are directly related to the intra- and extra - vascular coagulation that occurs in acute and chronic lung damage in patients with community - acquired pneumonia ( cap ) .objectives : this study examines the relationship between the severity of community - acquired pneumonia and d - dimer levels . in addition , the study examines the correlations among community - acquired pneumonia , the radiological extent of the disease and mortality.methods : the pneumonia severity index was used to classify patients into five groups . patients were treated at home or in the hospital according to the guidelines for community - acquired pneumonia . blood samples were taken from the antecubital vein with an injector and placed into citrated tubes . after they were centrifuged , the samples were evaluated with the quantitative latex method.results : the study included 60 patients who had been diagnosed with community - acquired pneumonia ( mean age 62.5 11.7 ) and 24 healthy controls ( mean age 59.63 6.63 ) . the average plasma d - dimer levels were 337.3 195.1ng / ml in the outpatient treatment group , 691.0 180.5 in the inpatient treatment group , 1363.2 331.5 ng / mlin the intensive care treatment group and 161.3 38.1ng / ml in the control group ( p < 0.001 ) . the mean d - dimer plasma level was 776.1 473.5ng / ml in patients with an accompanying disease and 494.2 280.1 ng / ml in patients without an accompanying disease ( p < 0.05 ) .conclusions : plasma d - dimer levels were increased even in community - acquired pneumonia patients who did not have an accompanying disease that would normally cause such an increase .

the plant antiaris toxicaria ( family moraceae ) is an indigenous plant common in ghanaian forests . foto or kyenkyen in akan and the bark cloth tree in english . despite considerable advancements in the treatment of neurological disorders currently available antiepileptic drugs ( aeds ) have debilitating adverse effects on cognition and behaviour . these adverse effects are commonly and consistently observed with barbiturates , benzodiazepines , and topiramate [ 4 , 5 ] . these problems are known to prevail more in developing countries due to lack of facilities for proper diagnosis and treatment along with monitoring of aed serum levels [ 6 , 7 ] . natural products and plants already used in traditional medicine can be a good place to start in the search for safer and more effective options . numerous plants used for the treatment of epilepsy traditionally have been shown to be potent in models of epilepsy and several such plants remain to be scientifically validated . leonotis leonurus , delphinium denudatum , mimosa pudica , and synedrella nodiflora are but a few examples [ 810 ] . preliminary screening of the aqueous extract of antiaris toxicaria revealed significant anticonvulsant effect in pentylenetetrazole - induced seizure test . hence , this study seeks to further explore the extract 's potential as an anticonvulsant .

antiaris toxicaria ( moraceae ) was evaluated for anticonvulsant activity in rodents . animal models used include maximal electroshock test ( mest ) ; pentylenetetrazole - induced ( ptz ) convulsions ; picrotoxin - induced ( pct ) convulsions ; strychnine- ( str- ) and 4-aminopyridine - induced convulsions . increase in latency to seizures as well as reduction in duration and frequency of seizures indicated anticonvulsant activity . the extract was more effective in all models used except the maximal electroshock test and strychnine - induced convulsions . antiaris toxicaria aqueous extract ( 200 , 400 , and 800 mg kg1 ) significantly ( p < 0.05 0.01 ) shortened the duration of convulsions in ptz- and pct - induced seizures . delay in the onset of convulsions in the two tests was significant ( p < 0.001 ) . reduction in the frequency of seizures was also significant ( p < 0.05 0.001 ) in both tests . antiaris further delayed the onset of seizures in 4-aminopyridine model while producing 75 % protection against death in mice . diazepam ( 0.1 , 0.3 , and 1 mg kg1 ) , carbamazepine ( 3 , 10 , and 30 mg kg1 ) , and sodium valproate ( 100400 mg kg1 ) were used as reference anticonvulsant drugs for various models . flumazenil blocked the effect of the extract in the ptz test significantly suggesting that antiaris toxicaria may be acting by enhancing the effects of the gabaergic system . antiaris toxicaria aqueous extract therefore possesses anticonvulsant activity .

rarely , severe cholecystitis may result in extravasation of bile through rupture of rokitansky - aschoff sinuses or mucosal ulceration causing severe fibrosis and formation of yellow intramural nodules and xanthogranulomatous reaction known as xanthogranulomatous cholecystitis ( xgc ) [ 1 - 4 ] . although there is a known association between gallbladder cancer and xgc , it is not clearly understood . computed tomography ( ct ) has recently become the gold standard investigation of choice in acute abdomen because it is quick , noninvasive , and provides a detailed map of the abdomen . furthermore , the introduction of multislice ct has increased the diagnostic accuracy of intra - abdominal conditions . however , ct may also detect incidental silent conditions requiring urgent attention such as abdominal aortic aneurysm ( aaa ) . we herein present a rare case of a patient who presented with signs of acute cholecystitis and gallbladder empyema . investigations showed evidence of chronic cholecystitis and an incidental large aaa . at surgery , a suspicious small nodule ( not seen on ct ) was excised . this rare coexistence of pathologies adds a further dimension to the management dilemma of the multidisciplinary team .

there have been reports of the coexistence of abdominal aortic aneurysm ( aaa ) with intra - abdominal malignancy including gastric , colonic , pancreatic , and renal . we herein report a case of a previously undiagnosed aaa and a presenting complaint consistent with acute cholecystitis . following cholecystectomy , this was noted to be a rare form of chronic cholecystitis : xanthogranulomatous cholecystitis . there is a known possible association of this uncommon condition with gallbladder cancer . the management of concomitant pathologies can present a real challenge to the multidisciplinary team , especially with large aneurysms .

neuro - cardiogenic interaction has been known for many years.1 ) 2 ) an excessive release of catecholamines , known as a trigger of takotsubo cardiomyopathy ( tc ) , is developed when sympathetic nervous system is hyperactivated in stressful conditions including cerebral seizure . cerebral seizure has been reported as a cause of tc internationally , and cardiac complications are one of the main causes of mortality in epilepsy.3 ) 4 ) biventricular tc is associated with more hemodynamic instability than isolated left ventricular tc . therefore , in that case , medical treatment should be more invasive and the course of hospitalization is longer.5 ) but , there has been no case report describing biventricular tc after cerebral seizure in korea . here , we report a case of a patient who presented with initial echocardiography showing biventricular apical ballooning after status epilepticus .

we describe a case of takotsubo cardiomyopathy in an elderly woman after status epilepticus . in an emergency echocardiography , not only left ventricular apical ballooning but also right ventricular apical hypokinesia was observed . after a medical management , the patient 's condition was improved and a follow - up echocardiography showed substantial recovery of left and right ventricular apical ballooning .

colorectal cancer ( crc ) is a major cause of mortality and morbidity , and the third most common malignancy in the world ( 1 ) . the incidence of this malignancy shows considerable variation among racially or ethnically defined populations in multiracial / ethnic countries . crc is the third most common type of cancer in men and the second most common cancer in women worldwide ( 2 ) . kashmir has been reported as being a high - incidence area of gastrointestinal ( git ) cancers ( 3,4 ) . in the kashmir valley , crc represents the third most common type of git cancer , following esophageal and gastric cancer ( 5,6 ) . the tumour - suppressor gene p16ink4a codes for a cyclin - dependent kinase inhibitor p16ink4a , which acts as a negative regulator of cell growth and proliferation in the g1 phase of the cell cycle ( 7,8 ) . functionally , p16ink4a has been identified as an inhibitor of cyclin - dependent kinase 4 and 6 . as a consequence , p16ink4a plays a significant role in the proliferation process of many types of tumour cell growth and apoptosis , and correlates closely with the expression of the proliferating cell nuclear antigen ki67 , which is usually viewed as the proliferation marker in intestinal tumours ( 9,10 ) . most human colorectal carcinomas show genetic alterations in the p16ink4a - cyclin d - prb pathway ( 11 ) . the p16ink4a gene of the cyclin d / prb pathway has been found to be inactivated in human malignancies with a frequency second only to p53 ( 12,13 ) . mutation , homozygous deletions and hypermethylation of the promoter are major mechanisms of p16ink4a inactivation ( 8,14,15 ) . hypermethylation of non - mutated promoter regions is one of the common mechanisms for inactivating tumour - suppressor genes , which leads to stable allele - specific loss of transcription function ( 16 ) . such methylations tend to occur at the sites of cpg dinucleotides , which are clustered as so - called cpg islands and are frequently found in promoters of p16ink4a and other tumour - suppressor genes ( 13 ) . in fact , the major mechanism of p16ink4a gene inactivation has been found to be promoter methylation ( 11 ) . a number of studies have been carried out on p16ink4a in different populations , implicating the role of hypermethylation in the development of cancers ( 1723 ) . p16ink4a gene promoter methylation has been observed in colorectal dysplasia , adenomas , malignant tumours and normal mucosa adjacent to tumours ( 18,19,24 ) . two significant investigations were previously carried out in the kashmir valley in order to establish the role of p16ink4a mutations and promoter hypermethylation in gastric and esophageal squamous cell carcinoma , respectively ( 13,25 ) . based on the hypothesis that crc carcinogenesis is a multi - step and multi - gene event , we designed this study to elucidate the role of p16ink4a promoter hypermethylation in the development and progression of crc in the kashmiri population and to correlate it with the clinicopathological parameters of crc cases .

hypermethylation of the promoter region of the p16ink4a ( p16 ) gene plays a significant role in the development and progression of colorectal cancer ( crc ) . the aim of the present study was to establish the role of the methylation status of the p16 gene in 114 crc cases and to correlate it with the various clinicopathological parameters . analysis of p16 promoter methylation was performed by methylation - specific pcr . forty - eight ( 42.1 % ) of the crc cases were found to be methylated for the p16 gene in our population . the methylation status was found to be associated with the gender , lymph node status , tumour stage , smoking status and tumour grade of the crc patients . p16 plays a pivotal role in tumour development and progression to advanced stages .

differential lipid composition between the apical and basolateral membrane domains of epithelial cell plasma membranes made it clear that membrane lipids are not laterally distributed in a homogeneous fashion . the lipid raft hypothesis was developed to explain lateral separation of bilayer lipids , and this idea quickly found applications in viral budding , endocytosis , and signal transduction ( reviewed in ) . in model membranes , lipids can separate into microscopically resolvable raft - like domains . plasma membrane surrogates formed by chemical membrane blebbing or cell swelling procedures also show phase behaviour [ 5 - 8 ] . similar domains are not evident upon direct observation of unperturbed plasma membranes in living cells , but the non - equilibrium nature of cell membranes , including endocytosis , exocytosis , and other motile processes , may prevent overt phase separation . likewise , quantitative analysis of lipid - anchored protein and lipid diffusion in cell membranes by fluorescence recovery after photobleaching ( frap ) , frster resonance energy transfer ( fret ) , and fluorescence correlation spectroscopy ( fcs ) [ 9 - 11 ] indicated that rafts in the plasma membrane of resting cells must be very small or ephemeral ( or both ) , forcing an evolution of the lipid raft hypothesis . these tiny clusters do not represent lipid phase separations but are probably short - range ordering imposed upon lipids by transmembrane proteins and cortical actin structures . thus , the current challenge for the field is to understand the interplay between protein and lipid that converts the exceedingly small , unstable clusters of components into larger , more stable membrane microdomains required for function .

evidence in support of the classical lipid raft hypothesis has remained elusive . data suggests that transmembrane proteins and the actin - containing cortical cytoskeleton can organize lipids into short - lived nanoscale assemblies that can be assembled into larger domains under certain conditions . this supports an evolving view in which interactions between lipids , cholesterol , and proteins create and maintain lateral heterogeneity in the cell membrane .

repetitive effortless vomiting is termed as rumination syndrome and is common in infants and mentally retarded individuals . it is associated with considerable morbidity in children who frequently miss the school , have history of multiple hospitalizations , and also suffer significant psychiatric morbidity . unfortunately , before reaching a correct diagnosis , a number of patients undergo unnecessary invasive testing and surgical treatments . symptoms are often confused with that of gastric motility disorders and diagnosis is often delayed due to poor awareness regarding adult rumination syndrome among physicians . here we are presenting a case that posed diagnostic confusion as already mentioned and showed improvement soon after the correct diagnosis was made . the main factors that helped in remission of symptoms were supportive psychotherapy and the firm attitude of the physician .

rumination syndrome is known to exist in infants and mentally retarded adults since long time . in past few years , some reports appeared that showed its existence in adult patients also . it is frequently confused with the intractable vomiting in adults and misdiagnosis leads to delay in appropriate management . we are here describing the case of a female patient with rumination syndrome where specific points in the history delineated the presence of this illness and helped in appropriate management . the patient became symptom free soon after the diagnosis was reached .

methanol has the potential to be an efficient fuel for direct methanol fuel cells ( dmfcs ) with many applications ranging from small portable devices to large stationary power plants . however , one major challenge that dmfc is facing is the fragility of the proton exchange membrane which is very thin in a dmfc . the thickness is typically less than 100 m . a tiny crack or defect could fail the whole fuel cell . ionic liquids ( ils ) can be a replacement of the conventional proton exchange membrane to overcome the risk of fragility . used as the electrolyte , ionic liquids possess many advantages such as high ionic conductivity , chemical stability , and resistance to high temperature . the current generation ionic liquids are stable even in the environment of moisture and air , making them ideal for general use as electrochemical media [ 3 , 4 ] . in developing il - based dmfc , the concentration of methanol must be controlled and monitored at several locations : the fuel feed , the electrolyte , the electrode assembly , and so forth . it is critical to develop a fast sensing technique for methanol in the environment of ionic liquids . in this paper the technique is based on potential step analysis and is reliable even when water is present in the ionic liquids .

the development of direct methanol fuel cells required the attention to the electrolyte . a good electrolyte should not only be ionic conductive but also be crossover resistant . ionic liquids could be a promising electrolyte for fuel cells . monitoring methanol was critical in several locations in a direct methanol fuel cell . conductivity could be used to monitor the methanol content in ionic liquids . the conductivity of 1-butyl-3-methylimidazolium tetrafluoroborate had a linear relationship with the methanol concentration . however , the conductivity was significantly affected by the moisture or water content in the ionic liquid . on the contrary , potential step could be used in sensing methanol in ionic liquids . this method was not affected by the water content . the sampling current at a properly selected sampling time was proportional to the concentration of methanol in 1-butyl-3-methylimidazolium tetrafluoroborate . the linearity still stood even when there was 2.4 m water present in the ionic liquid .

patients who are edentulous in the lower jaw and have to wear lower denture would usually complain of the poor retention . the retention is directly related to the vertical and torsion forces received , in other words , denture resistance against separation force from its sit . denture stability is believed widely to be related to resistance against other forces like oblique and anterior - posterior forces . the patient s satisfaction is directly influenced by the amount of denture retention as it has been shown through several studies [ 24 ] . the need for correcting the patient s problems with faulty denture is an inevitable consequence of retention failure and residual ridge resorption . several different strategies have been introduced to overcome the problem , one of which is the use of dental implants . three distinct methods of prosthetic treatments based on implants in the lower jaw are : implant supported fixed prosthesis ( fp-1 , fp-2 , fp-3 ) removable implant supported overdentures ( rp-4 ) combined implant - tissue supported over - dentures ( rp-5 ) . implant supported fixed prosthesis ( fp-1 , fp-2 , fp-3 ) removable implant supported overdentures ( rp-4 ) combined implant - tissue supported over - dentures ( rp-5 ) . the third of the above mentioned methods has the advantage of reducing the number of implants with a more simplified prosthetic approach . intra - osseous implants are considered as acceptable abutments in conjunction to attachments for efficient retention of the overdentures . factors involved in choosing the type of attachment include available space , maintenance necessity , spare part availability and ease of change , force distribution to the soft tissue or implant and the level of retention . another important fact is the level of wear seen in attachments following the use of overdenture . the aim of this research was to compare the effects of three different attachments ; nobel biocare ball ( nbb ) , nobel biocare bar and clip ( nbbc ) and sterngold era red ( erar ) on the retention and resistance of implant - supported overdentures .

objective : retention and resistance of the implant - tissue supported overdenture may be affected by the type of attachment . the aim of this research was to compare the retention and resistance of nobel biocare ball ( nbb ) , nobel biocare bar and clip ( nbbc ) and sterngold era red ( erar ) attachments on an implant - tissue supported overdenture model.materials and methods : the attachment samples were divided into 3 groups of nbb , nbbc , and erar ( 5 samples in each group ) . two parallel nobel biocare branemark implants were placed symmetrically at the symphysis region of a mandibular test model . a metallic overdenture was fabricated precisely adapted to the model and attached to a zwick testing machine ( crosshead speed of 51 mm / min ) . dislodging tensile forces were applied in three vertical , oblique , anterior - posterior directions and two situations , at the beginning and after 100 times of insertion / removal of the overdenture , for each sample . the maximum dislodging force was measured . a one - way anova test was employed followed by tukey s test.results : erar was the most retentive and resistant in both situations . nbb and nbbc showed the same anterior - posterior resistance at the beginning . all test groups represented a large amount of retention and resistance loss after the insertion / removal of the overdenture , while nbbc showed a higher loss of anterior - posterior resistance than nb.conclusion : a highest level of retention and resistance was seen in erar . the retention and resistance were affected by the wear of attachments .

snapping hip , also known as coxa saltans , is characterized by an audible snapping sound or sensation felt when the hip is in motion , and may be associated with pain1 ) . of different types , external snapping hip is accompanied by popping noise when the posterior border of the iliotibial band slides over the greater trochanter as the hip is flexed or extended , and confirmed a positive ober 's test2 ) . although snapping hip is usually painless , this syndrome may be painful when greater trochanteric bursitis is associated . for most cases , conservative and medical treatment showed good treatment response . when symptoms persist despite different conservative treatment , surgical intervention is considered . surgical treatment options are n - plasty with trochanteric bursectomy , z - plasty and others . although these invasive methods are effective in improving pain and snapping sound , skin incision leaves a large scar and the trendelenburg gait may follow as a complication3,4,5,6,7,8,9,10 ) . ilizaliturri et al.5 ) obtained comparable clinical results compared to open surgical techniques by performing arthroscopic iliotibial band release in 10 patients ( 11 cases ) . however , no literature has been reported on evaluating clinical results of arthroscopy for snapping hip . therefore , this study aimed to indentify benefits of arthroscopic treatment by evaluating clinical results of iliotibial band release and gluteal sling release performed arthroscopically and comparing the results with those of previous studies .

purposethe purpose of this study was to evaluate the clinical outcome of arthroscopic treatment for recalcitrant external snapping hip.materials and methodsbetween september 2011 and june 2013 , we evaluated 7 patients ( 10 cases ) with snapping hip who were refractory to conservative treatments for at least 3 months . two patients ( 4 cases ) were impossible to adduct both knees in 90of hip flexion . surgery was done in lateral decubitus position , under spinal anesthesia . we made 2 arthroscopic portals to operate the patients , and used cross - cutting with flap resection technique to treat the lesion . we performed additional gluteal sling release in those 2 patients ( 4 cases ) with adduction difficulty . average follow - up length was 19 months ( range , 12 - 33 months ) . clinical improvement was evaluated with visual analog scale ( vas ) , modified harris hip score ( mhhs ) , and also investigated for presence of limping or other complications as well.resultsthe vas decreased from 6.8 ( range , 6 - 9 ) preoperatively to 0.2 ( range , 0 - 2 ) postoperatively , and the mhhs improved from 68.2 to 94.8 after surgery . none of the patients complained of post - operative wound problem or surgical complications.conclusionthe clinical outcome of arthroscopic treatment for recalcitrant external snapping hip was encouraging and all patients were also satisfied with the cosmetic results .

mechanical plaque control is largely the responsibility of the individual using toothbrushes and interdental cleaning devices . despite one 's best efforts , mechanical aids fail to adequately remove plaque biofilm , for which chemical plaque control is often recommended as an adjunct to mechanical plaque control to help maintain gingival health . a number of chemical agents like phenolic compounds , bis - biguanides , pyrimidines , quaternary ammonium compounds , oxygenating agents , halogens , heavy metal salts which have antiseptic or antimicrobial action have been used , with variable success , to inhibit plaque formation and the development of gingivitis . chlorhexidine ( chx ) is the most studied and effective antiseptic for plaque inhibition and prevention of gingivitis when used twice daily as mouth rinse . chx besides its side effects including : brown discoloration of the teeth , some restorative materials and mucosa ; bitter taste and a slight increase in supragingival calculus formation is known as gold standard of antimicrobial rinses because of broad - spectrum activity and substantivity of 812 h. in order to overcome such side effects the world health organization advice researchers to investigate the possible use of natural products such as herb and plant extracts . a number of clinical studies have shown the effects of using mouthwashes extracted from herbs such as myrtus communis , qureucus infectoria , capparis spinosa , and cinnamon in the prevention of dental plaque accumulation and subsequent gingival inflammation . there is the minimum evidence that proves the efficacy of herbal mouth rinses and their ability to control plaque - induced gingivitis . thus , the aim of this study was to evaluate the clinical changes after the usage of herbal oral rinse and 0.12 % chx .

background : chlorhexidine ( chx ) is considered as a gold standard of antimicrobial rinses . various herbal oral rinses are available in the market . however , little is known of its effectiveness.aim : the aim of this study was to evaluate the clinical changes after the usage of herbal oral rinse and 0.12 % chx.materials and methods : in a randomized clinical trial , 76 patients with dental plaque - induced gingivitis were assigned to group i ( herbal oral rinse - hiora ) and 76 patients with dental plaque - induced gingivitis to group ii ( 0.12 % chlorhexidine - peridex ) . gingival index and plaque index scores were recorded at baseline and 21 days after scaling.results : intragroup comparison in both groups showed that plaque index and gingival index scores were statistically significant after 21 days as compared to baseline . intergroup comparison showed that plaque index scores and gingival index scores were statistically significant in group ii as compared to group i.conclusion : when herbal oral rinse was compared to 0.12 % chx , 0.12 % chx mouth rinse effectively reduced the clinical symptoms of plaque - induced gingivitis .

neuronal ceroid lipofuscinoses ( ncls ) are a group of progressive neurogenetic disorders . in 1998 , categorized the ncls into five major groups based primarily on age , clinical presentation , histological findings , and genetic loci ; infantile ncl ( incl ) , late infantile / early childhood ncl ( lincl ) , juvenile ncl ( jncl ) , adult ncl and variant , lincl ( vlincl ) . this classification is still widely used . within the last decade , mutations that cause ncl have been found in 14 human genes ( cln1 , cln2 , cln3 , cln4/dnajc5 , cln5 , cln6 , cln7/mfsd8 , cln8 , cln10/ctsd , cln11/grn , cln12/atp13a2 , cln13/ctsf , cln14/kctd7 , clcn6 , and sgsh ) . infantile ncl with cln1 mutation presents with motor disturbances ( ataxia , hypotonia , spasticity ) , visual impairment , seizures , dementia , and familial occurrence . late infantile with cln2 mutation manifests with onset between 2 and 4 years and symptoms of epilepsy , cognitive decline , ataxia , visual failure , and death in between 9 and 18 years . juvenile ncl , with cln3 mutation presents with progressive visual loss , speech and cognitive decline , epilepsy , behavioral disturbances and death in the 3 or 4 decade . however , they are already reclassified on the basis of newer molecular findings , which have provided a far more overlap for the different genetic variants that have previously suggested by the clinical phenotypes . we report three cases with atypical jncl and pertinent issues concerning diagnostic difficulties , ophthalmologic , neuroradiological , and laboratory findings are discussed .

the diagnosis of juvenile neuronal ceroid lipofuscinosis ( jncl ) is usually based on age of onset , initial clinical symptoms , clinical progression , and pathologic findings . our cases manifested atypical clinical symptomatology and/or pathologic findings and therefore , represent variant forms of jncl . case 1 and 2 presented with slow developmental regression from the age of 4 years and became blind and wheelchair bound at around 8 years . pathologic finding of lymphocytes showed fingerprint inclusion which was consistent with jncl . mutational analysis was positive for cln5 which usually presents as variant late infantile ncl ( lincl ) and more common in finnish population . case 3 presented with progressive visual loss from the age of 8 years . clinical symptomatology and age of onset were similar to that of jncl but was found to have low palmitoyl protein thioesterase , granular inclusion body , and cln1 mutation , thus representing milder form of incl . these three cases demonstrated phenotypic - genotypic variations . pertinent issues relating diagnostic difficulties , ophthalmologic , neuroradiological , and laboratory aspects are discussed .

phenolic compounds are the most commonly studied of all secondary metabolites because of their significant concentration and their significant roles in plant tissues [ 1 , 2 ] . this highly diverse group of secondary metabolites widely is distributed in vegetable foods ( legumes , cereals , and fruits ) and beverages ( tea , cider , and wine ) , which are important constituents of the human diet . the rapid degradation of flavonoids during the extraction is a major drawback for the accurate quantification of this ubiquitous group of compounds . because of their importance as potent antioxidants molecules , quantification flavonoids in fruits , vegetable , and other crops are important . they become perishable mainly due to the enzymatic oxidation regulated by the enzyme polyphenol oxidase and light [ 5 , 6 ] . polyphenol oxidase is activated when the plant tissues are macerated and the enzymes get mixed with the substrate and the major parts of the native flavonoids are destroyed before quantification . the sustainability of the tea industry mainly relies on developing new tea ( camellia sinensis , l. ) cultivars incorporated with genetic resistance to biotic and abiotic stresses and capable of producing diverse tea products of desired character . the quality of tea product depends on the chemical composition of fresh tea leaves and the method of manufacture . the chemical composition of tea leaves is determined by the inherent genetic attributes of the accession and geoclimatic factors . currently about 600 germplasm accessions are being maintained in the field gene bank of the tea research institute of sri lanka ( tri ) and these accessions are not adequately evaluated for biochemical , agronomic , and molecular traits [ 11 , 12 ] . most of the earlier attempts concentrated on single metabolite variation of tea cultivars , and work on measurement of a broad range of metabolites is relatively limited . thus , metabolite profiling of representative accessions from the sri lankan tea germplasm by chemical analysis of tea leaves would immensely contribute to the success of a tea breeding programme . the polyphenols , particularly catechins ( flavan-3-ols ) and their oxidation products , which are eventually responsible for the quality of tea , are readily oxidized by polyphenol oxidase enzymes . the collection , handling , and storage of a large number of leaf samples for metabolite profiling thus require a sample preparation procedure that would minimize the oxidation of polyphenols and formation of artifacts . in this backdrop , this research has been carried out with the objective to optimize the sample preparation procedure to minimize the chemical deterioration that takes place in tea flush due to the inevitable delay in analysis . for this purpose , a comparative study has been conducted between the fresh leaves ( conventional procedures ) and freeze - dried leaves ( new sampling method ) , for quantification of some critical metabolites gallic acid , catechins , and methylxanthines , by employing two cultivars , one ( dt1 ) of which is known to yield high quality black tea and the other ( tri2025 ) poor quality black tea .

chemical analysis of the sri lankan tea ( camellia sinensis , l. ) germplasm would immensely contribute to the success of the tea breeding programme . however , the polyphenols , particularly catechins ( flavan-3-ols ) , are readily prone to oxidation in the conventional method of sample preparation . therefore , optimization of the present sample preparation methodology for the profiling of metabolites is much important . two sample preparation methodologies were compared , fresh leaves ( as in the conventional procedures ) and freeze - dried leaves ( a new procedure ) , for quantification of major metabolites by employing two cultivars , one is known to be high quality black tea and the other low quality black tea . the amounts of major metabolites such as catechins , caffeine , gallic acid , and theobromine , recorded in the new sampling procedure via freeze - dried leaves , were significantly higher than those recorded in the conventional sample preparation procedure . additionally new method required less amount of leaf sample for analysis of major metabolites and facilitates storage of samples until analysis . the freeze - dried method would be useful for high throughput analysis of large number of samples in shorter period without chemical deterioration starting from the point of harvest until usage . hence , this method is more suitable for metabolite profiling of tea as well as other phenol rich plants .

severe accidental hypothermia is a condition associated with significant morbidity and mortality . in the years 20092012 the polish national statistics department reported 1836 deaths due to excessive exposure to natural cold . the severe accidental hypothermia center ( clhg centrum leczenia hipotermii glebokiej ) was set up in krakow in 2013 ( darocha , 2015 ) . it is a unit functioning within the structure of the cardiac surgery clinic , established in order to improve the effectiveness of the treatment of patients in the advanced stages of severe hypothermia . the coordination of rescue operations ( over an area of 32,950 square km ) was entrusted to a group of doctors ( 4 coordinators ) , who support the decision - making and organization of the operational process from the time of obtaining the information about the incident until reaching clhg .

abstractdarocha , tomasz , sylweriusz kosinski , maciej moskwa , anna jarosz , dorota sobczyk , robert galazkowski , marcin slowik , and rafal drwila . the role of hypothermia coordinator : a case of hypothermic cardiac arrest treated with ecmo . high alt biol med 16:352 - 355 , 2015.we present a description of emergency medical rescue procedures in a patient suffering from severe hypothermia who was found in the babia gora mountain range ( poland ) . after diagnosing the symptoms of ii / iii stage hypothermia according to the swiss staging system , the mountain rescue service notified the coordinator from the severe accidental hypothermia center ( clhg ) coordinator in krakow and then kept in constant touch with him . in accordance with the protocol for managing such situations , the coordinator started the procedure for patients in severe hypothermia with the option of extracorporeal warming and secured access to a device for continuous mechanical chest compression . after reaching the hospital , extracorporeal warming with ecmo support in the arteriovenuous configuration was started . the total duration of circulatory arrest was 150 minutes . the rescue procedures were supervised by the coordinator , who was on 24-hour duty and was reached by means of an alarm phone . the task of the coordinator is to consult the management of hypothermia cases , use his knowledge and experience to help in the diagnosis and treatment . and if the need arises refer the patient for ecmo at clhg . good coordination , planning , predicting possible problems , and acting in accordance with the agreed procedures in the scheme , make it possible to shorten the time of reaching the destination hospital and implement effective treatment .

pulmonary embolus ( pe ) refers to obstruction of the pulmonary artery or one of its branches by material ( e.g . , thrombus , tumor , air , or fat ) that originated elsewhere in the body . despite the high - incidence of pulmonary embolism , its diagnosis continues to be difficult primarily because of the nonspecific nature of the presenting signs and symptoms . the most common sources of pulmonary embolism are the pelvic veins or deep veins of the thigh . hemodynamically unstable pe results in hypotension , which by definition is systolic blood pressure < 90 mmhg for a period > 15 min or that requiring vasopressors or inotropic support and not explained by other causes including sepsis , arrhythmia , left ventricular dysfunction from acute myocardial ischemia or infarction , or hypovolemia . hemodynamically stable pe is defined as pe that does not meet the definition of hemodynamically unstable pe . majority of the cases of pulmonary embolism can be managed with medical therapy alone . for more than 30 years , thrombolytic agents have been used to dissolve or reduce the embolus and improve the circulation . however , embolectomy is indicated in patients with hemodynamically unstable pe in whom thrombolytic therapy is contraindicated . it is also a therapeutic option in those who fail thrombolysis and surgical intervention may be indicated in certain instances . currently , only few indications for surgical embolectomy have been described which include contraindications to thrombolytic therapy , presence of persistent thrombi in the right heart or pulmonary arteries , or deteriorating hemodynamic status . we report two cases of acute massive pe , which was managed successfully with surgical embolectomy .

acute massive pulmonary embolism is a life - threatening emergency that must be promptly diagnosed and managed . over the last several years , the use of computed tomography scanning has improved the clinician 's ability to diagnose acute pulmonary embolism . we report two cases of acute massive pulmonary embolism who presented with sudden onset of dyspnea and underwent successful open pulmonary embolectomy . the first case presented with acute onset of dyspnea of 2 days duration , in view of hemodynamic deterioration and two - dimensional echocardiography , it revealed clot in right ventricular ( rv ) apex and right pulmonary artery ; the patient underwent cardiopulmonary bypass and open pulmonary embolectomy with rv clot extraction . the second case presented with a sudden onset of dyspnea on the 15th postoperative day for traumatic rupture of urinary bladder , in view of recent surgery , the patient was subjected to surgical embolectomy . following surgical intervention , both the patients made a prompt recovery .

the symptoms of malaria include fever and anemia , and most of the deaths are caused by the parasite plasmodium falciparum . the merozoite form of the parasite invades red cells , grows to form ring- , trophozoite- and schizont stages , and after rupture of the infected red cell new merozoites are released that are ready to enter uninfected red cells . merozoite invasion is a process that takes only a few minutes , but it involves several complex receptor - ligand interactions . initial attachment of the merozoite is mediated by merozoite surface proteins such as msp1 and msp2 , and is followed by reorientation of the merozoite where apical membrane antigen 1 ( ama1 ) is of importance [ 4 , 5 ] . other ligands such as erythrocyte - binding antigens ( ebas ) , for example , eba140 , eba175 , and eba181 and p. falciparum reticulocyte - binding homologues ( pfrhs ) , including pfrh1 , pfrh2 , pfrh4 , and pfrh5 have also shown to be involved in the invasion process [ 69 ] , even though the exact function of each antigen is not known . genetic polymorphisms exist for many of the above - mentioned ligands , and based on some genes like msp2 , parasites can be grouped into two major allelic types : 3d7 and fc27 . serine repeat antigens ( seras ) are proteases that take part in forming a protein complex that is associated with the merozoite surface [ 1012 ] , and entry into the red blood cell is finally completed by an actin - myosin motor movement [ 13 , 14 ] . individuals who live in malaria endemic areas eventually develop immunity , but only slowly and after repeated exposure [ 15 , 16 ] . women have a greater risk of succumbing to malaria , and the fetus is also at risk . it is known that antibodies are important in the defence against malaria , and it has been shown that passive transfer of antibodies from immune donors to individuals with p. falciparum infection reduces parasitemia and clears clinical symptoms [ 1821 ] . however , exactly which specific antibodies are protective against future disease are not yet defined , and how they should be measured is even less clear . this information is urgently needed to be able to develop a functioning vaccine , something that has so far failed . we will here discuss the pros and cons for different methods available such as elisa , invasion inhibition assays ( iias ) , antibody - dependent cellular inhibition ( adci ) , and affinity , and we compare it to measurements of antibodies in other diseases and how the overall evaluation of immunity or vaccine status of malaria could possibly be improved .

immunity against malaria develops slowly and only after repeated exposure to the parasite . many of those that die of the disease are children under five years of age . antibodies are an important part of immunity , but which antibodies that are protective and how these should be measured are still unclear . we discuss the pros and cons of elisa , invasion inhibition assays / adci , and measurement of affinity of antibodies and what can be done to improve these assays , thereby increasing the knowledge about the immune status of an individual , and to perform better evaluation of vaccine trials .

dermoscopy is a valuable noninvasive technique that increases diagnostic accuracy in melanoma and non - melanoma skin cancer [ 1 , 2 ] . recently , its use as an aid in the monitoring of topical treatment response has also been described [ 24 ] . basal cell carcinoma ( bcc ) is the most frequent type of skin cancer in humans . surgical excision is still considered the gold - standard of treatment . however , a number of topical therapies are now available for the treatment of different types of basal cell carcinoma . despite the fact that bcc is associated with a low mortality and very rarely gives rise to metastatic disease , delays in its correct diagnosis and treatment prolong patient morbidity and increase the cost of care . dermoscopy has also shown to be useful in the assessment of early recurrence or tumor persistence . dermoscopic criteria such as pigmented structures , ulceration and arborizing vessels have been suggested to predict the presence of residual disease ( residual disease - associated dermoscopic criteria ) [ 4 , 5 ] . this case report exemplifies the usefulness of dermoscopy in the assessment of residual disease after incomplete surgical excision and also in the monitoring of topical treatment response .

introductiona relatively novel application for dermoscopy is its use in the monitoring of topical treatment response for non - melanoma skin cancer . basal cell carcinoma ( bcc ) is the most frequent type of skin cancer in humans . surgical excision is still considered the gold - standard of treatment . however , a number of topical therapies are now available for the treatment of different types of basal cell carcinoma.case reportthis case report exemplifies the usefulness of dermoscopy in the monitoring of residual disease after incomplete surgical excision and also in the monitoring of topical treatment response . imiquimod 5 % cream acts as a topical immune response modifier promoting a th-1 immune response enhancing the removal of neoplastic cells and has proven to reduce deregulated hedgehog ( hh ) /gli signal strength independent of toll - like receptor signaling , which makes it a valuable adjuvant topical therapy for the treatment of basal cell carcinoma.conclusionimiquimod 5 % cream is a valuable adjuvant therapy for the treatment of incompletely excised bcc . this case report adds further evidence to the usefulness of dermoscopy in the assessment and monitoring of treatment outcome.electronic supplementary materialthe online version of this article ( doi:10.1007/s13555 - 015 - 0088-z ) contains supplementary material , which is available to authorized users .

extra - hepatic hepatoid carcinomas are a rare group of aggressive tumors with clinical and pathologic features that closely resemble hepatocellular carcinoma ( hcc ) . they may arise in many areas outside of the liver including lungs , bladder , kidneys , uterus and ovaries , but most commonly in the stomach ( young et al . hepatoid carcinoma of the ovary ( hco ) is reported mainly in post - menopausal women with unilateral or bilateral ovarian masses and elevated serum alpha - fetoprotein ( afp ) . microscopically , these tumors demonstrate cells arranged predominantly in sheets and contain moderate to abundant amount of eosinophilic cytoplasm with pleomorphic nuclei ( lefkowitch , 1988 ) . these tumors must be distinguished from metastatic hcc and other afp - producing ovarian tumors including hepatoid yolk sac tumors ( hysts ) , sertoli leydig cell tumors , and dysgerminomas ( matsuta et al . , 1991 ) .

primary hepatoid carcinoma of the ovary ( hco ) is a rare aggressive tumor that typically presents at an advanced stage in postmenopausal women with unilateral or bilateral ovarian masses and elevated afp and ca125 . we report a case of hco in a 73 year - old woman who presented with abdominal distention , weight loss , and a large lower abdominal mass . postoperative serum afp was markedly elevated and trended down with initiation of chemotherapy . review of the literature revealed thirty - two reported cases with no consensus on histogenesis or consistent immunohistochemical profile other than positive afp staining in all but one case . although the optimal treatment has not yet been determined , tumor debulking surgery followed by a platinum and taxane based chemotherapy regimen has shown promise . both serum afp and ca125 appear to have prognostic value and can be used to follow response to treatment and screen for recurrence .

langerhans cell histiocytosis ( lch ) is a rare neoplastic disease of antigen - presenting cells , with an incidence rate of 4.05.4/1 million individuals . the most frequent sites of occurrence are skin , bone , central nervous system ( cns ) . computed tomography ( ct ) , magnetic resonance imaging ( mri ) , ultrasonic scan ( uss ) are mainly for the individual part , while multiple systems involvement need the whole body imaging . we present an unusual case of lch of the primary thyroid gland , which was confirmed by fine needle aspiration cytology . in addition to the thyroid gland , 18f - fluorodeoxyglucose ( 18f - fdg ) positron emission tomography ( pet ) /ct discovered multiple organs involvement such as pituitary stalk , maxillofacial skin lesion , lungs , and skull .

langerhans cell histiocytosis ( lch ) is a rare clonal proliferative disease , with an incidence rate of 4.05.4/1 million individuals . lch encompasses a spectrum of disorders with diverse clinical presentations ranging from a single organ to multiple organ involvement . lch rarely involves the thyroid gland . we presented a case with lch of thyroid gland . the patient had painless progressive neck enlargement and then diabetes insipidus . ultrasonic scan and magnetic resonance imaging scan revealed nodular goiter and pituitary stalk enlargement , respectively . histopathological analysis revealed features of histiocytoid cells . 18f - fluorodeoxyglucose ( 18f - fdg ) positron emission tomography / computed tomography ( pet / ct ) was performed in order to rule out the presence of whole body infiltration . 18f - fdg pet / ct also demonstrated increased uptake in the thickening pituitary stalk and maxillofacial skin lesion , in addition to the bilateral thyroid nodules , ct showed the left lung nodule and the skull destruction without 18f - fdg uptake . this report emphasizes the role of 18f - fdg pet / ct in multiple organs involvement of patients with lch .

major depressive disorder ( mdd ) is the most common mood disorder with a significant effect on the progression of medical conditions.1 factors accompanying depression , such as patients ' failure to look after their health , inability to adapt to their environment , social dissociation , chronic stresses of life , cigarette smoking , reduced physical activity , inappropriate nutrition and poor compliance with medical advice , make depression one of the risk factors of noncommunicable diseases.2 in addition to the effect of depression on lifestyle , the direct effect of depression on metabolic factors has been shown in many studies.3 recently , a relationship has been observed between depression and serum levels of lipoproteins and apolipoproteins ( apo ) , which are known risk factors of obesity and cardiovascular diseases.4 one theory of this relationship suggests a disturbance in function of the serotonergic system . in addition , metabolic changes in patients with mdd are due to genetic changes in the coding of serum lipoproteins.5 other theories describe changes in interleukin 2 , number of total tcells , melatonin and other cytokines in depressed patients.6 - 8 despite these studies , controversy exists about the relationship between depression and the lipid profile . studies have shown different results for the level of apo a one of the highdensity lipoprotein cholesterol ( hdlc ) subgroups , and of apo b the major protein of lowdensity lipoprotein cholesterol ( ldlc ) , in patients with mdd.4,9,10 sevincok and sarandol showed that the serum level of apo a in depressed patients was lower than that in control group.4,9 another study showed no significant difference in the serum levels of apolipoproteins between depressed patients and the control group.11 the lack of evidence and controversial results of previous studies led us design this study to compare the serum levels of apolipoproteins in depressed patients and normal individuals .

objective : to investigate the relation between major depressive disorder and metabolic risk factors of coronary heart disease.introduction : little evidence is available indicating a relationship between major depressive disorder and metabolic risk factors of coronary heart disease such as lipoprotein and apolipoprotein.methods : this case control study included 153 patients with major depressive disorder who fulfilled the criteria of the diagnostic and statistical manual of mental disorders , fourth edition ( dsmiv ) , and 147 healthy individuals . all participants completed a demographic questionnaire and hamilton rating scale for depression . anthropometric characteristics were recorded . blood samples were taken and total cholesterol , high and lowdensity lipoproteins and apolipoproteins a and b were measured . to analyze the data , ttest , 2 test , pearson correlation test and linear regression were applied.results : depression was a negative predictor of apolipoprotein a ( = 0.328 , p < 0.01 ) and positive predictor of apolipoprotein b ( = 0.290 , p < 0.05 ) . apolipoprotein a was inversely predicted by total cholesterol ( = 0.269 , p < 0.05 ) and positively predicted by highdensity lipoprotein ( = 0.401 , p < 0.01 ) . also , lowdensity lipoprotein was a predictor of apolipoprotein b ( = 0.340 , p < 0.01 ) . the severity of depression was correlated with the increment in serum apolipoprotein b levels and the decrement in serum apolipoprotein a level.conclusion : in view of the relationship between apolipoproteins a and b and depression , it would seem that screening of these metabolic risk factors besides psychological interventions is necessary in depressed patients .

osteoporosis is defined as a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fractures associated with chronic pain , disability , and mortality 1 . osteoporosis is caused by a disturbance of the number or activity of osteoclasts , resulting in inappropriately high bone resorption , which exceeds the capacity of osteoblasts . bone strength is an integration of bone density and bone quality , and bone mineral density ( bmd ) accounts for approximately 70 % of bone strength 1,2 . osteoporosis has become a significant public health problem throughout the world , and the identification of risk factors related to osteoporosis is important to predict and prevent this disease . estrogen maintains a balance between osteoclastic and osteoblastic activity , and bone remodeling increases when estrogen levels decline 3 . hormone levels are the main determinants of bone density ; however , other factors such as smoking , excessive alcohol consumption , lean body mass , low levels of physical activity , and the presence of other medical conditions , including chronic renal disease , hyperparathyroidism , hyperthyroidism , and diseases requiring systemic corticosteroid use , also increase the risk of osteoporosis 4 - 6 . a variety of neoplasms without bone metastasis are also known to be related to osteoporosis by producing circulating bone resorption stimulatory factors , leading to bone destruction and hypercalcemia 7 - 12 . in patients with gynecologic cancers , reduced spinal bmd has been reported in patients with cervical cancer 13,14 , but no significant differences were found in spinal or femoral bmd between patients with endometrial cancer and controls 15 . we hypothesized that hormone - dependent tumor , at least endometrial cancer , may preserve the bmd , contrary to cervical cancer . the aims of the present study were to compare the bone turn - over markers , bmd , and frequency of osteoporosis or osteopenia at the lumbar spine and femur between patients with cervical or endometrial cancer and controls . furthermore , we compared the bone turn - over markers and bmd base on their cancer stages .

objective : to evaluate the bone mineral density ( bmd ) in the lumbar spine and femur in postmenopausal women with cervical cancer and endometrial cancer without bone metastasis in comparison with that in healthy control postmenopausal women , and to assess the loss of bmd according to the cancer stage.materials and methods : we analyzed the bmd of the lumbar spine and femur using dual - energy x - ray absorptiometry ( dxa ) in 218 patients with cervical cancer , 85 patients with endometrial cancer , and 259 healthy controls . the serum levels of calcium ( ca ) , phosphorus ( p ) , osteocalcin ( osc ) , and total alkaline phosphatase ( alp ) , and urine deoxypyridinoline ( dpl ) were measured in all participants.results : age , body mass index , parity , and time since menopause were not significantly different between the three groups . serum ca level was higher in the cervical cancer group ( p = 0.000 ) , however , urine dpl was lower in endometrial cancer group ( p = 0.000 ) . the t - scores of basal bmd at the second and fourth lumbar vertebra ( l2 , l4 ) were significantly lower in patients with cervical cancer ( p = 0.038 , 0.000 , respectively ) compared to those in the healthy control groups . additionally , the incidence of osteoporosis and osteopenia basal status of bone mass was significantly higher in patients with cervical cancer compared to that in controls ( p = 0.016 ) . no differences in basal bmd of the lumbar spine and femur were observed between patients with cervical cancer according to their stages.conclusion : our results suggest that postmenopausal women with cervical cancer have a lower bmd and are at increased risk of osteoporosis in the lumbar spine before receiving anticancer treatment compared with postmenopausal women with endometrial cancer .

respiratory distress continues to account for significant mortality and morbidity in the neonatal intensive care unit . at birth , respiratory distress syndrome ( rds ) in premature infants is caused by a structural immaturity of lungs and the insufficient production of surfactant and its incidence is inversely related to gestational age . the problems concerning to the respiratory system prolonge the hospitalization period in the premature infants . endothelin ( et ) is a peptide of 21 amino acids in chain with two disulfide bonds with three distinct isoforms : et-1 , et-2 , and et-3 . endothelin causes isolated contraction of pulmonary veins , vascular smooth muscle mitogenesis , myocardial cell hypertrophy , positive innotropic and chronotropic effects , bronchoconstriction , mucous secretion , cellular proliferation , and inflammatory reactions . hypoxia , stress , antidiuretic hormone , and the secretion of some mediators stimulate its synthesis . clinical investigations have shown increased plasma concentrations of et-1 during rds and in case of pulmonary hypertension of other origins . but it is unclear whether et-1 is actually responsible for the pulmonary hypertension , or the increased et-1 plasma concentration is a result of the pulmonary hypertension that originated otherwise [ 58 ] . also transforming growth factor beta ( tgf- ) is a family of three isoforms that regulate cell growth and differentiation , extracellular matrix sythesis cytokines production , and vascular neogenesis . the increase in tgf- precedes the development of pulmonary hypertension which increases circulating et-1 levels in animals . tgf- induces et-1 gene expression and et-1 peptide synthesis in bovine pulmonary artery endothelial cells [ 10 , 11 ] . the cells responsible for increased et-1 sythesis during hypoxia are unclear , and short - term effects of hypoxia raise plasma et-1 levels in animal models ; whether chronic hypoxia would lead to different results is unknown . experimental studies have suggested that et-1 plays an important role in pulmonary vascular reactivity in neonatal rds . there is also an elevation of et-1 in tracheal aspirates from these infants . tgf- showed the strongest stimulatory effect on et-1 and gene transcription in vascular smooth muscular cells . there are few studies measuring et-1 and no study measuring tgf- by enzyme immunoassay with a very small number of human premature newborns suggesting that et-1 is elevated in rds . the purpose of this present study is to evaluate the serum levels of et-1 and tgf- in the newborns with respiratory distress ( diagnosis as rds , as transient tachypnea ( rds-2 ) , and as meconium aspiration syndrome ( mas ) ) , to investigate the meaningfulness of the repetitive values of et-1 in the followup of these diseases , and to determine the reflection of serum et-1 level on the mortality at the first six hours after birth .

the purpose of this present study was to evaluate the serum levels of et-1 and tgf- in the newborns with respiratory distress . in this study , newborns with respiratory distress hospitalized into the newborn intensive care unit were included . the highest values of et-1 and tgf- were obtained from newborns with diagnosis as meconium aspiration syndrome ( 5.70 5.87 pg / ml and 3.75 1.94 pg / ml , resp ) in the sample obtained in the first six hours after birth , and these are statistically different from control group ( p < .05 ) . also , same results were obtained for newborns with respiratory distress syndrome ( 3.37 1.59 pg / ml and 2.05 0.98 pg / ml , resp ) . after oxygen treatment , et-1 values obtained in the first six hours of life were decreased regularly in the following days ( p < .05 ) . in the differentiating diagnosis of the respiratory distress of newborns , the investigation of et-1 and tgf- levels is meaningful . the et-1 levels investigated in the first six hours is more useful in determining the prognosis , and repeating et-1 levels in the following days is more meaningful to determine clinical response .

thyroid cancer is the 10th commonest cause of cancer in russian women , and the age - specific incidence of thyroid cancer has been on the rise . while most thyroid cancers have a good prognosis , those that show tracheal invasion often show poor survival because of extensive resection or tumor recurrence . surgical intervention is the key point of treatment , and appropriate surgical planning is essential to get a promising prognosis , postsurgical quality of life , and social rehabilitation of a patient . despite an increasing role of nonadjuvant radiotherapy and/or chemotherapy in the treatment of thyroid cancer , the surgical approach is still used when recurrence is treated after radiotherapy / chemoradiotherapy or in the case of combined treatment of patients with thyroid papillary carcinoma invading the trachea . the extensive resection that may be necessary for locally invasive thyroid cancer has led some surgeons to attempt to conservatively approach these tumors using peeling or shaving techniques aiming at preserving function [ 2 , 3 ] . such conservative approaches rely on the administration of postoperative radioactive iodine with / without external beam radiotherapy to manage a microscopic disease . many patients with locally advanced thyroid cancer tend to be older patients with more poorly differentiated histologic variants . tumors in such patients can be nonradioactive iodine avid , and the response to radioactive iodine therapy can be disappointing . recently , the importance of sparing surgery has also increased in clinical head and neck oncology . it fully applies , for instance , to the treatment of patients with laryngeal cancer . better functional and cosmetic result for a patient should also be an objective . in this report , we present a patient with advanced thyroid papillary carcinoma involving the trachea , who has previously undergone total thyroidectomy followed by radioactive iodine therapy in 2012 . the first one was a window resection of the trachea followed by an open tracheostomy , and the formed knitted tini - based mesh endograft ( ktnme ) , as reported by muhamedov et al . the second stage was the reconstruction of the large tracheal defect with the harvested endograft and the skin draping over the wound .

published reports on salvage treatment for trachea reconstruction after total thyroidectomy or partial tracheotomy are available , some of them using structures of the trachea itself , auricular cartilage , a musculocutaneous flap , or other methods . in our report , we emphasize the importance of a search for a new material and approach for sparing surgery . the purpose of this article is to describe a case of a successful sparing surgery in a patient with advanced thyroid papillary carcinoma invading the trachea . after total thyroidectomy in 2012 , partial resection of the trachea was performed in 2014 . the lesion defect was 5.5 2.3 cm in size , located between 4 ( 2nd6th ) tracheal cartilaginous rings and involving about a semicircumference . it was reconstructed with the aid of the knitted tini - based mesh endograft , which has been prefabricated in the sternocleidomastoid muscle and further covered with the skin draped over the wound . the tracheostoma was fully closed 6 weeks after the surgery . there were neither side effects nor complications . this kind of tracheal surgery for extensive lesions demonstrates good functional and cosmetic outcomes .

in the recent past , even many historians of medicine and science have endorsed the widespread belief that the exodus of central european scientists and physicians during the nazi period could readily be described in terms of a linear equation of the subtractions and additions of intellect . this common interpretation has simplistically viewed the massive exodus of academics , intellectuals , and scientists after 1933 as an enrichment primarily of the north american and british medical and academic communities ( see medawar & pyke , 2001 or cornwell , 2003 , for example ) . although such a perspective is not entirely wrong when a rather quantitative meta - perspective is taken , it becomes less compelling when the individual biographies of the respective physicians and scientists themselves are taken into account and are placed in their contingent work environments . this includes their work situations , skill sets , along with the personal and psychological resources of each migr neuroscientist ( cf . this contribution introduces some of those local and cultural factors which implicated the arrival , acceptance , and integration of many german - speaking migrs doctors and brain researchers into canada , following their exile between 1933 and 1945 , which have largely gone unnoticed by the relevant scholarship on twentieth - century history of neuroscience . when tracing their career paths into the 1960s , during which the scientific research landscapes in canadian biomedicine gradually came to change with the creation of the medical research council ( mrc ) , the complex cultural modes and scientific interchanges associated with the forced migration process become fairly obvious ( mrc , 2000 ) . as the main title ( learning soft skills the hard way ) of this article implies , the integration of german - speaking migrs neuroscientists can not simply be perceived in terms of a supplementation of longstanding north american scientific traditions but needs to be viewed as a very complex process of acculturation on multiple levels of the social and cultural organization of contemporary canadian and american research landscapes . it is further more of a seemingly modern interest in the cultural makeup of science to analyze and understand the process of forced migration in the neuroscientific field while mapping the often drastic changes that took place to the career patterns of this particular group of medical professionals ( zeidman , 2014 ) . based on the existing historical evidence , the traditional views on the forced migration process in the neurosciences and psychiatry need to be significantly readjusted and refined .

abstractthis article is a historiographical exploration of the special forms of knowledge generation and knowledge transmission that occur along local cultural boundaries in the modern neurosciences . following the inauguration of the so - called law on the re - establishment of a professional civil service in nazi germany on april 7 , 1933 , hundreds of jewish and oppositional neurologists , neuropathologists , and psychiatrists were forced out of their academic positions , having to leave their home countries and local knowledge economies and traditions for canada and the united states . a closer analysis of their living and working conditions will create an understanding of some of the elements and factors that determined the international forced migration waves of physicians and clinical neuroscientists in the twentieth century from a historiographical perspective . while i am particularly looking here at new case examples regarding the forced migration during the national socialist period in germany , the analysis follows german - speaking migr neurologists and psychiatrists who found refuge and settled in canada . these individuals form an understudied group of refugee medical professionals , despite the fact that the subsegments of refugee neurologists and clinical psychoanalysts in the united states , for example , have been a fairly well - investigated population , as the works of grob ( 1983 ) , lunbeck ( 1995 ) , or ash and soellner ( 1996 ) have shown . this article is primarily an exploration of the adjustment and acculturation processes of several highly versatile and well - rounded german - speaking physicians , who had received their prior education in neurology , psychiatry , and basic brain research . they were forced out of their academic home institutions and had to leave their clinical research fields as well as their disciplinary self - understanding behind on the other side of the atlantic .

acne vulgaris is a very common chronic inflammatory disease of the pilosebaceous glands , which may occur with comedones , papules , pustule forms , cysts , nodules , and scarring in different area of the body , especially face . without proper treatment , it can cause scarring and hyperpigmentation . the prevalence of acne is very different in various countries ; ranging from 0 to over 90 % . according to the estimates of the us census bureau international data base ( 2004 ) , among 68 million iranians , approximately its importance should not be ignored because the disease can cause many psychological and social effects for the patient such as low self - esteem , social withdrawal , depression , anxiety , and embarrassment . four main factors involving in the pathogenesis of acne are the production of sebum , severe keratinized ( horny ) of the pilosebaceous duct , disruption of microbial flora , particularly propionate acne bacteria and inflammation . no topical drug has been found to be effective on all these factors , and there is no treatment for complete and permanent improvement of acne . therefore , it seems logical to investigate for simple , uncomplicated and yet effective treatment . chemical peeling was used in different communities for centuries . currently , the most commonly used superficial peelings are glycolic acid , tri - chlorine acetic acid , salicylic acid , pyruvic acid , resorcinol , and solid carbon dioxide . pyruvic acid ( ch3-co - cooh ) is -kato acid with properties such as keratolytic , antimicrobial , the ability to stimulate collagen building , and formation of elastic fibers . pyruvic acid efficacy is known for the treatment of many skin diseases such as acne , superficial scars , photo - damage , and pigment disorders . this study was designed to assess the effect of adding 50 % pyruvic acid compared to 30 % salicylic acid on the treatment of acne .

background : acne vulgaris is a chronic inflammatory disease of the pilosebaceous follicles and one of the most common skin diseases . the peeling method has been recently found to be effective for acne treatment . this study aimed to compare the efficacy of pyruvic acid 50 % and salicylic acid 30 % peeling in the treatment of mild to moderate acne.materials and methods : in a prospective single - blinded clinical trial , 86 patients with acne were randomly assigned into two groups . in both groups , the routine treatment of acne ( topical solution of erythromycin 4 % , triclorocarban soap , and sunscreen ) were used twice a day for 8 weeks . in addition , salicylic acid 30 % for the control group and pyruvic acid 50 % for the case group were used . in both groups , acne severity index ( asi ) was calculated before and at week 2 , 4 , 6 , and 8 of the treatment . patient satisfaction was assessed at the end of the treatment . side effects were recorded using a checklist.results : in both groups , the reduction in the number of comedones , papules , and asi were statistically significant ( p < 0.001 ) in the course of treatment . however , it was not significant regarding the number of pustules ( p = 0.09 ) . none of the number of comedone , papules , pustules , and asi was statistically different between study groups . both treatment groups had similar side effects except for scaling in the fifth session , which was significantly lower in salicylic acid treated patients ( p = 0.015 ) .conclusion : both pyruvic acid 50 % and salicylic acid 30 % are effective in the improvement of mild to moderate acne with no significant difference in efficacy and side effects .

hermansky and pudlak reported in 1959 two cases of unrelated albinos with lifelong bleeding tendency and peculiar pigmented reticular cells in the bone marrow as well as in lymph nodes and liver biopsies . one albino was female and the other was male , both were 33 years old . after her death , autopsy revealed horseshoe kidney with large amount of pigment in reticuloendothelial cells and in the walls of small blood vessels . hermansky - pudlak syndrome ( hps ) is an autosomal recessive disorder that is caused by different genetic mutations . this syndrome is characterized by oculocutaneous albinism , platelets storage - pool deficiency , and lysosomal accumulation of ceroid lipofuscin . these patients have decreased skin and hair pigmentation and transillumination of the iris with markedly decreased visual acuity . patients with hps have easy bruisability , secondary to the absence of platelet dense bodies , which trigger platelet aggregation . ceroid lipofuscin is an amorphous lipid protein complex , and its accumulation in tissues is believed to be responsible for pulmonary fibrosis and granulomatous colitis . this ceroid lipofuscin also accumulates in the kidney , giving it a dark appearance when examined during an autopsy or kidney biopsy [ 4 , 5 ] . although no specific renal disease has been attributed to hps , compromised renal function in these patients has been reported [ 1 , 4 ] . renal insufficiency has been thought to occur due to the ceroid lipofuscin deposition in the kidney . gahl et al . reported a series of 49 patients with hsp , of which 9 had ckd ; however , no kidney biopsies where performed and there is no information about the proteinuria and hypertension in any of the above reports . to our knowledge , we report the first pediatric renal pathology case of hps associated with ckd , tubular pathology , focal segmental glomerulosclerosis ( fsgs ) , and hypertension .

we report a child with hermansky - pudlak syndrome ( hps ) and chronic kidney disease ( stage ii ) with histological diagnosis of focal segmental glomerulosclerosis ( fsgs ) . a 15-year - old male of puerto rico ancestry with history of hps , hypertension ( htn ) , asthma , obesity , and chronic kidney disease ( ckd ) stage ii presented with new - onset proteinuria without edema . his blood pressure had been controlled , serum creatinine had been 0.91.4 mg / dl , and first morning urine protein / creatinine ratio ( upc ) ranged from 0.2 to 0.38 . due to persistent nonorthostatic proteinuria with ckd , renal biopsy was performed and fsgs ( not otherwise specified ) with chronic diffuse tubulopathy ( tubular cytoplasmic droplets ) and acute tubular injury was reported . ceroid - like material is known to infiltrate tissues ( i.e . , lungs , colon , and kidney ) in hps , but the reason for the renal insufficiency is unknown . nonspecific kidney disease and in one adult case iga nephropathy with anca - positive glomerulonephritis have previously been reported in patients with hermansky - pudlak syndrome . to our knowledge , we report the first pediatric renal pathology case of hps associated with ckd . this paper discusses presentation and management of renal disease in hps .

the choroid is a vessel - rich structure located between the lamina fusca of the sclera and the retinal pigment epithelium . choroidal thickness ( ct ) is thought to indicate the amount of choroidal vascularization and varies by age , sex , axial length ( axl ) , refractive status , and circadian rhythm.1,2 the choroid is reported to play a role in many vision - threatening diseases such as choroidal neovascularization , polypoidal choroidal vasculopathy , central serous chorioretinopathy , and chorioretinal atrophy associated with high myopia.36 thus , choroidal structural alterations are increasingly evaluated in scientific studies to understand the pathophysiology of these critical diseases . phacoemulsification surgery is the most frequently performed eye surgery , especially at advanced ages , and is generally associated with good visual outcomes . however , cataract surgery is known to have adverse effects on the retina , such as progression in diabetic retinopathy and pseudophakic cystoid macular edema , and the pathogenesis of such conditions is not yet clarified.7,8 also , epidemiological studies show that cataract surgery is associated with the onset of age - related macular degeneration ( amd ) , although the association is still controversial.9 the development of amd may be induced after cataract surgery due to reasons such as inflammatory reactions associated with cataract surgery , increased free radicals after surgery , the release of growth factors and prostaglandins , and increased light exposure during surgery.1014 amd is a serious disease , threatening vision due to neovascularizations arising from the choroid . an increment in the retinal thickness was reported after cataract surgery even in healthy eyes with no detected morphological impairment using spectral domain optical coherence tomography ( sd - oct ) .15 given the close link between the retina and choroid , affected change in ct might also be expected after cataract surgery . evaluation of choroid has been restricted to ultrasonography and angiography previously , while the choroid can be examined in detail with sd - oct . sd - oct provides detailed histological sectional images of the retina in vivo and provides useful information for the diagnosis , evaluation of the treatment options , and follow - up of several retinal diseases.16 the present study aims to examine the possible alterations in the ct after uncomplicated phacoemulsification surgery using sd - oct and to investigate the potential mechanisms that may cause such changes .

purposethe aim of the study was to analyze the effects of uneventful phacoemulsification surgery on choroidal thickness ( ct ) using spectral domain optical coherence tomography ( sd - oct ) .methodsin this prospective study , 38 eyes of 38 patients having phacoemulsification surgery were included . all patients underwent detailed ophthalmologic examination , including preoperative axial length ( axl ) measurement with optical biometry and intraocular pressure ( iop ) measurement preoperatively and 1 month postoperatively . the ct was measured perpendicularly at the fovea and 1.5 mm temporal , 3.0 mm temporal , 1.5 mm nasal , and 3.0 mm nasal using sd - oct preoperatively and 1 month postoperatively . changes in the ct after surgery and correlation of this change with age , axl , preoperative iop , and iop change were evaluated.resultsthere was a statistically significant increase in the ct at all regions evaluated . this increment was more prominent in the nasal and subfoveal regions . the iop decreased significantly 1 month after surgery ( 16.144.94 mmhg vs 13.914.86 mmhg ; p < 0.001 ) . the change in iop was correlated with the ct changes at all regions , whereas age , axl , and preoperative iop had no significant correlations with the changes in ct.conclusionphacoemulsification surgery may cause significant increase in ct , which is correlated with surgery - induced iop change in the short term . long - term follow - up of eyes having phacoemulsification surgery may provide further insight into the effects of cataract surgery on the choroid .

the prevalence of nephrolithiasis is 5 % to 20 % and varies with age , sex , race , and area of residence . nephrolithiasis is usually asymptomatic but the attacks can be painful and morbid , requiring an emergency medical visit and surgery . the focus on nephrolithiasis has shifted from these direct hazards to its effects , such as vascular events . nephrolithiasis and systemic diseases have been linked in several epidemiological studies , including coronary heart disease ( chd ) , hypertension , diabetes , atherosclerosis , and metabolic syndrome . ferraro et al demonstrated an association between kidney stones and an up to 1.48-fold higher risk of chd in prospective cohorts of women . atherosclerosis is the risk factor for chd and stroke , patients with nephrolithiasis might have a high stroke risk . domingos et al reported that patients with nephrolithiasis did not have a higher incidence of stroke than those without nephrolithiasis did . however , in their questionnaire - based study , adjustment for major confounders of stroke , such as hypertension , diabetes , and hyperlipidemia , was challenging in the absence of formal medical documentation . thus , a nationwide population database was used to assess the association of nephrolithiasis with stroke risks in a cohort study with a 13-year follow - up .

abstractnephrolithiasis is highly prevalent and has been associated with vascular diseases such as cardiovascular events . few studies have comprehensively associated renal stones with stroke.this study explored whether patients with renal stones were at a higher stroke risk than those without renal stones . a national insurance claim dataset of 22 million enrollees in taiwan was used to identify 53,659 patients with renal stones , and 214,107 were selected as age- , sex- , and comorbidity - matched controls for a 13-year follow-up.the relative stroke risk for the rs cohort was 1.06-fold higher than that for the non - rs group ( 95 % confidence interval [ ci ] = 1.011.11 ) . age - specific analysis revealed that the adjusted stroke risk for the rs cohort increased as age decreased , with the highest risk of 1.47-fold ( 95 % ci = 1.101.96 ) in patients aged 20 to 34 years , followed by a 1.12-fold risk ( 95 % ci = 1.001.25 ) in patients aged 35 to 50 years . sex - specific analysis clarified that women in the rs group had a 1.12-fold stroke risk compared with women in the non - rs group ( 95 % ci = 1.031.21 ) . patients who had undergone > 4 surgeries had up to 42.5-fold higher risk of stroke ( 95 % ci = 33.853.4 ) .the study utilized the national database and demonstrated that patients , particularly women and the younger population , with nephrolithiasis have an increased risk of ischemic stroke development . patients treated with medication or through surgery for rss showed steady and higher risks of stroke than those without surgical or medical intervention .

chronic hepatitis b virus ( hbv ) infection is a significant public health threat . approximately 3 - 4 billion people worldwide have been infected with hbv . the natural course of chronic hbv infection is variable , ranging from an inactive hbsag carrier state to a progressive chronic hepatitis which may eventually lead to cirrhosis and hepatocellular carcinoma ( hcc ) . previous research has shown that patients with persistent hbeag - positive state and high dna viral load ( > 10 copy / ml ) are at higher risk of hcc than the hbeag negative individuals with low dna viral load [ 1 , 2 ] . in order to have a better understanding of this phenomenon , we obtained hbsag - positive serum samples from clinical laboratory center of the first people 's hospital of yunnan province , kunming , yunnan , china , from february to august , 2005 . we also followed up a chronically hbv - infected patient who was hbeag positive with high hbv dna load ( 10 copy / ml ) for almost 3 years and studied the evolution of her hbv strains . by sequencing and phylogenetic analysis , we found mutations occurred within the genomes of hbv through time - course evolution . combined with clinical data , whether and how these hbv variants might contribute to viral persistence of infection or liver pathogenesis still needs to be further studied

mutations in full - length hbv isolates obtained from a chronic hbv - infected patient were evaluated at three time points : 1 day , 6 months , and 31 months . while 5 nucleotides variation , and an 18 bp deletion of pres1 have been kept in during at least the first two years , c339 t mutation occurring in the hydrophilic region of hbsag and t770c that caused polymerase v560a substitution were the new point mutations found existing in sequenced clones of the 3rd time point . internal deletion of coding region obviously appeared in the 3rd time point . the splicers included two new 5-splice donors and three new 3-splice acceptors besides the reported donors and acceptors and may have produced presumptive hbv - spliced proteins or truncated pres proteins . alt , hbeag and viral dna load varied during the follow - up years . these data demonstrated the diversity of genomes in hbv - infected patient during evolution . combined with clinical data , the hbv variants discovered in this patient may contribute to viral persistence of infection or liver pathogenesis .

hepatocellular carcinoma ( hcc ) is one of the most lethal malignancies , and surgical resection improves the survival rates for patients . however , the prognosis after surgical resection of hcc remains poor because of high recurrence rates . using biomarkers to identify patients presenting with a higher risk of poor prognosis may reduce mortality after curative hepatectomy . although there are many reports on histologic parameters for predicting hcc prognosis , molecular markers for hcc recurrence and prognosis could provide additional information . cancer cells frequently express genes that are specifically or preferentially expressed in male germ cells under normal conditions . atpase family aaa domain - containing 2 ( atad2 ) is one such , and works as an important cofactor for myc - dependent transcription . through myc and e2f transcription factors , atad2 increases the expression of proliferation - related and anti - apoptotic genes in many different types of cancer , including breast carcinoma , non - small cell lung carcinoma , and prostate carcinoma [ 5 - 8 ] . , atad2 has been identified as a candidate driver gene located within the amplified 8q24 locus . huang et al . reported that a novel highly up - regulated exon - exon junction was detected in atad2 gene by rna - seq and the gene was highly expressed in hcc tissues . a recent study found that the high expression of atad2 in hcc was an independent predictor of shortened overall survival . however , the prognostic significance of atad2 protein expression in hcc is unclear . in the present study , we evaluated atad2 protein expression by immunohistochemistry to elucidate the prognostic role of atad2 in 182 hcc patients with long - term follow - up .

purposecancer cells frequently express genes that are specifically or preferentially expressed in male germ cells under normal conditions . the atpase family aaa domain - containing 2 ( atad2 ) is one such and works as an important cofactor for myc - dependent transcription . in hepatocellular carcinoma ( hcc ) , atad2 has been identified as a candidate driver gene located within the amplified 8q24 locus . however , the prognostic significance of atad2 protein expression in hcc remains uncertain.materials and methodswe investigated atad2 protein expression by immunohistochemistry in tumor tissue from 182 hcc patients who underwent curative resection . associations of atad2 expression with clinicopathologic variables or prognosis of hcc patients were analyzed.resultsatad2 expression was observed in 119 ( 65.4 % ) of the 182 hccs and tended to be independent predictor of early recurrence ( p=0.059 ) . atad2 expression showed an unfavorable influence on recurrence - free survival ( rfs ) ( p < 0.001 ) . subgroup analysis among patients with tumor size 5.0 cm ( n=109 ) , patients at barcelona clinic liver cancer stage 0 or a ( n=92 ) , and patients with -fetoprotein 20 ng / ml ( n=61 ) , the atad2-positive groups unfavorably influenced rfs ( p=0.008 , p=0.009 , and p=0.013 , respectively ) . in addition , atad2 expression was an independent predictor of shorter rfs ( p=0.002 ) . atad2 expression showed an unfavorable influence on disease - specific survival ( p=0.001 ) , but was not an independent predictor of shorter disease - specific survival ( p=0.109 ) .conclusionatad2 protein expression may be a potential predictor of rfs in hcc patients after curative resection and atad2 may have prognostic value in patients with early stage hcc or normal serum -fetoprotein level .

nonalcoholic fatty liver disease ( nafld ) is the most common chronic liver disease in europe and the us with a prevalence of up to 30 % . it is associated with obesity and diabetes and is thus considered to be the hepatic manifestation of the metabolic syndrome . nafld ranges from simple hepatic steatosis , characterized by triglyceride accumulation in hepatocytes , to nonalcoholic steatohepatitis ( nash ) , which may be associated with fibrosis and progression to cirrhosis or hepatocellular carcinoma . while the diagnosis of nafld is based on histology and patients history , the increase in prevalence demands noninvasive methods for diagnosis and surveillance . hepatocyte apoptosis was identified as a key feature of nafld and correlates with disease severity . cytokeratin 18 ( ck18 ) is an intermediate filament expressed in single - layer epithelial tissues . during apoptosis , caspase - cleaved ck18 is released into the cytoplasm and released into the serum after cell death . therefore , soluble forms of extracellular ck18 in the serum are utilized to quantify activity of cell death . wieckowska et al . quantified cleaved ck18 fragments in patients with nafld and found a correlation with the occurrence of liver fibrosis and hepatic inflammation . [ 5 , 6 ] the published results of a multicenter validation study by feldstein et al . revealed ck18 fragments as a predictor of nash versus simple steatosis . most of its disassembly takes place in endothelial liver cells . because of the lack of function , fibrosis and cirrhosis lead to impaired clearance of hyaluronic fragments . several studies could show a correlation between serum hyaluronic acid and fibrosis stage in chronic liver diseases , including nafld [ 8 , 9 ] . here , we evaluated caspase - cleaved ck18 and hyaluronic acid as biomarkers for nafld and fibrosis in a cohort of 127 patients who underwent bariatric surgery and compared these results to the histological diagnosis , quantified by nafld - activity score ( nas ) , as established by kleiner et al . . in line with recent publications , we observed a clear correlation between caspase - cleaved ck18 and liver steatosis .

hepatocyte apoptosis is a key event in nonalcoholic fatty liver disease ( nafld ) , and serum apoptotic markers are emerging as surrogate markers for nafld . we studied the role of caspase - cleaved cytokeratin18 in the diagnosis of fibrosis in a cohort of 127 morbidly obese patients and also performed a review of the literature biomarkers of nafld and fibrosis . here , we found that cleaved caspase 18 correlated with liver steatosis and liver injury as assessed by serum transaminase levels . furthermore , hepatocyte apoptosis as assessed by cleaved ck18 and tunel staining correlated with the extent of fibrosis as assessed by sirius red staining and serum hyaluronic acid . these results underscore the important role of hepatocyte apoptosis in the pathogenesis of fibrosis in nafld , which led to the utilization of surrogate markers for apoptosis in the noninvasive diagnosis of nafld . we furthermore reviewed current literature of biomarkers of nafld and fibrosis .

drug - induced gingival overgrowth ( digo ) remains a significant problem for the dental clinicians . amlodipine is a third - generation dihydropyridine calcium channel blockers ( ccb ) that is used in the management of both hypertension and angina . ellis et al . , first reported gingival sequestration of amlodipine and amlodipine - induced gingival overgrowth ( aigo ) . since then , very few isolated cases of aigo have appeared in the dental literature although there are numerous reports of nifedipine induced gingival overgrowth until date . the incidence of gingival hypertrophy with nifedipine therapy has been reported to be as high as 20 % . other synonyms have been used to describe similar lesions , such as inflammatory pseudotumor , histiocytoma , xanthomatous granuloma , inflammatory myofibroblastic tumor , and spindle cell pseudotumor . it occurs primarily in the lungs , but has occurred in other extra - pulmonary sites . this lesion is not a neoplastic process , nor is it associated with a monoclonal expansion of a single plasma cell instead ; this is a reactive , inflammatory lesion which usually involves the mobile tissues of the oro - nasopharyngeal region , such as paranasal sinuses , buccal mucosa , tongue , and lip . they are even rarer on the gingiva and very few case reports have been documented . there are no reports of amlodipine - related plasma cell granuloma of gingiva existing in the extant literature . the present case report describes an unusual case of amlodipine induced massive plasma cell granuloma on the gingiva .

drug - induced gingival overgrowth ( digo ) can be a serious concern for both patients and clinicians . digo is a well - documented side - effect of some pharmacologic agents , including , but not limited to , calcium channel blockers , phenytoin , and cyclosporine . plasma cell granulomas ( pseudotumors ) are exceedingly rare , non - neoplastic , reactive tumor - like proliferation , primarily composed of plasma cells that manifest primarily in the lungs , but may occur in various anatomic locations . intraoral plasma cell granulomas involving the lip , oral mucosa , tongue , and gingiva have been reported in the past . this is the first case report of amlodipine induced plasma cell granuloma of the gingiva in the medical literature presenting a 54 year - old female patient with hypertension , who received amlodipine ( 10 mg / day , single dose orally ) for 2 years , sought medical attention because of developing maxillary anterior massive gingival overgrowth causing functional and esthetic problem , which was treated by excisional biopsy . histologically , these lesions were composed of mature plasma cells , showing polyclonality for both lambda and kappa light chains and fibrovascular connective tissue stroma confirming a diagnosis of plasma cell granuloma . this case also highlights the need to biopsy for unusual lesions to rule out potential neoplasms .

hepatitis b virus infection ( hbv ) is an inflammatory disease of liver due to double stranded virus of the hepadnaviridae family . hepatitis b infection possesses a major health concern and is the most common blood borne viral infection , placing health care workers and medical and dental professionals at higher occupational risk . the other mostly common communicable diseases include human immunodeficiency virus ( hiv ) and hepatitis c virus ( hcv ) . the possible forms of transmission of hepatitis virus include unprotected sexual contact , blood transfusion , reuse of contaminated needles , and vertical transmission from mother to child during pregnancy . in dental setting the most common mode of transmission is from percutaneous exposure ( needle stick injuries ) and also from contact with blood or saliva of infected patients . the possibility of hbv transmission from exposure to saliva and gingival crevicular fluid has been confirmed , which makes the oral health care professionals more vulnerable for hepatitis infection . nearly two billion people in the world have been infected by hbv and there are nearly 350 million people who are chronic carriers . hepatitis b and hepatitis c infection can become persistent and show the way to cirrhosis of liver and even liver cancer . it is mainly acquired in the course of contaminated needles or tainted blood products and infection patterns are diffuse . among the professionals , dentists are placed in high risk group as actual sufferers and carriers with a grim picture . it is of prime importance for all dental schools , medical staff , and dental staff to conduct talks and create awareness about hepatitis b infection . india has the intermediate endemicity of hepatitis b virus with surface antigen ( hbsag ) prevalence between 2 % and 10 % among the population studied . in india about four percent of the population was estimated to be hbv carriers giving a total pool of approximately 36 million carriers . chronic infection with hepatitis b may be either asymptomatic or may be associated with a chronic inflammation of the liver ( chronic hepatitis ) , leading to a cirrhosis over a period of several years . studies have shown that the risk of exposure for general dentists is about three to four times greater and for nonimmunized surgical specialists about six times greater than that of the general population . in the dental setting , there are special circumstances and opportunities which can lead to the transmission of such organisms to dental healthcare professionals and to dental clinical students . the incidence of hbv can be reduced by giving proper education regarding its transmission and immunizations to the public , all healthcare workers ( hcv ) , and students . there are no adequate data on the awareness of hepatitis among dental college students in india . hence this forms the base of the present study which aimed to analyze the awareness of hepatitis b infection among the clinical students in a private university .

hepatitis b virus transmission in a dental setting more commonly occurs due to inadequate / improper use of safety measures by the dentist . this particular study evaluated the hepatitis b virus infection related awareness among dental graduate students in a university dental college , india . a validated questionnaire regarding the awareness about hepatitis infection and various infection control measures was distributed among the students of different year of study in undergraduate bachelor dental graduate program . the data extracted were tabulated and analyzed . final year students showed an increased awareness when compared to third year students . there is need for improving the knowledge among the nonclinical students , mainly on transmission of virus through salivary contact . the overall awareness among the students is only fairly satisfying , which signifies the need for continued infection control education among the students .

a common reason for bringing an infant or child for medical visit is recurrent infections . this may refer to infections that are too great in number , too severe , or too long lasting ; that are associated with unusual complications ; or that fail to resolve with standard therapy . only 10 % of such cases are due to deficiency in immunity either adaptive or innate . congenital neutropenia has an estimated frequency of two to three per million in the general population . elane ( elastase , neutrophil expressed ) gene related neutropenia includes congenital neutropenia and cyclic neutropenia , both of which are primary hematologic disorders characterized by recurrent fever , skin , and oropharyngeal inflammation ( ie , mouth ulcers , gingivitis , sinusitis , and pharyngitis ) , and cervical adenopathy . the diagnosis of elane - related neutropenia relies primarily on serial measurements of the absolute neutrophil count ( anc ) and clinical findings . molecular genetic testing of the elane gene , the only gene known to be associated with elane - related neutropenia , is available on a clinical basis .

we descibe the case of a girl of indian origin who presented with recurrent infections . the only abnormality detected in the armoury of the immune system was consistent neutropenia . mutation analysis revealed ela2 ( neutrophil elastase ) gene mutation that has been associated with severe congenital neutropenia phenotype . patient was treated with the granulocyte - colony stimulating factor ( g - csf ) as prevention of infectious manifestations along with appropriate measure to curb secondary complications . she showed poor response to the g - csf during stringent surveillance . after being on treatment for 1 year , she developed acute myelogenous leukemia as inherit complication of this disease .

copy number variation ( cnv ) is a structural genomic variation of the human genome that may either be inherited or caused by de novo mutation . cnvs can range in size from kilobases ( kbs ) to several megabases ( mbs ) that have not been identified by conventional chromosomal analysis . however , recent technology of genome - wide analysis such as comparative genomic hybridization ( cgh ) has led to the discovery of extensive genomic structural variation [ 13 ] . a recent report using microarray technology revealed that as much as 12 % of the human genome are variable in copy number . these known cnvs are available from the interactive web - based database decipher ( database of chromosomal imbalance and phenotype in humans using ensembl resources , http : //decipher.sanger.ac.uk/ ) . the decipher database is a consortium comprised of an international network of more than 100 centers and has uploaded more than 2000 cases ( current statistics can be found on the decipher homepage ) . de novo mutations are more likely to contribute to the development of sporadic genomic disorders [ 6 , 7 ] . in psychiatric disorders , asd and schizophrenia , extension of genome - wide association studies ( gwas ) have led to the discovery of both inherited and de novo sporadic cnvs . such cnvs resulted in altering gene dosage and dosage - sensitive gene expression , which may contribute to these disorders complexities . these human genetics studies have detected several cnvs ( e.g . , 1q21 , 3q29 , 10q26 , 11p14 , 15q11 , 15q13 , 16p13 , 17p12 , and 22q11 ) . this discovery suggests an important role for the strict regulation of gene dosage in asd and schizophrenia . to understand psychiatric disorders , while it is difficult to model human psychiatric phenotypes in animals ( e.g . , hallucinations and delusions characteristic of schizophrenia that are human specific ) , animal models may contribute to the elucidation of brain anatomy , behavioral characteristics , and molecular mechanisms that reflect aspects of human phenotypes . although there is a strong association between genetic rearrangement and psychiatric disorders ( e.g . , asd and schizophrenia ) , valid animal models that reflect etiology are rare . several efforts have been made to generate mouse models of psychiatric disorders by conventional gene targeting , conditional gene targeting , and point mutation by chemical mutagens . but these techniques are not enough to reflect complex human genomic rearrangements , such as large deletions , inversions , and duplications . in this regard , the cre / loxp - based chromosome engineering technique is useful to generate this kind of complex genomic rearrangements in the mouse genome . by using this chromosome engineering technique , we can accomplish cnv - based unbiased animal models of psychiatric disorders . in this paper , we focus on animal model of asd ( and schizophrenia ) which was generated by chromosome engineering , principle of this technology , and discuss for future directions .

the development of genetic technologies has led to the identification of several copy number variations ( cnvs ) in the human genome . genome rearrangements affect dosage - sensitive gene expression in normal brain development . there is strong evidence associating human psychiatric disorders , especially autism spectrum disorders ( asds ) and schizophrenia to genetic risk factors and accumulated cnv risk loci . deletions in 1q21 , 3q29 , 15q13 , 17p12 , and 22q11 , as well as duplications in 16p11 , 16p13 , and 15q11 - 13 have been reported as recurrent cnvs in asd and/or schizophrenia . chromosome engineering can be a useful technology to reflect human diseases in animal models , especially cnv - based psychiatric disorders . this system , based on the cre / loxp strategy , uses large chromosome rearrangement such as deletion , duplication , inversion , and translocation . although it is hard to reflect human pathophysiology in animal models , some aspects of molecular pathways , brain anatomy , cognitive , and behavioral phenotypes can be addressed . some groups have created animal models of psychiatric disorders , asd , and schizophrenia , which are based on human cnv . these mouse models display some brain anatomical and behavioral abnormalities , providing insight into human neuropsychiatric disorders that will contribute to novel drug screening for these devastating disorders .

osteoporosis is a systemic skeletal disease characterized by reduced bone mineral density and microarchitectural deterioration , compromising bone strength and increasing risk of fractures . magnetic resonance imaging ( mri ) is an ionizing radiation - free imaging modality , the application of which could be beneficial in the elderly population to monitor incidence , progression , and therapy of osteoporosis . due to the lack of signal from the bone matrix in conventional mri sequences , high - resolution mri of the trabecular bone has been previously accomplished relying on the bone marrow signal surrounding the bone matrix [ 2 , 3 ] . the vertebral bodies , one of the most important fracture sites , are filled with red marrow , which is a mixture of haematopoietic red blood cells and fat cells . despite recent progress [ 4 , 5 ] , direct high - resolution imaging of the trabecular bone has been limited on distal sites ( e.g . , radius , tibia , or calcaneus ) and its application in red marrow regions remains technically challenging . previous mri investigations have studied alternative indirect measures of trabecular bone quantity and quality in red marrow regions , including approaches aiming to measure primarily bone marrow t2 [ 6 , 7 ] . another property of bone marrow , which has recently gained significant attention due to its potential association with bone loss pathophysiology , is its fat content [ 810 ] . mr investigations employing single - voxel magnetic resonance spectroscopy ( mrs ) have recently shown the increase of vertebral bone marrow fat content with age in large scale in vivo studies [ 12 , 13 ] . in addition to age - related change of bone marrow fat content , recent in vivo studies have shown that an increase in bone marrow fat content is associated with a decrease in bone mineral density ( bmd ) [ 7 , 1420 ] . furthermore , there have been a limited number of studies analyzing transiliac bone biopsy samples showing an association between bone marrow adiposity and bone microstructure . additionally , it has been shown that imaging - based trabecular bone microstructure and texture parameters ( using primarily computed tomography ( ct ) and its variants ) can add significant information beyond bmd on predicting bone strength [ 23 , 24 ] . based on the negative association between bmd and vertebral bone marrow fat content , previous studies have recently proposed mrs - based bone marrow fat quantification as a potential noninvasive biomarker for prediction of fracture risk . however , many of these studies have used dual x - ray absorptiometry ( dxa ) for measurement of bmd , including therefore contributions from both the trabecular and the cortical bone compartments in the reported bmd measurements [ 7 , 1517 ] . in addition , there has been no previous groundwork on directly investigating the relationship between bone marrow fat content and biomechanical strength . determining the relationship between bone marrow fat content and trabecular bone microstructure parameters would require sampling larger specimens than those obtained with biopsy . a multimodality ex vivo study in bone specimens combining ct and mrs measurements with biomechanical testing would be required to study the aforementioned relationships . therefore , the purpose of the present pilot study was to investigate the correlation of mrs - based proton density fat fraction with bmd / trabecular bone microstructure parameters obtained from multidetector ct ( mdct ) measurements and bone strength determined from biomechanical testing , using human vertebral cadaveric specimens .

bone marrow adiposity has recently gained attention due to its association with bone loss pathophysiology . in this study , ten vertebrae were harvested from fresh human cadavers . trabecular bmd and microstructure parameters were extracted from mdct . bone marrow fat fractions were determined using single - voxel mrs . failure load ( fl ) values were assessed by destructive biomechanical testing . significant correlations ( p < 0.05 ) were observed between mrs - based fat fraction and mdct - based parameters ( up to r = 0.72 ) and mrs - based fat fraction and fl ( r = 0.77 ) . these findings underline the importance of the bone marrow in the pathophysiology and imaging diagnostics of osteoporosis .

the aids epidemic which has hit southern africa with such devastating force affects a variety of reproductive issues among infected people . these include whether or not to become pregnant , when and which type of contraception to use , and decisions on whether to continue or try to terminate a pregnancy . findings from studies in both developing and developed nations indicate that a significant proportion of hiv infected adults still desire or intend to have children [ 14 ] . with the advent of highly active antiretroviral therapy ( haart ) and its impact on the health of the infected as well as its impact on lowering mother to child transmission of hiv , the number of hiv infected people considering childbearing has increased [ 57 ] . while much attention has been paid to the reproductive choices and intentions of the infected as well as to some factors that influence these [ 14 ] , most studies are silent on the role of health professionals in the reproductive and sexual lives of hiv infected people . there are few studies that mention the role of health professionals in the reproductive sphere of hiv positive people , yet these are the people who usually play a significant role in the decision making process of hiv positive people . this is because of their medical expertise and that most hiv infected people make their reproductive decisions within a biomedical and health institution context [ 7 , 9 , 10 ] . there are some studies that have involved health professionals and they found that biomedical considerations usually dominate health care providers ' attitudes towards reproduction by hiv infected people [ 11 , 12 ] . findings from this study indicate that there are three dominant discourses concerning childbearing by people with hiv among health professionals . the first two are rooted in the biomedical model of health where biomedical considerations are prominent while the third takes a human rights perspective .

objective . the role of health professionals in the decision making process of patients is usually heard or seen from the perspective of the patients . this paper gives the usually silent and invisible health professionals voice and visibility . it describes their views and attitudes towards reproduction by couples who are hiv positive and attempts to understand their perspectives . methods . in - depth interviews were conducted with twelve health professionals at an opportunistic infections clinic . transcribed interviews were analysed using the grounded approach to identify patterns and themes concerning views and attitudes of health professionals towards reproduction by hiv positive people . results . the study found that most health professionals generally had a negative attitude towards childbearing by hiv positive couples . their views and approaches on the issue were based mainly on biomedical considerations . the main discourses on childbearing that emerged from the study were the conditional choice , the antichildbearing , and the prorights . conclusion . most of the health professionals interviewed tend to take a generally negative stance towards reproduction by people with hiv / aids . there is a need for a clear set of guidelines for health professionals ( hps ) on how to deal with hiv positive people who may desire to reproduce .

corticosteroids remain the mainstay of treatment for the vast majority of patients with immune - mediated uveitis . however , those patients with active inflammation who are intolerant of or unresponsive to steroids require therapy with other immunosuppressive agents trying to prevent the potential sequelae associated with this vision - threatening condition . the off - label use of biologic agents and particularly those blocking tumor necrosis factor - alpha ( tnf- ) has demonstrated encouraging results when employed for management of patients with immune - mediated uveitis refractory to conventional treatment since their first reported use in 2001 . potential advantages of these agents when compared with traditional immunosuppressors include a substantial efficacy in recalcitrant cases , as well as a lower total immunosuppressive load , a rapid clinical effect , good safety profile , and significant improvement in quality of life . the present evidence shows that infliximab and adalimumab have the highest level of evidence and grade of recommendation , and thus both may be considered as first - line or second - line immunomodulatory agents for treatment of immune - mediated uveitis depending on which systemic immunologic disorder is associated with the intraocular inflammation [ 6 , 8 ] . golimumab ( glm ) ( trade name simponi ) , a fully human anti - tnf- monoclonal antibody , was approved by the us food and drug administration in 2009 for the use with methotrexate ( mtx ) in adults with moderate - to - severe active rheumatoid arthritis ( ra ) and with or without mtx or other biologic disease - modifying antirheumatic drugs in adults with active psoriatic arthritis ( psa ) or active ankylosing spondylitis ( as ) . some other studies have addressed the potential use of glm for treatment of uveitis , mainly associated with rheumatologic conditions [ 11 , 12 ] . we would like to present the results from three uveitis units in spain when using glm for treatment of patients with immune - mediated uveitis of various etiologies that had been resistant to several immunosuppressive agents .

objective . to evaluate , in three spanish tertiary referral centres , the short - term safety and efficacy of golimumab ( glm ) for treatment of immune - mediated uveitis resistant to previous immunosuppressive therapy . methods . nonrandomized retrospective interventional case series . thirteen patients with different types of uveitis that were resistant to treatment with at least 2 previous immunosuppressors were included in this study . all included patients were treated with glm ( 50 mg every four weeks ) during at least 6 months . clinical evaluation and treatment - related side effects were assessed at least four times in all included patients . results . eight men and 5 women ( 22 affected eyes ) with a median age of 30 years ( range 2038 ) and active immune - mediated uveitides were studied . glm was used in combination with conventional immunosuppressors in 7 patients ( 53.8 % ) . glm therapy achieved complete control of inflammation in 12/13 patients ( 92.3 % ) after six months of treatment . there was a statistically significant improvement in mean bcva ( 0.60 versus 0.68 , p = 0.009 ) and mean 1 mm central retinal thickness ( 317 versus 261.2 , p = 0.05 ) at the six - month endpoint when compared to basal values . no major systemic adverse effects associated with glm therapy were observed . conclusions . glm is a new and promising therapeutic option for patients with severe and refractory uveitis .

the small sizes of the nanoparticles and large surface to volume ratio put the nanoparticles in a position for tremendous and wide applications essentially in biomedicine . though the small sizes of engineered nanoparticles have been linked with highly desirable properties ( mechanical , electrical , and chemical ) for specific uses , yet these same desirable properties are also likely to be associated with unwanted biological / toxicological reactivity . although metal nanoparticles have received increasing attention due to their widespread medical , consumer , industrial , and military applications , studies have correlated particle size of some metal - based nanoparticles ( e.g . , ag , au , and cu ) with toxicity , even if the same material is relatively inert in its bulk form [ 2 , 3 ] . indeed , there are increasing concerns about the safety of nanoparticles for human health and environment [ 46 ] , highlighting the need for further investigations on the safety of metal nanoparticles . moreover , data on the safety / toxicity profiles of metal nanoparticles are scarce . perhaps , the fears of health risks may not be completely unfounded , if the small sizes and the large surface area to volume ratio as well as the chemical reactivity and/or biological activity of the nanoparticles are to be considered . also there are studies revealing the potential of nanoparticles to alter normal physiology by interacting with biomolecules in living cells [ 79 ] thereby causing adverse effects at the cellular , subcellular , and protein levels . furthermore , nanoparticles enter the human body through ingestion , inhalation , and skin contact or genitourinary tract and become deposited in vital organs such as brain , liver , or kidneys [ 10 , 11 ] . studies have shown that nanoparticles may change or damage cellular processes by passing through cellular membranes to interact with biomolecules leading to dna and protein damage [ 12 , 13 ] or cross the blood - brain barrier to cause neurotoxicity . these factors underscore the urgent need for investigations aimed at establishing the influence of nanoparticles on biochemical parameters . the present study determined the effect of the oral administration of silver nanoparticle on some biochemical parameters in wistar rats .

background . silver nanoparticles have found wider and increasing biomedical applications due to their broad antimicrobial characteristics . however , toxicity of nanoparticles is a subject of continued controversy , thus necessitating further studies in this direction . objectives . this study investigated the biochemical effects of silver nanoparticles in wistar rats . materials and methods . forty male rats were randomly distributed into eight experimental groups of five . group a served as the control and received distilled water . groups b to h were orally exposed to varying concentrations of silver nanoparticles ( agnps ) at 100 , 1000 , and 5000 mg / kg daily for 7 , 14 , and 21 days alternately . following cessation of treatments , rats were sacrificed and the blood and other vital organs were collected and prepared as specimens for biochemical analysis . results . administration of agnps to rats did not produce significant loss in feed intake and body weight . however , rat exposure to agnps caused significant alterations to levels of serum and tissue ast , alt , and alp . at the 100 mg / kg agnps exposure , rat serum and tissue ast and alt levels were significantly decreased ( p < 0.05 ) . in contrast , agnps administration elevated ( p < 0.05 ) alp levels in rat serum and tissues . conclusion . we show evidence that agnps administration to wistar rats altered some biochemical parameters .

most common cause of lower gastrointestinal hemorrhage ( lgib ) in elderly patient is diverticular disease and mortality rate is very low 24 % . a massive lgib from primary ilio - rectal fistula is rare and difficult to diagnosis but more common from secondary after previous vascular surgery a variety of treatment options are available , such as in situ graft , closure of defect alone , endovascular stent graft , extra - anatomical bypass and embolic coiling . exploration using laparotomy for ligation internal iliac aneurysm and rectal resection is a simple operative procedure which can be applied when emergency option is needed to save a life . we describe successful emergency surgery in primary ilio - rectal fistula when patient presents a massive lgib and hypovolemic shock .

abstractmassive lower gastrointestinal from primary isolated ilio - rectal fistula is a rare condition and difficult to diagnosis and emergency surgery for this situation has a high mortality rate . this report describes a successful operation in an 88-year - old man at present with massive lower gastrointestinal hemorrhage from ilio - rectal fistula and hypovolemic shock . underlying diseases are prostate cancer , hypertension , dyslipidemia , aortic stenosis , mitral valve stenosis and chronic renal disease . operative treatment is to explore laparotomy with internal iliac artery ligation and rectal resection . during postoperative period patient developed acute cholecystitis and treated by cholecystectomy 1 month after operation the patient went home without morbidity and 1-year follow - up he had not any complications .

diabetes , obesity , and cardiovascular diseases are interrelated , with diet being one factor that links them all together . specifically , the current obesity epidemic has been suggested to be a result of increased carbohydrate intake , while dietary fat has frequently been touted as the primary dietary culprit in the cause of many deleterious metabolic conditions . as a nation , we increased carbohydrate consumption during the latter years of the past century as the obesity epidemic began to surge . while it is laudable to try to change the behavior of individuals so they choose other foods , it might be more effective in the short term to address this nutritional issue by providing bioactive compounds that behave like traditional starch yet elicit more favorable metabolic outcomes ( acutely and chronically ) . in other words , let people continue to choose some of the foods they prefer , but make those foods healthier by incorporating bioactive ingredients . to that end , incorporating resistant starches into foods by substituting them for the typical starch has been shown to acutely decrease postprandial glucose and insulin . there are five types of resistant starch , with rs types 2 , 3 , and 4 tending to be studied more frequently . gram for gram , some resistant starches have been reported to elicit minimal glucose and insulin excursions compared with similar amounts of dextrose and are easily incorporated into regular food items with minimal aversion by consumers . given the number of resistant starches commercially available , there is a paucity of evidence from human trials illustrating the effects various types of resistant starches have on glucose metabolism . likewise , some consumers are looking to food to assist them with regulating food intake and/or regulating blood glucose . there is evidence that resistant starch might be able to achieve this by affecting satiety and subsequent food intake , and attenuating postprandial glycemia and insulinemia [ 2 , 5 ] . to complicate matters , behall et al . reported that it is imperative that individual starches and fibers be tested for efficacy given the unique structure and function qualities of starches that are quickly becoming available . for example , haub et al . observed that specific forms of rs2 and rs4 elicit different glycemic responses when compared at the same dose . while cross - linked rs4 has been shown to elicit significant reductions in glycemia and insulinemia , newer versions are being formulated and might provide even greater and/or different health impacts . one new version of rs4 is commercially available but has not been clinically tested to determine its efficacy to assist with regulating blood glucose and minimizing hyperglycemia . therefore , the purpose of this study was to determine the glycemic and satiety effects of novel forms of rs4 , derived from potato starch . the hypotheses were that consuming the rs4 treatments would not affect glycemia compared with a dextrose - only control solution ; and would increase ratings of fullness when added to dextrose control solution .

this study was designed to determine the efficacy of two novel type - four resistant starches ( rs4 ) on postprandial glycemia and ratings of fullness . volunteers ( n = 10 ) completed completed five interventions designed to determine the glycemic and satiety ( fullness ) effects of the starches ( 38 g , ) alone and when added on top of available carbohydrate . the dose of the starches provided 30 g of resistant starch per treatment . the treatments were : commercial resistant starch added to water ( pf ) , noncommercial resistant starch added to water ( pr ) , dextrose solution ( dex , 50 g ) , and dex with penfibe starch ( pf+ ) , and dex with the non - commercial starch added ( pr+ ) . blood glucose was measured in the fasted state and following the randomly assigned treatments at 30 , 45 , 60 , 90 , and 120 minutes post - consumption . a visual analog scale was used to determine fullness at each time point . there were no differences in the glucose incremental areas under the curve ( iauc ) for pf+ and pr+ compared with dex . the pf and pr treatments had decreased ( p < 0.05 ) iaucs for glucose compared with dex , pf+ , and pr+ . there were no treatment differences for rof . the dose ( 38 g ) of starches did not to alter glucose responses when added on top of 50 g of dextrose .

enamel subsurface lesions need to be diagnosed as early as possible for the best possible remineralization of enamel and restoration as well as a function of the tooth . there is evidence based on the remineralization potential of agents such as fluoride , casein phosphopeptide amorphous calcium phosphate ( cpp - acp ) , casein phosphopeptide amorphous calcium phosphate with fluoride ( cpp - acpf ) . it has been observed that cpp - acp remineralized initial enamel lesions and has shown increased remineralization potential when used along with fluoridated toothpaste . apf gel forms more fluoride in enamel than neutral gel and it is more efficient in reducing enamel demineralization of enamel blocks submitted to cariogenic challenge than the neutral one . cpp - acpf is proven to produce significantly greater mean percentage of remineralization in comparison with cpp - acp . mineral deposition throughout the lesion has been proven in relation to use of both cpp - acp and cpp - acpf . it has been observed that gums comprising of cpp - acp nano complexes have a marked remineralization potential . the cpp - acp has also been shown to remineralize enamel subsurface lesions in situ when delivered through oral care products . the probable anticariogenic mechanism of cpp - acp is its ability to localize acp at the tooth surface , which brings about buffering of calcium and phosphate free ion activities , thereby helping to maintain a state of super saturation with respect to tooth enamel negating demineralization and enhancing remineralization . cpp - acpf due to its added fluoride content has shown improved ability to remineralize initial caries . in incipient enamel caries low concentrations of fluoride are able to penetrate deeper into the body of the lesion and bring about remineralization , hence sodium fluoride ( naf ) ( 200 ppm/0.044 % ) has been opted for use in this study . the study aimed at quantitatively evaluating the enamel remineralizing potential of cpp - acp , cpp - acpf and naf using surface microhardness analysis ( vickers hardness test ) .

aim : the aim of this study is to evaluate the enamel remineralization after treatment with three different remineralizing agents using surface microhardness assessment.materials and methods : this in vitro study involves 50 enamel samples divided into five groups of 10 samples each . the positive control group consisted of intact enamel and a negative control group consisted of demineralized enamel samples . all groups excluding the positive control group were subjected to demineralization following which three of these groups were remineralized using remineralizing agents ( casein phosphopeptide amorphous calcium phosphate [ cpp - acp ] [ gc tooth mousse ] , casein phosphopeptide amorphous calcium phosphate with fluoride [ cpp - acpf ] [ gc tooth mousse plus ] , sodium fluoride [ phos - flur ] ) . the groups treated with remineralizing agents were subjected to ph cycling over a period of 28 days . this was followed with assessment of surface microhardness ( micro vickers hardness tester , matsuzawa co. , ltd , toshima , japan ) .statistical analysis : one - way analysis of variance test and posthoc tukey test were conducted for multiple group comparison.results : there was an improved enamel remineralization in the group , remineralized using cpp - acpf in comparison with the other groups.conclusion : casein phosphopeptide with fluoride is a promising material for remineralization of enamel subsurface lesions .

pancreatic neuroendocrine tumors ( pnets ) represent a relatively uncommon form of malignancy with an incidence of 0.43 cases per 100,000 in the usa . at diagnosis , nearly 70 % of patients have metastatic disease , of which 85 % will have liver metastases . management options for pnets metastatic to the liver include surgical , ablative , cytotoxic , and radioisotope approaches . unfortunately , due to the scarcity of these tumors there is a paucity of randomized trials to guide optimal therapy sequencing . the north american neuro - endocrine tumor society and european neuroendocrine tumor society both support the use of radioembolization for progressive or symptomatic liver metastasis [ 3 , 4 ] . to date , yttrium-90 ( y ) therapy has appeared safe ; however , there is no randomized controlled trial assessing toxicities . we present the case of a woman undergoing y therapy for metastatic pnet to the liver who developed liver enzyme elevation and subsequent cirrhosis following treatment . there are only 3 other reported de novo cases of cirrhosis following y administration , with only 1 demonstrating confirmatory pathology [ 6 , 7 , 8 ] .

backgroundmanagement options for pancreatic neuroendocrine tumors ( pnets ) metastatic to the liver include surgical , ablative , cytotoxic , and radioisotope approaches . one potential local treatment option includes selective internal radiotherapy utilizing yttrium-90 ( 90y ) microspheres . 90y has also been used in the treatment of hepatocellular carcinoma and tumors metastatic to the liver . it appears to be well tolerated ; however , there is no randomized controlled trial reporting long - term toxicities . previous retrospective reports have described biliary damage as a potential complication of therapy with 90y and chemoembolization ; however , the long - term sequelae of 90y treatment are poorly understood.case presentationwe present the case of a 65-year - old caucasian woman who suffered biliary damage following 90y administration for metastatic pnets and subsequently developed cirrhosis . given the timeline of her various treatments and the lack of any other identifiable etiology for her cirrhosis , we believe this to be a potential long - term complication of 90y therapy.conclusionthis case provides pathologic confirmation of cirrhosis as a potential long - term sequela of 90y treatment . this long - term risk needs to be considered when sequencing therapy for patients with neuroendocrine tumors who have a good prognosis . there are now several other systemic and ablative treatment options available to these patients , and long - term complications must be considered during treatment .

the other types of internal hernia that have been described include transmesenteric , supra- and/or perivesical , intersigmoid , foramen of winslow , and rarely , omental hernias . paraduodenal hernia is usually a congenital anomaly due to non - fusion of the mesocolon with the parietal wall that leaves a potential space . it manifests commonly in adults in the age group of 5060 years and usually presents as intestinal obstruction . internal hernias in todays era of advanced laparoscopic surgery are usually due to rents or defects in the mesentery . we present a case of intestinal obstruction due to internal herniation following laparoscopic donor nephrectomy , followed by a brief discussion .

internal hernias are a rare cause of small bowel obstruction . following laparoscopic bariatric surgery , specifically gastric bypass and laparoscopic colonic resections , there has been an increase in the incidence of internal hernias . this has been due to either a mesenteric or mesocolic defect being not closed or completely missed . small bowel loops usually herniate through these defects and present as intestinal obstruction . internal hernia following laparoscopic donor nephrectomy is a rare complication . the need for presenting this case is the rarity of its occurrence , to stress the fact that following major abdominal laparoscopic surgery the mesenteric or mesocolic defects should be closed , and that this complication was managed laparoscopically , through the same port sites as used earlier for the donor nephrectomy .

omega-3 ( n-3 ) fatty acids can be divided into alpha - linolenic acid ( ala ; c18:3n-3 ) from plant origin , and eicosapentaenoic acid ( epa ; c20:5n-3 ) and docosahexaenoic acid ( dha ; c22:6n-3 ) from seafood . because the human body lacks the enzymatic capacity to synthesize ala the estimated average ala intake in the united states and most european countries is 1.3 to 1.7 g / d [ 13 ] . the institute of medicine ( iom ) of the national academies established dietary reference intakes for macronutrients in 2002 . for ala , the adequate intake ( ai ) was set at 1.6 g / d for men and 1.1 the iom noted that intakes of n-3 fatty acids above the ai may confer additional health benefits , especially with respect to cardiovascular health . many advisory boards consider ala intakes greater than 1.5 g / d important for human health . to achieve an adequate ala intake , food sources such as flaxseed and flaxseed oil , walnuts and walnut oil , and canola and soybean oil are recommended . for epa and dha from fish this evidence has been confirmed in randomized controlled trials [ 58 ] . for ala , several large , prospective cohort studies in the united states have shown inverse associations of ala intake with risk of cardiovascular diseases , but other epidemiologic studies have been inconclusive [ 911 ] . a meta - analysis of observational studies showed that increased intake of ala might reduce coronary heart disease ( chd ) mortality by 21 % , although this was not statistically significant . in the lyon diet heart study , a randomized controlled trial in coronary patients , consumption of a mediterranean - type diet that included an additional daily intake of roughly 1 g of ala significantly decreased the risk of cardiac death and nonfatal myocardial infarction ( mi ) by more than 60 % . this study , however , was not specifically designed to assess the effect of ala supplementation , and many dietary factors differed between the experimental and control group . since then , no randomized controlled trials of ala and cardiovascular events have been published . this article summarizes the current literature ( published after 2008 ) on dietary ala intake , ala tissue levels , and cardiovascular health in humans .

there is a large body of scientific evidence that has been confirmed in randomized controlled trials indicating a cardioprotective effect for omega-3 fatty acids from fish . for alpha - linolenic acid ( ala ) , which is the omega-3 fatty acid from plants , the relation to cardiovascular health is less clear . we reviewed the recent literature on dietary ala intake , ala tissue concentrations , and cardiovascular health in humans . short - term trials ( 612 weeks ) in generally healthy participants mostly showed no or inconsistent effects of ala intake ( 1.23.6 g / d ) on blood lipids , low - density lipoprotein oxidation , lipoprotein ( a ) , and apolipoproteins a - i and b. studies of ala in relation to inflammatory markers and glucose metabolism yielded conflicting results . with regard to clinical cardiovascular outcomes , there is observational evidence for a protective effect against nonfatal myocardial infarction . however , no protective associations were observed between ala status and risk of heart failure , atrial fibrillation , and sudden death . findings from long - term trials of ala supplementation are awaited to answer the question whether food - based or higher doses of ala could be important for cardiovascular health in cardiac patients and the general population .

pancreatic cancer is the fourth leading cause of cancer death in the western world and shows the worst mortality among common malignancies with a 5-year survival rate of lower than 5 % . the current standard of care includes surgical resection when appropriate and gemcitabine - based chemotherapy . recent data suggests the use of folfirinox as initial treatment of patients with metastatic disease who have a good performance status improves survival . single - agent gemcitabine is often administered to patients with advanced , metastatic pancreatic cancer . studies with gemcitabine have demonstrated a significant clinical response ( decreased pain , increased functional status ) even in the absence of a measurable tumor response . unfortunately , there is currently no standard second - line chemotherapy for metastatic pancreatic cancer . one of the current major challenges is the lack of validated markers for prediction of response to chemotherapy in the metastatic pancreatic cancer setting .

pancreatic cancer exhibits profound chemoresistance resulting either from pre - existing ( intrinsic ) mechanisms , or from anticancer drug treatment itself ( acquired chemoresistance ) . we present the case of a patient with pancreatic adenocarcinoma metastatic to the liver who experienced clinical , radiographic and tumor marker response to three lines of gemcitabine - based chemotherapy . the regimens included : 8 cycles of gemcitabine and oxaliplatin ( gemox ) , 8 cycles of gemcitabine , docetaxel and capecitabine ( gtx ) and more than 3 cycles of gemcitabine and nab - paclitaxel , with an exceptional response 2 years from the initiation of chemotherapy for metastatic pancreatic cancer .

renal transplantation is the unique curative option for patients suffering from end - stage renal disease , but to date the evolution of each patient after transplantation can not be predicted . in the past decades , acute graft rejection has decreased dramatically as a result of the introduction of immunosuppressive drugs . however , immunosuppressive drugs carry undesired and severe side effects such as infections , malignancies , and metabolic disorders which may threaten patient 's life . yet , chronic rejection is still the main cause of long - term graft loss [ 2 , 3 ] . the holy grail of organ transplantation is to maintain long - term graft function without immunosuppressive treatment , namely , operational tolerance ( ot ) . however , ot is a rare event in kidney transplanted patients , as only about 0.03 % of cases are estimated to be in such state . thus , despite the efforts made in the past , there is still a clear need to find new strategies to achieve long - term tolerance and to investigate the immunological mechanisms that may be implicated in the process of ot . among the actors implicated in the mechanisms of the immune response , b and t lymphocytes are the main characters that lead to graft rejection . in this play , b lymphocytes have a dual key role since they present antigens of the donor to t cells in addition to secreting antibodies that can lead to acute rejection or , later in time , chronic rejection . nevertheless , a sparse b cell subset has been attributed immune regulatory functions which conveys that not all b cells play on the rejection side . although it was first described in 1974 it was not until 2000 that this population was named regulatory b cells ( breg ) . in the last decade , the regulatory role played by breg has been highlighted by many authors in autoimmune diseases such as systemic lupus erythematosus ( sle ) , rheumatoid arthritis , and pathologies that promote antineutrophil cytoplasmic antibodies and also in allograft tolerance in organ transplantation [ 12 , 13 ] . the current general consensus is that breg develop their function mainly via the secretion of il-10 [ 14 , 15 ] . however , a complete phenotype signature , development pathway , or the immunoregulatory properties of breg have not been fully discovered in mice nor in humans , thus granting future research on this cell type . in this review , our aim is to gather the current knowledge about regulatory b cells and their role in kidney transplantation tolerance in humans and to discuss their potential application as cellular therapeutic agent .

regulatory b cells ( breg ) are in the spotlight for their role in immune homeostasis maintenance and tolerance achievement as in the last years the correlation with functional and increased breg numbers in autoimmune diseases and transplantation has been extensively proven . their study is , however , in its infancy with still little knowledge and consensus on their origin , phenotype , and mechanism of action . all this hampers the pursuit of an effective breg induction method for therapeutic purposes . in this review we aim to summarize the studies on human breg and their implication in kidney transplantation and to further discuss the issues surrounding therapeutic applications of this cell subset .

an estimated 630,000 people worldwide were diagnosed with head and neck squamous cell carcinoma ( hnscc ) in 2008 , representing 6 % of all malignancies and making it the 6th most common cancer [ 1 , 2 ] . in the united states , approximately 48,000 cases occurred in 2009 , with 11,300 deaths . however , two - thirds of patients are diagnosed at a locoregional advanced stage ( iii - ivb ) , with 5-year survival rates of 30 to 60 % for these patients . in the past decade , treatment of locoregional advanced hnscc has shifted from primary surgery to organ preservation with combination chemoradiotherapy ( crt ) . the current approach attempts to achieve both organ preservation and function with outcomes superior to radiotherapy alone or surgery with postoperative radiotherapy [ 612 ] . a recent meta - analysis by pignon et al . showed an absolute survival benefit of 6.5 % at five years when chemotherapy was administered concomitantly with radiotherapy . the mechanism for the survival benefit of crt is thought to occur via increased tumor sensitization to the cytotoxic effects of radiotherapy , while providing adjuvant treatment for potential distant metastatic disease . however , crt has acute and long - term toxicities that can both limit treatment and increase morbidity . furthermore , although several crt regimens produce high rates of complete response at the primary site and regional neck nodes , there exists a high rate of failure to systemically eradicate micrometastases . this is demonstrated by the later occurrence of distant metastases , which account for many cancer - specific deaths . therefore , despite the successful use of numerous crt regimens and the development of multidisciplinary management , the prognosis of locoregional advanced hnscc remains poor . in this study , we review the outcomes of a heterogeneous cohort of patients with locoregional advanced hnscc . all patients were treated with curative intent with a uniform crt regimen that consisted of hyperfractionated radiotherapy and concurrent cisplatin/5-fluorouracil ( 5-fu ) . outcomes evaluated were overall survival ( os ) , locoregional control ( lrc ) , and disease - free survival ( dfs ) .

objective . we reviewed a cohort of patients with previously untreated locoregional advanced head and neck squamous cell carcinoma ( hnscc ) who received a uniform chemoradiotherapy regimen . methods . retrospective review was performed of 105 patients with stage iii or iv hnscc treated at greater baltimore medical center from 2000 to 2007 . radiation included 125 cgy twice daily for a total 70 gy to the primary site . chemotherapy consisted of cisplatin ( 12 mg / m2/h ) daily for five days and 5-fluorouracil ( 600 mg / m2/20 h ) daily for five days , given with weeks one and six of radiation . all but seven patients with n2 or greater disease received planned neck dissection after chemoradiotherapy . primary outcomes were overall survival ( os ) , locoregional control ( lrc ) , and disease - free survival ( dfs ) . results . median followup of surviving patients was 57.6 months . five - year os was 60 % , lrc was 68 % , and dfs was 56 % . predictors of increased mortality included age 55 , female gender , hypopharyngeal primary , and t3/t4 stage . twelve patients developed locoregional recurrences , and 16 patients developed distant metastases . eighteen second primary malignancies were diagnosed in 17 patients . conclusions . the crt regimen resulted in favorable outcomes . however , locoregional and distant recurrences cause significant mortality and highlight the need for more effective therapies to prevent and manage these events .

focal segmental glomerulosclerosis ( fsgs ) is a clinicopathologic entity responsible for up to 20 % of all cases of end - stage kidney disease in the united states . the incidence of fsgs is estimated at 7 per million individuals annually , has a slight male predominance ( male : female ratio 1.52 ) , and now represents the leading cause of idiopathic nephrotic syndrome in adults . although the pathogenesis of fsgs has not yet been fully described , the lesions that are induced include tuft collapse , segmental hyalinosis , and effacement of foot processes as revealed by electron microscopy . fsgs may also occur secondarily to certain genetic predispositions as well as disorders such as sickle cell disease , hiv nephropathy , and obesity ; in these instances , plasma exchange would not be considered a primary therapeutic option and treatment would instead be directed at the underlying driver . clinically , patients with fsgs manifest significant , nephrotic - range proteinuria , reduced renal function , and hypertension . eighty percent of fsgs cases are characterized as primary and are suspected to be caused by a circulating fsgs permeability factor , a low - molecular weight anionic protein . this same factor may be responsible for the recurrence of fsgs in the renal allograft , a scenario that occurs in approximately 2050 % of primary allografts , most commonly within the first 3 months following transplant [ 4 , 5 ] . plasmapheresis removal of this factor appears to effectively treat many such cases [ 6 , 7 ] . recurrent fsgs can be suspected in patients who develop impaired graft function and significant proteinuria , defined as > 1 g/24 h in the posttransplant period . in many cases early recognition is therefore critical in properly diagnosing and managing this disorder . if recurrent fsgs is suspected ( even in the absence of a pretransplant history of fsgs ) then it is important to inform the pathology department of this suspicion so that biopsy specimens can be properly processed for electron microscopy , which is needed to evaluate for the foot process effacement characteristic of fsgs . the american society for apheresis guidelines designate recurrent fsgs in the renal allograft as a category i indication for therapeutic plasma exchange ( grade 1b , strong recommendation ) . we present two patients who developed recurrences of fsgs in their primary renal allografts treated with plasmapheresis and intravenous immune globulin ( ivig ) .

focal segmental glomerulosclerosis ( fsgs ) causes glomerular lesions that can progress to end - stage renal disease . it is suspected to be caused by a circulating factor that is amenable to plasmapheresis removal and exhibits a risk for recurrence in the renal allograft . we present two patients with fsgs recurrence in their allograft kidneys diagnosed by biopsy after significant proteinuria developed in the posttransplant setting . treatment with therapeutic plasma exchange induced long - term remission in both patients . spot urine protein : creatinine ratios were monitored and treatment was continued until a target of < 0.5 was achieved . in patient number two , a second peak in proteinuria and azotemia was ultimately attributable to ureteral stenosis and these values normalized following repair . in conclusion , therapeutic plasma exchange is an effective treatment for fsgs recurring following renal transplant .

breast cancer , first described as early as 3000 b.c . by edwin smith papyrus of egypt , comprises 23 % of all female malignancies ( excluding non melanomatous skin cancer ) [ 1 , 2 ] . in 2008 , the number of deaths from breast cancer totaled 460,000 patients ; it is a global concern accounting for 14 % of all cancer deaths in females . it is the most common invasive cancer in women with an incidence that ranges between 19.3 per 100,000 in eastern africa to 89.7 per 100,000 in western europe [ 4 , 5 ] . the mortality in breast cancer patients is attributed to metastatic disease [ 3 , 6 ] . it is known to metastasize to numerous organs including lymph nodes , lung , bone , liver , skin , kidneys , brain , adrenal , thyroid , and heart [ 3 , 6 , 7 , 8 ] . breast cancer metastasizing to the urinary bladder has only been reported sporadically totaling 41 cases in the english medical literature [ 3 , 913 ] . bladder metastasis from breast cancer as the only organ involved is very rare , with only eight cases reported worldwide [ 3 , 11 , 12 , 14 ] . we herein present a patient who presented with bladder metastasis from breast cancer with the bladder being the only organ involved .

breast cancer is the most common malignancy in woman . the urinary bladder is an unusual site for metastasis from primary tumors of the breast , especially when it is the only organ involved . we present the case of a female patient with known breast cancer stage t2n3m0 who developed isolated bladder metastasis five years after the primary diagnosis . we reviewed the literature for similar cases and discussed the clinical presentation , pathophysiology , and prognosis of this entity .

coronary artery fistulae are direct connections from one or more coronary arteries to cardiac chambers or a large vessel . congenital anomalies are more common than acquired,1 ) 2 ) being found in up to 0.2 % of routine angiocardiography.3 ) most reported cases are about coronary artery fistulae to right cardiac structure,4 ) but the fistula between coronary artery and left ventricle is considerably rare.4 - 6 ) moreover , a case of multiple fistula emptied into the left ventricle through the entire left ventricular walls including left ventricular free wall , interventricular septum and apex is uncommon . the following we presented is such a case , with impressive echocardiac images which demonstrating diastolic massive abnormal color doppler flows on the entire left ventricular walls which were mimicking firecracker on the whole left ventricle .

coronary artery fistulae are usually identified during invasive coronary angiographies . however , in this case , we made the early detection of coronary artery fistulae during non - invasive transthoracic echocardiography , by demonstrating diastolic multiple abnormal color doppler flows on the entire left ventricular walls including left ventricular free wall , interventricular septum and apex , which were mimicking firecracker on the whole left ventricle . fistulous communication from the coronary artery to the left ventricle is rare . moreover , a case of multiple coronary fistulae emptying into the left ventricle through the entire left ventricular walls including left ventricular free wall , interventricular septum and apex is uncommon . we report a case of a 31-year - old woman who was diagnosed with multiple fistula communicating with entire left ventricular wall .

the detection and quantification of tumour - specific rearrangements are important issues in cancer research and in clinical diagnosis of tumours . in particular , its significance became obvious for haematological malignancies that exhibit characteristic translocations in specific tumour subgroups . although gene rearrangements are typical for haematological malignancies , they also may occur in solid tumours as characteristic changes . this has been shown for ret / ptc rearrangements in papillary thyroid carcinoma ( ptc ) that fuse the ret proto - oncogene to a variety of constitutively expressed partner genes ( for review see zitzelsberger ) . this was further improved by the development of fluorescence in situ hybridization ( fish ) techniques that allows a cytogenetic analysis of rearrangements on metaphase spreads as well as on interphase cell nuclei . multicolour fish approaches such as spectral karyotyping ( sky ) allowed a more detailed analysis of cytogenetic aberrations , in particular in the case of complex and hidden rearrangements [ 5 , 6 ] . the analysis of interphase nuclei by fish has the advantage that gene rearrangements can be investigated at single cell level in nonproliferating cells . an evaluation of fish signals is usually performed by visual inspection directly from the microscopic image . in this case , cell numbers for further statistical analysis and a possible bias of the investigator towards positivity or negativity of fish signals indicating the rearrangement are major limitations . in order to analyse a statistically relevant number of cells , an automatic scanning system for fluorescence spot counting using a fully motorized fluorescence microscope with an eight - slide scanning stage and a high - resolution ccd camera driven by the metacyte software ( metasystems , altlussheim , germany ) has been established and optimized . to demonstrate routine application of the scanning system , the ret / ptc rearrangement in papillary thyroid carcinomas has been scored with a probe set that produces split fish signals if a gene rearrangement is present . therefore , the parameters of the scanning system had to be optimized using cell culture models as positive and negative controls . the aims of the present study were to establish such optimised scanning parameters and to characterise chromosomal and ret / ptc rearrangements in a ptc cohort .

structural genomic rearrangements are frequent findings in human cancers . therefore , papillary thyroid carcinomas ( ptcs ) were investigated for chromosomal aberrations and rearrangements of the ret proto - oncogene . for this purpose , primary cultures from 23 ptc have been established and metaphase preparations were analysed by spectral karyotyping ( sky ) . in addition , interphase cell preparations of the same cases were investigated by fluorescence in situ hybridisation ( fish ) for the presence of ret / ptc rearrangements using ret - specific dna probes . sky analysis of ptc revealed structural aberrations of chromosome 11 and several numerical aberrations with frequent loss of chromosomes 20 , 21 , and 22 . fish analysis for ret / ptc rearrangements showed prevalence of this rearrangement in 72 % ( 16 out of 22 ) of cases . however , only subpopulations of tumour cells exhibited this rearrangement indicating genetic heterogeneity . the comparison of visual and automated scoring of fish signals revealed concordant results in 19 out of 22 cases ( 87 % ) indicating reliable scoring results using the optimised scoring parameter for ret / ptc with the automated metafer4 system . it can be concluded from this study that genomic rearrangements are frequent in ptc and therefore important events in thyroid carcinogenesis .

medical experts consider skin - lightening and skin - bleaching practices as one of the most common forms of harmful body modification practices ( charles 2003 , p. 711 ) . melanie de souza argues that the desire for even - toned , blemish - free skin spans human populations . skin - lightening is just one of the multiple options for augmenting the skin s surface appearance , including but not limited to tanning , scarification , makeup , tattooing , face lifts , nose jobs , botox , lip extensions , and piercings . the desire to change skin colour from darker to lighter or from lighter to darker share an enhanced effect for the consumer , which has subjective and objective characteristics . this enhanced effect is directed to the way products are marketed that is to achieve a desirable skin colour or to improve an undesirable one . ironically , such an enhanced effect is overdetermined by inherent health risks , including skin cancers , steroid - induced acne , atrophy and telangiectasia . this practice can be traced back to colonialism , a period of institutionalised exploitation by colonists of indigenous populations . during colonisation privileged lighter skin with socioeconomic privilege . this paper traces historical events in south africa which may have aided or influenced the uptake and use of skin lightening creams .

skin - lightening is an aesthetic practice of global concern . by adopting a biopsycho - social approach , we consider the interplay between the biological , psychological and social factors that underpin the circulation and consumption of skin lighteners in south africa . this paper reflects on biological aspects of skin lightening , interpersonal relationships , individual beliefs and expectations about the maintenance of health and well being that informs cosmetic practices . the paper seeks to examine claims made by historians ( thomas ) and political philosophers and activists ( biko ) that colonialism and apartheid in south africa historically reinforced the use of skin lightening products in the country . the paper also investigates the role of media in staking out the boundaries of beauty . we argue that men and women practice skin - lightening not only as a complex result of the internalization of global standards of beauty , but meshed with a national politics of race and colorism . banning skin lightening products without understanding the biological effects but also the social forces that underlie their increased popularity will prove futile . moreover , we must consider the immeasurable pleasures associated with lightening , and the feelings with achieving visibility in south africa , a country that continues to wrestle with blackness .

long term use of chronic oral anticoagulants can be complicated by anticoagulation associated intracranial hemorrhage ( aaich ) , the most devastating complication of anticoagulant therapy . among patients who received anticoagulant for management of thromboembolic problems , intracranial hemorrhages led to approximately 90 % of deaths and major disability in survivors5 ) . rapid reversal is essential for prevention of enlargement of the aaich , which could result in brain herniation . on the other hand , reversal and discontinuance of anticoagulant can result in development of several kinds of side effects , such as thromboembolic complication . the risk and incidence of thromboembolic complication after cessation of anticoagulation in korean society have not been accurately reported ; in addition , there is no consensus regarding the proper period for withholding anticoagulant in the case of these patients . based on results of other studies , discontinuation for seven to 10 days appears to be safe2 ) . however , this has limitation as a proper guideline because these data were reported from small western retrospective series3,6,11 ) . in this study , we discussed reasonable access for management of patients with aaich who are at a high thromboembolic risk in the view of using an anticoagulant .

objectivethere was no abundance of data on the use of anticoagulant in patients with previous high risk of thromboembolic conditions under a newly developed intracranial hemorrhage in korean society . the purpose of this study was to evaluate the safety of discontinuance and suggest the proper time period for discontinuance of anticoagulant among these patients.methodswe reviewed the medical records of 19 patients who took anticoagulant because of thromboembolic problems and were admitted to our department with newly developed anticoagulation associated intracranial hemorrhage ( aaich ) , and stopped taking medicine due to concern of rebleeding from january 2008 to december 2012 . analysis of the incidence of thromboembolic complications and proper withdrawal time of anticoagulant was performed using the kaplan - meier method.resultsour patients showed high risk for thromboembolic complication . the cha2ds2-vasc score ranged from two to five . thromboembolic complication occurred in eight ( 42.1 % ) out of 19 patients without restarting anticoagulant since the initial hemorrhage . among them , three patients ( 37.5 % ) died from direct thromboembolic complications . mean time to outbreak of thromboembolic complication was 21.3814.89 days ( range , 8 - 56 days ) . the probability of thromboembolic complications at 7 , 14 , and 30 days since cessation of anticoagulation was 0.00 , 10.53 , and 38.49 % , respectively.conclusionshort term discontinuance of anticoagulant within seven days in patients with aaich who are at high embolic risk ( cha2ds2-vasc score > 2 ) appears to be relatively safe in korean people . however , prolonged cessation ( more than seven days ) may result in increased incidence of catastrophic thromboembolic complications .

the combination of erosion , attrition and abrasion is called tooth wear . erosion is the loss of hard tissues due to chemical effects , but not bacteria . attrition is the wear of tooth against tooth and abrasion is the wear of teeth from other surfaces . recently , the role of abfraction has raised interest into abrasion and the link with attrition but this area is under research.1 extensive tooth wear is considered a potential threat to functional dentition . the management of tooth wear , especially from attrition , is becoming a subject of increasing interest in the prosthodontic literature , both from a preventive [ how to stop the progress of tooth substance loss ( tsl ) ] and from a restorative point of view ( how to replace the lost tooth substance and to restore function ) .2 by definition , attritional wear is the loss of tooth tissue due to friction between opposing teeth and is thus related to dental occlusion . tsl considered to be normal in aging process , in which depositioning of secondary dentine , alveolar growth , muscle adaptation , and attrition are all parts of a compensation mechanism.2 clinicians are often faced with the challenge of restoring severely worn dentition . a critical aspect for successful treatment of these patients is to determine the occlusal vertical dimension and the interocclusal rest space . a systematic approach to managing this type of complete oral rehabilitation can lead to a predictable and favorable treatment prognosis.3 when tooth surface loss is severe , it can be associated with decreased vertical dimension of the occlusion resulting in a poor aesthetic appearance , loss of muscle tone and decreased masticatory efficiency.4 in addition , tooth tissue loss from bruxism has been demonstrated to be associated with various dental problems such as tooth sensitivity , excessive reduction of clinical crown height and possible changes of occlusal relationship . this case report will present a sequence of treatment , including conservative multidisciplinary approach to restoring esthetics and function in a patient with worn anterior dentition .

the management of the interim phase of a complete oral rehabilitation in patients with severely worn dentition is often challenging due to the loss of occlusal vertical dimension , loss of tooth structure , uneven wear of teeth creating an uneven plane of occlusion , and parafunctional habits . this case report describes the management of excessive tooth tissue loss in a 45 year old woman with a history of bruxism , esthetical complaints in anterior teeth , and impaired dental function due to reduced tooth height . the patient used occlusal splint for a month and than resection of the alveolar bone was performed on the vestibular sides of the maxillary anterior teeth , except the interdental alveolar crest . maxillary anterior teeth were restored with zirconia porcelain . feldspathic porcelain was chosen to restore remaining teeth in both jaws ; the patient also was given an occlusion guard to protect the restoration against future bruxism . regardless of the cause of occlusal instability , it is important that the restorative dentist should be able to recognize its signs such as tooth hypermobility , tooth wear , periodontal breakdown , occlusal dimpling , stress fractures , exostosis , muscle enlargement , and loss of posterior disclusion . when restoring the worn dentition , the clinician should bear in mind the five p s : proper planning prevents poor performance .

locally advanced breast cancer ( labc ) is defined by presence of a large primary tumor ( > 5 cm or t3 ) , associated with or without skin or chest - wall involvement ( t4 ) or with fixed ( matted ) axillary lymph nodes or with disease spread to ipsilateral internal mammary or supraclavicular nodes in the absence of any evidence of distant metastases . labc accounts for 10 - 20 % in the west , while in india , it accounts for 30 - 35 % of all cases . labc encompasses a wide spectrum of malignant breast tumors with varying presentation and poses a significant therapeutic challenge . the introduction of neoadjuvant chemotherapy ( nact ) in labc offered us advantages like initiation of early systemic therapy , delivery of drugs through intact vasculature , down - staging of tumors , which makes inoperable tumors operable and renders tumors suitable for breast conserving surgery ( bcs ) . it also helps in vivo assessment of response . national surgical adjuvant breast and bowel project ( nsabp ) -18 and milan trials have shown that there were no difference in disease free survival ( dfs ) and overall survival between the patients who had received nact when compared to the patients who had received postoperative adjuvant chemotherapy . there are very few indian studies of nact in labc published until date . keeping this in mind , we have conducted a retrospective analysis to see the outcome of nact in labc patients at a tertiary care center .

background : introduction of neoadjuvant chemotherapy ( nact ) has dramatically changed the management of locally advanced breast cancer ( labc ) . however , very few randomized trials of nact have been carried out specifically in labc patients in our country . in this retrospective analysis , we presented our experience with nact in labc patients.materials and methods : medical records of 148 patients of stage iii labc patients treated with nact , followed by surgery and radiotherapy from january 2006 to december 2010 were reviewed . clinical and pathological responses to different chemotherapy regimens were assessed according to world health organization criteria . various factors influencing response to nact and clinical outcome were identified and analyzed.results : a total of 90 ( 60.8 % ) patients received anthracycline - based chemotherapy and 52 ( 35.1 % ) patients received mixed anthracycline and taxane - based chemotherapy.119 patients ( 80.4 % ) responded to nact either in the form of complete or partial response ( pr ) . complete response was seen in 27 ( 18.2 % ) patients and 92 ( 62.2 % ) patients showed pr after nact . pathological complete response was seen in 24 ( 16.2 % ) patients- . at a median follow - up period of 44 months 36 patients ( 24.3 % ) developed relapse of which six patients developed locoregional recurrence , while 28 ( 18.9 % ) patients developed distant metastasis . nodal status , response to chemotherapy , pathological tumor size < 3 cm and extracapsular extension ( ece ) came out to be important prognostic factors in this study.conclusion : neoadjuvant chemotherapy is a reasonable alternative to upfront surgery in the management of labc . clinicopathological variables such as nodal status , response to chemotherapy , pathological tumor size and presence of ece had significant impact on disease free survival .

protein protein interactions are essential to the function of the ubiquitous xenobiotic - metabolizing cytochrome p450 monooxygenases , or cyps . classic studies have demonstrated the importance of cyp interactions with the accessory proteins cytochrome p450 reductase ( cpr ) and cytochrome b5 ( b5 ) for both electron transfer and allosteric modulation . however , it has recently become clear that cyp enzymes may participate in additional interactions with other protein partners , such as progesterone receptor membrane component 1 ( pgrmc1 ) , human serum albumin ( hsa ) , and even other cyp isoforms . these interactions have been shown to alter cyp function and , in some cases , lead to the production of toxic metabolites . in this review , we attempt to summarize the available evidence from the primary literature and offer some future perspectives on the study of noncanonical protein protein interactions with cytochrome p450 enzymes .

through their unique oxidative chemistry , cytochrome p450 monooxygenases ( cyps ) catalyze the elimination of most drugs and toxins from the human body . protein protein interactions play a critical role in this process . historically , the study of cyp protein interactions has focused on their electron transfer partners and allosteric mediators , cytochrome p450 reductase and cytochrome b5 . however , cyps can bind other proteins that also affect cyp function . some examples include the progesterone receptor membrane component 1 , damage resistance protein 1 , human and bovine serum albumin , and intestinal fatty acid binding protein , in addition to other cyp isoforms . furthermore , disruption of these interactions can lead to altered paths of metabolism and the production of toxic metabolites . in this review , we summarize the available evidence for cyp protein protein interactions from the literature and offer a discussion of the potential impact of future studies aimed at characterizing noncanonical protein protein interactions with cyp enzymes .

with the improvement of diagnostic imaging , the incidence of uia diagnosis is increasing , along with the national cost containment pressures associated with treatment and management . economic considerations are important in the cost - benefit evaluation of treatments , and influence healthcare coverage , reimbursement , and policy . while many studies have already compared the treatment modalities for intracranial aneurysms , surgical clipping and endovascular coiling , in terms of the procedural invasiveness , clinical and functional outcomes , and durability , few studies have investigated the economic costs for such treatments23713 ) . plus , treatment costs show distinct disparities between countries313 ) .during the process of informed consent for clipping or coiling , uia patients are also concerned about the cost implications . therefore , the authors performed a cost comparison , and investigated the principal cost determinants of uia treatment in south korea .

objectivea cost comparison of the surgical clipping and endovascular coiling of unruptured intracranial aneurysms ( uias ) , and the identification of the principal cost determinants of these treatments.methodsthis study conducted a retrospective review of data from a series of patients who underwent surgical clipping or endovascular coiling of uias between january 2011 and may 2014 . the medical records , radiological data , and hospital cost data were all examined.resultswhen comparing the total hospital costs for surgical clipping of a single uia ( n=188 ) and endovascular coiling of a single uia ( n=188 ) , surgical treatment [ meanstandard deviation ( sd ) : 8,280,0001,490,000 ] resulted in significantly lower total hospital costs than endovascular treatment ( meansd : 11,700,0003,050,000 , p < 0.001 ) . in a multi regression analysis , the factors significantly associated with the total hospital costs for endovascular treatment were the aneurysm diameter ( p < 0.001 ) and patient age ( p=0.014 ) . for the endovascular group , a pearson correlation analysis revealed a strong positive correlation ( r=0.77 ) between the aneurysm diameter and the total hospital costs , while a simple linear regression provided the equation , y ( ) =6,658,630 + 855,250x ( mm ) , where y represents the total hospital costs and x is the aneurysm diameter.conclusionin south korea , the total hospital costs for the surgical clipping of uias were found to be lower than those for endovascular coiling when the surgical results were favorable without significant complications . plus , a strong positive correlation was noted between an increase in the aneurysm diameter and a dramatic increase in the costs of endovascular coiling .

intensive care requires not only the use of sophisticated equipment but also highly skilled and dedicated healthcare staff . as such , the intensive care unit ( icu ) takes a significant proportion of the total healthcare cost , and therefore patients with prolonged icu length of stay ( los ) can have serious cost implications . moreover , patients with prolonged icu - los can also lead to a shortage of icu beds and result in operations being cancelled . regarding the population of cardiac surgery patients , the prediction of their icu - los is a fact of great significance , based on the need for containing the burgeoning costs involved in cardiac operations , saving resources and icu costs . in addition , the cardiac surgery icu - los is a significant healthcare index that has been correlated with poor patient outcome , such as increased expenditure and higher morbidity and mortality rates . furthermore , the icu - los is a valuable indicator of the quality and the effectiveness of the provided care . the above data could interpret the scientific interest for the early prediction of the length of hospitalization in cardiac surgery icus . various predictive models for prolonged icu stay after cardiac surgery have been developed , during the last two decades [ 5 , 6 ] , and several papers have attended preoperative risk factors associated with prolonged icustay . these efforts are now more than ever in season and necessary because of the global financial crisis , that has affected negatively the healthcare systems ' operation , worldwide , and demands a more efficient use of the icu resources . the aim of this study was to identify the preoperative and intraoperative predictors for prolonged icu - los , among cardiac surgery patients . this identification could lead to the early recognition of the high - risk patients for longer icu hospitalization and , also , could provide an important aid to nursing administrators and leaders for the appropriate resource planning and effective choice of the operation list , with the low - risk patients being scheduled for surgery before the high - risk candidates .

the prediction of intensive care unit length of stay ( icu - los ) could contribute to more efficient icu resources ' allocation and better planning of care among cardiac surgery patients . the aim of this study was to identify the preoperative and intraoperative predictors for prolonged cardiac surgery icu - los . an observational cohort study was conducted among 150 consecutive patients , who were admitted to the cardiac surgery icu of a tertiary hospital of athens , greece from september 2010 to january 2011 . multivariate regression analysis revealed that patients with increased creatinine levels preoperatively ( odds ratio ( or ) 3.0 , p = 0.049 ) , history of atrial fibrillation ( af ) ( or 6.3 , p = 0.012 ) and high euroscore values ( or 2.6 , p = 0.017 ) had a significant greater probability to stay in the icu for more than 2 days . in addition , intraoperative hyperglycemia ( or 3.0 , p = 0.004 ) was strongly associated with longer icu - los . in conclusion , the high perioperative risk , the history of af and renal dysfunction , and the intraoperative hyperglycemia are significant predictors of prolonged icu stay . the early identification of patients at risk could allow the efficient icu resources ' allocation and the reduction of healthcare costs . this would contribute to nursing care planning depending on the availability of healthcare personnel and icu bed capacity .

colorectal cancer ( crc ) is one of the most prevalent cancer , along with lung and breast cancers . in 2012 , approximately 1.4 million new cases and 700,000 crc - related deaths were estimated worldwide ( 1 ) . over the last decade , crc incidence and mortality in the united states have been on a steady decline as a result of advances in its prevention , screening , and treatment . nevertheless , it is still the second leading cause of cancer deaths ( 2 ) . moreover , there has been a significant rise in crc incidence in newly developed or economically transitioning countries , such as south america , eastern european countries , and most parts of asia ( 3 ) . although crc is highly curable at an early stage , approximately 50 % of patients with crcs eventually develop metastatic disease ( 4 ) . five - year survival rate is approximately 10 % in patients with a stage iv disease ( 5 ) . there are many known risk factors for crc including age , sex , smoking , excessive alcohol consumption , high intake of red and processed meat , obesity , diabetes , inflammatory bowel disease , inherited genetic disorder , and family history of crc ( 6789101112 ) . among them , ulcerative colitis and crohn 's disease increase the overall risk of colitis - associated cancer ( 14 ) . approximately 20 % of patients with inflammatory bowel disease develop colitis - associated cancer within 30 years of disease onset ( 15 ) . inherited crc , including lynch syndrome and familial adenomatous polyposis , represent less than 5 % of crc cases ( 16 ) . in this review , we briefly review currently available drugs for the treatment of colorectal cancer and summarize clinical studies that use cell - based cancer immunotherapy as promising therapeutic strategy . we also suggest the use of cytokine - induced killer ( cik ) cells as an additional therapeutic approach for metastatic colorectal cancer .

colorectal cancer is the third leading cancer worldwide . although incidence and mortality of colorectal cancer are gradually decreasing in the us , patients with metastatic colorectal cancer have poor prognosis with an estimated 5-year survival rate of less than 10 % . over the past decade , advances in combination chemotherapy regimens for colorectal cancer have led to significant improvement in progression - free and overall survival . however , patients with metastatic disease gain little clinical benefit from conventional therapy , which is associated with grade 3~4 toxicity with negative effects on quality of life . in previous clinical studies , cell - based immunotherapy using dendritic cell vaccines and sentinel lymph node t cell therapy showed promising therapeutic results for metastatic colorectal cancer . in our preclinical and previous clinical studies , cytokine - induced killer ( cik ) cells treatment for colorectal cancer showed favorable responses without toxicities . here , we review current treatment options for colorectal cancer and summarize available clinical studies utilizing cell - based immunotherapy . based on these studies , we recommend the use cik cell therapy as a promising therapeutic strategy for patients with metastatic colorectal cancer .

the majority of swallowed indigestible foreign bodies pass through the gastrointestinal tract without complications [ 1 , 2 , 3 , 4 ] . however , there are three physiological narrowings involving the pylorus , duodenal c - loop and ileocecal valve . foreign bodies longer than 10 cm , such as a toothbrush , can not negotiate the duodenal c - loop due to its fixed retroperitoneal position . these objects should be endoscopically removed as soon as possible to avoid pressure necrosis and gastrointestinal perforation [ 5 , 6 , 7 ] . if endoscopic removal fails or there is evidence of obstruction or perforation , laparoscopic gastrotomy should be performed .

most ingested foreign bodies will pass uneventfully through the gastrointestinal tract . nevertheless , long and rigid foreign bodies are associated with an increased risk of gastrointestinal impaction , perforation and bleeding . moreover , there has been no case of spontaneous passage of a toothbrush reported . therefore , the prompt removal of such ingested foreign objects is recommended before complications develop . this case report describes a case of an 18-year - old woman who accidentally swallowed her toothbrush . the toothbrush was successfully removed via flexible endoscopy using a polypectomy snare . a swallowed toothbrush is a special clinical challenge . early endoscopic retrieval of the toothbrush is critical for reducing morbidity and mortality . in cases when endoscopic removal fails , a laparoscopic surgical approach may be an alternative .

solitary fibrous tumor ( sft ) is a rare neoplasm that was initially described in the visceral pleura and subsequently reported in extrapleural sites including the pericardium , peritoneum , mediastinum , lung , upper respiratory tract , thyroid , liver , testicle , nasal cavity , parotid , orbit , and meninges . sft development in the spine is an exceedingly rare event about which little is known . we present a unique case of an intradural extramedullary malignant sft having an extradural component with pulmonary metastases . to the best of our knowledge , this is the second case of malignant sft spine with distant metastases reported in literature .

solitary fibrous tumor ( sft ) usually originates from the pleura because of abnormal proliferation of fibroblast cells . it is extremely rare for the tumor to originate from the spine . here , we report the second case of malignant sft of thoracic spine with distant metastases in a 35-years - old female .

entrapment of the ulnar nerve in the elbow region is the second most common compression neuropathy in the upper extremity . many procedures have been advocated for decompression of the ulnar nerve at the elbow , including anterior subcutaneous transposition , anterior intramuscular transposition , anterior submuscular transposition , medial epicondylectomy , simple decompression , neurolysis , and in situ decompression . the introduction of endoscopic release , the newest of all the surgical options for this problem has been described by several authors . the new approach to peripheral nerve surgery specifically in cubital tunnel syndrome is the introduction of the endoscopic procedure . since the advent of endoscopic methods to release the course of the ulnar nerve entrapment at the elbow site , there has been a flurry of interest and controversy about the efficacy and safety of this newest technique . endoscopic decompression of the ulnar nerve at the elbow was first described in 1995 by tsai et al . . there are different variations of endoscopic surgical technique , but the purpose and goals preserve the vascularity of the ulnar nerve at the elbow , release all possible compression sites , allow early mobilisation of the elbow , avoid extensive surgical exposure , and scar discomfort . it provides for limited soft tissue dissection , thereby allowing more rapid recovery with minimal scarring . potential ulnar nerve entrapment can occur at five sites around the elbow : the arcade of struthers , the medial intermuscular septum , the medial epicondyle , the cubital tunnel , and the deep flexor pronator aponeurosis . various surgical techniques for decompression of the ulnar nerve have been described in the literature , and a definitive gold standard does not exist . comparative studies have shown some short - term advantages to one or another technique , but overall results between the treatments have essentially been equivocal . a thorough preoperative diagnosis and workup will help guide us for the type of surgical technique . we report our experience with this newer technique in six patients , with special focus on the clinical and surgical outcome .

cubital tunnel syndrome is one of the common upper extremity problem encountered . a mild syndrome can be often treated without surgery , but a failure of conservative treatment with constant symptoms or muscle atrophy and weakness requires surgical intervention . despite the fact that is the second most common nerve entrapment in the upper limb , there is no accepted gold standard in the surgical management . but with the new technique in minimally invasive surgery and available endoscope , it addresses all potential compression sites with good visualisation but with small surgical exposure . the procedure is safe and reliable way to address this problem .

attachment is a relatively stable emotional bond which is created between child and mother or those with whom an infant regularly interacts . parents responses to the signs of child 's attachment behavior and their availability in stressful situations , provides a safe place and condition for children , based on which , children organize their expectations from the environment . the attachment between child and primary caregiver ( usually mother ) would become internalized and later act as a mental model which is used by the adult person to use as a base for building friendship and romantic relationships ; it can affect the attitudes of people in their adulthood as well . adult attachment styles are subdivided into three categories : ( 1 ) secure : secure people are intimate and comfortable in making relationships , and they are sure that others would like them . ( 2 ) anxious - ambivalent : they have a strong desire for close relationships but also have many concerns of rejection . these people have a negative image of themselves , but a positive attitude toward others . ( 3 ) avoidance : for this group of people , self - reliance is the most valuable issue . hence , it can be said that attachment styles affect other aspects of one 's life and have an impact on persons relationships with other people after childhood . many researchers and authorities have shifted their focus toward the topics such as joy , happiness , life satisfaction , and positive emotions . according to many theories of emotions , one of the six great emotions is happiness ; the six great emotions include surprise , fear , anger , happiness , disgust , and worry . happiness is a type of conception about individual 's own life ; it includes items such as life satisfaction , positive emotions , and mood , lack of anxiety and depression and its different aspects of emotions . when people are satisfied with their living conditions and are frequently experiencing positive and less negative emotions , it is said that they are at high levels of mental health . increased levels of happiness is directly associated with the better status of health , appetite , sleep , memory , family relationships , friendships , family status , and ultimately mental health . the relationship between subjective well - being and emotion regulation with attachment styles in various studies has been explained . despite the important role of medical students in public health and the significance of their happiness which is related to their attachment styles , so far , this research was aimed to assess the relationship between attachment styles and happiness and demographic characteristics of medical students .

background : attachment theory is one of the most important achievements of contemporary psychology . role of medical students in the community health is important , so we need to know about the situation of happiness and attachment style in these students.objectives : this study was aimed to assess the relationship between medical students attachment styles and demographic characteristics.materials and methods : this cross - sectional study was conducted on randomly selected students of medical sciences in kurdistan university , in 2012 . to collect data , hazan and shaver 's attachment style measure and the oxford happiness questionnaire were used . the results were analyzed using the spss software version 16 ( ibm , chicago il , usa ) and statistical analysis was performed via t - test , chi - square test , and multiple regression tests.results : secure attachment style was the most common attachment style and the least common was ambivalent attachment style . avoidant attachment style was more common among single persons than married people ( p = 0.03 ) . no significant relationship was observed between attachment style and gender and grade point average of the studied people . the mean happiness score of students was 62.71 . in multivariate analysis , the variables of secure attachment style ( p = 0.001 ) , male gender ( p = 0.005 ) , and scholar achievement ( p = 0.047 ) were associated with higher happiness score.conclusion : the most common attachment style was secure attachment style , which can be a positive prognostic factor in medical students , helping them to manage stress . higher frequency of avoidant attachment style among single persons , compared with married people , is mainly due to their negative attitude toward others and failure to establish and maintain relationships with others .

human acute radiation syndrome ( ars ) follows intense , acute whole - body or significant partial - body radiation , of doses > 1 gy , delivered at relatively high rates . clinical components of ars include the hematopoietic sub - syndrome ( h - ars , 2 6 gy ) , gastrointestinal sub - syndrome ( gis ; 6 8 gy ) and the cerebrovascular ( > 8 gy ) sub - syndrome . dividing ars into these sub - syndromes oversimplifies the clinical reality of ars as it often involves complex , concurrent and multi - organ dysfunctions . cerebrovascular sub - syndrome is considered incurable , whereas h - ars alone or in combination with gis , are more likely to be amenable to countermeasures ; therefore , the later two sub - syndromes are specific targets for the development of novel medical countermeasures ( mcm ) . there are several biologics at different developmental stages to be considered as mcm for ars ( figure 1 , tables 1 and 2 ) . a brief description and current status of promising biologics are provided in this article . schematic representation of the biological agents as radiation countermeasures under development . currently , there are three agents with fda ind status : entolimod , hemamax and neupogen . neupogen and leukine have been procured for sns availability and are expected to obtain fda eua in the near future . pegylated g - csf is not currently stocked in the sns but may also obtain fda eua approval once filgrastim is approved . ars : acute radiation syndrome ; eua : emergency use authorization ; fgf : fibroblast growth factor ; ind : investigational new drug ; sns : strategic national stockpile . ars : acute radiation syndrome ; eua : emergency use authorization ; fgf : fibroblast growth factor ; ind : investigational new drug ; sns : strategic national stockpile . biologics with us fda ind / procured for sns / close to fda approval . gi : gastrointestinal ; ind : investigational new drug ; nhp : nonhuman primate ; pahpra : pandemic and all hazards preparedness reauthorization act ; rhuil-12 : recombinant human il-12 ; sns : strategic national stockpile . we are unable to cite all relevant references because of limitation of total number of references for this article . ars : acute radiation syndrome ; fgf : fibroblast growth factor ; fgf - p : fibroblast growth factor - derived peptide ; gi : gastrointestinal ; gis : gastrointestinal sub - syndrome ; nhp : nonhuman primate .

despite significant scientific advances toward the development of a safe , nontoxic and effective radiation countermeasure for acute radiation syndrome ( ars ) over the past six decades , no drug has been approved by the us fda . several biologics are currently under development as radiation countermeasures for ars , of which three have received fda investigational new drug ( ind ) status for clinical investigation . presently , two of these agents , entolimod ( cblb502 ) and hemamax ( recombinant human il-12 ) are progressing with large animal studies and clinical trials . neupogen ( g - csf , filgrastim ) has recently been recommended for approval by an fda advisory committee . filgrastim , gm - csf ( leukine , sargramostim ) , and pegylated g - csf ( neulasta ) have high potential and well - documented therapeutic effects in countering myelosuppression and may receive full licensing approval by the fda in the future . the former two biologics are available in the us strategic national stockpile ( sns ) for use in the event of nuclear or radiological emergency . the emergency use authorization ( eau ) application for entolimod may be filed soon with the fda . biologics are attractive agents that are progressing along the path for fda approval , to fill the unmet need for ars countermeasures .

chemically , phloroglucinol ( 1,3,5-trihydroxybenzene , pg ) and its methylated derivative tri - o - methylphloroglucinol ( tmp ) , figure 1 , are established pharmaceutical agents inhibit the action of catechol - o - methyl transferase , inducing relaxation of smooth muscles , and decreasing glycerol - induced abdominal pain and are also characterized by a swift and strong spasmolytic activity , hence relieving pain . therefore , pg is often used in combination with trimethylphloroglucinol as an antispasmodic drug and is regarded to be effective in decreasing smooth muscle spasm . pg / tmp combination is recommended against biliary calculi , severe pain of urinary or gastrointestinal tract , pain of abdominal region , spastic conditions of the female genital system , and pain in gynecology [ 17 ] . literature survey reveals that some of the analytical methods for phloroglucinol are available including extraction and high - performance liquid chromatography ( hplc ) [ 810 ] , hplc - mass spectrometry [ 11 , 12 ] , gas chromatography - mass spectrometry , and spectrophotometry . other reported methods include titrimetry , spectrophotometry , paper chromatography , and flow injection analysis [ 1520 ] . however , there is no simple and sensitive method to be followed on industrial basis especially in general quality control laboratories . therefore , they can not be followed in the laboratories particularly those of third world countries . hence our group already developed a cost effective method for its fixed dose composition in tablet form , but still there was a need for an analytical method which would help to determine the active pharmaceutical ingredients ( apis ) in parenteral products and physiological fluid . accordingly , the purpose of this write - up is to suggest a systematic approach for the development of a validated simple , sensitive , and stability indicating rp - hplc method that should meet the current ich and regulatory requirements .

a reverse phase stability indicating hplc method for simultaneous determination of two antispasmodic drugs in pharmaceutical parenteral dosage forms ( injectable ) and in serum has been developed and validated . mobile phase ingredients consist of acetonitrile : buffer : sulfuric acid 0.1 m ( 50 : 50 : 0.3 v / v / v ) , at flow rate 1.0 ml / min using a hibar bondapak ods c18 column monitored at dual wavelength of 266 nm and 205 nm for phloroglucinol and trimethylphloroglucinol , respectively . the drugs were subjected to stress conditions of hydrolysis ( oxidation , base , acid , and thermal degradation ) . oxidation degraded the molecule drastically while there was not so much significant effect of other stress conditions . the calibration curve was linear with a correlation coefficient of 0.9999 and 0.9992 for pg and tmp , respectively . the drug recoveries fall in the range of 98.56 % and 101.24 % with 10 pg / ml and 33 pg / ml limit of detection and limit of quantification for both phloroglucinol and trimethylphloroglucinol . the method was validated in accordance with ich guidelines and was applied successfully to quantify the amount of trimethylphloroglucinol and phloroglucinol in bulk , injectable form and physiological fluid . forced degradation studies proved the stability indicating abilities of the method .

the localization and subsequent translation of mrna are important means of regulating gene expression with high spatial and temporal control . in neurons , targeting mrna to specific sites and synthesizing proteins where and when they are needed is particularly beneficial because neurons have long dendrites and axons extending from a few hundred microns to up to a meter from the cell body . the physiological roles of mrna localization in neurons have been implicated in various neuronal functions such as synaptic plasticity , axonal guidance and regeneration . however , there are many remaining questions regarding how mrnas navigate through the complex neuronal arbors , how they are captured in specific regions , and how local translation is regulated ( buxbaum et al . , 2015 ; holt and schuman , 2013 ; hutten et al . , 2014 ; xing and bassell , 2013 ) . observing the dynamics of mrna localization and translation will provide critical information to help understand how precise spatio - temporal regulation of gene expression is processed . most previous studies have used in situ hybridization ( ish ) methods ( lawrence and singer , 1985 ) to visualize rna molecules inside a cell . in particular , fluorescence in situ hybridization ( fish ) enables the detection of individual rna molecules with various signal amplification procedures in fixed cells . single - molecule fish ( smfish ) , which uses multiple fluorescent probes hybridized to a single mrna ( femino et al . , 1998 ; , 2008 ) , is widely used to profile transcription , localization and degradation of rna . however , fish experiments using fixed cells can not provide temporal information on rna regulation . recent innovations in live - cell imaging technologies have made it possible to observe the sequence of molecular events in real time , which is critical to our understanding of mrna dynamics ( moon et al . , 2016 ; spille and kubitscheck , 2015 ) . by imaging single mrna molecules in live cells , we can begin to understand the cause - and - effect relationship and to model the kinetics of rna regulation more quantitatively and predictably . in this review , we provide a brief overview of recent progress in studies on mrna localization and translation in neurons . in particular , we highlight several recent reports that have used single - molecule imaging techniques to contribute to our knowledge of mrna translocation in dendrites and axons . additionally , we review new technical developments for multicolor imaging of single mrnas and their translational activities . these approaches will provide a powerful toolkit to help understand the molecular mechanisms of rna localization and local translation in neurons , with unprecedented temporal and spatial resolution .

local protein synthesis mediates precise spatio - temporal regulation of gene expression for neuronal functions such as long - term plasticity , axon guidance and regeneration . to reveal the underlying mechanisms of local translation , it is crucial to understand mrna transport , localization and translation in live neurons . among various techniques for mrna analysis , fluorescence microscopy has been widely used as the most direct method to study localization of mrna . live - cell imaging of single rna molecules is particularly advantageous to dissect the highly heterogeneous and dynamic nature of messenger ribonucleoprotein ( mrnp ) complexes in neurons . here , we review recent advances in the study of mrna localization and translation in live neurons using novel techniques for single - rna imaging .

retinoblastoma ( rb ) is a primary intraocular tumor that is most commonly malignant in childhood ; this condition arises from primitive neural retinal cells destined to become photoreceptors and corresponds to 11 % of all cancers in the first year of life . the incidence of rb worldwide is estimated at between 5,000 and 8,000 new cases per year , and although rb can occur at any age , this tumor occurs most often in preschool children ( 95 % of cases diagnosed before 5 years of age ) [ 3 - 5 ] . the primary genetic event associated with rb is the inactivation of both alleles of the rb1 gene ( gene i d : 5925 , omim 614041 ) in the 13q14 locus by translocations , deletions , insertions , and point mutations . genetically , rb presents as hereditary ( 40 % ) or non - hereditary ( 60 % ) . in the inherited form , a constitutional mutated allele is always transmitted via germs ; meanwhile , in the non - hereditary form , both alleles are inactivated by somatic mutations . the tp53 gene ( gene i d : 7157 , omim 191170 ) is located at 17p13.1 and provides instructions for making the p53 tumor protein ( p53 ) ; this protein acts as a tumor suppressor and binds directly to dna . when p53 is damaged , other genes are activated to repair the damage . if the dna can not be repaired , this protein prevents the cell from dividing and sends signals for apoptosis ; thus , the protein has been nicknamed the guardian of the genome . genetic polymorphisms are variants of genome mutations that appear in certain individuals . these polymorphisms are transmitted to offspring and acquire a certain frequency in the population after many generations . the most common polymorphisms are single base changes , known as single nucleotide polymorphisms ( snps ) . the aim of this study was to determine the frequency and association between the snp rs9568036 ( the rb1 gene ) and the snp rs1042522 ( tp53 ) and clinical characteristics in a group of mexican children with rb .

purposeto determine the frequency and association of polymorphisms in the tp53 and rb1 genes with clinical characteristics in a group of children with retinoblastoma ( rb ) in northern mexico.methodsa prospective , longitudinal , and analytical study of 11 patients diagnosed with rb was conducted . endpoint pcr and high - resolution real - time pcr were performed . chi - square and student t tests were used to evaluate associations between variables . allelic frequencies , as well as genotypic and hardy weinberg equilibriums , were evaluated using guo and thompson s method.resultswe found a statistically significant difference between the polymorphism rb1-gg / rs9568036 and tumor chemoresistance ( p < 0.05 ) . the allelic variants rb1-aa and ag / rs9568036 were determined to be associated with tumor chemosensitivity ( p < 0.05 ) . a statistically significant relation between the polymorphism rb1-gg / rs9568036 and males ( p = 0.0386 ) , rate ratio ( rr ) = 2.0 ( 95 % confidence interval [ ci ] = 0.765.32 ) , as well as between the allelic variants rb1-aa and ag / rs9568036 and females ( p = 0.0027 ) , rr = 8.0 ( 95 % ci = 1.2850.04 ) , was observed . we also observed a statistically significant association between the rs1042522 polymorphism in the tp53 gene and unilateral presentation of the disease.conclusionsthe rs9568036 polymorphism in the rb1 gene and the allelic variants can be associated with type of response to medical therapy and associated with male sex , while the allelic variant rs1042522 polymorphism in the tp53 gene is associated with the unilateral presentation of the disease in a group of mexican children with rb .

the nose is a central structure of the face , so attempts to reconstruct ideal form and esthetics can be complicated . the majority of patients with cleft lip nose deformity require augmentation rhinoplasty for a more balanced nasal dorsum . traditionally , autogenous cartilages from various sites are used to correct cleft lip nose deformity . however , sometimes results of corrective rhinoplasty using auricular or septal cartilages are unsatisfactory due to the weakness of the graft material . in that case , rib cartilage could be a good material of choice for corrective rhinoplasty for cleft lip nasal deformity . however , the harvesting procedure leaves a cutaneous scar that is unacceptable , especially for a young female patient . so we need to find alternative surgical options to replace the autogenous rib cartilage . in 1998 , a new biomaterial called permacol ( tissue science laboratories plc , aldershot , uk ) was licensed in europe for permanent implantation in human body . permacol consists of acellular , cross - linked porcine dermal collagen that is resistant to degradation by collagenase . it had been widely used in general and gynecological surgery in the treatment of hernia and otolaryngology surgery such as surgical closure of nasal septal perforation . recently it was described in facial contour augmentation surgery including esthetic augmentation rhinoplasty and reconstruction of a post - traumatic nasal deformity . the author augmented nasal dorsum after reconstruction of the lower third of the nose during corrective rhinoplasty in patients with cleft lip nasal deformity . in this report we describe three cases of rhinoplasty procedures using autogenous auricular cartilage and synthetic porcine dermal collagen with highlights of how to use it .

esthetic reconstruction of cleft lip nose deformity is a challenging task in surgical management of patients with orofacial cleft . the author reconstructed cleft lip nose deformity effectively using autogenous auricular cartilage and a relatively new graft material of porcine dermal collagen , permacol . after correction of the deformed lower third of the nose with patient s auricular cartilage , we applied permacol to augment the entire nasal dorsum . three patients were treated and followed for up to five years . all patients improved in nose aesthetics without any inflammatory or immunogenic reaction . the author suggests that the use of permacol for nasal profile augmentation in the treatment of cleft lip nose deformity is an alternative surgical strategy with minimal surgical invasiveness . the author report long - term experience with combined use of auricular cartilage and permacol in nasal reconstruction for cleft lip nose deformity .

prostate cancer ( pca ) is a frequent cancer that can be cured if early diagnosed ( 1 ) . prostate specific antigen ( psa ) has become an important tool in pca screening ( 2 , 3 ) and men with serum psa greater than 4ng / ml are at higher risk of pca . these patients are usually referred for a prostate biopsy ( bxp ) . however , increased psa levels are also associated with conditions other than cancer ( 3 ) , such as benign prostatic hyperplasia ( bph ) and prostatitis ( 4 , 5 ) . chronic abacterial prostatitis is a common diagnosis in men of all ages , with widespread demographics , and it is a common reason for yearly visits to the doctor in the united states ( 3 ) . only a few studies have linked prostatitis to an increase in serum psa ( 6 - 9 ) . subclinical inflammation of the prostate could elevate serum psa in asymptomatic patients , confounding the use of psa values to indicate bxp ( 10 ) . in the majority of cases , prostatitis is an incidental pathological finding that has no clinical relevance . there has been investigation into ways to decrease the misleading diagnosis resulting from inflammation . repeat psa measurements after a period of observation in asymptomatic men can help to avoid unnecessary bxp ( 10 - 12 ) . it has been suggested that antibiotic therapy ( at ) can also avoid bxp in many patients with prostate inflammation , in the psa grey zone ( 4.0 to 10.0ng / ml ) ( 6 , 13 , 14 ) . currently , the indications of re - bxp in patients with a negative initial biopsy are few ; therefore , the first bxp must be precise . in an effort to improve the reliability of psa reduction as an indicator , and consequently avoid unnecessary prostate biopsy , we conducted a prospective , controlled , non - randomized study to evaluate the effect of at on psa levels in patients who have an initially mild psa elevation ( 4.0 - 10ng / ml ) .

purpose we investigated the effect of antibiotics on psa in asymptomatic patients with mild psa elevation.materials and methods we prospectively evaluated , in a non - randomized design , 106 asymptomatic patients with psa of 4 - 10ng / ml , with a negative digital rectal examination and with no urinary tract infection evidence for 2 years . patients were divided into two groups : those treated with antibiotics for 3 weeks ( g1 ) and those who were not treated ( g2 ) . psa was taken six weeks after and prostate biopsy was performed in all patients.results pca was diagnosed in 25 of 106 patients ( 23.6 % ) : 16 ( 25.0 % ) in g1 and 9 ( 21.4 % ) in g2 ( p > 0.05 ) . psa normalization was experienced in 24.5 % . in g1 , psa returned to < 4ng / ml in 15 ( 23.4 % ) patients compared to 11 ( 26 % ) patients in g2 . in the patients with a positive biopsy , no significant variation was noted in psa , fpsa , % fpsa and dpsa after antibiotic treatment . a significantly lower cancer detection rate was noted with decreased psa , fpsa , and dpsa after antibiotic use . a psa reduction rate of 10 % occurred in 58.5 % , and this was similar in both g1 and g2 groups . the sensibility , specificity and accuracy of psa reduction of 10 % were 31 % , 23 % and 25 % , respectively.conclusion empirical antibiotic therapy in asymptomatic male patients is not related to psa reduction . the greater than 10 % psa reduction after antibiotic in this population can not postpone prostate biopsy .

charcot neuropathic osteoarthropathy ( cn ) is a chronic , progressive condition of bones , joints , and soft tissues , most commonly occurring in the area of the foot and ankle as a result of peripheral neuropathy . it is characterized by a local inflammatory process in the early stages and gradual development of bone loss , joint dislocation , and fixed deformities . these deformities diabetes mellitus , together with neuropathy , is currently considered the main cause of cn . data indicating the prevalence and incidence of the condition suggest that it often goes undiagnosed among sufferers of diabetes , with figures ranging from 0.4 to 13 % among diabetics . however , changes diagnosed by x - ray and corresponding with cn are detected in up to 29 % of diabetics . bilateral disability has been observed in numbers ranging from 9 to 39 % of patients . when mri is used as a diagnostic method , the common issue is an early diagnosis and an appropriate treatment , in case of an acute phase where it is difficult to differentiate an acute osteomyelitis . even though the treatment of cn is mostly conservative however , the crucial question is when , where , and how a surgical therapy has to be used .

charcot neuropathic osteoarthropathy of the foot is a relatively common complication of diabetic neuropathy . incorrect diagnosis and improper treatment often result in the extremity having to be amputated . this paper summarises the current view on the etiology , diagnostics , and treatment of diabetic charcot neuropathic osteoarthropathy , with particular focus on preserving the extremity through surgical intervention from our own experiences .

packaging is a link connecting production with marketing whereby the goods reach from the production center to the consumers in a safe and sound condition with a minimum overall cost . packaging can also be defined as the coordinated system which can enclose or protect the products for distribution , storage , preservation , transportation , information , and sales . the pharmaceutical brands are most vulnerable due to their higher market share , ease of production , and greater profit margins . products sidetracked from their proper distribution channel , or sold past their expiry date , or by modification of the package are associated with the problem of counterfeiting . counterfeits are unauthorized reproductions of a trademarked brand , which are closely similar or identical to genuine articles . the first international meeting on counterfeit medicines was held during april 13 , 1992 , at world health organization ( who ) in geneva and the following definition was accepted : a counterfeit medicine is one which is purposely and falsely mislabeled in accordance to identity and/or source . counterfeiting can pertain mutually to both branded as well as generic products comprising of either correct or incorrect ingredients , lacking active ingredients , or with forged packaging . later on , the concept was modified by the nigerian national agency for food and drug administration and control ( nafdac ) as those medicines with the same quantity of active ingredient as that of genuine brand , insufficient or no active ingredients , medicines which are post expiry date , herbal preparations that are toxic or ineffective and medicines which do not bear the name and address of the manufacturer are counterfeit . counterfeiting is a high - volume , high - profit business which causes the infringement of intellectual property rights , medicine legislations , and other aspects of criminal law . counterfeiting and piracy are in term the same since they are both the reproduction of identical copies of the genuine product . the most common counterfeit drugs in industrialized or developed countries are so - called lifestyle drugs . counterfeit drugs are the major cause of morbidity , mortality , and loss of confidence in the healthcare system . in india , the consumers reported a wider use of counterfeit and pirated products through reuse , repair , and refill of products . repackaging is one of the sources of fake drugs in europe and the united states . estimates put the total loss of life to counterfeit pharmaceuticals between 500,000 and 1,000,000 people per year .

packaging is the coordinated system that encloses and protects the dosage form . counterfeit drugs are the major cause of morbidity , mortality , and failure of public interest in the healthcare system . high price and well - known brands make the pharma market most vulnerable , which accounts for top priority cardiovascular , obesity , and antihyperlipidemic drugs and drugs like sildenafil . packaging includes overt and covert technologies like barcodes , holograms , sealing tapes , and radio frequency identification devices to preserve the integrity of the pharmaceutical product . but till date all the available techniques are synthetic and although provide considerable protection against counterfeiting , have certain limitations which can be overcome by the application of natural approaches and utilization of the principles of nanotechnology .

about 28 million people live in areas at risk of chagas disease , 1114.5 million of whom are affected worldwide . trypanosoma cruzi , the pathogen that causes chagas disease , is found in most south american countries , representing an important cause of heart damage among the economically active population . after a successful chemical control of triatoma infestans ( klugi , 1834 ) , the other main vectors of chagas causing agent , panstrongylus megistus burmeister , 1835 , rhodnius prolixus stal , 1859 , and triatoma brasiliensis sensu lato neiva 1911 . triatoma brasiliensis sensu lato ( s.l . ) , found in anthropogenic habitats and considered the main vector in northeast brazil [ 2 , 3 ] , was recently found to be a species complex that includes t. b. brasiliensis , t. b. macromelasoma galvo , 1956 , t. juazeirensis costa & felix , 2007 , t. sherlocki papa , jurberg , carcavallo , cerqueira & barata , 2002 , and t. melanica costa et al . these taxa exhibit wide phenotypic and morphological variability , displaying specific ecological requirements and chromatic patterns . in this respect , the systematic of triatominae species is based on morphological characters of the adult exoskeleton and male phallic structures . however , insects captured during vector monitoring and control or received for identification and notification are often immature . although their characteristics are similar to those of adult individuals , they are difficult to distinguish . the morphology of triatominae species is not well described ; with studies on the immature forms performed for only 40 species , eggs and nymphs described for only 20 species , a key to identify nymphs to the species level has yet to be developed . available keys are useful and partially applicable to other stages , but specific identification of all live forms remains unresolved . members of the t. brasiliensis complex have been distinguished by analyzing isoenzymes , mitochondrial dna sequences , and random amplification of polymorphic dna - rapd . in the present study we analyzed the barcoding co1 sequences of nine t. brasiliensis s.l . populations from northeastern brazil ( states of pernambuco , paraba , and rio grande do norte ) in order to identify their genetic relationships . we also conducted a pcr - rflp assay to distinguish between t. b. macromelasoma and t. b. brasiliensis subspecies .

triatoma brasiliensis sensu lato ( s.l . ) , the main vector of chagas disease in northeastern brazil , is a species complex comprising four species , one with two subspecies ( t. brasiliensis brasiliensis , t. brasiliensis macromelasoma , t. juazeirensis , t. sherlocki , and t. melanica ) , and each taxon displaying distinct ecological requirements . in order to evaluate the genetic relationships among nine t. brasiliensis s.l . populations from northeastern brazil , we analyzed their mitochondrial cytochrome c oxidase subunit 1 sequences and suggested a pcr - rflp assay to distinguish between t. b. macromelasoma and t. b. brasiliensis subspecies . all the specimens were morphologically identified as t. b. brasiliensis . the resulting phylogenies identified two major clades that are congruent with the geographical populations studied . based on collection sites and in accordance with type - location , one clade was identified as the subspecies t. b. macromelasoma . the second clade grouped t. b. brasiliensis populations . restriction endonuclease sites were observed in the sequences and used in pcr - rflp assays , producing distinct fingerprints for t. b. macromelasoma and t. b. brasiliensis populations . the results suggest that these are different species and that gene flow occurs only among t. b. brasiliensis populations , possibly associated with human activity in the area .

ablation of the cavotricuspid isthmus ( cti ) for the treatment of atrial flutter ( afl ) has become standard practice . most of the procedures are performed using radiofrequency energy ( rf ) [ 15 ] . high chronic success rates are described but the majority of the data comes from a relatively short term follow - up [ 113 ] . a recent study by chinitz et al . reported some interesting data regarding the long term follow - up of 80 patients with common type afl who underwent cti ablation using rf . they found a 12.5 % ( ten patients ) recurrence rate at an average of 21 months after the procedure with most patients having a recurrence after the first year post ablation . our prior experience using cryothermy in a limited number of patients also showed that afl may recur 1 year after cti cryoablation . the purpose of this study was to evaluate the long term outcome of cti cryoablation in a large patient population with common type afl in a single center .

objectiverecent literature has shown that common type atrial flutter ( afl ) can recur late after cavotricuspid isthmus ( cti ) catheter ablation using radiofrequency energy ( rf ) . we report the long term outcome of a large group of patients undergoing cti ablation using cryothermy for afl in a single center.methodspatients with afl referred for cti ablation were recruited prospectively from july 2001 to july 2006 . cryoablation was performed using a deflectable , 10.5 f , 6.5 mm tip catheter . cti block was reassessed 30 min after the last application during isoproterenol infusion . recurrences were evaluated by 12-lead ecg and 24 h holter recording every clinic visit ( 1/3/6/9 and 12 months after the procedure and yearly thereafter ) or if symptoms developed.resultsthe 180 enrolled patients had the following characteristics : 39 women ( 22 % ) , mean age 58 years , no structural heart disease in 86 patients ( 48 % ) , mean left atrium diameter 44 7 mm and mean left ventricular ejection fraction 57 7 % . the average number of applications per patient was 7 ( 3 to 20 ) with a mean temperature and duration of 88c and 3 min , respectively . acute success was achieved in 95 % ( 171 ) of the patients . there were no complications . after a mean follow - up of 27 17 ( from 12 to 60 ) months , the chronic success rate was 91 % . the majority of the recurrences occurred within the first year post ablation . one hundred and twenty three patients had a history of atrial fibrillation ( af ) prior to cti ablation and 85 ( 69 % ) of those remained having af after cryoablation . in 20 of 57 ( 35 % ) patients without a history of af prior to cti ablation , af occurred during follow-up.conclusionsthis prospective study showed a 91 % chronic success rate ( range 12 to 60 months ) for cryoablation of the cti in patients with common type afl and ratified the frequent association of af with afl .

an anal fistula is a chronic phase of anorectal sepsis and is characterized by chronic purulent drainage or cyclical pain associated with abscess formation , followed by intermittent spontaneous decompression [ 1 , 2 ] . the goals in the treatment of an anal fistula are to eliminate the primary fistula opening , any associated tracts , and any secondary openings without a change in continence . most anal fistulae are simple and can be treated using a fistulotomy , which has a low recurrence rate and an acceptable rate of morbidity [ 3 - 6 ] . however , the treatment of a complex anal fistula , which is defined as a fistula whose treatment poses an increased risk for a change in continence , still represent a challenge [ 7 - 9 ] . the recurrence rate for a complex anal fistula managed with a cutting seton is reported to be 0 to 8 % , with minor and major incontinence being reported in 34 to 63 % and 2 to 26 % of patients , respectively [ 10 - 14 ] . advancement flap is still considered to be the gold standard of treatment for a complex anal fistula . successful healing of the fistula has been demonstrated in 55 to 98 % of patients [ 8 , 10 , 15 - 17 ] . however , this procedure is technically demanding , and although the sphincter mechanism is not divided during advancement flap repair of the fistula , minor incontinence has been found in up to 31 % patients and major incontinence in up to 12 % of patients [ 10 , 18 , 19 ] . because of the risk of a change in continence with these conventional techniques , sphincter - preserving techniques for the management of complex anal fistulae have been evaluated . glue was easy to apply , but probably not ideal for fistula treatment because of its liquid consistency . a failure of the formed glue clot in a properly sealed tract , the inability to securely fix the material within the tract and the uncertainty of tissue in growth into the glue may all explain the possible causes of the poor outcomes . this article aims to review the literature and to identify the new sphincter - preserving techniques , such as the anal fistula plug , the ligation of intersphincteric fistula tract ( lift ) procedure and the cell therapy , used in the management of anal fistulae .

surgery for an anal fistula may result in recurrence or impairment of continence . the ideal treatment for an anal fistula should be associated with low recurrence rates , minimal incontinence and good quality of life . because of the risk of a change in continence with conventional techniques , sphincter - preserving techniques for the management complex anal fistulae have been evaluated . first , the anal fistula plug is made of lyophilized porcine intestinal submucosa . the anal fistula plug is expected to provide a collagen scaffold to promote tissue in growth and fistula healing . another addition to the sphincter - preserving options is the ligation of intersphincteric fistula tract procedure . this technique is based on the concept of secure closure of the internal opening and concomitant removal of infected cryptoglandular tissue in the intersphincteric plane . recently , cell therapy for an anal fistula has been described . adipose - derived stem cells have two biologic properties , namely , ability to suppress inflammation and differentiation potential . these properties are useful for the regeneration or the repair of damaged tissues . this article discusses the rationales for , the estimated efficacies of , and the limitations of new sphincter - preserving techniques for the treatment of anal fistulae .

a growing body of evidence demonstrates that susceptibility and progression of both acute and chronic central nervous system ( cns ) disease is closely associated with an innate immune response that can manifest from either direct infection and/or infection - triggered damage . a common feature of these diseases is the systemic activation of inflammatory mediators , which via the blood can disrupt the blood - brain barrier , affect the circumventricular organs in the brain ( which lack a blood - brain barrier ) , or interact with the brain endothelium , thereby eliciting brain inflammation . furthermore , the presence of activated inflammatory cells derived from systemic circulation or from dormant brain resident populations is a key feature of many cns diseases . more recently , the importance of innate immune receptors in cns injury , the so - called toll - like receptors ( tlrs ) , has also been emphasized . in this paper we will focus on how neonatal sepsis and tlr - mediated inflammation increase the vulnerability of the newborn brain .

a growing body of evidence demonstrates that susceptibility and progression of both acute and chronic central nervous system disease in the newborn is closely associated with an innate immune response that can manifest from either direct infection and/or infection - triggered damage . a common feature of many of these diseases is the systemic exposure of the neonate to bacterial infections that elicit brain inflammation . in recent years , the importance of innate immune receptors in newborn brain injury , the so - called toll - like receptors , has been demonstrated . in this paper we will discuss how neonatal sepsis , with particular emphasis on escherichia coli , coagulase - negative staphylococci , and group b streptococcal infections in preterm infants , and toll - like receptor - mediated inflammation can increase the vulnerability of the newborn brain to injury .

assessing the degree of walking independence among inpatients is one of the important roles of physical therapists . overestimation of a patient s ability to walk can result in falls , whereas underestimation can lead to disuse syndrome due to a decrease in physical activity . preliminary research investigating cutoff values for parameters of walking independence in patients with stroke has reported the efficacy of physical performance examinations such as assessments of walking speed1 . however , preliminary studies often exclude stroke patients with cognitive disorders in order to increase the rate of identifying patients with walking independence and improve the reliability of examinations . stroke patients with cognitive disorders are often examined in the clinical setting2 , 3 , where the cutoff value for excluding stroke patients with cognitive disorders in preliminary research can not be used to evaluate those with cognitive disorders . as a result , walking independence in stroke patients with cognitive disorders is presently being assessed on the basis of subjective assessment by a physical therapist , and no clear protocol exists regarding this issue . therefore , determination of the cutoff values for parameters of walking independence in patients with stroke and cognitive disorders is necessary . but there have been few studies so far that have evaluated the reference values associated with walking independence in stroke patients with a cognitive impairment4 . the purpose of this study was to determine the threshold for classifying walking independence in stroke patients with and without cognitive disorders .

[ purpose ] the aim of this study was to determine the threshold for classifying walking independence in stroke patients with and without cognitive disorders . [ subjects ] the subjects were 130 patients with initial stroke hemiplegia . [ methods ] the following factors were analyzed for associations with walking independence : brunnstrom stage , one - leg standing time on the paralytic side , one - leg standing time on the non - paralytic side , and 10-m walking speed . we classified the patients with mini - mental state examination ( mmse ) scores 24 points into the high - score group and those with mmse scores of 23 points into the low - score group and examined the main factors and cutoff values associated with walking independence in each group . [ results ] the high - score group included 69 subjects ( 53.1 % ) , and the low - score group included 61 subjects ( 46.9 % ) . the primary factor associated with high mmse scores among the stroke patients was the 10-m walking time . using a cutoff level for the 10-m walking speed of 41.4 m / min resulted in a positive likelihood ratio of 6.3 . the primary factor associated with low mmse scores among the stroke patients was the 10-m walking time . using a cutoff level for the 10-m walking speed of 48.0 m / min resulted in a positive likelihood ratio of 7.6 . [ conclusion ] the cutoff value for the 10-m walking speed can be used to evaluate walking independence in patients with stroke among patients with high or low mmse scores .

osteoma is a benign osteogenic lesion , which was first described as a specific entity by jaffe in 1935 . in the course of their slow but steady increase in size , osteomas of the maxillofacial bones remain asymptomatic until they attain sufficient sizes as to cause disfigurement and/or direct interference with the normal function of their anatomic location . osteomas are bone lesions with different onset and slow growth that may be divided into : ( 1 ) cranial and mandibular exophytic osteomas ( or eburnean exostoses ) ; ( 2 ) paranasal sinuses , facial bones , and orbit osteomas ( orbital cavity osteoma ) ; ( 3 ) exostoses or bone islands ; and ( 4 ) long bone superficial osteomas ( juxtacortical ) . the etiology seems to be unknown ; however , it may be developmental , infectious , or of traumatic origin . solitary osteomas of the facial skeleton are quite rare , although multiple osteomas of the jaws have been reported as part of gardner 's syndrome . little information is available about the gender predilection ; however , some authors suggest that there is a higher incidence of osteomas in male , especially in between second and fourth decade of life .

osteomas are benign slow growing , osteogenic lesions which may arise from proliferation of either cancellous or compact bone . they are usually sessile tumours composed of dense sclerotic , well formed bone projecting out from the cortical surface , most often of the skull and facial bones . this paper reports a case of a peripheral osteoma in the hard palate of a 45-year - old man , which was treated by periodontal flap surgery with surgical excision of the bony lesion . peripheral osteomas of jaw bone are uncommon and usually associated with gardner 's syndrome . histological examination confirmed the clinical impression of a peripheral osteoma . patient was reviewed after one year and was asymptomatic with no recurrence of the lesion .

fig fruit represents an important constituent of the diet , because of their nutritional and medicinal values . this type of diet is considered one of the healthiest and is associated with longevity . figs are an excellent source of minerals , vitamins , polyphenols , and dietary fiber ; they are fat and cholesterol - free and have a high antioxidant activity . figs have recently attracted a great deal of attention and are widespread throughout the world . the world produces over one million tons of figs yearly , of which 82 % are produced in mediterranean countries . in tunisia , the production is about 29 000 tons ; it represents 3 % of total world production . the fig is an economically important fruit species which is cultivated extensively in southeast regions . fig nursery plants production is mainly based on cuttings taken from the mother tree and placed in a rooting , which will eventually produce roots and shoots [ 68 ] . the traditional method for growing fig consisted in taking cuttings from one- or two - year - old shoots and directly planting them in soil to obtain new trees . however , the investigation on ways to propagate fig tree material and produce vigorous and healthy fig plants under field conditions becomes necessary in order to develop fig sector . the objective of this study was to characterize and compare fig nursery plants of some local fig cultivars by using hardwood cuttings under field conditions . in this way , five cultivars and six cuttings sizes were compared in order to optimize the propagation method of fig in tunisia .

this research was carried out in southeast of tunisia in 2009 and 2010 , in order to study the propagation of six ( ficus carica l. ) cultivars by using hardwood cuttings under the field conditions . the effect of the cultivars and the type of buds , shoots age , shoots length , and shoots diameter were recorded . ten cuttings per cultivar and/or cutting types with three replications were planted in rooting unit . percentage of root emergence and six morphological parameters of young fig plants were measured . results showed that the responses of cuttings as fig nursery plants presented a high variability among the five cultivars . the most widely varied characters were % root emergence ( re ) and cumulative growth of young plant ( cg ) . the first one ranged from 10 % to 90 % , the second varied within 32 and 112 cm . concerning the bither cultivar , 6 cutting types with different age , length , and diameter were evaluated . results showed a great variation in % of root emergence ( 090 % ) , length of nursery plant ( 377 cm ) , and number of roots / nursery plant ( 029 roots ) . the present research showed that the hardwood cutting of local fig cultivars can be propagated under field conditions in southeast of tunisia .

unintentional durotomy is a frequent complication of spinal surgical procedures , with a rate as high as 17 % ( 1 ) . a small percentage of patients with unintentional durotomy sustain intracranial haemorrhage , likely due to an alteration in intradural hydrostatic dynamics caused by cerebrospinal fluid hypovolaemia . despite the gravity of this complication , to our knowledge , only a few cases have been previously documented . to our knowledge a case of new onset epilepsy has never been reported in the literature . the purpose of this report is to describe a case in which new - onset tonic - clonic seizures occurred following an unintentional durotomy during lumbar discectomy and to discuss the importance of our findings in relation to the possible pathophysiological mechanisms .

we would like to present a rare case report describing a case in which new - onset tonic - clonic seizures occurred following an unintentional durotomy during lumbar discectomy and decompression . unintentional durotomy is a frequent complication of spinal surgical procedures , with a rate as high as 17 % . to our knowledge a case of new onset epilepsy has never been reported in the literature . although dural tears during surgery and csf hypovolaemia are thought to be the main contributing factors , one postulates on the effects of anti - psychiatric medication with epileptogenic properties . amisulpride and olanzapine can lower seizure threshold and should be used with caution in patients previously diagnosed with epilepsy . however manufacturers do not state that in cases where the seizure threshold is already lowered by csf hypotension , new onset epilepsy might be commoner . finally , strong caution and aggressive post - operative monitoring is advised for patients with csf hypotension in combination with possible epileptogenic medication .

prior to the availability of potent antiretroviral ( arv ) therapy , human immunodeficiency virus type 1 ( hiv-1 ) infection was notable for the inevitable progression to acquired immunodeficiency syndrome ( aids ) -defining events and death . with the advent of mono- and dual - nucleoside reverse transcriptase inhibitor ( nrti ) therapy , there was recognition of diverse drug - related adverse events . the introduction of combination arv therapy with dual nrtis plus protease inhibitors ( pis ) was associated with a dramatic decline in aids and mortality , along with an increased appreciation for the development of diverse metabolic complications , such as insulin resistance and dyslipidemia , as well as more recent reports actually showing evidence of premature cardiovascular disease . in addition , co - morbid conditions such as renal and hepatic disease increasingly influenced the quality of the lives of hiv-1-infected individuals . over the ensuing years research has attempted to define the potential role that select arv agents and hiv-1 infection itself have on hepatic , renal , and cardiovascular disease .

the first 15 years of the human immunodeficiency virus type 1 epidemic was characterized by patients progressing to clinical acquired immunodeficiency syndrome and death . the availability of potent antiretrovirals led to the recognition of unique adverse events associated with select drugs . more recent data suggest that end - organ damage may be associated with ongoing viremia . further understanding of the potential role different drugs and the virus itself has on various organs can enhance the clinician 's ability to manage patients in the clinic .

the rarity of reported cases may be due to medico - legal implications or the surgeon 's unwillingness to advertise his errors . the incidence of retained foreign body in literature is 1 per 1000 to 1500 laparotomies . locally here , the incidence is not documented but it is suspected that the incidence is of a higher magnitude bearing in mind the level of socio - economic development in our environment . with increasing awareness of the public to their rights and privileges , this medico - legal problem will in the near future retained foreign body in peritoneal cavity is one of the known but avoidable complications of abdominal surgery . it is more liable to occur when surgery is done in a non - ideal environment and negligence or ignorance on part of the medical personnel . it is the responsibility of the operating surgeon and the theatre staff to ensure that no foreign body is left inside the peritoneal cavity before closure of the abdominal cavity . retained foreign bodies are of various types and include sponges / gauzes ( gossypiboma or texilloma ) , artery forceps , other metal instruments , surgical needles , surgical drains , and rubber tubes . the surgical sponge / gauze ( gossiypiboma ) constitutes the most frequently encountered object because of its common usage , small size and amorphous structure . exudative reaction will give rise to abscess formation resulting in peritonitis , fistula formation , tender abdominal mass and gut perforation . in contrast retained artery forceps remain inert and induce their effects through mechanical means giving rise to pressure effects resulting in abdominal pain or direct tissue / viscus injury leading to tissue strangulation or perforation of viscus leading to for example peritonitis or vascular injury resulting in hemorrhage . the clinical presentation of retained intra - abdominal foreign material may be acute or delayed . such patient present in the surgical units with increasing abdominal pain , abdominal mass , discharging sinus , intra - abdominal abscesses and acute or sub - acute intestinal obstruction . whilst many patients will present within days or few weeks after the initial surgery and have a re - laparotomy for retrieval of the foreign body , some patients with intra - abdominal foreign material may go unnoticed for years or even decades . however many of this subset of patients will have chronic abdominal symptoms such as abdominal pain or discomfort . the pre - operative diagnosis is based on history , clinical examination , plain abdominal radiographs , ultrasound , ct and mri scans . yet generalized peritonitis , systemic complications and presentation of acute intestinal obstruction are associated with high mortality . we present a case of retained artery forceps causing intestinal strangulation managed in our centre and review the possible factors that led to the retained artery forceps and advice on possible preventive measures .

context : surgical instruments and materials continue to be retained in the peritoneal cavity despite precautionary measures . even though uncommon it is also under - reported and carries serious medico - legal consequences . gauzes and sponges ( gossypiboma ) are the most commonly retained materials and intra - abdominal retained artery forceps are much rarer but when they do occur lead to chronic abdominal pain and can be a rare cause of intestinal obstruction or strangulation with significant morbidity and mortality.case report : we present a case of intraabdominal retained artery forceps in a 70-years - old lady who underwent laparotomy with splenectomy for a large spleen in a peripheral hospital . upon discharge she continued to complain of intermittent abdominal pain of increasing severity . 12 months later she presented to us with an acute ( surgical ) abdomen requiring another laparotomy . at laparotomy she had strangulated / gangrenous lower jejunual and upper ileal bowel loops , the small bowel mesentery of this area being tightly trapped between the jaws of the retained artery forceps . she had gut resection and enteroanastomosis . unfortunately she died from continuing sepsis on the second post - operative day.conclusion : retained instruments in intra - abdominal surgery can cause serious complication and should be treated surgically . high index of suspicion and appropriate investigations like plain abdominal x - ray , abdominal ultrasound and ct and mri scans should be instituted in patients who develop chronic abdominal symptoms following laparotomy . preventive measures against retained instruments must follow strict laid down protocols for surgical instruments handling in theatre .

shingles , also called herpes zoster ( hz ) , is a common viral disease . psoriasis is another common , chronic relapsing and remitting inflammatory disease that involves the skin and joints with an overall prevalence of 2 % to 3 % of the world 's population . koebner phenomenon ( kp ) , also called isomorphic response , is initially referred to the formation of psoriasiform lesions after cutaneous trauma on healthy skin areas of psoriatic patients , and now is extended to the instances that the people who had pre - existing dermatosis develop lesions after trauma or injury . only a few of psoriatic kp following shingles have been reported in literature , and the kp lesions always occur at healing or healed hz eruptions with a latent period of 1 week to 4 months from the occurrence of shingles in this condition . herein , we report a psoriatic patient in whom kp is occurring at the site of developing hz lesions , and to our knowledge , no similar description has been reported before .

abstractboth shingles and psoriasis are common cutaneous diseases . about 25 % of the psoriatic patients develop koebner phenomenon ( kp ) after various injuries , and in rare instance , kp may occur at the site of healed or healing shingles.we report a 30-year - old man with 7-month history of scalp psoriasis who developed kp at the areas of developing shingles . cutaneous examination revealed scaly erythematous papules and plaques located on the scalp and forehead , and groups of clustered erythematous papules with silver scales in the dermatome distributed on the right side of chest wall the prior herpes zoster lesions involved . after removal of the scales on the papules , underlying bleeding points were present.the lesions on chest had good response to anti - psoriatic therapies , as the lesions on scalp did . after a year of follow - up , recurrent psoriasis occurred , but the lesions were located only on the scalp , and the areas of prior occurrence of shingles , because of which we considered diagnosis of recurrent psoriasis rather than relapsing kp for the chest lesions.not only the healing and healed shingles can trigger kp in psoriasis , but also the developing shingles can cause psoriatic kp at the site of herpes zoster lesions .

uterine malformations can cause amenorrhea , infertility , recurrent pregnancy loss and pain and can also be normally functioning , depending on the nature of the defect [ 13,5 ] . the prevalence of uterine malformation is estimated to be 6.7 % in the general population , slightly higher ( 7.3 % ) in the infertile population , and significantly higher in a population of women with a history of recurrent miscarriages ( 16 % ) . until the sixth week of life , the male and female genital systems are identical . there are two pairs of symmetrical genital ducts , the mesonephric ( wolffian ) ducts and the paramesonephric ( mullerian ) ducts . in the female embryo , the mullerian ducts grow caudally and become enclosed in the peritoneal folds , which later give rise to the broad ligaments of the uterus to which the ovaries , fallopian tubes and uterus are attached . the mullerian ducts approach each other and begin to fuse . at 9 weeks gestation , mullerian tract anomalies result from incomplete bilateral duct elongation , fusion , canalization , or septal resorption of the mullerian ducts . an accessory cavitated uterine mass ( acum ) is associated with an otherwise normal uterus . acum can be difficult to differentiate from true cavitated adenomyomas and cavitated rudimentary uterine horns . an accessory uterine mass can be caused by duplication and persistence of the ductal mllerian tissue in a critical area at the attachment level of the round ligament , possibly related to gubernaculum dysfunction . for the differential diagnosis of acum and cavitated non - communicating rudimentary uterine horns , hysterosalpingography showing a normal eutopic uterine cavity is helpful . an old classification had been put by jone h.w jr . in 1953 for the congenital anomalies of the female urogenital system : 1.uterus : ( a ) single uterus . a recent eshre / esge classification of female genital tract anomalies ( 1 ) uterine anomalies : - u0 . ( b ) without rudimentary cavity ( bi- or unilateral uterine remnants / aplasia ) .

highlightsobtaining a detailed medical history is important , and we should not depend on examination tools when dealing with patients.unexplained findings should raise suspicions regarding other possible diagnoses , and the same non - conclusive procedures should not be repeated.following this advice can prevent unnecessary operative procedures and the complication of perforation of the uterus .

iran is in the thalassemic belt with a frequency of about 6 -10 % in the northern and southern provinces ( 1 ) . cancer antigen 15.3 ( ca15.3 ) , a product of muc1 gene ; is an epithelial mucin and its high level is associated with breast cancer . in patients with breast cancer , evaluation of ca15.3 has not been recommended by national comprehensive cancer network guidelines for surveillance purposes , but its monitoring suggested to detect recurrences of cancer evaluating therapeutic response of advanced disease and the assessment of prognosis in patients with early breast cancer ( 2,3 ) . also it may be high in nonmalignant conditions such as inflammatory processes and some hematologic disorders like sickle cell anemia and thalassemia major ( 4 ) .improving management of thalassemia major has led to increased life expectancy and subsequently increased frequency of age related conditions such as malignancies ( 5 - 7 ) . as a result , some investigators have opted to check serum tumor markers in these patients . however , they showed an increased frequency of serum ca15.3 independent from the presence of malignancy in these patients . the suggestive mechanism is erythroid hyperplasia which could result in high level of muc1 expression on bone marrow - appoptosing progenitor cells ( 5 , 8 ) . up to our knowledge , evaluation of serum ca15.3 in patients with thalassemia minor has not been conducted . our hypothesis was that patients with beta - thalassemia minor has a higher serum level of ca15.3 compared to healthy individuals and patients with thalassemia major but with a milder degree . present study was designed to measure the serum level of ca15.3 in patients with beta - thalassemia minor compared to healthy individuals and to patients with cancer . also we aimed to determine the frequency of beta - thalassemia minor in a population of young patients with malignancies .

background : high serum level of cancer antigen 15.3 ( ca15.3 ) has been reported in some malignant and nonmalignant conditions including thalassemia major which could have been resulted from ineffective erythropoiesis . we aimed to evaluate the serum level of ca15.3 in carriers of beta - thalassemia by comparing them with cancer patients and healthy individuals . methods : this cross - sectional study was done from february to december 2011 in southern iran . participants consisted of 32 subjects with beta - thalassemia minor , 49 with cancer and 25 healthy individuals . the serum levels of ca15.3 were measured and compared in different groups . results : the serum levels of ca 15.3 in all participants were in the normal range ( < 35 u / ml ) . also it did not significantly differ among various groups of the participants ( p=0.723 ) . age was not significantly correlated with the serum level of ca 15.3 ( r= 0.039 , p=0.702 ) . the most frequent cancer in the group of patients with malignancies was hematologic malignancies ( 96 % ) with the highest frequency for acute lymphoblastic leukemia ( 37 patients ) . frequency of thalassemia minor in patients with cancer was 11 ( 22.4 % ) . conclusion : no correlation was found between ca 15.3 serum level with beta - thalssemia minor or with childhood malignancies . compared to general population , a high proportion of beta - thalssemia minor was observed in patients with cancer in our study . future prospective studies are needed to evaluate the relationship between cancer and beta - thalassemia minor accurately .

the accelerated emergence of antibiotic resistance among the prevalent pathogens is of global health concern . enterococcus , is one such pathogen which is the leading cause of nosocomial bacteremia , urinary tract infections ( uti ) , and surgical site infections . enterococcus resistance to antimicrobial agents to which the genus streptococcus are generally susceptible and its ability to transfer the drug resistance genes from vancomycin - resistant strains to staphylococcus aureus is of concern . the therapeutic challenge of multiple - drug resistant ( mdr ) enterococci , identifies them as important nosocomial pathogens . enterococci infections have traditionally been treated with cell wall inhibitor agents in combination with an aminoglycoside . reduced susceptibility to -lactam antibiotics and vancomycin ; in combination with a high level aminoglycoside resistance ( hlar ) interferes with the penetration of the aminoglycoside into the bacterial cytoplasm , thus making the antibiotic synergism ineffective . hence , this study was designed to identify the magnitude of enterococcal infections and their antibiotic susceptibility pattern in a tertiary care hospital in the eastern region of india .

background : resistance to commonly used antibiotics by enterococci causing nosocomial infections is of concern , which necessitates judicious , responsible and evidence - based use of antibiotics . the present study was conducted to review the prevalence and identify therapeutic options for nosocomial enterococcal infections in our tertiary care hospital.materials and methods : isolates identified by morphological and biochemical characteristics were tested for antibiotic susceptibility using kirby - bauer method.result:153 of 2096 culture positive clinical samples comprised of 101 urine , 30 wound swab / pus , 13 blood and 09 high vaginal swab isolates were identified as enterococcus faecalis ( 90.85 % ) , enterococcus faecium ( 8.50 % ) and enterococcus gallinarum ( 0.65 % ) . enterococci accounted for 8.45 % , 4.53 % , 4.23 % , 4.43 % of urinary , wound swab or pus , blood , high vaginal swab isolates respectively , causing 7.3 % of all nosocomial infections . significant number of enterococci isolated from nosocomial urinary tract infection ( 66.01 % ) and wound infections ( 19.6 % ) were multidrug resistant ( mdr ) . although all isolates were sensitive to vancomycin and linezolid , resistance to erythromycin ( 71.24 % ) and ciprofloxacin ( 49.67 % ) was frequently observed . high - level gentamicin resistance was observed in 43.88 % , and 61.53 % of e. faecalis and e. faecium isolates respectively . minimal inhibitory concentration of vancomycin of all the isolates were 1 g / ml . 7 % of the enterococcal isolates were mdr strains and vancomycin or linezolid were the only effective antibiotics.conclusion : a combination of vancomycin and/or linezolid were effective against enterococci causing nosocomial infections in our tertiary care facility , nevertheless continuous and frequent surveillance for resistance patterns are necessary for judicious and evidence based use of antibiotics .

the wideness of interest of a scientific discipline , and its impact on knowledge and the research progress may be estimated through the number of journals issued in its field , the quantity of articles published in a given timespan , and the number of citations these articles obtained . no doubt , this is a rough estimate but it may allow to quantitate and compare the data taken from qualified databases , and to foresee future developments . during the last fifteen years , the number of journals published in the biomedical field has significantly increased : for instance , based on the thomson reuters journal citation report ( https : //jcr.incites.thomsonreuters.com ) the journals in the subject categories of biology increased from 51 to 85 , those in cell biology from 147 to 184 , in medicine ( experimental & research ) from 74 to 123 , and in oncology from 103 to 211 , with an impressive ( though hardly computable ) surge of published articles . research in biomedicine has taken advantage of the progress in several disciplines , first of all in molecular biology and related omics . microscopy and histochemistry also played a major role , especially in recent years , by providing new instrumentations and refined techniques . in the attempt to assess the impact of histochemistry in the biomedical field , it may be interesting to look at the articles recently published in qualified journals , reporting the results of investigations performed by histochemical methods .

especially in recent years , biomedical research has taken advantage of the progress in several disciplines , among which microscopy and histochemistry . to assess the influence of histochemistry in the biomedical field , the articles published during the period 2011 - 2015 have been selected from different databases and grouped by subject categories . as expected , biological and biomedical studies where histochemistry has been used as a major experimental approach include a wide range of basic and applied researches on both humans and other animal or plant organisms . to better understand the impact of histochemical publications onto the different biological and medical disciplines , it was useful to look at the journals where the articles published in a multidisciplinary journal of histochemistry have been cited : it was observed that , in the five - years period considered , 20 % only of the citations were in histochemical periodicals , the remaining ones being in journals of cell & tissue biology , general and experimental medicine , oncology , biochemistry & molecular biology , neurobiology , anatomy & morphology , pharmacology & toxicology , reproductive biology , veterinary sciences , physiology , endocrinology , tissue engineering & biomaterials , as well as in multidisciplinary journals . it is easy to foresee that also in the future the histochemical journals will be an attended forum for basic and applied scientists in the biomedical field . it will be crucial that these journals be open to an audience as varied as possible , publishing articles on the application of refined techniques to very different experimental models : this will stimulate non - histochemist scientists to approach histochemistry whose application horizon could expand to novel and possibly exclusive subjects .

candidemia and invasive candidiasis ( c / ic ) show an increasing incidence in the nosocomial setting . the crude mortality of those infections ranges between 36 % 63 % depending on patient population.14 comorbidities , aging and age - associated physiological changes , higher rates of oropharyngeal colonization with candida species , and concomitant drug use make elderly patients ( > 65years old ) more vulnerable to infections . for this reason fungal infections have become a major problem in older adults , since age is a well - documented predisposing factor with increased impact on mortality.57 the cutoff age for the elderly population can not be clearly defined because aging is a continuous process . it is also clear that aging is a multifactorial process influenced by both genetic and environmental parameters . many studies dealing with candida infection in the elderly have used several different arbitrary cutoff points such as over 60 , 65 , or 70 years old . however , most prospective epidemiological studies define elderly population as the age group > 65 years.59 the elderly population is large and is growing in proportion to the general hospitalized population , but available data on epidemiology , clinical impact , and outcome of nosocomial fungal infections are limited.710 the indications for antifungal therapy are the same for older as well as younger individuals , and the initial antifungal therapy should be selected on the basis of the infecting organism and the local epidemiology.9,11 fluconazole is generally effective against c / ic but its use may be limited by the increasing prevalence of candida species ( spp . ) with acquired or intrinsic resistance . echinocandins are recommended as first - line treatment for c / ic in all patients , and more specifically in hemodynamically unstable patients or in those with prior azole exposure , or for invasive infections caused by c. krusei or c. glabrata because of their activity against azole - resistant strains , while amphotericin b remains the cornerstone of antifungal treatment.1,9,1115 in this review , we aim to discuss the management and treatment options of fungal infections in the elderly population , considering additionally the specific conditions and the impact of potential comorbidities and drug interactions .

fungi are major causes of infections among immunocompromised or hospitalized patients with serious underlying diseases and comorbidities . candida species remain the most important cause of opportunistic infections worldwide , affecting predominantly patients over 65 years old , while they are considered to be the fourth most common cause of nosocomial bloodstream infections . the rapidly growing elderly population has specific physiological characteristics , which makes it susceptible to colonization and subsequent infection due to candida species . comorbidities and multidrug use should be taken into account any time the therapeutic regimen is under consideration . different classes of antifungal drugs are available for the treatment of invasive fungal infections but echinocandins , apart from their activity against resistant strains ( candida glabrata and candida krusei ) , seem to be safe , with limited adverse events and minimal drug drug interactions in comparison to the other regimens . therefore , these agents are strongly recommended when dealing with elderly patients suffering from an invasive form of candida infection .

percutaneous transluminal coronary angioplasty was introduced by gruntzig in the late 1970s as an alternative to coronary artery bypass graft surgery for coronary revascularization.1 since then , percutaneous coronary intervention ( pci ) has been accepted as a safe , reliable , and effective treatment for coronary artery disease , and its use has spread worldwide . nevertheless , in - stent restenosis ( isr ) , a complex phenomenon resulting in renewed symptoms , need for re - intervention , and poor patient outcome remained for many years the achilles heel of pci.2 the introduction , a decade ago , of first - generation drug - eluting stents ( dess ) transformed the practice of pci by drastically reducing the rate of this complication.3 the efficacy of dess has largely been demonstrated in large randomized trials , leading to their current widespread use in clinical practice . even in high - risk populations , isr incidence does not currently go above 5 % 10 % .46 however , major concerns regarding the long - term safety of these first - generation dess have progressively arisen , especially the increased risk of late / very late stent thrombosis ( st ) 714 and the need for prolonged dual antiplatelet therapy ( dapt ) with an inherent increase of bleeding complications . aside from patient- and lesion - related factors , delayed re - endothelialization and recovery of endothelial function after stenting as well as inhibition of vascular repair after des implantation , all of which promote inflammation and thrombotic pathways , have been implicated in the pathophysiology of late / very late st . of note , stent polymer has also been cited as one of the main causes of these late events . in fact , the persistence of a durable polymer after complete release of the anti - proliferative drug has been shown to be responsible for local hypersensitivity and inflammatory reactions.15 these safety concerns prompted additional research , new trial design , and development of new - generation dess to reduce the rate of this rare but critical event . apart from the progress in stent platforms ( thinner struts and stent designs ) , recent research in this field has subsequently been focused on the development of new more biocompatible durable polymers or completely biodegradable polymers . third - generation dess using biodegradable polymers , like the biolimus - eluting stent ( bes ) ( nobori ; terumo corporation , tokyo , japan ) , have been developed to overcome the long - term adverse vascular reactions related to the durable polymer . in this article we then discuss the results of recent publications investigating the safety and effectiveness of the use of the third - generation bes ( nobori ) for the treatment of coronary artery lesions .

first - generation drug - eluting stents have raised concerns regarding the risk of late and very late stent thrombosis compared with bare metal stents and require prolonged dual antiplatelet therapy . despite extensive investigations , the physiopathology of these late events remains incompletely understood . aside from patient- and lesion - related risk factors , stent polymer has been cited as one of the potential causes . in fact , the persistence of durable polymer after complete drug release has been shown to be responsible for local hypersensitivity and inflammatory reactions . third - generation drug - eluting stents with more biocompatible or biodegradable polymers have subsequently been developed to address this problem . in this article , we evaluate and discuss the concept and clinical results ( safety and efficacy ) of a third - generation drug - eluting stent with biodegradable polymer : the nobori stent .

the modern concept of decompression for traumatic brain injury ( tbi ) was introduced by harvey cushing before world war i . the monro - kellie hypothesis dictates that the amount of space within the skull is constant ; therefore , when the pressure is raised death occurs by herniation when the capacity for adjustment by fluid shifts from the cerebrospinal fluid and vascular compartments are already maximized . increasing the skull size by removing bone and opening the dura delays or prevents these limits from being reached . however , in the 90 years since cushing made these observations , medical , radiographic , and surgical advances in the management of tbi have obviated the need for an aggressive surgical approach in all but a minority of cases . in spite of the ability to control intracranial pressure ( icp ) elevation in most cases with removal of mass lesions , osmotic diuretics , ventricular drainage , sedative / hypnotic agents , and prevention of hypercapnea , occasional cases occur in which icp elevation accelerates in spite of maximal conservative medical therapy , and then so - called heroic measures are employed . these are considered at the ' option ' level in the american association of neurological surgeons criteria for management of severe brain injury because no large randomized trial has proven their efficacy . in the pediatric population , ruf and colleagues as well as taylor and associates have addressed the issue of using decompressive craniectomy as a more formal part of a head injury protocol before going to other ' option ' therapies once icp elevation is affirmed . bifrontal decompressive craniectomy is an aggressive approach described by kjellberg and prieto before the era of modern neuroimaging with computed tomography . this approach is particularly useful in the pediatric population , in which diffuse injury without mass lesions and with icp elevation is relatively common . hemicraniectomy represents a large cranial and dural decompression , often associated with removal of mass lesions such as subdural hematoma or traumatic intracerebral hematoma . bitemporal decompressions are unilateral or bilateral bony decompressions designed to take the pressure off the temporal lobes to prevent uncal herniation , and have been used in other cranial conditions such as pseudotumor cerebri . gower and coworkers reported 40 % mortality and 50 % favorable outcome in a study of subtemporal decompression for icp control in 10 patients with closed head injury who had failed medical therapy , including barbiturate coma . cerebellar decompression for mass lesion is a standard neurosurgical response to any process in the posterior fossa ( hemorrhage , tumor , infection , or stroke ) that threatens cerebellar tonsillar herniation .

more frequently than adults , pediatric victims of severe traumatic brain injury experience diffuse severe cerebral edema without mass lesions . these patients require methods to reduce intracranial pressure quickly and reliably . surgical decompression provides rapid relief of increased intracranial pressure and is an alternative to maximal medical therapy for these individuals . based on previous trials , most of which are anecdotal but now include attempts at case controlled and cohort matched investigations , ruf and colleagues describe a series of six pediatric patients treated with a prospectively implemented protocol of decompressive craniectomy for severe traumatic brain injury . the heterogeneous approaches presented ( which include hemicraniectomy , bifrontal craniectomy , and suboccipital craniectomy ) undermine the applicability of the results . however , this report , coupled with similar papers , does highlight the need for a true controlled trial of this modality to examine whether craniectomy can emerge as more than a second line option for the management of increased intracranial pressure .

debilitating conditions , such as disc herniation or lumbar spinal stenosis , are one of the most common causes of lumbago and lumbar radiculopathy . it may be easily recognized by their clinical symptoms and signs . magnetic resonance imaging ( mri ) nevertheless , there are uncommon causes of lumbago or radiculopathy , which include intraspinal extradural masses , such as synovial cyst , ganglion cyst , pseudocyst , hematoma and metastatic tumor , as well as arachnoid cysts . on the basis of clinical examination and history taking , these uncommon causes are generally difficult to distinguish from those that are more common . of these uncommon causes , intraspinal extradural cysts that communicate with the intervertebral discs are quite rare . this is a case report of a lumbar discal cyst in a patient with low back pain and pain that radiates to the legs .

discal cysts are a rare cause of lumbar radiculopathy . there are only a few reports of this disease in medical literature . the authors describe the case of a 40-year - old man with a lumbar discal cyst that led to radiculopathy . an intraspinal extradural cystic mass was responsible for low and high signal intensities observed in lumbar lesions on t1 and t2 weighted magnetic resonance images . this cyst was a grossly spherical mass with clear serous fluid , which was connected to an adjacent intervertebral disc . histopathology of the cystic walls revealed fibrous connective tissues without specific cell linings . clinical symptoms were promptly relieved after surgical resection . further research on the pathophysiology and treatment of discal cysts are needed .

peripheral nerve injuries are commonly caused by trauma to the upper limbs and are present in an estimated 23 % of all patients admitted to a level 1 trauma center ( noble et al . , 1998 ) . the economic impact of nerve injuries can be large with operative costs , hospital charges , rehabilitation visits , and lost time at work . only subtle improvements to peripheral nerve repair have been made recently , and our current knowledge of nerve physiology and regeneration vastly exceeds our current repair capabilities . poor outcomes of peripheral nerve injury are largely due to the slow process of axonal outgrowth . after nerve injury , severed proximal axons with intact cell bodies can grow up to 1mm / day . regenerating axons preferentially target appropriate end organ receptors but do not always take a direct route to their target ( fox et al . , 2012 ) . thus , functional recovery is not always obtained due to slow growth and poor alignment of motor and sensory fibers . muscle atrophy initiates immediately after muscle denervation , and if motor axons do not reach their target muscle within a critical time window , muscle tissue is less receptive to re - innervation . the most common current strategies to augment recovery after nerve injury such as decellularized nerve allografts , tissue matrices and nerve growth guides involve techniques to enhance axonal regeneration and decrease surrounding inflammation . despite these advancements , the combination of slow axonal outgrowth , wallerian degeneration , and muscle atrophy are still barriers to significant progress .

the management of traumatic peripheral nerve injury remains a considerable concern for clinicians . with minimal innovations in surgical technique and a limited number of specialists trained to treat peripheral nerve injury , outcomes of surgical intervention have been unpredictable . the inability to manipulate the pathophysiology of nerve injury ( i.e . , wallerian degeneration ) has left scientists and clinicians depending on the slow and lengthy process of axonal regeneration ( ~1 mm / day ) . when axons are severed , the endings undergo calcium - mediated plasmalemmal sealing , which limits the ability of the axon to be primarily repaired . polythethylene glycol ( peg ) in combination with a bioengineered process overcomes the inability to fuse axons . the mechanism for peg axonal fusion is not clearly understood , but multiple studies have shown that a providing a calcium - free environment is essential to the process known as peg fusion . the proposed mechanism is peg - induced lipid bilayer fusion by removing the hydration barrier surrounding the axolemma and reducing the activation energy required for membrane fusion to occur . this review highlights peg fusion , its past and current studies , and future directions in peg fusion .

. main cause of acs is intra abdominal hypertension ( iah ) due to various factors such as abdominal surgery , ileus , intestinal obstruction , intraabdominal malignancy , and organomegaly . the most important clinical presentations of acs are symptoms due to abdominal distension , acute oliguria , and respiratory problems 1 . we report a patient with external compression of distal duodenal segment due to the metastatic lymph nodes and acute kidney injury ( aki ) as a result of acs . it was diagnosed with computed tomography ( ct ) and after surgical intervention his clinical status improved significantly . we report this case because to date , a case of acs due to metastatic prostate cancer has not been reported .

key clinical messageorgan dysfunctions caused by intraabdominal hypertension is named as abdominal compartment syndrome ( acs ) . a patient with prostate cancer admitted with dyspnea and oliguria . after decompression his health status improved . for patients with malignant disorders presented with oliguria and respiratory problems who have abdominal distension , acs should be in mind .

osteoarthritis is a degenerative condition that increases in incidence and prevalence with age and is a major cause of morbidity in people older than 65 years . this condition most commonly occurs at the knee , particularly in the medial tibiofemoral compartment , and varus knee osteoarthritis accounts for more than 95 % of knee osteoarthritis in japan . despite the occurrence of significant morbidity , the etiology and factors involved in the pathogenesis of osteoarthritis and the development of varus knee osteoarthritis have not been fully elucidated . there have been few reports that compared cartilage , ligament , and meniscus degeneration and radiographic alignment in patients with severe varus knee osteoarthritis . the aim of this study was to examine the relationship between cartilage , ligament , and meniscus degeneration and radiographic alignment in patients with severe varus knee osteoarthritis in order to understand the development of varus knee osteoarthritis , observing in detail the degeneration of the knee compartments of the patients who had total knee arthroplasty for their severe varus knee osteoarthritis .

objectivesthe aim of this study was to examine the relationship between cartilage , ligament , and meniscus degeneration and radiographic alignment in severe varus knee osteoarthritis in order to understand the development of varus knee osteoarthritis.designfifty-three patients ( 71 knees ) with primary varus knee osteoarthritis and who underwent total knee arthroplasty were selected for this study . there were 6 men and 47 women , with 40 right knees and 31 left knees studied ; their mean age at operation was 73.5 years . the ligament , meniscus , degeneration of joint cartilage , and radiographic alignments were examined visually.resultsthe tibial plateau tibial shaft angle was larger if the condition of the cartilage in the lateral femoral condyle was worse . the femorotibial angle and tibial plateau tibial shaft angle were larger if the conditions of the lateral meniscus or the cartilage in the lateral tibial plateau were worse.conclusionbased on the results of this study , progression of varus knee osteoarthritis may occur in the following manner : medial knee osteoarthritis starts in the central portion of the medial tibial plateau , and accompanied by medial meniscal extrusion and anterior cruciate ligament rupture , cartilage degeneration expands from the anterior to the posterior in the medial tibial plateau . bone attrition occurs in the medial tibial plateau , and the femoro - tibial angle and tibial plateau tibial shaft angle increase . therefore , the lateral intercondylar eminence injures the cartilage of the lateral femoral condyle in the longitudinal fissure type . thereafter , the cartilage degeneration expands in the whole of the knee joints .

each year , an estimated 10 million health care office visits to gynecologists are due to vulvovaginitis . vulvovaginitis refers to a variety of inflammatory lower genital tract disorders that may be secondary to infection , irritation , allergy , or systemic disease . infectious causes of vulvovaginitis include bacterial vaginosis , candidiasis , and trichimoniasis ; while noninfectious causes include exposure to chemicals , allergens , genital atrophy , and trauma . of the infectious vaginitides , only vulvovaginitis due to candida offers over the counter medications for women to self diagnose and treat their condition . these nonprescription antifungals , introduced to the market in 1990 , are among the top ten best selling over - the - counter drugs in the us with annual sales of approximately $ 250 million . one survey reports that 73 % of women with recurrent vulvovaginitis have resorted to over - the - counter medications to reduce health care cost and avoid an expensive office visit . further , homeopathic drug sales were estimated at $ 201 million in 1995 and have steadily risen to an estimated 300450 million in 2003 [ 3 , 4 ] . this article attempts to clarify the efficacy of the available over - the - counter options for women seeking self treatment for vaginitis symptoms and further discern which products are appropriate for treating self - diagnosed yeast vaginitis .

background . the fda approved over - the - counter ( otc ) use of vaginal antifungals in 1990 . subsequently , a plethora of otc products have become available to women on drugstore shelves . objectives . the purpose of this study was to determine the availability of otc products marketed for the treatment of vaginitis and to determine if their efficacy had been confirmed by published prospective randomized control trials ( rcts ) . materials and methods . the authors chose four retail locations frequented by women seeking vaginitis treatment . all products deemed a viable treatment option were purchased . results . all intravaginal imidazoles purchased , regardless of treatment duration or active ingredient , were found to be of proven efficacy . we were unable to find an rct confirming the effectiveness of vaginal anti - itch creams and homeopathic treatments for vaginitis . conclusion . 45 % of products available to women in the feminine hygiene section of the stores surveyed could not be confirmed to be effective for treating infectious vaginitis .

they may have similar presentations but possibly different treatment modalities , ie , hysterectomy for adenomyosis versus conservative management or hysterectomy for leiomyomas , or both . however , only limited studies have been performed on the efficacy of conservative treatment of adenomyosis , and these typically do not improve or preserve fertility . . mri provides better tissue contrast and may be superior to other imaging modalities in certain pelvic pathologies , such as congenital uterine anomalies , leiomyoma , adenomyosis , and endometriomas . some reports suggest mri is a reliable preoperative tool available to physicians to assist in differentiating between fibroids and adenomyoma / adenomyosis . in this study , we evaluated the predictive value of the pre - operative mri in differentiating between leiomyoma and adenomyosis compared with pathologic findings .

objective : we evaluated the role of mri as a preoperative diagnostic tool for leiomyoma and adenomyosis.method : this is a retrospective chart review at a university - based hospital . the study included 1517 women who underwent hysterectomy or myomectomy over a 5-year period , and 153 women with a preoperative pelvic mri were included . comparisons were made between the results of the mri and postoperative pathology reports.results : the mri and pathology report were the same for 136 of 144 women with leiomyoma and 12 of 31 women with adenomyosis . the mri had 94 % sensitivity and 33 % specificity for leiomyoma and 38 % sensitivity and 91 % specificity for adenomyosis . positive and negative predictive values of mri for leiomyoma were 95 % and 27 % with 90 % accuracy . positive and negative predictive values of mri for adenomyosis were 52 % and 85 % , respectively , with 80 % accuracy.conclusion : mri has a high sensitivity and a low specificity for diagnosing leiomyoma and a high specificity and a low sensitivity for diagnosing adenomyosis . due to the high cost and technical variations , we suggest using mri only as an adjunctive diagnostic tool when ultrasound is not conclusive and differentiation between the 2 pathologies ultimately affects patient management .

the utility of this model stems from the fact that few assumptions are needed to determine hazard ratios based on the coefficients . the stratified cox ( sc ) model is a modification of the cox ph model , which allows for control by stratification of a predictor that does not satisfy the ph assumption . parametric models are used only occasionally in analyzing clinical studies of survival despite offering some advantages over semiparametric models . parametric regression analysis is an attractive alternative to the widely used cox model when hazard functions themselves are of primary interest , or when relative survival times are the primary measure of association . when empirical information is available , parametric models can provide insight into the shape of the baseline hazard and baseline survival . furthermore , difficulty choosing the appropriate family of distributions leads many researchers to prefer the cox model . some parametric models are accelerated failure time ( aft ) models which assume that the relationship between the logarithm of survival time and covariates is linear one approach to address these difficulties is fitting the generalized gamma ( gg ) distribution . this extensive family contains nearly all commonly used distributions including the exponential , weibull , and log normal , making it particularly useful for estimating individual hazard functions as well as both relative hazards and relative survival times . in this analysis , we applied both semiparametric and parametric models under different conditions of the ph and aft assumptions and compared their results .

background : the goal of this study is to extend the applications of parametric survival models so that they include cases in which accelerated failure time ( aft ) assumption is not satisfied , and examine parametric and semiparametric models under different proportional hazards ( ph ) and aft assumptions.methods : the data for 12,531 women diagnosed with breast cancer in british columbia , canada , during 19901999 were divided into eight groups according to patients ages and stage of disease , and each group was assumed to have different aft and ph assumptions . for parametric models , we fitted the saturated generalized gamma ( gg ) distribution , and compared this with the conventional aft model . using a likelihood ratio statistic , both models were compared to the simpler forms including the weibull and lognormal . for semiparametric models , either cox 's ph model or stratified cox model was fitted according to the ph assumption and tested using schoenfeld residuals . the gg family was compared to the log - logistic model using akaike information criterion ( aic ) and baysian information criterion ( bic ) .results : when ph and aft assumptions were satisfied , semiparametric and parametric models both provided valid descriptions of breast cancer patient survival . when ph assumption was not satisfied but aft condition held , the parametric models performed better than the stratified cox model . when neither the ph nor the aft assumptions were met , the log normal distribution provided a reasonable fit.conclusions : when both the ph and aft assumptions are satisfied , the parametric and semiparametric models provide complementary information . when ph assumption is not satisfied , the parametric models should be considered , whether the aft assumption is met or not .

chronic cardiovascular diseases ( cvds ) are considered the leading cause of mortality worldwide ( 1,2 ) . mortalities by cvds occur mainly due to coronary heart disease ( chd ) , stroke , rheumatic heart , and myocardial infarction ( mi ) . approximately 80 % of these deaths occur in low and middle income families and in poor countries ( 3 ) . it is estimated by who that approximately 20 million individuals are likely to succumb to cvds in the year 2015 ( 4 ) . in addition , non - communicable diseases are to account for over 75 % of mortalities worldwide ( 1 ) . infectious diseases , tuberculosis , and malaria followed by nutritional disorders are the primary cause of such mortalities ( 5 ) . cvds are also the largest contributor to global mortality of heart patients ( 3,6 ) . the epidemiology of heart diseases has been described by many researchers in the literature . for the epidemiological studies of heart diseases , a significant percentage of cvd mortalities occur in younger individuals and children in developing nations due to malnutrition , low income , poverty , unemployment , excessive alcohol consumption , tobacco smoking , car accidents , and other factors ( 5 ) . approximately 41 % individuals die between the age of 35 and 64 years in south africa , 35 % in india , 28 % in brazil , 12 % in the usa , and 9 % in portugal ( 7 ) . the median age of heart attack and first stroke and death from ischemic heart disease ( ihd ) as well as acute myocardial infarction ( ami ) are very important ( 3 ) . hypertension , high blood pressure ( hbp ) , high blood cholesterol , obesity , diabetes , reduced physical activity , psychological stress and other factors are also responsible for cvds . the historical trends in cv mortality and tobacco use in north america increased between 1900 and 1990 ( 8 ) . in the uk , a 38-year follow - up study of men showed that baseline differences in tobacco use , hbp pressure , and cholesterol were associated with a 10- to 15-year shorter life expectancy ( 9 ) . the rise in cigarette smoking in young individuals indicates increased tobacco - related mortalities in many countries ( 10 ) . by the year 2030 , who ( 2008 ) projects that over 80 % of tobacco - related deaths are to occur in young people in developing countries . currently , malnutrition and obesity occur within the same population in many low and middle income families ( 11,12 ) . malnutrition is common in many low and middle income countries of africa , latin america , and south asia ( 7 ) . the global prevalence of overweight in children aged 517 years is 10 % , varying from under 2 % in sub - saharan africa to over 30 % in the usa ( 14 ) . the epidemiological research of cvds suggests that dietary changes are associated with nutritional transition , specifically the increasing consumption of energy - dense diets high in fats , oils , sodium , and sugars , which contribute to an increase in cvd incidence in low and middle income families ( 15 ) .

cardiovascular diseases ( cvds ) are the leading cause of mortality worldwide . coronary heart disease ( chd ) is the main cause of mortality in heart patients following stroke , rheumatic heart disease and myocardial infarctions . approximately 80 % of individuals succumb to cvds , due to poor living conditions in low and middle income families and malnutrition . infectious diseases , human immunodeficiency , tuberculosis , malaria , high blood pressure or hypertension , obesity and overweight , and nutritional disorders including smoking , excessive alcohol consumption , high salt and sugar intake , as well as other factors are responsible for cvds and chds in young as well as elderly individuals . the focus of the present review are recent epidemiological aspects of cvd and chd as well as the usefulness of a mediterranean diet for heart patients and the prevention of heart diseases .