Datasets:

KaiLv

/

UDR_PubMed

like 0

metastases to the spleen from various sites are a rare occurrence and usually occur in the presence of widely disseminated disease . previously documented sites of primary disease include the ovaries , melanoma , breast , lung and the colon and are typically associated with high disease burden . splenic metastases from the colon involving low levels of disease burden are rare in the literature and to date , there have been only two documented cases of metastases to the spleen originating from a caecal tumour .

introductionthe spleen is a highly vascular organ and is in close proximity to many potential primary sites such as the stomach , breast , pancreas and colon . it is however an unusual site for metastatic disease . the reasons for this are not fully understood at the present time . a number of hypotheses have been postulated . definitive diagnosis and subsequent treatment of metastatic disease to the spleen presents a number of challenges for the surgeon and the wider multi disciplinary team.presentation of casea 60 year old male presented with a three week history of lower abdominal pain , distension , nausea and a palpable mass in the right iliac fossa . imaging revealed a large circumferential caecal mass consistent with malignancy with secondary small bowel obstruction . the patient underwent an emergency right hemicolectomy and was subsequently treated with systemic chemotherapy for lymph node positive caecal adenocarcinoma . two years following initial presentation , two suspicious lesions were noted within the spleen during routine surveillance imaging with computerised tomography of the thorax , abdomen and pelvis . of note , one month prior to this the patient had a normal surveillance colonoscopy performed with multiple interval carcinoembryonic antigen ( cea ) levels recorded within the normal range . image guided splenic biopsy and subsequent histology confirmed metastatic caecal adenocarcinoma.discussionsplenic metastases from any source including the colon are a rare phenomenon.conclusionthis case questions the value of routine post operative cea monitoring , underlines the importance of multimodal pathways of surveillance and highlights recent advances in image guided splenic biopsy techniques .

recent advances in repair of thoracoabdominal aortic aneurysms ( taaa ) allow one to choose between three therapeutic options : conventional open surgery , a hybrid open - endovascular procedure or endovascular repair . despite significant progress in operative technique and procedural anesthesia , a conventional open surgical repair of taaa is still accompanied by significant morbidity and mortality . a number of large studies dealing with outcomes following open taaa surgical treatment indicate that the 30-day mortality of elective cases ranges between 5 % and 19 % , while one - year mortality increases to even 30 % [ 1 , 2 ] . however , only experienced high - volume vascular centers can treat taaa surgically with a mortality rate below 10 % . in high - risk patients , hybrid procedures combining extra - anatomic bypasses and endovascular techniques with branched and fenestrated aortic stent grafts have been used to reduce the risk of conventional taaa with the repair of visceral arteries . in patients with crawford type iv taaa , employment of fenestrated aortic stent grafts has been proved to provide better early results than open surgical procedures . endovascular repairs in patients with taaa are limited so far to anatomical factors , such as ostial stenosis , severe vessel angulations and tortuosity as well as narrow iliac , renal and visceral arteries . other limitations to the common use of fenestrated stent grafts include high costs and the time delay between qualification and manufacture of the tailored grafts . today , there are only a few studies in the literature reporting application of fenestrated stent grafts in the treatment of complex abdominal aortic aneurysms involving four visceral vessels . we describe a case of a high - risk patient with taaa involving the visceral vessels in which the endovascular technique was chosen as the most appropriate therapeutic option .

conventional open surgical repair of thoracoabdominal aortic aneurysm ( taaa ) is associated with high perioperative mortality and morbidity risk . our report of successful treatment of a 56-year - old patient with taaa involving all visceral arteries and with many comorbidities with a fenestrated stent graft supports its application in high - risk taaa patients .

acute liver failure ( alf ) can occur as a result of various etiologies including hepatic injury by drugs and poison , viral hepatitis , ischemia , or other causes . the mechanisms by which liver cells are destroyed as well as the processes mediating liver regeneration , remain largely unknown . it has become evident that liver cell death can occur via distinct biochemical pathways and morphological alterations , including apoptosis , autophagic cell death , and necrosis . apoptosis is defined by chromatin condensation , nuclear fragmentation , cell shrinkage , blebbing of the plasma membrane , and formation of apoptotic bodies that contain nuclear or cytoplasmic material ( kerr et al . , 1972 ; autophagic cell death , on the other hand , is characterized by a massive accumulation of double - membrane containing vacuoles , called autophagosomes , that subsequently fuse with lysosomes . necrotic cell death is often negatively defined as a form of cell death that lacks signs of apoptosis or autophagy . typically , necrotic cells show cytoplasmic swelling , dilation of organelles , and mechanical rupture of the plasma membrane . although necrosis has been deemed to be a mainly passive process , the initiation , and modulation of necrotic cell death are currently under intense investigation at the molecular level . the relative contribution of apoptosis or necrosis to organ dysfunction in alf remains controversial ( schulze - osthoff and bantel , 2011 ) . necrosis is typically the consequence of acute metabolic perturbation with atp depletion , whereas apoptosis represents an atp - dependent cell death program . furthermore , in several cases , the nature and duration of cellular injury determine if cells die by apoptosis , necrosis , or other mechanisms . at low doses , a variety of injurious stimuli often induce apoptosis , but the same stimuli can result in necrosis at higher doses . therefore , in many situations cell death might be not executed as a clear - cut form of cell death , but as a continuum with intermediate features of both apoptosis and necrosis . a distinction of different cell death forms is therefore not only relevant for semantical reasons , but has important clinical implications when considering the therapeutic targeting of cell death processes . thus , an understanding of the cell death processes is most important for development of effective interventions to prevent hepatocellular death in acute liver damage ( fischer and schulze - osthoff , 2005 ) .

acute liver failure ( alf ) can be the consequence of various etiologies , that might vary between different geographic regions . most frequent are intoxications with acetaminophen , viral hepatitis , or liver damage of unknown origin . alf occurs when the extent of hepatocyte death exceeds the regenerative capacity of the liver . the mode of liver cell death that is predominantly induced in alf , i.e . , apoptosis or necrosis , is still controversial and presumably determined by the etiology , duration , and magnitude of liver injury . severe liver damage involves oxidative stress and depletion of atp resulting in necrosis . in contrast , maintenance of atp stores is required for the execution of apoptosis . recent data suggest that necrosis resulting from severe liver damage is associated with poor outcome of alf patients . discrimination between apoptosis and necrosis might be therefore useful for the identification of alf patients requiring liver transplantation . identification of the molecular cell death mechanisms remains an important issue not only for early prediction of alf outcome , but also for therapeutic interventions . in view of the pleiotropic functions of critical mediators of cell death and tissue regeneration , a particular challenge will be to reduce hepatocellular death without inhibiting the regenerative capacity of the liver . here , we review the molecular mechanisms of hepatocyte injury and the pathways leading to apoptosis and necrosis , which might represent potential diagnostic and therapeutic targets in alf .

age - related macular degeneration ( amd ) is subdivided into the dry form and the wet form . according to bressler et al . the minimally classic / occult trial of the anti - vegf antibody ranibizumab in the treatment of neovascular age - related macular degeneration ( marina ) evaluated the benefit of ranibizumab in a dose of 0.5 mg per month . at 12 months , 95 % of patients had lost < 15 early treatment diabetic retinopathy study ( etdrs ) letters from baseline and 34 % of patients had a best corrected visual acuity ( bcva ) gain of 15 etdrs letters . the study ranibizumab in patients with subfoveal choroidal neovascularization ( cnv ) secondary to age - related macular degeneration ( sustain study ) was designed to further evaluate the safety , tolerability , and efficacy of optical coherence tomography ( oct ) /bcva - guided , individualized , and flexible pro re nata ( prn , as needed ) dosing regimen for ranibizumab . at 12 months , 92.5 % of patients had lost < 15 etdrs letters from baseline and 19.3 % of patients had a bcva gain of 15 etdrs letters . whether the fixed or prn regimen was used in the treatment of wet amd , the therapeutic response of individual patients was not always the same . current observations suggest that the factors which affect the response to the initial treatment with ranibizumab are individual . the aim of this study was to assess the importance of various factors ( age , gender , baseline bcva , baseline macula thickness , and type and size of cnv ) for early morphological therapeutic response to ranibizumab in clinical practice .

aim . to assess the significance of age , gender , baseline best corrected visual acuity , baseline macula thickness , and type and size of choroidal neovascularization in early morphological therapeutic response to ranibizumab treatment in patients with the wet form of age - related macular degeneration . methods . from 09/2008 to 06/2013 we evaluated 1153 newly diagnosed , treatment - nave patients treated with ranibizumab . based on the morphological findings in the macula following the initial 3 injections of ranibizumab , the patients were divided into two groups based on active and inactive choroidal neovascularization . results . after the initial 3 injections of ranibizumab , we examined the sample of 841 eyes with active cnv and 312 eyes with inactive cnv . in the inactive group , we found a statistically higher proportion of occult cnv ( p < 0.001 ) and lower incidence of cnv greater than 5da ( p < 0.001 ) compared with the active group . we found no statistically significant difference in age , gender , baseline best corrected visual acuity , or baseline macula thickness between the inactive and active groups . conclusion . occult cnv and cnv smaller than 5da are optimistic factors for a better morphological therapeutic response at the beginning of ranibizumab treatment .

few similar cases are reported in literature but none of them is associated with mirizzi syndrome . radiological images could help the surgeon to choose the surgical strategy and to evaluate the presence of associated diseases . in our case laparoscopic surgery showed to be an excellent approach for both the cholecystectomy and the repair of the defect of the abdominal wall .

a gallbladder incarcerated hernia associated with mirizzi syndrome is a very rare entity and to our knowledge this is the first case ever described in literature . an 85-year - old man presented at the emergency department with a tender right upper quadrant mass . computed tomography ( ct ) revealed the presence of a gallbladder lithiasis with signs of acute cholecystitis , herniated through the abdominal wall with an associated mirizzi syndrome . laparoscopic cholecystectomy and repair of the abdominal wall defect were performed . the patient recovered very well and the postoperative period was uneventful .

neglected tropical diseases ( ntds ) is an umbrella term used to describe infectious diseases that primarily affect low - income populations in tropical regions and are often widespread , chronic , and debilitating . although the number of diseases that are officially recognized as ntds by various public health authorities ranges from less than 10 to over 40 , the list of 17 diseases currently classified as ntds by the world health organization ( who ) is widely accepted as accurate and comprehensive ( 20 ) . of these 17 diseases , four are caused by bacterial pathogens ( buruli ulcer , leprosy , trachoma , and yaws ) , three are caused by protozoan parasites ( chagas disease , human african trypanosomiasis and leishmaniasis ) , two are viral ( dengue and rabies ) , and the other eight are caused by various species of parasitic worms ( 20 ) . the most recent data available indicating the estimated number of cases of each ntd are listed in table 1 . estimated number of cases of neglected tropical diseases ( ntds ) worldwide . prevalence ( total number of existing and new cases ) is reported for chronic ntds and incidence ( total number of new cases ) is reported for acute ntds or ntds with a high rate of recurrence . cdc , centers for disease control ; cfsph , center for food security and public health , iowa state university ; n / a , data not available ; who , world health organization . ntds exert an immensely deleterious effect on the public health and economies of much of the developing world . yet , by definition , ntds are issues for which the levels of awareness and resources necessary to develop effective solutions have not been sufficiently garnered . because ntds are largely confined to poor areas and have relatively low mortality rates , the policy makers and financiers of global health campaigns may underestimate or simply not be aware of the magnitude of the problem . it is for precisely these reasons ( that ntds are chronically debilitating , affect a large number of indigent people , and are often overlooked ) that it is crucial to increase the amount of education , research , and public outreach devoted to their study and treatment . even though ntds are largely confined to developing countries , there are a number of reasons why addressing ntds is important to developed countries such as the united states , and to the educational systems therein . the argument for increasing the focus on teaching about ntds can be distilled into three main points : ( i ) the sheer magnitude of the impact that ntds have on global health and interconnected world economies warrants a proportionately significant amount of attention in our classrooms ( ii ) increased awareness of ntds in western countries is crucial because successful ntd research programs and public health campaigns can significantly benefit from leadership , expertise , and funding from those with the greatest resources , and ( iii ) teaching and learning about ntds provides a unique opportunity to bridge myriad connections between basic science and other disciplines and to promote civic engagement and critical thinking .

neglected tropical diseases constitute a significant public health burden , affecting over one billion people globally , yet this group of diseases is underrepresented in the appropriation of both monetary and intellectual capital for developing improved therapies and public health campaigns . the topic of neglected tropical diseases has been similarly marginalized in the biology classrooms of our nation s high schools and colleges , despite offering an opportunity to teach and learn about a diverse area of microbiology with far - reaching public health , social , and economic implications . discussed herein is an argument for increasing the representation of neglected tropical diseases in microbiology education as a means to generate increased interest in these diseases among the generation of future researchers and policy - makers , and to promote interdisciplinary learning , civic engagement , and critical thinking .

haemophilus spp . generally colonize the upper respiratory tract and can cause infections such as bronchitis , sinusitis , epiglottitis , pneumonia and meningitis . h. influenzae has been reported as a rare cause of genitourinary tract infection such as urinary tract infection , , , , , pyelonephritis , , prostatitis , epididymitis , salpingitis and endometritis . we report here an immunocompetent japanese man with bacteremic pyelonephritis caused by nontypable h. influenzae associated with a left ureteral calculus .

haemophilus species are known to colonize the upper respiratory tract and can cause infections . however haemophilus influenzae has been rarely described as a cause of genitourinary tract infection . we report a 44-year - old nonimmunocompromised japanese man with bacteremic pyelonephritis caused by a nontypable h. influenzae associated with a left ureteral calculus . the organism was isolated from both blood and urine cultures . treatment consisted of 14 days of intravenous ceftriaxone and oral amoxicillin one after than other and insertion of a left ureteral stent . after discharge , he underwent extracorporeal shock wave lithotrity for the left ureteral calculus . he had no recrudescence of the symptoms . h. influenzae should be considered as a genitourinary pathogen among patients with certain risk factors such as anatomical or functional abnormality of genitourinary tract . collaboration between clinicians and microbiology laboratory personnel is essential for correct identification of the organism and appropriate therapy for genitourinary tract infections due to this organism .

congenital coarctation of the aorta is a narrowing of the descending aorta which typically is located at the ligamentum arteriosum just distal to the left subclavian artery . this condition may be undiagnosed until adult life , when the clinical presentation most often is high blood pressure ( bp ) in both or more seldom in only one of the upper extremities . other typical clinical manifestations may include headache , fatigue on exertion , and bilateral lower limb claudication . coarctation of the aorta occurs in 5 - 8 % of cases of congenital heart defects . this condition may occur along with ventricular septal defect and other related heart defects , or may occur isolated . in rare cases , severe trauma and injury may lead to coarctation of the aorta . in extremely rare cases , severe atherosclerosis or inflammatory diseases of the aorta may cause narrowing of the artery leading to aortic coarctation .

the present case shows that a normal brachial blood pressure ( bp ) does not exclude severe coarctation and should be considered in normotensive patients presenting with a systolic murmur and/or unexplained severe left ventricular hypertrophy . congenital coarctation of the aorta is a narrowing of the descending aorta , usually located distal to the origin of the subclavian artery , causing hypertension in the upper part of the body . this condition may be undiagnosed until adult life where the clinical presentation most often is high bp in the upper extremities . a 57-year - old patient with severe aortic coarctation and left ventricular hypertrophy presented with normal brachial bp . however , standard suprasternal view by echocardiography indicated coarctation . multislice computed tomographic ( ct ) angiography revealed an uncommon location of the aortic narrowing with the right and left subclavian arteries originating below the area of coarctation , explaining the equally low bp in both upper extremities .

micrornas ( mirnas ) are single stranded non - coding rna molecules of 22 nucleotides ( nt ) that regulate gene expression via post - transcriptional and/or translational repression ( ambros , 2004 ) . primary mirna ( pri - mirnas ) are transcribed in the nucleus by rna polymerase ii or iii , where 70 nt stem - loop mirna precursors ( pre - mirnas ) are subsequently excised by the microprocessor complex containing the rnase iii enzyme drosha , and exported to the cytoplasm via exportin-5 ( kim et al . , 2009 ) . dicer , another rnase iii enzyme , further processes pre - mirnas to produce mature mirnas , the final product being a 22 base - pair duplex with 2 nt - long 3 overhangs ( he and hannon , 2004 ) . then , one strand of the mature mirna is loaded onto argonaute ( ago , also known as eif2c ) , a core protein of the rna - induced silencing complex ( risc ) . mirna forms base pairs with a target mrna as a guide for ago binding and to direct the specificity of the risc effector , decreasing target mrna levels and/or its translation ( fabian et al . , 2010 ) , where mrna destabilization is the dominant mechanism ( eichhorn et al . , 2014 ; guo et al . , mirnas are abundant in the mammalian genome ( more than 2000 human mirnas are currently reported in mirbase ) ( kozomara and griffiths - jones , 2014 ) and their regulatory role is essential , affecting various biological phenomena ( kim , 2005 ; sim et al . , 2014 ) . supporting evidence derives from the fact that a lethal phenotype during early development was observed in dicer1-null ( bernstein et al . , 2003 ) or ago2-null ( liu et al . , 2004 ) mice , and various biological defects were also reported after losses of individual mirnas ( park et al . , 2010 ) . in addition , alterations of mirna regulation are related to many diseases such as neurological disorders ( hebert and de strooper , 2009 ) , various types of cancer ( croce , 2009 ) , and cardiovascular diseases ( olson , 2014 ) . importantly , all of these defects were ultimately caused by a dysregulation in target gene expression . however , the limitation here is our ability to delineate a general principle for identification of specific rna targets upon which mirnas act . the problem stems from the observation that most of mirna target sites have partial complementarity ( ambros , 2004 ) .

micrornas ( mirnas ) are small non - coding rnas ( 22 nucleotides ) regulating gene expression at the post - transcriptional level . by directing the rna - induced silencing complex ( risc ) to bind specific target mrnas , mirna can repress target genes and affect various biological phenotypes . functional mirna target recognition is known to majorly attribute specificity to consecutive pairing with seed region ( position 28 ) of mirna . recent advances in a transcriptome - wide method of mapping mirna binding sites ( ago hits - clip ) elucidated that a large portion of mirna - target interactions in vivo are mediated not only through the canonical seed sites but also via non - canonical sites ( 1580 % ) , setting the stage to expand and determine their properties . here we focus on recent findings from transcriptome - wide non - canonical mirna - target interactions , specifically regarding nucleation bulges and seed - like motifs . we also discuss insights from ago hits - clip data alongside structural and biochemical studies , which highlight putative mechanisms of mirna target recognition , and the biological significance of these non - canonical sites mediating marginal repression .

prostate cancer , one of the most commonly diagnosed male malignancies in western countries , is now the leading cause of cancer - related death in men . over the years , genetic epidemiological evidence has accumulated in favor of a considerable hereditary component in prostate cancer susceptibility . genetic linkage analysis in 360 hereditary prostate cancer pedigrees revealed the presence of a hereditary prostate cancer susceptibility gene ( s ) at xq27 - 28 ( hpcx ) . in agreement with this finding , further data were obtained by analyzing linkage disequilibrium of molecular markers of x chromosome in a finnish x haplotype . xq27 is a region containing a number of genes important in cancer and embryonic development , including the sperm protein associated with the nucleus in the x chromosome ( spanx ) gene family that consists of the two subfamilies spanx - n and spanx - a / d ( human genome build 37.1 ) . spanx - a / d genes map within segmental duplications , which are regions involved in genomic rearrangements resulting in an abnormally high level of structural polymorphisms . accordingly , the spanx - b and the spanx - c genes were shown to be present in a variable number of copies ( ranging from one to > 11 ) in the normal population ; however , no association was found between spanx copy number and the occurrence of hereditary prostate cancer by the genetic locus described by xu , thus leaving uncertain the possible identification of the aforementioned locus with spanx gene cluster . spanx proteins are normally expressed in germ cells ; however , their expression has also been detected in a number of tumors , including melanoma , myeloma , glyoblastoma , breast carcinoma , prostate cancer , and testicular germ cell tumors . the present study was undertaken to evaluate the expression of spanx proteins in normal prostate tissues and in prostate cancer by immunohistochemistry .

the sperm protein associated with the nucleus in the x chromosome ( spanx ) gene family encodes for proteins that are not only expressed in germ cells , but also in a number of tumors . in addition , spanx genes map in an interval of the x chromosome ( namely , xq27 ) , which has been found to be associated with familial prostate cancer by linkage analysis . the aim of this study was therefore to evaluate spanx protein expression in normal prostate tissues and in prostate carcinoma . for this purpose , formalin - fixed and paraffin - embedded sections obtained from 15 normal ( at autopsy ) donors and 12 men with prostate cancer were analyzed by immunohistochemistry . about 40 % of both normal and tumor prostate samples resulted spanx positive . signals were exclusively within the nucleus in normal prostate cells , whereas both nuclear and cytoplasmic positivity was observed in tumor cells . in conclusion , these findings showed that spanx genes are expressed in both normal and tumor prostate gland , but the latter showed a peculiar cytoplasmic staining positivity . this suggests a possible association between spanx over expression and prostate cancer development . additional studies are needed to corroborate this hypothesis .

ewing 's sarcoma family of tumors are a group of small round - cell neoplasms , which include ewing 's sarcoma ( ews ) , primitive neuroectodermal tumor ( pnet ) , askins tumor , pnet of the bone , and extraosseous ewing 's sarcoma ( ess ) . ewing 's sarcoma / peripheral primitive neuroectodermal tumor , presumed to be neuroectodermal in origin , most often occurs in the bone and soft tissues of children and young adults . the intracranial extraosseous ewing 's sarcoma ( cns - ess ) is extremely rare and often misdiagnosed as central nervous system pnet ( c - pnet ) or as other primary intracranial neoplasms .

ewing 's sarcoma / peripheral primitive neuroectodermal tumors occur most often in bone and soft tissues of children and young adults . the intracranial manifestation of the disease is rare , and when present , this is often misdiagnosed with other varieties of primary brain tumors . we report such a case of extraosseous ewing 's sarcoma , which was initially suspected to be a case of meningioma in an 11-year - old girl .

nitric oxide ( no ) is known to have several important vasculo - protective effects ( el - mas et al 1997 ; grdal et al 2005 ) . reduced production of no may lead to atherosclerosis ( lscher and vanhoutte 1990 ; harrison 1997 ; shimokawa 1999 ) . the synthesis of no from the amino acid , l - arginine , is catalysed by no synthase ( nos ) . no then plays a critical role in the relaxation of vascular smooth muscle cells ( vsmcs ) . it is well known that no is involved in reducing vsmc proliferation , adhesion of platelets and leukocytes ( moncada and higgs 1993 ; draijer et al 1995 ; myers and tanner 1998 ; brocq et al 2008 ) . no is likely , therefore , to be an important contributory factor in the pathogenesis of some forms of stroke . there are 3 distinct isoforms of nos identified in humans : endothelial ( enos ) , neuronal nos ( nnos ) and inducible nos ( inos ) . it synthesizes very low levels no under basal conditions ( lscher and vanhoutte 1990 ; harrison 1997 ; shimokawa 1999 ) . because enos plays a central role in the maintenance of vascular homeostasis , including regulation of the cerebral circulation , a number of studies have been conducted to investigate the genetic association between the enos gene and the incidence of ischemic stroke . howard and colleagues ( 2005 ) detected 3 single nucleotide polymorphisms ( snps ) in the promoter region , 1 in exon 7 ( g894 t ) and 1 insertion / deletion polymorphism within intron 4 among 110 cases with ischemic stroke and 206 controls . they found strong associations of both the 922 g - a and 786 t - c snps with ischemic stroke . hou and colleagues ( 2001 ) were the first to report the genetic association between the enos gene and ischemic stroke in a chinese population and a recent work has confirmed the intial finding ( berger et al 2007 ) although the enos association failed to be replicated in a japanese population ( yahashi et al 1998 ) . this study might have been hampered by poor replication , a common problem with genetic analysis . linkage disequilibrium ( ld ) structure and sample power may be one of major reasons for poor replication of an initial finding . therefore , the present study was designed to apply a large sample size to investigate genetic association between the enos gene and ischemic stroke .

we recruited 560 unrelated patients with ischemic stroke and 153 unrelated controls to undertake a genetic analysis for association between the nos3 gene and ischemic stroke . all the subjects were chinese of han descent . because the nos3 gene spans about 21 kb of dna and contains 26 exons , we selected a single nucleotide polymorphism ( snp ) rs3918181 , an a to g base change located in intron 14 of the gene , as a dna marker . pcr - based restriction fragment length polymorphism analysis was applied to genotype rs3918181 ( rsai site ) . the chi - square ( 2 ) goodness - of - fit test showed that the genotypic distributions of the marker were not deviated from hardy - weinberg equilibrium in both the patient group ( 2 = 0.166 , p = 0.684 ) and the control group ( 2 = 0.421 , p = 0.517 ) . the cocaphase analysis showed allelic association of rs3918181 with ischemic stroke in males ( 2 = 4.04 , p = 0.044 , or = 1.43 , 95 % ci 1.012.02 ) and frequency of allele a was significantly higher in male patients than male control subjects . the 2 test revealed genotypic association between rs3918181 and ischemic stroke in males ( 2 = 4.26 , df = 1 , p = 0.039 , or = 1.61 , 95 % ci 1.022.53 ) but not in females . the present work suggests that rs3918181 is associated with ischemic stroke in male patients . this finding gives further evidence in support of the enos association with ischemic stroke in the chinese population .

businesses offering goods and services to consumers often request feedback from former customers to assess strengths and weaknesses and to leverage positive feedback and testimonials as marketing materials . as these testimonials become more digitized and more public on sites like yelp , facebook , and google+ , businesses have a high stake in ensuring that their consumers are satisfied with the quality of service or goods they provide [ 2 , 3 ] . in the healthcare space , the hospital consumer assessment of healthcare providers and systems ( hcahps ) initiative provides a survey tool to measure patients ' perspectives and satisfaction within hospital systems . the hcahps survey aims to produce standardized data on patients ' perspectives on hospital care to allow for meaningful comparisons between hospitals based on consumer importance and publicly represent these findings to encourage transparency and incentivize hospital systems to improve their quality of care . the hcahps initiative has identified 21 rating items that have been determined to affect patient perspectives on hospital care and has generated a 32-question survey that assesses quality of care from nurses and doctors , hospital environment , and experiences in the hospital . while this survey instrument is widely used in the hospital setting , an equivalent tool does not exist to evaluate satisfaction and perspectives in other areas of medicine and health , including addiction rehabilitation programs . unique in its function , residential addiction treatment centers simultaneously operate as healthcare providers and hospitality managers , delivering medical and psychological support while offering accommodations , meals , and amenities in lieu of a clients ' typical home environment . in this exploratory study , we aim to determine which criteria are most significant to influencing overall alumni satisfaction with an inpatient drug or alcohol rehabilitation facility . because the residential and intensive outpatient addiction rehabilitation industry functions at the crux of social science , medicine , and hospitality services , we hypothesize that alumni perceptions of facility amenities and perceived quality of individual therapies and group counseling will have significant influence on alumni satisfaction . we also hypothesize that the presence of subsequent relapse after discharge from a facility as a proxy measurement for success will negatively influence alumni satisfaction .

objective . the primary objective of this investigation is to determine which individual and aggregate factors of residential addiction treatment centers are most significant influencers of alumni satisfaction . design . survey targeted alumni of residential addiction treatment facilities . alumni were queried through a survey , which utilized likert - scale matrices and binary response options : 379 respondents met the completion threshold . alumni rated amenities and individual and group counseling factors ; additionally , respondents provided feedback on two satisfaction proxies : cost worthiness and future recommendations . descriptive and relational analyses were conducted , with the latter utilizing logistic regression models . results . individual factors ' scores of group counseling , and overall aggregate group counseling score , are most enthusiastically positive . group counseling is also the most significant influencer of satisfaction . other significant influencers of satisfaction are met expectations for individual counseling and psychiatric care offerings . conclusions . while individual counseling and facility amenities should not be ignored , group counseling may be the most significant influencer of alumni satisfaction . long - term outcomes are not single - faceted ; however , treatment providers should be encouraged to invest in high - quality group counseling offerings in order to best satisfy , and thereby empower , clients .

the majority of japanese patients with type 2 diabetes mellitus are not obese , as reported by kosaka and ogata more than 50 years ago . eastern asian subjects might share common characteristics of the disease , comparable to those reported in korean people . it is , therefore , debatable whether we can apply epidemiological evidence obtained from studies of caucasian subjects with type 2 diabetes and obesity to eastern asian people , especially in the fields of diabetic complications , which are influenced not only by hyperglycemia but also by obesity . for example , type 2 diabetes is a relative risk factor for cardiovascular disease in asians , as in western societies , but the absolute risk differs greatly between these populations [ 47 ] . recently , the legacy effect of intensive glycemic control early after the diagnosis of diabetes was advocated based on the ukpds follow - up study . however , there is no report about the legacy effect of past obesity over a lifetime on diabetic complications . although there have been inconsistent results as to whether obesity is a risk for diabetic nephropathy [ 912 ] , it was reported that current obesity and maximum past body mass index ( bmi ) were significant risk factors for diabetic nephropathy in the japanese . although caucasian subjects with type 2 diabetes usually maintain their body weight status during their disease course , the majority of patients of eastern asian ethnicity begin to lose body weight from around the time of diagnosis of diabetes [ 3 , 13 ] . this was easily overlooked , even if the effect of obesity in the past persisted for a long time , because they were already nonobese at the start of clinical follow - up . to clarify the influence of past obesity on diabetic complications is an important clinical concern in patients of eastern asian ethnicity . we therefore analyzed the difference in the prevalence of diabetic nephropathy in japanese type 2 diabetics according to their history of body weight status to clarify the effect of past obesity on diabetic nephropathy .

aims . we analyzed the prevalence of nephropathy according to past body weight status in japanese subjects with type 2 diabetes because the influence of past obesity on diabetic complications is not certain . methods . we examined the prevalence of nephropathy in 2927 subjects with type 2 diabetes mellitus according to current bmi and maximum bmi in the past . we defined current obesity as bmi on hospitalization of 25 or more , previous obesity as bmi on hospitalization of less than 25 and self - reported maximum bmi in the past of 25 or more , and continuously lean as maximum bmi of less than 25 . results . the prevalence of nephropathy was significantly higher in subjects with current obesity ( 40.6 % ) or previous obesity ( 35.6 % ) than in those who were continuously lean ( 24.3 % ) ( p < 0.017 ) . in logistic regression analysis , previous obesity , as well as current obesity , was a significant risk factor for nephropathy , independent of sex , age , disease duration , hypertension , dyslipidemia , hba1c , and diabetic retinopathy . conclusions . obesity in the past , as well as the present body weight status , was a risk factor for diabetic nephropathy .

monoamine oxidases ( mao ) are mitochondrial enzymes responsible for the metabolic breakdown of monoamines ( serotonin , norepinephrine , and dopamine ) in neuronal tissues causing depletion of monoamines and clinical depression ; while mao inhibitors ( maois ) result in the clinical improvement of mood states . interestingly , drugs that possess maoi properties but are used for purposes unrelated to antidepressant activity are furazolidone ( an antiinfective ) ; procarbazine ( drug used for hodgkin 's disease ) ; and linezolid ( an antibiotic used for serious infections ) . we report a case of serious adverse drug interactions between escitalopram and linezolid precipitating near - fatal serotonin syndrome ( ss ) in an elderly female . relevant literature was retrieved via pubmed , embase , and psycinfo using the keywords ; linezolid , escitalopram , serotonin syndrome supplemented with a manual search of cross references .

linezolid is a synthetic antimicrobial agent of the oxazolidinone class with weak , nonspecific inhibitor of monoamine oxidase enzymes . concomitant therapy with an adrenergic or serotonergic agent or consuming tyramine ( > 100 mg / day ) may induce serotonin syndrome ( ss ) . we present a case report of near - fatal adverse interaction between linezolid and escitalopram inducing ss in a 65-year - old woman with sepsis , under empirical antibiotic treatment . this report also summarizes the current relevant literature as identified via pubmed , embase , and psycinfo , supplemented with a manual search of cross references .

aerobic ammonia oxidation , the first and rate - limiting step in nitrification , is the only biological process converting reduced to oxidized inorganic nitrogen species on earth . for over 100 years , this process was thought to be mediated by autotrophic beta - proteobacteria and gamma - proteobacteria ( aob ) occasionally supported by heterotrophic nitrifiers in soil environments . however , in situ measurements of nitrification in marine and terrestrial environments showed that ammonia oxidation often proceeds at substrate concentrations significantly below the growth threshold of cultured aob ( e.g . ) indicating the presence of unknown nitrifiers . the recent discovery of homologs of ammonia monooxygenase genes in archaea [ 57 ] and the cultivation of autotrophic ammonia - oxidizing archaea ( aoa ) [ 811 ] revealed that an additional group of microorganisms is able to catalyze this process . the widespread distribution of putative archaeal ammonia monooxygenase ( amo ) genes and their numerical dominance over their bacterial counterparts in most marine and terrestrial environments suggested that aoa play a major role in global nitrification [ 1215 ] , but our understanding of their evolutionary history and metabolic repertoire is still in its infancy .

thaumarchaeota range among the most abundant archaea on earth . initially classified as mesophilic crenarchaeota , comparative genomics has recently revealed that they form a separate and deep - branching phylum within the archaea . this novel phylum comprises in 16s rrna gene trees not only all known archaeal ammonia oxidizers but also several clusters of environmental sequences representing microorganisms with unknown energy metabolism . ecophysiological studies of ammonia - oxidizing thaumarchaeota suggest adaptation to low ammonia concentrations and an autotrophic or possibly mixotrophic lifestyle . extrapolating from the wide substrate range of copper - containing membrane - bound monooxygenases , to which the thaumarchaeal ammonia monooxygenases belong , the use of substrates other than ammonia for generating energy by some members of the thaumarchaeota seems likely .

diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion , insulin action , or both ( 1 ) . the chronic hyperglycemia of diabetes is associated with long - term damage , dysfunction , and failure of different organs , especially of eyes , kidneys , nerves , heart , and blood vessels ( 1 ) . the main forms of diabetes are divided into those caused by lack of insulin secretion , due to damage of - cells of the pancreas ( type 1 dm ) , and those that are a consequence of insulin resistance that occurs at the level of skeletal muscles , liver and adipose tissue , with varying degrees of - cells damage ( type 2 dm ) . diabetes mellitus classification ( 2 ) the prevalence of type 2 diabetes is increasing globally and represents a heavy burden on public health and socioeconomic development of all nations ( 3 ) . type 2 diabetes is a multifactorial disease and due to a combination of environmental and genetic risk factors ( many environmental risk factors contribute to the pathogenesis of type 2 diabetes , including lifestyles such as sedentary behavior , diet , smoking and alcohol consumption , internal environmental factors such as inflammatory factors , adipocytokines and hepatocyte factors , external environmental factors such as environmental endocrine disruptors ) ( 3 ) . so no isolated known defect predominates , as is the case with hla connection with type 1 dm . . it was found that the risks for diabetes in african - americans , hispanics , and native americans are approximately 2 , 2.5 , and 5 times greater , respectively , than in caucasians . the main reason for this is that symptoms , when seen on their own , seem harmless . however , the earlier diabetes is diagnosed , the greater the chances are that serious complications , which can result from having diabetes , can be avoided . most common diabetes symptoms are : frequent urination , disproportionate thirst , intense hunger , weight gain , unusual weight loss , increased fatigue , irritability , blurred vision , cuts and bruises do not heal properly or quickly , skin and/or yeast infections , itchy skin , gums are red and/or swollen gums pulled away from teeth , frequent gum disease / infection , sexual dysfunction among men , numbness or tingling , especially in feet and hands .

introduction : diabetes is a group of metabolic diseases characterized by hyperglycemia , and represents a disease of the modern age , disease of the 21st century . prevention of this disease is listed as imperative . aim of this article was to evaluate questionnaires on the assessment of risk factors for diabetes mellitus type 2.material and methods : a total of 540 questionnaires handed out randomly to citizens of canton sarajevo of all ages , sexes and educational levels ( in january 2016 ) were analyzed.results : analyzed questionnaires showed relatively low risk of getting diabetes in the next ten years in the majority of the population . these results are rather encouraging but may in some way be in confrontation with the statistics which show a rapid outburst of diabetes.conclusion : the life - style is the main reason for such a thing to happen , and looking at these questionnaires , we might get the feeling that we really do live in a , conditionally speaking , physically active society . that , from our everyday experience is not entirely true . it would be wise to continue doing research on this topic on the territory of bosnia and herzegovina .

the collective arrangement of the teeth in function is quite important and has been subjected to a great deal of analysis and discussion over the years . as the mandible moves laterally , the lower posterior teeth leave their centric contact with the upper teeth and travel sideways down a path dictated by the condyles in the back and by the lateral anterior guidance in the front . in the diversified literature on occlusion and its role for functional patterns of the masticatory system , two concepts stand out : ( 1 ) canine protection as described by damico is said to favor a vertical chewing pattern and to prevent wear of teeth , as in lateral occlusion where the canine guides the mandibular movement directly through contact or indirectly through periodontal receptors . ( 2 ) group function as described by beyron following his observations on australian aborigines implies contact and stress on several teeth in lateral occlusion and indicates abrasion as a positive and inevitable adjustment . the reason for bringing any teeth into lateral function is to distribute stress and wear over more teeth . group function occlusion , which is also commonly known as unilateral balanced occlusion , is a widely accepted and used method of tooth arrangement in restorative dental procedures today . , the contacting inclines must be perfectly harmonized to border movements of the condyles and the anterior guidance . kleinberg has pointed out the importance of the feedback mechanism between mechanoreceptors in the temporomandibular joint and the functional mandibular movement pattern . in addition , a probable change in the input signals from the periodontal receptors after occlusal adjustment seems to affect the functional movement of the mandible . ingervall recorded tooth contact patterns in laterotrusion , protrusion of the mandible , and in the retruded position in young men with varying types of occlusion . contact on the nonfunctional side was found in half of the subjects in a 1.5-mm laterotrusive position and in one third of them in a 3-mm laterotrusive position . yaffe & ehrlich recorded the dynamic contact pattern of teeth in lateral glide movement in 72 individuals , 19 to 35 years of age , with normal tooth alignment and angle s class i molar and canine relationship . the lateral glide movement was divided into three stages to simulate the total range of events in lateral glide movement naturally demonstrated by the patient . this study has shown that lateral glide movement is a complex movement in which the nature of tooth contact is altering in location , direction , and number of teeth participating . consequently the restoration of an occlusion in accordance with a given concept does not always apply to all patients . the present study was designed to evaluate the incidence of occlusal patterns in a group of dental students .

background and aims this study observed occlusal contacts and their area on the teeth during lateral mandibular movements . the percentage of each occlusal pattern was determined . materials and methods fifty subjects ( male : 27 , female : 23 ) , aged 20 - 29 years , were included in the study . the criteria for selection were as follow : all subjects ( i ) were in their twenties ; ( ii ) had normal occlusal alignment , no temporomandibular signs and symptoms with angle s class i relationship ; ( iii ) had full dentition except for third molars ; ( iv ) had no history of orthodontic therapy ; and ( v ) had no restorations involving a cusp . the occlusal contacts were recorded with occlusion foil in three lateral excursions : 1 , 2 and 3 mm from the maximum intercuspation . data were analyzed with chi - square test . results most of working - side contact patterns were classified as group function ( 60 % ) . canine protection was rare ( 17 % ) . contact patterns other than canine protection and group function were found in 23 % of the contact patterns on the right side . on the left side , group function was seen in 51 % , canine protection in 21 % and others patterns in 28 % of the studied subjects . conclusion on laterotrusion , most subjects had group function on the working side but canine protection was rare .

zinc deficiency is an important cause of morbidity due to infectious diseases and growth - faltering among young children . increased demand of zinc due to rapid growth and decreased intake of zinc due to inadequate feeding practices predispose preschool children , especially living in communities of low socioeconomic level at an elevated risk of zinc deficiency ( 1 ) . compelling evidence from intervention trials suggests that supplementation of zinc could reduce the risk of pneumonia and the risk and duration of diarrhoea , dysentery , and malaria among preschool children ( 25 ) . however , little information is available on the global prevalence of zinc deficiency . on the other hand , the population / national - level zinc - supplementation programmes have achieved limited success in alleviating zinc deficiency worldwide ( 6 ) . lack of reliable methods to determine the levels of plasma zinc , paucity of knowledge of the socioeconomic , dietary and demographic factors influencing the distribution of zinc deficiency , and inadequate documentation of rates and causes of zinc deficiency among vulnerable preschool children and its impact on childhood morbidities among different populations are some most important limiting factors ( 78 ) . traditionally , zinc deficiency at the population level has been estimated by the surrogate markers , such as total daily per - capita amount of zinc in the food - supply , compared to the likely zinc requirements , or by the rates of stunting among preschool children ( 9 ) . using the food balance - sheets , wuehler et al . estimated that about 71.2 % of the total population in southeast asia was at risk of developing zinc deficiency ( 10 ) . the prevalence of zinc deficiency among a population can be assessed by a combination of techniques , such as the prevalence of clinical outcomes of zinc deficiency ( diarrhoea , pneumonia , stunting ) , assessment of intake of dietary zinc , biochemical measures of zinc concentration , or assessment of functional outcomes of zinc supplementation ( 11 ) . a community - based study conducted in the north - west frontier province in pakistan reported that one in two preschool children suffers from zinc deficiency ( 12 ) . zinc deficiency has been suspected to be prevalent among preschoolers in india due to high consumption of cereal - based weaning diets and high rates of recurrent infections . there is also limited systematically - collected information on the quantitative estimates of zinc deficiency , especially those living in communities of low socioeconomic level ( 13 ) . determining the magnitude of zinc deficiency and its association with risk of morbidities among preschool children in india can contribute to planning strategies to alleviate zinc deficiency and the related adverse health consequences . in this study , we present the descriptive epidemiology of zinc deficiency and the associated risk of morbidity due to infectious diseases among preschool children in an urban slum in northern india .

community - based data relating to factors influencing zinc deficiency among preschool children in india are inadequate . data of a large , double - blinded , randomized , controlled zinc - supplementation trial were used for assessing the descriptive epidemiology of zinc deficiency among children aged 635 months ( n=940 ) . in total , 609 children were followed up for 120 days for information on morbidity . of these children , 116 from the control group belonging to the upper and the lower 25th quartile of plasma zinc status at baseline were selected for assessing the association of zinc deficiency with prospective morbidity . at baseline , demographic , socioeconomic and dietary information was collected , and anthropometric measurements and levels of plasma zinc were assessed . at baseline , 73.3 % of the children were zinc - deficient ( plasma zinc < 70 g / dl ) , of which 33.8 % had levels of plasma zinc below 60 g / dl . a significantly higher risk of morbidity was prevalent among the subjects with lower plasma zinc compared to those with higher levels of plasma zinc .

intradural disc herniation ( idh ) is a rare disease and its incidence is reported as 0.26 - 0.30 % of all disc herniations16 ) . idhs primarily occur as a result of chronic degenerative diseases and rarely occur due to traumatic events1,14 ) . traumatic lumbar spine lesions usually result in bony fractures and paraspinal soft tissue injuries rather than isolated disc herniations . in this report , we present a rare case of a patient who exhibited an intradural mass lesion at l1 , which initially mimicked a spinal subdural hematoma ( sdh ) and was later determined to be an idh without an accompanying lumbar spine bony fracture after a traumatic event .

intradural lumbar disc herniation is a rare disease . according to the reports of intradural lumbar disc herniations , most cases have developed as a chronic degenerative disc diseases . traumatic intradural lumbar disc herniations are even rarer . a 52-year - old man visited our emergency center with numbness in his left calf and ankle after falling accident . initial impression by radiologic findings was a spinal subdural hematoma at the l1 level . a follow up image two weeks later , however , did not demonstrate any interval change . the patient was decided to have an operation . in operative findings , a ruptured disc particle penetrating the ventral and dorsal dura was indentified after laminectomy . it was assumed to be a traumatic outcome not a degenerative change .

initially , they were considered as metastasis from an occult primary tumor in gonads , but now it is known that they arise either as a consequence of abnormal migration of germ cells during embryogenesis or from a different histogenetic origin . choriocarcinoma of liver without a detectable primary tumor in gonads , retroperitoneum or mediastinum is termed as primary hepatic choriocarcinoma . due to varied clinical presentations and extreme rarity of the tumor , diagnosis on small needle biopsy is difficult . we present a case of adult male diagnosed to have primary hepatic choriocarcinoma on histopathology and immunohistochemical studies .

choricarcinoma is a beta human chorionic gonadotrophin secreting neoplasm pertinent to uterus and pregnancy mostly . it occurs primarily in gonads but rarely in extragonadal sites . primary hepatic choriocarcinoma is an extremely rare tumor . most of the reported cases are seen in infants representing metastasis from an occult placental choriocarcinoma . till date , only 7 cases of primary hepatic choriocarcinoma in adults have been reported in literature . we present a case of a 40-yearold male presenting as haemoperitoneum due to ruptured hepatic tumor . he underwent emergency left lateral segmentectomy . he died on 10th postoperative day . the surgical specimen and autopsy findings confirmed it to be primary hepatic choriocarcinoma . this is the first case report from indian subcontinent . a brief case report and review of literature is presented .

human ifn-2 ( il-28a ) is a relatively new cytokine , in which the genomic structure resembles that of the il-10 family , but the protein structure is more closely related to type i ifn than to interleukin- ( il- ) 10 [ 1 , 2 ] . for example , it can induce antiviral activity in cell lines , though the potency is weaker than other ifns , and has the potential antitumor effect against human lung cancer cells . it has also been discovered that ifn-2 is capable of exacerbating t - cell - mediated autoimmune diseases such as uveitis . treatment with ifn-2 completely halts and reverses the development of collagen - induced arthritis , dramatically reduces the numbers of proinflammatory il-17-producing th17 and t cells in the joints and inguinal lymph nodes , and restricts recruitment of il-1b - expressing neutrophils . however , ifn-2 seems not effective in inducing tr1 cells and can not induce proliferation of regulatory t cells from cord blood cd4 ( + ) t cells . recently , it was found that the expression level of ifn-2 mrna was significantly increased during naturally occurring respiratory viral infections in children with asthma and that ifn-2 modulates lung dendritic cells ( dc ) function to promote th1 immune skewing and suppresses allergic airway disease . these suggest that ifn-2 is not only involved in autoimmune diseases but also associated with allergic airway disorders . we therefore investigated the potential involvement of ifn-2 in allergic airway diseases in the present study . to our surprise , information on the ifn-2 expressing cells is very limited . it was found that ifn-2 expressed in tracheobronchial tissue cells from the patients with copd . dc express moderate quantity of ifn-2 when using lipopolysaccharide ( lps ) as the maturation stimulus , and vitiligo patient skin and/or peripheral blood mononuclear cells express ifn-2 mrna . in order to understand the role of ifn-2 , we examined the cell origins of ifn-2 in the present study . the aim of the study is to investigate the expression of ifn-2 in peripheral blood of allergic airway disorders , its correlation with cytokines and tryptase , and its potential cell location . we found that the levels of ifn-2 were elevated in the plasma of ar and ar + as and that several cell types express ifn-2 .

this study investigated the expression levels of interferon- ( ifn- ) 2 in peripheral blood and tissues . the results showed that the levels of ifn-2 were elevated by 17.9 % and 14.2 % in the plasma of allergic rhinitis ( ar ) and combined rhinitis with asthma ( ar + as ) , which was positively correlated with the level of tryptase but negatively correlated with the level of il-10 . ifn-2 was predominately expressed in the cd16 + cells and cd14 + cells in healthy control subjects ( hc ) but upregulated only in cd8 + cells of ar and in eosinophils of asthma . it was observed that approximately 6.6 % and 7.0 % dispersed tonsil cells and 5.8 % and 0.44 % dispersed lung cells are ifn-2 + mast cells and macrophages . moreover , tryptase and agonist peptides of par-2 induced enhanced ifn-2 mrna expression in a549 cells . in conclusion , the elevated levels of ifn-2 in the plasma of ar and ar + as indicate that ifn-2 is likely to contribute to the pathogenesis of allergic airway disorders . the potential origins of the elevated plasma ifn-2 include mast cells , macrophages , and epithelial cells in tissues , neutrophils , monocytes , cd8 + t cells , and eosinophils in peripheral blood . development of ifn-2 related therapy may help to treat or prevent allergic airway disorders .

placental polyp is a somewhat pedunculated remnant of chorionic tissue retained in the uterine cavity for an indefinite time . it may result in abnormal uterine bleeding and slightly elevated detectable titers of serum -human chorionic gonadotropin ( hcg ) . these pedunculated masses of villi are often found within days to weeks following abortion or delivery of a term placenta . since trophoblastic neoplasms especially placental site trophoblastic tumor may have similar symptoms and signs , it is important to consider placental polyp in differential diagnosis in such situations .

placental polyp is retained placental tissue within the endometrial cavity , which forms a nidus for inflammation and bleeding . there are very few reported cases of the clinical placental polyp . here , we report a case of 34-year - old g4l3ab1 woman with the chief complaint of intermittent vaginal bleeding since her last normal vaginal delivery 3 months ago . serum human chorionic gonadotropin ( hcg ) titer was slightly elevated . a polypoid mass was detected within the endometrial cavity by imaging studies . history of the patient , mass lesion within the endometrial cavity and slightly elevated serum hcg titer raised the suspicion of trophoblastic neoplasms . endometrial curettage yielded unsatisfactory specimen containing only fibrin deposition and was followed by total hysterectomy . the uterus showed slight global enlargement resulting from the presence of a polypoid mass within the endometrial cavity . the red - colored mass had a smooth outer surface and fragile consistency without any permeation into the myometrium . pathology reported it as the placental polyp . although very rare , placental polyp should be kept in mind as one of the reasons of abnormal uterine bleeding in parous women . definite diagnosis is made by pathology examination .

halogen bonding has emerged in recent years as an effective alternative to hydrogen bonding in directing the formation of self - assembling architectures , with fruitful applications in many chemical and biological systems . halogen bonding is an electrostatically driven noncovalent interaction between a halogen atom in one molecule and a lone - pair ( n ) or -electron donor in another . the electron - withdrawing effect of groups covalently bound to a halogen atom depletes the electron density in the n orbital to yield an electropositive -hole . halogen bonding serves as an ideal cohesive force in self - assembling systems due to its linear directionality , tunable bonding strength , and stability in hydrophobic environments . in addition to attractive intermolecular forces , self - assembling processes may be aided via cooperative effects , i.e . , nonadditive enhancement from polarization and charge transfer . the existence of cooperativity in halogen bonding has been identified in previous crystallographic and theoretical studies covering molecular complexes with varied structures and strengths . the present computational study expands upon previous efforts to quantitatively examine cooperative effects and optimal motifs for linear and multiply halogen bonded systems and to consider their potential in the construction of self - assembling architectures . by performing density functional theory ( dft ) calculations , enhanced understanding is sought on the nature of cooperativity through geometrical , energetic , and natural bonding orbital ( nbo ) analyses . factors are considered that could influence interaction strength such as polarization , secondary interactions , and spacing between halogen bonds . recently , modeling of halogen bonding interactions in supramolecular systems has been facilitated in force fields by representing the -hole as a partial positive point charge attached to the halogen atom . carter et al . also redesigned a force field for halogen bonds by including angular dependency into the standard lennard - jones potential . in the present work , model systems are considered and then extended to construct cylindrical complexes analogous to carbon nanotubes ( cnts ) .

halogen bonding , due to its directionality and tunable strength , is being increasingly utilized in self - assembling materials and crystal engineering . using density functional theory ( dft ) and molecular mechanics ( opls / cm1ax ) calculations , multiply halogen bonded complexes of brominated imidazole and pyridine are investigated along with their potential in construction of self - assembling architectures . dimers with 110 halogen bonds are considered and reveal maximal binding energies of 336 kcal / mol . cooperative ( nonadditive ) effects are found in complexes that extend both along and perpendicular to the halogen bonding axes , with interaction energies depending on polarization , secondary interactions , and ring spacers . four structural motifs were identified to yield optimal halogen bonding . for the largest systems , the excellent agreement found between the dft and opls / cm1ax results supports the utility of the latter approach for analysis and design of self - assembling supramolecular structures .

benign prostatic hyperplasia ( bph ) is found in over half of 60-year - old men and in almost all 80-year - old men who develop bladder outlet obstruction ( boo ) and lower urinary tract symptoms ( luts ) . boo is the initial pathophysiological change caused by an enlarged adenoma and is followed by detrusor overactivity ( do ) or underactivity ( dua ) . the degree of boo is an important factor that can reflect the severity of disease and that can aid in choosing a treatment method as well as in measuring the outcome of the treatment . it has been shown that one third of male patients with luts do not have definite boo and that 5 to 35 % of the patients with luts and undefined boo do not have favorable symptom recovery after transurethral resection of the prostate ( turp ) [ 2 - 7 ] . relevant examinations ranging from serum prostate - specific antigen ( psa ) to urodynamics can all reflect different aspects of the severity of bph . urodynamics is the only method , however , that can quantify the degree of boo and the status of detrusor contractility . therefore , guidelines from the international scientific committee and the american urological association on the management of bph both recommend the use of urodynamics to evaluate bph patients considered as candidates for invasive therapy . however , the routine use of preoperative urodynamics is still a controversial point in published articles because of the invasiveness and high costs of the method . in this research , we attempted to determine whether other parameters could be used to measure the severity of boo through less - invasive or noninvasive examinations by analyzing correlations among parameters from clinical history , symptoms , ultrasonography , and urodynamics .

purposethe aim of this research was to assess the value of the transitional zone index ( tzi ) and intravesical prostatic protrusion ( ipp ) from transrectal ultrasonography in evaluating the severity and progression of disease by analyzing the relationship between the 2 parameters and symptoms , clinical history , and urodynamics in benign prostatic hyperplasia ( bph ) patients undergoing different treatment.materials and methodsa total of 203 patients receiving medication and 162 patients who underwent transurethral resection of the prostate because of bph were enrolled in this retrospective analysis . the clinical history and subjective and objective examination results of all patients were recorded and compared after being classified by tzi and ipp level . linear regression was used to find correlations between ipp , tzi , and urodynamics.resultsthe 2 parameters were found to differ significantly between patients receiving medication and patients undergoing surgical therapy ( p < 0.05 ) . psa , maximum flow rate ( qmax ) , detrusor pressure at qmax ( pdetqmax ) , and the bladder outlet obstruction index ( booi ) differed according to various tzi levels ( p < 0.05 ) . in addition , the voiding symptom score , qmax , and booi of subgroups with various ipp levels were also significantly different ( p < 0.05 ) . both tzi and ipp had significant effects on qmax , booi , and pdetqmax ( p < 0.05 ) and the incidence of acute urinary retention ( p=0.000 ) .conclusionsthe results demonstrated that both tzi and ipp had favorable value for assessing severity and progression in patients with bph . further studies are needed to confirm whether the two parameters have predictive value in the efficacy of bph treatment and could be considered as factors in the selection of therapy .

apert syndrome ( acrocephalosyndactylia ) is a developmental malformation characterized by craniosynostosis , a cone - shaped calvarium ( acrocephaly ) , hypertelorism , midface hypoplasia , pseudo cleft - palate , a parrot beak - shaped nose , pharyngeal attenuation , and syndactyly of the hands and feet.1 - 3 the inheritance of apert s syndrome is autosomal dominant with the locus of a mutation of fgfr2 on chromosome 10q ( 10q2526 ) . suture progenitor cells with fibroblast growth factor receptors ( fgfr2 ) that have undergone a mutation can not transduce signals from extracellular fibroblast growth factors ( fgfs ) . therefore , these cells do not receive the signal to produce the necessary fibrous material essential for a normal calvarial suture.3 apert syndrome was first reported by wheaton in 1894 and french pediatrician eugene apert published a series of nine cases in 1906.1,4 most cases are sporadic , with an incidence of 1:160 000 ; however due to high infant mortality , the incidence in the general population is lower . advanced male parental age has been consistently noted.5 during the course of the disease , growth and mental retardation can be observed.1,5 in apert cases , the spheno - occipital and spheno - ethmoidal synchondroses and the fronto - ethmoidal suture fuse early , resulting in a severely shortened posterior cranial base and a relatively short anterior cranial base with a resultant hypoplastic midface . consistent with the observation of midface hypoplasia , the maxilla also exhibits a transverse deficiency.3 the most readily observed malocclusions are a severe maxillary anterior open bite and a severely crowded and retrusive maxillary arch due to the constricted secondary palate.3 the maxillary alveolar arch is v - shaped.6 due to the narrower maxillary arch , bilateral or unilateral posterior crossbite can be observed.4,7 impactions , severe crowding of developing teeth within the alveolus , delayed eruption , thick gingiva , and sometimes supernumerary teeth or congenitally missing teeth are the hall marks of maxillary dental development in apert patients.8 the nasopharyngeal and oropharyngeal attenuation cause apert s individuals to become mouth breathers with a resultant anterior open bite.3

the purpose of this report is to present apert syndrome patient by highlighting craniofacial characteristics and orthodontic approach to treatment.the patient , a 16-day - old female and the second child of healthy parents , was admitted to our department with primary complaint of cleft palate . she had a cone - shaped calvarium , midface hypoplasia , syndactyly of the hands and feet , hypertelorism , proptosis and cleft palate . after taking maxillary impression , an acrylic appliance was applied to orientate the growing and enable the feeding.a case with apert syndrome undergoes the orthodontic treatment for a long time and also a multidisciplinary approach is essential to determine the best collaborative corrective plan for the deficiencies of the patient .

, it accounts for the largest number of deaths from malignant neoplasms in women and the third largest number in men . however , since the recurrence rate of t1 colorectal cancer ( invasion no deeper than the submucosa ) without lymph node metastasis is approximately 1 % , the outcome of t1 colorectal cancer is considered to be good . on the other hand , the incidence of synchronous liver metastases in colorectal cancer has been reported to be about 10 % , yet t1 colorectal cancer with synchronous liver metastasis is considered to be rare [ 3 , 4 ] . therefore , there have been many reports of lymph node metastases , but few reports of the risk factors of synchronous or metachronous distant metastases from t1 colorectal cancer . we report a case of t1 colorectal cancer of the ascending colon with synchronous liver metastasis .

the patient was a 68-year - old man who was admitted to our hospital with a liver tumor . abdominal ultrasonography and computed tomography revealed a liver tumor 30 mm in diameter . on colonoscopy , a pedunculated tumor with a central depression ( 20 mm in diameter ) was observed in the ascending colon , and this tumor was considered to be invading deeply into the submucosal layer . right hemicolectomy with d3 lymphadenectomy and partial hepatectomy were performed simultaneously . on histopathological examination of the resected specimen , the tumor was a well - differentiated tubular adenocarcinoma with 3,000 m invasion of the submucosal layer . the liver tumor showed histological findings similar to those of the primary colorectal carcinoma . the pathological stage according to the 7th edition of the tnm classification was stage iv ( t1n0m1 ) . nine months after the operation , computed tomography revealed hepatic hilar lymph node metastases and a great deal of ascites . the patient ultimately died 14 months after the operation .

granulocyte macrophage colony - stimulating factor ( gm - csf ) is a hematopoietic growth factor which was originally recognized as a stimulator for the proliferation of granulocytes and macrophages from bone marrow precursor cells . it has also been shown to promote the survival and activation of mature myeloid cells and therefore contributes to the maintenance of innate immune homeostasis . recent studies suggest that gm - csf also has proinflammatory functions and plays critical roles in the development of autoimmune and inflammatory diseases , particularly in th17 driven diseases [ 3 , 4 ] .

granulocyte macrophage - colony stimulating factor ( gm - csf ) is a hematopoietic growth factor , which stimulates the proliferation of granulocytes and macrophages from bone marrow precursor cells . in autoimmune and inflammatory diseases , th17 cells have been considered as strong inducers of tissue inflammation . however , recent evidence indicates that gm - csf has prominent proinflammatory functions and that this growth factor ( not il-17 ) is critical for the pathogenicity of cd4 + t cells . therefore , the mechanism of gm - csf - producing cd4 + t cell differentiation and the role of gm - csf in the development of autoimmune and inflammatory diseases are gaining increasing attention . this review summarizes the latest knowledge of gm - csf and its relationship with autoimmune and inflammatory diseases . the potential therapies targeting gm - csf as well as their possible side effects have also been addressed in this review .

hypertrophic cardiomyopathy ( hcm ) is the most common cause of sudden death in young patients . whereas especially patients with a nonobstructive form of hcm are thought to stay stable for a long time ; a small distinct subset of patients can develop end stage heart failure , which includes a reduction of systolic function and a transition from a former hcmphenotype to a dilated phenotype.1 several mechanisms underlying this transition are discussed and may include specific genetic backgrounds and microischemiainduced damages . in addition , temporary progression of the disease can be induced because of not primarily cardiacdependent stress factors . therefore , the differential diagnosis of the socalled end stage hcm is important not to overlook specific treatment options . we report here a case from a young hcm patient where cardiac inflammatory but not primarily hcmdependent processes induced a decompensating dilated cardiomyopathy ( dcm ) like phenotype and show that an antiinflammatory treatment led to a reverse remodelling under these conditions .

abstractwe report the case of a 17yearold female patient with known hypertrophic cardiomyopathy and a wolffparkinsonwhite syndrome . she came to our department for further evaluation of a new diagnosed dilated cardiomyopathy characterized by an enlargement of the left ventricle and a fall in ejection fraction . clinically , she complained about atypical chest pain , arrhythmic episodes with presyncopal events , and dyspnea ( nyha iii ) during the last 6 months . noninvasive and invasive examinations including magnetic resonance imaging , electrophysiological examinations , and angiography did not lead to a conclusive diagnosis . therefore , endomyocardial biopsies ( embs ) were taken to investigate whether a specific myocardial disease caused the impairment of the left ventricular function . emb analysis resulted in the diagnosis of a virusnegative , active myocarditis . based on this diagnosis , an immunosuppressive treatment with prednisolone and azathioprine was started , which led to an improvement of cardiac function and symptoms within 3 months after initiating therapy . in conclusion , we show that external stress triggered by myocarditis can induce a reversible transition from a hypertrophic cardiomyopathy to a dilated cardiomyopathy phenotype . this case strongly underlines the need for a thorough and invasive examination of heart failure of unknown causes , including emb investigations as recommend by the actual esc position statement .

telemedicine utilization is rising due to the increased availability and decreased cost of communication technology , in parallel with growing recognition of key areas of health care that may benefit from its use . although phone communication continues to be a common form of patient - provider communication , internet - based video communication is being deployed in several settings as well . the portion of the population with internet access is rapidly growing74 % of english - speaking americans have access , an absolute increase of 30 % from 2000 to 2009 . given the widespread availability of internet access and the decreasing costs of video communication via computer , it is important to understand preferences and potential barriers , from the patient perspective , to facilitate telemedicine implementation . telemedicine can be employed in a synchronous or asynchronous manner . in asynchronous telemedicine , also known as store and forward , health information is obtained and communicated between visits , at which point discussion of that information may occur . this aspect of telemedicine is already commonly practiced in many settings ; examples include remote transmission of information from specialists ( such as radiology ) as well as patient use of email or weblogs for conveying information . by comparison , synchronous telemedicine involves real time interaction between provider and patient , such as by telephone or video . use of this method is growing in several settings as follows : providing acute decision making , such as in telestroke ; facilitating intermittent , low - level management of chronic illnesses ; increasing accessibility for patients who are either geographically isolated or find local travel challenging ; enabling patients with uncommon diseases to access specialists [ 4 , 5 ] . the potential benefits of synchronous telemedicine include improved access to healthcare , reduced waiting times for appointments , and increased patient adherence to chronic illness treatment plans . chronic diseases account for 75 % of healthcare spending and represent a key target for both cost reduction and care improvement via telemedicine . although payer organizations have been reluctant to accept telemedicine due to uncertainties in its efficacy , an increasing body of literature demonstrates that telemedicine may be as effective ( and in some cases superior to ) the current standard of care in the treatment of chronic diseases such as diabetes , hypertension , and aids . obstructive sleep apnea ( osa ) is present in 420 % of adults ( depending on the study and the operational definition ) and remains underdiagnosed [ 7 , 8 ] . osa is often comorbid with other chronic conditions such as heart disease and hypertension , and requires long - term management . home sleep testing devices are increasingly common , and even telemetric continuous positive airway pressure ( cpap ) titration has been shown to be effective . patients receiving in - person visits or video visits were equivalent in terms of satisfaction and treatment adherence . we undertook the current study to answer three important questions regarding patient perceptions of in - person versus telemedicine forms of patient care in an academic sleep disorders clinic population as follows : ( 1 ) what are the barriers to in - person clinic visits ?

telemedicine is an increasingly recognized option for cost - effective management of chronic conditions . we surveyed sleep clinic patients about their experiences and preferences regarding different forms of telemedicine . adult sleep clinic patients seen between 2009 and 2011 received a brief survey either by postal mail ( n = 156 ) or , for those with an available email address , electronically ( n = 282 ) . the overall response rate was 28.1 % ( n = 123 responses ) , with email response rates being higher than postal mail responses . the most commonly reported barriers to in - person physician visits were parking cost ( 44 % ) , time away from work / school ( 34 % ) , and cost of gas ( 26 % ) . whereas 89 % of respondents indicated using telephone and 55 % of respondents indicated using email to communicate with providers , none reported experience with video telemedicine . despite this lack of experience , over 60 % reported feeling comfortable or willing to try it . of those who were uncomfortable about video telemedicine , the two main reasons were that in - person visits feel more natural ( 48 % ) and that the doctor might need to perform an examination ( 24 % ) . more than half of respondents reported willingness to pay a copay for a video visit . video telemedicine represents a feasible option for chronic sleep disorders management .

chromosome 22q13.3 deletion syndrome is a well - recognized cause of global developmental delay ( gdd ) [ 1 , 2 ] while duplication of the same chromosome is a rare occurrence [ 35 ] . the presence of both abnormalities in the same family has never been reported , to our knowledge . we report the presence of 22q13.3 deletion and 22q13.3 duplication in two siblings , with the mother carrying an inversion of chromosome 22 ( 46 , xx , inv ( 22 ) ( p13q13.32 ) ) a 6 year - old male was noted in infancy to have mild global developmental delay without dysmorphic features . his 4 year - old brother was noted in early infancy to have severe global developmental delay and dysmorphic features related to 22q13.3 deletion to the terminus . the mother 's inversion may rearrange to form 22q duplication or deletion when passed on to children . the chance of a child born with a chromosome imbalance is as high as 50 % .

chromosome 22q13.3 deletion syndrome is a well - recognized cause of global developmental delay , while duplication of the same chromosome is a rare occurrence . the presence of both abnormalities in the same family has never been reported , to our knowledge . we report a rare occurrence of 22q13.3 duplication and 22q13.3 deletion in siblings , as a consequence of a mother 's inversion on her 22nd chromosome ( p13 ; q13.32 ) . a 6 year old male was noted in infancy to have mild global developmental delay without dysmorphic features . his genetic testing revealed he had 22q13.3 duplication to the terminus . his 4 year old brother was noted in early infancy to have severe global developmental delay and dysmorphic features related to 22q13.3 deletion to the terminus . their mother had a long inversion on her 22nd chromosome . genetic tests for their father and eldest brother were unremarkable . the mother 's inversion may rearrange to form 22q duplication or deletion when passed on to children . the chance of a child born with a chromosome imbalance is as high as 50 % .

glaucoma remains the third or fourth most common cause of blindness in different regions around the globe . since this is a treatable disease , early diagnosis and adequate follow - up are gaining importance . also , direct and indirect economic burdens tend to increase for governments with patients extended lifetime expectancy and complexity of disease stage . so far standard automated perimetry ( sap ) is still considered the gold standard method for function analysis even though defects are only detectable after substantial cell loss . since its introduction , optical coherence tomography ( oct ) has turned into a fundamental tool in the evaluation of a variety of different retinal diseases , in particular primary open angle glaucoma ( poag ) . thinning of the peripapillary retinal nerve fiber layer ( rnfl ) and full macular thickness ( mt ) have been largely used in poag evaluation [ 3 , 4 ] . in addition , recent improvements in oct technology ( i.e . , spectral oct and software analysis ) not only increased image resolution but also allowed customized analysis of the individual retinal layers . glaucoma damage is primarily related to the ganglion cells . thus oct retinal layer segmentation allows us to directly analyze the ganglion cell layer separately and thereby look directly at the site of damage . indeed , ganglion cell - inner plexiform layer ( gcipl ) segmentation can identify changes and correctly diagnose glaucoma with a similar sensitivity as the rnfl or optic nerve head ( onh ) parameters [ 68 ] . thus segmentation may allow a more sensitive structure - function correlation in different stages of disease . although the increased number of oct manufacturing companies may contribute positively to price competition as well as hardware and software improvements , it also leads to variability in measurements and analysis methodology . in this study , we determined if the brand of the spectral - domain oct used and their respective segmentation programs influence structure - function analysis differently . to the best of our knowledge , this is the first study to compare two different oct systems and their respective macula layer segmentation software and associate them with sap in structure - function analysis .

purpose . to compare two different spectral - domain optical coherence tomography ( oct ) systems in regard to full macular thickness ( mt ) and ganglion cell layer - inner plexiform layer ( gcipl ) measures and in regard to structure - function correlation when compared to standard automated perimetry ( sap ) . methods . seventeen primary open angle glaucoma patients and 16 controls ( one eye per subject ) were enrolled . mt and gcipl thicknesses were measured by cirrus and spectralis octs . octopus perimeter 101 ( g2 protocol ) reports sensitivity in mean defect ( db ) . differences between measurements were assessed with student 's t - test and bland altman . diagnostic performance was also compared between each parameter calculating the areas under the operator receiver ( roc ) . linear models were used to investigate structure - function association between oct and sap . results . disagreement between octs in both mt and gcipl values was significant . spectralis values were thicker than cirrus . average difference between octs was 21.64 m ( sd 4.5 ) for mt and 9.8 m ( sd 5.4 ) for gcipl ( p < 0.001 ) . patients differed significantly from controls in both octs , in both measurements . mt and gcipl were negatively associated with md ( p < 0.001 ) . conclusions . although oct values were not interchangeable , both machines differentiated patients from controls with statistical significance . structure - function analysis results were comparable , when either oct was compared to sap .

in order to introduce a new plant variety to the markets commercially , it is necessary to register a newly bred variety , which relies upon the results of dus ( distinctness , uniformity , and stability ) tests ; that is , for a new genotype to be registered as a commercial variety , it needs to be distinct ( d ) from all other released varieties , uniform ( u ) , and stable ( s ) for morphological and other evaluated traits [ 1 , 2 ] . therefore , dus test has been established to be the foundation of plant variety protection and also to identify a new variety from reference collection . the new variety should pass legal examinations to be commercialized and receive the certificate for the plant breeder 's rights , a part of which consists of dus tests according to morphological characteristics . the varieties to be assessed are increasing in number where their variability reduces , and the reference collections are expanding because of their internationalization , both of which result in the dramatic increase in expenses associated with these methods . moreover , the existing methods are time consuming , which have altogether led to more necessity for developing a substitutionary , less costly system . thus , the studies on the use of molecular markers in dus testing proving the expected capability of molecular markers have encouraged international union for the protection of new varieties of plants ( upov ) to contemplate the introduction of molecular markers to the dus testing system . nevertheless , before this decision could be made dus testing would benefit from the use as molecular markers that have been shown to be more rapid and cost effective in comparison with morphological traits . in several registration processes such as cultivar identification , primarily , studies were restricted to using the dominant type of markers [ 5 , 6 ] where continuous development of simple sequence repeat ( ssr ) markers has recently resulted in the prevalence of mentioned markers [ 2 , 3 , 7 ] . microsatellite markers have been characterized with multiallelic nature , codominance inheritance , and relative abundance as well as requiring small quantities of dna for amplification which have made these markers efficiently applicable in dus test of rice varieties [ 9 , 10 ] . upov has confirmed the application of ssr markers as one of the commonly practical molecular marker systems for the identification of plant varieties . this marker was previously confirmed to be applied to the distinction between plant varieties as well as complementary features in dus tests where microsatellites were used in dus tests on pepper , canola , and corn . in this study , the efficiencies of ssr markers were evaluated as complementary tools for the distinction of these varieties .

identification and registration of new rice varieties are very important to be free from environmental effects and using molecular markers that are more reliable . the objectives of this study were , first , the identification and distinction of 40 rice varieties consisting of local varieties of iran , improved varieties , and irri varieties using pic , and discriminating power , second , cluster analysis based on dice similarity coefficient and upgma algorithm , and , third , determining the ability of microsatellite markers to separate varieties utilizing the best combination of markers . for this research , 12 microsatellite markers were used . in total , 83 polymorphic alleles ( 6.91 alleles per locus ) were found . in addition , the variation of pic was calculated from 0.52 to 0.9 . the results of cluster analysis showed the complete discrimination of varieties from each other except for ir58025a and ir58025b . moreover , cluster analysis could detect the most of the improved varieties from local varieties . based on the best combination of markers analysis , five pair primers together have shown the same results of all markers for detection among all varieties . considering the results of this research , we can propose that microsatellite markers can be used as a complementary tool for morphological characteristics in dus tests .

hydrocephalus refers to the accumulation of excessive cerebrospinal fluid ( csf ) within the brain or cranial vault . medical treatment of hydrocephalus , which aims to reduce csf production , is usually only palliative . surgical shunting of csf from the ventricular system to another body cavity , usually the peritoneum and less often the right atrium , is the gold standard treatment in people , and can provide a superior long - term prognosis . ventriculoperitoneal shunt ( vps ) placement is the most commonly utilised surgical procedure in human and veterinary patients with hydrocephalus . despite this , complications following vps surgery are common , with failure rates in people of up to 50 % within the first year . mechanical failure remains the most common cause of vps malfunction in people , with shunt obstruction being the leading cause ( 46 % ) , followed by shunt disconnection , infection ( with reported rates of 410 % and 7.6 % ) and over - drainage . recent veterinary studies have reported complication rates of 22 % , 25 % and 29 % . in one study , shunt occlusion and infection occurred in 11 % and 8.5 % of animals , respectively , although the patient numbers were vastly lower than those in human studies . retrograde migration of the peritoneal catheter ( pc ) to the ventricle , the subgaleal space and the subcutaneous tissues of the head , neck and chest , often with coiling of the catheter in areas of loose skin , has been described in several human case reports , although this remains a much less common mechanical complication . martinez - lage et al reported an incidence of 0.6 % in 500 human shunt procedures , and sayers reported pc migration resulting in shunt malfunctions in only 3/1390 cases . there is very limited literature regarding postoperative complications of vps in veterinary patients and a distinct lack of information regarding the incidence of retrograde migration of the pc , especially in cats . to our knowledge only a single case report exists in the japanese veterinary literature , describing pc migration to the subcutaneous tissue of the dorsal chest in a cat and drainage tube obstruction 5 years postoperatively in another cat , along with a further report describing multiple episodes of kinking of the pc in a cat . this case report describes the retrograde migration and subcutaneous coiling of the pc of a vps , detected 72 h following percutaneous aspiration of a vps - associated seroma in a cat with non - communicating , unilateral hydrocephalus .

case summary ventriculoperitoneal shunt placement is the most commonly utilised surgical treatment for hydrocephalus in human and veterinary patients . migration of the peritoneal catheter is an uncommon but well - documented complication in people , usually occurring within the first 3 months postoperatively , although only a single feline case report exists . a ventriculoperitoneal shunt was placed in a domestic shorthair cat , aged 4 years and 10 months , following a diagnosis , with mri , of unilateral , non - communicating hydrocephalus . diarrhoea , increased vocalisation and pruritus were reported within the first 3 months postoperatively . a shunt - associated seroma developed , which was aspirated under ultrasound guidance . within 3 days , the entire peritoneal catheter was subcutaneously coiled at the level of the seroma . the peritoneal catheter was replaced within the abdomen via a new subcutaneous tunnel . no further complications had occurred 24 months following revision surgery.relevance and novel information this is the second report describing peritoneal catheter migration in a cat . repetitive head and neck movements during self - grooming , raised intra - abdominal pressure secondary to vocalisation and tenesmus , and negative pressure exerted during seroma aspiration may have contributed to ventriculoperitoneal shunt migration . excessive loose skin and increased activity may further increase the risk of migration in cats . diagnostic imaging should be offered prior to and following aspiration of shunt - associated swellings , and minimal negative pressure should be exerted . attempts to reduce the frequency of postoperative self - grooming , prevention and prompt treatment of conditions predisposing to raised intra - abdominal pressure and moderate exercise restriction , particularly within the first 3 months , may help reduce the risk of peritoneal catheter migration .

between 25 % and 30 % of non - small cell lung cancer ( nsclc ) patients will develop metastatic disease in the brain ( brain metastases from non - small cell lung cancer frequently they are the first site of recurrence in early - stage nsclc patients treated with definitive therapies [ 15 ] . the prognosis is poor for untreated patients with bmf - nsclc , with median overall survival ( os ) 12 months [ 1 , 4 , 5 ] . the combination of neurosurgery with stereotactic radiosurgery ( srs ) and/or whole - brain radiotherapy ( wbrt ) can increase the os up to 36 months , and in selected cases over 12 months [ 1 , 4 , 610 ] . currently , the role of systemic treatment of bmf - nsclc patients is being widely discussed [ 3 , 4 , 10 ] . historically , chemotherapy was considered as a poorly effective method of treatment , mainly because of predicted difficulties in penetrating the blood - brain - barrier ( bbb ) . for a long period of time , patients with bmf - nsclc were excluded from controlled clinical trials for chemotherapy of nsclc [ 1 , 3 , 4 , 11 , 12 ] . nowadays it seems that even if most of the drugs can not penetrate normal bbb , the integrity of the bbb is significantly altered , e.g . in bmf - nsclc patients , which can be proved by oedema and increased contrast uptake around the metastatic site . the significant amount of information indicates the possibility of efficient palliative systemic treatment of chosen patients with bmf - nsclc [ 2 , 3 , 10 , 11 , 13 ] . the role of targeted therapies , besides chemotherapy , is significantly increasing [ 1 , 4 , 10 , 13 , 14 ] . the purpose of this work is to review , relying on the literature , the actual knowledge on the methods and results of systemic treatment of brain metastases from non - small cell lung cancer .

in the systemic treatment of brain metastases from non - small cell lung cancer ( bmf - nsclc ) chemo- and targeted therapy are used . response rates after platinum - based chemotherapy , range from 23 % to 45 % . development of epidermal growth factor receptor tyrosine kinase inhibitors ( egfr - tkis ) : gefitinib or erlotinib , was an improvement in treatment of advanced nsclc patients . egfr mutations are present in 1025 % of nsclc ( mostly adenocarcinoma ) , and up to 55 % in never - smoking women of east asian descent . in the non - selected group of patients with bmf - nsclc , the overall response rates after gefitinib or erlotinib treatment range from 10 % to 38 % , and the duration of response ranges from 9 to 13.5 months . in the case of present activating egfr mutation , the response rate after egrf - tkis is greater than 50 % , and in selected groups ( adenocarcinoma , patients of asian descent , never - smokers , asymptomatic bmf - nsclc ) even 70 % . gefitinib or erlotinib treatment improves survival of bmf - nsclc patients with egfr mutation in comparison to cases without the presence of this mutation . there is no data on the activity of the anti - eml4-alk agent crizotinib . bevacizumab , recombinant humanised monoclonal antibody anti - vegf , in the treatment of advanced non - squamous nsclc patients is a subject of intense research . data from a clinical trial enrolling patients with pretreated or occult bmf - nsclc proved that the addition of bevacizumab to various chemotherapy agents or erlotinib is a safe and efficient treatment , associated with a low incidence of csn haemorrhages . however , the efficacy and safety of bevacizumab used for therapeutic intent , regarding active brain metastases is unknown .

many organs can be herniated into the scrotum such as small intestine , appendix , colon , and ovaries . ureteral herniation is extremely rare , usually asymptomatic and is reported as isolated case report or small series . we report the case of an 88-year - old man treated for inguinoscrotal hernia where the left ureter was incidentally found in the herniated retroperitoneal fat . presenting symptoms , diagnostic evaluation , and surgical management

an inguinoscrotal hernia is a common disorder that usually contains intraperitoneal organs ( small intestine , colon , appendix , ovaries ) . extraperitoneal ureteral herniation into an inguinoscrotal hernia is a rare condition and often associated with congenital abnormalities or postoperative anatomic changes . a high index of suspicion is needed in order to avoid intraoperative ureteric injuries . we herein report the case of a ureteric herniation into an inguinoscrotal hernia incidentally found during a scheduled hernia repair .

the incidence of non - hodgkin lymphoma ( nhl ) is 100200-fold higher in hiv - infected individuals than in the general population . nhl is an aids - defining illness and in 35 % of cases , the lymphoma is the initial manifestation of aids . the most common hiv - associated lymphomas are diffuse large b cell lymphoma ( dlbcl ; often primary in the central nervous system ) , burkitt lymphoma , primary effusion lymphoma , and plasmablastic lymphoma of the oral cavity . primary mediastinal large b cell lymphoma is a subtype of diffuse large b cell lymphoma arising in the mediastinum with distinctive clinical , morphologic , and genotypic features . most patients are young adult females presenting with localized mediastinal mass and symptoms often related to local effects of the large mediastinal tumor such as superior vena cava syndrome . dlbcl is one of the most common lymphomas in the setting of hiv , but the incidence of pmlbcl in hiv is not well established . only one reported case of hiv - associated pmlbcl has been found in the english literature .

primary mediastinal large b cell lymphoma ( pmlbcl ) is a subtype of diffuse large b cell lymphoma arising in the mediastinum with distinctive clinical and morphological features . though diffuse large b cell lymphoma is one of the most common non - hodgkin lymphoma associated with aids , there are no data available regarding the association of hiv and pmlbcl . we report here two cases of pmlbcl arising in aids patients . in both cases , pmlbcl presented in a setting of low cd4 t - cell count as rapidly enlarging mediastinal mass . the morphologic and immunophenotypic findings are characteristic of pmlbcl . one of the two patients , a 25-year - old woman who had localized disease and evidence of epstein barr virus in lymphoma cells , did not respond to chemotherapy and died of disease progression 5 months after diagnosis . the second patient , a 38-year - old male with disseminated disease , responded to therapy and is disease - free after 9 months of follow - up .

patients with ibd should be periodically examined regarding their dermatologic conditions . in a previous report from iran , the prevalence of dermatological manifestations was reported to be 5.9 % in patients with ibd with a higher rate in crohn s disease ( 7.29 % ) compared with patients with ulcerative colitis ( 4.07 % ) . they were more common in women ( 52 % ) than in men ( 48 % ) . one of the rare dermatological manifestations in patients with ibd is pyoderma gangrenosum . which is more common in patients with ulcerative colitis . since pyoderma gangrenosum is a rare occurrence , its explicit prevalence is unknown , but generally it has been estimated to occur in 3 - 10 million patients annually . in iran , the prevalence of pyoderma gangrenosum in patients with ulcerative colitis has been reported to be 1.4 % . the diagnosis of pyoderma gangrenosum is based on physical examination , and examining the lesions regarding its type , number , size , and location as well as associated symptoms of ulcerative colitis . most pustular lesions in patients with ibd should be considered as pyoderma gangrenosum variants and be treated accordingly . even though histopathologic examination is not deemed diagnostic for pyoderma gangrenosum , skin biopsy should be performed to rule out other conditions simulating pyoderma gangrenosum . pyoderma vegetans is a sign of ibd , but rarely occurs in iranian patients . in case of facing pyoderma vegetans in a patient without significant medical history , the mean age for the onset of dermatological manifestations in iranian patients with ibd is 31 years .

some dermatologic manifestations are common in ulcerative colitis ( uc ) . herein , we present a 36-year - old woman with ulcerative colitis and uncommon nasal mucosa pyoderma vegetans . the patient presented to our hospital with symptoms of active colitis and a concomitant 345 cm dermato - mucosal lesion in her left nasal lumen . after surgery of the mucosal lesion , the treatment for her active colitis was initiated with intravenous infliximab and oral asacol . after a 1-year follow - up , no sign of recurrence favoring mucosal lesion was noted and symptoms of ulcerative colitis were managed properly .

rna can play an important functional role in catalysis , e.g . ribozymes are rna enzymes that cleave rna phosphodiester bonds at specific sites ( 1 ) ; see ( 2 ) for an overview of potential therapeutic applications of ribozymes to cleave mrnas of oncogenes ( ras or bcr - abl ) and viral transcripts ( hiv-1 ) , to overcome drug resistance , control arthritis , etc . such is the case for the aminoglycoside and macrolide families of antibiotics , which disrupt rna translation in prokaryotes by targeting ribosomal ( rrna ) ( 3 ) . in contrast to mrna , noncoding rna ( ncrna ) is transcribed from genomic dna and plays a biologically important role , although it is not translated into protein . examples of ncrna include ribozymes , riboswitches , micro rna , small interfering rna ( 4 ) , trna , rrna , etc . riboswitches have recently been discovered to interact with small ligands and up- or down - regulate certain genes . breaker and co - workers ( 5 ) report the crystal structures of the add a - riboswitch and xpt g - riboswitch aptamer modules , which distinguish between bound adenine and guanine ; see ( 6 ) for an overview of bacterial riboswitches , and ( 7 ) for the structure , as given in the pdb code 1u8d of a guanine - responsive riboswitch with the metabolite hypoxanthine . rnaomics ( 8 ) , analogous to proteomics , concerns aspects of the secondary and tertiary structure , folding pathway , kinetics , comparison , function and regulation of all rna in a living organism . rnaomics requires the application of numerous existent tools , as well as the development of new computational methods . well - known rna computational tools include secondary structure prediction web servers mfold ( 9 ) and vienna rna package ( 10 ) , the sfold web server ( 11 ) to sample secondary structures according to the boltzmann probability distribution , the trnascan - se gene finder for trna ( 12 ) , multiple sequence alignment for the statistical detection of rna secondary structure msari ( 13 ) , dynamic programming pairwise sequence - structure alignment dynalign ( 14 ) , tertiary structure modeling tool mc - sym ( 15 ) , etc . only a few of the many important computational tools for rna structure prediction , gene finding , alignment , etc . have been listed . in this paper , we describe the web server rnaloss , based on the algorithm of clote ( 16 ) , which computes an aspect of the folding landscape of an rna nucleotide sequence s = s1 , , sn . given s , this algorithm runs in time o ( n ) and space o ( n ) , and computes for each k , the number of k - locally optimal secondary structures ( explained below ) . work by clote ( 16 ) was motivated by the following question , as has been suggested for proteins ( 17 ) : is it the case that rna has been under selective pressure to fold rapidly ? using the algorithm of the web server rnaloss , it appears that structural rna has a different folding landscape than random rna of the same dinucleotide frequency ; specifically , for small values of k , there appear to be fewer k - locally optimal secondary structures than in random rna . related , but distinct work has appeared in ( 1821 ) , for discussion see ( 16 ) .

rnaomics , analogous to proteomics , concerns aspects of the secondary and tertiary structure , folding pathway , kinetics , comparison , function and regulation of all rna in a living organism . given recently discovered roles played by micro rna , small interfering rna , riboswitches , ribozymes , etc . , it is important to gain insight into the folding process of rna sequences . we describe the web server rnaloss , which provides information about the distribution of locally optimal secondary structures , that possibly form kinetic traps in the folding process . the tool rnaloss may be useful in designing rna sequences which not only have low folding energy , but whose distribution of locally optimal secondary structures would suggest rapid and robust folding . website : .

central neuropathic pain ( central pain ) is pain caused by a disease or lesion in the central nervous system . central pain develops in about 8 % of stroke patients ( andersen et al 1995 ) , 25 % of patients with multiple sclerosis ( osterberg et al 2005 ) , and 40 % 50 % of patients with spinal cord injury ( budh et al 2003 ; siddall et al 2003 ; werhagen et al 2004 ) and may develop secondary to brain and spinal cord tumors and other diseases affecting the central nervous system . central pain thus affects a large number of patients worldwide and often it has a substantial impact on the quality of life , mood , sleep , cognition , social relations , etc . central pain is characterized by ongoing pain , which may be burning , squeezing , pricking , and shooting and/or evoked types of pain , eg , pain evoked by light touch . the pain is located within an area of sensory disturbance covering various proportions of the deafferented body regions . treatment of central pain is often difficult and requires a different approach than nociceptive pain . central pain is usually treated with antidepressants , anticonvulsants , and opioids ; treatments which provide partial pain relief at best and which are often associated with side - effects . pregabalin is a novel , centrally acting neuromodulating agent that was approved by the us food and drug administration ( fda ) in 2004 for the treatment of painful diabetic peripheral neuropathy and post - herpetic neuralgia . in 2005 it was approved as adjunctive therapy in adults with partial seizures and recently it has been approved for the treatment of fibromyalgia . pregabalin is approved by the european medicines agency ( emea ) for the treatment of peripheral and central neuropathic pain in adults , as adjunctive therapy in adults with partial seizures , and for the treatment of generalized anxiety disorder ( gad ) in adults ( emea 2006 ; pfizer 2007 ) .

central neuropathic pain ( central pain ) is treated with antidepressants , various anticonvulsants , opioids , and cannabinoids , but in many cases treatment is insufficient and associated with a range of side - effects . this review addresses a new treatment for neuropathic pain , the anticonvulsant pregabalin . we review the pharmacology , mode of action , pharmacokinetics , and safety of pregabalin as well as two randomized efficacy studies in central pain and a brief overview of efficacy in peripheral neuropathic pain . pregabalin appears to have efficacy in treating central pain comparable to that in peripheral neuropathic pain as well as efficacy of other recommended drugs for central pain . pregabalin also improves disturbed sleep and anxiety . pregabalin is well tolerated ; the most common side - effects are somnolence , dizziness , ataxia , and weight gain . pregabalin is suitable for patients on multiple drugs although there may be additive cns - related side - effects . thus , pregabalin has a primary role in central pain patients .

pancreatic heterotopia is defined as the presence , outside its usual location , of pancreatic tissue which lacks anatomical and vascular continuity with the pancreas proper ( 1 ) . the heterotopic pancreas ( hp ) is a relatively uncommon congenital anomaly , with an incidence between 0.55 % and 13.7 % in autopsy series and mean frequency between 1 and 2 % . hp has been found in all age groups , predominantly in the sixth decade of life ( 2 ) . the usual locations of hp are in the stomach in 25 - 38 % cases , the duodenum in 17 - 36 % and the jejunum in 15 - 22 % of cases . it is usually silent but it may become clinically evident when complicated by inflammation , bleeding , obstruction or malignant transformation ( 3 ) . symptomatic patients require surgical exploration in order to obtain a definitive diagnosis and to exclude malignancy .

heterotopic , aberrant or ectopic pancreas is defined as the presence of pancreatic tissue in topographic anomaly , with no anatomical , neural or vascular connection to the normal pancreas . it is a rare condition found mainly in stomach , duodenum and jejunum . ileal heterotopic pancreas is an uncommon condition and has been rarely reported in children so far . hereby we report a case of heterotopic pancreas presenting as ileal poyp leading to ileoileal intussusception in a 12 year child .

cytomegalovirus ( cmv ) infection still remains a major cause of morbidity and mortality in allogeneic stem cell transplantation ( sct ) recipients . while cmv infection of the central nervous system ( cns ) in acquired immune deficiency syndrome patients has been reported relatively frequently , it is an unusual presentation in allogeneic sct recipients , but fatal in all cases ( 1 - 4 ) . recently , unrelated cord blood or t - cell depleted grafts have been increasingly used as an alternative source of hematopoietic stem cells . however , the use of these grafts has been associated with an increased frequency of unusual cmv infections . here , we report a case of cmv ventriculoencephalitis after unrelated double cord blood sct with an alemtuzumab - containing preparative regimen for philadelphia - positive acute lymphoblastic leukemia . the patient had recurrent cmv dnaemia despite long - term treatment with antiviral agents ( foscarnet combined with ganciclovir ) and anti - cmv immunoglobulin .

despite the prophylaxis and preemptive strategies using potent antiviral agents , cytomegalovirus ( cmv ) remains a major infectious cause of morbidity and mortality in allogeneic stem cell transplantation ( sct ) recipients . delayed immune reconstitution after sct , such as cord blood and t - cell depleted sct with the use of alemtuzumab , has been associated with an increased frequency of cmv disease as well as cmv reactivation . cmv disease involving central nervous system is an unusual presentation in the setting of sct . we report a case of cmv ventriculoencephalitis after unrelated double cord blood sct with an alemtuzumab - containing preparative regimen for philadelphia - positive acute lymphoblastic leukemia .

due to increasing life expectancy of the dentition , older adults are experiencing root caries and gingival recession , putting them at even higher risk for periodontal disease . root caries is the major cause of tooth loss in older adults , and tooth loss is the most significant oral health - related negative variable of quality of life for the elderly . one prominent goal of the dental profession is to preserve and maintain dentitions throughout life . population projections suggest that the proportion of the population aged 65 years and older will nearly double between 2000 ( 12.6 percent ) and 2030 ( 20.0 percent ) , and that the proportion of those aged 85 years and older will increase dramatically over the next 10 to 15 years . this population trend coupled with compelling evidence that people are retaining their teeth into old age suggests that there will be an increased number of older adults with many more natural teeth in the years to come . there are known clinical and behavioral risk factors involved in the production and progression of root caries in the elderly . risks are described in a number of levels , from socioeconomic status to salivary flow to presence of dentures . data have shown correlations of dietary and oral habits and other variables on root caries . many risk factors can compromise an older adult 's systemic health such as sociodemographic variables , nutrition / diet , and weakened immune system . this paper examines salivary hypofunction , the systemic and oral immune system ( immunoglobulins found in saliva ) in older adults , and their manifestations . there are several indicators that provide insight into the incidence and prevalence of caries in healthy people and the medical or disability conditions that place individuals at increased caries risk . one indicator is the presence of mutans streptococci , an established etiologic agent for caries activity . one of the main oral behaviors to reduce the amount of bacteria in the oral cavity is regular tooth brushing with a fluoride - containing dentifrice . conditions that compromise good oral hygiene behaviors and oral health are also positively associated with caries risk . these include certain illnesses , physical and mental disabilities , and the presence of existing restorations or oral appliances . fermentable carbohydrate consumption fuels acid formation and demineralization and is associated with caries , particularly in the absence of fluoride . long - term regular doses of medications containing glucose , fructose , or sucrose may also contribute to caries risk .

root caries is one of the most significant dental problems among older adults today . many studies have demonstrated that older adults are at greater risk for developing root caries . here we examine what risk factors older adults are prone to and explain how they contribute to higher rates of oral disease , in particular root caries . the elderly are at risk for root caries due to dentures , lack of dexterity , a shift from complex to simple sugars , and poor oral hygiene . decreased salivary flow and its manifestations with other social / behavioral and medical factors may provide a more comprehensive explanation to a higher frequency of root caries in older adults .

the functions of the salivary glands are controlled by the autonomic nervous system and influenced by the sensory nervous system . when parasympathetic impulses dominate , salivary flow is greatly enhanced and the saliva has a low protein content . studies of animal and human innervation have revealed that parasympathetic nerve fibers are present around acinar cells , ducts , and blood vessels in the major salivary glands . a research has also shown that beside the classic transmitters noradrenaline and acetylcholine , neuropeptides such as substance p ( sp ) , calcitonin gene - related peptide ( cgrp ) , and vasoactive intestinal polypeptide ( vip ) ( figure 1 ) are present in the nerve fibers of the autonomic nervous system as well as in the auriculotemporal nerve , facial nerve , and cervical dorsal root fibers . these neuropeptides are known to cause salivation in rats [ 27 ] . in recent years , the mechanisms of actions of drugs that used to treat xerostomia have been elucidated pharmacologically from the viewpoint of salivary neuropeptide levels . anethole trithione and pilocarpine have been shown to elevate sp and cgrp levels in human saliva [ 811 ] . cevimeline hydrochloride hydrate ( cevimeline ) ( figure 2 ) is a novel muscarinic acetylcholine receptor agonist currently being developed as a therapeutic agent for sjgren 's syndrome . sjgren 's syndrome is a serious and chronic autoimmune disorder characterized by inflammation in the exocrine glands such as the salivary and lacrimal glands , leading to xerostomia ( dry mouth ) and xerophthalmia ( dry eyes ) . cevimeline acts as a stimulator of the m3 acetylcholine receptor expressed on salivary glands and has been shown to increase saliva secretion in patients with sjgren 's syndrome . although cevimeline is useful for the treatment of dry mouth , it only enhances saliva production in 60 % of the patients , and the mechanism of the drug response is still unknown . it is possible that individual variability of neuropeptide nerve stimulation in response to cevimeline may be involved in the variable drug response to cevimeline . the objective of the present study is to examine the effects of cevimeline on saliva and plasma levels of sp- , cgrp- , and vip - like immunoreactive substances ( iss ) in humans , as markers of nerve stimulation of these neuropeptides .

cevimeline is a novel muscarinic acetylcholine receptor agonist currently being developed as a therapeutic agent for xerostomia . we examined the effects of cevimeline on salivary and plasma levels of substance - p- ( sp- ) , calcitonin - gene - related - peptide- ( cgrp- ) , and vasoactive - intestinal - polypeptide- ( vip- ) like immunoreactive substances ( iss ) in humans . an open - labeled crossover study was conducted on seven healthy volunteers . saliva volume was measured , and saliva and venous blood samples were collected before and 30240 min after a single oral dose of cevimeline or placebo . salivary and plasma levels of sp- , cgrp- , and vip - is were measured using a highly sensitive enzyme immunoassay . a single oral dose of cevimeline resulted in significant increases in salivary but not plasma sp - is level compared to placebo . cevimeline administration did not alter the salivary or plasma levels of cgrp - is or vip - is compared to placebo . significant increases in salivary volume were observed after cevimeline administration compared to placebo . a significant correlation was observed between the total release of sp - is and that of salivary volume . these findings suggest an association of sp with the enhancement of salivary secretion by cevimeline .

the chronic diseases like cardiovascular diseases , diabetes and cancer contributes to almost half of the all - cause mortality in india . weighted prevalence of ischemic heart diseases was observed as 25.3/1000 population , and 118.0/1000 population for diabetes mellitus in an urban area of india . it was observed due to common risk factors like physical inactivity , unhealthy diet , tobacco use and stress . along with growth and development , reduction in common risk factors was considered to be one of the essential preventive and control strategies for chronic diseases . like modern medicine , the complementary and alternative medicine ( cam ) - ayurveda ( knowledge or science of life ) - primarily concerned with the body . it had been mentioned in ayurveda , about the three pillars for healthy and long life ; proper diet ( ahar ) , proper activities ( vihar ) , and divine life - style and control of sexuality ( brahmacharya ) . improper and unbalanced diet like undigested , junk , and accumulated food was also considered toxic for the body . ayurveda had been oldest and most organized scientific discipline , which was providing health - care . once upon a time , their classical text like charak samhita ( 100 ad ) is an excellent source of information about the holistic health , herbs , diseases , and surgical treatment for the entire country and the world . like yoga , ayurveda derived its origin to the hoary vedas and considering one of the sub - vedas ( upa - veda ) . therefore , its traditional holistic approach and principles observed to be have a potential in order to reduce the risk factors of chronic diseases in the community . it was already evident that cam had been widely used in africa ( 80.0 % ) , australia ( 49.0 % ) , indonesia ( 40.0 % ) , france ( 75.0 % ) , and even in united states ( 29.0 - 42.0 % ) . in india as well , people are using the cam services through 2860 large hospitals across the country . cam has been integrated into primary health - care of the country under the national rural health mission . pattern of reported diseases at the cam facilities has not been shared with the modern medicine in india despite the provision of care to a significant group of the population . therefore , the present study was undertaken to describe the clinical profile of patients with chronic diseases at a tertiary care ayurvedic hospital in north india .

since a very long time , a significant number of patients have been seeking treatment at complementary and alternative medicine health facilities , but the disease burden at these facilities has never been assessed and documented . present cross - sectional study was carried out at ayurvedic tertiary care hospital to document and to assess the rationale of disease reporting at ayurvedic institutions of the northern state of india from january 2011 to october 2011 . almost half of the patients morbidities were not classified at all into any of the disease categories . the common reported morbidities at study hospital were : respiratory ( 10.5 % ) , neuromuscular ( 9.5 % ) , digestive ( 9.2 % ) and circulatory ( 9.1 % ) disorders . as the majority of diseases were unclassified , so mainstreaming of the effective disease surveillance would be required to understand the morbidity pattern and successful treatment practices at health facilities .

proinflammatory cytokines ( il-1 , il-6 , and tnf- ) may significantly influence the development of obesity and concomitant disorders such as type 2 diabetes , arterial hypertension and metabolic disorders . it is suggested , that il-6 may affect the increase of free fatty acids level . tnf- is secreted mainly by macrophages and lymphocytes in response to cell damage caused by infection or malignant transformation . however , it can be also secreted by many other type of cells and tissues , e.g . , adipocytes . tnf- , similarly to il-6 , is a proinflammatory cytokine , characterized by a broad spectrum of functions which also include cytotoxic and cytostatic effects against cancer cells . it is able to inhibit lipoprotein lipase ( lpl ) at both mrna and protein levels . it also inhibits the expression of two major adipose tissue differentiation regulators : ccaat transcription factor that increases binding of alpha proteins ( cebp- ) and nuclear receptor ppar-2 . in consequence , changes in the expression of adipose tissue proteins , such as lpl , ap2 , fatty acid synthase , acetyl - coa carboxylase , glycerol 3-phosphate dehydrogenase ( gpdh ) , glucose receptor glut-4 , and others are observed . the aim of the present study was to assess the relation between il-6 and tnf- levels in serum of obese and normal weight subjects and to relate it to the crp concentration in obese subjects .

backgroundthe development of obesity and related disorders , e.g . , type ii diabetes ( t2d ) , hypertension , and metabolic disturbances is strongly related to increased levels in proinflammatory cytokines ( il-1 , il-6 , and tnf- ) . both il-6 and tnf- are secreted by adipocytes and their concentration correlates with the percentage and distribution of fat tissue in the body . both cytokines are the main factors responsible for the induction of acute phase proteins production ( e.g . , crp ) and to inflammatory state.objectiveto compare of tnf- and il-6 concentrations in serum from obese subjects with those in subjects with normal bmi and to analyze the relation between tnf- , il-6 , bmi and the inflammatory state as measured by the level of crp.material and methodsthe study included 80 obese subject ( 54 males and 26 females ) bmi > 25 kg / m2 . a control group consisted of 53 healthy subjects ( 24 males and 29 females ) with bmi < 25 kg / m2 . to determine the blood plasma concentration of il-6 and tnf , commercial elisa assay kits were used.resultsthe concentration of il-6 was lower in the control compared with the obese patients , but a significance difference concerned only female subjects ( p = 0.001 ) . tnf- concentration was significantly higher in all obese subjects ( p < 0.001 ) . a higher level of this cytokine was also found in patients with obesity suffering from t2 dm . a positive correlation was present between il-6 and tnf- concentrations . only did the il-6 level correlate with the concentration of crp in serum.conclusionsthe study confirmed that increased inflammatory cytokines lead to the persistence of inflammation in obese subjects . however , some other factors , such as gender , may contribute to the development of obesity - related inflammatory states .

the empa - reg outcome trial ( clinicaltrials.gov identifier , nct01131676 ) recently announced the effects of empagliflozin on the cardiovascular outcomes ( cvo ) and mortality in persons with type 2 diabetes mellitus ( t2 dm ) . in this seminal cvo trial ( cvot ) , 7020 patients with t2 dm with coexisting cardiovascular disease ( cvd ; myocardial infarction [ mi ] , stroke , or peripheral arterial disease ) were randomized to either 10 mg empagliflozin , 25 mg empagliflozin , or placebo , over and above standard of care . the primary composite outcome was a total of three endpoints ( death from cv causes , non - fatal mi , and non - fatal stroke ) , while the key secondary endpoint included a fourth endpoint the results of this study revealed a statistically significant reduction in the primary endpoint with empagliflozin use ( 10.5 % in the empagliflozin group vs. 12.1 % in the placebo group ; hazard ratio 0.86 ; relative risk reduction ( rrr ) 14 % , 95 % confidence interval 0.740.99 ; p = 0.04 ) . similarly , a rrr reduction is noted in death from cv causes ( rrr 38 % ; 3.7 % vs. 5.9 % ) , hospitalization for heart failure ( rrr 35 % ; 2.7 % vs. 4.1 % ) , and all - cause death ( rrr 32 % ; 5.7 % vs. 8.3 % ) . however , the difference in rates of non - fatal mi and non - fatal stroke did not reach statistical significance . this article is based on previously conducted studies and does not involve any new studies of human or animal subjects performed by the author .

this article discusses the recently published empa - reg outcome trial , which assessed cardiovascular outcomes with empagliflozin therapy in persons with type 2 diabetes mellitus and coexisting cardiovascular disease . the article describes the background and challenges of modern cardiovascular outcome trials , points out the strengths of the empa - reg outcome study , and places the results in perspective . it highlights the significant impact that these results will have on cardiovascular preventive pharmacotherapy , and on future drug development in diabetes . at the same time , it reminds readers of the limitations of the results , and lists the questions raised by , or left unanswered by , the trial .

primary neuroendocrine carcinoma ( nec ) of the breast is a rare distinct clinicopathological entity , comprising 0.5 - 2 % of breast carcinomas world - wide . in 2003 , primary nec of the breast was identified as a distinct entity by the world health organization ( who ) classification of tumors . the who classification defines primary nec of the breast as tumors that express 50 % or more of ne markers there are no previous reports of f-18 fluorodeoxyglucose ( fdg ) positron emission tomography / computed tomography ( pet / ct ) in patients with primary nec of breast with liver and bone metastasis .

cases of primary neuroendocrine carcinoma ( nec ) of the breast have been reported , though rare . we report the case of a 45-year - old woman presented with jaundice and evaluated to have liver metastasis from neuroendocrine origin . she underwent whole body positron emission tomography / computed tomography , which showed left breast lesion and bone metastasis . fine - needle aspiration ( fna ) of breast revealed a nec . a diagnosis of a primary nec of the breast was rendered with hepatic and bone metastasis . she was treated with peptide receptor radionuclide therapy and is on follow - up .

malignant unilateral or bilateral ureteral obstruction may be secondary to direct tumor invasion , extrinsic compression , or encasement by metastatic retroperitoneal or pelvic lymph nodes . the selection of cancer patients for diversion should take into account factors such as tumor stage , prognosis of the primary cancer , likelihood of additional antineoplastic therapy , and quality of life . contemporary management options include external drainage via percutaneous nephrostomy ( pcn ) and internal drainage via the insertion of double - j stents . regular double - j stents used to relieve ureteral obstructions that are secondary to extrinsic causes , such as malignancies , have high rates of failure . pcn is commonly used as an alternative , either as a primary procedure or after the failure of transurethral procedures . however , pcn is more invasive than double - j stent insertion and may also have a greater incidence of accidental tube dislodgement . the invasiveness of the procedure and the high incidence of tube dislodgement may result in a reduction in patient quality of life . in addition , some patients are unwilling to accept a pcn tube because it requires an external collecting device . the limitations associated with conventional treatments for ureteral obstructions highlight the need for a novel treatment that can maintain ureteral patency while minimizing the deterioration of patient quality of life . several types of metallic stents have been used in the palliative treatment of malignant ureteral obstructions , but implantation of these stents has yielded results that are not uniform and the stents have been associated with various complications . a novel polytetrafluoroethylene ( ptfe ) membrane - covered metal mesh stent prevents obstruction from tissue ingrowth and reduces stent migration as a result of its unique structure . here we report our initial experience with a ptfe membrane - covered self - expandable metallic stent ( uventa stent ) for the palliative care of malignant ureteral obstruction .

purposewe assessed the efficacy and safety of insertion of a polytetrafluoroethylene membrane - covered self - expandable metallic stent ( uventa stent ) for palliation of malignant ureteral obstruction on the basis of our early results.materials and methodseighteen patients underwent uventa stent insertion for extrinsic malignant ureteral obstructions of 20 ureters . the uventa stents were deployed retrogradely under cystoscopy and fluoroscopy . candidates for the procedure had preexisting double - j stents that were nonfunctional or caused excessive bladder irritation . we recorded the success and patency rate in addition to any complications associated with the procedure.resultsthe mean length of obstruction was 10.6 cm ( range , 2 to 20 cm ) . two ureters were obstructed in the upper ureter , 9 in the lower ureter , and 9 in multiple levels of ureter . simultaneous balloon dilation was performed in 12 ureters . uventa stents were successfully inserted in all patients . no obstruction of the uventa stents occurred during the mean follow - up period of 7.3 months ( patency rate 100 % ) , but de novo ureteral obstruction developed in 4 ureters . there were no instances of stone formation , hyperplastic reaction , encrustation , or migration . abnormally elevated serum creatinine decreased to normal levels and hydronephrosis gradually resolved during the 4 weeks after uventa insertion . no significant complications developed except for transient and self - limiting hematuria and mild lower abdominal pain.conclusionsuventa stents may relieve malignant ureteral obstruction safely and easily . long - term follow - up is necessary to assess the role of this stent in the treatment of malignant ureteral obstruction .

chronic obstructive pulmonary disease ( copd ) is characterized by progressive and partially reversible airflow limitation , and it is among the leading causes of mortality worldwide.1 copd is a multicomponent disease , and patients present a range of comorbidities that have an impact on prognosis and may increase the risk of mortality.2 the effects of copd on respiratory and physical function have been well studied ; moreover , due to the heavy burden of psychological disturbance , psychiatric morbidity , and disability in daily life , the mental health of copd patients has received growing attention in recent years.3,4 the prevalence of cognitive impairment in patients with copd ranges from 12 % to 88 % 5 and is associated with depression , poor quality of life , which may affect patients ability to manage their disease , and reduced compliance with medication and oxygen therapy,6,7 leading to adverse clinical outcomes.811 therefore , cognitive function as well as emotional function are important aspects of the overall clinical care of patients with copd . it has been suggested that a multidimensional assessment and personalized disease management approach could be an optimal strategy for addressing comorbidities , self - management education , and risk factor modification in copd patients.7 the early identification of cognitive dysfunction is critical if outcomes are to be improved in this population , and an understanding of the characteristics associated with a higher risk of cognitive impairment may assist health care professionals to address this challenge . the primary aim of this study was to examine the cross - sectional prevalence of cognitive impairment in an unselected population of copd patients ; the secondary objective was to determine the relationships between cognitive impairment and major demographic and clinical variables , such as lung function , depression , and quality of life .

purposewe investigated the association between cognitive impairment and chronic obstructive pulmonary disease ( copd ) , taking into account demographic and clinical variables evaluated during routine practice.patients and methodswe performed a post hoc analysis of a cross - sectional study that included subjects with stable copd . sociodemographic and clinical information was recorded using the body mass index , airflow obstruction , dyspnea and exacerbations index and the charlson comorbidity index . cognitive performance was studied by the mini - mental state examination , with a score less than 27 indicating clinical impairment . depressive symptoms , physical activity , and quality of life ( euroqol-5 dimensions and copd assessment test ) were also evaluated.resultsthe analysis included 940 subjects . the prevalence of cognitive impairment was 39.4 % . multivariate logistic regression models revealed that cognitive impairment was associated with educational level ( odds ratio [ or ] = 0.096 , 95 % confidence interval [ ci ] = 0.0110.447 ) and poorer quality of life measured by the euroqol-5 dimensions social tariff ( or = 0.967 , 95 % ci = 0.9500.983 ) . when questionnaires were not included in the analysis , cognitive impairment was associated with educational level ( or = 0.063 , 95 % ci = 0.0100.934 ) , number of exacerbations ( or = 11.070 , 95 % ci = 1.45084.534 ) , body mass index , airflow obstruction , dyspnea and exacerbations index score ( or = 1.261 , 95 % ci = 1.0491.515 ) , and the charlson comorbidity index ( or = 1.412 , 95 % ci = 1.1181.783 ) .conclusioncognitive impairment is common in copd and is associated with low educational level , higher disease severity , and increased comorbidity . this could have therapeutic implications for this population .

intestinal helminths are among the most common and widespread of human infections , contributing to poor nutritional status , anemia and impaired growth ( 1 ) . intestinal helminthiases are also known to aggravate pre - existing anemia by decreasing appetite and thus food and iron intake ( 2 , 3 ) . worldwide , anemia is an important reproductive health problem because of its association with adverse pregnancy outcome such as increased rates of maternal and perinatal mortality , premature delivery , low birth weight , etc ( 4 ) . women in developing countries spend half of their reproductive lives pregnant and lactating and a high proportion of women in developing countries become anemic during this period . women of reproductive age who are iron deficient but not anemic may become anemic during pregnancy as a consequence of increased iron requirements and expanded plasma volume . epidemiological surveys have revealed that poor sanitation and inappropriate environmental conditions coupled with indiscriminate defaecation , geophagy and contamination of water bodies are the most important predisposing factors to intestinal worm infection ( 5 ) . practices such as hand washing , disposal of refuse , personal hygiene , wearing of shoes and others , when not done properly may contribute to the infection or picking of these worms from the environments ( 6 ) . this research investigates the prevalence of helminth infection and its hematological alterations during pregnancy findings of this study will serve as a tool in evidence based health education on the need to intensify efforts at preventing helminthiases and its attendant risk of anemia during pregnancy .

backgroundthe incidence and hematological effects of helminth infection during pregnancy were investigated among pregnant women in isiala , mbano , southeast nigeria.methods : totally 282 pregnant women were enlisted for the study between october 2011 and september 2012 . stool samples were examined for intestinal helminths using formalin - ether sedimentation technique . hemoglobin ( hb ) and packed cell volume ( pcv ) levels were evaluated in venous blood samples using sahli s and microhaematocrit methods respectively.results : forty six ( 16.3 % ) subjects were infected with at least one helminth parasite ; 24 ( 8.5 % ) hookworm , 14 ( 5.0 % ) and 2 ( 0.7 % ) a. lumbricoides and trichuris trichiura infections respectively . intestinal helminthiases in pregnant women was significantly associated with age ( p < 0.05 ) . the prevalence of intestinal helminthiases by parity was also significantly different ( p < 0.05 ) with primigravidae having the highest infection rate ( 27.5 % ) . hematological assessment showed that the prevalence of anemia among the women was 58.9 % ( meansd = 9.31.0 ) . the differences in hemoglobin levels by age groups was statistically significant ( p < 0.05 ) . the contributory effect of gastrointestinal helminths in anemia showed that infected pregnant women had lower mean hemoglobin ( 8.600.22g / dl ) than the uninfected ( 9.720.07g / dl ) . significant difference ( t - value = 5.660 , p < 0.05 ) was observed between the hb of the infected and uninfected pregnant women . in addition , infected pregnant women had mean pcv of 26.090.65 % while the uninfected had 34.542.96 % . the mean pcv of infected pregnant women was significantly different ( t - value= 0.013 , p < 0.05 ) from that of the uninfected.conclusionanti-helminthic therapy after the first trimester should be part of the antenatal programme . intestinal helminth infection showed significant negative correlation with hb and pcv and contributed moderately to anemia .

soft tissue sarcomas are very rare tumors ; however , there are many histologic subtypes . among those subtypes , furthermore , among sarcomas originating within the retroperitoneum , which constitute 1015 % of all soft tissue sarcomas , liposarcomas are the most common histologic type , accounting for 41 % of these tumors [ 2 , 3 ] . liposarcomas are generally located in the head , neck , trunk , mediastinum , upper and lower extremities , gastrointestinal tract , and retroperitoneum . they commonly occur in patients aged 4060 years , and men and women are equally affected . the dimensions and weight of liposarcomas are variable ; those over 20 kg are called herein , we report a giant retroperitoneal liposarcoma weighing 25.0 kg , encasing the entire left kidney and adherent to adjacent structures which was successfully removed with kidney and aorta preserving .

retroperitoneal liposarcoma is a rare tumor . the dimension and weight of liposarcoma are variable ; those over 20 kg are called giant liposarcoma . herein , we report giant retroperitoneal liposarcoma measuring 45 cm in diameter and 25 kg in weight encasing the entire left kidney and adherent to adjacent structures . a 71-year - old woman presented for a regular checkup . image study revealed a huge mass probably indicative of retroperitoneal liposarcoma encasing the entire left kidney and adherent to adjacent structures . we performed an organ - preserving surgical removal . the pathologic report was liposarcoma . at postoperative month 16 , a follow - up ct revealed a locally recurrent tumor . the patient underwent surgical removal of the newly discovered mass . after the second surgery , the patient underwent regular follow - up ct for approximately 12 months , and to date , there has been no evidence of tumor recurrence . high - grade liposarcoma shows sensitivity to radiation therapy . however , the toxic effect of radiation therapy limits this option by treatment modality . the use of chemotherapy is also controversial . as a result , complete resection is the gold standard treatment . here , we report a giant retroperitoneal liposarcoma encasing the entire left kidney and adherent to adjacent structures , describe successful organ - preserving surgical removal and discuss prognosis .

emergence of bacterial resistance to many different antibiotics is considered as a great concern in human health . pseudomonas aeruginosa ( pa ) has been recognized as one of the significant pathogens of nosocomial infections ( 1 ) . key mechanism of antibiotic resistance in p. aeruginosa is the expulsion of antibiotics through multidrug resistance ( mdr ) efflux systems belonging to the resistance - nodulation - division ( rnd ) family ( 2 ) . mexab - oprm , mexcd - oprj , mexef - oprn , mexxy , mexjk and mexvw contribute the most significantly to antibiotic resistance ( 3 ) and play an important role in intrinsic and acquired multidrug resistance ( 2 ) . resistance of p. aeruginosa to multiple antibiotics is largely attributable to expression of the mexab - oprm efflux pump ( 4 ) . among all the rnd pumps of pa , mex - ab - oprm was the first efflux pump found to target multiple classes of antibiotics including -lactam ( carboxypenicillins , aztreonam , extended - spectrum cephalosporins , penems , the carbapenems such as meropenem and panipenem except imipenem and biapenem ) ; fluoroquinolones , tetracyclines , chloramphenicol , macrolides , novobiocin , trimethoprim and sulfonamides ( 5 , 6 ) . the mexab - oprm efflux pump belongs to the superfamily of ribonucleoproteins and consists of an inner membrane ( mexb ) , a periplasmic membrane fusion protein ( mexa ) and a channel - forming outer membrane protein , oprm ( 7 ) . in this study , we investigated the role of mex - ab - oprm efflux pump . transcription level of efflux pump genes mexa , mexb , oprm , mexr and ampc were analyzed using real - time pcr .

background and objectives : pseudomonas aeruginosa ( pa ) is one of the most important causes of nosocomial infections and has an intrinsic resistance to many antibiotics . among all the resistance - nodulation - division ( rnd ) pumps of p. aeruginosa , mexab - oprm is the first efflux pump found to target multiple classes of antibiotics . this study was aimed to evaluate the expression level of genes expressing mexab - oprm in clinical isolates of p. aeruginosa.materials and methods : in this study , 45 p. aeruginosa strains were isolated from patients admitted to children s medical center hospital , an iranian referral hospital . disk diffusion and minimum inhibitory concentration ( mic ) methods were used for determination of the patterns of resistance to antibiotics . real - time pcr was used to investigate the expression level of genes of mexab - oprm efflux pump.results : among 45 resistant pa isolates , the frequency of genes overexpression was as follows : mexa ( n=25 , 55.5 % ) , mexb ( n=24 , 53.3 % ) and oprm ( n=16 , 35.5 % ) . in addition , in 28 strains ( 62 % ) overexpression was observed in one of the studied three genes of mexab - oprm efflux pump.conclusion : in our study 28 isolates ( 62 % ) had increased expression level of efflux pumps genes , mexab - oprm . although the efflux pumps play important roles in increasing the resistance towards different antibiotics but the role of other agents and mechanisms in evolution of resistance should not be ignored . since the concomitant overproduction of other mex efflux systems might have additive effects on antibiotic resistance , the co - expressing of a multicomponent efflux pump is recommended . on the other hand , the concomitant overproduction of two mex pumps might have additive effects on resistance to antibiotic . therefore co - expressing of mex efflux systems is recommended .

severe sepsis and septic shock are common causes of mortality and morbidity in an intensive care unit ( icu ) setting . the endotoxin ( lipopolysaccharide [ lps ] ) derived from the outer membranes of gram - negative bacteria is considered a major factor in the pathogenesis of sepsis . the toll - like receptor ( tlr ) family can be found in mammalian cells . endotoxins transduce their signal through the tlr4 transmembrane receptor , and innate immune cascades are initiated , which promote excessive cytokine release and tissue damage . the endotoxin level is associated with clinical outcome and higher activity correlates with greater icu mortality . therapeutic strategies aimed at minimizing or preventing the action of endotoxins are , therefore , attractive . however , the blockage of an endotoxin via binding with monoclonal antibodies has failed to improve outcome in clinical studies . the reduction of endotoxin levels or blockage of endotoxins can potentially interrupt the biological cascade of sepsis . polymyxin b ( pmx ) is an antibiotic agent that has strong gram - negative bactericidal activity and carries very high affinity for endotoxins . intravenous ( iv ) administration of pmx has significant nephrotoxicity and neurotoxicity , which has limited its clinical use . pmx can be immobilized covalently on polystyrene - based carrier fibers which preserve its endotoxin binding capacity without producing toxicity . a pmx immobilized fiber column was shown to improve blood pressure , oxygenation and mortality in patients with severe sepsis . the alteco endotoxin hemoadsorber ( alteco medical ab , lund , sweden ) is a similar device with strong endotoxin - binding capacity . during the treatment , we performed this randomized controlled trial ( rct ) in patients who suffered from septic shock due to intra - abdominal sepsis . we hypothesized that alteco endotoxin hemoadsorption may provide extraclinical benefit in terms of faster organ function improvement and hemodynamic stabilization when compared with conventional treatment .

background and aims : severe sepsis and septic shock are common causes of mortality and morbidity in an intensive care unit setting . endotoxin , derived from the outer membranes of gram - negative bacteria , is considered a major factor in the pathogenesis of sepsis . this study investigated the effect of alteco endotoxin hemoadsorption device on gram - negative septic shock patients.materials and methods : an open , controlled , prospective , randomized , single - center trial was conducted between february 2010 and june 2012 . patients with septic shock due to intra - abdominal sepsis were randomized to either conventional therapy ( n = 8 ) or conventional therapy plus two 2-hourly sessions of alteco endotoxin hemoadsorption ( n = 7 ) . primary endpoint was the sequential organ failure assessment ( sofa ) score changes from 0 to 72 h. secondary end points included vasopressor requirement , pao2/fio2 ratio ( pfr ) , length of stay ( los ) , and 28-day mortality.results : this study was terminated early as interim analysis showed a low probability of significant findings . no significant difference was noted between the two groups with respect to change in sofa score , vasopressor score , pfr , los , and 28-day mortality . side - effect was minimal.conclusions : we could not identify any clinical benefit on the addition of alteco endotoxin hemoadsorption to conventional therapy in patients who suffered from intra - abdominal sepsis with shock . the side effect profile of this novel device was acceptable .

ameloblastoma is seen to have a benign appearance on histology , irrespective of its variable clinical behavior . microscopically various patterns have been described ( follicular , plexiform , acanthomatous , papilliferous - keratotic , granular cell type , desmoplastic , vascular , and dentinoameloblastoma ) . [ 13 ] majority of patients present in the fourth decade . men are affected slightly more often than female , with a particularly elevated incidence in eastern africa . more than 80 % of ameloblastomas arise in the mandible ( mostly angle or ramus ) . they are either primary or secondary soft tissue tumors , the latter appearing after operations . radiologically , ameloblastomas present as unilocular or multilocular translucencies . malignancy in the ameloblastoma has been divided into two distant lesions . a malignant ( metastasizing ) ameloblastoma is diagnosed when a seemingly histologically benign ameloblastoma produces a metastasis resembling the original lesion . ameloblastic carcinoma is an odontogenic tumor having the overall microscopic architectural features of ameloblastoma but in addition having malignant cytological features such as marked nuclear atypia and numerous mitotic figures . in the year 1965 , tsukada et al . two years later , a case of granular cell ameloblastoma with metastasis to cervical vertebrae was reported . we reviewed the literature for any cases of granular cell ameloblastoma with metastasis , which might have been reported from year 1967 until now . to the best of our knowledge

ameloblastoma is a slow growing odontogenic epithelial tumor of jaw . it accounts for 1 % of all tumors and cysts arising in maxilla and mandible . although it is locally invasive and has a marked tendency to recur , metastasis is rare . of the various histological patterns of ameloblastoma , the granular cell type is extremely rare accounting for 4 % of ameloblastomas . we report a case of granular cell ameloblastoma with metastasis to the cervical lymph node presenting in a 40-year - old indian female .

mesenteric and omental mesothelial cysts are responsible for only 1 in 100,000 of adult hospital admissions , and are thus left low on the list of differential diagnoses for abdominal pain . further evaluation of such masses is first directed at determining a tissue origin if possible . lymphangioma accounts for the most commonly reported of such lesions , followed by enteric cyst , enteric duplication cyst , non - pancreatic pseudocyst , and mesothelial cyst . gastrointestinal leiomyomas ( cystic spindle cell tumors ) in particular have been reported to undergo central liquefactive necrosis and hemorrhage , appearing as cystic mesenteric or omental lesions on imaging . the pathogenesis of a mesothelial cyst involves failed coalescence of mesothelial - lined surfaces , typically involving the small bowel , mesentery , or mesocolon . imaging usually demonstrates a fluid - filled cavity without a readily identifiable wall . unlike lymphangiomas , however , given the overlapping features of such cystic intra - abdominal masses on imaging , definitive diagnosis is made on thorough histopathologic analysis of the resected specimen .

highlightsmesenteric cystic masses account for a very small fraction of abdominal pain cases.symptoms arise likely as a result of mass effect , even when these lesions are small.on detection of these lesions by imaging , it is important to exclude neuroendocrine tumors.complete surgical excision is curative of symptoms caused by local mass effect.histopathological examination of specimens is the definitive means to differentiate between such lesions , that appear similarly on imaging .

in the past , a number of studies1,2 have given insight into the epidemiology of primary open - angle glaucoma . for caucasians , it is estimated that almost 2 % of the population will suffer from the disease , and for afro - caribbeans this percentage goes to almost 8 % . according to the world health organization , age - related cataract causes 48 % of world blindness . in the united states , age - related lenticular changes have been reported in 42 % of those between the ages of 52 and 64 years , 60 % of those between the ages of 65 and 74 years , and 91 % of those between the ages of 75 and 85 years.3,4 it is therefore almost inevitable that a glaucoma patient will sooner or later need to undergo cataract surgery independently from his chronic disease . the objective of the following systematic review is to examine whether there is strong evidence in order to draw safe conclusions on the long - term survival of a trabeculectomy performed before phacoemulsification.57

the purpose of our systematic review is to document the adverse events that follow phacoemulsification in eyes with trabeculectomy due to glaucoma and to determine whether phacoemulsification jeopardizes the survival of the trabeculectomy . our research was based on english- and non - english - language articles obtained using the medline , embase , web of science and scopus databases . additional studies were identified by searching bibliographies in the british library and abstracts presented at the association for research in vision and ophthalmology annual meetings . search terms included randomized controlled trial , controlled clinical trial , random allocation , double - blind method , matched studies and trabeculectomy failure , glaucoma - filtering operation failure , bleb failure and cataract surgery or phacoemulsification . only prospective or retrospective matched studies testing the survival of a trabeculectomy alone versus clear corneal phacoemulsification after a trabeculectomy in patients with glaucoma were included . data were independently extracted by two authors using predefined data fields . pubmed yielded 152 results , scopus 235 , embase 222 , and web of science ( science citation index ) 216 . we read the abstracts of all the trials , and after reading the full text of 31 studies , we decided that 13 studies should be comprehensively evaluated . current evidence does not allow us to draw safe conclusions on the scientific question so far .

sarcoidosis is a rare condition with a prevalence of 4.46.3 patients per 100,000 personyears in australia , a figure similar to that of the united state 1 , 2 . it is a multisystem granulomatous disorder of unknown etiology predominantly affecting young and middleaged adults 3 , 4 . diagnostic criteria are based on a compatible clinical and radiological features supported by the histological evidence of noncaseating granulomas in the affected tissues , and the exclusion of other known causes of granulomatous inflammation 3 , 4 . pulmonary infiltration and hilar lymphadenopathy are the most common findings in more than 90 % of cases , and transbronchial lung biopsy has been the recommended diagnostic procedure 3 , 4 . other organs involvement includes skin , eyes , liver , spleen , heart , musculoskeletal system , gastrointestinal tract , bone marrow , and the central nervous system . anemia has been reported in cases of sarcoidosis with the frequency ranging from 3.4 % to 31 % with a variety of explanations . these include hypersplenism , burden of chronic disease , autoimmunity , and bone marrow infiltration 5 . histological evaluation of extrapulmonary sarcoidosis depends on the site of involvement , but its diagnosis is rarely made via bone marrow biopsy 6 . features which may suggest bone marrow infiltration in sarcoidosis include extrapulmonary involvement and varying degree of cytopenia 7 . the characteristic granuloma in sarcoidosis is a noncaseating focal aggregation of macrophages or epithelioid cells , with or without multinucleated giant cells . its presence confirmed the diagnosis of a nonnecrotizing granuloma , in particular sarcoidosis 8 , 9 .

key clinical messagesarcoidosis is a diagnosis that should be considered in patients receiving interferon therapy , who present with anemia and multiorgan dysfunction regardless of the duration of their treatment . when sarcoidosis is suspected , bone marrow biopsy should be considered especially for cases predominant by extrapulmonary features .

seizure in patients with systemic lupus erythematosus ( sle ) is considered to be one of the major manifestations of the disease . the prevalence of seizure has been documented as about 10 to 20 % in the patients with sle ( 1 , 2 ) . this neuropsychiatric event is likely to be primary to the sle or secondary due to other concomitant conditions , including infection , hypertension , hyperlipidemia , metabolic derangement and the toxic effects of therapy ( 3 , 4 ) . hyperglycemic hyperosmolar syndrome ( hhs ) is a metabolic emergency , and it commonly occurs in elderly , disabled people with type 2 diabetes . the report of sament and schwartz in 1957 is widely credited as the original description of hhs . the proposed criteria for hhs are a plasma glucose concentration > 33.3 mm / l , a serum carbon dioxide concentration > 15 mm / l , no or mild ketonuria , absent to mild ketonemia , a serum osmolarity > 320 mm / kg and mental change ( 5 ) . however , hhs without other metabolic derangement and that occurs in a patient with lupus nephritis without diabetes and who received short term steroid therapy is a very rare complication .

a 51-yr - old female was referred to our outpatient clinic for the evaluation of generalized edema . she had been diagnosed with idiopathic thrombocytopenic purpura ( itp ) . she had taken no medicine . except for the itp , she had no history of systemic disease . she was diagnosed with systemic lupus erythematosus . immunosuppressions consisting of high - dose steroid were started . when preparing the patient for discharge , a generalized myoclonic seizure occurred at the 47th day of admission . at that time , the laboratory and neurology studies showed hyperglycemic hyperosmolar syndrome . brain mri and eeg showed brain atrophy without other lesion . the seizure stopped after the blood sugar and serum osmolarity declined below the upper normal limit . the patient became asymptomatic and she was discharged 10 weeks after admission under maintenance therapy with prednisolone , insulin glargine and nateglinide . the patient remained asymptomatic under maintenance therapy with deflazacort and without insulin or medication for blood sugar control .

an article recently published demonstrated the efficacy of eculizumab in the treatment of children with severe hematopoietic stem cell transplantation - associated thrombotic micro - angiopathy ( hsct - tma ) . we report the case of an adult with hsct - tma successfully treated with eculizumab . hsct - tma is a rare but very serious complication of allogeneic hematopoietic progenitor stem cell transplantation . several factors have been implicated in the endothelial damage which leads to hsct - tma : calcineurin inhibitors , acute graft versus host disease ( gvhd ) and cytomegalovirus ( cmv ) infection ; however , in recent years another mechanism has been described in which complement deregulation plays an important role . therefore complement - modulating therapies are beginning to gain ground in the treatment of this complication .

a 30-year - old man with acquired aplastic anemia underwent an hla - identical bone marrow transplant . he developed a grade iii acute graft versus host disease ( gvhd ) refractory to various lines of treatment . on post - transplant day 196 , he was diagnosed with stem cell transplantation - associated thrombotic micro - angiopathy ( hsct - tma ) and he received treatment with eculizumab 900 mg iv weekly for 4 doses followed by a single dose of 1200 mg 2 weeks later . after the first dose of eculizumab , the patient ceased to require transfusions and a progressive improvement in analytical parameters for microangiopathy was observed until their complete normalization . coinciding with the improved of hsct - tma , the patient presented a clear response to his acute gvhd with disappearance of the diarrhea and bilirubin normalization . he was discharged eight weeks after the start of treatment . unfortunately , one month later , the patient was readmitted for a gvhd relapse and he died two weeks later by an acute respiratory distress syndrome . in our case , the rapid clinical and analytical response to early treatment with eculizumab supports the implication of the complement in hsct - tma and suggests that the drug has a beneficial effect when used as coadjuvant therapy in acute gvhd .

hemifacial spasm is a disorder of the seventh cranial nerve , and is characterized by irregular , involuntary and recurrent tonic and clonic contractions of the ipsilateral facial expression muscles . each spontaneous motor paroxysm starts with eye twitching and progresses to involve the other muscles innervated by the facial nerve . the episode characteristically begins with a series of twitches that increase in frequency and intensity , followed by a sustained spasm . the disorder is typical during adulthood and is commonly attributed to vascular compression of the facial nerve emergence at the brain stem . altogether , posterior fossa or cerebellopontine angle tumors are rare causes of hemifacial spasm , reported in less than 1 % of a large series of adult patients . in children , the association of hemifacial spasm with tumors is also rare , with very few cases reported .

hemifacial spasm is a disorder of the seventh cranial nerve , which is characterized by irregular , involuntary and recurrent tonic and clonic contractions of the ipsilateral facial expression muscles . this disorder affects mainly adults , and there are few cases reported in childhood . the main etiologies are vascular problems , although tumors are an important cause of hemifacial spasm via a direct or an indirect mass effect . we report a 6-year - old girl who presented with right hemifacial spasm . magnetic resonance imaging showed a lesion in the cerebellopontine angle , extending from the midbrain to the pons with a slight mass effect on the fourth ventricle . the histological examination revealed a pilocytic astrocytoma .

varicella zoster virus ( vzv ) is a neurotropic dna alpha herpesvirus that infects more than 95 % of the world population . usually , varicella results from primary infection . the virus then becomes latent in ganglion neurons along the entire neuroaxis , and after reactivation , vzv moves transaxonally to the skin resulting in zoster . less often , vzv reactivation leads to neurologic complications more common in immunocompromised patients , such as vzv vasculopathy . vasculitis has , however , been reported in patients with dermatomal herpes zoster infection without trigeminal nerve involvement . the average time from rash to neurologic symptoms and signs is 4.1 months , but sporadically the patient can present with rash and stroke simultaneously . nonetheless , approximately one third of patients have no history of rash . in recent years , the number of recognized vzv vasculopathies has grown , but the diagnosis is not easy because , frequently , clinical presentation and imaging features are not specific of this entity . antiviral and antithrombotic treatment should probably be considered in stroke associated with vzv vasculopathy , but data on which to base therapeutic decisions are lacking .

ischemic and hemorrhagic stroke are recognized complications of varicella zoster virus ( vzv ) infections , although uncommon and poorly documented . the authors report the case of a 31-year - old woman admitted with acute ischemic stroke of the right posterior cerebral artery and a history of a thoracic rash 1 month before . aspirin and simvastatin were prescribed , but the patient suffered a stepwise deterioration the following days , with new areas of infarction on brain imaging . despite no evidence of cardiac or large vessel embolic sources , anticoagulation was started empirically 6 days after stroke onset . one week later , symptomatic hemorrhagic transformation occurred . the diagnosis of vzv vasculopathy was then considered , and treatment with acyclovir and prednisolone was started with no further vascular events . cerebrospinal fluid analysis and digital subtraction angiography findings corroborated the diagnosis . the patient was discharged to the rehabilitation center with a modified rankin scale ( mrs ) score of 4 . on the 6-month follow - up , she presented only a slight disability ( mrs score 2 ) . in conclusion , vzv vasculopathy needs to be considered in young adults with stroke . a high index of suspicion and early treatment seem to be important to minimize morbidity and mortality . anticoagulation should probably be avoided in stroke associated with vzv vasculopathy .

the definition of street children differs across countries and cultures.1 one way to identify this group is by categorizing the children s background according to their relationship to their family of origin , as follows:2,3 1 ) children on the street : this category comprises children working on the street , but who maintain more or less regular ties with their families ; 2 ) children of the street : children in this category maintain only weak relations with their families ; and 3 ) abandoned children : children in this category have no ties with their biological families and are completely on their own . with increasing awareness of governments and international agencies to the phenomenon of street children , this group of children has been identified as a highly vulnerable group that needs special attention and care . it has been reported that the number of street children range from 10 million to 100 million ; the majority of them are living in major urban areas in developing countries.1 in amman , jordan , it is estimated that 3 % of children aged 1018 years were working , which is the highest percentage noted in the capital.4 according to the palestinian central bureau of statistics , 3.5 % of palestinian children were working in 2001.5 more than one factor plays a role in driving children onto the streets . these include dropping out of school,2 family economic problems,3 child abuse and neglect,68 urbanization,7 broken families,9,10 peer pressure,11 as well as the role of media in promoting this phenomenon.7 the world health organization has identified that street children are prone to developing malnutrition disorders,12 sexually transmitted diseases,1 dental problems,13 psychiatric problems,14 cognitive and learning problems , unplanned pregnancies,1 as well as being prone to being trafficked.1 due to its longstanding situations of war and economic sanctions , this phenomenon is not unknown in iraq . however , there is no clear estimate of the size of the problem in iraq . since formal education is compulsory for the age group ( 612 years ) , the only clue to the magnitude of this problem is the school drop - out rate , which was found to be 1.9 million out of 4.3 million primary school - aged children.6,15 there is no evidence , neither in duhok nor in the kurdistan region , on the demographic characteristics or the psychopathology of street children in this country . this study aims to explore the demographic data and psychiatric morbidity among street children in duhok .

backgrounddue , in part , to family constraints in dealing with the economical burden of raising a family , a wave of street children is sweeping the developing world . such children are prone to both somatic and mental illnesses . this is the first ever study that has been conducted to explore the psychopathology among street children in the duhok governorate.methodsthe study was conducted between march 2004 and may 2005 in duhok city among street children who attended the zewa center the only center for street children in the region at the time of the study . among a total of 107 eligible children , 100 agreed to participate ( 93 % response rate ) . a modified family map ( genogram ) was used to obtain demographic data from the children and their caregivers through semi - structured interviews . in addition , the mini international neuropsychiatric interview for children and adolescents ( mini - kid ) structured interviews were conducted with the children.resultsthe study found that 98 % of children worked on the street because of the economic need and pressure on their families . there was high rate of parental illiteracy ( 90 % of fathers and 95 % of mothers ) , and 61 % of respondents were shown to have at least one psychiatric disorder . a high percentage ( 57 % ) of these children suffered from anxiety disorders including posttraumatic stress disorders ( 29 % ) . ten percent had depression , and 5 % had attention deficit hyperactivity disorder.conclusionstreet children in duhok seem to be working children due to their families needs .

the repercussions and clinical impact of this minimally invasive technological advance have been broadly highlighted in the international scientific literature and more recently expanded to pulmonology and thoracic oncology . endobronchial ultrasound ( known as ebus ) has faced greater technical bottlenecks , related to the smaller diameters of the bronchoscope , its working channel , the patients ' airways and , especially , the interface between the ultrasound and air.1 the first sectorial echobronchoscope was launched on the international market only in the middle of the first decade of 2000 . gastrointestinal endosonography ( known as eus ) , on the other hand , has been in use as a routine procedure for more than 15 years at large hospitals performing high - complexity procedures , including those in brazil.2 - 4 its diagnostic and therapeutic range has been well established for pancreatic and pelvic diseases ; mediastinal lesions can also be approached through the intrathoracic esophagus.5,6 fine - needle aspiration ( fna ) of masses and lymph nodes through the esophageal wall has been performed at specialized centers , with minimal risks of infection or bleeding and without great technical difficulty.5 - 8 the importance and usefulness of eus for the mediastinal staging of primary lung cancer has been well known since 1996.6 the main limitation of eus is its inability to access the anterior mediastinum because of the interference of air present in the trachea.1,7,8 this study aims to assess the performance of eus - guided fna in diagnosing mediastinal tumor lesions ( including lymph node enlargements ) and to describe some advantages and particularities of the technique .

objectives : to disseminate transesophageal ultrasound - guided fine needle aspiration ( eus - fna ) as an alternative to investigate mediastinal tumoral lesions because it is an underused modality that has been available in brazil for more than 15 years.methods : descriptive analysis of a single endoscopy service 's experience since 1997 in the accomplishment of eus - fna for mediastinal staging of previously known malignancies ( group 1 ) or diagnostic definition of suspect lymph nodes and masses ( group 2 ) .results : eus - fna was performed in 51 patients between 26 and 87 years of age . the diameter of the lesions ranged between 1.1 and 9.8 cm ( mean 3.9 cm ) . their location corresponded to the following stations : higher paratracheal ( 4 cases ) , lower paratracheal ( 7 ) , aortic window ( 12 ) , para - aortic ( 6 ) , subcarinal ( 9 ) , paraesophageal ( 8 ) , and hilar ( 5 ) . in group 1 , 17 patients had previously diagnosed primary lung ( 9 ) , breast ( 4 ) , kidney ( 2 ) , colon ( 1 ) , and bladder ( 1 ) cancer . fifteen of these punctures were positive for malignity . two others were later submitted to mediastinoscopy , which identified metastases not detected by eus - fna . group 2 comprised 34 patients . among these patients , eus - fna diagnosed 22 neoplasms , five cases of tuberculosis and two duplication cysts . cytology was inconclusive or without a specific diagnosis in five other cases . mediastinoscopy identified two undiagnosed cases of oat - cell carcinoma , one lymphoma and one cryptococcosis , and confirmed one reactive lymphadenitis . there were no complications related to the method.conclusions : eus-fna obviated the need for surgical procedures in 86.3 % of cases . therefore , oncologists , pulmonologists , and thoracic surgeons should always remember the technique 's potential and availability .

direct coronary stent implantation is an elegant technique for coronary artery revascularization.1 however , calcified coronary lesions , often seen in older patients suffering from diabetes mellitus , renal failure and hypertension , are challenging to deal with , as they require optimal lesion preparation prior stenting for avoiding stent underexpansion which is related to in - stent restenosis , target lesion revascularization and subsequent stent thrombosis.2 several strategies and technologies have been developed to address the problem of heavily calcified coronary lesions . these include simple dilatation using standard non - compliant balloon , cutting balloon and plaque modification using rotational atherectomy . we report on the management of an underexpanded bare - metal stent in a patient with heavily calcified lesion not amenable to high - pressure balloon - dilatation .

calcified coronary lesions are challenging to deal with , as they require optimal lesion preparation . direct stenting in this scenario is associated with risk of stent - underexpansion , which is related to in - stent restenosis , target lesion revascularization and stent - thrombosis . we report on the interventional management of an underexpanded bare - metal stent not amenable to high - pressure balloon dilation and cutting - balloon . by using rotablation we could abrade the underexpanded stent struts and the calcification with subsequent implantation of a drug - eluting stent . follow - up of 6 months revealed good results without evidence of significant restenosis . our clinical experience and case reports in the literature suggest that this strategy might be an option for underexpanded stents not amenable to conventional techniques .

the efficiency and function of the left ventricle ( lv ) as a pump are represented as systole and diastole . the systolic function is energy dependent ; the diastolic function is an important part of cardiac output ( as preload ) and also includes active processes such as the suction effect , which is also energy dependent and can be weakened by ischemia . thus , diastolic dysfunction ( ddf ) is an early marker of ischemia , because it is sensitive to impaired perfusion . most physicians pay attention to the lv ejection fraction ( ef ) for systolic function in the preoperative echocardiographic evaluation of patients about to undergo surgery ; however , lv ddf is often overlooked in such cardiac risk evaluation . lv ddf , and even diastolic heart failure ( dhf ) , are usually not significant problems in the daily life of patients who do not suffer from exercise intolerance , dyspnea , or pulmonary edema . however , when they reach the ward after an operation , they often end up in the intensive care unit ( icu ) with unstable vital signs in combination with pulmonary edema , which are not responsive to the normal use of intravenous ( iv ) epinephrine or norepinephrine . this can lead to poor outcomes , caused by lv ddf regardless of lv systolic dysfunction ( sdf ) , with hemodynamic instability developing due to surgery - induced adrenergic stimulation and anesthesia - induced sympathetic attenuation , resulting in a lengthy stay in the icu or even death . in american heart association - american college of cardiology ( aha - acc ) guidelines , lv ddf is still underestimated in preoperative risk assessment and few clinical data supporting its importance are available . in particular , such patients need more appropriate anesthetic management to prevent postoperative complications and to aid in recovery from anesthesia . because overlooking patients with lv ddf or lv dhf during the perioperative period , regardless of lv systolic function , can be very dangerous and cause poor outcomes , it is important that anesthesiologists are familiar with the pathophysiology , management , and surgical outcomes and are able to notice their phenotypic characteristics , and diagnostic parameters .

anesthesiologists frequently see asymptomatic patients with diastolic dysfunction or heart failure for various surgeries . these patients typically show normal systolic function but abnormal diastolic parameters in their preoperative echocardiographic evaluations . the symptoms that are sometimes seen are similar to those of chronic obstructive pulmonary disease . patients with diastolic dysfunction , and even with diastolic heart failure , have the potential to develop a hypertensive crisis or pulmonary congestion . thus , in addition to conventional perioperative risk quantification , it may be important to consider the results of diastolic assessment for predicting the postoperative outcome and making better decisions . if anesthesiologists see female patients older than 70 years of age who have hypertension , diabetes , chronic renal disease , recent weight gain , or exercise intolerance , they should focus on the patient 's diastologic echocardiography indicators such as left atrial enlargement or left ventricular hypertrophy . in addition , there is a need for perioperative strategies to mitigate diastolic dysfunction - related morbidity . specifically , hypertension should be controlled , keeping pulse pressure below diastolic blood pressure , maintaining a sinus rhythm and normovolemia , and avoiding tachycardia and myocardial ischemia . there is no need to classify these diastolic dysfunction , but it is important to manage this condition to avoid worsening outcomes .

gingival recession is defined as the partial denudation of the root surface due to the apical migration of the gingival margin . etiological factors include trauma from tooth brushing , malposition of teeth , ectopic insertion of frenum , and muscle attachments . the major therapeutic goals in mucogingival surgery are a correction of esthetic problems and management of hypersensitivity . numerous surgical procedures have been described to achieve soft tissue coverage of exposed root surfaces including coronally repositioned flaps , pedicle grafts , free gingival grafts , subepithelial connective tissue grafts ( ctg ) , and guided tissue generation ( gtr ) were commonly used procedures . the treatment of isolated or multiple buccal recessions with different surgical procedures depends on many factors such as defect size , presence or absence of keratinized tissue adjacent to the defect , and thickness of the gingiva . since the patients are concerned about their esthetic appearance , every effort should be made to achieve complete root coverage up to the cementoenamel junction ( cej ) . originally sullivan and atkins described a technique for coverage of exposed root surfaces using the free gingival autogenous graft . the graft survival over large expanses of avascular root surfaces was unpredictable , and complete root coverage was rarely achieved . demonstrates that the underlying connective tissue has a direct bearing on the type of epithelium that is superimposed upon it . edel showed that a significant increase in the volume of gingiva can be achieved by grafting gingival connective tissue alone . langer and langer described the ctg technique in root coverage on both single and multiple adjacent teeth . the advantage is the dual blood supply from the overlying flap and palatal connective tissue , which maximizes graft survival . when multiple adjacent teeth with gingival recessions are present in esthetic regions of the mouth , the preferred surgical technique should be such the one , which provides the possibility of achieving maximum root coverage . one of the problems with multiple root coverage grafting is the unavailability of the large blood supply of donor tissue . if connective tissue supply is limited , more than one surgical procedure may be needed . the purpose of the present study was to evaluate the effectiveness and the predictability of expanded mesh ctg ( e - mctg ) procedure for the treatment of multiple adjacent gingival recession defects .

background : multiple approaches have been used to replace lost , damaged or diseased gingival tissues . the connective tissue graft ( ctg ) procedure is the golden standard method for root coverage . although multiple sites often need grafting , the palatal mucosa supplies only a limited area of grafting material . to overcome this limitation , expanded mesh graft provides a method whereby a graft can be stretched to cover a large area . the aim of this study was to evaluate the effectiveness and the predictability of expanded mesh ctg ( e - mctg ) in the treatment of adjacent multiple gingival recessions.materials and methods : sixteen patients aged 2050 years contributed to 55 sites , each site falling into at least three adjacent miller 's class 1 or class 2 gingival recession . the ctg obtained from the palatal mucosa was expanded to cover the recipient bed , which was 1.5 times larger than the graft . clinical measurements were recorded at baseline and 3 months , 12 months postoperatively.results : a mean coverage of 1.96 mm 0.66 mm and 2.22 mm 0.68 mm was obtained at the end of 3rd and 12th month , respectively . twelve months after surgery a statistically significant increase in cal ( 2.2 mm 0.68 mm , p < 0.001 ) and increasing wkt ( 1.75 0.78 , p < 0.001 ) were obtained . in 80 % of the treated sites , 100 % root coverage was achieved ( mean 93.5 % ) .conclusions : the results of this study demonstrated that multiple adjacent recessions were treated by using e - mctg technique can be applied and highly predictable root coverage can be achieved .

nowadays a highlighted issue for an increasing number of consumers is the problem of meat tenderness , as the result of its physicochemical and biochemical mechanisms acting mainly on myofibrillar structures postmortem . because calpastatin inhibits both calpain1 and calpain2 , it remains unclear whether one or both calpains are active in postmortem muscle . most of the studies that have used appropriate methodology have found the same effect of postmortem storage on the activity of the components of the calpain system [ 24 ] . this conclusion seems to be based on the finding that calpain2 is not autolyzed during postmortem storage [ 5 , 6 ] . but some studies also have now suggested that both unautolyzed calpain1 and calpain2 are proteolytically active [ 7 , 8 ] . the lack of expression data of the calpain2 gene in chicken makes it difficult to verify the role of calpain2 in control of meat quality and carcass traits . in this study , we aimed to ( 1 ) develop a convenient approach to quantify the abundance of the calpain2 transcripts in chicken tissues and ( 2 ) determine tissue distribution and ontogenic expression of this gene , particularly in muscle tissues .

we quantified chicken calpain 2 ( capn2 ) expression in two chinese chicken breeds ( mountainous black - bone chicken breed [ mb ] and a commercial meat type chicken breed [ s01 ] ) to discern the tissue and ontogenic expression pattern and its effect on muscle metabolism . real - time quantitative pcr assay was developed for accurate measurement of the capn2 mrna expression in various tissues from chickens of different ages ( 0 , 2 , 4 , 6 , 8 , 10 , and 12 weeks ) . results showed that the breast muscle and leg muscle tissues had the highest expression of capn2 compared to the other tissues from the same individual ( p < .05 ) . overall , the capn2 mrna level exhibited a rise developmental change in all tissues . the s01 chicken had a higher expression of the capn2 mrna in all tissues than the mb chicken . our results suggest that chicken capn2 expression may be related to chicken breeds and tissues .

acupuncture is a promising treatment approach in patients with low back pain ( clbp ) with nearly the same or even better results compared to conventional therapy . since in fact various acupuncture strategies are used in clinical practice , research in order to define the best acupuncture technique is of clinical interest for many medical practitioners as well as for clinical researchers designing acupuncture trials . allready for chinese acupuncture , representing the most widely used style , the specific manner in which acupuncture is applied ( treatment regimens , point selection , needle techniques ) appears to vary among , regions and countries . the same holds true for randomized clinical trials ( rct ) on clbp , with point selection being fixed for all patients , or points being selected on an individual basis according to trigger points , chinese meridians , syndromes , various microsystems to name a few . in rcts needle stimulation may range from non - existent to strong , needle insertion may be deep or shallow , the number of acupuncture treatments may vary from 1 to 15 , and the stimulation of ahshi points may be mandatory or forbidden . despite the multiplicity of existing approaches to acupuncture , in a previous study we ascertained that there is a high degree of concurrence on certain aspects ( minimal criteria ) of chinese acupuncture for the treatment of clbp . a systematic review by yuan et al . arrived at a similar conclusion , while detecting differences between chinese expert opinions , textbooks and acupuncture treatments in rcts . on the basis of a broad , international delphi survey the aim of this study was to find out how leading acupuncture experts from non - chinese countries would rate the acupuncture methods used in existing rcts of acupuncture for clbp . furthermore we calculated the correlation between the results of this expert survey and with a low back pain acupuncture score ( lbpas ) , derived from our recently published acupuncture questionnaire for low back pain .

backgroundacupuncture is a promising treatment approach in patients with chronic low back pain ( clbp ) but little is known about the quality of acupuncture in randomized controlled trials ( rct ) of acupuncture clbp.objectiveto determine how international experts ( ies ) rate the quality of acupuncture in rcts of clbp ; independent international validation of the low back pain acupuncture score ( lbpas ) .methodologyfifteen experts from 9 different countries outside china were surveyed ( ies ) . they were asked to read anonymized excerpts of 24 rcts of clbp and answer a three - item questionnaire on how the method of acupuncture conformed to 1 ) chinese textbook standards , 2 ) the expert 's personally preferred style , and 3 ) how acupuncture is performed in the expert 's country . likert scale rating , calculation of the mode for each answer , and spearman 's rank correlation coefficient between all three answers and the lbpas were calculated.resultson comparison with chinese textbook standards ( question 1 ) , 6 rcts received a good rating , 8 trials a fair and 10 trials a poor or very poor rating . 5 of the 6 trials rated good , received at least a good rating also in question 2 or 3 . we found a high correlation of 0.85 ( p < 0.0001 ) between the ies and lbpas ratings for question 1 and question 2 , and a correlation of 0.66 ( p < 0.0001 ) for question 3.conclusionthe international expert survey ( ies ) revealed that only 6 out of 24 ( 25 % ) rcts of acupuncture for clbp were rated `` good `` in respect to chinese textbook acupuncture standards . there were only small differences in how the acupuncture quality was rated in comparison to chinese textbook acupuncture , personally preferred and local styles of acupuncture . the rating showed a high correlation with the low back pain acupuncture score lbpas .

the practice of psychiatry and the shift to noninstitutional care of severe psychiatric disorders are the result of antipsychotic medications , beginning with chlorpromazine in the early 1950s . approximately 10 other drugs , known as first - generation or typical antipsychotics , followed over the subsequent 30 years . these drugs were effective in treating positive symptoms of psychosis such as hallucination and delusion but did not alleviate the negative symptoms of withdrawal , apathy , cognitive impairment , or loss of affect . furthermore , they were associated with frequent extrapyramidal symptoms , including acute dystonia , akinesia , akathisia , tardive dyskinesia , and parkinsonism . a series of newer drugs began emerging in 1989 , referred to as second generation or atypical antipsychotics , thought to be more effective than the older agents in alleviating the negative , cognitive , and affective symptoms , with fewer extrapyramidal adverse effects . the antipsychotic drugs differ in their side effect profiles , as they affect different neuroreceptors ( histamine , -adrenergic , muscarinic , dopamine , or serotonin ) . the principal concern for endocrinologists with the newer drugs has been the metabolic effects of weight gain , glucose intolerance , hyperlipidemia , and hypertension . this is particularly important with the increasing use of these agents in pediatrics to treat bipolar disorder , schizophrenia , autism , oppositional and other behavior disturbances , tourette disorder , and pervasive developmental disorder . in 2003 - 2004 the importance and implications of the metabolic side effects of atypical antipsychotics for pediatric patients have been recently reviewed [ 1 , 4 ] . this paper will examine the side effect of hyperprolactinemia in children and adolescents treated with antipsychotic drugs .

there is increasing use of antipsychotic drugs in pediatric and psychiatry practice for a wide range of behavioral and affective disorders . these drugs have prominent side effects of interest to pediatric endocrinologists , including weight gain and associated metabolic risk factors and hyperprolactinemia . the drugs block dopamine action , thus disinhibiting prolactin secretion . hyperprolactinemia is especially prominent with first - generation antipsychotics such as haloperidol and the second - generation drugs , most commonly risperidone , with some patients developing gynecomastia or galactorrhea or , as a result of prolactin inhibition of gonadotropin releasing hormone from the hypothalamus , amenorrhea . with concern about the long - term effects of antipsychotics on bone mass and pituitary tumor formation , it is prudent to monitor serum prolactin levels in antipsychotic drug - treated pediatric patients and consider treatment with an agent less likely to induce hyperprolactinemia .

there are approximately 287,000 preventable maternal deaths annually , of which 99 % occur in developing countries . as a sentinel event , maternal death is also a prime indicator in evaluating the quality of a nation 's health care delivery systems [ 2 , 3 ] . mothers are pivotal to the social , economic , and cultural development of a community ; maintaining their health elevates the physical , psychological , and social well - being of their children and families and , by extension , society as a whole . for this reason , improving maternal health has been proposed by the world health organization ( who ) as one of their eight millennium development goals ( mdg ) . however , in countries with few maternal deaths , this approach fails to provide comprehensive information , leaving policy makers to react based on current rather than past statistics . to facilitate the development of precautionary measures and safer environments that minimize maternal deaths , it is essential that near miss data are recorded and analyzed . the who defines an individual having experienced severe acute maternal morbidity ( samm ) ( i.e . , near miss ) as a woman who nearly died but survived a complication that occurred during pregnancy , childbirth or within 42 days of termination of pregnancy . in fact , maternal near miss includes those cases in which a woman nearly died but survived during pregnancy or during 42 days after the delivery . using near miss data in maternal death prevention planning first , because the number of near miss cases exceeds maternal death cases , near miss is a better predicate for preventive planning . second , because the mother survives a near miss , she can provide valuable details on what she experienced . lastly , because near miss is one step removed from death , obtaining any information about the event could prove useful in preventing maternal death [ 810 ] . the prevalence of maternal near miss varies among different countries based on health care quality and availability . nevertheless , in a systematic review using disease - specific criteria , near miss rates have been reported to be between 0.6 % and 14.98 % . from a global perspective , iran has been notably successful in reducing maternal mortality . between 1990 and 2008 , iran has managed to decrease its maternal mortality rate by 80 % , which , at present , translates to about 25 deaths in 100,000 . the availability of emergency obstetrical care , improvements in women 's education , and the expansion of family planning services have all contributed to the decrease in maternal mortality . in iran , a national maternal mortality surveillance system examines maternal death cases by reviewing files and interviewing key parties to determine the cause of death . although some studies have been carried out in iran and the middle east regarding the causes of maternal death and risk factors of pregnancy [ 1217 ] , the authors know of no published study on severe maternal morbidities and near miss occurrences from iran or other middle eastern countries . the present study aimed to establish a profile of severe maternal morbidities in iran and their relationship with other underlying factors

this prospective study aimed to estimate the incidence and associated factors of severe maternal morbidity in southeast iran . during a 9-month period in 2013 , all women referring to eight hospitals for termination of pregnancy as well as women admitted during 42 days after the termination of pregnancy were enrolled into the study . maternal near miss conditions were defined based on say et al . 's recommendations . five hundred and one cases of maternal near miss and 19,908 live births occurred in the study period , yielding a maternal near miss ratio of 25.2 per 1000 live births . this rate was 7.5 and 105 per 1000 in private and tertiary care settings , respectively . the rate of maternal death in near miss cases was 0.40 % with a case : fatality ratio of 250 : 1 . the most prevalent causes of near miss were severe preeclampsia ( 27.3 % ) , ectopic pregnancy ( 18.4 % ) , and abruptio placentae ( 16.2 % ) . higher age , higher education , and being primiparous were associated with a higher risk of near miss . considering the high rate of maternal near miss in referral hospitals , maternal near miss surveillance system should be set up in these hospitals to identify cases of severe maternal morbidity as soon as possible .

patients show increasing declines in cognition , and behavioral symptoms occur in all stages of ad . while all ad patients can present with depression , agitation , and aggressive behaviors , behavioral difficulties are most pronounced in the advanced stages of the disease.13 rivastigmine , inhibiting both acetylcholinesterase and butyrylcholinesterase , is the first transdermal treatment available for ad patients , and has been widely approved for the symptomatic treatment of ad.4,5 by providing continuous delivery of medication from the skin into the bloodstream , these patches achieve sustained , high drug concentration in the plasma over 24 hours.6 however , the investigation of transdermal exelon in alzheimer s disease ( ideal ) study revealed that ad patients receiving a 10 cm patch frequently suffered from nausea ( 7.2 % ) and vomiting ( 6.2 % ) .4 further , japanese ad patients receiving an 10 cm patch also showed similar adverse events , including nausea ( 7.0 % ) and vomiting ( 8.0 % ) .5 ad patients have been reported to stop the medication because of these adverse effects ; however , no technique is currently available to predict the occurrence of these adverse effects . the antiemetic domperidone is often administered in order to administer higher , more effective dosages of cholinesterase inhibitors ( cheis ) , and such a combination with domperidone has been shown to be effective in preventing rivastigmine - related gastrointestinal disturbances when administered orally in the rivastigmine capsule form.7 in the present study , we examined the occurrence of gastrointestinal disturbances related to the use of the rivastigmine patch using the frequency scale for the symptoms of gastroesophageal reflux disease ( fssg ) ,8 bristol stool form scale,9 laboratory data , body weight , and amount of food intake . in addition , we compared the differences in gastrointestinal disturbances when using a rivastigmine patch with domperidone ( rwd ) and without domperidone ( rwod ) in order to examine the efficacy of domperidone orally .

objectivewhile acetylcholinesterase inhibitors , such as donepezil , galantamine , and rivastig - mine , are beneficial in treating behavioral symptoms of patients with alzheimer s disease ( ad ) , their dose - limiting effects include gastrointestinal disturbances , such as nausea , vomiting , and diarrhea . we aimed to predict the occurrence of these gastrointestinal disturbances with rivastigmine therapy for optimal drug choice and improved compliance.materials and methodsthirty patients with mild - to - moderate ad ( scores 1022 on the minimental state examination ) were administered a rivastigmine 18 mg patch with domperidone 30 mg ( rwd ) and without domperidone ( rwod ; n = 15 each ) for 20 weeks . gastrointestinal disturbances were evaluated using a frequency scale for symptoms of gastroesophageal reflux disease ( fssg ) , bristol stool form scale , laboratory data ( hemoglobin , albumin , total cholesterol ) , body weight , and amount of food intake.resultsafter 12 weeks , fssg scores were higher in the rwod group compared to baseline scores ; however , no significant differences were noted between the rwd and rwod groups . we then subdivided each group based on high and low baseline scores ; the rwod high - score ( 4 ) subgroup showed increased fssg after 12 weeks compared with the baseline score . in both rwd and rwod groups , the low - score ( 3 ) subgroups showed no changes during the dose - escalation phase.conclusionfor ad patients with higher fssg scores at baseline , domperidone was effective in preventing rivastigmine - related gastrointestinal disturbances .

health - care associated infections ( hcais ) are one among the major health related hazards and account for a major global disease burden . they pose a health threat toward patients and health care workers . these have a global impact and pose a disease burden to millions of people worldwide . these promote resistance to antibiotics , complicate the delivery of patient care and also lead to an additional monetary expenditure to the and also lead to additional monetary expenditure to the patients with underlying pathology . hospital - acquired infections account for more than 1.4 million people worldwide.1 health - care delivery exposes the hospital workers toward infections such as tuberculosis , needle stick injuries , and hiv . the practice of hand hygiene ( hh ) has long been considered as a gold standard and has passed the test of time as an infection control measure successfully preventing hcais . the single most important preventive measure against hcai is to practice proper hh technique by either washing the hands with soap or with a disinfectant , but this practice is usually given minimal priority by the hospital staff.2 in general , health care workers are not carriers , but vectors . centers for disease control and prevention defines the clinical contact surfaces as the surfaces that can be contaminated directly from patient materials either by direct spray or the generated splatter during dental procedures or with contact of dental health care provider s gloved hands . examples of such surfaces include light and door handles , switches , dental x - ray equipment dental chair , pens , telephone , door knobs , etc . contamination of these surfaces is frequently reported , but the risk of infection for patients and the dental staff is not yet , determined with high accuracy . dental healthcare workers skin could transiently carry potential pathogens coming from the environment and the use of gloves does not automatically eliminate the need for hand washing , because gloves can have unapparent defects or can be torn during use , due to sharp equipment , widespread in dental healthcare . in addition , the opportunistic pathogens may multiply at a very rapid rate in a moist environment that is usually present underneath the gloves . an aspect associated with microbial contamination of gloved hands is the use of finger rings . indeed , rings can make glove donning difficult with consequent damage and loss of integrity . a large number of studies are there establishing the association of hcais with improper hh , but only a handful of studies have demonstrated that the skin underneath finger rings is more enormously colonized than other comparable areas in the finger skin . however , whether wearing of the finger rings increases the likelihood of pathogen transfer is still unknown.3 a significance level of microbial contamination on the skin under ringed finger is also least examined . hence , the present study was done to investigate the occurrence of potential pathogenic bacteria and fungi on skin of gloved hands of dental health care workers who wore finger rings with those who did not wore finger rings under gloves .

background : disease prevention is better than its cure . the role of healthcare worker s hand in the transmission and spread of an infectious disease to the patient is well acknowledged . indeed , the hands of a health care worker can easily pick potentially pathogenic bacteria and fungi from hand touch surfaces before wearing of gloves . for these microorganisms to multiply rapidly , a moist environment present underneath the gloves acts a good cultivating media . it is also reported that the multiplication rate also increases several folds with the duration of glove use.materials and methods : dentists 20 with rings and 20 without rings were considered . skin samples from the hand soon after professional hand cleaning and glove disposal were collected . the occurrence of potentially pathogenic fungi and bacteria were examined and investigated disposal were collected . the occurrence of potentially pathogenic fungi and bacteria were examined and investigated with biochemical and cultural laboratory tests.results : bacteria and fungi were significantly more frequent in dentist s hand with rings than those without rings . 63 % versus 37 % ( bacterial prevalence ) , among the isolated potentially pathogenic microorganisms were staphylococcus aureus , escherichia coli , and candida albicans.conclusion : in the present study potentially pathogenic microorganisms were more frequent in dentists who wore finger rings under gloves .

conjunctival tick attachment is a rare occurrence , with only 7 cases reported in the literature . the tick species ixodes holocyclus is found in australia and belongs to the family of hard ticks , ixodidae , which are a group of blood - sucking acarine ectoparasites [ 1 , 2 ] . it is also known as the paralysis tick because it produces a toxin that can cause motor paralysis , which is mainly a problem seen in veterinary medicine and rarely in humans , although children under 5 years of age are at greatest risk . ticks are known vectors of infectious diseases and are associated with a range of ocular and systemic conditions . we describe a rarely seen ophthalmic finding : conjunctival attachment of a live paralysis tick . we also discuss the literature regarding ocular tick attachment , clinical features , and management .

we describe a rare clinical finding of conjunctival tick attachment in a child . a 10-year - old boy presented to the clinic with right - eye itch . he was found to have a live tick firmly attached to his right temporal conjunctiva . the tick was identified as the larval stage of the paralysis tick , ixodes holocyclus . the tick was removed completely by conjunctival excision . although various methods of removing a tick have been described in the literature , the goal of treatment is the safe and complete removal of the tick to prevent further transmission of pathogens , allergens , and toxins to the patient .

however , it has not been reported with fluoroscopically - guided endovascular procedures.the rapidly proliferating keratinocytes in the hair matrix are most sensitive to radiation . the insult damages the keratinocytes , which results in thin , weakened hair shaft that is susceptible to trauma.complete hair re - growth occurs in a time period between two to four months following the insult . the insult damages the keratinocytes , which results in thin , weakened hair shaft that is susceptible to trauma . complete hair re - growth occurs in a time period between two to four months following the insult . fluoroscopy - guided neuro - radiological endovascular procedures for treatment of arteriovenous malformations are getting commonplace in modern health care facilities of india . temporary alopecia of the scalp is an uncommon but documented side - effect of these procedures , especially when a certain threshold of radiation is exceeded . to the best of our knowledge , this is the first case of temporary alopecia after fluoroscopically - guided coiling procedure for a ruptured cerebral aneurysm being described in a dark haired woman from india .

a 47-year - old indian woman with dark hair developed dramatic alopecia of the occipito - vertical area two weeks after a fluoroscopically - guided endovascular procedure for treatment of cerebral aneurysm . there was spontaneous repopulation of hair in 14 weeks . neuro - radiological intervention procedures are becoming commoner by the day in india , and the rare but documented possibility of such reactions occurring in patients should be kept in mind by the treating surgeon as well as dermatologist . necessary counseling regarding this uncommon side - effect is of essence , especially when the radiation dose exceeds 3 gy . we believe this is the first case ever reported in indian dermatology literature .

hemicrania continua ( hc ) is an uncommon primary headache disorder characterized by a continuous , mild to moderate intensity , unilateral headache [ 14 ] . most patients will experience superimposed exacerbations of more severe pain , often associated with ipsilateral autonomic symptoms . headache for greater than 3 months fulfilling the following criteria : all of the following : unilateral pain without side shift , daily and continuous , without pain - free periods , moderate intensity , but with exacerbations of severe pain.at least one of the following autonomic features occurs during exacerbations and ipsilateral to the side of pain : conjunctival injection and/or lacrimation , nasal congestion and/or rhinorrhea , ptosis and/or miosis.a complete response to therapeutic doses of indomethacin.finally , not attributed to another disorder . unilateral pain without side shift , daily and continuous , without pain - free periods , moderate intensity , but with exacerbations of severe pain . at least one of the following autonomic features occurs during exacerbations and ipsilateral to the side of pain : conjunctival injection and/or lacrimation , nasal congestion and/or rhinorrhea , ptosis and/or miosis . a complete response to therapeutic doses of indomethacin . finally , not attributed to another disorder . there is a group of patients that meets the above criteria for hc , but has to discontinue indomethacin secondary to adverse effects , primarily involving the gastrointestinal ( gi ) tract . the side effects can range from gastritis to severe bleeding , patients may also develop an allergy to indomethacin , see an elevation of blood pressure , or an exacerbation of asthma symptoms . gabapentin is often used in an off label fashion for the treatment of neuropathic pain and is well tolerated from a side effect profile . marinano da silva , alcantara , bordini , and speciali reported a case of a unilateral headache similar to hc that was responsive to gabapentin .

the objective of this study is to examine the efficacy of gabapentin for the treatment of hemicrania continua ( hc ) in cases where patients had difficulty tolerating indomethacin due to adverse effects . a retrospective chart review of nine patients with hc between october 2006 and february 2008 . inclusion criteria included men and women age 18 or above presenting to the headache center with a headache that meets international headache society criteria for hc including a response to indomethacin , but were not able to continue on indomethacin secondary to adverse effects . four patients report being pain free , three patients report a 5080 % reduction of pain , one patient reports a 10 % reduction of pain , and one patient reports no change in pain . seven out of nine patients demonstrated at least a 50 % reduction of pain on gabapentin , four patients becoming completely pain free .

the centers for disease control and prevention report that autism spectrum disorder ( asd ) now affects 1 in 88 children in the usa and 1 in 47 in utah . asd is 5 times more likely in boys with 1 in 54 boys identified nationally . more children will be diagnosed with asd this year than with aids , diabetes , and cancer combined . a diagnosis of autism is based on observed behavior and educational and psychological testing . currently , there is no single definitive treatment for autism , nor is there presently a cure . traditional treatments may be biomedical , sensory , behavioral , developmental , sports - related , or arts - based .

focus area : pediatricsintroduction : the centers for disease control and prevention report that autism spectrum disorder ( asd ) now affects 1 in 88 children in the usa and 1 in 47 in utah . asd is 5 times more likely in boys with 1 in 54 boys identified nationally . more children will be diagnosed with asd this year than with aids , diabetes , and cancer combined . a diagnosis of autism is based on observed behavior and educational and psychological testing . currently , there is no single definitive treatment for autism , nor is there presently a cure . traditional treatments may be biomedical , sensory , behavioral , developmental , sports - related , or arts-based.objectives : the objective was to conduct qualitative research using light hands - on touch energy work with children diagnosed with asd with focus on the following behaviors : eye contact , appropriate social behavior , verbal tics , motor control and coordination , neural impulses related to the sensory organs , immune system , and ability to learn.methods or target groups : six participants between 9 and 16 years of age were treated by teams of two practitioners in 10 sessions using light touch energy work protocol focusing on boosting the immune system and strengthening organs of the body and brain functioning . assessments included parental and practitioner observations using verified and unverified research instruments.results or activities : over a 15-month period , participants had an overall improvement of 70 % in 5 categories evaluated . specifically , there was an improvement of 81 % in eye contact , 72 % in social behavior , 61 % in motor control / coordination , 75 % in sensory neural reorganization , and 65 % in learning evolution.conclusion or deliverables : energy work may positively impact people living with asd and can be safely integrated with other healthcare modalities . further research needs to be conducted , and more reliable research instruments for complementary and alternative healthcare need to be developed .

the optimal time of catheter removal following radical prostatectomy ( rp ) is not defined . from a patient 's perspective , early removal of the urinary catheter is desirable due to catheter - related discomfort , penile pain , bladder irritation / spasm , pericatheter urine leaks , etc . , however , the surgeon 's concerns with early catheter removal are the possibility of anastomotic site leak and acute urinary retention . with experience and improvement in techniques , the duration of catheterization has decreased from an average of 21 days in open rp era to 710 days in cases where robot - assisted rp ( rarp ) is performed . in fact , there are numerous reports about the feasibility and safety of even earlier ( i.e . on the postoperative day 35 ) catheter removal after radical retropubic prostatectomy or rarp . with early catheter removal , some concerns have been raised about increased risk of acute urinary retention . therefore , in practice , the majority of the institutions perform catheter removal after 7 days of surgery . however , there is a variation in the practice of performing cystograms before catheter removal which is done primarily to rule out anastomotic site leak . with the improvement in anastomotic technique , it is rare to find anastomotic site leak after rarp , and it may not always be necessary to obtain a routine check cystogram . we , therefore , evaluated our 230 consecutive rarp patients and the outcomes of their cystogram findings to determine the indications for cystogram before catheter removal .

introduction : with the improvement in anastomotic technique , it is rare to find anastomotic site leak after robot - assisted radical prostatectomy ( rarp ) . it may not always be necessary to do regular check cystogram before catheter removal . we evaluated our 230 consecutive rarp patients and their cystograms to determine the indications for selective use of cystogram before catheter removal.materials and methods : we reviewed our prospectively collected rarp database of 230 consecutive patients . cystography was performed at low pressure by gravity instillation of diluted contrast through the catheter . patients were observed under fluoroscopy in lateral oblique position for any contrast leak at the site of anastomosis . all patients were followed for a minimum of 6 months , and the longest follow - up was 5 years.results : a total of 207 patients ( 90 % ) underwent catheter removal on postoperative day 7 . nine patients ( 3.9 % ) had extravasation on initial cystogram . two patients with leak had a history of transurethral resection of prostate ( turp ) and seven other had bladder neck reconstruction for wide bladder neck . three patients with minimal leak did not require catheter replacement . in rest of the 6 patient with leak , continued catheter drainage was done . no significant difference in the intraoperative variables , blood loss , duration of drain , length of hospital stay , and continence outcomes was noted between the patients with leak compared to rest of the patients . none of the patient needed any procedure / intervention related to the surgery and none developed bladder neck stenosis.conclusion : in usual circumstances , catheter removal can be done safely on a postoperative day 7 without routine cystography . selective use of check cystogram can be done in the case where bladder neck reconstruction is performed or those had a prior turp and a wide bladder neck .

successful laparoscopic treatment has been described previously in only a few cases . rarely the diagnosis is suspected preoperatively when using only ultrasound . other diagnostic tests like magnetic resonance cholangiopancreatography ( mrcp ) , endoscopic retrograde cholangiopancreatography ( ercp ) and intraoperative cholangiogram can be more accurate in the diagnosis of this condition . intraoperative cholangiogram represents a powerful tool for the surgeon when dealing with double gallbladder , it help to delineate the anatomy and confirms the diagnosis . ( 1,2 ) we present a case report of a patient with symptomatic cholelithiasis with double gallbladder treated laparoscopically using intraoperative cholangiogram .

double gallbladder is a rare finding in patients with symptomatic cholelithiasis or acute cholecystitis . the incidence has been described as 1 in every 4000 - 5000 patients during autopsy . to identify the gallbladder ( gb ) duplication prior to surgical removal of the gb is of upmost importance . it is not unusual to identify this diagnosis intraoperatively , but by using us , ercp or mrcp more than 50 % of the cases are diagnosed preoperatively . the use of intraoperative cholangiogram helps to identify the anatomy and confirm the diagnosis during laparoscopic cholecystectomy in patients with gallbladder duplication .

isolated double - orifice mitral valve ( domv ) is an extremely rare congenital anomaly whose exact incidence has not been conclusively determined . interestingly , this cardiac abnormality rarely presents as an isolated finding , preferentially associated with valvular regurgitation rather than stenosis . the etiology of domv has been recognized in the abnormal fusion of the endocardial cushions and abnormal development of the mitral valve during the delamination process . transthoracic echocardiography is the modality of choice for the characterization of this anomaly ; in this respect , the parasternal short - axis view allows a full morphologic characterization of the anomaly and should always be performed in the case of a meaningful clinical suspect . we present the case of an asymptomatic patient with isolated domv who was referred for cardiac evaluation to achieve a certificate of fitness for competitive sports .

double - orifice mitral valve ( domv ) is a very rare congenital anomaly that usually presents as mitral regurgitation . we present the case of a 39-year - old asymptomatic , healthy man with no previous medical history who was affected by isolated complete bridge type domv , incidentally detected by two - dimensional echocardiographic examination in the parasternal short - axis view . the mitral valve of the patient was normally functioning without any other coexistent cardiac abnormalities . isolated domv was also confirmed by cardiac magnetic resonance imaging . the patient is now followed up to detect possible complications .

the largest mercury processing in the western hemisphere was in huancavelica in the peruvian andes , now a town of 30,000 people situated at 3676 m altitude . the extensive mercury deposits have been mined since pre - hispanic times , they are just above the present town at ~4000 m. although the mine closed 30 years ago , mining continues on small scales . the legacy of 500 years of mercury mining is now found in the city trenches and waterways , which are lined with mercury but this legacy is less evident in today 's inhabitants of huancavelica .

mercury is added to the biosphere by anthropogenic activities raising the question of whether changes in the human chromatin , induced by mercury , in a parental generation could allow adaptation of their descendants to mercury . we review the history of andean mining since pre - hispanic times in huancavelica , peru . despite the persistent degradation of the biosphere today , no overt signs of mercury toxicity could be discerned in present day inhabitants . however , mercury is especially toxic to the autonomic nervous system ( ans ) . we , therefore , tested ans function and biologic rhythms , under the control of the ans , in 5 huancavelicans and examined the metal content in their hair . mercury levels varied from none to 1.014 ppm , significantly less than accepted standards . this was confirmed by microfocused synchrotron x - ray fluorescence analysis . biologic rhythms were abnormal and hair growth rate per year , also under ans control , was reduced ( p < 0.001 ) . thus , evidence of mercury 's toxicity in ans function was found without other signs of intoxication . our findings are consistent with the hypothesis of partial transgenerational inheritance of tolerance to mercury in huancavelica , peru . this would generally benefit survival in the anthropocene , the man - made world , we now live in .

periapical pathoses of pulpal origin develop in response to microbial irritants in the root canal systems . bacterial cell wall components react with monocytes , macrophages , other cells of the immune system , as well as with fibroblasts , leading to the production of proinflammatory cytokines , such as il-1 , il-1 , tnf- , il-6 , and il-8 . irritants may be mechanical or chemical , but are most often bacterial . the interaction between these irritants and host defensive cells results in release of numerous mediators that , through the root canal system , are capable of initiating immunologic reactions in periapical tissues resulting in the formation on inflammatory periapical lesions . these reactions include immune response mediated by cells , through the actions of t lymphocytes and cytokines , and hummoral immune response mediated by antibodies , activated by b - lymphocyte products . tnf- is a monocyte - derived protein that has a wide range of proinflammatory and immunomodulatory effects on a number of different cell populations . tnf- is a cytokine which stimulates bone resorption , prostaglandin synthesis , and protease production by many cell types , including fibroblasts and osteoblasts . the local production of pge2 , il1- , and tnf- has been demonstrated in periapical lesions [ 4 , 5 ] . tnf- is a cytokine initially identified as a causative of hemorrhagic necrosis in certain tumors and was later shown to be the same molecule as cachectin , a serum product earlier known as a mediator of wasting in chronic disease . in addition to its diverse bioactivities , tnf- is the only molecule other than il-1 that is presently known to have osteoclast - activating function . although extensive research has been performed in the area of periapical inflammatory mediators , only few studies focused on the role and levels of tnf- in periapical exudate [ 6 , 7 ] . the aim of this study was to determine the levels of tnf- in periapical exudates and to evaluate possible relationships between this cytokine and radiological findings in the involved teeth .

aim . the aim of this study was to determine tumor necrosis factor - alpha ( tnf- ) levels in periapical exudates and to evaluate their relationship with radiological findings . methodology . periapical exudates were collected from root canals of 60 single - rooted teeth using absorbent paper points . tnf- levels were determined by enzyme - linked immunosorbent assays . the samples were divided into three groups according to the periapical radiolucent area . results . nonparametric kruskal - wallis test revealed significant differences between tnf- concentrations in control group ( 40 , 5728 , 15 pg / ml ) and group with larger radiolucent areas ( 2365 , 79582 , 95 pg / ml ) , as well as between control and canals with small radiolucent areas ( 507 , 66278 , 97 ) ( p < .05 ) . conclusions . the levels of tnf- increase significantly in teeth with periapical pathosis , from smaller to bigger lesions . this research and its results have shown that objective analysis of the tnf- levels enables establishment of a relationship between different concentrations of tnf- and different radiological changes .

the traditional management of gallstone pancreatitis ( gp ) has been to perform cholecystectomy during the same hospital admission after resolution . however , when gp develops in the immediate postoperative period from a major colorectal operation , cholecystectomy may be fraught with difficulty due to the inflammatory response that occurs . thus , delaying cholecystectomy until the inflammatory response subsides may be worthwhile , and it maximizes the chances of completing the cholecystectomy laparoscopically . the best management strategy for gp under these circumstances , we have described our management of 2 patients with gp occurring after colorectal operations requiring proximal diverting ileostomy . a 31-year - old male with adenomatous polyposis coli gene mutation and familial adenomatous polyposis presented prophylactic surgical treatment . he underwent an uncomplicated laparoscopic total proctocolectomy with ileal j - pouch anal anastomosis and diverting loop ileostomy . on postoperative day ( pod ) 8 , he developed acute epigastric and right upper quadrant ( ruq ) pain . laboratory studies revealed a white blood cell ( wbc ) count of 14,000 , serum lipase and amylase of 1300 , and normal bilirubin . he was placed on bowel rest with iv hydration until pancreatitis improved clinically and biochemically . cholecystectomy was deferred until planned ileostomy reversal . to decrease the risk of recurrent episodes of gp , the patient then underwent ileostomy reversal and cholecystectomy as described below 6 weeks later . a 44-year - old male with a history of sigmoid colectomy for endoscopically unresectable adenoma presented to us with rectal bleeding . laboratory studies revealed a wbc count of 13,000 , lipase and amylase above 400 , and normal bilirubin . gp was diagnosed and then managed non - operatively , similar to our first case . he refused ercp / s . after discharging , the patient returned in 6 weeks for ileostomy reversal and cholecystectomy as described below . in both cases , anastomosis was found to be healed on pouchogram and pouchoscopy at 6 weeks postoperatively . after establishing general anesthesia and administration of pre - incisional antibiotics , the proximal and distal portions were marked with different colored sutures and placed within the abdomen . a 12-mm balloon - tipped port was placed through the residual defect for the laparoscope . three 5 mm ports were placed in the ruq away from any intra - abdominal adhesions [ figure 1 ] . the two limbs of ileum were eviscerated in proper anatomic position using the colored sutures .

traditional management of gallstone pancreatitis ( gp ) has been to perform cholecystectomy during the same hospital admission after resolution . however , when gp develops in the immediate postoperative period from a major colorectal operation , cholecystectomy may be fraught with difficulty due to the inflammatory response that occurs . thus , delaying cholecystectomy until the inflammatory response subsides may be worthwhile , and it maximizes the chances of completing the cholecystectomy laparoscopically . we have described our management of 2 patients with gp occurring after colorectal operations , which required proximal diverting ileostomy . in both cases , we deferred management of gp with either endoscopic retrograde cholangiopancreatography ( ercp ) or medical conservative measures during the acute attack and performed laparoscopic cholecystectomy during ostomy reversal surgery utilizing the existing ostomy takedown site for port placement . both patients tolerated this management well .

high - grade gliomas , who grade iii or iv [ 1 , 2 ] , are the most common primary brain tumors in adults [ 1 , 3 ] . who grade iv tumors are almost exclusively ( 8090 % ) glioblastoma multiforme ( gbm ) , which are the most common high - grade glioma ( 4045 % ) [ 1 , 3 ] , the most common form of brain tumor overall ( 1215 % ) [ 1 , 3 ] , and the most aggressive malignant primary brain tumor . despite limited significant advances in standard therapy , notably temozolomide , median overall survival ( os ) remains low : 15 months for newly - diagnosed gbm [ 5 , 6 ] and 57 months for recurrent / relapsed gbm [ 710 ] . in a clinical trial setting , the current standard of care ( radiotherapy plus temozolomide followed by 6 cycles of adjuvant temozolomide ) provided 2- and 5-year survival rates of 27 and 10 % for patients with newly diagnosed gbm . given the poor prognosis of gbm , the primary objectives of therapy are to reduce morbidity , restore or preserve neurologic functions and the capacity to perform daily activities as long as possible . the aim of this review is to examine the impact of gbm therapy on qol , neurocognitive function , and their correlates .

the maintenance of quality of life ( qol ) in patients with high - grade glioma is an important endpoint during treatment , particularly in those with glioblastoma multiforme ( gbm ) given its dismal prognosis despite limited advances in standard therapy . it has proven difficult to identify new therapies that extend survival in patients with recurrent gbm , so one of the primary aims of new therapies is to reduce morbidity , restore or preserve neurologic functions , and the capacity to perform daily activities . apart from temozolomide , cytotoxic chemotherapeutic agents do not appear to significantly impact response or survival , but produce toxicity that is likely to negatively impact qol . new biological agents , such as bevacizumab , can induce a clinically meaningful proportion of durable responses among patients with recurrent gbm with an acceptable safety profile . emerging evidence suggests that bevacizumab produces an improvement or preservation of neurocognitive function in gbm patients , suggestive of qol improvement , in most poor - prognosis patients who would otherwise be expected to show a sudden and rapid deterioration in qol .

adrenal myelolipoma is a tumor - like lesion composed of variable amounts of mature adipose tissue and bone marrow elements . in spite of wbc and rbc precursors such as megakaryocytes giercke in 1905 first described and 24 years later , oberling coined the term myelolipoma . only two cases under the age of 16 are reported and to the best of our knowledge , this patient is the youngest pediatric case of adrenal myelolipoma reported in the english literature .

myelolipoma is a rare benign tumor of adrenal gland and rarer in children . myelolipoma contains adipose tissue and myeloid precursor producing white blood cells ( wbc ) , red blood cells ( rbc ) and megakaryocytes . asymptomatic tumor does not require treatment whereas symptomatic tumor needs operation . we are reporting a rare adrenal myelolipoma in a child with review of literature .

nutcracker syndrome is generally referred to as the compression of the left renal vein between the superior mesenteric artery and aorta ( 1 ) . this compression leads to lrv hypertension and results in direct communication of the renal vein with the calyceal cavity and the varicosities of the collateral pathway of the lrv ( 2 ) . renal varicosities or abnormal branching of the superior mesenteric artery from the aorta are the most common factors considered responsible for this condition ( 1 , 2 ) . the other causes , such as compression of the retroaortic lrv between the aorta and spine ( which is referred to as ' posterior ncs ' in contrast to the more common ' anterior ncs ' ) or aberrant right renal artery constricting the lrv , are uncommon ( 3 , 4 ) . however , three recently reported cases of nutcracker phenomenon associated with the left inferior vena cava ( livc ) suggest that some anomalies of the inferior vena cava ( ivc ) can also impair lrv blood outflow and result in ncs ( 4 - 6 ) . here we reported a case of complicated malformation of livc with interrupted ivc and azygos continuation and retroaortic right renal vein causing posterior ncs , which has been diagnosed by both color doppler ultrasound and computed tomographic angiography ( cta ) . to the best of our knowledge , this is the first report of an association between a complicated anomaly of the livc and ncs .

various anatomic anomalies have been considered the causes of nutcracker syndrome ( ncs ) . posterior ncs refers to the condition , in which vascular narrowing was secondary to the compression of the retroaortic left renal vein while it is crossing between the aorta and the vertebral column . here , we report an unusual case of posterior ncs associated with a complicated malformation of the interrupted left inferior vena cava with azygos continuation and retroaortic right renal vein , diagnosed by both color doppler ultrasonography and ct angiography .

since the international subarachnoid trial , coil embolization of aneurysms is now accepted as a primary optional treatment19 ) . however , endovascular treatment ( evt ) of middle cerebral artery ( mca ) aneurysms has been less often applied in many institutions because of the feasibility of surgical clipping afforded by the superficial anatomy of mca aneurysms and favorable outcomes8,24 ) . a large series of evt of mca aneurysms was recently reported with favorable results and a low recurrence rate4,11,27 ) , but evt of wide - necked and fusiform mca aneurysms remains still challenging . after self - expandable stents became available , many of complex aneurysms have been treated by coil embolization1,3,17,18,21,23 ) . to our knowledge , there are a few reports regarding stent - assisted evt of mca aneurysms , but they treated complex mca aneurysms with one self expandable intracranial stent6,26,29 ) . the aim of this study was to evaluate the feasibility and clinical and angiographic outcomes of stent - assisted coiling for complex mca aneurysms using more than one stent .

objectiveto evaluate the feasibility and clinical and angiographic outcomes of stent - assisted embolization for complex middle cerebral artery ( mca ) aneurysms.methodsthe records of 23 consecutive patients with 24 mca aneurysms , who underwent stent - assisted embolization of the aneurysm , were retrospectively evaluated.resultsfifteen aneurysms were treated with one stent and 8 were treated using more than two stents ( 5 a stent - within - a - stent , 1 triple stents , and two y - stent ) . angiographically , complete or near complete occlusion was achieved in 15 aneurysms ( 65.2 % ) , residual neck in five ( 21.7 % ) , and residual aneurysm in three ( 13.1 % ) . five aneurysms demonstrated thrombosis within the stent during the procedure and hospitalization , and were resolved by intraarterial and intravenous tirofiban injection . symptomatic thromboembolic complications were developed in five patients and permanent deficits demonstrated in two patients with modified rankin scale 1 and 2 , respectively . treatment - related permanent morbidity and mortality rates were 8.3 % and 0 % with relatively high complication rate . angiographic follow - up was available in 17 aneurysms at 6 - 31 months ( mean , 13.2 months ) and showed stable or improved in 15 ( 88.2 % ) and major and minor recurrence in one , respectively.conclusioncomplex mca aneurysms could be treated by stent - assisted coiling and showed lower recanalization rate during mid - term follow - up by effective flow diversion due to various stent - assisted techniques . our results warrant further study with a longer follow - up period in a larger sample .

expression of genes is regulated at many different levels , transcription of dna being one of the most critical stages . specific configurations of transcription factors ( tfs ) that interact with gene promoter regions are recruited to activate or modulate the production of a given transcript . many of these tfs possess the ability to recognize a small set of genomic sequence footprints called tf - binding sites ( tfbss ) . these motifs are typically 615 bp long and in some cases , they show a high degree of variability . in addition because of these flexible binding rules , computational methods for the identification of regulatory elements in a promoter sequence tend to produce an overwhelming amount of false positives . however , the identification of conserved regulatory elements present in orthologous gene promoters ( also called phylogenetic footprinting ) has proved to be more effective to characterize such sequences ( 13 ) . in fact , the ever - growing availability of more genomes and the constant improvement of bioinformatics algorithms hold great promise for unveiling the overall network of gene interactions of each organism ( 4 ) . typically , computational methods to detect regulatory elements use their own training set of experimental annotated tfbss . these annotations are usually collected from bibliography or from general repositories of gene regulation information , such as jaspar ( 5 ) and transfac ( 6 ) . however , each program establishes different criteria and formats to retrieve and display the data that forms the final training set , which makes the comparison between different methods very difficult . the construction of a good benchmark to evaluate the accuracy of several pattern discovery methods is therefore not a trivial procedure ( 7 ) . although important efforts are being carried out to standardize the construction of collections of promoter regions ( 8 ) or the presentation of experimental data ( 9 ) , there is a clear necessity to provide stable and common datasets for future algorithmic developments . in this direction , we present here the release 1.0 of the abs database constructed from literature annotations that have been experimentally verified in human , mouse , rat or chicken .

information about the genomic coordinates and the sequence of experimentally identified transcription factor binding sites is found scattered under a variety of diverse formats . the availability of standard collections of such high - quality data is important to design , evaluate and improve novel computational approaches to identify binding motifs on promoter sequences from related genes . abs ( ) is a public database of known binding sites identified in promoters of orthologous vertebrate genes that have been manually curated from bibliography . we have annotated 650 experimental binding sites from 68 transcription factors and 100 orthologous target genes in human , mouse , rat or chicken genome sequences . computational predictions and promoter alignment information are also provided for each entry . a simple and easy - to - use web interface facilitates data retrieval allowing different views of the information . in addition , the release 1.0 of abs includes a customizable generator of artificial datasets based on the known sites contained in the collection and an evaluation tool to aid during the training and the assessment of motif - finding programs .

livestock animals are subjected to a huge sort of stress factors , such as environmental conditions , animal management or diets that may disrupt the intestinal ecosystem and increase the risk of pathogenic infections . in the swine industry , transition from the liquid to a solid diet during weaning and post - weaning are critic processes due to an important decrease of feed intake , impairing animal performance , immune function , microbiota and therefore , gut homeostasis . concerning the immune system , these performance stages lead to the end of transference of passive maternal immunity from the sows to the piglets which still have an immature or developing immune system . this means that piglets become highly susceptible to intestinal pathogens such as enterotoxigenic e.coli ( etec ) or salmonella enterica ser . antibiotic growth promoters ( agps ) have been extensively used as dietary additives to minimize the risk of infections , especially during the critical periods of animal production , like weaning . however , after european ban of agps ( ec 1831/2003 ) several studies proposed the use of probiotics and prebiotics as natural alternatives to agps . in that sense , the health benefits of probiotics and prebiotics have been widely accepted as gut microbiota stabilizers because they are believed to avoid pathogenic colonization and therefore improving animal welfare . our group recently published in vitro results that demonstrated the potential of probiotic saccharomyces cerevisiae var boulardii and prebiotic -galactomannan ( gm ) to prevent intestinal infections by e.coli and salmonella in pigs . here , we aimed to extend the knowledge about the prebiotic role of gm against salmonella challenge according to its polysaccharide structure .

prebiotics and probiotics are considered natural alternatives to dietary antibiotics in animal production . plant extracts and yeast cell walls are mannose rich products that can be used as substrate for adhesion of gram - negative bacteria . we assessed whether the structure of these saccharides is relevant to develop their role as prebiotics and therefore , their suitability to be used as alternatives to antibiotics to prevent intestinal infections in pigs . the prebiotic functionality of -galactomannan ( gm ) , mannanoligosaccharide from yeast saccharomyces cerevisiae ( mannan sc ) and monosaccharide d - mannose were studied in porcine intestinal epithelial cells ( ipi-2i ) challenged with salmonella enterica ser . typhimurium . results showed that in vitro challenge with salmonella induces the secretion of proinflammatory cytokine il6 and chemokine cxcl8 compared with control without infection . both gm and mannan sc , attenuate salmonella - induced secretion of il6 and cxcl8 . interestingly , cells treated with d - mannose showed similar levels of proinflammatory il6 and cxcl8 compared with the control of infection . these data suggest that prebiotic role of gm is related to its oligosaccharide structure .

obsessive compulsive disorder ( ocd ) is a common psychiatric disorder ( 2 % - 3 % of the general population ) which is diagnosed easily most of the time by the psychiatrist or even the physician . it is sometimes very difficult to properly diagnose a person for ocd based only on an interview . the presentation of ocd may be so atypical or unusual that the patients may be referred to different specialties before the actual diagnosis can be made . neuropsychological studies have consistently found cognitive impairment in the domains of memory and attention in patients of ocd . anxiety , lack of confidence , indecisiveness , associated clinical symptoms of ocd , along with impaired memory and attention , may further complicate or interfere in the delivery of information .

obsessive compulsive disorder ( ocd ) is a common psychiatric disorder which is easily recognized . however , sometimes patients of ocd present in such an atypical or bizarre way that their problem comes to notice as being a psychiatric disorder after multiple consultations in different specialties . we are reporting a case of a man who had first sought opinion in the department of ear , nose and throat ( ent ) for hearing impairment . he was then referred to a neurologist and a general physician for evaluation of neurological cause of his symptom . as no pathology related to ent or neurology could be detected , he was referred to the department of psychiatry . the patient 's chief complaints were difficulty in hearing and inability to understand at once . he could be diagnosed as a case of ocd after meticulous evaluation and studying his response to treatment . there was significant improvement in all the presenting symptoms over a period of 6 weeks on 60 mg of fluoxetine .

helicobacter pylori is the most common chronic bacterial infection in humans , affecting 50 % of the world population . chronic colonization increases the risk of duodenal ulcer and gastric cancer , including adenocarcinoma and mucosa associated lymphoid tissue ( malt ) lymphoma . the relative risk of gastric carcinoma in infected persons is 2.3 to 8.3 times greater than that in normal population . according to the world health organization ( who ) classification , h. pylori has been classified as group i carcinogens . although family members are the most likely source of infection , the factors that make some people more susceptible to infection have not been determined . it has been suggested that infection with this organism starts in infancy , and most cases occur before the age of three . the mechanism of transmission of this organism is unknown , but the most likely route of transmission is fecal - oral or oral - oral . the prevalence of h. pylori infection is much higher in developing countries . in children , the risk factors for h. pylori infection include socioeconomic status , number of siblings , race / ethnicity , rural residence , institutional residence , lack of maternal education and infection status of family members . the protective effect of breast milk and its beneficial effects in preventing respiratory infections and diarrhea have long been known . several studies have suggested that breastfeeding can also prevent bacterial colonization of h. pylori during childhood . however , other studies had conflicting results and the importance of breastfeeding in the prevention of h. pylori is still under question . in fact , there are studies that have reported that breastfeeding may even increase the risk of h. pylori infection . breast milk may be infected by h. pylori and horizontal infection through breastfeeding may occur . we conducted the present study to evaluate the effects of breastfeeding on h. pylori infection in kurdish children in sanandaj , ir iran , by using the h. pylori stool antigen test ( hpsa ) . sanandaj is the center of kurdistan province , in west iran , with a population of about 450000 . a previous study has detected a high prevalence of h. pylori in children in this city .

objective : helicobacter pylori ( h. pylori ) is the most common chronic bacterial infection in humans . chronic colonization increases the risk of duodenal ulcer and gastric cancer . the risk factors for acquiring the infection have been extensively studied . however , there are conflicting results on the role of breastfeeding in the prevention of h. pylori infection . we conducted a study to evaluate the effects of breastfeeding on the h. pylori infection in kurdish children in sanandaj , ir iran.methods : a historical cohort study was carried out from january 2011 through december 2012 . totally 221 children who were going to attain 2 years old during the study period were randomly enrolled . they were divided into two groups , i.e . breastfed and non - breastfed . we used h. pylori stool antigen test to detect infection in the selected group of children after age of 2 years and cessation of breastfeeding . each group was subdivided into two subgroups , infected and non - infected . the associations of breastfeeding with h. pylori infection was assessed using statistical software.findings : we found no difference in the odds of infection between breastfed and non - breastfed groups ( or=0.809 , 95 % ci [ 0.4531.444 ] ) . an association between age and the prevalence of infection was found ( p=0.008 ) . there was an increase in the odds of infection as the family size grew ( or=1.93 , 95 % ci [ 1.043.6 ] ) as well as increasing housing density ( or=2.12 , 95 % ci [ 1.104.10 ] ) .conclusion : the data suggests that breastfeeding in infancy does not protect against h. pylori infection for long duration among studied children in iran . the protective effects of breastfeeding , if any , are at most transient .

chronic sialadenitis is one of the major disorders that can cause salivary hypofunction and correct diagnosis and management is essential for its recovery . the classification of this pathological condition has changed in the past decade and nowadays was revised and modified , for new diagnostic ( high - resolution ultrasonography , ct and mr sialography and sonoelastography ) and therapeutic methods ( sialendoscopy ) were introduced . sialolithiasis is the most common cause of inflammatory diseases of large salivary glands and occurs in about 1.2 % of the population [ 9 , 21 ] mostly in the submandibular gland87 % . salivary gland stones are single or multiple , located in the efferent duct distally or proximally , rarely occur intraparenchymally , representing various shapes and sizes . the annual increase in size of salivary stones is estimated at 1 mm , and thus the duration of complaints history is crucial for treatment planning . contemporary achievement in endoscopy caused strong common belief that stones of up to 45 mm in diameter can be successfully removed through sialendoscopy ( se ) . this applies especially to stones which lie freely in the lumen of the duct and are mobile . in these cases , the stones can be extracted under endoscopic control in more than 80 % of cases [ 8 , 9 , 14 ] . larger sialoliths may , however , be fragmented in the lumen of the duct , either mechanically or using a laser beam . lithotripsy ( eswl ) is another possibility for the fragmentation of large sialoliths of any size and location ; although up to three sessions of lithotripsy may be required . thus , the introduction of sialendoscopy has significantly reduced the number of submandibular glands removal in the course of sialolithiasis [ 5 , 6 , 8 , 9 , 14 , 17 ] . according to literature data , the use of lithotripsy is effective in 75 % of cases , and in turn , allows for the complete retrieval of stones in half of the cases [ 2 , 3 , 6 , 7 , 22 ] . the number of successes in the use of lithotripsy clearly decreases with increase in the stone diameter . despite notable technological progress , 510 % of patients with sialolithiasis can not be successfully treated using minimally invasive techniques . the main cause appears to be the large size of the stones and long - standing history of recurrent inflammations , which lead to the impaction of the sialolith to the wall of the efferent duct . in these cases , the aim of the study was to analyze the trends in the treatment methods in submandibular sialolithiasis in the past decade , the effectiveness of particular methods and to present treatment schedule proposed by the authors .

our research was conducted to determine the algorithm changes during the treatment of submandibular sialolithiasis . two time periods were compared between 20042008 and 20092012 . the turning point was december 2008 , when sialendoscopy procedure was introduced . in the first period , 48 patients were treated : 31 outpatient duct incisions with stone evacuation and 17 surgical excision of submandibular gland . in the second period , 207 sialendoscopy procedures were performed on 197 patients . out of this particular group , 158 patients were diagnosed with pathological obstruction of salivary glands and 64 of them were confirmed to have sialolithiasis of submandibular gland . deposits of calcifications in 40 individuals ( 62.5 % ) affected by sialolithiasis were removed endoscopically ; however , in 21 patients , due to the increased circumference of the stone , the intimate association of deposits within the wall of the duct along with its presence inside the deep portions of the gland , double approach ( incision of the floor of the mouth in hilar area and sialendoscopy ) was performed . three individuals had their salivary glands totally removed due to the presence of calcified deposits within the glandular parenchyma . our results allow us to affirm that sialendoscopy is the current treatment of choice for submandibular glands affected by sialoliths . indication for a complete removal of the gland is becoming uncommon as a first line treatment although still indispensable in chosen cases .

diabetes mellitus ( dm ) is one of the most common chronic metabolic diseases , which is on the rise globally.123 ) the dm prevalence for all age groups worldwide was estimated to be 2.8 % in 2000 and projected to be 4.4 % by 2030 . during this period , the total number of people with dm is expected to rise from 171 million to 366 million.4 ) several explanations have been provided for the increase in dm - prevalence , such as population growth , aging , urbanization , increasing obesity prevalence , and physical inactivity.5 ) diabetes poses a challenge not only to those living with the disease,6 ) but also to their families , communities , and the health care system.789 ) monitoring the dm prevalence and incidence trend is important for assessing the national burden of the disease to describe the impact of risk factors , develop interventions , and project needs for future health services.410 ) the states in the co - operation council for the arab states of the gulf ( gcc ) have some of the highest rates of type 2 dm in the world . five of the international diabetes federation 's top ten countries for dm prevalence in 2011 and projected prevalence in 2030 are in this region.11 ) the recent and rapid socioeconomic development of the gcc countries has been associated with this rising prevalence.12 ) according to the international diabetes federation , the number of people with dm in its middle east - north africa region will increase to 83 % by 2030.11 ) in the united arab emirates ( uae ) , the dm prevalence has reached 24 % and 17.4 % among citizens and expatriates,13 ) respectively . the dm prevalence in the uae was ranked to be the 2nd highest in the world ( 19.5 % ) in 2007 , and the expected prevalence for 2025 is 21.9 % .12 ) the uae has developed a national diabetes care continuum program with guidelines to combat this disease.13 ) based on a population study conducted in al ain , in the uae , the age - standardized prevalence rates for dm ( diagnosed and undiagnosed ) and pre - diabetes among people aged 30 - 64 years were 29.0 % and 24.2 % , respectively.14 ) no published data are available about the age - standardized incidence rates of dm in the uae . such data are important , because information on incidence will help plan specific preventive and control strategies , and will enhance our knowledge about the profile of this disease in the uae . therefore , this study was conducted to determine the age and gender specific incidence rate of dm among nationals in ajman medical district in 2010 .

backgrounddiabetes mellitus ( dm ) , particularly type-2 is a major public health concern worldwide . not much information is available with regard to the incidence of dm in united arab emirates ( uae ) . this study aimed at determining the incidence rate of diabetes mellitus among emirati population in ajman , uae . this is a retrospective cohort study.methodsthis study was conducted in all primary health care centers and shaikh khalifa and gmc hospitals , ajman , uae where the emirati population primarily go for diagnosis and treatment . the incident cases of diabetes mellitus were collected during the period 2010 january to december.resultsa total of 158 cases newly detected in 2010 , 54 were among non - emiratis and one was type-1 diabetes . eliminating these , the remaining 101 were included in the analysis . the age of the patients ranged from 23 years to 78 years ; 35 ( 34.7 % ) males and 66 ( 65.3 % ) were females . the overall incidence observed was 4.8/1,000 person - years ( py ) with a female predominance of 6.3/1,000 py against incidence among males of 3.3/1,000 py . with regard to age specific incidence rate among males , it increases with age till 60 years and then showed a decreasing trend . among females also the same trend was observed but not as similar to males.conclusionthe highest incidence rate was observed in the 55 - 59 age group among males , 23.4/1,000 py and females , 32.4/1,000 py . among males the incidence rate was much less compared to females in - the age groups older than 59 years .

it is characterized by neuropsychiatric manifestations . in minimal hepatic encephalopathy ( mhe ) , patients have alterations in sleep pattern , and there is difficulty in performing even day - to - day routine activities like driving a vehicle , doing simple calculations , and so forth [ 13 ] . initially there is a mild impairment in cognition and psychomotor skills which then progress to a gross impairment in orientation and general consciousness . these manifestations are potentially reversible , especially , if the diagnosis is made early in the course of the disease [ 4 , 5 ] . the diagnosis of minimal hepatic encephalopathy ( mhe ) is made using a battery of neuropsychometric or neurophysiological tests . the existing neuropsychometric tests include paper - pencil tests like the number connection tests a and b , the figure connection test ( fct ) , trail tracing test , block design test , digit symbol test , and the comparatively recent inhibitory control test . inaccuracies in the paper - pencil tests have been widely reported [ 7 , 8 ] . also , there is a lack of consensus on the diagnostic criteria and a limited correction for educational level and age in these studies . the fct was designed for the indian population and has been widely accepted as a sensitive test to detect mhe in illiterate individuals . however , this test assesses only a few discrete domains of impairment ( attention and psychomotor skills ) . much of the tests hitherto mentioned are seldom used in day - to - day clinical practice . more recent objective neurophysiological tests include critical flicker frequency ( cff ) and , auditory and visual evoked potentials . all these tests involve expensive specialized equipment and trained experienced personnel [ 7 , 11 ] . there is therefore a need to design an inexpensive test which would measure all the impaired domains of the mind using the same metric . we designed a test that would examine the three important domains cognition , memory , and psychomotor skills and used this test in patients with chronic liver disease to detect mhe .

background and aims . minimal hepatic encephalopathy ( mhe ) is diagnosed using neuropsychometric tests or neurophysiological tests that are either inapplicable to illiterate patient population in resource - poor settings or require sophisticated and expensive equipment . the available tests assess discrete domains of mental impairment . our aim was ( a ) to design a neuropsychometric test that measures all domains of mental impairment in mhe using one metric ; ( b ) to evaluate its sensitivity , specificity , and reproducibility . methods . the mind and liver test ( malt ) , a psychometric test assessing cognition , memory , and psychometric impairment , each on a scale of 20 , was designed keeping in mind the requirements of a universal test . 40 cirrhotics and 36 controls were subjected to critical flicker frequency ( cff ) and malt in same sitting . roc curve was plotted for malt using cff as gold standard . bland - altman plot was used to find test - retest agreement . results . cff values and malt scores varied significantly between the cases and the controls ( p < 0.05 ) . malt was 94 % sensitive and 83 % specific . using roc with cff as gold standard , the auc for diagnosis of mhe using malt score was 0.89 . test - retest agreement was high ( icc = 0.89 ) . conclusion . in this pilot study , malt proved to be highly sensitive , specific , inexpensive , and reproducible .

pseudocholinesterase ( pche ) is an enzyme with a complex molecular structure.1 it is synthesized in the liver and immediately released into the plasma.2 the plasma half - life has been estimated to be approximately 12 days.3 deficiency or reduced activity of this enzyme results in significant prolongation of mivacurium- or succinylcholine - induced neuromuscular blockade.4 in addition , a number of disease states or concomitant drug administration may reduce pche activity . mivacurium , which is a nondepolarizing neuromuscular blocking drug administered in doses of 0.1 to 0.2 mg / kg , also produces rapid onset of neuromuscular blockade lasting for 15 to 30 minutes.5 the rapid ester hydrolysis of mivacurium by pche results in the short duration of action of this drug , which is ideal for providing muscle relaxation for brief surgical procedures.6 but the duration of mivacurium of action in adults is inversely related to serum pche activity.7,8 sertraline is an antidepressant and antipanic agent that is a potent and selective inhibitor of serotonin reuptake into the presynaptic terminals . it has relatively weak effects on the cytochrome p450 system , a tolerability profile that is positive compared with antidepressants of other classes , and it is relatively safe in overdose . these findings contribute to sertraline being the first - line agent for the treatment of several psychiatric disorders.9 it was shown , however , that sertraline and other antidepressants inhibited acetylthiocholine hydrolysis by cholinesterases in human serum and erythrocyte membrane.10 in this article , we share our experience of a case with acquired pseudocholinesterase enzyme deficiency due to sertraline use , and provide a literature review .

a 47-year - old turkish male was scheduled for laparoscopic cholecystectomy under general anesthesia . the patient had 2 operations 28 and 19 years ago under general anesthesia . it was learned that the patient was administered succinylcholine during both of these previous operations and that he did not have a history of prolonged recovery or postoperative apnea . the patient had been using sertraline for 3 years before the operation . pseudocholinesterase is a drug - metabolizing enzyme responsible for hydrolysis of the muscle - relaxant drugs mivacurium and succinylcholine . deficiency of this enzyme from any cause can lead to prolonged apnea and paralysis following administration of mivacurium and succinylcholine . the diagnosis of pseudocholinesterase enzyme deficiency can be made after careful clinic supervision and peripheral nerve stimulator monitoring . a decrease in the activity of pseudocholinesterase enzyme and a decline in the block effect over time will help verify the diagnosis . our patient s plasma cholinesterase was found to have low activity . instead of pharmacological interventions that may further complicate the situation in such cases , the preferred course of action should be to wait until the block effect declines with the help of sedation and mechanical ventilation . in our case , the prolonged block deteriorated in the course of time before any complications developed .

with the aging of the population worldwide , dementia is a real public health priority . in 2000 , the estimated number of dementia cases was 25.5 million people , representing 0.4 % of the worldwide population . nearly two thirds of all people with dementia lived in low- and middle - income countries . the other most important risk factors are low level of education , heredity , low early - life economic conditions , smoking , alcohol , weak social network , hypertension , cardiovascular diseases , stroke , epilepsy , diabetes , anemia , parkinson 's disease , and head trauma . although several population - based studies were conducted in developed countries to better understand the epidemiology of this new epidemic , only a few studies have been done in africa . in senegal , the estimated number of elderly aged 65 years was 421,305 in 2008 and 420,795 in 2009 . considering the economic cost of dementia care , senegal is not able to afford such cost . it is important to have reliable information on the prevalence of dementia to plan for more accurate provision of social and medical services for the elderly population . studies on dementia in the senegalese elderly population are rare [ 20 , 21 ] . thus , a study was conducted in senegal to determine the epidemiology of dementia in an elderly population utilizing a primary health care service for retirees in dakar , senegal . the aim of the present study was to identify risk factors associated with dementia in this population of retirees utilizing the social and medical center ( smc ) of ipres ( institution de prevoyance retraite du senegal ) , dakar , senegal .

backgroundwith the aging of the population , dementia is increasing worldwide . the objective of this study was to identify risk factors for dementia in an elderly population utilizing a primary health care service in dakar , senegal.methodsthrough a cross - sectional study conducted from march 2004 to december 31 , 2005 , 507 elderly patients aged 65 years who came to the social and medical center of ipres , dakar , senegal , were first screened with the screening interview questionnaire aging in senegal . those who were cognitively impaired underwent a clinical examination to detect dementia . univariate , bivariate , and multivariate logistic regression analyses were done.resultsthe whole population had a mean age of 72.4 years ( 5.2 ) and was mostly male , married , and non - educated . hypertension , arthritis , and gastrointestinal diseases were the main health conditions reported in the past medical history . smoking was important while alcohol consumption was rare . social network was high . forty - five patients ( 8.87 % ) had dementia . in the multivariate model , only advanced age , education , epilepsy , and family history of dementia were independently associated with dementia.conclusionthe risk factors identified are also found in developed countries confirming their role in dementia . it is important to take dementia into consideration in senegal and to sensitize the community for prevention .

the national library of medicine 's ( nlm ) medline / pubmed biomedical literature database ( ) is rapidly expanding and as of the 2006 edition , the baseline database contains more than 15 million citations . a number of papers have introduced tools to perform searches more advanced than those available with the current entrez - pubmed user interface to mine the abstracts ( 14 ) . to have more control in conducting searches , investigators have also started to reorganize the medline data into structured relational systems ( 5 ) or to exploit different data formats and create new databases ( ) . these nlm citations are available in several formats ( e.g . medline , asn.1 , and so on ) . importing these citation data into a traditional , relational database limits the query capability to sql ( structured query language ) techniques . the extensible markup language ( xml ) format , however , is emerging as a de facto standard for the hierarchical organization of data in a highly granular structure , and provides a much richer query capability beyond what is available through traditional sql . oracle xml db , available in oracle 9i and 10 g , recognizes this new format . it supports both the necessary massive storage requirements and the extensions to traditional sql that enable a different kind of query which is hierarchical and highly granular . an early study using oracle xml db involved the evaluation of data - form standards and database technologies for medical informatics systems ( 6 ) ( ) . as described by wang et al . ( 6 ) , the set of utilities associated with xml db permits data to be represented both as xml elements from xml documents and as cells within relational tables . a recently developed website that includes a specialized , oracle - based resource for the clostridial neurotoxins , botdb ( 7 ) ( ) , has been extended to conduct literature searches of medline / pubmed using botxminer . the application of xml db for botxminer was based , in large measure , on the documentation and thorough analysis of an original implementation using xml - formatted medline citations ( ) . an advantage offered by botxminer over pubmed is that it can make certain queries possible that can not be performed using the entrez - pubmed interface . the practical example herein illustrates how citations , containing user - supplied search terms , selected medline search fields and terms , are grouped and displayed as hyperlinked tabulated or graphic results . a more detailed technical description of the architecture associated with botxminer and

this paper outlines botxminer , a publicly available application to search xml - formatted medline data in a complete , object - relational schema implemented in oracle xml db . an advantage offered by botxminer is that it can generate quantitative results with certain queries that are not feasible through the entrez - pubmed interface . after retrieving citations associated with user - supplied search terms , medline fields ( title , abstract , journal , mesh and chemical ) and terms ( mesh qualifiers and descriptors , keywords , author , gene symbol and chemical ) , these citations are grouped and displayed as tabulated or graphic results . this work represents an extension of previous research for integrating these citations with relational systems . botxminer has a user - friendly , intuitive interface that can be freely accessed at .

lymphangioma circumscriptum ( lc ) or microcystic lymphatic malformation is a hamartomatous malformation of the lymphatic channels of the skin . treatment of lc is difficult because of the persistent nature of the disease due to deeper subcutaneous cisternal connections . we report here a case of lc treated effectively with radiofrequency ablation without any recurrence .

lymphangioma circumscriptum ( lc ) , a hamartomatous lymphatic malformation , is a therapeutic challenge for the dermatologist . various modalities like surgical excision , lasers , and sclerotherapy have been used in the past to treat this notorious skin condition . we report the efficacy of a radiofrequency ablation in a patient with lc . the treatment efficacy of radiofrequency was satisfactory in our patient with no recurrence during 1 year follow - up period . the radiofrequency technique is a safe and economic treatment for management of lc .

spinal epidural hemangiomas have been reported in the literature , but most of them were cavernous type hemangiomas that enable a preoperative differential diagnosis with relative ease . the limited number of spinal epidural hemangiomas and few radiological findings make an exact diagnosis difficult prior to surgery . a high vascularization of spinal epidural hemangiomas may result in an unexpected surgical situation in the case of preoperative misinterpretation . in the current case ,

a spinal epidural hemangioma is rare . in this case , a 51 year - old female patient had low back pain and right thigh numbness . she was initially misdiagnosed as having a ruptured disc with possible sequestration of granulation tissue formation due to the limited number of spinal epidural hemangiomas and little - known radiological findings . because there are no effective diagnostic tools to verify the hemangioma , more effort should be put into preoperative imaging tests to avoid misdiagnosis and poor decisions ) .

numerous investigators have reported improved function , reduced pain , and high rates of implant survivorship at up to 20 years followup [ 4 , 29 ] . however , concerns about limitations in implant longevity related to the osteolysis associated with metal - on - polyethylene ( m - pe ) bearing surface wear have led to innovation in tribology [ 10 , 15 , 16 ] and the introduction of new tha bearing couples over the past decade . in particular , second - generation hard - on - hard bearings , including metal - on - metal ( m - m ) and ceramic - on - ceramic ( c - c ) , have been introduced into the us market based on laboratory studies showing lower wear rates when compared with m - pe bearings [ 9 , 10 , 15 ] . lower wear rates associated with hard - on - hard bearings are likely to have the biggest impact on revision rates in younger , more active patients , who are at higher risk for wear - related failures [ 3 , 12 , 17 , 18 , 27 ] . the long - term benefits of more costly hard - on - hard bearings are less obvious in older patients , who are at lower risk for wear - related failures . however , a potential benefit of m - m bearings is the ability to use large diameter femoral heads , which theoretically could result in a lower short - term risk of dislocation when compared with m - pe bearings . this potential benefit could be particularly advantageous in older patients who are reportedly at higher risk for tha dislocation [ 5 , 25 , 28 ] . however , that study employed a cross - sectional study design , and due to the nature of the database used ( the nationwide inpatient sample ) , we were unable to compare longitudinal patient outcomes and differences in the risks of complication and revision tha among patients with different tha bearings . the purpose of this study was to compare the short - term risk of complication and revision tha among medicare patients having a primary tha with m - pe , m - m , and c - c tha bearings .

backgroundto address the long - term problems of bearing surface wear and osteolysis associated with conventional metal - polyethylene ( m - pe ) total hip arthroplasty ( tha ) , metal - metal ( m - m ) , and ceramic - ceramic ( c - c ) bearings have been introduced . these bearing surfaces are associated with unique risks and benefits and higher costs . however the relative risks of these three bearings in an older population is unknown.questions/purposeswe compared the short - term risk of complication and revision tha among medicare patients having a primary tha with metal - polyethylene ( m - pe ) , metal - metal ( m - m ) , and ceramic - ceramic ( c - c ) bearings.methodswe used the 2005 to 2007 100 % medicare inpatient claim files to perform a matched cohort analysis in three separate cohorts of tha patients ( m - pe , m - m , and c - c ) who were matched by age , gender , and us census region . multivariate cox proportional - hazards models were constructed to compare complication and revision tha risk among cohorts , adjusting for medical comorbidities , race , socioeconomic status , and hospital factors.resultsafter adjusting for patient and hospital factors , m - m bearings were associated with a higher risk of periprosthetic joint infection ( hazard ratio , 3.03 ; confidence interval , 1.029.09 ) when compared with c - c bearings ( 0.59 % versus 0.32 % , respectively ) . there were no other differences among bearing cohorts in the adjusted risk of revision tha or any other complication.conclusionsthe risk of short - term complication ( including dislocation ) and revision tha were similar among appropriately matched medicare tha patients regardless of bearing surface . hard - on - hard tha bearings are of questionable value in medicare patients , given the higher cost associated with their use and uncertain long - term benefits in older patients.level of evidencelevel ii , prognostic study . see guidelines for authors for a complete description of levels of evidence .