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a pulmonary nodule is defined as a spherical well - circumscribed radiographic opacity that is surrounded completely by aerated lung . lesions that are larger than 3 cm are described as lung masses . as size has been shown to be important for classification of nodules ( see below ) the term micronodules is usually applied to very small nodules ( < 7 mm , < 5 mm ) which are almost always multiple and diffuse . if only one pulmonary nodule is detected , it is described as a solitary pulmonary nodule ( spn ) . if a nodule is detected in an examination performed for other reasons than a search for pulmonary nodules , it is called an incidental nodule , .

abstractthis article describes the aetiology , epidemiology and clinical significance of incidental non - solid pulmonary nodules . non - solid nodules are more likely malignant . if malignant , they are mostly due to atypical adenomatous hyperplasia and bronchioloalveolar carcinoma . as these may be negative on positron emission tomography and slow growing , the diagnostic algorithms that are used for solid nodules have to be modified for non - solid nodules .

hemorrhage from pelvic blood vessels after trauma or obstetric delivery are major health care problems . trauma is a leading cause of death worldwide and a major cause of lost quality - adjusted life years ( qalys ) . treatment of pelvic trauma is difficult since hemorrhage can be massive and it is difficult to apply direct pressure to the bleeding vessels . postpartum hemorrhage is the leading cause of obstetric deaths and causes an estimated 150,000 maternal deaths per year . definitive control of severe pelvic bleeding from any cause often requires aggressive measures such as arterial embolization , laparotomy , internal fixation , or pelvic packing . these procedures are difficult to perform because they require immediate access to sophisticated medical and surgical expertise and equipment . blood volume must be maintained by transfusion of red blood cells , platelets , and clotting factors . this could provide time to mobilize more sophisticated resources and might decrease transfusion requirements and the need for aggressive therapy . pneumatic anti - shock garments ( pasg ) , also called medical or military anti - shock trousers ( mast ) , have been shown to greatly decrease pelvic blood flow [ 2 , 3 ] , and case reports imply that they are effective in patients with pelvic injuries and postpartum hemorrhage . however , most of the patients enrolled in clinical trials had thoracic or abdominal trauma and had ready access to definitive surgery . they only autotransfuse about 250 cc of blood from the lower body into the central circulation and have little or no effect on cardiac output . these findings would explain differing outcomes for upper body versus pelvic hemorrhage . in their favor pasg unfortunately pasg are complicated , expensive , and rarely available in the low resource areas where they would seem most useful . a simple and less expensive alternative to pasg this non - pneumatic anti - shock garment ( nasg ) is made of neoprene and is tightly applied to the patient using velcro straps . it has been commercialized as the zoex non - inflatable anti - shock garment ( zoex , ashland , or , usa ) . the nasg has been shown to decrease postpartum blood loss by 50 % [ 8 , 9 ] and improve survival rates from postpartum hemorrhage . we measured pelvic blood flow in volunteers before and after being placed in the nasg and pasg .

backgroundpelvic bleeding from trauma and postpartum hemorrhage is often difficult to treat successfully by emergency providers particularly in low resource environments , when hospital presentation is delayed or there is a lack of immediate surgical , anesthesia , and transfusion capabilities . pneumatic anti - shock garments ( pasg ) decrease pelvic blood flow and hemorrhage . a tightly fitted neoprene non - pneumatic anti - shock garment ( nasg ) has been shown to decrease blood loss and improve survival rates from postpartum hemorrhage.aimsthe objective of this study was to determine whether blood flow to the pelvis is decreased by use of the nasg or by an improvised pasg.methodsa pasg was made using three bicycle tubes , placing one tube on each leg and one on the lower abdomen / pelvis , wrapping firmly with sheets and inflating the tubes to approximately 3.5 bar ( 45 psi ) . a doppler ultrasound was used to measure distal aortic blood flow in 12 healthy adults at baseline and in both devices . data were analyzed with one sample and paired t tests.resultsmean flow was 1.99 l / min at baseline . mean flow decrease was 1.11 [ 95 % confidence interval ( ci ) : 0.641.57 , p = 0.0003 for the difference ] for the pasg and 0.65 ( 95 % ci : 0.031.26 , p = 0.04 ) for the nasg . the pasg decreased blood flow more than the nasg ( mean difference : 0.46 , 95 % ci : 0.020.90 , p = 0.04 ) .conclusionsboth devices decreased distal aortic blood flow , but the improvised pasg device decreased it by a larger margin .

clinical presentations vary from nonspecific systemic symptoms ( e.g . , fever , myalgia , palpitation , chest pain , dyspnea ) to fulminant hemodynamic collapse and sudden death . infections ( viral , bacterial , fungal , protozoal , parasitic ) , toxins , immunological syndromes , and hypersensitivity can cause myocarditis . among these lewin et al . reported that seven explanted hearts from 288 heart transplants ( 2.4 % ) had histological evidence of hypersensitivity myocarditis . unlike other forms of myocarditis , the prognosis of hypersensitivity myocarditis is excellent , usually improving after administration of the causative drug is ceased . , we report a case of hypersensitivity myocarditis , as confirmed by cardiac magnetic resonance imaging ( cmr ) and endomyocardial biopsy ( emb ) , which subsequently improved after cessation of the causative drug and administration of prednisolone .

myocarditis often occurs due to viral infections and postviral immune - mediated responses . hypersensitivity myocarditis is a rare form of myocarditis . numerous drugs can induce myocarditis , which is typically reversible after withdrawal of the causative agent . here , we report a case of hypersensitivity myocarditis that was probably triggered by amoxicillin and that resolved completely with heart failure management as well as discontinuation of the drug . a 68-year - old woman presented with acute chest pain mimicking acute coronary syndromes , but the coronary angiography was normal . a recent history of taking medications , skin rash , and peripheral eosinophilia suggested a diagnosis of hypersensitivity myocarditis , which was confirmed by cardiac magnetic resonance imaging and endomyocardial biopsy .

liver cancer is the second most common cause of cancer - related death worldwide , the fifth most common cancer among men and the ninth most common cancer among women.1 hepatocellular carcinoma ( hcc ) is responsible for ~90 % of primary liver cancers.2 in the united states , hcc is the fastest rising cause of cancer - related death , and its incidence has nearly tripled since the 1980s.3,4 despite increased focus and research , the overall prognosis for hcc remains poor . curative modalities , such as liver transplant , resection and radiofrequency ablation , do exist when hcc is diagnosed early ; however , only ~15 % of patients are eligible for such treatments ( table 1 ) .3,5,6 the majority of patients are diagnosed with advanced - stage hcc , for which the median survival time is < 50 % at 1 year and only 12 % at 5 years.7,8 chemotherapy is rarely used for the treatment of hcc due to its minimal success rate of 1020 % and high levels of toxicity.2 the only therapy currently approved by the food and drug administration ( fda ) for the treatment of advanced hcc is sorafenib , a tyrosine kinase inhibitor that has been shown to decrease cell proliferation and tumor angiogenesis.9,10 while sorafenib represents a major advancement in the treatment of hcc , its effects are modest , with the sharp trial demonstrating an increase in overall survival from 7.9 months to 10.7 months and an increase from 2.8 months to 5.5 months in the median time to radiological progression.10 it demonstrated even less robust benefits in the asia - pacific trial , with overall survival in the treatment group of 6.5 months and median time to radiological progression of 2.8 months.9 furthermore , after experiencing an initial response to treatment , most hcc patients develop a decrease in efficacy with sorafenib.11 many novel therapies are currently under investigation in clinical trials . in a recently published phase iii trial , regorafenib , an oral multikinase inhibitor , has demonstrated an increase in median overall survival ( 10.6 months vs. 7.8 months ) and an increase in median progression - free survival ( pfs ; 3.1 months vs. 1.5 months ) compared to placebo in patients with advanced hcc who have progressed on sorafenib.12 to date , however , there are no fda - approved second - line or salvage therapies for those patients who progress with or are intolerant to sorafenib.13 one of the most promising new therapies under investigation is tivantinib ( arq 197 ) , which has demonstrated positive results in early - phase clinical trials as a second - line agent for multiple solid tumors .

hepatocellular carcinoma ( hcc ) is the fastest rising cause of cancer - related death in the united states and carries a very poor prognosis , with a median survival time of < 50 % at 1 year for advanced disease . to date , sorafenib is the only therapy approved by the food and drug administration for the treatment of advanced hcc . tivantinib ( arq-197 ) , a non - atp competitive inhibitor of cellular mesenchymal epithelial transcription factor ( c - met ) , has shown a survival benefit in patients with advanced hcc who have failed or are intolerant to sorafenib in phase i and ii trials . those patients who have tumors with high concentrations of met ( met - high ) appear to derive the greatest benefit from tivantinib therapy . currently , two large randomized double - blind placebo - controlled phase iii trials ( metiv - hcc [ nct01755767 ] and jet - hcc [ nct02029157 ] ) are evaluating tivantinib in patients with met - high advanced hcc , with the primary end points of overall survival and progression - free survival , respectively . this study reviews the evidence for the use of tivantinib in advanced hcc . specific topics addressed include the pharmacology , dosing , toxicity , and biomarkers associated with tivantinib use .

there is evidence corroborating the relationship of vascular dysfunction during the first decade of life with risk factors such as familial hypercholesterolemia and hypertension . however , the question whether or not people exposed to cigarette smoke also develop these dysfunctions remains controversial . numerous studies have been conducted on adults exposed to passive smoking , particularly partners of smokers , and various aspects of cigarette smoke on these individuals have been evaluated [ 2 , 3 , 4 , 57 ] . however , only a few limited studies have addressed the issue of children exposed to passive smoke and the consequences on their blood pressure . [ 8 , 9 , 10 , 11 ] parental smoking affects children and neonates , and is associated with low birth weight , sudden infant death , asthma , bronchitis , pneumonia , otitis media , increased risk of contracting tuberculosis on exposure , crohn s disease , learning disorders , development retardation and dental caries . nevertheless , it is not yet clear whether children exposed to passive smoke develop vascular dysfunction or major changes in blood pressure . since the impact of cigarette smoke on children s blood pressure will provide yet another logical reason for parents to quit smoking or avoid smoking in the presence of their children , we have conducted this study to assess this relationship .

objectivemany diseases form their basis during childhood . one example is the changes in vascular structure and function , leading to atherosclerosis . in this study , we have assessed the impact of exposure to cigarette smoke on blood pressure of elementary school children in kermanshah.methods80 elementary school children exposed to cigarette smoke and 80 not exposed to smoke were studied in fall 2010 . information regarding the smoking status of parents and the children s health were obtained through questionnaires completed by parents . after physical examination and exclusion of those children with acute and chronic diseases as well as those consuming medicine , we measured and compared blood pressure in the exposure and non - exposure groups . data were analyzed using the anova statistical test . values are expresses as meansd.findingsthe mean systolic and diastolic blood pressures of the exposure group were higher than those of the non - exposure group ( 109.39.97/64.927.36 vs105.478.98/62.57.01 , respectively ; ci : 0.95 , p < 0.05 ) . meanwhile , difference between two groups according to sex was not statistically significant.conclusionour study indicates that systolic and diastolic blood pressures are higher in those elementary school children exposed to cigarette smoke compared to those who are not .

gastroesophageal reflux disease ( gerd ) is one of the most frequently occurring benign functional disorders in western industrial countries . the effectiveness of laparoscopic antireflux surgery for recalcitrant gerd has been clearly demonstrated in several series . these laparoscopic results , in combination with a shorter hospital stay and a more rapid return to normal activities , have promoted the emergence of minimally invasive antireflux surgery as the method of choice for the operative management of gerd . antireflux surgery has a higher failure rate in mo , which is in direct relation to high body mass index . the increased intraabdominal pressure and the morbid obesity - related comorbidities lead to a higher failure rate of the standard antireflux procedures in this group of patients . over the past 40 years , surgery has become the most effective long - term treatment for morbid obesity . the national institutes of health during their consensus development conference on gastrointestinal surgery for morbid obesity in 1991 recognized the role of bariatric surgery in the treatment of highly selected , well - informed , motivated patients who are acceptable operative risks and fail or are likely to fail a medical weight loss program . bariatric operations allow for substantial weight loss , extended weight maintenance , and control or reversal of obesity - related health problems . several series have now reported that lrygbp improves gerd symptoms , but few have included standardized quality of life tools . the objective of this study was to evaluate the efficacy of lrygbp as an antireflux procedure on gerd - related symptoms in morbidly obese patients by using a heart - burn - related quality of life score and other standardized outcomes tools .

background and objectives : gastroesophageal reflux disease ( gerd ) is commonly associated with morbid obesity ( mo ) . antireflux surgery has a higher failure rate in mo and addresses only one of the comorbidities present . this paper reviews the results of laparoscopic rouxen - y gastric bypass ( lrygbp ) performed for recalcitrant gerd in mo.methods : patients with recalcitrant gerd and a body mass index ( bmi ) > 35 undergoing lrygbp were included . lrygb included crural repair , creation of a small gastric pouch ( 30 ml ) , and intestinal bypass ( 150 to 180 cm ) . all patients were followed in clinic and by telephone.results : from february 1999 to april 2001 , 57 patients ( 51 f , 6 m ) with a mean age of 43 ( range , 22 to 67 ) and a median bmi of 43 underwent lrygbp . hiatal hernia or esophagitis , or both , were present in 48 , barrett 's in 2 . lrygbp was possible in 52 patients ; 5 required open conversion . the median hospital stay was 3 days . complications included 1 leak , 1 pulmonary emboli , 2 reoperations for internal roux limb hernia , and 7 gastrojejunal strictures . at a mean follow - up of 18 months ( range , 3 to 30 ) , all patients report improvement or no symptoms of gerd and a mean weight loss of 40 kg ( range , 16 to 70 ) . quality of life scores ( sf-36 ) were above national norms for physical and mental components ( median 55 , norms=50 ) . gerd - health related quality of life median score was < 1 ( scale , 0 to 45 , 0=asymptomatic , 45=worse ) .conclusion : lrygbp was effective for recalcitrant gerd in mo . lrygbp also led to weight loss and improvement in other comorbidites . surgeons with minimally invasive expertise should consider lrygbp for treatment of gerd in the morbidly obese .

acute epidural hematoma ( edh ) accounts for 2.7 % to 11 % of traumatic brain injuries ( tbis ) , and if the size is large , the disease leads to devastating results.1712 ) generally , a small edh does not cause neurological deficits , and it has a good prognosis . however , if an initially small edh suddenly expands , the patient 's condition may deteriorate quickly.2813 ) this may cause death or a serious neurological disorder in a patient , and thus , it always requires attention and quick action . so far , much of the literature has reported on the expansion of acute edh , and most types have been analyzed , including asymptomatic hematoma expansion found in the follow - up of computed tomography ( ct ) .5111719 ) the change of the hematoma in edh treatment - not only the change of radiologic imaging size but also the degree of expansion of the hematoma leading to operation - is important . thus , we investigated the early predictors and risk factors of hematoma expansion in patients who underwent delayed surgery when their neurological condition worsened due to the expansion of the hematoma during the conservative treatment of edh .

objectivea small epidural hematoma ( edh ) that has been diagnosed to be nonsurgical by initial brain computed tomography ( ct ) can increase in size and need surgical removal , resulting in a poor prognosis . however , there have been few studies , which focused delayed operated edh . therefore , we analyzed the clinical factors to determine the predicting factors of delayed operated edh.methodsbetween january 2011 and january 2014 , 90 patients , who were admitted due to edh , were enrolled in this study . none of the patients were indicated for operation initially . based on the presence of surgery , we classified the patients into a delayed - surgery group ( dg ) and a non - surgical group ( ng ) . additionally , we analyzed them according to the following : time interval between the trauma and the initial ct , gender , age , medical history , drinking , change of mean arterial pressure ( map ) , volume of edh and other traumatic brain lesion.resultsamong the 90 patients , the dg was 19 patients . compared with ng , the dg revealed increased map , less presence of drinking , and a short time interval ( dg vs. ng : + 9.684 mm hg vs. -0.428 mm hg , 5.26 % vs. 29.58 % , 1.802 hours vs. 5.707 hours , respectively , p < 0.05 ) . analyzing the time interval with receiver operating characteristic , there was 88.2 % sensitivity and 68.3 % specificity at the 2.05-hour cut - off value ( area under the curve=0.854 ) .conclusionaccording to our results , the time interval between the trauma and the initial ct along with blood pressure change are potential predicting factors in the cases of delayed operation of edh .

duodeno - duodenal intussusception , which involves the distal invagination of a segment of the duodenum , is a rare condition owing to the retroperitoneal fixation of the duodenum , which is sometime absent in cases of intestinal malrotation . the vast majority ( 8090 % ) of cases of intestinal intussusception are secondary to pathological masses in the intestine , such as brunner s gland hamartomas , lipomas and adenomas . the presence of a duodenal membrane may cause retention of food resembling a pathologic mass , which may in turn facilitate intussusception . we describe the interesting case of a patient with intestinal malrotation who developed acute pancreatitis as a result of a duodenal intussusception involving the head of pancreas which was caused by a duodenal membrane . other symptoms include gastro - oesophageal reflux , weight loss , fatigue , anaemia due to iron deficiency ; pancreatitis due to obstruction of the outlet duct has also been described [ 36 ] . owing to the intermittent nature of the symptoms delay in diagnosis

highlightsintussusception is not always seen on ultrasonography but can revealed by a ct-scan.any child , and especially those with previous congenital disorders , must undergo upper gi- endoscopy at the presence of intermittent upper gastrointestinal symptoms as vomiting , abdominal pain and gastro - oesophageal reflux , to exclude upper gi anomaly .

it is characterized by autoantibodies that target against liver - specific and non - organ - specific antigens ( 1 ) . corticosteroids , especially prednisone or prednisolone ( pd ) , have been the key drugs of initial antiinflammatory and immuno - suppressive therapy of autoimmune hepatitis in children ( 2 ) . however , it is well known that long - term use of corticosteroid is associated with the risk of steroid - induced toxicities , and this requires newer immunosuppressive agents for the treatment of autoimmune hepatitis , especially in growing children . we report on the case of a 11-yr - old korean girl with type-1 autoimmune hepatitis who discontinued pd due to steroid - induced toxicities , but who remained in biochemical and clinical remission while undergoing deflazacort and ursodeoxycholic acid ( udca ) combination therapy .

prednisone or prednisolone are the mainstay drug treatments for autoimmune hepatitis in children . however , long - term use of corticosteroid is associated with the risk of steroid - induced toxicities , and this situation requires newer immuno - suppressive agents for the treatment of autoimmune hepatitis , especially in growing children . an 11-yr - old korean girl with type-1 autoimmune hepatitis discontinued prednisolone due to toxicities , i.e . , hirsutism , buffalo hump , and skin striae , and remained clinical and biochemical remission under replacement of deflazacort and ursodeoxycholic acid combination therapy . a follow - up liver biopsy after 19 months of deflazacort and ursodeoxycholic acid treatment showed histologic remission .

congenital mitral valve anomalies are very rare clinical entities involving one or more components of the mitral valve apparatus . the majority of these abnormalities are causing mitral valve insufficiency and commonly presenting in the early part of life . common clinical presentations include left ventricular outflow tract obstruction , valvular insufficiency and heart failure . we report a rare and unique case of congenital mitral valve anomaly associated with anomalous coronary artery in a middle age man who presented with stroke .

a 55-year - old male presented with stroke . transesophageal echocardiogram and cardiac computed tomography revealed an unrecognized congenital malformation of the anterior mitral leaflet associated with anomalous left coronary circumflex artery , arising from the right coronary artery , diagnosed first by echocardiogram . this case represents a unique unforeseen mitral valve anomaly that might be considered as potential cardiac source of embolism . this finding broadens the spectrum of known mitral valve anomalies .

nontraumatic spontaneous intracranial hemorrhage ( ich ) causes significant morbidity and mortality throughout the world . ten to 20 % of strokes are caused by ich in western countries.6 ) over 45 years of age , ich is common,5 ) 16 ) 21 ) but rare before then . therefore , the goal of our study was to perform a descriptive analysis of ich etiology and prognostic factors in patients aged 40 years .

objectivespontaneous intracerebral hemorrhage ( ich ) in young adults is rare . the purpose of this study was to investigate causes , sites and other factors affecting the prognosis of ich in young adults aged 40 years.methodswe reviewed 39 consecutive patients diagnosed with spontaneous ich between january 2001 and june 2012 . patients with primary subarachnoid hemorrhage , previously diagnosed brain tumor bleeding , or vascular malformation were excluded . we analyzed the differences in prognostic factors such as hemorrhage location and vascular structural etiology . the outcome was measured using the glasgow outcome scale ( gos ) , and a good outcome was defined as a score of 4 or more.resultswe retrospectively evaluated 39 patients ( mean age , 33 years ; sd = 6.4 , range 17 to 40 years ) . the most common structural etiology was arteriovenous malformation . a statistically significantly higher proportion of patients with good outcomes had a lower initial systolic blood pressure ( sbp 160 mmhg , p = 0.036 ) , a higher initial glasgow coma scale ( gcs ) ( 9 or more , p = 0.034 ) , lower cholesterol levels ( < 200 mg / dl , p = 0.036 ) , and smoking history ( at discharge , p = 0.008 ; 6 months after discharge , p = 0.019 ) .conclusionin this study , cryptogenic ich was the leading cause of spontaneous ich . a gcs score of 9 or more on admission , a lower serum cholesterol level ( < 200 mg / dl ) , and a lower sbp ( < 160 mmhg ) predicted a good outcome .

hyponatraemia is the most commonly encountered electrolyte abnormality in hospitalised patients particularly in the intensive care unit ( icu ) . in a post - surgical icu , the syndrome of inappropriate secretion of antidiuretic hormone ( siadh ) is a frequent cause for hyponatraemia . vaptans , a new group of vasopressin receptor antagonists , are increasingly being used for the treatment of euvolaemic , hypervolaemic forms of hyponatraemia . conivaptan is now gradually becoming the most popular drug among the vaptans for correction of this condition in the icu . this is administered as an initial intravenous ( iv ) bolus followed by an infusion , which may be continued for days . in this study , we aimed to assess the effectiveness of a single dose iv conivaptan for correction of hyponatraemia in post - operative icu patients .

background and aims : conivaptan , a vasopressin receptor antagonist , is commonly used for the treatment of euvolaemic , hypervolaemic hyponatraemia . usually , an intravenous ( iv ) bolus followed by infusion is administered for many days . we decided to assess the effectiveness of single dose conivaptan for correction of hyponatraemia in post - operative patients.methods : this was a prospective , randomised trial conducted in 40 symptomatic post - operative intensive care unit ( icu ) patients with a serum sodium level of 130 meq / l . group a patients received iv conivaptan 20 mg over 30 min , whereas in group b infusion of 3 % hypertonic saline was started as an infusion at the rate of 2030 ml / h . serum sodium levels were measured at 12 , 24 , 48 and 72 h and the daily fluid balance was measured for 3 days . the chi - square test , wilcoxon signed rank test and mann - whitney tests were used as applicable.results : the serum sodium levels before initiating treatment were comparable between groups . however , subsequent sodium levels at 12 , 24 and 48 h showed significantly high values in group a. though at 72 h the mean sodium value was high in group a , it was not statistically significant . group a showed a significantly high fluid loss on day 1 , 2 and 3 . the mean volume of hypertonic saline required in group b showed a steady decline from day 1 to 3 and only 13 patients required hypertonic saline on the 3rd day.conclusion : single dose conivaptan is effective in increasing serum sodium levels in post - operative icu patients up to 72 h associated with a significant negative fluid balance .

child abuse is defined as any physical or emotional injury which causes harm or substantive risk of harm to the child 's health or welfare . it includes sexual abuse , neglect , or being physically dependent upon an addictive drug at birth . types of child abuse , include physical abuse , emotional abuse and neglect , healthcare neglect ( medical and dental ) , physical neglect , sexual abuse , failure to thrive , safety neglect , intentional poisoning , and munchausen syndrome by proxy ( fabricated or induced illness by parent ) . factors contributing to abuse include stress [ 35 ] ( e.g . life crises such as unemployment or homelessness ) , lack of a support network , substance / alcohol abuse , learned behavior ( many abusers were previously victims ) , and other forms of family violence in the home such as spousal or elderly abuse . [ 69 ] craniofacial , head , face , and neck injuries happen in more than half of the cases of child abuse . although the oral cavity is a frequent point of sexual abuse in children , obvious oral injuries or infections are rare . the american academy of pediatric dentistry defined dental neglect as the willful failure of a parent or guardian to seek and follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection . indeed , many dentists who regularly treat children assert that management of dental neglect is part of daily practice . however , based on the literature , dentists feel unprepared to play a child protection role and are unsure what to do if they suspect that a child has been maltreated . [ 1215 ] the aim of this study was to provide data on prevalence and factors of orofacial lesions relating child abuse in iran to lend evidence to support preventing child abuse .

background : family violence , including child abuse , neglect , and domestic violence , is a public health problem . the aim of this study was to provide data on prevalence and factors of orofacial lesions relating child abuse in iran to lend evidence to support preventing child abuse.materials and methods : the overall approach was a case - note review of children having child abuse note , recording by personnel of social services . research ethical approval was sought from the central social service organization . this study was conducted in isfahan , iran ( 2011 ) .result : the mean age of children , when abuse had been occurred was 8 years ( sd = 1.68 ) , and there were approximately an equal number of boys and girls . children had a high physical experience ( 66.1 % ) .of these children , at least 60 % sustained trauma to the face and mouth . emotional abuse was 77.1 % , neglect was 64.1 % , and lower experience of sexual abuse which was 4.1 % . there was a strong relationship between gender and abuser which shows girls have been affected by stepfathers ( p = 0.001 ) .conclusion : preliminary data suggest that there are strong evidence regarding the incidence of child abuse relating orofacial lesions which dentists should be aware of them . future trials may draw on these useful baseline data to help their study design .

oncocytes are observed in lesions of several organs such as the thyroid , kidney , pancreas , ovary , liver , and salivary gland . in the salivary glands , oncocytes are known to arise in warthin tumor , oncocytoma , oncocytic carcinoma , and oncocytosis . oncocytosis is a rare non - neoplastic lesion that is classified as diffuse oncocytosis and multifocal adenomatous oncocytic hyperplasia ( maoh ) ; it comprises approximately 0.1 % of salivary gland lesions [ 3 , 4 ] . the correct cytological diagnosis of oncocytosis can be difficult because oncocytes are seen in a variety of other salivary gland lesions , and it is usually diagnosed by histological examination [ 5 , 6 , 7 , 8 ] . here

multifocal adenomatous oncocytic hyperplasia ( maoh ) is a non - neoplastic lesion that is classified as oncocytosis . maoh is a rare entity of the parotid gland and accounts for approximately 0.1 % of salivary gland lesions . here , we report a case of maoh of the parotid gland . the patient was a 71-year - old woman who presented with discomfort at the left side of her neck . fine - needle aspiration cytology of the parotid gland revealed a loose sheet - like cluster of round to polygonal cells with granular cytoplasm against a hemorrhagic background . the cells had round to oval , centrally located nuclei with granular chromatin and without distinct nucleoli . histologically , the lesion was formed of many variable - sized nodules , comprising oncocyte - like cells with small round nuclei and eosinophilic granular cytoplasm that was positive for mitochondrial antibodies . the diagnosis of maoh is difficult to make by cytology alone , because the findings overlap with those of other oncocytic lesions . in particular , the cytological findings of maoh have not been sufficiently reported to date . a correlation of cytology and histology was expected .

various methods including chemical , electro - chemical , and physical deposition techniques have been employed to synthesize 1d zno nanostructures [ 3 - 5 ] . on the other hand , the wet - chemical methods [ 6 - 8 ] have been used for producing varied zno one - dimensional ( 1d ) nanostructures , such as nanotube , nanopencil , nanoneedle , and nanoscrew . recent experiments have shown that the zno 1d nanostructures have excellent field emission properties , far better than other semiconductors . an important advantage of using aligned nanorods , nanowires , nanobelts , and nanotubes for field emission is their high aspect ratio . the field enhancement factor is a key parameter which is determined by turn - on field , threshold field , and work function . also , the value of relates to the structure , shape , size , alignment , crystalline , aspect ratio , etc . . many effects , such as morphological effects , surface states , and densities of nanorods have been studied . the result showed that the zno nanoneedle arrays exhibit excellent properties due to their small emitter radius and high nanorod density remarkably reduces the local field at the emitters owing to the screening effect . wang et al . investigated the density effects on the field emission of zno nanorods and pointed out that the mezzo density of zno nanorods had the best field emission properties . but there is no report about the aspect ratio effects on the field emission properties of zno nanorod arrays . in this work , zno nanrod arrays with different aspect ratios and densities are synthesized by controlling the reaction times and concentrations of solution . the field emission properties of zno nanorod arrays with different aspect ratios and densities have been investigated for showing the enhancement factor was enhanced with increasing the aspect ratio of zno nanorods and the enhancement factor was decreased with reducing the density of nanorods . an optimum density and aspect ratio of zno nanorod arrays ( sample c )

zno nanorod arrays are prepared on a silicon wafer through a multi - step hydrothermal process . the aspect ratios and densities of the zno nanorod arrays are controlled by adjusting the reaction times and concentrations of solution . the investigation of field emission properties of zno nanorod arrays revealed a strong dependency on the aspect ratio and their density . the aspect ratio and spacing of zno nanorod arrays are 39 and 167 nm ( sample c ) , respectively , to exhibit the best field emission properties . the turn - on field and threshold field of the nanorod arrays are 3.83 v/m and 5.65 v/m , respectively . importantly , the sample c shows a highest enhancement of factor , which is 2612 . the result shows that an optimum density and aspect ratio of zno nanorod arrays have high efficiency of field emission .

the adverse consequences of the acquired immune deficiency syndrome ( aids ) or t cell immunodeficiency provide evidence of the vital role of cytotoxic t - lymphocytes ( ctl ) in the immune response . indeed , ctl are well - known elements of the immune response to virus - infected , tumour and allogeneic cells [ 13 ] . more recently , the role of ctl was expanded significantly when the ability to mediate direct killing of microbial pathogens was identified . research defining the precise mechanisms underlying ctl killing of microbes , however , is still in its infancy . remarkably , granulysin ( in contrast to granzymes ) has emerged as a fundamental mediator of microbial killing . the mode of action of granulysin appears to be through the disruption of membrane permeability . it follows that granulysin has been found to insert into the microbial membrane through ionic interactions between the positively charged amino acid residues and negatively charged phospholipids . insertion of granulysin in turn disrupts membrane permeability resulting in the influx of fluid into the cytoplasm and death by osmotic lysis . other mechanisms identified in the killing of tumor cells may also play a role , including ca influx and k efflux , and activation of a sphingomyelinase associated with the cell membrane to generate ceramide . ctl killing of extracellular pathogens involves direct microbial recognition by the ctl ( figure 1 ( a ) ) . in contrast to tumour and virus - infected cells , recognition of extracellular pathogens occurs through an apparent mhc - independent mechanism ( as microbes have not been found to express mhc ) . successful recognition induces the release of granulysin which may directly bind and kill the microbe . in the case of intracellular microbes these interactions , like recognition of tumor and virus - infected cells , are often mhc - restricted and antigen - specific . binding triggers the release of granulysin , which must enter the infected host cell for microbial killing to occur ( figure 1 ( b ) ) . this is thought to be mediated through perforin - generated pores in the host cell membrane . these pores facilitate the influx of extracellular ca which triggers the target cell to endocytose the damaged region of the membrane and internalize nearby granulysin [ 79 ] . alternatively , ctl may mediate lysis of the infected host cells releasing microbes which may then be recognized and killed by nearby ctl ( figure 1 ( c ) ) . to acquire microbicidal activity , this priming event can occur in response to cytokines such as t cell growth factors , stimulation by a mitogen , or antigen - specific responses . the receptors and signalling pathways involved in priming may be the same , but also might be quite distinct from the receptors and signalling that lead to immediate killing . following the priming event , the microbicidal ctl is then ready to receive the signal that triggers them to kill the pathogen .

cytotoxic t - lymphocytes ( ctl ) are famous for their ability to kill tumor , allogeneic and virus - infected cells . however , an emerging literature has now demonstrated that ctl also possess the ability to directly recognize and kill bacteria , parasites , and fungi . here , we review past and recent findings demonstrating the direct microbicidal activity of both cd4 + and cd8 + ctl against various microbial pathogens . further , this review will outline what is known regarding the mechanisms of direct killing and their underlying signalling pathways .

skin tissue integrity is a crucial factor to maintain the homeostasis generated through physical barriers , separating the organism from the environment . every disruption of dermal integrity triggers a complicated cascade of events , including rapid blood clot formation , inflammatory response , and wound healing , leading to the restoration of the integrity and formation of new tissue . however , repaired structures , known as scars , are nonfunctioning , tight , and tense masses of fibrotic tissue that maintain 7080 % of normal strength , with even less flexibility . inflammatory responses are necessary for wound healing , preventing multiple infection and contamination and stimulating the proliferation , revascularization , and remodeling of the extracellular matrix [ 2 , 3 ] . nevertheless , wound healing might become uncontrolled and , combined with the inflammatory response , results in massive fibrotic tissue formation called fibrosis . in this review , we will focus on the molecular mechanisms underlying skin fibrosis as a post - wound - healing pathological disorder and the impact of bone marrow - derived cells and inflammation on the formation of scars .

skin tissue scar formation and fibrosis are often characterized by the increased production and deposition of extracellular matrix components , accompanied by the accumulation of a vast number of myofibroblasts . scaring is strongly associated with inflammation and wound healing to regain tissue integrity in response to skin tissue injury . however , increased and uncontrolled inflammation , repetitive injury , and individual predisposition might lead to fibrosis , a severe disorder resulting in the formation of dense and stiff tissue that loses the physical properties and physiological functions of normal tissue . fibrosis is an extremely complicated and multistage process in which bone marrow - derived leukocytes act as both pro- and antifibrotic agents , and therefore , few , if any , effective therapies are available for the most severe and lethal forms of fibrosis . herein , we discuss the current knowledge on the multidimensional impact of leukocytes on the induction of fibrosis , focusing on skin fibrosis .

bone grafting is common in neurosurgery for spinal fusion and in orthopedic reconstruction surgery for revision hip replacement , repairing skeletal defects after a trauma , and for support when removing a tumor . three types of bone graft are used : autograft ( autologous graft ) , allograft , and alloplastic graft . an alloplastic graft is a synthetic substitute , usually created from ceramics ( calcium phosphate , calcium sulfate , or bioactive glass ) , polymer ( derivative from acrylate ) , or growth factors ( the family of bone morphogenetic proteins ) . intraoperative complications might occur and affect subsequent tissue healing , motor function recovery , and the surgical outcome . approximately 500,000 surgical site infections caused by bacteria and viruses occur every year in the united states . postoperative transmission of an infection can be devastating to the graft and the patient : it may lead to serious illness and even death . patients with a preexisting illness are at a higher risk for an infection than are those who are otherwise healthy . delayed union and nonunion fracture are two of the most common complications after orthopedic surgery , and both require additional reconstruction using bone grafts . moreover , after bone surgery , patients with an immunocompromised disease , like diabetes mellitus ( dm ) , have a greater risk of infection . two other increasing chronic infectious diseases in asia , tuberculosis ( tb ) and acquired immunodeficiency syndrome ( aids ) , may compromise the immunity of patients and relate to the incidence of bone infection . treating deep infection alternatively , a skin graft or flap might be required to improve the outcome after infection . for most patients , removing the graft might be the only way to fix the problem , because the fresh tissue may be the source or a nidus for infection recurrence . nevertheless , there is no prior study that examines the risk factors of infection after bone - grafting surgery . we examined the risk factors of infection in patients that underwent bone grafting in taiwan . data were collected from the taiwan national health insurance research database ( nhird ) ( http : //nhird.nhri.org.tw/en/background.html ) and analyzed for all patients who were admitted to hospitals from 1997 through 2012 for primary bone - grafting treatment . the incidence of recipient graft site infection in patients who underwent bone grafting , and the risk factors associated with postoperative infection , were evaluated . this is the first large national database study of the factors associated with bone - grafting surgery .

abstractbone grafting is a commonly used orthopedic surgical procedure that will provide bone formation in bone defects or regions of defective bone healing . a major complication following bone grafting is a postoperative recipient graft site infection that is associated with substantial mortality and increased use of medical resources . the purpose of the study was to identify the risk factors associated with infection after bone - grafting surgery.data from 1,303,347 patients listed in the taiwan national health insurance research database ( nhird ) and admitted to hospitals from 1997 through 2012 who underwent primary bone grafting ( mean age : 46.57 years old ; mean length of hospital stay : 8.04 days ) were analyzed . the incidence of infection by age , hospital stay , gender , income , chronic disease ( tuberculosis [ tb ] ; diabetes mellitus [ dm ] ; acquired immunodeficiency syndrome [ aids ] ) , fracture complications ( nonunion ; delayed union fracture ) , types of graft and hospital was evaluated.three percent of the patients developed a postoperative recipient graft site infection . multivariable analysis revealed that patients were more likely to develop a post bone - grafting surgery infection if they were older , had a longer hospital stay , were male , had a lower income , or had comorbid tb , dm , or aids . patients were more likely to develop an infection if they had a nonunion , an alloplast graft , or treated in a local clinic.our findings should provide a clinically relevant reference for surgeons who perform bone grafting . patients should be informed of the potential risks .

fetus in fetu ( fif ) was first described by meckel in the early 19th century , and it was defined as a mass containing a vertebral axis often associated with other organs or limbs around this central axis in 19351 ) . since then , this disease entity has been rarely reported . with advance in prenatal diagnosis techniques , more than half of the cases have been detected prenatally . in this report fif differentiating a fif from other cause of meconium peritonitis is discussed with review of literature .

fetus - in - fetu ( fif ) is a rare congenital condition in which a fetiform mass is detected in the host abdomen and also in other sites such as the intracranium , thorax , head , and neck . this condition has been rarely reported in the literature . herein , we report the case of a fetus presenting with abdominal cystic mass and ascites and prenatally diagnosed as meconium pseudocyst . explorative laparotomy revealed an irregular fetiform mass in the retroperitoneum within a fluid - filled cyst . the mass contained intestinal tract , liver , pancreas , and finger . fetal abdominal cystic mass has been identified in a broad spectrum of diseases . however , as in our case , fif is often overlooked during differential diagnosis . fif should also be differentiated from other conditions associated with fetal abdominal masses .

torus hyperplasia is a very rare condition also known as focal pyloric hypertrophy ( 1 ) . this lesion is caused by a circular muscle hypertrophy affecting the lesser curvature near the pylorus . pathogenesis of the lesion is unclear , some considering it as a persistence of infantile pyloric hypertrophy to adulthood , others noting that it develops within a few weeks in adult ( 1 , 2 ) . some have speculated that the lesion results from chronic gastritis or from repeated spastic contractions of the area secondary to visceral - visceral reflexes that could be established as a result of local irritation stimulating afferent fibers and starting a reflex arc involving efferents that locally innervate the circular pyloric musculature ( 1 , 3 ) . in summary , focal hypertrophic stenosis of the pyloric antrum in adult is classified as primary or secondary types ; 1 ) primary type being an idiopathic torus hyperplasia uncertain of origin , and 2 ) secondary type from a result of muscular thickening due to inflammation , ulceration , or carcinoma ( 4 ) . after the first report on 1946 , torus hyperplasia has been reported as a rare disease ( 5 ) . although there are some typical findings ( i.e . , recognizable radiologically by narrowing and enlongation of the pyloric cancal and endoscopically by appearances resembling those of the cervix so called characteristic pyloric `` cervix sign `` ) in this benign disease ( 6 , 7 ) , it is difficult to confirm without resection . moreover , it is hard to predict the prevalence of the disease because of its ' rarity ( 3 ) . herein , we report a 56-yr - old man who was diagnosed as torus hyperplasia with appendiceal mucocele after visiting our hospital because of abdominal discomfort . to the best of our knowledge , this is the first case of torus hyperplasia with appendiceal mucocele which is found incidentally .

primary or idiopathic hypertrophy of the pyloric muscle in adult , so called torus hyperplasia , is an infrequent but an established entity . it is caused by a circular muscle hypertrophy affecting the lesser curvature near the pylorus . since most of the lesions are difficult to differentiate from tumor , distal gastrectomy is usually preformed to rule out most causes of pyloric lesions including neoplastic ones through a pathological study . a 56-yr - old man with a family history of gastric cancer presented with abdominal discomfort of 1 month duration . upper gastrointestinal endoscopy showed a 1.0 cm sized irregular submucosal lesion proximal to the pylorus to the distal antrum on the lesser curvature . on colonoscopy examination , a 1.5 cm sized protruding mass was noticed on the appendiceal orifice . gastrectomy and cecectomy were done , and histological section revealed marked hypertrophy of the distal circular pyloric musculature and an appendiceal mucocele . to the best of our knowledge , this is the first case of torus hyperplasia with appendiceal mucocele which is found incidentally .

for ensuring post - endodontic restorations which provide tooth function and form with adequate force distribution , placement of fiber posts to the root canal are used commonly.1 moreover , the placement of a post is often needed for the restoration of a root canal treated tooth in order to support the core material.2,3 due to the requirement for aesthetics , circular fiber posts have recently gained popularity and these materials are developed gradually.2 the lack of adaptation of the circular posts to the canal walls are filled with resin cements . but , the major factor for clinical performance of the post supported restorations is cement thickness.4 adhesive failures associated with fiber posts are common and usually happens along the resin cement that fills the post - dentin interface.5 although the ideal thickness of the resin cement needed to improve retentive bond strength is unknown , the fit of the fiber posts into the post spaces should be as tight as possible.6 ovoid shaped fiber posts have recently been introduced because of the clinical problems in oval - shaped canals , especially in canines and mandibular premolars.7 oval fiber posts are produced to mimic the oval - shaped canals , thus it can be a better fit to the post - spaces.7,8 the present study evaluated whether the push - out bond strength to dentin varies between oval and circular fiber posts , and how the resin cement thickness around oval and circular fiber posts cemented into oval shaped canals differed . the first null hypothesis of the current study was that the push - out bond strength is not significantly different circular versus oval fiber posts in ovoid root canals . the second null hypothesis of the current study was that the resin cement thickness is not significantly different circular versus oval fiber posts in ovoid root canals .

purposethe aim of this study was to evaluate whether the push - out bond strength varies between oval and circular fiber posts , and to examine the effect on the resin cement thicknesses around the posts.materials and methodseighteen mandibular premolar roots were separated into two groups for oval and circular fiber posts systems . post spaces were prepared and fiber posts were luted to the post spaces . roots were cut horizontally to produce 1-mm - thick specimens . resin cement thicknesses were determined with a metallographic optical microscope and push - out tests were done.resultsno significant differences were observed in terms of push - out bond strength between the oval and circular fiber posts ( p > .05 ) the resin cement thicknesses of the oval posts were greater than those of the circular posts group in the coronal , middle and apical specimens ( p < .05 ) .conclusionin the light of these results , it can be stated that resin cement thickness does not affect the push - out bond strength .

pediatric soft - tissue sarcomas ( stss ) account for approximately 7 % of all childhood tumors . out though surgery is the mainstay of treatment , advent of neoadjuvant chemotherapy ( nact ) has reduced the incidence of recurrence / metastasis . we present a case of ifs with early and unusual distant metastasis , localized on fluorodeoxyglucose positron emission tomography - computed tomography ( fdg pet - ct ) scan .

infantile fibrosarcoma ( ifs ) is a rare soft - tissue sarcoma originating from extremities and occasionally from axial soft tissue . the prognosis is good with favorable long - term survival . it is rarely metastasizing tumor , the chances being lesser with ifs originating from extremities . use of neoadjuvant chemotherapy ( nact ) as a treatment regime further reduces the chances of local relapse and distant metastasis . the organs commonly affected in metastatic ifs are lungs and lymph nodes . we report an unusual case of an ifs originating from extremity , which received nact , yet presented with an early metastatic disease involving soft tissues and sparing lungs and lymph nodes , as demonstrated on fluorodeoxyglucose positron emission tomography - computed tomography .

now they need more attention because as the average life expectancy , elderly population , and subsequent resulting osteoporosis continue to increase , orthopaedic surgeons will get more such cases [ 14 ] . intertrochanteric fractures in the elderly are associated with high rates of mortality , ranging from 15 to 20 % , as they are at a high risk for deep vein thrombosis ( dvt ) , urinary tract infections , and pulmonary embolism if they fail to mobilize or ambulate early . surgical stabilization fulfills the aim of early mobilization and facilitates union in an anatomical position . due to this , operative stabilization of these fractures is now the gold standard treatment . although other options are available , the standard approach is to use a dynamic hip screw ( dhs ) with a 4-holed side plate in stable fractures in most centers [ 68 ] . traditionally a wide surgical exposure is necessary for this procedure which comes with its drawbacks like a large skin incision , considerable soft tissue trauma , significant blood loss , and pain . to avoid these problems minimally invasive it has theoretical advantages of decreased blood loss , better cosmesis , less pain , and rapid rehabilitation . we conducted a prospective comparative study of conventional ( open ) dhs and minimally invasive dhs at our center to test the utility of this new approach .

background . intertrochanteric fractures of the proximal femur are one of the most common fractures encountered , and dynamic hip screw with a side plate is the standard treatment . we compared a minimally invasive surgical technique with the conventional surgical technique used in the fixation of intertrochanteric fractures with the dynamic hip screw ( dhs ) device . methods . thirty patients with such fractures were treated with the conventional open technique and 30 with a new minimally invasive technique . patients in both groups were followed up for 1 year . results . there was less blood loss , minimal soft tissue destruction , shorter hospital stay , and early mobilization with the minimally invasive technique . conclusion . the present study finds minimally invasive technique superior to conventional ( open ) dhs .

with the ever increasing importance of clinical effectiveness , audit and quality assurance ; it is becoming mandatory to grade one 's own treatment results . the idea of individuals grading their own performance is a self - teaching exercise and improves the quality of future treatment . the assessment of orthodontic treatment needs and the outcome has traditionally been accomplished using subjective opinion and the experiences of clinicians . however , the variations in criteria used by different orthodontists and lack of reproducibility are limitations of the subjective evaluation . visual analog scale ( vas ) has been the most widely used as a subjective assessment method for the validation of various indices . in early surveys , various classifications were used as determinants of treatment needs and outcome . however , various authors such as massler and frankel , drakers , bjoerk et al . , and summers devised indices to evaluate malocclusion on the basis of objective requirements of occlusal discrepancies . pickering and vig were the first to investigate the use of summers occlusal index as objective grading version to assess the outcome of treatment . devised peer assessment rating ( par ) indices to evaluate malocclusion on the basis of objective requirements of occlusal discrepancies . the american board of orthodontics ( abo ) model grading system is presently one of the most detailed scoring systems in use . comprehensive clinical evaluation as outcome assessment was developed which included facial form , dental esthetics , vertical control , arch form , periodontium management , root structure preservation , and treatment efficiency . to assess clinical performance , both objective and although there are many studies in the literature mentioning the orthodontic treatment outcome of various bracket systems , various extraction pattern , various bracket slot size , type of orthodontic practice , that is , private versus university practice , timing of treatment ; and general practitioner versus orthodontist but , to our knowledge , there are very few studies in the literature mentioning the effect of assessment of treatment outcome on the orthodontic treatment outcome . thus , the present study was conducted to find out the role of posttreatment critical evaluation ( ptce ) implementation on the effect of orthodontic treatment outcome . to eliminate any institutional bias ,

objective : the aim of the study was to evaluate the effect of post- treatment critical evaluation on the quality of orthodontic care in a postgraduate orthodontic clinic.materials and methods : orthodontic treatment outcome of 109 consecutively treated cases was evaluated in phase - i evaluation . following phase - i evaluation , ptce of each case was made mandatory . after 6-years of implementation of compulsory ptce for each case , orthodontic treatment outcome of all consecutively treated cases ( n = 126 ) was evaluated ( phase - ii ) . the treatment outcome was evaluated by american board of orthodontics model grading system ( abo mgs ) and subjective evaluation ( visual analogue scale , vas ) .results : based on the abo scores , the cases were divided into three grades , that is , grade - i , grade - ii , and grade - iii . the mean total abo score was improved significantly in phase - ii evaluation ( p < 0.01 ) . the total number of cases in abo grade - ii were increased significantly ( p < 0.01 ) whereas cases in abo grade - i remained comparable . the vas score was improved from 5.66 0.77 at phase - i to 6.02 0.99 at phase - ii evaluation ( p < 0.01 ) .conclusion : the implementation of ptce significantly improved the quality of orthodontic care in a postgraduate orthodontic clinic.clinical significance : grading one 's own treatment improves the quality of future treatment .

steroid hormones have been traditionally associated with regulation of peripheral organs , associated with stress ( corticosterone ) or with gonadal function ( estrogen and androgens ) . over the years , it became evident that these hormones also act within the hypothalamus , in a feedback regulatory loop , to affect the release of the neural factors that modulate production of the steroid hormones . more recently , several observations have elucidated new roles of steroid hormones in modulating higher cns functions . specifically , both stress and steroid hormones have been shown to affect synaptic receptors and ion channels and therefore regulate in several different ways synaptic transmission and neuronal plasticity . consequently , stress hormones have been implicated in processes ranging from homeostatic to cognitive functions . furthermore , in some disorders of the nervous system , hormones have been shown to play critical roles : favoring or halting the disease process . thus , the interaction between peripheral hormones and central networks seem to be more intense than ever imagined before . in the present study we review current knowledge on the effects of steroid hormones on synaptic plasticity and define their influence on hippocampal cognitive and emotional functions .

several new observations have shifted the view of the hippocampus from a structure in charge of cognitive processes to a brain area that participates in the formation of emotional memories , in addition to its role in cognition . specifically , while the dorsal hippocampus is involved in the processing of cognitive memories ; the ventral sector is mainly associated with the control of behavioral inhibition , stress , and emotional memory . stress is likely to cause this switch in control of hippocampal functions by modulating synaptic plasticity in the dorsal and ventral sectors of the hippocampus through the differential activation of mineralocorticosteroid or glucocorticosteroid receptors . herein , we will review the effects of stress hormones on synaptic plasticity in the hippocampus and outline the outcomes on stress - related global functions of this structure . we propose that steroid hormones act as molecular switches : by changing the strength of synaptic connectivity in the hippocampus following stress , they regulate the routes by which the hippocampus is functionally linked to the rest of the brain . this hypothesis has profound implications for the pathophysiology of psychiatric disorders .

primary amenorrhea is the absence of menstruation and secondary sexual characteristics in phenotypic women aged 14 years or older . common hormonal cause of primary amenorrhea includes pituitary dysfunction , chronic systemic disease , and absent ovarian function . gonadal failure in genetically xx individuals is ovarian failure ; when this occurs at any time before onset of sexual maturation , there will be primary amenorrhea and incomplete breast development . xy individuals with gonadal failure will have female genitalia because mullerian inhibiting factor and testosterone will not be produced . gonadal tumors occur in up to 25 % of women with a y chromosome ; unlike complete androgen insensitivity , these gonads do not secrete hormones and should be removed at the time of diagnosis . the incidence of the chromosomal abnormality ( ca ) in live births is around 90 per 10,000 . included in the incidence are the numerical ( monosomy / trisomy / mosaicism ) as well as the structural ( translocation / isochromosome / deletion / duplication / ring ) ca .

background : primary amenorrhea is defined as the absence of menstruation and secondary sexual characteristics in phenotypic women aged 14 years or older . hormonal disorders are main causes of primary amenorrhea . common hormonal cause of primary amenorrhea includes pituitary dysfunction and absent ovarian function . the aim of this study was to estimate the incidence and types of chromosomal abnormalities in patients with primary amenorrhea in egypt.materials and methods : chromosomal analysis and hormonal assay were carried out on 223 patients with primary amenorrhea that were referred from different parts of egypt to cytogenetic laboratory of genetic unit , children hospital mansoura university , from july 2008 to december 2010 . fish technique was carried out in some of cases to more evaluation.results : the frequency of chromosomal abnormalities was 46 ( 20.63 % ) in primary amenorrhea patients . the chromosomal abnormalities can be classified into four main types . ( 1 ) the numerical abnormalities of the x chromosome were detected in 23 ( 50 % ) . ( 2 ) structural abnormalities of the x chromosome were detected in 11 ( 23.91 % ) . ( 3 ) mosaicism of x chromosome was found in 10 ( 21.74 % ) . ( 4 ) male karyotype 46 , xy was presented in 2 ( 4.35 % ) .conclusion : the present study showed that karyotype and fish are necessary to detect the causes of primary amenorrhea . this study also revealed the incidence of chromosomal abnormalities in women with primary amenorrhea in egypt is similar to that reported in previous literatures .

d - penicillamine has been known as one of the agents that are able to induce pemphigus ( 1,2 ) . n- ( 2-mercapto-2-methylpropionyl ) -l - cysteine ] is a thiol compound contained two free sulfhydryl groups , whereas d - penicillamine has only one sulfhydryl radical ( 3 ) . while drug - induced pemphigus was not infrequently demonstrated in association with d - penicillamine , it has rarely been reported with bucillamine and has never been reported in rheumatoid arthritis ( ra ) and polymyositis ( pm ) overlap syndrome . hereby , we report a case of bucillamine - induced pemphigus vulgaris in a patient with ra and pm overlap syndrome .

bucillamine is a disease modifying anti - rheumatic drug , structurally similar to d - penicillamine . although d - penicillamine - induced pemphigus has been not infrequently demonstrated , pemphigus associated with bucillamine was rarely reported . we describe a patient complicating pemphigus vulgaris after bucillamine treatment in rheumatoid arthritis ( ra ) and polymyositis ( pm ) overlap syndrome . pm and ra overlap syndrome was diagnosed three years ago and bucillamine was administrated for 20 months . skin lesions including erythematous flaccid blisters on her chest , axillae , and back were occurred and were compatible with pemphigus vulgaris by typical pathology . withdrawal from bucillamine and prednisolone treatment made rapid improvement of pemphigus lesions .

the - and -lactam scaffolds are found in various biologically relevant compounds . additionally , these core structures are crucial intermediates in the synthesis of various natural products as well as pharmaceuticals , prompting the development of new methods for the synthesis of these valuable structures . our group has explored the synthesis of -lactams by the reactions of aryl- , thioaryl- , and cyano - substituted anhydrides . furthermore , we have demonstrated that one - pot four - component reactions ( 4crs ) are possible in the case of thioaryl substitution . recent computational studies of the cyanosuccinic anhydride reactions demonstrate that they proceed by a mannich - like mechanism via the enol tautomer of the anhydride . related reactions reported by castagnoli , cushman , and haimova likely proceed by this mechanism as well . consistent with the proposed mechanism , those anhydrides are poorly enolizable and require forcing conditions . two decades later , cushman and haimova reported analogous reactions with homophthalic anhydride , which is highly enolizable . the high reactivity of this anhydride at lower temperatures is consistent with the mannich - like mechanism . these results prompted us to explore mannich - type reactions and related 4crs of variously substituted anhydrides . although aryl - substituted succinic anhydrides showed some variation in reactivity based on the substituents attached to the aromatic ring , direct attachment of an electron - withdrawing group resulted in higher reactivity . furthermore , in the case of cyanosuccinic anhydrides , the diastereoselectivity was reversed relative to the aryl and thioaryl cases and could be controlled by resident stereogenic centers . we envisioned that the electron - withdrawing capability of a sulfone would impart the anhydride with similar reactivity as the nitrile - substituted anhydride , albeit with drastically different steric requirements ( scheme 1 ) . herein we report the development of anhydride mannich reactions ( amrs ) using sulfone - substituted anhydrides for the synthesis of - and -lactams as well as a six - step formal synthesis of ( ) -isoretronecanol .

sulfone - substituted - and -lactams have been prepared in a single step with high diastereoselectivity . sulfonylglutaric anhydrides produce intermediates that readily decarboxylate to provide -lactams with high diastereoselectivity . substituents at the 3- or 4-position of the glutaric anhydride induce high levels of stereocontrol . sulfonylsuccinic anhydrides produce intermediate carboxylic acids that can be trapped as methyl esters or allowed to decarboxylate under mild conditions . this method has been applied to a short synthesis of the pyrrolizidine alkaloid ( ) -isoretronecanol .

almost 40 % 60 % of patients with colorectal cancer ( crc ) develop metastasis , predominantly in the liver . tumor angiogenesis has been implicated as a major factor in the development and spread of these metastases . the recent discovery of vascular endothelial growth factor - c ( vegf - c ) and vegf receptor-3 ( vegfr-3 ) involvement in lymphatic vessel development and specific lymphatic markers has provided new insights into the field of lymphangiogenesis . using these markers , studies have suggested that lymphangiogenesis plays an active role in the formation and spread of colorectal liver metastases ( clm ) [ 4 , 5 ] . the patterns of intratumoral lymphatics may have potential clinical significance as a predictive marker of disease recurrence and patient survival . in this study , we investigated the patterns of tumor lymphangiogenesis using monoclonal d2 - 40 and lyve-1 antibody , as a predictive marker for disease - free survival in patients with clm . blood vessels were examined using cd34 antibody to differentiate the blood vessels from the lymphatic vessels .

background . colorectal cancer ( crc ) is the most common form of cancer diagnosed in australia across both genders . approximately , 40 % 60 % of patients with crc develop metastasis , the liver being the most common site . almost 70 % of crc mortality can be attributed to the development of liver metastasis . this study examines the pattern and density of lymphatics in colorectal liver metastases ( clm ) as predictors of survival following hepatic resection for clm . methods . patient tissue samples were obtained from the victorian cancer biobank . immunohistochemistry was used to examine the spatial differences in blood and lymphatic vessel densities between different regions within the tumor ( clm ) and surrounding host tissue . lymphatic vessel density ( lvd ) was assessed as a potential prognostic marker . results . patients with low lymphatic vessel density in the tumor centre , tumor periphery , and adjacent normal liver demonstrated a significant disease - free survival advantage compared to patients with high lymphatic vessel density ( p = 0.01 , p > 0.01 , and p = 0.05 , resp . ) . lymphatic vessel density in the tumor centre and periphery and adjacent normal liver was an accurate predictive marker of disease - free survival ( p = 0.05 ) . conclusion . lymphatic vessel density in clm appears to be an accurate predictor of recurrence and disease - free survival .

carotid blow - out syndrome is the most feared complication in head and neck surgery . the syndrome occurs in 3 % to 4 % of all head and neck cancer patients and is easy to happen following fistula formation , bad wound healing and tumor recurrence . carotid blow - out syndrome presents an average of 2.7 years after the initial diagnosis of cancer , usually occurs proximal to the carotid bifurcation , and is bilateral in 2 % of cases . carotid blow - out syndrome occurred in a patient undergoing reoperation for recurrent thyroid cancer , and was repaired using the remaining carotid sheath , sterno - thyroid muscle , sterno - hyoid muscle and the harvested external jugular vein .

abstractthe patient had thyroid cancer and underwent subtotal thyroidectomy . local recurrence occurred on both sides 5 years and 6 months later . the sterno - hyoid muscle and sterno - thyroid muscle were severed and the tumor around the cricoid cartilage was removed . the tumor extended into the space between the right common carotid artery and internal jugular vein and was located under the right common carotid artery and vagus nerve on the lateral side . the carotid sheath was peeled off of the carotid artery quite easily . the right common carotid artery ruptured abruptly at the distal side during this procedure.the right common carotid artery had two layers , which were very fragile , so the direct suture or repair with a graft was impossible . the carotid artery could not be trapped with ligation because the cerebral vascular supply was not examined preoperatively . this portion was repaired using the remaining carotid sheath . however , re - bleeding occurred at the proximal portion of the previous laceration spontaneously . fibrin glue with oxidized cellulose was initially used to seal the second small hole in this lesion . the second ruptured section was repaired using the remaining sterno - thyroid and sterno - hyoid muscles . the proximal portion of the right common carotid artery was reinforced with the harvested external jugular vein.these procedures resulted in hemostasis . three - dimensional ct angiography showed irregular stenosis just after the operation , but it recovered 11 days later . no cerebral infarction occurred after the operation and the patient s general condition was good .

sulfonamides and sulfones serve both as useful intermediates in organic synthesis and as important target molecules in their own right . for example , enantioenriched secondary benzylic sulfonamides and sulfones display a range of biological activity ( e.g . , protein tyrosine phosphatase inhibitor , antisepsis agent , and -secretase inhibitor ) . however , to the best of our knowledge , there are no methods for the direct catalytic asymmetric synthesis of such sulfonamides , and just a few for such sulfones . one potential route to these compounds is the stereoconvergent coupling of a racemic -halosulfonamide / sulfone with an appropriate nucleophile ( eq 1 ) . during the past several years , we have described an array of nickel - catalyzed enantioselective cross - couplings of secondary alkyl electrophiles . whereas couplings of activated electrophiles ( a leaving group to a carbonyl , aryl , alkenyl , alkynyl , or cyano group ) proceed in good ee with a variety of nucleophiles ( alkyl- , aryl- , and alkenylmetal ) , reactions of unactivated electrophiles have been limited , with three exceptions , to alkylmetals , specifically alkyl- ( 9-bbn ) reagents.1 because -halosulfonyl compounds are generally poor substrates for sn2 reactions , and the sulfonyl group does not effectively stabilize an adjacent radical ( bond dissociation energy for a c h bond of dimethylsulfone : 99 kcal / mol ) , we view them as unactivated alkyl electrophiles . herein , we report the first examples of the stereoconvergent cross - coupling of unactivated alkyl electrophiles with nucleophiles other than organoboranes , as well as the first general method for their coupling with aryl- or alkenylmetal reagents ; in particular , we describe nickel / bis ( oxazoline ) -catalyzed cross - couplings of racemic -bromosulfonamides and -sulfones with organozinc and organozirconium reagents , thereby furnishing secondary benzylic and allylic sulfonamides and sulfones in good enantiomeric excess ( eq 2 ) .2

the development of efficient methods for the generation of enantioenriched sulfonamides and sulfones is an important objective for fields such as organic synthesis and medicinal chemistry ; however , there have been relatively few reports of direct catalytic asymmetric approaches to controlling the stereochemistry of the sulfur - bearing carbon of such targets . in this report , we describe nickel - catalyzed stereoconvergent negishi arylations and alkenylations of racemic -bromosulfonamides and -sulfones that furnish the desired cross - coupling product in very good ee and yield for an array of reaction partners . mechanistic studies are consistent with the generation of a radical intermediate that has a sufficient lifetime to diffuse out of the solvent cage and to cyclize onto a pendant olefin .

gold nanorods ( gnrs ) are anisotropic particles whose surface plasmon modes can be tuned as a function of aspect ratio , with optical resonances ranging from visible to near - infrared wavelengths . gnrs have been investigated as contrast agents for optical biomedical imaging modalities such as optical coherence tomography and photoacoustic tomography ; they are also capable of producing linear and two - photon excited luminescence , with detection limits at the single - particle level . the large absorption cross sections of gnrs can also generate localized photothermal effects , with application toward the release of molecular cargo and hyperthermic effects on diseased cells and tissues . these attributes have sparked a global effort to develop gnrs into theranostic agents for nanomedicine . one hurdle in the scalable manufacturing of gnr - based materials is the efficient exchange and removal of cetyltrimethylammonium bromide ( ctab ) , a micellar surfactant used in the batch synthesis of gnrs . ctab is cationic and moderately cytotoxic ( although not insupportably so ) , most of which can be removed by multiple washes and exchanges with chemisorptive surfactants ( e.g . , pegylated thiols or dithiocarbamates ) , phospholipids , or other surface - active agents . however , ctab - coated gnr dispersions are frequently destabilized during surfactant exchange , resulting in partial aggregation and low recovery yields . furthermore , ligand - modified gnrs are often contaminated with residual ctab , which can induce nonspecific protein adsorption and cell uptake under physiological conditions , or produce surface charge defects in materials applications . we have previously shown that ctab - depleted gnr dispersions can be prepared when using sodium polystyrenesulfonate ( na - pss ) as a mild detergent ; nevertheless , the stability of such suspensions remains capricious in subsequent manipulations . we thus sought to develop a practical method for producing ctab - free gnr dispersions that would be universally compatible with surface conjugation protocols . in this letter we describe an efficient method for converting ctab - stabilized gnrs into citrate - stabilized gnrs ( cit - gnrs ) via intermediate treatment with pss . the surface exchange process was monitored in stages by x - ray photoelectron spectroscopy ( xps ) , an invaluable tool for quantitative elemental analysis of surface adsorbates , as well as by attenuated total reflectance infrared ( atr - ir ) spectroscopy and surface - enhanced raman scattering ( sers ) . our analyses indicate that ctab removal by pss treatment is highly efficient , as is the subsequent displacement of pss by citrate . the cit - gnrs are fully dispersible in low - salt solutions , and are easily functionalized by further ligand exchange ( discussed in a companion article ) .

stable aqueous dispersions of citrate - stabilized gold nanorods ( cit - gnrs ) have been prepared in scalable fashion by surfactant exchange from cetyltrimethylammonium bromide ( ctab ) -stabilized gnrs , using polystyrenesulfonate ( pss ) as a detergent . the surfactant exchange process was monitored by infrared spectroscopy , surface - enhanced raman scattering ( sers ) , and x - ray photoelectron spectroscopy ( xps ) . the latter established the quantitative displacement of ctab ( by pss ) and of pss ( by citrate ) . the cit - gnrs are indefinitely stable at low ionic strength , and are conducive to further ligand exchange without loss of dispersion stability . the reliability of the surface exchange process supports the systematic analysis of ligand structure on the hydrodynamic size of gnrs , as described in a companion paper .

the goals of surgical management include correction and maintenance of sagittal and coronal alignment , establishment of length and rotation , and early functional range of movements of knee and ankle . interlocking nailing of tibial fractures is desirable because this technique allows some load sharing , spares extra osseous blood supply , avoids extensive soft tissue dissection , and is familiar to most surgeons . nailing of metaphyseal fractures with short distal fragment is associated with an increase in malalignment particularly in coronal plane , nonunion , and need for secondary procedures to achieve union . as there is a mismatch between the diameters of the nail and the medullary canal , with no nail - cortex contact , the nail may translate laterally along coronally placed locking screws and increased stress is placed on the locking holes to maintain fracture alignment after surgery . various techniques have been recommended to improve nailing the metaphyseal fractures including blocking screws ( poller screw ) , temporary unicortical plating , percutaneous reduction clamps , and fibular plating .

aim . to evaluate the clinical use of blocking screws as a supplement to stability in distal tibial metaphyseal fractures treated with statically locked intramedullary nail . main outcome measurement . alignment and reduction preoperatively , postoperatively , and at healing were the main outcome measured with an emphasis on maintenance of initial reduction on followup . patients and methods . this was a prospective study of 20 consecutive cases of distal tibial metaphyseal fractures treated with statically locked intramedullary nailing with supplementary blocking screw between august 2006 and september 2007 with a maximum followup of 3 years . medullary canal diameter was measured at the levels of fracture and isthmus . results . the mean diameter of tibia at the level of isthmus was 11.9 mm and at the fracture site was 22.9 mm . mean length of distal fracture segment was 4.6 cm . mean varus / valgus alignment was 10.3 degrees preoperatively and 1.7 degrees immediatly postoperatively and was maintained till union . using karlstrom - olerud score the outcome was excellent to good in 90 % . conclusion . we conclude that the use of blocking screw as a supplement will aid in achieving and maintaining the reduction of distal tibial metaphyseal fractures when treated with intramedullary nailing thereby extending the indication of intramedullary nailing .

fibrous dysplasia of bone is characterized by the replacement of medullary bone with fibro - osseous tissue . this results in the distortion and overgrowth of bone , leading to characteristic deformities . based on the bony involvement , fibrous dysplasia is divided into three types : monostotic , polyostotic , and mccune albright syndrome ( mas ) . mas is characterized by a triad of monostotic / polyostotic fibrous dysplasia , caf-au - lait macules ( calms ) , and endocrine hyperfunction . the disease is congenital but not hereditary and is due to an activating mutation in g protein - coupled receptor . it manifests usually in childhood , with recurrent fractures , distorted bones , precocious puberty , acromegaly , or hyperthyroidism . untreated disease leads to permanent disfigurement , and the disease is classified as paucibacillary or multibacillary depending on the proliferation of the bacilli . the risk factors for the disease are living in endemic areas with poor hygiene conditions and defects in cell - mediated immunity . we recently encountered a patient with mas who presented with cutaneous features of hansen 's disease . we report the same for the unusual association and to highlight the relevant review of the literature .

mccune albright syndrome ( mas ) comprises a triad of fibrous dysplasia of bone , caf - au - lait macule , and endocrinopathy . the disease is due to activating mutation of g protein - coupled receptor leading to hyperfunction of glands . hansen 's disease is caused by infection with mycobacterium leprae and is seen with underlying immunosuppressed conditions in genetically predisposed individuals . we recently encountered a patient with hansen 's disease along with underlying mas and report the same in this report .

midfacial defects are classified as midline midfacial defects , that include the nose and/or upper lip ; and lateral defects , which include the orbital contents and cheek . facial prosthesis is generally considered over surgical reconstruction to restore function and appearance in patients with facial defects that resulted from cancer resection.1,2 the health of the patient might not permit to undergo another surgery . an intraoral prosthesis such as an obturator is often needed to restore mastication , speech and improves patient appearance.3 fabrication of an extra oral facial prosthesis is a challenging task as it tests the creative ability of the prosthodontist . the choice of material for extraoral prosthesis depends on the need to engage desirable undercuts , mobility of tissue bed , defect size and the weight of the prosthesis . it may be retained by means of medical grade adhesives , resilient attachments , clips and osseointegrated implants . it can also be connected to obturator by magnets.4 this clinical report highlights the rehabilitation of a lateral midfacial defect with a two piece prosthesis that included an intraoral obturator and extra oral facial prosthesis with the use of magnets .

facial prosthesis is generally considered over surgical reconstruction to restore function and appearance in patients with facial defects that resulted from cancer resection . retention of the prosthesis is challenging due to its size and weight . retention can be achieved by using medical grade adhesives , resilient attachments , clips and osseointegrated implants . it can also be connected to obturator by magnets . this clinical report highlights the rehabilitation of a lateral midfacial defect with a two piece prosthesis that included an extra oral facial prosthesis and an intraoral obturator with the use of magnets .

the incidence of well - differentiated thyroid carcinoma , particularly papillary cancer , has been increasing since the last 2030 years . the surveillance , epidemiology and end results ( seer ) database shows more than a 2-fold increase in thyroid cancer since 1995 . an important contributing factor for the increased incidence of such well - differentiated cancers is the increasing diagnostic rates of papillary thyroid microcarcinoma ( ptm ) . other factors such as iodination programmes in low iodine intake areas , detailed histopathological examination of the excised thyroid tissue , and the increase in bilateral total excision of the thyroid gland during thyroid surgery have also been attributed to the increasing rates of large ( > 10 mm ) and micropapillary carcinoma [ 25 ] . a vast majority of ptm cases are incidentally determined on postoperative histopathological examination of the excised thyroid tissue for the surgical treatment of benign thyroid disorders . incidental ptm ( i - ptm ) is a tumour focus that is clinically unsuspected before thyroid surgery and is identified in the final pathological examination of a thyroidectomy specimen . therefore , several controversies regarding the need for completion surgery for excision of the remaining thyroid tissue and lymph nodes exist . the objectives of this study were to describe the incidence and clinical / pathological characteristics of ptm and discuss our experience with i - ptm cases in an endemic goitre area .

clinical and pathological characteristics of incidental papillary thyroid microcancer cases , surgical , medical , and nuclear treatment methods , and patients ' outcome were studied during follow - up period of 102 months . we studied 37 patients with incidental papillary thyroid microcancer ( i - ptm ) . the surgical procedure was total thyroidectomy in 29 and hemithyroidectomy in 8 patients . size , multifocality , and bilateralism of ptm foci , thyroid capsule invasion , and presence of lymphovascular invasion were histopathological parameters . we analysed adjuvant medical and nuclear treatment and patients ' outcome during follow - up period of 102 ( 61144 ) months . the prevalence rates of i - ptm were 9.4 % in 395 thyroidectomy cases . histopathological examination reported unifocal disease in 30 and multifocal disease in 7 ( 18 % ) patients . multifocal disease was bilateral in 6 ( 20.1 % ) patients . the mean size of the ptm foci was 4.88 mm . the rate of thyroid capsule invasion was 5.4 % . all patients received a suppressive dose of lt4 to achieve a low serum tsh level . adjuvant surgical and nuclear treatment was not performed in our cases . we did not find any negative changes in blood chemistry and ultrasound imaging , and any unfavourable events as locoregional and systemic recurrence . in conclusion , diagnosis of i - ptm is common that multifocality and bilateralism appear as pathologic features . the prognosis is excellent after surgical treatment and tsh suppression . routine adjuvant nuclear treatment is unnecessary in majority of patients .

misdiagnosis of bipolar disorder is a potentially serious problem for patients , which sometimes leads to inappropriate treatment.1 however , it is not unusual for bipolar disorder to be misdiagnosed as a major depressive disorder.2 previous studies have shown that the proportion of cases of bipolar disorder misdiagnosed as a major depressive disorder is 20.8 % 40 % .24 nevertheless , there are few biomarkers for accurate diagnosis . if patients become depressive for the first time and have never experienced a manic episode , it is difficult to determine whether that depressive episode is unipolar or bipolar depression , and the risk of a manic switch is unknown . near - infrared spectroscopy ( nirs ) is a noninvasive and useful method that uses near - infrared light to measure hemoglobin concentration changes in the cortical surface area . although changes in the nirs signals measured on the forehead during the word fluency task may be partially associated with changes in skin blood flow,5 the changes in oxygenated hemoglobin ( [ oxyhb ] ) are associated with changes in the regional cerebral blood volume . nirs enables the assessment of brain function , and recent studies have shown that the frontal hemodynamic patterns detected by nirs can be a biomarker for the diagnosis of major psychiatric disorders.6,7 in the present case , nirs during the word fluency task was measured during the clinical course of bipolar disorder . in brief , [ oxyhb ] and deoxygenated hemoglobin ( [ deoxyhb ] ) were measured with a 52-channel nirs machine ( hitachi etg-4000 ; hitachi medical corporation , tokyo , japan ) at two wavelengths of near - infrared light ( 695 and 830 nm ) , the absorption of which was measured , and [ oxyhb ] and [ deoxyhb ] were calculated as previously described.8 the distance between pairs of source - detector probes was set at 3.0 cm and each measured area between pairs of source detector probes was defined as a channel . the probes of the nirs machine were fixed with 3 11 thermoplastic shells , with the lowest probes located along the fp1-fp2 line according to the international 1020 system used in electroencephalography . we used the word fluency task because it is easy to understand and execute , and it is also an executive task that produces distinct differences in performance and neuroimaging data among each diagnostic group of psychiatric disorders.7 additionally , plasma levels of homovanillic acid ( hva ) , a dopamine metabolite , and 3-methoxy-4hydroxyphenylglycol ( mhpg ) , a noradrenaline metabolite , were measured longitudinally using high performance liquid chromatography . in our hospital , we measured both plasma levels of monoamine metabolites ( every 3 weeks in principle ) and nirs ( before and after the treatment ) in psychiatric inpatients with mood disorders to investigate the association between plasma monoamine metabolites and nirs signals . this protocol was approved by the ethics committee of fukushima medical university , and the patient consented to participate after having been informed of the purpose of the study .

misdiagnosis of bipolar disorder is a serious , but not unusual problem for patients . nevertheless , there are few biomarkers for distinguishing unipolar and bipolar disorder . near - infrared spectroscopy ( nirs ) is a noninvasive and useful method for the measurement of hemoglobin concentration changes in the cortical surface area , which enables the assessment of brain function . we measured nirs and plasma monoamine metabolite levels in a patient with bipolar disorder . a 22-year - old man was admitted due to major depression . at admission , nirs findings showed oxygenated hemoglobin reincrease in the posttask period , which is characteristic of schizophrenia . after treatment with paroxetine , he became manic with psychotic symptoms . his plasma level of homovanillic acid just before the manic switch was ten times higher than that just after paroxetine initiation . treatment with lithium and antipsychotics was successful , and plasma homovanillic acid decreased after treatment . in this case , the nirs findings may predict a possible risk of a manic switch , which is likely induced by paroxetine . nirs may be able to help distinguish unipolar and bipolar disorder in clinical settings .

chronic subdural hematoma ( csdh ) is a rare complication of unruptured aneurysm clipping surgery5,12 ) . because csdh signs and symptoms may appear slowly , it can cause problems such as headache , dizziness , seizure , and hemiparesis , and requires surgical drainage . mori et al.11 ) reported severe complications of surgical drainage of postoperative csdh , such as tension pneumocephalus and acute subdural hematoma , which can cause permanent neurologic deficits or death . the general incidence of csdh after brain surgery is reported to be approximately 0.3 - 1.5 % 8,12 ) however , aneurysm clipping surgery is regarded as an important risk factor of postoperative csdh7,10,11 ) . it is known that advanced age ( > 70 years ) and male gender may contribute to csdh after clipping surgery5,12 ) . additionally , postclipping csdh considering the relatively benign course of unruptured aneurysms , it is important to prevent csdh and identify its risk factors after clipping surgery in order to minimize treatment - related morbidity . the purpose of this study was to determine the incidence and risk factors of postoperative csdh after surgical clipping for unruptured anterior circulation aneurysms .

objectivechronic subdural hematoma ( csdh ) is a rare complication of unruptured aneurysm clipping surgery . the purpose of this study was to identify the incidence and risk factors of postoperative csdh after surgical clipping for unruptured anterior circulation aneurysms.methodsthis retrospective study included 518 patients from a single tertiary institute from january 2008 to december 2013 . csdh was defined as subdural hemorrhage which needed surgical treatment . the degree of brain atrophy was estimated using the bicaudate ratio ( bcr ) index . we used uni- and multivariate analyses to identify risk factors correlated with csdh.resultssixteen ( 3.1 % ) patients experienced postoperative csdh that required burr hole drainage surgery . in univariate analyses , male gender ( p < 0.001 ) , size of aneurysm ( p=0.030 ) , higher bcr index ( p=0.004 ) , and the use of antithrombotic medication ( p=0.006 ) were associated with postoperative csdh . in multivariate analyses using logistic regression test , male gender [ odds ratio ( or ) 4.037 , range 1.287 - 12.688 ] , high bcr index ( or 5.376 , range 1.170 - 25.000 ) , and the use of antithrombotic medication ( or 4.854 , range 1.658 - 14.085 ) were associated with postoperative csdh ( p < 0.05 ) . postoperative subdural fluid collection and arachnoid plasty were not showed statistically significant difference in this study.conclusionthe incidence of csdh was 3.1 % in unruptured anterior circulation aneurysm surgery . this study shows that male gender , degree of brain atrophy , and the use of antithrombotic medication were associated with postoperative csdh .

tuberous sclerosis complex ( tsc ) is a genetic disorder that can affect almost all organ systems . renal manifestations occur with high frequency , the most prevalent being angiomyolipoma ( aml ) . tsc - associated amls tend to be larger , more numerous , and more likely to cause spontaneous hemorrhage compared with sporadic amls . removal of renal calculi from kidneys with amls is particularly difficult because these tumors increase the potential for hemorrhage . we report the case of a 65-year - old man with tsc - associated aml and a renal calculus greater than 4 cm in his left kidney . the calculus was successfully removed by retrograde flexible ureterorenoscopy ( f - urs ) with holmium laser lithotripsy .

renal calculi in patients with renal angiomyolipomas are difficult to treat because of the hemorrhagic potential of these tumors . we describe the case of a 65-year - old man having tuberous sclerosis complex - associated multifocal renal angiomyolipomas with a large renal calculus . the patient presented with left flank dullness and a previous history of spontaneous angiomyolipoma rupture . intravenous pyelography revealed a 43 16 mm calculus in the pelvis and lower calyx of the left kidney . the calculus was successfully removed by retrograde flexible ureterorenoscopy and holmium - yag lithotripsy . flexible ureterorenoscopy is an effective , minimally invasive therapy for patients at high risk of renal hemorrhage .

the diagnosis of unexplained syncopal episodes and sustained palpitations remains a difficult task in clinical cardiology . standard 24 h holter monitoring has a low diagnostic yield , while implantable loop recorder ( ilr ) has a higher diagnostic yield , but it is expensive and mildly invasive , making its role in diagnostic work - up of unexplained syncope and palpitations questionable . the utility of external prolonged electrocardiogram ( ecg ) monitoring in work - up of syncope is still undefined . the few available studies , generally single - centre and retrospective , provided conflicting results , mainly due to heterogeneity of patient populations and devices capabilities . in sustained palpitations , the external loop recorders ( elrs ) utility was more established . earlier elrs with relatively low - storage capacity and brief patient - activated ecg tracings had limited usefulness in syncope or asymptomatic arrhythmias . recently , newer elrs with auto - trigger capabilities showed 30 % diagnostic yield for syncope and 75 % for palpitations . external ecg recorders were also utilized to evaluate the burden of asymptomatic atrial fibrillation ( af ) , as in cryptogenic transient ischaemic attacks or after transcatheter ablation . syncope and palpitations tend to occur in clusters , with higher reoccurrence rate early after an event , thus an early use of long - term ecg monitoring may increase the likelihood of clinical diagnosis . the synarr - flash study ( monitoring of syncopes and/or sustained palpitations of suspected arrhythmic origin ; clinicaltrial.gov nct02253134 ) is the first international , multicentre , prospective trial designed to evaluate the feasibility and usefulness of external prolonged ecg monitoring in the early clinical work - up of unexplained syncope and/or sustained palpitations of suspected arrhythmic origin .

aimssynarr - flash study ( monitoring of syncopes and/or sustained palpitations of suspected arrhythmic origin ) is an international , multicentre , observational , prospective trial designed to evaluate the role of external 4-week electrocardiogram ( ecg ) monitoring in clinical work - up of unexplained syncope and/or sustained palpitations of suspected arrhythmic origin.methods and resultsconsecutive patients were enrolled within 1 month after unexplained syncope or palpitations ( index event ) after being discharged from emergency room or hospitalization without a conclusive diagnosis . a 4-week ecg monitoring was obtained by external high - capacity loop recorder ( spiderflash - t , sorin ) storing patient - activated and auto - triggered tracings . diagnostic monitorings included ( i ) conclusive events with reoccurrence of syncope or palpitation with concomitant ecg recording ( with / without arrhythmias ) and ( ii ) events with asymptomatic predefined significant arrhythmias ( sustained supraventricular or ventricular tachycardia , advanced atrio - ventricular block , sinus bradycardia < 30 b.p.m . , pauses > 6 s ) . synarr - flash study enrolled 395 patients ( 57.7 % females , 56.9 18.7 years , 28.1 % with syncope , and 71.9 % with palpitations ) from 10 european centres . for syncope , the 4-week diagnostic yield was 24.5 % , and predictors of diagnostic events were early start of recording ( 015 vs. > 15 days after index event ) ( or 6.2 , 95 % ci 1.329.6 , p = 0.021 ) and previous history of supraventricular arrhythmias ( or 3.6 , 95 % ci 1.49.7 , p = 0.018 ) . for palpitations , the 4-week diagnostic yield was 71.6 % and predictors of diagnostic events were history of recurrent palpitations ( p < 0.001 ) and early start of recording ( p = 0.001 ) .conclusionthe 4-week external ecg monitoring can be considered as first - line tool in the diagnostic work - up of syncope and palpitation . early recorder use , history of supraventricular arrhythmia , and frequent previous events increased the likelihood of diagnostic events during the 4-week external ecg monitoring .

red cell transfusions are frequently used to treat severe anemia and to reduce the effects of sickle cells . unlike many patient populations , patients with scd have a much higher risk of adverse events from transfusion therapy , due in part to known antigen incompatibility between blood donors , who are mostly of european descent , and the blood recipients , who are of african descent . alloantibody formation in this population can be life - threatening , because delayed hemolytic transfusion reactions ( dhtr ) may sometimes initiate a hyperhemolytic process whereby there is not only hemolysis of transfused allogeneic cells but also the patient s own autologous cells . there are also descriptions of hyperhemolysis associated with autoantibodies , as well as cases with no antibodies . regardless of whether an antibody is present or not , the end result of these hyperhemolytic events is a profoundly low hemoglobin , even lower than pre - transfusion levels . despite profoundly low hemoglobin values in addition to avoidance of transfusions , therapies are often directed at suppressing the immune system ( i.e . corticosteroids and ivig ) . we identified an associated autoantibody that caused robust hemolysis and severe anemia , which was temporally associated with end - organ dysfunction and death . what makes this case unique is that the predominant organ affected was not the brain or the lung , but the bone marrow . bone marrow ischemia , the cause of vaso - occlusive pain , is common in scd ; however , extensive bone marrow necrosis is rare . this case underscores the risks associated with transfusion in scd , especially in a heavily alloimmunized patient .

in patients with sickle cell disease , hyperhemolysis is a rare but life - threatening complication of transfusion . in this case report , we describe a 61 year - old woman with hemoglobin sickle cell ( sc ) disease and history of alloimmunization who developed hyperhemolysis associated with a transfusion . she was found to have a warm and a clinically - significant cold autoantibody . severe anemia ( hb 2.7 g / dl ) with reticulocytopenia and thrombocytopenia prompted a bone marrow biopsy , which demonstrated extensive bone marrow necrosis . despite treatment , the bone marrow failure did not improve and the patient died on hospital day 38 . this case illustrates the potential risks of transfusion in a patient with sickle cell disease , especially one with previous hemolytic reactions . while uncommon , hyperhemolysis can cause death , in this case by extensive bone marrow necrosis . in patients with sickle cell disease , judicious use of red cell transfusions with phenotypically - matched units can diminish , but never completely abrogate , the risks associated with transfusion .

techniques for instrumented fixation and fusion of the cervical spine have rapidly advanced in the past 30 years . these techniques have helped surgeons adequately manage complex trauma , tumor , and degenerative pathologies . hadra in 1890 described the use of wiring and graft techniques to perform the first spinal fusion procedures . these techniques were standard until the start of modern cervical spinal fusion with roy - camille in the 1970s . since this time there have been improvements in technique and implants , which have made the procedures safer , thus leading to increased adoption of instrumented cervical fusion . within the united states , approximately 150 000 cervical fusion procedures are performed each year . around 90 % of cervical fusions the use of plate and screw instrumentation for anterior cervical fusion has become a mainstay , so much so that in 2010 the american medical association combined 2 current procedural terminology codes into a comprehensive code . the indications for cervical fusion are well established , based on an abundance of studies showing clinical and biomechanical efficacy . despite these studies there is a paucity of literature detailing the complications associated with cervical spinal fusion . most studies are retrospective in design , contain a small numbers of patients , report single - institution data , relate to a single indication , or contain information with outdated procedures . the overall complication rate for cervical fusion procedures is low , and these earlier studies may not reliably provide data on less common complications . while rare , screw backout or misplaced screws can lead to morbidity , the need for revision surgery , and increased costs .

study design : a multicenter , retrospective case series.objective : in the past several years , screw fixation of the cervical spine has become commonplace . for the most part , this is a safe , low - risk procedure . while rare , screw backout or misplaced screws can lead to morbidity and increased costs . we report our experiences with this uncommon complication.methods : a multicenter , retrospective case series was undertaken at 23 institutions in the united states . patients were included who underwent cervical spine surgery from january 1 , 2005 , to december 31 , 2011 , and had misplacement of screws requiring reoperation . institutional review board approval was obtained at all participating institutions , and detailed records were sent to a central data center.results : a total of 12 903 patients met the inclusion criteria and were analyzed . there were 11 instances of screw backout requiring reoperation , for an incidence of 0.085 % . there were 7 posterior procedures . importantly , there were no changes in the health - related quality - of - life metrics due to this complication . there were no new neurologic deficits ; a patient most often presented with pain , and misplacement was diagnosed on plain x - ray or computed tomography scan . the most common location for screw backout was c6 ( 36 % ) .conclusions : this study represents the largest series to tabulate the incidence of misplacement of screws following cervical spine surgery , which led to revision procedures . the data suggest this is a rare event , despite the widespread use of cervical fixation . patients suffering this complication can require revision , but do not usually suffer neurologic sequelae . these patients have increased cost of care . meticulous technique and thorough knowledge of the relevant anatomy are the best means of preventing this complication .

thymic carcinoma is an aggressive anterior mediastinal malignancy that can cause severe chest pain , although its incidence is rare . echocardiography is useful for assessing chest pain in the emergency room , but the diagnosis of an extracardiac mass can be missed . the purpose of this report is to describe the validation of echocardiography for accessing an extracardiac mass that presented with chest pain .

we report a case of thymic carcinoma that was initially detected by echocardiography in an 80-year - old male who visited the emergency room for chest pain and had a history of myocardial infarction and percutaneous coronary intervention . transthoracic echocardiography showed a huge extracardiac mass that was located in the anterior mediastinum and was diagnosed as a thymic carcinoma by biopsy .

bromodomains are epigenetic readers that specifically recognize acetyl - lysine ( kac ) marks on proteins . targeting this protein interaction module with small molecules has recently emerged as a potential therapeutic strategy for the treatment of several diseases including cancer and inflammation . to date , most inhibitor development efforts have been focused on the bet family of bromodomain proteins for which several inhibitors have now entered clinical testing . bromodomains have good predicted druggability , and selective chemical tool compounds have been developed even for less attractive binding sites that possess open or highly charged acetyl - lysine binding pockets such as baz2 and atad2 . in addition , potent inhibitors have been developed for highly druggable bromodomains present in brpf , cbp , and brd9 . interestingly , several recent inhibitor development projects have highlighted the success of fragment - based approaches identifying inhibitors , in particular for poorly druggable bromodomains . p300/cbp - associated factor ( pcaf , also known as histone acetyltransferase kat2b ) is a multidomain protein that harbors an acetyltransferase ( hat ) and e3 ubiquitin ligase domains as well as a c - terminal bromodomain that may associate with the hats p300 and cbp . while the roles of the acetyltransferase and the e3 ubiquitin ligase activities have been shown to be required for cell proliferation and apoptosis , little is known about the regulatory function of the pcaf bromodomain in cellular processes . selective inhibitors , so - called chemical probes , would therefore be interesting reagents to unravel the functions of the pcaf bromodomain and to assess its therapeutic potential as a targeting site for drug development . an important role of the pcaf acetyl - lysine recognition module has already been demonstrated for the replication of aids viruses . the pcaf bromodomain targets the hiv tat protein acetylated at k50 , an essential association that activates hiv-1 transcription and promotes the integrated proviral replication . development of pcaf bromo - domain inhibitors has therefore been proposed as a potential strategy for the treatment of aids , and this strategy has been confirmed by early n1-aryl - propane-1,3-diamine - based compounds that have been shown to prevent pcaf / tat association . this compound class has recently been followed up by the development of a series of 2- ( 3-aminopropylamino ) pyridine 1-oxide derivatives that however did not lead to improvement of the micromolar potency of current pcaf bromodomain inhibitors . this prompted us to identify more diverse chemical starting points using fragment screening by thermal shifts assays and nmr as well as structure - based approaches .

the p300/cbp - associated factor plays a central role in retroviral infection and cancer development , and the c - terminal bromodomain provides an opportunity for selective targeting . here , we report several new classes of acetyl - lysine mimetic ligands ranging from mm to low micromolar affinity that were identified using fragment screening approaches . the binding modes of the most attractive fragments were determined using high resolution crystal structures providing chemical starting points and structural models for the development of potent and selective pcaf inhibitors .

medical doctors move across borders being motivated by higher salaries , better working conditions , new professional experience , and training and career opportunities . in europe , migration of medical doctors has been observed since the 1940s and has shown various dynamics over the years . european integration has offered new possibilities for medical doctors to improve their skills , to study or to work in other countries . however , outflows from eastern europe started before accession , due to the political transitions of the late 1980s and the last 1990s . the eu enlargement , first in 2004 and then in 2007 , has generated increased mobility , especially from east to west , namely from eu-12 to eu-15 . studies have shown that migration of physicians from new member states has been lower than the leaving intentions . given the increasing trends in health professionals mobility , the european union has established a legal framework to regulate both the recognition of professional qualification and the free mobility of doctors and patients within europe . however , a legal framework for the recognition of professional qualification for physicians willing to work outside europe and for those coming from non - european countries is still lacking . migration of health professionals in generally and of medical doctors in particular has its roots in current problems of healthcare systems . medical doctors decide to move from one country to another not only because of higher incomes , but in search of better working environments , career opportunities and social recognition . thus , mobility of medical doctors is seen as a symptom of more fundamental health systems problems . these need to be addressed by policy makers in an integrated manner because health professional mobility can not be considered in isolation . while some european countries have to deal with major shortages of medical doctors , other are confronted with increasing pressures to manage maldistribution , both geographically and in terms of specialities needed . usually the positive effects occur when mobility is temporary and with the purpose of achieving new experiences , new specialities and training , followed by return in home country . in addition , mobility of doctors impacts positively the patients access to medical treatment and medical service , because patients can benefit of the knowledge and training achieved by medical doctors in other countries . if mobility is for long - term and outflows occur in countries struggling with shortages of medical doctors , then the negative impacts on the healthcare systems are felt both at macro level - financial loss for the country that has paid for the education of the physicians , national health system has to be adapted to the new situation , and at micro level lack of sufficient medical doctors or maldistribution will impact patients safety and access to care , and finally patients health .

this chapter aims at providing an insight into some major aspects linked to migration of medical doctors within europe . the article describes main factors which contribute to doctors migration . further , the current and future mobility trends in europe are discussed . a major part of this chapter is dedicated to an overview of the eu legal framework impacting healthcare professionals mobility , followed by some useful information related to the procedures for recognition of professional qualifications and offices in charge of mobility . finally , the impacts on healthcare systems and the policy implications of doctor s mobility are described in context of personalised medicine .

parkinson 's disease ( pd ) is a neurodegenerative condition characterised clinically as a movement disorder consisting of bradykinesia , rigidity and rest tremor , as a consequence of striatal dopamine depletion secondary to degeneration of the dopaminergic neurons of the substantia nigra . in addition , pathology in other regions results in cognitive deficits and a dementia in some cases , neuropsychiatric manifestations including depression and anxiety , sleep disturbances including rapid - eye movement sleep behavior disorder , and autonomic features ( kalia and lang , 2015 ) . the motor disorder of pd responds well to dopamine - replacement therapies such as levodopa or dopamine agonists . however , systemic administration of dopaminergic agents results in non - physiological release of dopamine in the striatum resulting over time in disabling motor dyskinesias , and off - target effects resulting in neuropsychiatric complications , including impulse control behaviours , which can be very severe in some patients . there remains therefore , a currently unmet need for a means of introducing dopamine to the striatum in a more physiological and targeted manner , and as such there is much interest in emerging cell - based regenerative treatments for pd ( jenner , 2003 ; barker et al . , 2015 ; kalia and lang , 2015 ) . a variety of sources of dopaminergic cells have been investigated for treating pd in this way , and in this review we discuss the basis of these , as well as their prospects for use in clinical practice .

parkinson 's disease ( pd ) is a neurodegenerative condition which causes a characteristic movement disorder secondary to loss of dopaminergic neurons in the substanitia nigra . the motor disorder responds well to dopamine - replacement therapies , though these result in significant adverse effects due to non - physiological release of dopamine in the striatum , and off - target effects . cell - based regenerative treatments offer a potential means for targeted replacement of dopamine , in a physiological manner . dopaminergic neurons for cell - based therapies can be obtained from several sources . fetal ventral mesencephalon tissue contains dopaminergic neuron progenitors , and has been transplanted into the striatum of pd patients with good results in a number of cases . however , the ethical implications and logistical challenges of using fetal tissue mean that fetal ventral mesencephalon is unlikely to be used in a widespread clinical setting . induced pluripotent stem cells can be used to generate dopaminergic neurons for transplantation , providing a source of autologous tissue for grafting . this approach means that challenges associated with allografts , such as the potential for immune rejection , can be circumvented . however , the associated cost and difficulty in producing a standardized product from different cell lines means that , at present , this approach is not commercially viable as a cell - based therapy . dopaminergic neurons derived from embryonic stem cells offer the most promising basis for a cell - based therapy for parkinson 's disease , with trials due to commence in the next few years . though there are ethical considerations to take into account when using embryonic tissue , the possibility of producing a standardized , optimized cell product means that this approach can be both effective , and commercially viable .

panoramic radiography is a cost - effective , low - dose method used in dental radiology for evaluating oral health status in routine dental practice.1 this technique allows examination of the maxillary and mandibular arches and their supporting structures on a single image.23 the advantages of panoramic radiography are time - saving , broad anatomic coverage , and high patient acceptability.34 abnormalities such as root fragments , impacted teeth , neoplasms , and foreign bodies are often overlooked when they do not cause symptoms or clinical signs.5 panoramic radiography is often used in routine examinations of edentulous jaws to detect asymptomatic conditions such as root fragments , retained teeth , radiolucent lesions , and foreign bodies.67 thus it is a valuable diagnostic tool in prosthetic treatment planning . in addition , they provide the clinician with information about the sinus floor position in edentulous regions for implant placement . several studies have been carried out including the occurrence rate of these asymptomatic pathologies.2467 however , only a few studies have documented the rate of these radiographic findings requiring treatment.4567 consequently , the aim of this study was to report the frequency of significant radiographic findings , to discuss utility of panoramic radiographs and to obtain the rate of the conditions which treatment is necessary before conventional or implant supported prosthetic rehabilitation in edentulous patients .

purposethe aim of this study was to determine the frequency of significant panoramic radiographic findings and eventual treatment requirements before conventional or implant supported prosthetic treatment in asymptomatic edentulous patients.materials and methodsa total of 743 asymptomatic edentulous patients were retrospectively evaluated using a digital panoramic system . we analyzed the radiographic findings , including impacted teeth , retained root fragments , foreign bodies , severe atrophy of the posterior maxillary alveolar bone , mucous retention cysts , soft tissue calcifications and radiopaque - radiolucent conditions.resultsfour-hundred-eighty-seven ( 65.6 % ) patients had no radiographic finding . a total of 331 radiographic findings were detected in 256 ( 34 % ) patients . in 52.9 % ( n=175 ) of these conditions , surgical treatment was required before application of implant - supported fixed prosthesis . however , before application of conventional removable prosthesis surgical treatment was required for 6 % ( n=20 ) of these conditions.conclusionthe edentulous patients who will have implant placement for implant - supported fixed prosthesis can frequently require additional surgical procedures to eliminate pathological conditions .

spinal epidural lipomatosis ( sel ) is a rare disease that is characterized by pathologic overgrowth of lumbar or thoracic epidural fat tissue . although the etiology of sel is not known , sel has been frequently diagnosed in obese patient groups and exogenous steroid administration groups , so steroid metabolism is presumed to be related with sel . excessive epidural fat deposition in the spinal canal can contribute to various neurologic symptoms , such as back pain , radiculopathy , myelopathy , claudication and even cauda equina syndrome . in this case , we present a sel patient who had taken steroid hormone medicine for 20 years , after a suprasellar tumor resection .

spinal epidural lipomatosis ( sel ) is an abnormal localized accumulation of fat tissues in the epidural space . it is strongly related with steroid administration . the symptoms of sel are various and range from back pain to paraplegia . in severe cases , decompressive laminectomy is the choice of treatment . a 32-year - old woman who had been under long - term steroid administration after suprasellar tumor resection was admitted for both leg radiating pain and weakness . she was diagnosed with sel and had a decompressive laminectomy . during the operation , we found the nerve roots were compressed by epidural fat tissues and engorged vessels . after the operation , her radiating pain was relieved and motor weakness was improved .

increased long - term survival following effective treatment of childhood lymphomas has placed greater emphasis on residual sequelae of therapy for lymphoma and the impact of these sequelae as the cause of further morbidity and mortality . following treatment of childhood hodgkin 's disease , cardiac pathology is second only to neoplasm as the cause of death in initial survivors . as the number of cancer survivors increases , so does the number of patients exposed to therapies toxic to the heart and lung , including radiation and chemotherapeutic modalities that employ anthracyclines . the literature is replete regarding effects of anthracyclines and radiation on the heart ; however , there is still debate regarding the detection of cardiac sequelae , their significance , and the relation between different treatment modalities and the development of cardiac sequelae . we hypothesized that protocols employing anthracyclines and radiation would adversely affect long - term cardiac function and that these effects would differ between survivors who received different treatment modalities . we therefore prospectively evaluated long term cardiac function in 45 survivors of childhood lymphomas , using clinical parameters , electrocardiography , and echocardiography and compared these parameters between lymphoma subtypes .

objectives . we studied long - term effects of therapy for childhood lymphoma on cardiac function . design and patients . we prospectively evaluated 45 survivors of childhood lymphoma , using clinical parameters , electrocardiography and echocardiography . further comparisons were made between lymphoma subgroups and between males and females . results . mean age at diagnosis was 9.1 years . mean followup duration was 10.9 years . the nyha functional class was i in 43 patients and ii in 2 patients . a prolonged qtc interval ( > 0.44 msec ) was found in 8 patients . left ventricular ( lv ) systolic function and compliance were normal ( lv shortening fraction 40 5.6 % ; cardiac index 2.84 1.13 l / min / m2 ; e / a wave ratio 2.5 1.3 ; mean s.d . ) , lv mass was normal ( 97 40 grams / m2 , mean s.d . ) . mitral regurgitation was observed in 7/45 patients ( 16 % ) . asymptomatic pericardial effusions were found in 3/45 ( 7 % ) patients . conclusions . long - term follow - up shows that most parameters of cardiac function are normal in survivors of childhood lymphoma . this is likely due to relatively low doses of anthracyclines in modern protocol modalities . abnormalities in mitral valve flow , qtc prolongation and in a small proportion of survivors , and functional capacity necessitate long - term cardiac follow - up of these patients .

temporal arteritis / giant cell arteritis ( gca ) is a systemic immune - mediated vasculitis first described by horton et al . that affects medium - sized and large - sized arteries , which include main branches of the aorta , its primary and auxiliary arteries , superficial temporal , ophthalmic , posterior ciliary and vertebral arteries . it is commonly seen in older women more than 50 years ( m : f ratio 2:5 ) . vision loss due to ischemia of the optic nerves may result from temporal arteritis secondary to vascular occlusion . since vision loss is permanent , temporal arteritis can drastically reduce the prevalence of vision loss associated with gca ( giant cell arteritis ) /temporal arteritis . additional life - threatening conditions like mi , aneurysm of the aorta , infarction of the intestine , renal insufficiency , pulmonary embolism , transient ischemic attacks and stroke may be related to temporal arteritis / gca ( giant cell arteritis ) . to avoid further complications , early diagnosis and appropriate management are essential . temporal arteritis has a wide spectrum of clinical manifestation related to both systemic inflammation and ischemia . the most prevalent signs and symptoms include temporal headache , jaw claudication , pmr ( polymyalgia rheumatica ) , scalp tenderness , and constitutional syndrome ( asthenia , anorexia , with appetite loss ) . orofacial manifestations of temporal arteritis include trismus , throat pain during chewing , changes in tongue sensation , tongue claudication , odontongenic pain , dysphagia , dysarthria , submandibular mass , lip and chin numbness , macroglossia , glossitis , lip and tongue necrosis , and facial swelling . the present article discusses a rare case of temporal arteritis , rheumatoid arthritis with extra cranial manifestation ( interstitial lung disease ) presenting as pulo - periodontol pathology .

a 75-year - old male patient was planned for dental treatment due to pain of suspected pulpo - periodontal origin in relation to right maxillary first molar . careful evaluation revealed the pain to be non - odontogenic in nature and led to the diagnosis of temporal arteritis with rheumatoid arthritis along with interstitial lung disease ( ild ) . characteristic findings of temporal arteritis include headache , jaw claudication , visual loss , and constitutional symptoms ( malaise , fever , weight loss , loss of appetite ) . temporal artery biopsy ( tab ) remains the gold standard for diagnosis . additional diagnostic tests include blood tests ( esr , crp ) . this article reports and discusses how the orofacial manifestations can lead to misdiagnosis of temporal arteritis . hence , temporal arteritis should be included in the differential diagnosis of orofacial pain in the elderly especially to prevent complications like vision loss .

microbial keratitis is an infective process of the cornea with a potentially sight - threatening condition and serious visual impairments ( 1 ) . untreated or severe keratitis may lead to significant public health problems like perforation of cornea and endophthalmitis ( 2 , 3 ) . contact lenses are a major cause of microbial keratitis in the developed countries especially among young people with about 12 % hospitalized cases requiring corneal transplantation ( 4 , 5 ) . contact lenses may reduce the epithelial barrier function by interfering with normal epithelial cell proliferation and differentiation . with the growth of soft contact lens wear , the incidence of this problem raised globally ( 3 , 6 ) . there are several differences in the incidence of contact lens keratitis ( clk ) across the world ( 7 ) . pseudomonas aeruginosa can adhere to the surface of the contact lens and colonize during wear and survive in contact lens storage cases . these processes maybe lead to corneal ulcers ; a severe infection can cause permanent blindness ( 8 ) . although corneal ulcer is a rare complication of contact lens wear , increasing in the number of lens wearers and the risk of blindness , provide important reasons to evaluate patients with contact lens induced corneal ulcers ( 9 , 10 ) . the number of contact lens wearers has dramatically increased in iran , particularly among young adults in recent years . therefore , the purpose of the present study was to evaluate the frequency and microbiological characteristic of clk in patients referred to the emergency department ( ed ) of teaching hospitals , babol , iran .

introduction : microbial keratitis is an infective process of the cornea with a potentially and serious visual impairments . contact lenses are a major cause of microbial keratitis in the developed countries especially among young people . therefore , the purpose of the present study was to evaluate the frequency and microbiological characteristic of clk in patients referred to the emergency department ( ed ) of teaching hospitals , babol , iran . methods : this is a cross - sectional study of all patients with contact lens induced corneal ulcers admitted to the teaching hospitals of babol , iran , from 2011- 2013 . an ophthalmologist examined patients with the slit - lamp and clinical features of them were noted ( including pain , redness , foreign body sensation , chemosis , epiphora , blurred vision , discomfort , photophobia , discharge , ocular redness and swelling ) . all suspected infectious corneal ulcers were scraped for microbial culture and two slides were prepared . data were analyzed using spss software , version 18.0 . results : a total of 14 patients ( 17 eyes ) were recruited into the study ( 100 % female ) . the patients age ranged from 16 - 37 years old ( mean age 21.587.23 years ) . the most prevalent observed clinical signs were pain and redness . three samples reported as sterile . the most common isolated causative organism was pseudomonas aeroginosa ( 78.6 % ) , staphylococcus aureus 14.3 % , and enterobacter 7.1 % , respectively . treatment outcome was excellent in 23.5 % , good in 47.1 % , and poor in 29.4 % of cases . conclusion : improper lens wear and care as well as the lack of awareness about the importance of aftercare visits have been identified as potential risk factors for the corneal ulcer among contact lens wearers . training and increasing the awareness of adequate lens care and disinfection practices , consulting with an ophthalmologist , and frequent replacement of contact lens storage cases would greatly help reducing the risk of microbial keratitis .

monoamine oxidase is a flavoprotein located at the outer membrane of mitochondria in neuronal , glial and other cells . it catalyzes oxidative deamination of monoamine neurotransmitters such as serotonin , norepinephrine and dopamine and hence is a target enzyme for antidepressant drugs . in addition , it is also responsible for the biotransformation of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine into 1-methyl-4-phenylpyridinium a parkinsonian producing neurotoxin . cloning and sequencing of mao - a and mao - b has great impact in understanding their molecular properties respectively . this has established the fact that both the enzymes are separate and share many similar properties such as covalent link between fad and cysteine residue , cys 406 in mao - a and cys 397 in mao - b , through an 8- ( cysteinyl ) -riboflavin . in spite of these similarities , therefore , design of specific inhibitors would lead to little or no side effects which most of existing inhibitors suffer from . mao - a has a higher affinity for serotonin and norepinephrine , while ; mao - b preferentially deaminates phenylethylamine and benzylamine . selective mao - a inhibitors are used in the treatment of neurological disorders such as depression , whereas the mao - b inhibitors are useful in the treatment of parkinson s and alzheimer s disease . in the light of these facts , we ventured into developing a pharmacophore for a set of 64 coumarin analogs , with close comparisons from structure based interactions .

flavoprotein monoamine oxidase is located on the outer membrane of mitochondria . it catalyzes oxidative deamination of monoamine neurotransmitters such as serotonin , norepinephrine and dopamine and hence is a target enzyme for antidepressant drugs . mao ( mono amine oxidase ) has two isoforms , namely mao - a and mao - b . mao - a isoform has higher affinity for serotonin and norepinephrine , while ; mao - b preferentially deaminates phenylethylamine and benzylamine . these important properties determine the clinical importance of mao inhibitors . selective mao - a inhibitors are used in the treatment of neurological disorders such as depression . in this article we have developed a hypogen pharmacophore for a set of 64 coumarin analogs and tried to analyze the intermolecular h - bonds with receptor structure .

open radical cystectomy ( orc ) is currently regarded as the gold standard for the management of muscle - invasive bladder cancer , extensive uncontrollable non - muscle - invasive cancer , and refractory carcinoma in situ ( cis ) . although recent development and refinement of surgical technique has improved postoperative patients ' quality of life and has reduced complications , orc is still associated with significant morbidity . laparoscopic radical cystectomy ( lrc ) is one of the minimally invasive options , and some reports have shown that oncological outcomes were equivalent to orc [ 3 - 5 ] . however , lrc does not yet have widespread use because of the technical difficulty of the procedure and long operation time . with the recent development of the da vinci robot system , robot - associated laparoscopic surgery has been applied to radical cystectomy . surgeons have begun to report small series of robot - assisted laparoscopic radical cystectomy ( rlrc ) [ 6 - 8 ] . these reports have demonstrated the surgical effectiveness of rlrc with advantages in blood loss , return of bowel function , and even hospital discharge . however , a large case of prospective randomized trials has not been reported . in this study , we present the short - term clinical and oncologic outcomes of our 17 consecutive cases of rlrc with pelvic lymph node dissection and extracorporeal urinary diversion .

purposerobot - assisted laparoscopic radical cystectomy ( rlrc ) is a new option for the treatment of muscle - invasive bladder cancer , and case series for rlrc have been increasing recently . we report our operative technique and initial experiences with rlrc with extracorporeal urinary diversion.materials and methodsbetween october 2008 and november 2009 , 17 consecutive patients with muscle - invasive bladder cancer underwent rlrc , pelvic lymph node dissection , and extracorporeal urinary diversion . urinary diversion included 13 ileal conduits and 4 orthotopic neobladders ( studer method ) . data were collected prospectively on patient demographics , intraoperative parameters , pathologic staging , and postoperative outcomes.resultsthe mean patient age was 63.7 years . the mean body mass index was 22.6 kg / m2 . no patients had a history of previous abdominal surgery . the mean operative time was 379.1 minutes , including 32.6 minutes for pelvic lymph node dissection , 185.2 minutes for rlrc , and 159.4 minutes for urinary diversion . the mean estimated blood loss was 210.5 ml . the mean hospital stay was 20.7 days and the mean time to oral intake and ambulation was 5.0 and 1.3 days , respectively . there were no major perioperative complications . the pathologic reports showed urothelial cell carcinomas in all cases.conclusionsour initial clinical experiences indicate that rlrc with pelvic lymph node dissection and extracorporeal urinary diversion is a safe and feasible procedure with minimal blood loss and rapid recovery . long - term follow up in a larger patient population is needed to determine the true oncological and functional benefit of this procedure .

endoscopic retrograde cholangiopancreatography ( ercp ) is a well - established modality in the management of pancreaticobiliary conditions . the procedure carries with it several well - recognised complications , as well as other much less common ones such as splenic injury , which can be associated with significant morbidity or mortality . since the first reported case of post - ercp splenic injury in 1989 , there have been a total of only 19 cases reported to date in the english , german and spanish literature [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ] . herein , we report on a patient who had a peri - splenic haematoma following ercp and was successfully managed conservatively . we also review in detail all of the published cases to better understand this rare complication .

splenic injury following endoscopy is a rare but potentially fatal complication . while this has been found to occur more frequently after colonoscopy , splenic injury following endoscopic retrograde cholangiopancreatography ( ercp ) remains highly uncommon since its first reported case in 1989 . indeed , there have been only 19 such cases reported in the english , german , and spanish literature collectively over the past 27 years . we report on a 59-year - old woman who developed a peri - splenic haematoma diagnosed on abdominal computed tomography the day following ercp and stenting for mirizzi syndrome . the patient was treated conservatively and made a full recovery . we reviewed all cases of post - ercp splenic injuries reported to date and discuss the published opinions on the likely mechanism of injury , predisposing factors , presenting features , investigation , and treatment options . ultimately , patient outcome relies on clinical suspicion of this rare complication following ercp .

hepatocellular carcinoma ( hcc ) is the most common primary malignancy of the liver , the sixth most common cancer ( 749,000 new cases each year ) , and the third cause of cancer - related death worldwide . in the western world , most cases of hcc develop within an established background of chronic liver disease and portal hypertension ( 70 % 90 % of all patients ) . liver resection is only possible in selected cases due to the high incidence of morbidity and mortality in patients with cirrhosis and elevated portal pressures . liver transplantation ( lt ) has become the treatment of choice for patients with hcc and end - stage liver disease , as it has the advantage of eradicating the tumor and the premalignant cirrhotic liver . recurrence after lt ranges from 8 % to 15 % when a specific criterion for selection of patients is used . surgical resection and ablation therapies have been associated with much higher rates of recurrence . after milan criteria were established ( single nodule less than 5 cm or 3 nodules less than 3 cm ) , excellent results have been reported with survival in the range of 60 % 70 % at 5 years [ 3 , 4 ] . nonetheless , shortage of organ donors is increasing the waiting time and consequently leading to 30 % 40 % dropout per year because of tumor progression . therefore , the practice of treating hcc patients with locoregional therapies before lt , as they are waiting to be transplanted , has become standard in most centers . we reviewed the literature on the use of locoregional therapies prior to liver transplantation and analyzed patients undergoing transplantation for hcc in our institution with emphasis on bridging therapy .

hepatocellular carcinoma ( hcc ) is the most common primary malignancy of the liver accounting for 7 % of all cancers worldwide . most cases of hcc develop within an established background of chronic liver disease . for that reason , liver resection is only possible in selected patients . liver transplantation has become the treatment of choice in patients with hcc , end - stage liver disease , and significant portal hypertension . shortage of organ donors has resulted in overall increase of waiting list time with increased risk of dropout due to tumor progression . neoadjuvant therapies have emerged as an alternative to control tumor growth in patients while waiting . the aim of this study is to review the literature on the role of bridging therapy and downstaging prior to liver transplantation in patients with hcc . we are also presenting our single - center experience of 96 patients undergoing transplantation for hcc with and without bridging therapy .

lung cancer remains the most lethal cancer , with over 160,000 annual deaths in the usa alone.1 over the past decade , the discovery of driver mutations has changed the landscape for the treatment of non - small - cell lung cancer ( nsclc ) .2 targeted therapies against epidermal growth factor receptor ( egfr ) or anaplastic lymphoma kinase ( alk ) have now been approved by the us food and drug administration as part of the standard first - line treatment of nsclc . despite good initial responses , most patients develop resistance within 812 months and have disease progression . hsp90 is a chaperone protein assisting other cellular proteins to fold properly , and stabilizes them against oxidative and heat stress , as well as helping with protein degradation.3 hsp90 is a weak atpase with a very rapid turnover rate ( 0.1/minute in humans ) . unlike alk and egfr nsclc that is driven by oncogenic mutations , the activity of hsp90 is regulated by the binding of cochaperone molecules that induce conformational change in the hsp90 . to date , over 20 cochaperone molecules have been identified.4 recent insights from the cancer genome atlas revealed that multiple malignancies overexpress or possess mutant kinases that depend on the hsp90chaperone complex.5 hsp90 has been shown to stabilize various signaling molecules , such as pi3k and akt proteins , thus inhibiting cellular apoptosis in cancerous cells ( figure 1 ) .6 it also appears that hsp90 can act as a protector of unstable protein by - products of dna mutations , such as v - src and mutant forms of p53.7 relevant to nsclc , mutant egfr,8 erbb2,9 met,10 mutant braf,11 and the eml4alk translocation product12 are all hsp90-dependent proteins , the degradation of which leads to loss of tumor - cell viability in the corresponding adenocarcinoma subset . expression of hsp90 has thus been shown to correlate with a worse clinical prognosis and to be correlated with resistance to chemo- and radiotherapy.13 the first class of hsp90 inhibitors to be characterized were the benzoquinone ansamycins , including geldanamycin and its derivatives 17-allylamino-17-demethoxygeldanamycin ( 17-aag ) and 17-dimethylaminoethylamino-17-demethoxygeldanamycin ( 17-dmag ) .14 they were derivatives of geldanamycin , which is an ansamycin antibiotic derived from a streptomyces sp . , and block atp binding to the active site of hsp90 . however , the clinical application of these drugs was limited by their poor pharmacokinetics and dynamics , including poor solubility , formulation problems , and potential multidrug efflux.15 as single agents , these molecules have shown only limited efficacy , thus pointing toward better results in combination therapy.16 in an effort to overcome these limitations , several second - generation synthetic hsp90 inhibitors representing multiple drug classes are currently under development . the goal of this review is to present the data supporting the use of hsp90 inhibitors in nsclc and to give an overview of the ongoing clinical trials involving new - generation hsp90 inhibitors .

lung cancer remains the most lethal cancer , with over 160,000 annual deaths in the usa alone . over the past decade , the discovery of driver mutations has changed the landscape for the treatment of non - small - cell lung cancer ( nsclc ) . targeted therapies against epidermal growth factor receptor ( egfr ) or anaplastic lymphoma kinase ( alk ) have now been approved by the food and drug administration as part of the standard first - line treatment of nsclc . despite good initial responses , most patients develop resistance within 812 months and have disease progression .

breast cancer ( bc ) is a malignant tumor that originates from healthy mammary gland cells . bc is most frequent among women aged between 50 and 70 , 1 - 3 . it affects one in eight women on average and is the most common type of cancer among women , 1 - 3 . about one million new cases of bc are diagnosed each year worldwide , representing about a third of new cases of all female cancers in industrialized countries and 15 % of new cases in developing countries . with the improvement of treatments , the survival rate of women diagnosed with bc has increased by 2 % a year during the last twenty years , 1 - 3 . however , despite this improvement , the mortality due to bc remains significant among women with about 20 women over 100 000 dying from this disease each year worldwide , 1 - 3 . while bc stages i ( localized tumors of less than 2 cm ) and ii ( tumors of 2 to 5 cm without nodes ) can be cured relatively simply using surgery resulting in a mortality rate of less than 50 % , those of grades iii ( infiltrating tumors without metastases ) and iv ( presence of metastases ) are much harder to treat , usually require heavy treatments often involving a combination of surgery , chemotherapy and radiotherapy , and result in a mortality rate of more than 50 % , 1 - 3 . firstly , bc arises because of several risks factors , such as aging , disease ( hyperplasia ) , a diet with a high intake of saturated fat , overweight , excessive alcohol consumption , exposure to ionizing radiation , the consumption of oral contraceptives , hormone replacement therapy , 1 - 3 . the first method , which can result in a decrease in the bc mortality rate , lies in the control of these risk factors , for example by making the women way of life healthier . secondly , the bc mortality rate can be decreased by improving bc diagnosis , 1 - 3 . the latter needs to be carried out frequently , accurately and early enough , i. e. possibly before stages iii and iv of bc have been reached . it yields controversial results due to the difficulty for the women to detect a tumor by themselves . instead , it is usually recommended that women should consult a trained doctor who carries out a clinical exam to detect a tumor inside the breast . the main and most reliable technique used for bc detection is mammography . with this technique , an image of the inside of the breast is obtained using x - rays and breast abnormalities are looked for . in the united states , 70 % of women above 40 years old have had a mammography during the last two years , 4 . one of the main problems with mammography is the significant percentage of overdiagnosis ( ~ 10 % ) , 5 , which leads women to be diagnosed with bc and treated whereas their condition is not life threatening and in some cases will never cause any symptoms . the third way to decrease bc mortality consists in improving bc treatments . indeed , it has shown its efficacy , specifically for treatments of bc of stages iii and iv for which the mortality rate is high and efficient treatments are lacking . the purpose of this review is to highlight the positive impacts as well as drawbacks of three different types of thermotherapies , hyperthermia , thermoablation and magnetic hyperthermia for bc treatment . ( general information regarding the different types of thermotherapies is provided in table 1 ; the advantages of magnetic hyperthermia compared with other types of thermotherapies are summarized in table 2 ) .

in this article , the use of different types of thermotherapies to treat breast cancer is reviewed . while hyperthermia is most commonly used as an adjuvant in combination with radiotherapy , chemotherapy , targeted therapy or cryotherapy to enhance the therapeutic effect of these therapies , thermoablation is usually carried out alone to eradicate small breast tumors . a recently developed thermotherapy , called magnetic hyperthermia , which involves localized heating of nanoparticles under the application of an alternating magnetic field , is also presented . the advantages and drawbacks of these different thermotherapies are highlighted .

anaesthetic management of a pregnant patient with an intracranial space occupying lesion ( sol ) requires modification of neuroanaesthetic and obstetric practices , which have competing clinical goals to achieve the optimal safety of both mother and foetus . maternal alterations during pregnancy may complicate the anaesthetic management and increase monitoring requirements for safety of both mother and foetus . neuroanaesthesia for the pregnant patient is required infrequently , as overall frequency for non - obstetric surgery during pregnancy is low and surgery for intracranial sol during pregnancy is rare . intracranial tuberculomas are clinically and radio graphically indistinguishable from enhancing neoplastic lesions . tuberculosis ( tb ) of central nervous system accounts for about 5 % of extra pulmonary cases and manifests as meningitis or uncommonly as tuberculoma .

intracranial space occupying lesion [ sol ] during pregnancy presents several challenges to the neurosurgeons , obstetricians and anaesthesiologists in not only establishing the diagnosis , but also in the perioperative management as it requires a careful plan to balance both maternal and foetal well - being . it requires modification of neuroanaesthetic and obstetric practices which often have competing clinical goals to achieve the optimal safety of both mother and foetus . intracranial tuberculoma should be considered in the differential diagnosis of intracranial sol in pregnant women with signs and symptoms of raised intracranial pressure with or without neurological deficits , especially when they are from high incidence areas . we report a 28-week pregnant patient with intracranial sol who underwent craniotomy and excision of the lesion , subsequently diagnosed as cranial tuberculoma .

oxidative stress has been defined as the cellular imbalance of prooxidants versus antioxidants that overwhelms the cell 's capacity to scavenge the oxidative load and contributes to the pathogenesis of various diseases . reactive oxygen species ( ros ) are free radicals derived from molecular oxygen that play a key role in promoting oxidative stress . there are several products of oxygen metabolism , both nonradicals and radicals that form ros such as hydrogen peroxide ( h2o2 ) and superoxide anions ( o2 ) . contributors of ros can modify the intracellular redox status through unfavorable interactions with endogenous regulators of oxidative stress . superoxide radicals can interact with mitochondrial nitric oxide to form peroxynitrite which can alter antioxidant enzymes such as aconitase and the mitochondrial complexes of the electron transport chain . on the other hand , the presence of oxidative stress can alter normal cellular homeostasis by modifying proteins involved in dna repair ; activating signal transduction pathways involved in cell survival and inflammation ; as well as , inducing cellular apoptotic pathways that are detrimental to the cell . for many years , scientists have tried to combat free radical generation and superoxide production through the utilization of the exogenous antioxidant supplementation , such as ascorbate , vitamin e , as well as linoleic acid . however , many of these trials have failed showing no significant decrease in cancer incidence , death , or major cardiovascular events . herein , we will focus on several novel signaling pathways affecting ros generation , such as p53 signaling and the interaction between p53 and manganese superoxide dismutase ( mnsod ) and how to potentially target these pathways for cancer therapy .

the formation of reactive oxygen species ( ros ) is a result of incomplete reduction of molecular oxygen during cellular metabolism . although ros has been shown to act as signaling molecules , it is known that these reactive molecules can act as prooxidants causing damage to dna , proteins , and lipids , which over time can lead to disease propagation and ultimately cell death . thus , restoring the protective antioxidant capacity of the cell has become an important target in therapeutic intervention . in addition , a clearer understanding of the disease stage and molecular events that contribute to ros generation during tumor promotion can lead to novel approaches to enhance target specificity in cancer progression . this paper will focus on not only the traditional routes of ros generation , but also on new mechanisms via the tumor suppressor p53 and the interaction between p53 and mnsod , the primary antioxidant enzyme in mitochondria . in addition , the potential consequences of the p53-mnsod interaction have also been discussed . lastly , we have highlighted clinical implications of targeting the p53-mnsod interaction and discussed recent therapeutic mechanisms utilized to modulate both p53 and mnsod as a method of tumor suppression .

a severe ocular injury sometimes results in an anterior segment anomaly and a posterior segment disturbance , simultaneously . a variety of corneal injuries can cause an opaque cornea that impedes the visualization of the fundus during vitreoretinal surgery . for this circumstance , an endoscopy - assisted vitrectomy is one solution , and the application of temporary keratoprosthesis ( tkp ) is another solution [ 25 ] . a penetrating keratoplasty ( pkp ) procedure is usually performed after a pars plana vitrectomy ( ppv ) using tkp . however , the long - term outcomes of this triple procedure ( ppv + tkp + pkp ) were not so optimistic for the traumatized eyes [ 25 ] . the main reasons for these unfavorable results were ciliary body malfunction and secondary graft failure . in our center , a different strategy was used in treating patients with coexisting vitreoretinal injury and severe corneal opacification . after a tkp assisted ppv , an allograft corneal transplant was not performed at the same time ; instead , the patient 's trephined corneal button was sutured back . herein , we present the anatomic outcome of this procedure ( tkp + ppv + replacement of the trephined cornea [ rtc ] ) .

in this case series of 74 patients with coexisting vitreoretinal injury and severe corneal opacification , after temporary keratoprosthesis ( tkp ) assisted pars plana vitrectomy ( ppv ) , an allograft corneal transplant was not performed at the same time ; instead , the patient 's trephined corneal button was sutured back . one year after the surgery , if intraocular pressure of the injured eyes was above 8 mmhg , removing silicone oil was attempted , and penetrating keratoplasty could be performed . finally , 10 eyes ( 13.5 % ) were enucleated due to atrophia bulbi ; 46 eyes ( 62.2 % ) were silicone - oil sustained ; 15 eyes ( 20.3 % ) were anatomically restored ; and 3 eyes ( 4.0 % ) experienced recurrent retinal detachment . these figures only demonstrate a small percentage of the injured eyes in our series , which have pkp indications . it is a practical option to suture back the patient 's trephined cornea following a tkp assisted ppv ; keratoplasty was reserved for selected cases .

tooth development involves a complex interaction of physiologic growth processes and morphologic stages to achieve tooth 's final form and structure . prevalence of supernumerary teeth ranges from 0.1 % to 3.6 % of which mesiodens comprise one - third . incidence of mesiodens of 1.6 % and distribution of 87 % , 12 % , and 1 % with one , two , and multiple supernumerary teeth respectively has been reported . mesiodens may cause delayed or impaired eruption , displacement , rotation , dilacerations , root resorption , crowding , diastema , cyst formation , infection , or mesiodens pulpitis .

mesiodens is the most common type of supernumerary teeth found in the premaxilla between the two central incisors . early and proper diagnosis and appropriate treatment plan is critical in eluding the extent of treatment needed . this case report presents the successful orthodontic and esthetic management of an unusual case of indian origin with twin mesiodens in the maxillary arch causing torsiversion and attrition of mandibular incisors due to occlusal trauma .

giant cavernous hemangiomas ( gch ) , measuring more than 6 cm , may harbor unique radiological findings of tumefactive appearance , including mass - effect , midline shift , perilesional edema , and contrast enhancement , with a conspicuous absence of calcifications . such a radiological finding in a child with raised intracranial pressure ( icp ) should be distinguished from intracranial neoplastic lesions . in this report , we describe the clinico - radiological features of a supratentorial gch in a 2-month - old infant and a 14-year - old boy who were admitted with the diagnosis of intra - tumoral bleed . the pathological result made us review the unique radiological findings in retrospect , providing a word of caution while diagnosing such cases .

this study reports two children , including a 2-month - old infant , harboring giant cavernous hemangiomas ( gch ) in the supratentorial compartment , causing raised intracranial pressure and focal deficits . relevant demographic details , clinical presentation , and radiological findings of gch are discussed in light of tumefactive presentation . differential diagnoses of such radiological findings are elaborated .

they were isolated from a herbaceous perennial plant called peganum harmala family ( zygophillacea ) - ( syrian rue or harmal ) ( 1 ) .the plant had been used extensively in the traditional medicine of middle east , india , china and africa as emmenagogue , hallucinogen , snuff , abortifacient , antidepressant , anti - inflammatory , antimalarial , anti - leishmania and anti - microbial ( 1 ) . nowadays , many -carbolins have been found to possess antibacterial , antiviral , antiparasitic and anticancer activities ( 1 ) . chloroquine ( cq ) is still the safest , cheapest and the most efficient among other antimalarials , ( 2 ) but unfortunately it started to lose its token as a potent drug due to emergence of chloroquine resistant and tolerant strains of plasmodium falciparum . the former is associated with loss of drug response to higher doses while the latter is accompanied by higher incidence of the disease reoccurrence ( 3 , 4 ) . this issue has urged the scientist to search for other alternatives or agents that can chemosensitize cq and reduce its resistance or tolerance ( 5 ) . in this communication , both the anti - plasmodium and cq resistance reversal potencies of three different -carbolins alkaloids ; harmalin , harmol and harmalol were tested against both 3d7 ( cq sensitive ) and k1 ( cq resistant ) strains of p. falciparum .

background : nowadays , scourge of malaria as a fatalistic disease has increased due to emergence of drug resistance and tolerance among different strains of plasmodium falciparum . emergence of chloroquine ( cq ) resistance has worsened the calamity as cq is still considered the most efficient , safe and cost effective drug among other antimalarials . this urged the scientists to search for other alternatives or sensitizers that may be able to augment cq action and reverse its resistance.method : three -carbolin derivatives , namely , harmalin , harmol and harmalol were tested for their anti - plasmodial and cq resistance reversal effects against p. falciparum 3d7 and k1 . sybre green-1 based drug sensitivity assay and isobologram analysis were used to screen the mentioned effects respectively.results : all of them showed moderate anti - plasmodium effect and harmalin was the most effective as compared to the others in reversing cq resistance and tolerance.conclusion : the mentioned phytochemicals are not ideal to be used as conventional antimalarials and only harmalin can be suggested to reverse cq resistance in p. falciparum k1 .

primary effusion lymphoma ( pel ) is a rare form of non - hodgkin 's lymphoma characterized by malignant fluid accumulation in the absence of lymphadenopathy . typical sites of accumulation include pleural , pericardial , and ascites fluid . pel is associated with immunodeficiency states such as acquired immunodeficiency syndrome ( aids ) and infectious etiologies such as human herpes virus 8 ( hhv8 ) . the world health organization ( who ) uses the pel term for only hhv - related pel . in our case , the term hhv8-unrelated pel - like lymphoma has been used in the literature to describe such cases .

we present a 71-year - old female with human herpes virus 8 ( hhv8 ) -unrelated primary effusion lymphoma ( pel ) -like lymphoma . dyspnea and pericardial effusion led to pericardiocentesis , diagnosing diffuse large b - cell lymphoma . she underwent positron emission tomography / computed tomography ( pet / ct ) , which demonstrated hypermetabolic pericardial , pleural , and ascites fluid without lymphadenopathy elsewhere . malignant fluid in the absence of lymphadenopathy is a hallmark of pel . pel is associated with immunodeficiency states such as acquired immunodeficiency syndrome ( aids ) and infectious agents such as hhv8 . our patient had no such history and had not received immunosuppressive chemotherapy . we present the pet / ct findings of this rare case of hhv8-unrelated pel - like lymphoma .

autism spectrum disorders ( asd ) are lifelong conditions severely impairing social skills and autonomy . according to the fifth edition of the diagnostic and statistical manual of mental disorders ( dsm-5 ) , asd core features are : persisting deficits of social communication and interaction ; restricted and repetitive behaviors , interests , activities . compared to the previous edition ( dsm - iv - text revision ) , dsm-5 introduced significant changes . in the diagnostic criteria , language abilities not employed in social communication have been de - emphasized . further , the diagnostic subcategories , that is , autistic disorder , asperger disorder , rett disorder , childhood disintegrative disorder , and pervasive developmental disorder ( pdd ) not otherwise specified , have been abolished . dsm-5 describes three levels of increasing severity of asd , from ( 1 ) ( requiring support ) to ( 2 ) ( requiring substantial support ) , finally to ( 3 ) ( requiring very substantial support ) . we report two explanatory cases affected by asd with the same severity level , according to dsm-5 , but with remarkable differences regarding the neuropsychological and neurobehavioral profile .

the fifth edition of the diagnostic and statistical manual of mental disorders ( dsm-5 ) introduced significant changes in the classification of autism spectrum disorders ( asd ) , including the abolition of the diagnostic subcategories proposed by dsm - iv - text revision . dsm-5 describes three levels of increasing severity of asd . the authors report two explanatory cases with asd ( verbal boys , aged about 7 and a half years , without intellectual disability ) . according to dsm-5 , both cases fall into the lowest severity level of asd . however , their neuropsychological and neurobehavioral profile varies significantly . while the first boy showed a prevalent impairment of visuoconstructional and visuoperceptual abilities , the second one presented a predominant involvement of verbal functions , with qualitative impairments in communication . a further step forward in the definition and classification of asd , taking into account both intensity and quality of symptoms , is recommended in order to formulate a reliable prognosis , plan an individualized treatment and monitor the clinical course over time .

eating disorders were described in the early descriptions of patients with asperger syndrome.1 asperger syndrome is a serious and chronic neurodevelopmental disorder , which is presently defined by social deficits , restricted interests , and relative preservation of language and cognitive ability.2 in diagnostic and statistical manual of mental disorders ( dsm ) -iv , the syndrome was considered to be separate , but it fell under the broader category of pervasive developmental disorders . in dsm - v , asd is a disorder with persistent deficits in social interaction and communication skills , accompanied by restricted , repetitive patterns of behavior , interests , or activities and by atypical sensory reactivity.3 we know nowadays that eating disorders take various forms and are often presented in asd , complicating both diagnosis and therapy . rastam4 offered a summary of these disorders stating that abnormal eating behaviors are overrepresented in asd , including food refusal , pica , rumination , and selective eating . she considers the connection between anorexia nervosa ( an ) and asd as interesting and states that asperger syndrome is sometimes not recognized in female teenagers with eating disorders . there is a risk that autistic traits in girls with an are overlooked , which may lead to a simplification in the diagnostic consideration and therapeutic procedures . a contemporary review publication has explained that asds are overrepresented in individuals who develop an and also that asds are common in chronic cases of an.5 this comorbidity has been associated with a poorer prognosis.6 the research by baron - cohen et al7 confirms that girls with an have elevated autistic traits . the authors point out that clinicians should consider whether a focus on autistic traits might be helpful in the assessment and treatment of anorexia . early - onset an ( in children under the age of 12 years ) represents approximately 5 % of all cases . it is a serious disorder jeopardizing the development of children in the somatic and psychosocial areas , and it seems that its incidence is growing.8 in individual research groups where early - onset is indicated , there is not always agreement as to the precise age definition of early - onset ; some authors describe premenarcheal girls , others refer to the age between 8 and 14 years.9 both an and early - onset eating disorders include syndromes of food avoidance emotional disorder and selective eating . specific psychopathology of early - onset an is very similar to the disorder onset in adolescence.10 an extensive study by halmi et al11 suggests that the predominant feature that precedes all an subtypes is global childhood rigidity , which is a trait that leads to resistance to changes . pooni et al12 found a higher incidence of autistic traits in individuals with early - onset eating disorders ( 816 years ) compared with typically developing peers , namely , repetitive and stereotyped behaviors , and also trends toward higher levels of autistic social impairment . coombs et al13 looked into the relationship between eating disorder psychopathology and autistic symptomatology in a non - clinical sample of school children aged 1114 years with no recorded psychiatric diagnoses , and found a significant relationship between the level of eating disorder symptomatology and asd symptomatology . according to karlsson et al14 eating disorders are common in asd but are often being overlooked . they developed a psychometrically and statistically valid swedish eating assessment for autism spectrum disorders questionnaire detecting eating disorders , which has been designed for individuals with asd aged 1525 years with normal intelligence ; in younger patients , clinical assessment has to suffice at the moment .

eating disorders frequently occur in conjunction with autism spectrum disorders , posing diagnostic and therapeutic difficulties . the comorbidity of anorexia nervosa and asperger syndrome is a significant clinical complication and has been associated with a poorer prognosis . the authors are presenting the cases of an eleven - year - old girl and a five - and - a - half - year - old girl with comorbid eating disorders and asperger syndrome .

iniencephaly is a rare birth defect having retroflexion of the head combined with severe distortion of the spine . based on the presence or absence of encephalocele , lewis has classified iniencephaly into two groups - iniencephaly apertus and iniencephaly clausus . cardiovascular disorders , diaphragmatic hernias , and gastrointestinal malformations are other additional defects seen in these cases . most of iniencephalic babies are still born or die soon after birth ; however the milder forms of iniencephaly cases are not fatal . here

iniencephaly is a rare neural tube defect characterized by extreme retroflexion of the head with the absence of neck due to spinal deformities . the important features that help us to diagnose a case of iniencephaly are occipital bone deficit leading to enlarged foramen magnum , fusion of malformed cervical and thoracic vertebrae , and upward turned face with chin continuous with chest because of the absence of neck . the differential diagnoses include anencephaly with spinal retroflexion , klippel fiel syndrome , nuchal tumors such as teratoma , goiter , and lymphangioma and jarcho levin syndrome . previously many case reports on radiological features of iniencephaly are published , but there are very few articles on necropsy findings and differential diagnosis . in the present case we have discussed in detail the necropsy findings of iniencephaly clausus with special reference to differential diagnosis .

for survival and reproduction , the body has developed an intricately balanced system to efficiently control energy homeostasis at multiple levels . in short , the brain continually monitors the systemic metabolic state and adjusts behavior , as well as humoral and neuronal outputs to peripheral effector organs , to ensure an appropriate energy supply . if the central nervous system ( cns ) senses a caloric shortage or surplus , the brain orchestrates responses that alter food intake , nutrient partitioning and physiological functions such as hepatic glucose production , adiposity and thermogenesis . efficient maintenance of the delicate homeostatic balance of energy , glucose and lipid metabolism largely depends on system - wide synchronicity of metabolic processes that can only be achieved by central regulatory influences and master circuits in the brain . disruption of such synchronicity , or failure of any of the key components of this system , are common pathophysiological causes of metabolic disorders such as obesity and diabetes . the most well - studied metabolic sensing region in the forebrain is the hypothalamus , where a number of nuclei such as the arcuate nucleus ( arc ) and ventromedial hypothalamus ( vmh ) express high levels of receptors that bind adipokines ( cell signaling molecules secreted by adipose tissue , such as leptin ) and gut hormones . central leptin resistance , one of the major causes of obesity , is caused by defective leptin sensing in these brain regions ( gautron and elmquist , 2011 ) . in the hindbrain , the nucleus tractus solitarius ( nts ) dorsal motor nucleus of the vagus ( dmv ) complex is the best - studied brain area with respect to detection of metabolic feedback , especially from the gastrointestinal system via vagal afferents or the circulation ( berthoud et al . , 2006 ) . in this article and the accompanying poster , we provide an overview of current knowledge regarding coordinated system - wide connections that maintain energy homeostasis , highlighting how disruptions in metabolic sensing and integration between the brain , white adipose tissue ( wat ) and the gastrointestinal system can contribute to metabolic disorders . adipose - tissue communication pathways , it is important to acknowledge that other important cns - peripheral communications ( such as those involving muscle and brown adipose tissue ) also contribute to energy homeostasis .

one of the side effects of our modern lifestyle is a range of metabolic diseases : the incidence of obesity , type 2 diabetes and associated cardiovascular diseases has grown to pandemic proportions . this increase , which shows no sign of reversing course , has occurred despite education and new treatment options , and is largely due to a lack of knowledge about the precise pathology and etiology of metabolic disorders . accumulating evidence suggests that the communication pathways linking the brain , gut and adipose tissue might be promising intervention points for metabolic disorders . to maintain energy homeostasis , the brain must tightly monitor the peripheral energy state . this monitoring is also extremely important for the brain s survival , because the brain does not store energy but depends solely on a continuous supply of nutrients from the general circulation . two major groups of metabolic inputs inform the brain about the peripheral energy state : short - term signals produced by the gut system and long - term signals produced by adipose tissue . after central integration of these inputs , the brain generates neuronal and hormonal outputs to balance energy intake with expenditure.miscommunication between the gut , brain and adipose tissue , or the degradation of input signals once inside the brain , lead to the brain misunderstanding the peripheral energy state . under certain circumstances , the brain responds to this miscommunication by increasing energy intake and production , eventually causing metabolic disorders . this poster article overviews current knowledge about communication pathways between the brain , gut and adipose tissue , and discusses potential research directions that might lead to a better understanding of the mechanisms underlying metabolic disorders .

the three main causes of anaemia are blood loss , lack of red blood cell production , and high rates of red blood cell destruction . blood loss is the most common cause of anaemia , especially iron - deficiency anaemia ( ida ) . between 2 and 5 % of adult men and postmenopausal women in the developed world have ida [ 1 , 2 ] . in premenopausal women , menstrual blood loss is the most common cause for ida , but , in postmenopausal women and men , the commonest cause is blood loss from the gastrointestinal ( gi ) tract [ 36 ] . the most frequent causes of occult gi blood loss are nonsteroidal anti - inflammatory drugs , colonic cancer / polyp , gastric cancer , angiodysplasia , crohn 's disease , and ulcerative colitis . therefore , an upper and lower endoscopy is an important and necessary examination in the assessment of anaemic patients . apart from the more usual causes of ida , there are also less frequent and often overlooked causes of gi blood loss , such as paraoesophageal herniae ( ph ) . the prevalence of ida in patients with large ph is between 6 and 37 % [ 811 ] , a clinical correlation first established by segal in 1931 . however , the exact cause of this association is not fully elucidated . in 1986 , cameron and higgins described the presence of linear gastric erosions at the waist of the hernia ( so called cameron lesions ) , which can cause chronic blood loss . although the association between cameron lesions and hiatal hernias is well described [ 14 , 15 ] , the pathophysiological mechanisms underlying these lesions remain unclear . however , these lesions do not fully explain ida , as only 1/3 or less of anaemic patients with a large ph might have cameron lesions at endoscopy [ 9 , 18 ] . although ida is a recognised complication of hiatus hernia , there are few published data regarding the incidence and outcome of severe , transfusion - dependent ida in patients with ph ( as opposed to mild anaemia not requiring treatment ) . the aim of this study was to specifically identify such patients and to assess resolution of the anaemia after laparoscopic repair of the hiatal hernia .

introduction . a paraoesophageal hernia ( ph ) may be one reason for iron - deficiency anaemia ( ida ) but is often overlooked as a cause . we aimed to assess the incidence and resolution of transfusion - dependent ida in patients presenting for hiatal hernia surgery . methods . we analysed a prospective database of patients undergoing laparoscopic hiatal repair in order to identify patients with severe ida requiring red cell / iron transfusion . results . of 138 patients with ph managed over a 4-year period , 7 patients ( 5.1 % ; m : f 2 : 5 ; median age 62 yrs ( range 5782 ) ) with ida requiring red cell / iron transfusion were identified . preoperatively , 3/7 patients underwent repetitive and unnecessary diagnostic endoscopic investigations prior to surgery . only 2/7 ever demonstrated gastric mucosal erosions ( cameron ulcers ) . all patients were cured from anaemia postoperatively . discussion . ph is an important differential diagnosis in patients with ida , even those with marked anaemia and no endoscopically identifiable mucosal lesions . early recognition can avoid unnecessary additional diagnostic endoscopies . laparoscopic repair is associated with low morbidity and results in resolution of anaemia .

extracorporeal shock wave lithotripsy ( swl ) has been the most common treatment of choice , especially for small renal stones ( < 2 cm ) , since its introduction by chaussy et al . the effectiveness of swl on kidney stones varies from 69.5 % up to 99 % [ 2 - 4 ] . failure to fragment by swl could result in unnecessary exposure of the renal parenchyme to shock waves and the requirement for an alternative procedure , which increases medical cost . therefore , it is important to identify patients who would benefit most from swl before treatment . there have been many reports on the factors predicting stone disintegration by swl . in particular , radiographic findings have been studied , such as the skin - to - stone distance ( ssd ) and the hounsfield unit ( hu ) for measuring the density of the stone on noncontrast computed tomography ( ncct ) . patient characteristics such as body mass index ( bmi ) have also been reported as significant predictors of the results of swl . in this study , we evaluated possible predictive variables for the outcome of swl of renal stones to help to better define the indications for swl treatment and to determine the efficiency with which we can check hu and stone size .

purposethe aim of this study was to evaluate possible predictive variables for the outcome of shock wave lithotripsy ( swl ) of renal stones in a single center.materials and methodsbetween march 2008 and march 2010 , a retrospective review was performed of 115 patients who underwent swl for solitary renal stones . the patients ' characteristics and stone size , location , skin - to - stone distance ( ssd ) , and hounsfield units ( hu ) of stone were reviewed . the impact of the possible predictors on the disintegration of the stones was evaluated by logistic regression analysis . receiver operator characteristic ( roc ) curves were generated to compare the predictive powers of the variables.resultsseventy-nine patients ( 68.7 % ) had successful outcomes , whereas 36 patients ( 31.3 % ) had residual stones . significant differences were found in the mean size and mean hu of the stones ( size : 8.343.58 mm vs. 13.575.41 mm , p < 0.001 ; hu : 675.29254.34 vs. 1,075.00290.41 , p < 0.001 ) . in the unadjusted model , age , stone size , and stone density were significant predictors . in the reduced model , stone density and size were significant predictors for the outcome of swl . the area under the roc curve ( auc ) was significantly higher for stone density and size than for the other parameters , but the auc between stone density and size did not differ significantly ( stone density : 0.874 , stone size : 0.827 , p=0.388 ) .conclusionsstone density and size were significant predictors of the outcome of swl for renal stones less than 2.0 cm in diameter . we should consider hu and stone size when making decisions on the treatment of renal stones .

complexity of a human biological system typically allows its relations to be expressed only in a nonlinear way . because of this complexity diabetes mellitus is a metabolic disorder of endogenous insulin allowing excessive amount of glucose to stay in blood . in general , blood glucose is transformed into energy required by human activities , such as , walking , and this transformation requires insulin functionality . however , in diabetes mellitus , since a human body fully or partially lacks the insulin functionality , unchanged glucose remains in blood . a condition of high blood glucose profiles results in several complications , such as , eye , kidney , and nerve damage , called hyperglycemia . thus , in order to avoid the hyperglycemia , a continuous supply of exogenous insulin is required , and the insulin - dependent diabetic therapy usually does this . on the contrary , too much insulin supply may lead to a condition of low blood glucose profiles resulting in drowsiness , mental malfunctioning , irritability , and loss of consciousness . thus , the insulin - dependent diabetic therapy must concern both hyperglycemia and hypoglycemia by providing an appropriate amount of exogenous insulin timely . at the beginning of the insulin - dependent diabetic therapy , it is required to obtain an approximation of the insulin - glucose relation . two methods are taken in this process , namely , empirical and fundamental methods . arguably , this process is most time consuming . based on mathematical equations representing the insulin - glucose mechanism , broadly , controlling the blood glucose levels is achieved by means of three strategies , namely , open - loop , closed - loop , and partially closed - loop schemes . in general , the fully and partially closed - loop schemes involves several medical devices but the open - loop scheme does not . while in the closed - loop scheme , a system is aimed to completely encompass the diabetic , open- and partially closed - loop require the physician 's contribution to complete the loops . therefore , typically any decisions of the insulin injections are made by a physician in open- and partially closed - loop schemes . this paper is the second part of our survey of insulin - dependent diabetes . our first paper , the first part of the survey , mostly spent its pages on the background of insulin - dependent diabetes therapy , such as , description of type 1 and type 2 diabetes , the insulin functionality , and medical devices involved in the insulin - dependent therapy . in this paper , we survey blood glucose control schemes which lie on the basics of the insulin - dependent diabetes therapies and systems . the rest of the paper is organized as follows . in section 2 , we briefly summarize diabetes mellitus for the sake of induction to the topic . in section 3 , we explain empirical and fundamental schemes to derive mathematical models of the insulin - glucose dynamics . from sections 4 through 6 , we explore the control strategies , especially for the insulin - glucose dynamics . in these sections , we provide several applications based on the controls .

we survey blood glucose control schemes for insulin - dependent diabetes therapies and systems . these schemes largely rely on mathematical models of the insulin - glucose relations , and these models are typically derived in an empirical or fundamental way . in an empirical way , the experimental insulin inputs and resulting blood - glucose outputs are used to generate a mathematical model , which includes a couple of equations approximating a very complex system . on the other hand , the insulin - glucose relation is also explained from the well - known facts of other biological mechanisms . since these mechanisms are more or less related with each other , a mathematical model of the insulin - glucose system can be derived from these surrounding relations . this kind of method of the mathematical model derivation is called a fundamental method . along with several mathematical models , researchers develop autonomous systems whether they involve medical devices or not to compensate metabolic disorders and these autonomous systems employ their own control methods . basically , in insulin - dependent diabetes therapies , control methods are classified into three categories : open - loop , closed - loop , and partially closed - loop controls . the main difference among these methods is how much the systems are open to the outside people .

germ cell tumors often complicate uncorrected cryptorchidism with an incidence of 9.8 % reported by martin . occurrence of pure yolk sac tumor however is uncommon in the undescended testis with only a few cases reported in literature . we present a case of yolk sac tumor in a 2-year - old boy in the undescended testis which was primarily diagnosed by fine needle aspiration cytology ( fnac ) .

yolk sac tumor is the most common germ cell tumor in infants and children . majority of them arise in the gonads . yolk sac tumor of undescended testis has been rarely diagnosed . we present a case of yolk sac tumor in right undescended testis in a 2-year - old child primarily diagnosed by fine needle aspiration cytology .

incomplete regression of the mammary ridges may result in aberrant breast tissue , which can be classified based on its components . among the various types of breast choristoma , ectopic breast tissue , comprised of only glandular tissue without a nipple or areola , although ectopic breast tissue does not have a secretory ductal system , it is histologically no different from anatomically normal breast tissue . ectopic breast tissue therefore shows physiologic and pathogenic processes similar to those of eutopic breast tissue . clustered microcalcifications on mammography are a relatively common feature of invasive carcinoma or ductal carcinoma in situ . however , the microcalcification of ectopic breast tissue is difficult to delineate on mammography , and is often not detected . we report herein a case of ductal carcinoma in situ originating from axillary ectopic breast tissue that had revealed clustered microcalcifications on screening mammography .

ectopic breast tissue can occur anywhere along the incompletely regressed mammary ridge . among the various types of breast choristoma , ectopic breast tissue , which has only glandular tissue without a nipple or areola , is most commonly detected in axillary areas . however , ectopic breast cancer is often not detected until significant clinical symptoms have been revealed , or diagnosis is delayed . furthermore , an examination of ectopic breast tissue tends to be omitted from a screening mammography . especially , the microcalcifications of ectopic breast tissue are difficult to delineate on mammography . herein , the authors report a case of ectopic breast carcinoma that showed clustered microcalcifications on screening mammography , and discuss the interpretation and implications of microcalcification in ectopic breast tissue .

the influenza pandemic of 19181920 was the most lethal natural event in recorded human history . within a few months , the influenza a / h1n1 pandemic spread worldwide and killed 4080 million people . , during the pandemic , influenzarelated mortality increased in all affected populations ; however , it markedly varied across locations and among demographic subgroups at specific locations . for example , during the pandemic , previously healthy young adults had relatively high mortality risk ; the unprecedented wshaped relationship between mortality and age remains unexplained . also , during the pandemic , influenzarelated mortality rates were extraordinarily high in some island and other isolated populations ( e.g . , arctic ) . this has led researchers to believe that mortality was because of a lack of crossprotective immunity provided by prior influenza virus strains . the analysis of isolated communities , and specifically demographic subgroups within those communities , can help to understand the outcome of infection . mortality differed by more than 10fold across apparently similar island populations and more than 30fold across demographic subgroups of specific island populations . the 1918 influenza a / h1n1 virus was efficiently transmitted but not inherently or inevitably lethal . most individuals who were infected with the pandemic strain had unremarkable clinical courses with complete recovery . nearly all pandemicrelated deaths were because of postinfluenza bacterial pneumonias rather than direct pathologic effects of the virus . in the absence of antivirals , antibiotics , mechanical ventilation , and intensive medical care , significant differences in mortality among various island populations were unlikely related to differences in medical care . also , because most epidemics on isolated islands were caused by point source introduction of the pandemic strain ( e.g . , via the arrival of a single ship ) , it is thought that nearly all humans were immunologically susceptible to infection with the pandemic strain in 1918 . the wide ranges of mortality across islands and across subgroups on the same islands suggest that the number and nature of prior respiratory infections ( with influenza viruses and other respiratory infectious agents ) may have significantly influenced clinical expressions and outcomes of infections with the pandemic strain . we hypothesize that exposures to few , and a limited diversity of , respiratory infectious agents prior to the 19181920 influenza pandemic enabled extremely high mortality in isolated communities , particularly islands , during the 19181920 influenza pandemic . for this report , we examined the influenza mortality records from several island communities , both civilian and military , to assess the relationships between prior influenza and other respiratory infectious disease experiences and mortality during pandemicrelated epidemics in 19181920 .

please cite this paper as : shanks et al . ( 2012 ) epidemiological isolation causing variable mortality in island populations during the 19181920 influenza pandemic . influenza and other respiratory viruses 6 ( 6 ) , 417423 . background during the 1918 pandemic period , influenzarelated mortality increased worldwide ; however , mortality rates varied widely across locations and demographic subgroups . islands are isolated epidemiological situations that may elucidate why influenza pandemic mortality rates were so variable in apparently similar populations . objectives our objectives were to determine and compare the patterns of pandemic influenza mortality on islands . methods we reviewed historical records of mortality associated with the 19181920 influenza pandemic in various military and civilian groups on islands . results and conclusions mortality differed more than 50fold during pandemicrelated epidemics on pacific islands [ range : 04 % ( hawaii ) to 22 % ( samoa ) ] , and on some islands , mortality sharply varied among demographic subgroups of island residents such as saipan : chamorros [ 12 % ] and caroline islanders [ 04 % ] . among soldiers from island populations who had completed initial military training , influenzarelated mortality rates were generally low , for example , puerto rico ( 07 % ) and french polynesia ( 013 % ) . the findings suggest that among island residents , those who had been exposed to multiple , antigenically diverse respiratory pathogens prior to infection with the 1918 pandemic strain ( e.g . , less isolated ) experienced lower mortality . the continuous circulation of antigenically diverse influenza viruses and other respiratory infectious agents makes widespread high mortality during future influenza pandemics unlikely .

injuries in classical ballet are common and often challenging to treat for a number of reasons . many practitioners do not understand the physical demands of the sport or the terminology describing the common mechanisms of over use . classical ballet dancers subject themselves to repetitive loads that require progressive training over hundreds of hours both increasing the risk of overuse injury and complicating rehabilitation that involves any rest from dance . the ability to dance en pointe ( on the tips of the toes ) for instance , requires progressive development of the kinetic chain from the back to the toes , any disruption of which may result in overuse injury anywhere in the chain . foot and ankle injuries that are more common in classical ballet are both anterior and posterior ankle impingement , flexor hallucis longus tendonitis , and stress fractures at the base of the second metatarsal and fibula . this article will address the diagnosis and treatment of anterior ankle impingement including when performers should return to dance .

anterior impingement is a common problem in dancers occurring primarily secondary to the repetitive forced ankle dorsiflexion inherent in ballet . symptoms generally occur progressively and may respond to conservative treatment including addressing biomechanical faults that contribute to the problem . as impingement progresses , movements essential to ballet may become impossible and arthroscopic ankle surgery is often effective for both diagnosis and treatment , allowing athletes to return to dance .

post - herpetic neuralgia is a serious complication of herpes zoster that causes critical pain to patients even after skin lesions have healed . epidural blocks are achieved either by single injection of local anesthetic through the epidural needle or as continuous block by infusion pump through an epidural catheter . the epidural catheter can be inserted not only in thoracic and lumbar vertebra , but also in cervical vertebra . knotting of epidural catheters is very rare , but knotting in lumbar epidural catheters has been reported in a number of studies , and most of these cases involved removal difficulty . we report a case in which we inserted a cervical epidural catheter in a patient who was experiencing severe post - herpetic neuralgia and then removed the knotted catheter without complications .

epidural block is achieved either by single injection of local anesthetic through an epidural needle or as a continuous block by infusion pump through an epidural catheter . complications associated with epidural catheters include breakage , entrapment , and knotting . knotting of epidural catheters is very rare , but knotting in lumbar epidural catheters has been reported in a number of studies , and most of these cases involved removal difficulty . we report a case in which we inserted a cervical epidural catheter in a patient who was experiencing severe post - herpetic neuralgia and then removed the knotted catheter without complications .

however , insufficient body water due to continuous dehydration caused by prolonged exercise leads to a decrease in plasma volume and cardiac output and an increase in plasma osmolarity and core temperature1 , 2 . furthermore , inefficient heat dispersion caused by a decreased rate of blood flow to the skin can accelerate fatigue and deteriorate exercise performance by retaining body heat3 , 4 . therefore , to improve exercise performance in athletes and to enhance the effects of regular exercise for health maintenance and promotion , it is important to develop a method that can alleviate exercise - induced rise in body temperature . far infrared electromagnetic wavelengths of 5.61,000 m can activate cells and promote metabolism when absorbed by the human body . previous studies verified the efficacy of ge - coated clothing5 , 6 , and observed that ge - containing fibers emitted far infrared rays and anions and had an antibacterial effect . these results suggested that ge - containing fibers could promote blood circulation and had the potential to suppress fatigue and relieve thermal stress by wearing ge - containing and/or ge - coated clothing during exercise . however , a scientific approach to proving such an effect has been very limited . therefore , the present study aimed to investigate the effects of wearing ge - coated functional clothing during exercise on tympanic temperature ; thermal sensation ; heat shock protein 70 ( hsp70 ) , which is involved in homeostatic regulation in exercise - induced thermal stress ; and lactate , an indicator of fatigue .

[ purpose ] the present study investigated the effects of wearing germanium - coated functional clothing on tympanic temperature , thermal sensation , heat shock protein 70 ( hsp70 ) , and lactate during endurance exercise . [ subjects and methods ] nine healthy and untrained male subjects were enrolled . subjects ran for 60 min on a treadmill ( 75 % heart rate reserve ) in the following 2 tests : 1 ) control test ( wearing conventional clothing ) and 2 ) experimental test ( wearing germanium - coated functional clothing ) . during each test , the tympanic temperature and thermal sensation were measured , and blood samples were collected immediately before exercise and immediately after exercise . thermal sensation was measured using a disc score . [ results ] the tympanic temperature immediately after exercise was significantly increased compared to the temperature immediately before exercise in the control test , while no significant change was observed in the experimental test . in both tests , the disc score and hsp70 and lactate levels immediately after exercise were significantly increased compared to those immediately before exercise . in addition , the disc score immediately after exercise was significantly higher in the control test than in the experimental test . [ conclusion ] wearing germanium - coated functional clothing during endurance exercise may have the positive effect of alleviating thermal stress that accumulates in the body during exercise .

the receptor apj remained orphan until 1998 , when tatemoto and his coworkers isolated its endogenous ligand from bovine stomach extract . they isolated a 36-amino - acid peptide which was named apelin ( from apj endogenous ligand ) . apelin exists in at least three forms , consisting of 13 , 17 , or 36 amino acids , all originating from a common 77-amino - acid precursor . apelin has been shown to be involved in vessel formation , where it exerts a pro - angiogenic role [ 3 , 4 ] , and in the regulation of cardiovascular function , by reducing arterial blood pressure , via stimulation of nitric oxide - mediated vasorelaxation [ 5 , 6 ] . moreover , apelin has recently been added to the family of adipokines [ 7 , 8 ] , which are adipocytokines mainly derived from adipose tissue as well as endothelial cells ( ecs ) in various parts of the body . hepatitis c virus ( hcv ) has been recognized as a major cause of chronic liver disease ( s ) ( cld ) in egypt . the emerging role of apelin in cld is complex , as described in a recent report linking apelin to the initiation and maintenance of the inflammatory and fibrogenic processes occurring in the fibrotic liver , as well as to the vascular and haemodynamic abnormalities in cirrhosis and its complications [ 11 , 12 ] . however , clinical data demonstrating the role of apelin in cld is limited , as depicted by bertolani and marra . although barely detectable in normal liver , production of tnf- from t - cells occurs at the early onset in many types of liver injury and has been related to fibrosis progression . moreover , adipokines as leptin , resistin , visfatin , and adiponectin are recently considered as regulators of liver fibrogenesis and may explain why obesity influences fibrosis progression . hepatic insulin signaling is markedly impaired in hcv patients ; in addition , down regulation of hepatic insulin mediators is associated with enhanced hepatocyte apoptosis and fibrogenesis . currently some evidence supports a relationship between insulin resistance ( ir ) and hepatitis c on one hand , playing role in progression of liver disease [ 1720 ] , and between ir and apelin level on the other hand in cases of obesity . therefore , highlighting the apelin system would present a new therapeutic target for liver disease . thus , this study aims to address if there is relation between apelin serum levels and liver disease progression in a previously characterized cohort of established chc egyptian patients . the second question is whether obesity , inflammation ( tnf- ) , and ir are cofounders for this association .

objective . highlighting the apelin system would present a new therapeutic target for liver disease . apelin ; endogenous ligand for the orphan receptor apj , was recently suggested to be associated with fibrosis progression and cirrhosis in addition to insulin resistance ( ir ) and inflammation . the present study was conducted to evaluate blood apelin level changes among 73 chronic hepatitis c ( chc ) egyptian patients and if associated with body mass index ( bmi ) , ir , and tumor necrosis factor - alpha ( tnf- ) . serum apelin levels were significantly higher in patients with chc with median value ( 3.25 ) when compared with controls ( 1.11 ) , at p < 0.0001 , with significant apelin variations among asymptomatic carriers ( asc ) , fibrosis , and cirrhosis patients , and also among obese and nonobese patients . multiple regression analysis depicted that bmi , triglycerides , and total cholesterol were independent correlation factors to apelin levels , whereas tnf- was found to be significantly negatively correlated to adjusted apelin in chc patients ( r = 0.5944 , p < 0.0001 ) . ir was positively correlated to adjusted apelin in chc patients ( r = 0.2663 , p < 0.05 ) . conclusion . apelin level varies among stages of chc , which may contribute to fibrosis progression . in addition , obesity and ir could act as comorbid factors affecting apelin level in patients with chc .

artery - ureteral fistula ( auf ) is a relatively rare but life - threatening condition because of the potential of massive hemorrhage and hematuria . risk factors for auf include previous abdominal vascular surgery , previous extensive and radical oncologic treatment in the pelvis and chronic ureteral stenting . because of the increased prevalence of these risk factors , the chances of encountering auf are increasing . various treatment options have been reported to manage an existing fistula . conventionally , auf is treated by open surgery to close the fistula ; however , this is associated with high mortality and morbidity rates because the surgical field often has adhesions from previous treatments such as surgery or radiotherapy . recently , endovascular stent graft placement for auf has been employed as a less invasive and safer therapeutic option with satisfactory outcomes . herein , we present a case of auf after surgery for an abdominal aortic aneurysm , which was successfully treated with an endovascular procedure using a covered stent .

artery ureteral fistula ( auf ) is a rare condition but there is an increase in the number of reported cases . it is frequently difficult to treat . a 63-year - old male who had undergone a dacron y - graft placement for an infrarenal aortic aneurysm 3 years earlier , presented with hematuria . contrast - enhanced computed tomography revealed a fistula located between the right common iliac artery and the right ureter at graft anastomosis . endovascular treatment using a covered stent was performed successfully .

oral squamous cell carcinoma ( oscc ) is the most common type of tumor in the oral cavity . the majority of the tumors are locally advanced and have relatively poor prognosis with 5 years survivals < 50 - 60 % . at present , the standard of care for resectable locally advanced oscc is the surgical treatment of the primary tumor and neck followed by postoperative radiotherapy or chemoradiotherapy , depending on the presence of intermediate- or high - risk features . extensive procedures are required in these locally advanced cancers which are associated with a substantial amount of cosmetic deformity and functional morbidity . the recent advances in reconstruction techniques have enabled the possibility of wider resections with limited morbidity . however , resectability of the tumor must be a fine balance between achieving negative surgical margins with acceptable functional and cosmetic deformities . neoadjuvant chemotherapy ( nact ) in head and neck cancers has been investigated for long with an aim of reducing surgical margins , distant metastasis rates , and improving outcomes . the meta - analysis of chemotherapy on head and neck cancer meta - analysis of 31 trials involving more than 5000 patients failed to demonstrate significant survival benefit following induction chemotherapy . however , the trials that used 5- fluorouracil ( 5-fu ) and cisplatin as a part of nact regime showed significant overall survival ( os ) benefit compared to other combination regimens and single agent nact . the trials included in the meta - analysis did not specifically address oral cavity cancers and had less number of oscc patient . most of these trials were from the pretaxane era , and impact of taxanes in the neoadjuvant setting is not addressed with this meta - analysis . the interest in nact has been rekindled by recent studies such as tax 323 and 324 which included taxane ( docetaxel ) along with fluorouracil and cisplatin ( tpf ) containing regimen . the tpf induction regimen showed improved survival in advanced head and neck squamous cell carcinoma ( hnscc ) as compared to patients receiving an induction regimen with cisplatin and fluorouracil ( pf ) alone . however , these trials included various head and neck subsites and also were not exclusively designed for oscc . the aim of this paper is to critically review the current evidence for nact in locally advanced oscc and suggest an algorithmic approach to the patient population who might benefit from nact for oscc .

the standard of care treatment for oral squamous cell carcinoma ( oscc ) at present , consist of surgical resection followed by adjuvant radiotherapy and chemotherapy as indicated . despite recent advances the overall prognosis remains guarded . role of neoadjuvant chemotherapy is being explored with premise of reducing extent of surgical resection , improving loco - regional control and decreasing distant metastasis , thereby improving treatment outcomes by decreasing mortality and morbidity . however , indications of neoadjuvant chemotherapy in oral cancers are not clearly defined . majority of studies have failed to demonstrate a significant benefit of neoadjuvant chemotherapy in terms of loco regional control and overall survival in resectable oscc . in a select subset of patients with locally very advanced and unresectable oscc , neoadjuvant chemotherapy has been shown to cause tumor shrinkage and improve resectability . these hypothesis generating findings of reduction in distant metastasis , improved resectability and functional outcome , however need further validation . in summary , the role of neoadjuvant chemotherapy for oscc remains investigational and has a limited role outside clinical trial .

many reports have demonstrated that gene polymorphisms of the renin - angiotensin system ( ras ) are associated with hypertension . there have been some reliable reports about susceptible genes for hypertension including the results from the millennium genome project for hypertension in japan ( 2000~2005 ) [ 1 , 2 ] ; however , no convincing gene has yet been detected . some of the genes regulating blood pressure might also be related to the response to antihypertensive medication [ 3 , 4 ] . indeed , we and other collaborators have investigated several susceptible genes related to hypertension [ 515 ] , including genes of not only the renin - angiotensin system and sodium handling but also insulin resistance , oxidative stress , and sympathetic nervous system ( described in the section 2 ) ; however , the genes involved in the response to antihypertensive medication have not yet been identified . in addition , exhaustive gene expression analysis ( transcriptome analysis ) for lifestyle - related diseases has not been performed thus far . we performed a large collaboration with the study group led by professor katayama at saitama medical university to perform a randomized controlled trial called azelnidipine ( a calcium ( ca ) channel blocker ) and temocapril ( an ace inhibitor ) in hypertensive patients with type 2 diabetes study ( attest ) , which included genetic analysis to evaluate the therapeutic effects of azelnidipine and temocapril . the goals of this study were , first , to assess the association between polymorphisms of susceptible genes for hypertension ( 18 genes ) and each treatment or phenotype and , second , to assess the association between expression in peripheral blood of susceptible genes for hypertension and each treatment or phenotype .

we performed a prospective study to examine the genetic effect on the response to a calcium ( ca ) channel blocker , azelnidipine and an ace inhibitor , temocapril treatment in patients with hypertension , as a part of the prior clinical trial , the azelnidipine and temocapril in hypertensive patients with type 2 diabetes study ( attest ) . methods and results . all subjects who gave informed consent for genetic research were divided into two groups : the subjects treated with azelnidipine or temocapril , for 52 weeks . we selected 18 susceptible genes for hypertension and determined their genotypes using taqman pcr method . rna samples were extracted from peripheral blood , and quantitative real time pcr for all genes was performed using taqman method . one of the polymorphisms of the rgs2 gene was extracted as being able to influence the effect of these treatments to reduce bp . at eight weeks , bp change showed a significant interaction between the a-638 g polymorphism of regulator of g protein signaling-2 ( rgs2 ) gene and treatment with azelnidipine or temocapril . there was no gene whose expression was associated with bp phenotypes or the polymorphisms of each gene . conclusions . a-638 g polymorphism of the rgs-2 gene could be a predictive factor for therapeutic performance of ca channel blockers .

factors adversely affecting short term survival include impaired consciousness , leg weakness and increasing age . on the other hand , long term survival the pattern of survival is changing with time in many populations with gradual improvement of survival and decrease in mortality.3 review of the literature suggests that immediate mortality after stroke approaches 30 % in the first month.4 five year survival rates range between 35 - 45 % . furlan reported a 5 year survival rate in stroke patients of 77 % compared to 85 % in matched normal controls.4 al rajah , in a study from saudi arabia showed that ischemic strokes accounted for 76.2 % of all strokes . strokes caused by intro - cerebral and sub - arachnoid hemorrhage constituted 21.4 % and 2.4 % respectively.5 radiological changes in brain computed tomography ( ct ) correlates with survival . hankey reported that lesions greater than 50 mm in diameter have a higher mortality than lesions less than 50 mm8 . poor prognosis is also noted in ct findings of intracerebral hemorrhage , mass effect and deep intracerebral lesions.7 in this study , the prognostic effects of age , sex , hypertension , diabetes mellitus and presentation in coma on the survival pattern of stroke patients presenting to a referral hospital , are reviewed .

background : prognosis of stroke has been studied in various population . factors adversely affecting short term survival include impaired consciousness , leg weakness and increasing age.aim of the study : in this study , the prognostic effects of age , sex , hypertension , diabetes mellitus and presentation in coma on the survival pattern of stroke patients presenting to a referral hospital , are reviewed.methodology : the medical records of all patients hospitalized with definite stroke at king fahd specialist hospital , buraidah , for the period between june 1986 and june 1991 , were reviewed . the cranial ct scans were also reviewed.results : one hundred and seventy four patients , 106 males and 68 females , with a mean age of 64 years who had definite stroke were studied to estimate overall survival and the various risk factors influencing it . the case records and cranial ct scans were reviewed.conclusion : the factors adversely affecting survival in this study , were age above 60 ( p < 0.04 ) , presentation in coma ( p < 0.003 ) and pre - existing heart disease ( p < 0.0009 ) . there was no significant effect on survival due to sex , hypertension and/or diabetes mellitus .

diabetes is the seventh leading cause of death in the u.s . and is widely considered a forthcoming global epidemic ( 1 ) . it is more prevalent in certain vulnerable subgroups , particularly in african americans and latinos and those of lower socioeconomic status ( ses ) . additionally , there are significant racial / ethnic and ses disparities in diabetes care , management , and health outcomes ( 2 ) . african americans and latinos , for example , have two to four times the rate of related renal disease , blindness , amputation , and amputation - related mortality compared with non - hispanic whites ( 3 ) . disparities in diabetes outcomes are the product of multiple interacting factors , including individual , family , neighborhood , and community factors . disparities in outcomes are also likely due to poorer - quality diabetes care received by vulnerable populations . as evidence of this , the agency for healthcare research and quality has reported disparities of up to 20 % in the receipt of preventive services for diabetes across race / ethnicity , income , and education groups ( 4 ) . other studies have found that differences in diabetes care vary according to characteristics of primary care practices ( 5,6 ) . individuals with diabetes receive the majority of their care in a primary care setting ( 7 ) . thus it is imperative to understand health care factors that influence care in this setting , especially with the advent of changes to the primary care environment . a medical home reflects an accessible , ongoing source of primary care that delivers or coordinates the majority of a patient s care . medical - home definitions vary considerably across organizations , but there is consensus on at least four key features : first - contact care , continuity , comprehensiveness , and coordination ( 8,9 ) . other features sometimes include aspects of community - oriented care , family - centered care , and cultural competence . the evidence cited to promote the medical home is derived almost wholly from the literature on primary care delivery ( 10 ) . there is a substantive literature demonstrating the benefits of primary care to equity and efficiency and in health care ( 11 ) , and primary care is a cornerstone of health system efforts to reduce disparities ( 12 ) . most of these studies assess the general population in need of preventive care , not those from vulnerable populations who have chronic conditions , such as diabetes . thus we undertook this study to evaluate whether patient - reported indicators of care that are consistent with the medical - home model are associated with patient - reported receipt of recommended preventive diabetes services for adults considered vulnerable . we hypothesized that patients with physicians who are reported to function more like a medical home will be more likely to report better preventive diabetes care ( including both recommended screening and patient education ) .

objectivethe patient - centered medical home has gained much traction . little is known about the relationship between the model and specific health care processes for chronic diseases such as diabetes . this study assesses the impact of features of a medical home on diabetes care.research design and methodsa cross - sectional survey of 540 patients with medicaid ( medi - cal ) health insurance and type 2 diabetes in los angeles county was performed . the primary care assessment tools was used to measure seven features of medical - home performance.resultsthe response rate of the patient survey was 68.9 % . patient - reported medical - home performance averaged a score of 2.85 0.29 ( on a 14 scale , with 4 equaling the best care ) . patients who received more timely and thorough diabetes care reported higher medical - home performance in every feature except for the comprehensiveness - services available . for example , the first - contact access feature score was higher among patients who had an hba1c test in the past 6 months versus those who did not ( 2.38 vs. 2.25 ; p < 0.05 ) . before and after adjusting for sociodemographics and health status , total medical - home performance was positively associated with each diabetes care measure . a 1-point increase in total medical - home score was associated with 4.53 higher odds of an hba1c test in the past 6 months and 1.88 higher odds of an eye exam in the past year.conclusionsfeatures consistent with higher medical - home performance are associated with improvements in patient - reported diabetes care process measures , even in this low socioeconomic status setting . the patient - centered medical - home model may help in caring for people with type 2 diabetes .

oral health is an integral part of general health . with the life expectancy increasing to 66.8 years1 among the indian population , the role oral health plays in improving the quality of a person s life can not be overstated . over the last five decades , there has been a steady increase both in the prevalence and in the severity of dental caries in india . it is evident from the literature that 30 % of children suffer from mal - aligned teeth and jaws diminishing the potential of dentofacial apparatus to function properly.2 oral cancer constitutes 35 - 40 % of total body cancers which could be attributed to the wide usage of tobacco , betel nuts , quid , pan masala etc.3 the health care delivery system in india embodies a public sector , a private sector , and an unofficial nexus of health care providers operating within an unchecked environment , with no supervision on the services provided with respect to the provider , way of provision of services , costs involved , and there is no standardization in measuring the quality of care . this impromptu health care system has created a wide disparity in access to dental care , with the frivolous and lackadaisical public health system rubbing salt into the wound . for most indians , a visit to a dental office is considered an extraordinary and an unexpected event . according to the concept given by bhore committee in 1946 , a primary health center ( phc ) is supposed to be a basic health unit that provides curative and preventive health care services in an integrated manner to the rural population emphasizing on the preventive and promotive genres of health care , situated as close to the people as possible . the national health plan ( 1983 ) recommended reconstitution of phcs at a ratio of one phc for every 30,000 rural population in the plains . this ratio is 1:20,000 in hilly , tribal , and backward areas to render comprehensive coverage.4 though the national oral health policy had recommended dentists to be recruited in all phcs , it is unfortunate that this policy has not been implemented till date and there are no dentists appointed in phcs in some states . there are nine clusters under the phc with a population coverage of 41,650.5 the main objective of any oral health care system was to maintain and improve oral health care , which depends on the willingness of the individuals to seek care . in many developing countries , utilization is measured as the number of visits per year or the number of people with at least one visit during the previous year , and utilization studies serve as an important tool in designing and modifying oral health policies.6 with this background a study is planned to know the dental services utilization among the rural population under the phc , with the following objectives : to know the normative needs among the rural population.to know the factors determining utilization of dental services . to know the normative needs among the rural population . to know the factors determining utilization of dental services .

background : the oral disease burden in india is showing a steady increase in the recent years . utilization of dental care being the major factor affecting the oral health status of the population is used as an important tool in oral health policy decision - making and is measured in terms of the number of dental visits per annum.materials and methods : a cross - sectional house to house questionnaire survey was conducted in three rural clusters which were randomly selected from a total of eight clusters served by a primary health center . simple random sampling was used to select 100 houses from each cluster . screening was done to examine the existing oral diseases . a total of 385 completed questionnaires were collected from 300 houses.results : of 385 study subjects , 183 have experienced previous dental problems . major dental problem experienced by the study subjects was toothache ( 68.85 % ) and the treatment underwent was extraction ( 50.27 % ) . most preferred treatment centers by the study subjects were private dental hospital ( 68.25 % ) and reason identified was accessibility which constituted ( 45.24 % ) of all the reasons given . negative attitude toward dental care is one of the important barriers ; 50.8 % of the non - utilizers felt dental treatment is not much important.conclusion : persons attitude , lack of awareness , and affordability remain the barriers for utilization of dental services . effective methods have to be exercised to breach such barriers .

alkaptonuria ( aku ) is a rare hereditary autosomal recessive disease characterized by a defect in the gene which codes for homogentisate-1 , 2 dioxygenase resulting in the metabolic disorder of the aromatic amino acids , phenylalanine and tyrosine7 ) . the enzyme - homogentisic acid oxidase catalyzes the conversion of homogentisic acid ( hga ) to maleylacetoacetic acid , and its absence leads to increase in hga accumulation in the body . some of the excess hga excretes through the urine which turns dark on exposure to oxygen or alkalization occurs . rest of accumulated hga oxidizes initially , and deposits within the connective tissue irreversibly and subsequently turns into melanin - like pigment . it occurs especially in the cartilage of the joints and in the intervertebral discs , which is named as ochronosis1114 ) . ochronosis not only affects the cardiovascular , genitourinary and respiratory systems , but also results orthopedic disorders like spondylosis and arthropathy . the disease progresses from simple alkaptonuria to alkaptonuric ochronosis , leading to ochronotic arthropathy10 ) . cervical myelopathy is usually due to degenerative changes in the spine with the osteophytes from the posterior part of the vertebral body and uncinate process encroaching upon the neural canal . numerous reports on the successful management of ochronotic arthropathy of the peripheral joints like the knee and hip joints using total joint replacement . however , there is a paucity of reports that have shown successful surgical intervention for spinal especially cervical spine involvement . in this paper , we report a woman patient suffering from ochronotic spondylosis who was diagnosed during the late course of disease once the spondylitic myelopathy had set in resulting in increased neck and back pain , and associated with walking trouble and hands clumsiness .

ochronosis is a musculoskeletal manifestation of alkaptonuria , a rare hereditary metabolic disorder occurs due to the absence of homogentisic acid oxidase and leading to various systemic abnormalities related to deposition of homogentisic acid pigmentation ( ochronotic pigmentation ) . the present case reports the clinical features , radiographic findings , treatments and results of a cervical spondylotic myelopathy woman patient due to the ochronotic arthropathy of the cervical spine . the patient aged 62 years was presented with gait disturbance and hand clumsiness . physical examination , x - rays , computed tomography and lab results of the urine sample confirmed the presence of ochronosis with the involvement of the cervical spine . the patient underwent a modified cervical laminoplasty due to multi - segment spinal cord compression . the postoperative follow - up showed a good functional outcome with patient satisfaction . the present study concludes the conditions and important diagnostic and surgical aspects of a patient . it is necessary to identify the condition clinically and if cord compression is observed , appropriate surgical interventions needs to be instituted .

being a primary care professional ( pcp ) means being at the forefront of managing chronic , complex , and difficult areas of health . working with patients who have cancer , those who are dying and those who experience or have experienced family and/or sexual violence can be difficult and emotionally confronting . in a day 's work , pcps see many complicated and complex patients , but those who experience family violence can be particularly demanding and challenging because of chronic health issues , psychological distress , relationship and authority issues , and coping strategies such as denial or somatization . if we then add to the potential emotional impact of survivor stories on pcps , the mental and emotional work of caring for these patients , the patient - professional interaction and boundary issues , and the long - term nature of the care required , we will have the perfect recipe for increased pcp stress . work - related stress is already experienced by family physicians and nurses , with burnout being the most investigated area [ 47 ] . prevalence rates of burnout for medical residents ( including family medicine residents ) have been reported between 18 and 82 % and between 10 and 55 % for family physicians [ 4 , 6 , 7 ] . a number of factors have been identified as important contributors to burnout ; these include the work environment , changing policy , changes in the practice of family medicine , workload , loss of autonomy , and feeling a lack of personal accomplishment [ 4 , 7 ] . personal characteristics of the pcps themselves , such as being high achievers and perfectionists , the relationship between work and self - esteem , gender , age , and family and support networks , may also contribute to their susceptibility to stress [ 4 , 7 , 8 ] . pcp 's recognition and support of patients who have experienced violence may improve the mental and physical health through early intervention and better service access [ 912 ] . working with family violence can , in itself , be difficult and confronting for pcps because of the patient 's experience within their family . pcps may also be both victims and perpetrators of family violence and this can influence their ability to work effectively with patients . an earlier study by sugg and inui reported that 15 % of male doctors and 31 % of female doctors had a personal history of child abuse or intimate partner violence . pcps may be concerned that family violence is a private no - go area that can not be discussed without offending the patient . they describe feeling overwhelmed and concerned about broaching the topic with patients , that they lack the time and the confidence to deal with the problem , that they might make the situation worse , and that they can not fix it personal safety issues often confront those who work with victimized children and adults . the traumatic nature of child abuse and adult violence with its negative effects on the emotional , mental , and physical health of victim / survivors is well documented . less discussed is the impact of working in this area on the well - being of the medical professionals and their staff . this paper outlines a theoretical framework for understanding the possible reactions of pcps who work in this area . we then discuss the emotional and physical safety issues while being at work and the social , emotional , and physical impacts of child abuse and violence at work .

primary care professionals ( pcps ) are increasingly being expected to identify and respond to family and sexual violence as the chronic nature and severity of the long - term health impacts are increasingly recognized . this discussion paper reports the authors ' expert opinion from their experiences running international workshops to prevent trauma among those who work and research sexual violence . it describes the burnout and secondary traumatic stress literature which provides the evidence supporting their work . implications for practicing basic training in response to trauma and ongoing education are a key area for responding to family violence and preventing professional stress . a professional culture that supports and values caring well for those who have experienced family violence as well as caring for the carer is needed . working in teams and having more support systems in place are likely to protect pcps from secondary traumatic stress and burnout . undergraduate and postgraduate training of pcps to develop trauma knowledge and the skills to ask about and respond to family violence safely are essential . in addition , the healthcare system , workplace , and the individual practitioner support structures need to be in place to enable pcps to provide safe and effective long - term care and access to other appropriate services for those who have experienced family violence .

meconium aspiration syndrome ( mas ) is defined as respiratory distress in an infant born through meconium - stained amniotic fluid ( msaf ) with characteristic radiological changes and whose symptoms can not be otherwise explained . because meconium is rarely found in the amniotic fluid prior to 34 weeks ' gestation , mas is often a disease of the term and near - term infant and is associated with significant respiratory morbidity and mortality . cleary and wiswell have proposed a severity criteria to define mas : ( a ) mild mas is a disease that requires less than 40 % oxygen for less than 48 hours , ( b ) moderate mas is a disease that requires more than 40 % oxygen for more than 48 hours with no air leak , and ( c ) severe mas is a disease that requires assisted ventilation for more than 48 hours and is often associated with pphn . in this paper , we look at the current understanding of the pathogenesis and management of mas .

meconium aspiration syndrome ( mas ) is a common cause of severe respiratory distress in term infants , with an associated highly variable morbidity and mortality . mas results from aspiration of meconium during intrauterine gasping or during the first few breaths . the pathophysiology of mas is multifactorial and includes acute airway obstruction , surfactant dysfunction or inactivation , chemical pneumonitis with release of vasoconstrictive and inflammatory mediators , and persistent pulmonary hypertension of newborn ( pphn ) . this disorder can be life threatening , often complicated by respiratory failure , pulmonary air leaks , and pphn . approaches to the prevention of mas have changed over time with collaboration between obstetricians and pediatricians forming the foundations for care . the use of surfactant and inhaled nitric oxide ( ino ) has led to the decreased mortality and the need for extracorporeal membrane oxygenation ( ecmo ) use . in this paper , we review the current understanding of the pathophysiology and management of mas .

food additives are widely used in foodstuffs to prevent from spoilage and improve color , flavor , and texture of foods . however , these additives in foods may affect individuals who are sensitive with some type of allergy , asthma , and hay fever . consequently , authorities have set threshold values for acceptable daily intake , varying from country to country . for instance , the list of authorised food additives and maximum permitted levels in european union are laid down in the annexes of council directive [ 1 , 2 ] . to ensure food safety from farm to fork , it is also essential to develop effective and reliable analytical methods for the monitoring of the additive levels in food . therefore , various analytical methods have been reported for the simultaneous determination synthetic food additives , such as thin layer chromatography , uv - visible spectrophotometry [ 5 , 6 ] , voltammetry [ 7 , 8 ] , differential pulse polarography , capillary electrophoresis , hplc - dad [ 1114 ] , hplc - ms , and hplc - ms - ms [ 16 , 17 ] . until now , although many analytical techniques have been developed for the determination of various food additives in foods , there is no report about simultaneous determination of this combination in food samples . among these analytical methods , hplc coupled with uv / vis or diode array detectors ( dads ) are the most commonly used methods due to their sensitivity , selectivity , and high resolution . so , development of effective chromatographic separation method involves judicious selection of experimental conditions that is suitable for the separation of interested components at an adequate resolution with reasonable run time . in this it not only is a timesaving method but also it has an ability to reveal possible interactions between variables [ 19 , 20 ] . hence , experimental designs have been increasingly used to determine the optimum conditions of chromatographic separation of some analytes in food , drug , and biological fluid samples with a minimum number of experiments for over the past decade [ 2128 ] . in this paper , a new rp - hplc method was developed , using experimental design , for simultaneous determination of five synthetic food additives in soft drinks , including three synthetic colorants ( carmoisine , allura red , and ponceau 4r ) , two preservatives ( potassium sorbate and sodium benzoate ) , and caffeine . for the optimization procedure , box - behnken design ( bbd ) was used to construct mathematical models that predict how changes input or controlled by variables ( ph , flow rate , and mobile phase ratio ) affected the resolution in defined experimental region . further , the method validation has been carried out according to the international conference on harmonization guidelines . the optimized and validated method was successfully applied to some commercial soft drinks containing potassium sorbate , sodium benzoate , carmoisine , allura red , ponceau 4r , and caffeine .

box - behnken design was applied to optimize high performance liquid chromatography ( hplc ) conditions for the simultaneous determination of potassium sorbate , sodium benzoate , carmoisine , allura red , ponceau 4r , and caffeine in commercial soft drinks . the experimental variables chosen were ph ( 6.07.0 ) , flow rate ( 1.01.4 ml / min ) , and mobile phase ratio ( 8595 % acetate buffer ) . resolution values of all peak pairs were used as a response . stationary phase was inertsil octadecylsilane- ( ods- ) 3v reverse phase column ( 250 4.6 mm , 5 m ) dimensions . the detection was performed at 230 nm . optimal values were found 6.0 ph , 1.0 ml / min flow rate , and 95 % mobile phase ratio for the method which was validated by calculating the linearity ( r 2 > 0.9962 ) , accuracy ( recoveries 95.75 % ) , precision ( intraday variation 1.923 % , interday variation 1.950 % ) , limits of detection ( lods ) , and limits of quantification ( loqs ) parameters . lods and loqs for analytes were in the range of 0.100.19 g / ml and 0.330.63 g / ml , respectively . the proposed method was applied successfully for the simultaneous determination of the mixtures of five food additives and caffeine in soft drinks .

sacral fractures are complex injuries that rarely occur in isolation,1 2 3 and therefore they often require a multidisciplinary treatment approach including orthopedic trauma surgeons and spine surgeons ( either orthopedic surgeons or neurosurgeons ) . many classifications have been proposed for sacral fractures , but none are comprehensive or universally accepted.4 5 6 7 8 9 the development of a comprehensive , reliable , and universally accepted classification of these fractures is critical to allow for effective communication between treating physicians and trainees as well as researchers ; furthermore , a well - designed classification may lead to the development of an optimal treatment algorithm for these challenging injuries . the existing sacral injury classifications are based on either fracture morphology or an inferred mechanism of injury . the existing systems are either very broad and simplistic , such as the commonly used denis classification that separates fractures broadly based on the location of the fracture with respect to the foramen , or they are exceedingly specific so that they can only be applied to a very select type of sacral fracture , such as the isler classification , which is only relevant for a vertical fracture through the foramen . alternatively , sacral fractures may be incorporated into pelvic injury classifications , but despite being one of the critical structures involved in posterior pelvic ring stability,10 only a rudimentary evaluation of sacral injuries is considered in pelvic fracture classifications.8 finally , despite the fact that the treatment decisions are often affected by the neurologic status of the patient and associated soft tissue injuries , none of the existing classifications formally consider these variables.4 5 6 7 8 9 recognizing the limitations of the existing classifications , the aospine trauma knowledge forum is partnering with pelvic trauma experts from aotrauma to develop a comprehensive sacral fracture classification similar to the aospine thoracolumbar injury classification system and the aospine subaxial cervical spine injury classification system.11 12 13 14 importantly , one of the main goals of this project is to develop a classification system that will achieve global acceptance from both spine surgeons and orthopedic traumatologists . however , given the complexity of sacral fractures , multiple controversial areas will have to be addressed . in an effort to develop a classification that will be able to obtain global acceptance , a survey was sent to all aospine and aotrauma members and their input was sought on controversial aspects of sacral fracture classification . the goal of this study is to determine the global perspective on controversial aspects of sacral fractures .

study design survey study . objective to determine the global perspective on controversial aspects of sacral fracture classifications . methods while developing the aospine sacral injury classification system , a survey was sent to all members of aospine and aotrauma . the survey asked four yes - or - no questions to help determine the best way to handle controversial aspects of sacral fractures in future classifications . chi - square tests were initially used to compare surgeons ' answers to the four key questions of the survey , and then the data was modeled through multivariable logistic regression analysis . results a total of 474 surgeons answered all questions in the survey . overall 86.9 % of respondents felt that the proposed hierarchical nature of injuries was appropriate , and 77.8 % of respondents agreed that that the risk of neurologic injury is highest in a vertical fracture through the foramen . almost 80 % of respondents felt that the separation of injuries based on the integrity of l5s1 facet was appropriate , and 83.8 % of surgeons agreed that a nondisplaced sacral u fracture is a clinically relevant entity . conclusion this study determines the global perspective on controversial areas in the injury patterns of sacral fractures and demonstrates that the development of a comprehensive and universally accepted sacral classification is possible .

direct restoration is the most commonly used technique for both anterior and posterior teeth . however , with direct restoration , excessive polymerization shrinkage increases the stress at the composite - tooth interface and can compromise the integrity of the bond . in large posterior cavities , especially in those with cervical margins located in dentin , excessive shrinkage can produce marginal defects and gaps that promote microleakage and result in marginal discoloration , post - operative sensitivity , secondary caries and pulpal irritation . when some mistakes in placement and finishing are added to these material problems , resulting marginal leakage and poor anatomical form and proximal contacts can reduce restoration longevity . recent developments in resin - based composite resins have made it possible to fabricate esthetic indirect adhesive restorations that aim to overcome the shortcomings of direct composite resin restorations , such as polymerization shrinkage and inadequate degree of conversion . the high percentage by volume of inorganic fillers in indirect restorative material when compared with composite resins used in direct restorations results in improved mechanical and physical properties . however , indirect restoration requires more dentin exposure than direct restoration and thus increases dentin sensitivity . previous studies have shown the clinical performance of indirect composite restorations to be significantly affected by both the bonding of the luting agent to the tooth and the restorative material and the surface treatment prior to bonding . in their systematic review of materials , van meerbeek et al . whereas , etch and rinse systems require dentin to be acid - etched , rinsed and dried before the bonding agent is applied , self - etching bonding systems require no dentin pre - conditioning . the simultaneous etching and resin infiltration that occurs with self - etching systems provides the important advantage of reduced technical sensitivity . whereas , shortall et al . reported indirect adhesive restoration to be a better alternative to direct composite restoration for larger cavities , wakiaga et al . reported no reliable evidence of either a direct or indirect type of veneer restoration being superior in terms of restoration longevity . however , recent advances in indirect restoration technology may improve the clinical life of indirect restorations over direct restorations . , schaumburg , il , usa ) claim that these products show great success for occlusal restorations . the aim of this study was to test the null hypothesis that restoration preparation technique ( direct / indirect ) , surface conditioning ( etch and rinse / self - etch ) and curing of bonding agents ( light cure / dual cure ) had no effect on the retention strength of resin composite used with seven different adhesive systems .

objective : the aim of this study was to test the null hypothesis that different surface conditioning ( etch and rinse and self - etch ) and curing techniques ( light cure / dual cure ) had no effect on the shear bond strength of direct and indirect composite inlays.materials and methods : a total of 112 extracted human molar teeth were horizontally sectioned and randomly divided into two groups according to restoration technique ( direct and indirect restorations ) . each group was further subdivided into seven subgroups ( n = 8 ) according to bonding agent ( etch and rinse adhesives scotchbond multi - purpose plus , all - bond 3 , adper single bond and prime bond nt ; and self - etch adhesives clearfil liner bond , futurabond dc and g bond ) . indirect composites were cemented to dentin surfaces using dual - curing luting cement . shear bond strength of specimens was tested using a universal testing machine . two samples from each subgroup were evaluated under scanning electron microscopy to see the failing modes . data was analyzed using independent sample t - tests and tukey 's tests.results : surface conditioning and curing of bonding agents were all found to have significant effects on shear bond strength ( p < 0.05 ) of both direct and indirect composite inlays . with direct restoration , etch and rinse systems and dual - cured bonding agents yielded higher bond strengths than indirect restoration , self - etch systems and light - cured bonding agents.conclusions : the results of the present study indicated that direct restoration to be a more reliable method than indirect restoration . although etch and rinse bonding systems showed higher shear bond strength to dentin than self - etch systems , both systems can be safely used for the adhesion of direct as well as indirect restorations .

especially c jejuni and c coli , are considered to be amongst the most prevalent foodborne pathogens associated with sporadic diarrhoea in humans ( engberg et al . , 2001 ; colonise the intestines of food animals and they can contaminate meat during slaughter or post - slaughter processing ( hermans et al . , 2011 ; mackiw et al . , although campylobacter infections are usually self - limiting and do not require antibiotic treatment , in some cases such as prolonged enteritis and septicaemia , antimicrobial treatment is needed . macrolides and fluoroquinolones are the drugs of choice in treatment of human campylobacteriosis ( van looveren et al . , 2001 ; guevremont et al . , 2006 ; moore et al . , 2006 ) , however emergence of resistance to these agents has prompted worries related to their use ( moore et al . , 2005 ) . in 2009 , zanoni and colleagues described a new campylobacter species isolated from rabbit caecal contents named c. cuniculorum . so far there are no data on antimicrobial susceptibility in this novel campylobacter species , so the aim of this study was to define for the first time the antimicrobial susceptibility in c. cuniculorum isolated from rabbits for meat .

the present study aimed to investigate the antimicrobial susceptibility in campylobacter cuniculorum . to do so , 29 isolates from rabbits reared in 18 intensive and 11 rural farms not epidemiologically correlated were tested . minimum inhibitory concentration of 8 antimicrobial agents was determined using the agar dilution method recommended by the clinical and laboratory standards institute ( wayne , pa , usa ) , modified for what supplements in the base medium and incubation conditions concern for c. cuniculorum isolates . the isolates obtained from rural farming resulted susceptible to all the antimicrobial agents tested , with the exception of one isolate resistant to nalidixic acid . all the isolates obtained from intensively farmed rabbits were sensitive to chloramphenicol and ampicillin ; 16 isolates were resistant to tetracycline ; 15 to nalidixic acid and erythromycin ; 13 and 10 isolates to ciprofloxacin and enrofloxacin , respectively ; and only 1 to gentamicin . the resistance of several isolates to macrolides and fluoroquinolones , which are the drugs of choice in treatment of human campylobacteriosis , could pose a risk to human health if a pathogenic role of c. cuniculorum was demonstrated .

atherosclerotic plaques with a large lipid core are a frequent cause of acute coronary syndromes . in 1993 near - infrared spectroscopy ( nirs ) was first used for atherosclerotic plaque imaging in an experimental animal model . in further ex vivo validation studies , nirs was found to accurately detect the lipid ( cholesterol ) content of human atherosclerotic plaques . in 2001 , a device prototype for intracoronary imaging was developed . nirs provides a chemogram of the wall of the coronary artery and aims to detect lipid - rich plaques .

acute coronary syndromes are frequently caused by vulnerable coronary plaques with a lipid - rich core . in 1993 near - infrared spectroscopy ( nirs ) was first used to detect the lipid ( cholesterol ) content of atherosclerotic plaques in an experimental animal study . nirs was then carefully validated using human atherosclerotic plaques ( ex vivo ) , and has subsequently been developed for intracoronary imaging in humans , for which now an fda - approved catheter - based nirs system is available . nirs provides a chemogram of the coronary artery wall and is used to detect lipid - rich plaques . using this technology , recent studies have shown that lipid - rich plaques are very frequent in the culprit lesion of patients with an acute coronary syndrome , and are also common in non - culprit coronary lesions in these patients as compared to patients with stable coronary disease . first studies are evaluating the impact of statin therapy on coronary nirs - detected lipid cores . intracoronary nirs imaging represents a highly interesting method for coronary plaque characterization in humans and may become a valuable tool for the development of novel therapies aiming to impact on the biology of human coronary artery plaques , likely in combination with other intracoronary imaging techniques , such as optical coherence tomography .

helicobacter cinaedi has come to be recognized as an important organism , especially among immunocompromised patients . h. cinaedi sometimes causes cellulitis but the main symptom is only fever without any focal findings in most cases . furthermore , unlike most other infectious diseases , the clinical course is not acute . for these reasons , when an sle patient becomes febrile , we should determine whether there has been an exacerbation of sle itself or whether the condition is a complication of an infectious disease . this is vital because opposite strategies are used in the treatment of sle and infectious diseases . in the present case , h. cinaedi bacteremia occurred in a patient with sle , who initially only showed fever . these symptoms mimicked a flare of the disease , which led us initiate the bolus administration of methylprednisolone .

a 40-year - old woman with systemic lupus erythematosus ( sle ) presented with high - grade fever and severe thrombocytopenia . acalculous cholecystitis and thrombocytopenia were initially suspected to be complicated with sle and vasculitis . contrary to our expectation , however , the patient was finally diagnosed with helicobacter cinaedi bacteremia . sle patients show various symptoms , especially when their condition is complicated with vasculitis , which mimics h. cinaedi bacteremia . it is therefore difficult to provide a definite diagnosis . physicians should be mindful of the presence of h. cinaedi infection .

interactions of rna with other biomolecules are fundamental in cellular processes . in particular , noncoding rna protein interactions play important roles in protein synthesis ( 1,2 ) , gene expression ( 3,4 ) , rna processing ( 57 ) , developmental regulation ( 8,9 ) , etc . some lncrnas function as transcriptional regulators through direct association with transcription factors ( 1012 ) , while others indirectly interact with proteins in cooperation with genomic dnas ( 13 ) . the functional importance of many ncrna protein interactions for correct transcriptional regulation has been demonstrated ( 1419 ) , suggesting wide - ranging effects of ncrna protein interaction . in addition to targeting or being targeted by proteins or protein - coding transcripts , ncrnas could also potentially target other ncrnas , resulting in a layer of regulatory interactions between noncoding rna classes ( 11,20 ) . consequently , cataloguing interactions of ncrnas and other biomolecules is significant for gaining insight into biological processes and understanding the mechanism by which ncrnas carry out their regulatory function . given the importance of ncrna interactions in various pathways , we embarked on a project to build a comprehensive catalogue of such data and established the npinter database ( 21 ) . a large amount of new research has led to deeper insight into ncrna interactions at a variety of levels ; thus , npinter has been updated to v2.0 to accommodate for such expanding data resources . following data collection as described below , noncoding molecules in npinter were automatically filtered and assigned identifiers from noncode ( 22 ) or mirbase ( 23 ) , while protein - coding molecules were assigned identifiers from uniprot ( 24 ) , refseq ( 25 ) or unigene ( 26 ) . with the exception of rrnas and trnas , all reported interactions of ncrnas were included . the aim of the database is to provide a platform that will facilitate both bioinformatic as well as experimental research . in addition to a user - friendly interface and a convenient search option that allow efficient recovery of related interactions and other information , npinter v2.0 also provides a visualization platform for related interactions .

npinter ( http : //www.bioinfo.org/npinter ) is a database that integrates experimentally verified functional interactions between noncoding rnas ( excluding trnas and rrnas ) and other biomolecules ( proteins , rnas and genomic dnas ) . extensive studies on ncrna interactions have shown that ncrnas could act as part of enzymatic or structural complexes , gene regulators or other functional elements . with the development of high - throughput biotechnology , such as cross - linking immunoprecipitation and high - throughput sequencing ( clip - seq ) , the number of known ncrna interactions , especially those formed by protein binding , has grown rapidly in recent years . in this work , we updated npinter to version 2.0 by collecting ncrna interactions from recent literature and related databases , expanding the number of entries to 201 107 covering 18 species . in addition , npinter v2.0 incorporated a service for the blast alignment search as well as visualization of interactions .

fecundity is reduced in male patients with congenital adrenal hyperplasia ( cah ) due to 21-hydroxylase deficiency . recent studies suggested that development of testicular adrenal rest tumors ( tarts ) , which cause an obstruction of the seminiferous tubules , may play a major role [ 1 , 2 ] . in addition , suppression of the gonadal axis due to adrenal androgen excess might also cause reduced fertility . both pathomechanisms are thought to be a consequence of insufficient hormonal control . besides these somatic causes of impaired fertility in cah males , there might be aspects of psychosocial adaption and sexual well - being which may be additional factors for impaired fertility . however , up to now there are no studies investigating sexual well - being in male cah patients . sexual function is best measured by patient self - report avoiding interviewer bias and only patients can report on issues such as sexual interest and the extent to which sexual dysfunction has an adverse effect on their quality of life . the brief sexual function inventory ( bsfi ) provides an excellent tool to assess a self - reported measure of current sexual functioning . the aims of our two - year prospective study in adult male patients with congenital adrenal hyperplasia wereto investigate changes in hypothalamic - pituitary - testicular regulation by gnrh testing , to evaluate changes in sexual functioning and quality of life . to investigate changes in hypothalamic - pituitary - testicular regulation by gnrh testing , to evaluate changes in sexual functioning and quality of life .

introduction . men with congenital adrenal hyperplasia ( cah ) due to 21-hydroxylase deficiency show impaired fecundity due to testicular adrenal rest tumors and/or suppression of the gonadal axis . sexual well - being might be an additional factor ; however , no data exists . patients and methods . prospective longitudinal monocentric study included 20 male cah patients ( 14 salt wasting , 6 simple virilizing ; age 1849 yr ) . clinical assessment , testicular ultrasound , biochemical and hormonal parameters , three validated self - assessment questionnaires ( sf-36 , gbb-24 , and hads ) , and male brief sexual function inventory ( bsfi ) were analyzed at baseline and after two years . results . basal lh and testosterone levels suggested normal testicular function . lh and fsh responses to gnrh were more pronounced in patients with a good therapy control according to androstenedione / testosterone ratio < 0.2 . this group had significant higher percentage of patients on dexamethasone medication . gbb-24 , hads , and sf-36 showed impaired z - scores and no changes at follow - up . bsfi revealed impairments in dimensions sexual drive , erections , and ejaculations , whereas problem assessment and overall satisfaction revealed normal z - scores . androstenedione levels correlated ( p = 0.036 ) inversely with z - scores for sexual drive with higher levels associated with impaired sexual drive . conclusion . male cah patients showed a partly impaired sexual well - being which might be an additional factor for reduced fecundity .

conventional laparoscopic surgery requires the placement of multiple ports through the abdominal wall , with the aims of maintaining adequate internal spacing of instruments to reduce clashing and facilitating tissue manipulation for dissection . these multiple transabdominal punctures are associated with morbidity and risks such as herniation , bleeding , and damage to internal organs , as well as decreased cosmesis . laparoendoscopic single - site ( less ) surgery has been developed to overcome the port - related complications of laparoscopic surgery , to minimize morbidity , and to maximize cosmetic outcome . less surgery is performed through a single keyhole incision , typically at the umbilicus , allowing the completion of several urologic procedures with the use of familiar laparoscopic instruments and skills . since raman et al . first reported less nephrectomy ( less - n ) in 2007 , subsequent studies have demonstrated that less - n is safe and feasible with outcomes equivalent to those of conventional laparoscopic nephrectomy for both benign and malignant kidney diseases . the skill of surgeons at high - volume surgery centers has now reached a sufficient level such that less partial nephrectomy of small selected renal masses yields results comparable to those of conventional partial nephrectomy . however , the passage of all of the instruments through a single access point promotes instrument clashing and maneuverability problems , loss of triangulation , and unfamiliar working angles , even for surgeons skilled at less surgeries , and these limitations have prevented these procedures from entering mainstream clinical practice . furthermore , when the need for bleeding control , increased traction , or a suture arises , it can become necessary to apply an additional port or convert to conventional laparoscopy . these limitations are encountered not only by novices but also by experienced surgeons during complicated or difficult cases . to facilitate less techniques and overcome the learning curve for novices , magnetic anchoring and guidance systems ( magss ) these devices harness magnetic forces to steer and operate completely insertable intracorporeal instruments via externally controlled magnets . the devices are typically inserted through an already established entry site into the peritoneal cavity and are then coupled via magnetic attraction across the body wall to a handheld external component . by moving the external component around on the patient 's abdominal wall the aim of this study was to investigate the feasibility and safety of mags for surgeons performing less - n for the first time in a porcine model .

purposemagnetic anchoring devices may reduce the number of port sites needed in laparoscopic surgery . in this study , we prospectively assessed the feasibility of using a magnetic anchoring and guidance system ( mags ) in laparoendoscopic single - site ( less ) surgery performed by novices.materials and methodsa total of 10 less simple nephrectomies were performed with or without mags in a nonsurvival porcine model by 6 operators with no previous less surgery experience . after installation of the homemade single port , an intra - abdominal magnet was fixed to the renal parenchyma with suturing and stabilized by an external magnet placed on the flank so that the position of the kidney could be easily changed by moving the external handheld magnet . the length of the procedure and any intraoperative complications were evaluated.resultsoperative time ( meanstandard deviation ) was shorter in the group using the magnetic anchoring device ( m - less - n ) than in the group with conventional less nephrectomy ( c - less - n ) ( 6320.8 minutes vs. 8240.7 minutes , respectively ) . although all nephrectomies were completed uneventfully in the m - less - n group , renal vein injury occurred during dissection of the renal hilum in two cases of c - less - n and was resolved by simultaneous transection of the renal artery and vein with an endo - gia stapler.conclusionsless-n using mags is a feasible technique for surgeons with no less surgery experience . taking into account the 2 cases of renal vein injury in the c - less - n group , the application of mags may be beneficial for overcoming the learning curve of less surgery .

restrictive cardiomyopathies are defined as restrictive ventricular physiology in the presence of normal or reduced diastolic volumes ( of one or both ventricles ) , normal or reduced systolic volumes , and normal ventricular wall thickness . usually , patients develop severe symptoms of heart failure over a short period , and the majority die within a few years following diagnosis unless they receive a cardiac transplant . genetic investigations have shown that the condition may be caused by mutations in sarcomeric disease genes or genes for desmin and even may coexist with hypertrophic cardiomyopathy in the same family as seen in our case .

restrictive cardiomyopathy ( rcm ) is a relatively rare form of cardiomyopathy with high mortality which is characterized by impaired filling of the ventricles in the presence of normal wall thickness and systolic function . rcm is generally seen in association with infiltrative , storage , or systemic diseases . we present a rare case of familial rcm with pregnancy which was successfully managed .

severe obesity is defined as a body mass index ( bmi ) > 40 kg / m which is associated with comorbidities such as insulin resistance , diabetes mellitus , systemic hypertension , dyslipidemia , and cancer . furthermore , severely obese subjects have an increased total mortality with a concomitant increased risk of sudden death , which may be caused by fatal arrhythmias . heart rate variability ( hrv ) which is the fluctuation of heart rate around mean heart rate that may be assessed with a 24-hour cardiac holter monitoring provides valuable information on the activity of the cardiac autonomic nervous system ( ans ) . the ans is an important contributor to the regulation of both the cardiovascular system and energy expenditure and it is assumed to play a role in the pathophysiology of obesity and related complications [ 1 , 2 ] . in obese subjects , many studies have observed abnormalities in the sympathetic and the parasympathetic ans activity , which could partly explain the relation between obesity , comorbidities , sudden death , and arrhythmias [ 1 , 3 ] . available data regarding the metabolic and ans impacts of weight loss in severely obese subjects by other methods than gastric bypass [ 4 , 5 ] and hypocaloric diet [ 3 , 69 ] are sparse . obesity is associated with decreased left ventricular ( lv ) systolic function and impaired lv diastolic function [ 1 , 10 ] . whereas some studies using surgical procedures have reported that substantial weight loss induces significant improvements in lv diastolic function [ 1014 ] , the effect of modest weight loss on lv diastolic dysfunction in obese subjects has been less extensively investigated but has never been reported in severe obesity . diet and exercise programs are associated with disappointing long - term results on weight loss in severely obese subjects . weight loss medication is recommended for subjects with a bmi > 30 kg / m or with a bmi > 27 kg / m associated with 1 risk factor of cardiovascular disease . orlistat is a gastrointestinal lipase inhibitor , reducing fat absorption , which may result in weight loss of approximately 5 % 10 % of the initial weight after one year . it may be relevant to investigate the impact of modest weight loss on lv diastolic function and on hrv since these parameters may be associated with increased cardiovascular risk [ 18 , 19 ] . this pilot study aimed to determine the impact of weight loss induced by orlistat on hrv and on lv diastolic function in severely obese patients with type 2 diabetes .

objective . determine the impact of orlistat - induced weight loss on metabolic profile and cardiovascular function in severely obese patients with type 2 diabetes . methods . twenty - nine patients were randomized either to a nonplacebo control group or to a treatment group with orlistat thrice a day . metabolic profile , anthropometric parameters , heart rate variability indices , and echocardiographic variables were measured before and after a 12-week treatment period . results . treatment with orlistat induced a modest but significant weight loss compared to controls ( 3.7 3.0 versus 0.5 2.2 kg , resp . ; p = .003 ) . there was significant decrease in fasting glycemia ( 7.9 3.0 versus 6.7 2.2 mmol / l ; p = .03 ) and significant improvements in left ventricular diastolic function ( p = .03 ) and in the sympathovagal balance ( lf / hf ratio ) ( p = .04 ) in the orlistat group . conclusion . these results suggest that a modest weight loss improves fasting glycemia , left ventricular diastolic function , and sympathovagal balance in severely obese patients with type 2 diabetes .

maintaining the microsurgical field , free from flooding with irrigation fluid , is important to get good vessel approximation in microsurgery . the commonly followed practice is to keep dry gauze at the periphery of the field so as to siphon off the excessive fluid . a certain amount of the irrigation fluid still remains in the field and causes adhesion of the suture material with the anastomotic clamp or the background material or to the vessel wall and thereby frustrating the surgeon while applying the microknots . we present our technique that avoids the aforementioned , and in addition provides a good platform to perform microvascular anastomosis . this is folded over a dry gauze and then fenestrations are made in the surface and on the two margins [ figure 1 ] of the glove component so as to provide for continuous drainage of the irrigation fluid to the gauze . the tip of the infant feeding tube ( size 4 ) is then passed in to the gauze [ figure 2 ] and the whole assembly is then placed in the microsurgical field deep to the vessels to be anastomosed and thus provides a platform for the microanastomosis . the vessels to be anastomosed are laid over a background on the platform and then the proximal part of the feeding tube is connected to a suction system so as to provide continuous suctioning of the irrigation fluid that keeps the microsurgical field clean and dry and also by keeping away the tip of the feeding tube from the surgical field [ figure 3 ] . the wrist part of the glove with open ends and fenestrations on the surface to facilitate siphoning off of the irrigation fluid the tip of a size 4 infant feeding tube is passed between the layers of gauze the entire assembly is shifted to the neck for anastomosis forming a good platform for anastomosis . the proximal end of the infant feeding tube is connected to the suction tube the wrist part of the glove component has been described in the past to transfer the pedicle of the flap from the oral cavity to the neck for microanastomosis and in this report we present a technique in which the component can be used to keep the operative field clean and dry and also to provide a stable platform to perform a perfect microanastomosis .

during microvascular anastomosis , it is important to maintain the microsurgical field irrigated yet dry so as to achieve a good view of the vessels for approximation . in this method , an infant feeding tube ( size 4 ) , with its tip sandwiched between layers of dry gauze and a surgical glove component placed in the anastomotic field and the other end connected to a suction apparatus , is used to maintain the microsurgical field free from flooding . it also has the additional advantage of providing a stable platform for microvascular anastomosis .

mixed urinary incontinence ( mui ) is a troublesome condition for patients and incontinence specialists because for treatment to be successful , both the stress and the urge components of the incontinence need to respond to therapy . the international continence society 's standardized nomenclature defines mixed urinary incontinence as `` the complaint of involuntary leakage associated with urgency and also with exertion , effort , sneezing or coughing . `` . the most appropriate definition for mixed incontinence is not known . from a pragmatic standpoint , patients with mui and their clinicians want information about the chance of a favorable outcome following their primary incontinence treatment . the clinical consequences of not understanding the role of the stress and urge components in mui include the persistence of urge incontinence after stress urinary incontinence ( sui ) surgery , which the patient then perceives as surgical failure [ 2 - 4 ] . the urgency component in mui may consist of either detrusor instability , urethral relaxation , or an uninhibited premature micturition reflex . others have argued that the `` urge incontinence `` component of mui appears to be different from that of urge urinary incontinence ( uui ) and have suggested that urge incontinence may be overdiagnosed in patients with sui who misinterpret their fear of leaking ( because of sui ) for urge incontinence . in our study , we tried to identify whether symptoms of urgency increase along with the severity of sui symptoms . in an effort to define more precisely the specific pathophysiology of incontinence in women , we examined whether women suffering from mui exhibit clinical and urodynamic characteristics that are distinct from those of patients with pure sui .

purposethis study aimed to determine whether symptoms of urinary urgency increase according to the severity of stress urinary incontinence ( sui ) . for this purpose , we recruited women with symptoms of mixed as well as pure sui and compared the clinical characteristics of each subgroup.materials and methodsa total of 241 female patients who were diagnosed with sui and mixed urinary incontinence ( mui ) were analyzed retrospectively . patients with only sui were categorized as group 1 . patients with mui were categorized as group 2 . clinical and urodynamic differences between the 2 groups were compared.resultsthe proportion of stamey grade was significantly different between the 2 groups : grade 1 sui was higher in group 1 , but grades 2 and 3 sui were higher in group 2 . the incidence of urgency was proportional to the degree of stamey grade ( 23.5 % in grade 1 , 36.9 % in grade ii , and 60.0 % in grade iii ) . in the urodynamic study , the presence of detrusor overactivity was significantly higher in group 2 than in group 1 ( 25.9 % vs. 49.4 % ) . other clinical parameters were also significantly different between the 2 clinical groups : q - tip angle ( group 1 : 42.1 , group 2 : 28.6 , p < 0.05 ) , maximal urethral closure pressure ( group 1 : 54.7 cmh2o , group 2 : 44.1 cmh2o , p < 0.05 ) , maximal bladder capacity ( group 1 : 356.3 ml , group 2 : 282.0 ml , p < 0.05 ) , and bladder volume at first desire ( group 1 : 144.6 ml , group 2 : 123.2 ml , p < 0.05 ) .conclusionsaccording to this analysis , the more serious the symptoms of sui , the higher the incidence of urinary urgency .