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lymphoma is a heterogeneous malignancy of the lymphatic system characterized by proliferation of lymphoid cells or their precursors . they are generally categorized as hodgkin 's and non - hodgkin 's lymphomas ( nhls ) based on the presence and absence of typical hodgkin 's cells . hodgkin 's lymphoma rarely presents as extranodal disease , whereas nhl commonly presents at extranodal sites ( 2545 % ) such as gastrointestinal tract , skin and bone . in the head and neck , primary nhl occurs in waldeyer 's ring , oral mucosa , salivary glands , paranasal sinuses , laryngeal tissue and bone . when it does occur , mandibular nhl closely mimics an ameloblastoma , a tumor of odontogenic epithelial origin , both clinically and radiographically . genetic diseases , environmental agents and infectious agents have been attributed to the development of nhl . barr virus , human t - cell lymphotropic virus 1 , human immunodeficiency virus , helicobacter pylori , chlamydia and human herpesvirus-8 are known to be associated with an increased risk of nhl . while the actual role of viruses in lymphomagenesis remains to be understood , some types of nhl have shown insertion of exogenous genes by oncogenic viruses . we present a rare case of rapidly progressing swelling of the left mandible which on routine histopathological examination appeared to be a spindle - cell sarcoma . immunohistochemical analysis enabled a final diagnosis of spindle - cell variant of lymphoma , an occurrence previously reported only once in english literature .

a 64-year - old male farmer presented with a rapidly progressive swelling of the left mandible since 6 months . the swelling was firm to hard , diffuse , nontender , obliterating the vestibule with paresthesia of lower lip . the cone beam computed tomography imaging revealed an ill - defined , moth - eaten radiolucency with destruction of the buccal and lingual cortical plates . the rapid growth and aggressive behavior of the lesion coupled with guidance from the patient 's previous reports from the incisional biopsy and fine needle aspiration cytology warranted a mandibular resection . microscopic examination showed an encapsulated lesion situated in the connective tissue containing a mixture of proliferating spindle - shaped cells arranged in fascicles and round cells infiltrating into the connective tissue stroma and bone . the neoplastic cells exhibited atypical features such as pleomorphism , hyperchromatism and increased mitotic figures with noncleaved nuclei . a working diagnosis of a spindle - cell sarcoma was arrived at with various differentials provided such as fibrosarcoma , rhabdomyosarcoma , leiomyosarcoma , malignant peripheral nerve sheath tumor , langerhans cell histiocytosis and lymphoma and stating the need for immunohistochemistry to subtype the tumor . the neoplastic cells were negative for van gieson 's stain and masson 's trichrome . immunohistochemical analysis performed using desmin , smooth muscle actin , s-100 and cd1a in a bid to determine the phenotype of the tumor and rule out the previously stated differentials were all negative for the lesion . lymphoid markers such as leukocyte common antigen and cd20 ( cluster differentiation marker for b - cells ) showed positivity in spindle - shaped cells as well as round cells indicating the tumor to be a lymphoproliferative lesion of b - cell type . a final diagnosis of spindle - cell variant of non - hodgkin 's lymphoma was rendered based on the immunohistochemical profile .

recently , integration of semiconductor with ferromagnetic function has been focused on in spintronics because of the difficulties associated with the injection of spins from magnetic metal into nonmagnetic semiconductors in conventional spintronic devices . many groups have found rtf in transition or rare earth metal doped compound semiconductors such as tio2 , zno , sno2 , and in2o3 . when groups of people try to explain the fm in transition metal doped semiconducting oxides , an unexpected fm was reported in pure hfo2 thin film , which challenges the understanding of magnetism for the researchers . suggested that oxygen vacancies were key factors in introducing fm to hfo2 , while pemmaraju and sanvito suggested that the origin of rtf in hfo2 was due to defects on hf sites . hu et al . presented that rtf observed in pure mgo results from cation vacancies . . suggested that a small concentration of ca vacancies in cao can also induce fm based on results of the ab initio electronic structure calculation , which could be a path to new ferromagnets . recently , similar fm has been reported in other pure semiconductor materials , such as tio2 , zno , sno2 , in2o3 , al2o3 , and ceo2 , where the origin of fm is believed to be oxygen defects . cuo , as a narrow band gap p - type semiconductor , has been recognized as an industrially important material for a variety of practical applications , such as catalysis , batteries , solar energy conversion , gas sensing , and field emission [ 12 - 14 ] . therefore , the synthesis and study of cuo nanostructures should be of practical and fundamental importance . apart from this , if one can find fm without any magnetic impurity doping , this may bring a new opportunity to the field of spintronics because there will be no issues due to clustering or precipitation of dopants . indeed , punnoose et al . and mishra et al . represented the presence of an exchange interaction between the ferromagnetic surface and the antiferromagnetic core . recently , xiao et al . and shang et al . reported the observation of rtf in cuo nanostructures . however , the fm in cuo remains controversial because most groups suggested that cu atoms have no clustering tendency and cu - based oxides are not ferromagnetic . here , we synthesize cuo nanoparticles by a simple co - precipitation method to avoid the influences of substrate and the interface between film and substrate . we found the cuo nanoparticles show rtf , and the origin of the fm is discussed .

room temperature ferromagnetism ( rtf ) is observed in pure copper oxide ( cuo ) nanoparticles which were prepared by precipitation method with the post - annealing in air without any ferromagnetic dopant . x - ray photoelectron spectroscopy ( xps ) result indicates that the mixture valence states of cu1 + and cu2 + ions exist at the surface of the particles . vacuum annealing enhances the ferromagnetism ( fm ) of cuo nanoparticles , while oxygen atmosphere annealing reduces it . the origin of fm is suggested to the oxygen vacancies at the surface / or interface of the particles . such a ferromagnet without the presence of any transition metal could be a very good option for a class of spintronics .

simple obesity is currently one of the most common metabolic diseases and its incidence has been increasing every year . this is mainly due to changes in lifestyle and dietary habits of contemporary society as well as the development of inappropriate nutrition and physical activity patterns already in early childhood . obesity increases the risk of hypertension , dyslipidemia and abnormal glucose tolerance , which results in an increased risk of heart and metabolic diseases . obesity as a disease of affluence affects the youngest patients increasingly frequently . over the last decades a gradual increase in the prevalence of excessive body weight and obesity has been observed around the world . this is true not only for the adult population , but for children as well . it is thought that if this trend is not stopped , the present generation of children , despite the considerable progress in medical sciences , will probably be the first generation to live shorter than the parents . the additional tests for children with simple obesity most commonly ordered by primary care physicians include the assessment of thyroid function conducted in order to exclude hormonal imbalances that cause obesity . obese individuals relatively often have elevated levels of the thyroid - stimulating hormone ( tsh ) in the blood serum , called hyperthyrotropinemia , which has a tendency to rise with age . the substance which is responsible for this is leptin , which regulates body weight and hunger , influencing the level of tsh in the blood serum by modifying its synthesis in the pituitary gland . another mechanism accounting for the elevated levels of this hormone in obese patients consists in the possible resistance to thyroid hormones at the level of the pituitary gland and disruption of the negative feedback phenomenon . as a result , the tsh concentration is observed to decrease following the reduction of body weight to a normal level . an attempt at broadening the diagnostic investigation by conducting an imaging examination of the thyroid gland , in addition to tests of free thyroxine , triiodothyronine and antibodies against thyroid peroxidase and thyroglobulin seems to be an obvious course of action . according to them one of the indications for the ultrasound examination of the thyroid gland is a suspected disease based on abnormal laboratory test results , including hyperthyroidism , hypothyroidism and thyroiditis . correct interpretation of a thyroid ultrasound examination in an obese child may become one of the fundamental elements affecting further course of action or therapeutic decisions , especially with borderline values of tsh or thyroid hormones . lesions in the thyroid gland which may be associated with obesity have been reported in medical literature for some time . the most important ones include increased volume of the gland , changed echogenicity and the presence of focal lesions .

obesity as a disease of affluence also affects younger children . numerous observations suggest a link between excessive body weight and thyroid function disorders . subclinical hypothyroidism has been diagnosed increasingly frequently in patients with obesity . a growing number of papers also point to morphological changes of the thyroid gland in the ultrasound examination in obese children . these reports mainly concern changes in echogenicity . the present paper discusses the most important aspects of this topic on the basis of the literature as well as containing a brief analysis based on own experiences .

anaesthesiology today is a vast speciality in medical science with its subspecialties ranging from perioperative patient care to critical care , trauma care , pain management and palliative care . choosing a career is a complex exercise and maybe influenced by several intrinsic and extrinsic factors . the subject has vital implications in national workforce planning and future recruitment strategies , in a speciality that is reported as an unattractive choice for medical students both in developing and developed countries . it is also an important input for academic bodies and government agencies to formulate and decide the number of postgraduate students to be allotted to the speciality . the aim of this study was to explore some of the reasons why anaesthesiology as a speciality is not preferred by undergraduate medical students as a postgraduate choice . the study also aimed at finding the various factors influencing their speciality choice ; assess the awareness and knowledge about scope of anaesthesiology at the time of medical postgraduate counselling , opinion about speciality and stress levels after working as a postgraduate . views regarding diploma in anaesthesiology and undergraduate exposure to speciality among postgraduate students in a developing country were also assessed .

trends in selection of a career in medicine vary from country to country . to plan future recruitment strategies and to balance distribution of physicians among medical specialties , each country needs to examine these reasons as part of educational research . the aim of this study was to explore the anaesthesiology postgraduate students knowledge about anaesthesia as a speciality , their attitude towards anaesthesia as a career choice , stress levels during the period of postgraduation , views regarding diploma in anaesthesiology and undergraduate exposure to the subject . eight hundred pretested questionnaires were provided to the anaesthesia postgraduate students attending various national level conferences in india . the collected data were statistically analysed using spss version 20 . only 31.6 % of the students were aware of scope of anaesthesiology and 42.3 % of students joined the speciality out of the interest to learn the subject , whereas 55.7 % joined for other reasons , including non - availability of other specialties during medical postgraduate counselling . about 70 % of students were stressed out during postgraduation , 31.6 % found difficulty in accommodating the demands of challenging job and 3.8 % went into depression . majority of anaesthesiology postgraduate students were unaware of the scope of anaesthesiology at the time of medical postgraduate counselling ; only two - fifth of the students joined the speciality out of interest to learn the subject and most of them felt stressed out during the period of postgraduation . majority of the students were of the opinion that diploma in anaesthesia was not a viable career option and should be scrapped .

pregnancy - associated breast cancer ( pabc ) , which occurs during pregnancy or within one year of delivery , is the second most common cancer in pregnant women 1 - 3 . a normal full - term pregnancy is believed to be one of the most effective means to decrease the lifetime - risk of breast cancer , whereas pabc is associated with the most aggressive clinical course and the highest mortality rate among breast malignancies 1 - 3 . these seemingly conflicting impacts are believed to result from aberrant proliferation and differentiation of stem cells , and pathological alterations of the microenvironment and extracellular matrix 3,4 . neither the molecular or cellular mechanisms , nor the specific molecules linking to aggressiveness and invasiveness of pabc , however , have been identified . promoted by the fact that the myoepithelium is the sole source of several tumor suppressors , including maspin , wilms ' tumor 1 ( wt-1 ) , p63 , and p73 , which show significant paracrine inhibition on tumor cell growth and invasion in vitro 5 - 10 , our recent studies compared the expression of these tumor suppressors in pabc and the stage , grade , and age matched non - pabc . pabc were found to have several unique alterations , including ( 1 ) the absence of p63 and wt-1 expression in a vast majority of myoepithelial cells , and ( 2 ) intense cytoplasmic p63 expression in a subset of normal or hyperplastic epithelial cells , which are arranged as segregated clusters or lobules 11 . first , as the p63 gene encodes multiple protein isoforms that regulate p53 , p73 , and other tumor suppressors 12,13 , aberrant p63 expression may result in aberrant expression of these tumor suppressors . second , as p63 is required for normal development of the breast and other organs 12,13 , aberrant p63 expression may result in structural defects of breast tissues , making them more acceptable to external or internal insults that promote carcinogenesis . third , as cytoplasmic p63 expression is associated with poorer patient survival in lung cancer and tumor grade in meningiomas 14,15 , aberrant p63 expression may have oncogenic properties that contribute to tumor aggressiveness and invasiveness . thus , our current study attempted to further elucidate the cellular and molecular profiles of these normal or hyperplastic appearing epithelia with cytoplasmic p63 expression , to assess : ( 1 ) whether they harbor aberrant expression of other tumor suppressors or malignancy - associated changes , and ( 2 ) whether they differ substantially in dna copy numbers compared to morphologically similar counterparts without cytoplasmic p63 expression .

our previous studies revealed that pregnancy associated breast cancer ( pabc ) had significantly reduced nuclear p63 expression in myoepithelia , while intense cytoplasmic p63 expression in associated epithelia . our current study assessed these epithelia using immunohistochemistry with a panel of aggressiveness and invasiveness related markers and comparative genomic hybridization ( array - cgh ) with over 30,000 dna probes . these epithelia showed several unique alterations , including ( 1 ) immunohistochemical and morphological resemblance to invasive cancer , ( 2 ) significant gain in copy numbers of dna coding genes for morphogenesis , angiogenesis , and metastasis , and ( 3 ) significant loss in copy numbers of dna coding genes for tumor suppressors , cell adhesion , and macromolecular complex assembly or intra - cellular trafficking . detected array - cgh alterations correlated well with in vivo expression of a number of corresponding proteins tested . these findings suggest that aberrant sub - cellular localization of p63 expression in normal or hyperplastic appearing epithelial cells may significant contribute to increased invasiveness and aggressiveness of these cells .

service user involvement ( sui ) is emphasized in many strategies , plans , and declarations . it is a recognized value in social work and in health care , yet in practice , sui is not always achieved [ 13 ] . there is a dissonance between the philosophies of sui and the existence of these philosophies in the reality of mental health nursing practice . sui is a difficult and complex concept to define , and it is often used as a synonym for participation . on the other hand , a distinction can be made between these two concepts . service user involvement entails preconditions of the service user 's impact on services in some way while user participation can mean users merely taking part in an activity or acting as an informant . consumerism or the ethos of markets sees service users as customers , consumers or stakeholders whose views need to be taken into account . approach where service user involvement serves the interests of the organizations , service systems , and markets . in contrast , the democratic , or empowerment model is concerned with service users having a voice in services , civil rights , and equal opportunities . the empowerment model is more about the bottom - up interests of service users themselves , and involvement is seen and valued as an end in itself . state that user involvement has the ability to improve the quality of care , but equally important is the potential effect it has on the service users ' personal and collective identity , sense of self - worth , and civil rights . in finland , sui is exercised mainly through local democratic mechanisms , elections , and patient organizations . there are also acts covering the rights and status of patients , social service clients , and complaints systems . the national plan for mental health and substance abuse work was introduced in 2009 , and it outlines common national objectives for mental health and substance abuse work . the plan emphasizes that the client 's status must be reinforced ; user experts and peers should be included in the planning , implementation , and evaluation of mental health and substance abuse work . as goodwin and happell point out , published research about service user involvement and participation is limited , and there is a lack of research reflecting the views and opinions of service users themselves . the purpose of this study was to describe service user involvement in mental health and substance abuse work from the viewpoint of clients . the following study question was addressed : what are service users ' conceptions of sui in mental health and substance abuse work ?

service user involvement ( sui ) is a principal and a guideline in social and health care and also in mental health and substance abuse work . in practice , however , there are indicators of sui remaining rhetoric rather than reality . the purpose of this study was to analyse and describe service users ' conceptions of sui in mental health and substance abuse work . the following study question was addressed : what are service users ' conceptions of service user involvement in mental health and substance abuse work ? in total , 27 users of services participated in the study , and the data was gathered by means of interviews . a phenomenographic approach was applied in order to explore the qualitative variations in participants ' conceptions of sui . as a result of the data analysis , four main categories of description representing service users ' conceptions of service user involvement were formed : service users have the best expertise , opinions are not heard , systems make the rules , and courage and readiness to participate . in mental health and substance abuse work , sui is still insufficiently achieved and there are obstacles to be taken into consideration . nurses are in a key position to promote and encourage service user involvement .

megaloblastic anemia is an important morbidity in children and adolescents especially in developing countries and with poor socioeconomic status . imerslund grasbeck syndrome ( igs ) is a rare autosomal recessive megaloblastic anemia characterized by selective vitamin ( vit ) b12 deficiency and asymptomatic proteinuria . it is the most common cause of cobalamin deficiency in certain communities like lapps in scandinavia , north african jews , few families in norway and finland . about 300 cases have been reported worldwide with new cases appearing in eastern mediterranean countries . it has varying manifestations like failure to thrive , insidious onset of infections , hematological and neurological symptoms . igs is resistant for oral vit b12 supplements , but responds very well for parenteral therapy . [ 27 ] we report a case of young female who presented with pancytopenia and proteinuria , evaluated in local hospitals as chronic hemolytic anemia ( autoimmune cause ) , finally diagnosed as igs on complete evaluation .

imerslund grasbeck syndrome ( igs ) is a rare autosomal recessive childhood disorder characterized by selective vitamin ( vit ) b 12 malabsorption with asymptomatic proteinuria without any structural renal pathology . the patients stay healthy for decades with life - long parenteral vit b12 . we report a case of young female who presented with pancytopenia and proteinuria , evaluated in local hospitals as chronic hemolytic anemia ( autoimmune cause ) , finally diagnosed as igs on complete evaluation . she was treated with injectable vit b12 ( 1000 g cyanocobalalmin ) and showed drastic recovery . igs should be considered in patients with megaloblastic anemia not responding to oral vit b12 and associated proteinuria .

the pathophysiology of irritable bowel syndrome ( ibs ) seems to involve disturbances at many levels of the so - called gut - brain axis.1 recent research has emphasized the role of food in abdominal symptom generation,2 in particular low - digestible carbohydrates.3 our group has previously shown that the ingestion of the unabsorbable , but fermentable disaccharide lactulose provokes more symptoms in patients with ibs than in healthy individuals.4,5 intriguingly , the symptoms provoked by lactulose were similar to the patients habitual complaints.4 fermentable carbohydrates that escape digestion and absorption within the small intestine are metabolized by colonic microbiota . hunter6 has previously suggested that the disturbances of colonic fermentation play a significant role in ibs symptom generation , and has proposed the term enterometabolic disorder to describe such alterations . colonic fermentation yields short - chain fatty acids ( scfas ; mainly acetic , propionic , and butyric acids ) and gases ( mainly co2 , h2 , and ch4 ) . hence , the efficacy of the fermentation may be evaluated by scfa analysis . due to regional differences regarding the availability of fermentable substrates and abundance of saccharolytic microbes , fermentation of low - digestible carbohydrates takes place mainly in the cecum and the proximal colon , rather than in the distal parts.7 a correlation has previously been demonstrated between cecal levels of scfa and portal and aortic blood levels of scfa in rats,8 and assessment of scfa in peripheral venous blood may be considered as an indirect measure of colonic fermentation.9 the aim of the present study was to compare serum scfa levels in patients with ibs and healthy controls before and after the ingestion of lactulose . since a previous study has shown that the mean orocecal transit time of a 10 g lactulose solution is approximately 90 minutes,10 and that the onset of symptoms after a meal often occurs within 90 minutes,11 we chose this time point for evaluating the lactulose - stimulated response .

backgroundingestion of low - digestible carbohydrates triggers symptoms in patients with irritable bowel syndrome ( ibs ) . these carbohydrates become substrates for microbial fermentation in the colon , yielding short - chain fatty acids ( scfas ) that are readily absorbed . aiming to compare colonic fermentation in patients with ibs and healthy controls , we analyzed the concentrations of scfa in serum at fasting and 90 minutes following ingestion of an unabsorbable , but fermentable carbohydrate , lactulose.methodspatients with ibs according to rome iii criteria ( n=22 ) and healthy controls ( n=20 ) ingested 10 g lactulose dissolved in water . symptoms were graded by questionnaires and scfa were analyzed using hollow fiber - supported liquid membrane extraction coupled with gas chromatography.resultslactulose induced more symptoms in patients with ibs than in healthy controls ( p=0.0001 ) . fasting serum levels of scfa did not differ between patients with ibs and controls . however , the postprandial levels of total scfa ( p=0.0002 ) , acetic acid ( p=0.005 ) , propionic acid ( p=0.0001 ) , and butyric acid ( p=0.01 ) were significantly lower in patients with ibs compared with healthy controls . there was no correlation between the levels of serum scfa and symptom severity.conclusionlow-serum levels of scfa after lactulose ingestion may indicate impaired colonic fermentation in patients with ibs . conceivably , this disturbance is related to symptom generation , but the mechanism is not clear .

benign prostatic hyperplasia ( bph ) is one of the most frequently occurring urologic diseases in men older than 50 . the bladder outlet obstruction causes a variety of urinary symptoms including nocturia , incomplete voiding , urgency , and hesitancy and comes to the fore as a significant health problem interrupting the quality of life of men over middle age . the prevalence rate of bph increases with age ; bph occurs in 40 % to 70 % of men aged 60 to 70 years . the current korean population is aging very rapidly compared with other countries ; with this , interest in health after middle age is increasing throughout society . however , owing to a lack of recognition about bph , the time until visiting the hospital is often delayed , and this tendency is truer in rural areas than in urban areas . in this situation , it is necessary to understand the prevalence rate of bph , but few systematic epidemiologic investigations have been carried out about bph in korea . also , there are limitations in the epidemiologic research conducted so far because the previous data were not collected by use of standardized diagnostic criteria or a specific clinical definition . therefore , in this study , the prevalence rate of bph was estimated among males living in the rural korean area of yangpyeong country .

purposewe investigated the prevalence rate of benign prostatic hyperplasia ( bph ) among korean males in a rural area through a cross - sectional , community - based epidemiologic survey and analyzed the correlation with epidemiologic factors.materials and methodsa total of 779 males who lived in yangpyeong county participated in a prostate examination campaign . targeting these men , we collected the international prostate symptom score ( ipss ) , medical history , demographic information , serum prostate - specific antigen , and prostate volume as measured by transrectal ultrasonography . the data for 599 participants were analyzed , excluding 180 men who had a possibility of prostate cancer . bph was defined as an ipss of 8 points or higher and a prostate volume of 25 ml or more.resultsthe prevalence rate of bph was 20.0 % . the prevalence rate increased with age . there were 2 subjects ( 4.4 % ) in the age group of 40 - 49 years , 18 subjects ( 10.9 % ) in the age group of 50 - 59 years , 44 subjects ( 22 % ) in the age group of 60 - 69 years , and 56 subjects ( 26.6 % ) in the age group of over 70 years ; this increase with age was statistically significant ( p < 0.001 ) . in the bph group , the average ipss was 14.675.95 , the average prostate volume was 37.0411.71 g , and the average prostate - specific antigen value was 1.560.88 ng / ml . in the analysis of correlations between the epidemiologic factors and the risk of bph , smoking was the only statistically significant factor.conclusionsthe total prevalence rate of bph in this study was 20.0 % , which was a little lower than the rate reported in other cities or rural areas .

chronic prostatitis / chronic pelvic pain syndrome ( cp / cpps ) is a common male chronic pain condition . its prevalence ranges from 9 to 16 % worldwide and from 5 to 25 % in korea [ 1 - 3 ] . cp / cpps presents with various voiding symptoms , perineal or suprapubic pain , erectile dysfunction or sexual disturbance , and psychological problems such as depression and anxiety that have a negative impact on health - related quality of life . various theories have been hypothesized , such as inflammation , pathogen and host - specific factors , pelvic floor tension myalgia , and differences in systemic pressure sensitivity [ 6 - 8 ] . it has been suggested that there are significant psychological components to this condition , because most cp / cpps patients have depression and anxiety . it has also been suggested that stress is a potent factor in the development , prolongation , and perpetuation of the symptoms in the condition known generally as chronic prostatitis . the severity of stress has been reported to depend on individual perception or subjective interpretation of causative factors rather than on the contents or frequency of factors causing stress . that is , individual coping strategies for each stress and cognitive assessment of stress have been suggested to significantly affect stress progression . coping strategies refer to cognitive and behavioral efforts that are used to satisfy external or internal demands , and they have been known to act as regulators between stress and psychological disorders or physical diseases . therefore , in addition to stress frequency , differences in stress perception and coping strategies should be considered as factors causing or deteriorating stress symptoms in patients with cp / cpps . in korea , several studies on psychological problems related to cp / cpps have been conducted , but few studies on the relationship of coping strategies for stress have been conducted . accordingly , this study was conducted to compare the psychological features and coping strategies of patients with cp / cpps with those of a healthy control group , to investigate differences between the two groups , and to provide useful information for the treatment of cp / cpps .

purposethe objective of this study was to examine the psychological features and coping strategies of patients with chronic prostatitis / chronic pelvic pain syndrome ( cp / cpps ) .materials and methodsthe participants consisted of 55 military personnel suffering from cp / cpps and 58 military personnel without cp / cpps symptoms working at the military capital hospital . the national institutes of health chronic prostatitis symptom index ( nih - cpsi ) was used to assess cp / cpps symptoms . the responses to hospital anxiety and depression ( had ) scale , social readjustment rating scale , and global assessment of recent stress ( gars ) scale were compared between the two groups . the weisman coping strategy scale was used to assess coping ability with cp / cpps.resultsthe nih - cpsi score of the cp / cpps group was significantly higher than that of the control group for all domains including pain , urinary symptoms , quality of life , and summed score . the anxiety and depression domain of the had showed significant differences between the two groups . there were no significant differences in the social readjustment rating scale between the two groups , but the sum of the gars score was higher in the cp / cpps group than in the control group . these were correlated with the pain , quality of life , and sum domains of the nih - cpsi . the weisman coping strategy scale showed that intellectualization , redefinition , and flexibility were higher in frequency in descending order , and that fatalism , externalization , and self - pity were lower in frequency.conclusionsthe cp / cpps patients had depression , anxiety , and higher perception of stress . in particular , these were closely related to the pain and quality of life of the patients .

serotonin syndrome is a potentially life - threatening condition caused by excessive serotonergic activity in the central nervous system . it is characterized by mental status changes ( eg , confusion , agitation , lethargy , coma ) , autonomic instability ( eg , hyperthermia , tachycardia , diaphoresis , nausea , vomiting , diarrhea , dilated pupils ) , and neuromuscular hyperactivity ( eg , myoclonus , hyperreflexia , rigidity , trismus ) . serotonin syndrome classically occurs in patients receiving two or more serotonergic drugs , but it can occur with monotherapy . we report a case of a 20-year - old man who developed serotonin syndrome resulting from overdose of escitolapram with concomitant use of cocaine . it is a very important area in medicine as serotonin syndrome should be suspected especially in drug abusers who are being treated with psychotropic agents for mental illnesses .

introductionserotonin syndrome is a potentially life - threatening condition caused by excessive serotonergic activity in the central nervous system . it is characterized by mental status changes ( eg , confusion , agitation , lethargy , coma ) , autonomic instability ( eg , hyperthermia , tachycardia , diaphoresis , nausea , vomiting , diarrhea , dilated pupils ) , and neuromuscular hyperactivity ( eg , myoclonus , hyperreflexia , rigidity , trismus ) . serotonin syndrome classically occurs in patients receiving two or more serotonergic drugs , but it can occur with monotherapy . we report a case of a 20-year - old man who developed serotonin syndrome resulting from overdose of escitolapram with concomitant use of cocaine . it is a very important area in medicine as serotonin syndrome should be suspected especially in drug abusers who are being treated with psychotropic agents for mental illnesses .

size and geography of airborne tungsten particles collected in fallon , nevada , and sweet home , oregon ( figure 1 ) , were compared as part of ongoing research on the cooccurrence of airborne tungsten and a cluster of childhood leukemia in fallon . fallon experienced a cluster of childhood leukemia beginning in 1997 , with the last case announced in 2004 . although the cluster is thought to have abated , at least one additional case of childhood leukemia has occurred in fallon since 2004 . given fallon 's pediatric population of about 2500 children up to 19 years in age , and a national expected rate of childhood leukemia of 4.1 cases per 100,000 children up to 19 years in age per year , the expected rate of childhood leukemia for fallon should be only one case every ten years . this cluster , deemed , multiple lines of evidence have shown that fallon has elevated levels of airborne tungsten and cobalt [ 913 ] . although nevada is naturally rich in tungsten minerals , including geologically and hydrologically [ 15 , 16 ] , fallon also has a potential anthropogenic source of airborne tungsten . an industrial facility specializing in hard - metal metallurgy , which uses tungsten carbide and cobalt to produce tool materials , is located within fallon . this hard - metal facility was named by the nevada state health division as a candidate source of tungsten in fallon . morphological and chemical characteristics of airborne tungsten particles in fallon indicate that they are anthropogenic in origin , not natural . to improve understanding of possible connections between airborne tungsten and public health in fallon , it would be useful to replicate this research in other small communities that have an industrial source of airborne tungsten in order to compare airborne tungsten and rates of cancer across towns . sweet home , oregon , is another town that has an industrial source of airborne tungsten . as a first step in comparing sweet home to fallon , elevated airborne tungsten was accurately indentified near the known industrial facility in sweet home relative to outlying forests and to the outskirts of sweet home . to our knowledge , sweet home this prompts a question about airborne tungsten and public health : if exposure to airborne tungsten and/or cobalt particles caused , or even contributed to , the cluster of childhood leukemia in fallon , then why is there not an increased rate of childhood leukemia in sweet home ? one possible answer to this question could be that tungsten particles and/or geographical traits differ between fallon and sweet home such that actual human exposure to airborne tungsten differs between these towns . accordingly , the objectives of this research were ( a ) to measure and characterize the size of airborne tungsten particles of both towns , ( b ) to analyze spatial patterns of dispersal of airborne tungsten of both towns , and ( c ) to compare potential human exposure to airborne tungsten between fallon and sweet home .

to improve understanding of possible connections between airborne tungsten and public health , size and geography of airborne tungsten particles collected in fallon , nevada , and sweet home , oregon , were compared . both towns have industrial tungsten facilities , but only fallon has experienced a cluster of childhood leukemia . fallon and sweet home are similar to one another by their particles of airborne tungsten being generally small in size . meteorologically , much , if not most , of residential fallon is downwind of its hard metal facility for at least some fraction of time at the annual scale , whereas little of residential sweet home is downwind of its tungsten facility . geographically , most fallon residents potentially spend time daily within an environment containing elevated levels of airborne tungsten . in contrast , few sweet home residents potentially spend time daily within an airborne environment with elevated levels of airborne tungsten . although it can not be concluded from environmental data alone that elevated airborne tungsten causes childhood leukemia , the lack of excessive cancer in sweet home can not logically be used to dismiss the possibility of airborne tungsten as a factor in the cluster of childhood leukemia in fallon . detailed modeling of all variables affecting airborne loadings of heavy metals would be needed to legitimately compare human exposures to airborne tungsten in fallon and sweet home .

in spite of the availability of antimicrobial agents , pneumonia constitutes the sixth most common cause of death and the number one cause of death from infection . pneumonia can be particularly life - threatening in the elderly , patients with pre - existing cardiac or pulmonary conditions , in immunocompromised individuals , and in pregnant women . infections are the most common cause of morbidity and mortality in patients with malignant disorders , and in haematopoietic stem cell transplant ( sct ) recipients , despite the use of infection prophylaxis , growth factors , and newer antimicrobial agents [ 2 , 3 ] . the main risk factors for development of infection in patients with malignant disorders include : uncontrolled malignancy , cytotoxic chemotherapy , immunosuppressive treatment , and immunological deficits , e.g . hypogammaglobulinaemia and t - cell depletion . in this category of patients , the risk of infection is directly proportional to the intensity and duration of cytotoxic chemotherapy and immunosuppressive treatment .

moraxella catarrhalis is a gram negative diplococcus that causes a variety of upper and lower respiratory tract infections . patients with malignant , hematological disorders treated with intensive cytotoxic chemotherapy , and recipients of various forms of haematopoietic stem cell transplant receiving immunosuppressive agents are at high risk of developing severe infections and septic complications . early detection of the organism and prompt treatment with appropriate antibiotics provide both resolution of the infection and prevention of further consequences . two patients with haematopoietic stem cell transplant who developed pneumonia caused by m. catarrhalis at king faisal specialist hospital and research centre in riyadh are reported and the literature is reviewed . to our knowledge , these are the first case reports of m. catarrhalis pneumonia in haematopoietic stem cell transplant patients .

the global prevalence of colorectal cancer is increasing , and the incidence in south korea is rapidly increasing owing to a westernized diet . colon carcinogenesis occurs through either the adenoma - carcinoma sequence or a de novo pathway . it is known that over two - thirds of colorectal cancer cases develop from adenomas ; therefore , detection and removal of adenomas by colonoscopy is the best way to prevent colorectal cancer . according to an american study in 2008 , polyps over 9 mm in size have been detected in 6 % to 7 % of health screening examinations ; the reported adenoma detection rate in korea varies , but is approximately 9 % during screening examinations . diagnosis and removal of colorectal polyps is increasing because of the widespread availability of colonoscopy . follow - up colonoscopy is required to reduce the risk of colorectal carcinogenesis after polypectomy for adenoma . metachronous lesions were detected in 20 % to 30 % of patients during follow - up colonoscopy 3 to 5 years after polypectomy to remove one or more adenomas [ 3 - 7 ] . advanced adenomas ( > 10 mm in diameter , over 25 % villous component , or high - grade dysplasia ) were found in 20 % of these patients [ 3 - 8 ] , and a small number had invasive colorectal cancer [ 5,9 - 14 ] . in addition , interval cancer was reported during an adequate follow - up period after screening colonoscopy [ 15 - 17 ] , and 19 % to 27 % of such interval cancers are known to be caused by incomplete removal of polyps . enhanced colonoscopy surveillance may be needed for screening of patients at high risk of colorectal carcinogenesis , for prediction of progressive colorectal tumor development , management of incompletely removed polyps , and appropriate follow - up .

the detection and removal of adenomatous polyps and postpolypectomy surveillance are considered important for the control of colorectal cancer ( crc ) . surveillance using colonoscopy is an effective tool for preventing crc after colorectal polypectomy , especially if compliance is good . in current practice , the intervals between colonoscopies after polypectomy are variable . different recommendations for recognizing at risk groups and defining surveillance intervals after an initial finding of colorectal adenomas have been published . however , high - grade dysplasia and the number and size of adenomas are known major cancer predictors . based on this , a subgroup of patients that may benefit from intensive surveillance colonoscopy can be identified .

working memory ( wm ) dysfunctions can be found among the difficulties that appear in the functioning of the memory of patients with alzheimer disease ( ad ) . although there are several models of wm , the model proposed by baddeley and hitch [ 2 , 3 ] is one of the most used in the neuropsychological research of cognitive aging . according to this model , the wm system includes 4 components : the phonological loop , which holds verbal information ; the visuospatial sketchpad , which holds visual and spatial information ; an episodic buffer that links the two prior components with long - term memory , and a central executive in charge of the attentional control of information . the verbal component of wm has been one of the most studied in ad patients . in huntley and howard 's review of wm and ad , there were more studies showing significant differences in wm verbal tasks between healthy elderly and alzheimer patients in early stages of the disease , or between mild and moderate phases , than studies not showing such differences . however , in relation to visuospatial wm tasks , research has shown that they are clearly affected in alzheimer patients and that this involvement can be found in patients with mild cognitive impairment ( mci ) [ 8 , 9 ] and even in healthy elders . however , there are currently very few studies investigating the effect of gender on verbal and visuospatial wm tasks in patients with ad and mci . regarding ad , heun and kockler found that women , on average , had more difficulties in visuoconstructive skills compared to men . moreover , women had greater deficits in verbal skills ; a difference which was not expected a priori , which according to the authors is probably explained by a pattern of differential neuronal degeneration in men and women . these findings are collected in a meta - analysis where the analysis of 253 publications showed a greater overall deterioration in women with ad compared to men . regarding gender differences in mci , one study reported that men performed better in visuospatial tasks than women , but in verbal tasks , women were better than men . the lack of research on gender differences in mci is still greater than in ad , and to date , there are no definitive studies on this issue . the objective of the present research was to study the effect of gender on the performance of verbal and visuospatial wm tasks in mci and ad patients . it was based on a previous study , in which a greater deterioration in the visuospatial component than in the verbal component of the wm of alzheimer patients was obtained , without finding significant differences between sexes . subsequently , the cognitive deterioration was enlarged with a mci sample and also by including new verbal and visuospatial tasks . the following hypotheses were considered : ( 1 ) the performance in visuospatial tasks will be more affected in women than in men in each of the groups ( ad , mci , and normal aging ) ; ( 2 ) the performance in verbal tasks will be more affected in women in the more advanced stages of cognitive impairment .

background / aimsto date , there are few studies on gender differences in patients with mild cognitive impairment ( mci ) and alzheimer disease ( ad ) . in the present study , the existence of differences between sexes in verbal and visuospatial working memory tasks in the evolution of cognitive and pathological aging was examined.methodninety participants took part in this study : 30 ad , 30 mci , and 30 healthy elderly participants ( 50 % men and 50 % women ) .resultsthere were no significant differences between men and women with ad in visuospatial tasks , whereas these differences were found within the mci group , with the average of men achieving significantly higher results than women . in verbal tasks , there were no differences between sexes for any of the groups.conclusionexecution in visuospatial tasks tends to depend on gender , whereas this does not occur for verbal tasks .

good photochemical properties , chemical stability , and ease of synthesis make coumarins an important class of fluorescent probes for biological studies . in addition to being versatile fluorophores , coumarin chromophores can be used as light - removable protecting groups , so - called caging groups . caged molecules have been extensively applied in the optical control of cellular processes . in particular , the 6-bromo-7-hydroxycoumarinmethyl caging group undergoes fast two - photon photolysis at 740 nm and has been used to optically control neurotransmitters , secondary messengers , and oligonucleotides . two - photon irradiation enables optical activation of biological processes with enhanced tissue penetration of up to 1 mm . moreover , two - photon caging groups can be released with greater precision in three - dimensional space than simple one - photon caging groups . here we report the site - specific incorporation of three coumarin amino acids into proteins via genetic code expansion with unnatural amino acids ( uaas ) to integrate the optical properties of coumarin probes into cellular systems . genetic code expansion requires the addition of orthogonal translational machinery to achieve site - specific uaa incorporation into proteins . recent advances in engineering pyrrolysyl - trna synthetase / trna pairs for the incorporation of sterically demanding amino acids prompted us to synthesize coumarin lysines 13 ( figure 1a ) and to test their incorporation into proteins . the photochemical characteristics of these uaas complement and enhance the properties of caged and fluorescent amino acids that have been genetically encoded in bacterial and mammalian cells . lysines 13 were assembled in three steps from their corresponding coumarin alcohols ( supporting information , scheme s1 ) . briefly , the coumarin alcohols were activated with nitrophenyl chloroformate and coupled to commercially available boc - lysine . a global deprotection under acidic conditions furnished the corresponding coumarin derivatives 13 in good yields . all three coumarin lysines 13 contain identical benzopyrone cores as fluorescent probes . however , subtle substitutions result in a set of coumarin derivatives with unique photochemical properties . introduction of a bromine at the 6-position enables decaging not only with uv ( single photon ) light ( in case of 1 ) , but also near ir ( two - photon ) excitation ( in case of 2 ) . in contrast , extension of the coumarin carbamate linker by a single carbon atom results in coumarin lysine 3 , which does not undergo photolysis and thus represents a stable coumarin amino acid probe . thus , coumarin lysines 1 and 2 can be used as both fluorescent and light - activated probes for optochemical control of protein function using uv or near - ir light , while coumarin lysine 3 may serve as a stable fluorescent probe that does not decage under uv excitation .

the site - specific incorporation of three new coumarin lysine analogues into proteins was achieved in bacterial and mammalian cells using an engineered pyrrolysyl - trna synthetase system . the genetically encoded coumarin lysines were successfully applied as fluorescent cellular probes for protein localization and for the optical activation of protein function . as a proof - of - principle , photoregulation of firefly luciferase was achieved in live cells by caging a key lysine residue , and excellent off to on light - switching ratios were observed . furthermore , two - photon and single - photon optochemical control of egfp maturation was demonstrated , enabling the use of different , potentially orthogonal excitation wavelengths ( 365 , 405 , and 760 nm ) for the sequential activation of protein function in live cells . these results demonstrate that coumarin lysines are a new and valuable class of optical probes that can be used for the investigation and regulation of protein structure , dynamics , function , and localization in live cells . the small size of coumarin , the site - specific incorporation , the application as both a light - activated caging group and as a fluorescent probe , and the broad range of excitation wavelengths are advantageous over other genetically encoded photocontrol systems and provide a precise and multifunctional tool for cellular biology .

metabolic syndrome is a wellestablished risk factor for cardiovascular disease ( cvd ) , including coronary artery disease and heart failure.1 alterations in metabolic risk linked to cvd may develop over decades before clinical cvd.2 , 3 , 4 , 5 prior work in large , communitybased populations have defined a role for early , cumulative changes in blood pressure6 and obesity7 in forecasting risk of subclinical cvd in midlife and beyond . lifecourse perspective on cardiometabolic risk and resulting recommendations to maintain an ideal body weight , diet , physical activity , and lipid profile is critical to decrease incident cvd.8 although obesity has frequently been cited as a central pathogenic factor for cvd risk , emerging literature suggests that cardiometabolic risk may evolve independently from body mass index ( bmi ) .9 , 10 therefore , defining how cardiometabolic risk evolves during early adulthood and how these changes are related to cvd risk independent of cumulative exposure to obesity is critical to differentiate healthy young adult populations from atrisk ones , ultimately to allow for personalized cvd prevention . we investigated individuals from the coronary artery risk development in young adults ( cardia ) study to define transitions in cardiometabolic risk over 25 years independent of obesity . including left ventricular ( lv ) mass ( lvm ) , function , and coronary artery calcium at 25 years after baseline visit among different groups of participants that follow distinct patterns of transition in metabolic risk . we hypothesized that individuals who experienced worsening cardiometabolic risk during young adulthood would exhibit a poorer subclinical cvd profile at midlife , defined by increased myocardial mass , decreased myocardial function , and coronary artery calcification ( cac ) .

backgrounddespite evidence suggesting that early metabolic dysfunction impacts cardiovascular disease risk , current guidelines focus on risk assessments later in life , missing early transitions in metabolic risk that may represent opportunities for averting the development of cardiovascular disease.methods and resultsin 4420 young adults in the coronary artery risk development in young adults ( cardia ) study , we defined a metabolic risk score based on components of the third report of the adult treatment panel 's definition of metabolic syndrome . using latent class trajectory analysis adjusted for sex , race , and timedependent body mass index , we identified 6 distinct metabolic trajectories over time , specified by initial and final risk : lowstable , lowworsening , highstable , intermediateworsening , intermediatestable , and highworsening . overall , individuals gained weight over time in cardia with statistically but not clinically different body mass index trend over time . dysglycemia and dyslipidemia over time were highest in initially high or worsening trajectory groups . divergence in metabolic trajectories occurred in early adulthood ( before age 40 ) , with 2 of 3 individuals experiencing an increase in metabolic risk over time . membership in a higherrisk trajectory ( defined as initially high or worsening over time ) was associated with greater prevalence and extent of coronary artery calcification , left ventricular mass , and decreased left ventricular strain at year 25 . importantly , despite similar rise in body mass index across trajectories over 25 years , coronary artery calcification and left ventricular structure and function more closely tracked risk factor trajectories.conclusionstransitions in metabolic risk occur early in life . obesityrelated metabolic dysfunction is related to subclinical cardiovascular phenotypes independent of evolution in body mass index , including coronary artery calcification and myocardial hypertrophy and dysfunction .

levobupivacaine , ropivacaine , and mepivacaine are aminoamide local anesthetics that belong to the n - alkyl - substituted pipecholyl xylidine family . addition of carbon to the basic structure of the n - alkyl - substituted pipecholyl xylidine increases lipid solubility and potency [ 2 , 3 ] . levobupivacaine , ropivacaine , mepivacaine , and lidocaine produce vasoconstriction both in vivo and in vitro [ 1 , 512 ] . levobupivacaine and ropivacaine are long - acting aminoamide local anesthetics , whereas mepivacaine and lidocaine have an intermediate duration . depending on the vascularity of the injection site , vasoconstriction induced by local anesthetic and the addition of epinephrine may contribute to decreased absorption of local anesthetics into systemic circulation . this leads to prolonged nerve exposure to local anesthetics and reduced plasma levels , in addition to the potency of intrinsic vasoconstriction being partially associated with duration of anesthesia produced by the local anesthetic [ 3 , 14 ] . however , to our knowledge , the physicochemical property of local anesthetics that is primarily responsible for determining the local anesthetic - induced vasoconstriction potency has not yet been identified . therefore , the aims of this in vitro study were to investigate the potency of local anesthetic - induced vasoconstriction and to determine which physicochemical property is principally involved in determining this potency in isolated rat aortic rings .

aminoamide local anesthetics induce vasoconstriction in vivo and in vitro . the goals of this in vitro study were to investigate the potency of local anesthetic - induced vasoconstriction and to identify the physicochemical property ( octanol / buffer partition coefficient , pka , molecular weight , or potency ) of local anesthetics that determines their potency in inducing isolated rat aortic ring contraction . cumulative concentration - response curves to local anesthetics ( levobupivacaine , ropivacaine , lidocaine , and mepivacaine ) were obtained from isolated rat aorta . regression analyses were performed to determine the relationship between the reported physicochemical properties of local anesthetics and the local anesthetic concentration that produced 50 % ( ed50 ) of the local anesthetic - induced maximum vasoconstriction . we determined the order of potency ( ed50 ) of vasoconstriction among local anesthetics to be levobupivacaine > ropivacaine > lidocaine > mepivacaine . the relative importance of the independent variables that affect the vasoconstriction potency is octanol / buffer partition coefficient > potency > pka > molecular weight . the ed50 in endothelium - denuded aorta negatively correlated with the octanol / buffer partition coefficient of local anesthetics ( r2 = 0.9563 ; p < 0.001 ) . the potency of the vasoconstriction in the endothelium - denuded aorta induced by local anesthetics is determined primarily by lipid solubility and , in part , by other physicochemical properties including potency and pka .

in pursuit of large - scale evolutionary questions , biologists are increasingly using massive phylogenetic datasets to reconstruct evergrowing portions of the tree of life . these large phylogenetic trees are commonly inferred using a supermatrix approach , in which multiple datasets are combined and analyzed simultaneously.1 however , assembling and utilizing supermatrices is challenging due to difficulties such as determining homology of molecular sequences , assembling chimeric operational taxonomic units , and managing the amount of missing data . despite these challenges , the phylota browser2 provides a web interface to view all genbank sequences within taxonomic groups clustered into homologs . a different approach is implemented in the programs , such as phlawd3 and ncbiminer,4 which mine genbank for sequence clusters homologous to guide sequences provided by the user . the method implemented in supermatrix constructor ( sumac ) combines elements of both approaches ; the user can perform an exploratory clustering of all genbank sequences within a taxonomic group or provide guide sequences to build homologous sequence clusters in a more targeted manner . furthermore , by calculating supermatrix assessment metrics derived from the concept of phylogenetic decisiveness,5 sumac provides a unique toolkit with which genbank can be repeatedly mined using different settings and the resulting data matrices can be compared . in this article , my objectives are to ( 1 ) introduce the sumac software , ( 2 ) describe a novel metric that assesses the effect of missing data in phylogenetic supermatrices , and ( 3 ) illustrate the use of sumac with a case study .

the amount of phylogenetically informative sequence data in genbank is growing at an exponential rate , and large phylogenetic trees are increasingly used in research . tools are needed to construct phylogenetic sequence matrices from genbank data and evaluate the effect of missing data . supermatrix constructor ( sumac ) is a tool to data - mine genbank , construct phylogenetic supermatrices , and assess the phylogenetic decisiveness of a matrix given the pattern of missing sequence data . sumac calculates a novel metric , missing sequence decisiveness scores ( msds ) , which measures how much each individual missing sequence contributes to the decisiveness of the matrix . msds can be used to compare supermatrices and prioritize the acquisition of new sequence data . sumac constructs supermatrices either through an exploratory clustering of all genbank sequences within a taxonomic group or by using guide sequences to build homologous clusters in a more targeted manner . sumac assembles supermatrices for any taxonomic group recognized in genbank and is optimized to run on multicore computer systems by parallelizing multiple stages of operation . sumac is implemented as a python package that can run as a stand - alone command - line program , or its modules and objects can be incorporated within other programs . sumac is released under the open source gplv3 license and is available at https : //github.com/wf8/sumac .

the ingestion of foreign bodies ( fb ) is a common problem worldwide and affects all ages , however it is particularly important in the pediatric population and in mentally impaired adults , . commonly ingested fb include medication packaging , dentures , coins and fish and chicken bones , amongst others . the typical outcome of fb ingestion is good , with approximately 80 % of ingested material passed spontaneously through the gastrointestinal tract without requiring any invasive medical intervention , 20 % of patients requiring an endoscopic removal , and just 1 % of ingested material will cause perforation requiring surgical treatment , , . it is important to mention that serious complications can occur due to ingested fb , such as ; obstruction , ulcer formation , gastrointestinal ( gi ) bleeding , gi perforation , tracheoesophageal fistula formation and bacteremia , amongst others , , , , , . when this fb become impacted , they often do so at sites of physiologic narrowing , such as the pharynx , upper and lower esophageal sphincter , stomach , duodenum and ileum . the most usual site is the ileum and the most common complication is an intra - abdominal abscess . we present a case of extraluminal migration to the spleen generating splenic rupture and hemoperitoneum which presented as acute abdominal pain .

highlightsforeign body ingestion is a relatively common and benign condition ; some serious complications , however , can arise.approximately 1 % of all ingested fb will cause perforation requiring surgical treatment.sharp fb , such as fish bones , chicken bones and needles , are more prone to migrate outside the gastrointestinal lumen if they are not removed early.the patient reported here is the first one in the literature to present a splenic rupture due to extra - luminal migration of an ingested fish bone through the splenic flexure of the colon .

amyloidosis is rare disease of difficult diagnosis that occurs due accumulation of amyloid substance localized or systemic . on the localized form a single organ is affected , and the most common sites are lungs , brain , and skin . on the systemic form , many organs may be affected , leading to significant morbidity and mortality . once it is diagnosed in the oral cavity , the patient must be supervised regularly to control potential systemic complications of the disease . some authors attest that localized form has a better prognosis , in particular when the head and neck area is affected . the subtypes are currently named according to the specific protein that is deposited , using the prefix a for amyloid , followed by letters that indicate the protein . amyloid light chain amyloidosis is the primary systemic form and one of the most common subtypes , usually associated with plasma cell dyscrasia and multiple myeloma ; the most common affected organs are kidneys , liver , heart , and nerves . amyloid a or secondary systemic amyloidosis , is usually associated with other chronic infectious or inflammatory diseases , such as osteomyelitis , tuberculosis , rheumatoid arthritis , and crohn 's disease . on the head and neck area , amyloidosis of the oral cavity is less frequent , and usually appears as multiple soft nodules on the mucosa , and can be associated to a localized disease . when tongue is affected , it can result in macroglossia and be associated to systemic form . after oral amyloidosis diagnosis , systemic involvement should be evaluated .

amyloidosis is a rare disease of difficult diagnosis that occurs due accumulation of amyloid substance localized or systemic . the oral cavity is an unusual site and can be related to both localized and systemic forms and for that reason a full investigation is necessary to determine the extent of the disease . this study reports a case of a 58-year - old melanoderm male patient referred to the department of oral and maxillofacial surgery with white plaques on the tongue and multiple nodules in the region of the buccal mucosa and labial commissure , with 6 months of evolution and painful symptoms . an incisional biopsy was performed on both sites and histological examination indicated the presence of eosinophilic amorphous material within the connective tissue , positive for crystal violet staining , consistent with amyloidosis . at the present time , there is no consensus on the management of local amyloidosis . surgical treatment of localized forms is indicated in some cases to reduce the functional prejudice . moreover , follow - up is mandatory , both to manage recurrences and to monitor the possible evolution of the disease to the systemic form .

gender bias in different types of congenital defects is well know . a significant bias in sex ratio has been documented for congenital heart disease with several lesions occurring more frequently in males or in females.12 this difference may be related to differences in hormonal constitution . it has been proposed that foetal sex is partially determined by hormone levels of both parents around the time of conception has put forward35 but it is unclear whether such hormonal variations may also be responsible for sex - biasing of congenital anomalies . a literature search shows that transposition of the great arteries has been shown to have a gender bias ( table 1 ) but no explanation has been put forward in order to account for this observation . sex ratio of transposition of the great arteries in published reports in this study , we compare gender of patients with transposition with controls . in the general population , females tend to be smaller than male and in this study , we also attempt to relate gender ratios of patients with transposition with birth weight , maternal age and parental occupation .

a significant bias in sex ratio has been documented for several congenital cardiac malformations . transposition of the great arteries has been associated with a such a bias but no explanation has been proposed for this bias . we evaluated 95 isolated livebirths with transposition of the great arteries cases referred to the sicilian registry of congenital malformations from 1991 to 1998 . we found a statistically significant male bias of 2.8 and this was significantly associated with both maternal and paternal occupational exposure to agricultural chemicals for male infants with transposition , but not for female infants . this study raises new questions about the possible role played by environmental chemicals in relationship to birth defects and to sex ratio imbalance .

development of novel biomaterials for drug delivery which forms a part of the so - called novel drug delivery systems has always been exhilarating . using nanotechnology , it is possible to tailor materials at the atomic and molecular scales to meet the desired outcomes . the necessity of elucidating the mechanical behavior of those materials which would be subjected to load or stress during its application is inevitable . topical gels are intended to be applied with pressure or stress for uniform application on the skin or any other target area . in this regard , the evaluation of the mechanical behavior of nanodroplet gel ( ndg ) , equipped as a novel biomaterial for topical delivery of eugenol against inflammation , is extremely significant . eugenol ndg is an effective delivery system since topical gels are an excellent choice for anti - inflammatory agents . in this work , we have studied the microstructure - strength relationships of the topical ndgs when subjected to shear . use of rheological parameters to optimize topical gels have been carried out extensively over the past years and has been considered of utmost importance . rheological characterization is useful in studying the microstructural environment or mobility which is responsible for drug diffusion and compatibility . flow curve measurements have been carried out in the present work for this purpose to study the effect of eugenol concentration on the mechanical behavior of the ndg . rheological modeling was also done in order to relegate the obscurity in flow and deformation behavior of the ndgs .

introduction : development of novel biomaterials for drug delivery which forms a part of the so called novel drug delivery systems has always been exhilarating . mechanical evaluation of polymer based topical gels , which would be subjected to load or stress during its application , is inevitable.methods : rheological characterization was done by studying viscosity and yielding . rheological modeling was also carried out.results : the viscosity and yield stress were inversely dependent on the eugenol concentration . the gels followed herschel bulkley and bingham rheological models.conclusion : nanodroplets are colloidal systems and the microstructural changes in the carbopol based nanodroplet gels were unveiled using rheometry .

extracorporeal shockwave lithotripsy ( eswl ) has been considered as a first - line treatment for ureteral stones for the past 20 years . the success rate of eswl in the treatment of ureteral stones is about 80 to 90 % . some patients whose stones may not be fragmented by repeated eswl will require other surgical interventions . the success rate is influenced by stone factors ( stone size , location , composition , degree of obstruction ) , clinical factors ( symptom severity , patient 's expectations , associated infection , solitary kidney , abnormal ureteral anatomy ) , and technical factors ( available equipment , cost ) . however , it is not certain which factors influence the outcome of eswl [ 5 - 8 ] . recently , several studies have reported the incidence of secondary signs and their influence in eswl treatment [ 9 - 12 ] . however thus , we investigated the predictive factors of eswl outcome , including secondary signs , in the treatment of ureteral stones .

purposeextracorporeal shock wave lithotripsy ( eswl ) has shown successful outcomes for ureteral stones . we investigated predictive factors for failure of eswl for treating ureteral stones.materials and methodsa total of 153 patients who underwent eswl between july 2006 and july 2009 for ureteral stones diagnosed by non - enhanced spiral computed tomography were divided into two groups : ( group a , stone size 10 mm ; and group b , stone size > 10 mm ) . the failure was defined as remnant stones > 4 mm . we assessed age , sex , body mass index , stone size , laterality , location , skin - to - stone distance ( ssd ) , hounsfield unit , and the presence of secondary signs ( hydronephrosis , renal enlargement , perinephric fat stranding , and tissue rim sign ) . we analyzed predictive factors by using logistic regression in each group.resultsthe success rates were 90.2 % and 68.6 % in group a and b , respectively . in the univariate analysis of each group , stone size , ssd , and all secondary signs showed statistically significant differences in terms of the outcome of eswl ( p < 0.05 ) . in the multivariate logistic regression , stone size ( odds ratio [ or ] , 50.005 ; 95 % confidence interval [ ci ] , 6.207 to 402.852 ) was an independent predictive factor in group a. the presence of perinephric fat standing ( or , 77.634 ; 95 % ci , 1.349 to 446.558 ) and stone size ( or , 19.718 ; 95 % ci , 1.600 to 243.005 ) were independent predictive factors in group b.conclusionsstone size is an independent predictive factor influencing failure of eswl for treating ureteral stones . in larger ureteral stones ( > 10 mm ) , the presence of perinephric fat stranding is also an independent predictive factor .

several randomized trials have demonstrated that breast - conserving surgery followed by radiation therapy , which is called breast - conserving therapy ( bct ) , is as effective as mastectomy and should be a standard treatment for early - stage breast cancer . recently , there has been an increase in reports of angiosarcoma ( as ) after bct [ 2 , 3 , 4 ] . lymphedema - associated cutaneous as , so - called stewart - treves syndrome , was first described in 1948 by stewart and treves . herein , we report a case of as which developed after bct and a case of stewart - treves syndrome with a focus on lymphedema .

several randomized trials have shown that breast - conserving therapy ( bct ) is as effective as mastectomy and should be a standard treatment for early - stage breast cancer . recently , there has been an increase in reports of angiosarcoma ( as ) after bct . herein , we report a case of as which developed after bct and a case of stewart - treves syndrome with a focus on lymphedema . chronic lymphedema is the primary risk factor for as , which was first described in 1948 by stewart and treves [ cancer 1948 ; 1:6481 ] . radiation therapy secondarily tends to induce the development of as , since radiation therapy induces fibrosis and proliferation of lymphatic vessels via cytokines such as vascular endothelial growth factor , which is followed by subclinical chronic edema . it is suggested that axillary lymph node dissection predisposes patients to the development of as , since it is closely associated with lymphedema . breast surgeons and radiologists should be aware of skin changes in order to improve the early detection of as during the follow - up of patients who have undergone bct , and especially those treated with axillary lymph node dissection .

hemoglobin a1c ( hba1c ) is the gold standard for the measurement of long - range glycemic control in patients with diabetes mellitus . many studies have reported diabetes mellitus to be a risk factor in patients with alcoholic liver disease and nonalcoholic fatty liver disease ( nafld ) for the development of fibrosis and fibrosis progression [ 13 ] . in the united states , 2 % of adult americans ( 5.3 million ) are infected with hepatitis b or c and an estimated 31 % or more with nafld [ 5 , 6 ] . glucose intolerance is seen in up to 80 % of patients with cld , and frank diabetes is present in 3060 % [ 7 , 8 ] . depending on its etiology , cld has a significant impact on hepatic glucose metabolism . among patients with cld , these factors can contribute to longer or shorter red blood cell ( rbc ) survival and can lead to alteration of the hba1c . factors such as nutritional anemia can lead to increased rbc survival and falsely elevated hba1c levels , whereas bleeding and hemolysis can lower rbc survival time and falsely lower hba1c values . very few studies are dedicated to systematically evaluating the accuracy of hba1c in cld patients . in a screening of 20,000 measurements of hba1c , of nine abnormally low results , six were the result of cirrhosis , two resulted from hematological neoplasms with anemia , and one was due to hemoglobin f . in a small case series ( 15 patients with compensated cirrhosis and 20 patients with chronic hepatitis ) , 40 % of cirrhotic patients with diabetes had hba1c levels below reference range for patients without diabetes . methodist university hospital transplant institute has been systematically screening its liver transplantation candidates for diabetes with hba1c levels . measuring hba1c is the gold standard for monitoring blood glucose control in diabetes and can now also be used to diagnose diabetes when its results are 6.5 % . the study objective is to look at glucose and hba1c levels in cirrhotic patients and determine if hba1c levels are a reliable predictor of glycemic control in patients who are presented for liver transplantation at methodist university hospital transplant institute between january 1 , 2006 , and january 1 , 2014 .

introduction . aim of this study is to determine if hba1c levels are a reliable predictor of glycemic control in patients with decompensated cirrhosis . methods . 200 unique patients referred for liver transplantation at university of tennessee / methodist university transplant institute with a hba1c result were included . three glucose levels prior to the measured a1c ( ma1c ) were input into an hba1c calculator from the american diabetes association website to determine the calculated a1c ( ca1c ) . the differences between ma1c and ca1c levels were computed . patients were divided into three groups : group a , difference of < 0.5 ; group b , 0.511.5 ; and group c , > 1.5 . results . 97 ( 49 % ) patients had hemoglobin a1c of less than 5 % . discordance between calculated and measured hba1c of > 0.5 % was seen in 47 % ( n = 94 ) . higher level of discordance of greater than > 1.5 was in 12 % of patients ( n = 24 ) . hemoglobin was an independent predictor for higher discordance ( odds ratio 0.77 95 % , ci 0.600.99 , and p value 0.04 ) . hba1c was an independent predictor of occurrence of hcc ( or 2.69 955 , ci 1.385.43 , and p value 0.008 ) . conclusion . hba1c is not a reliable predictor of glycemic control in patients with decompensated cirrhosis , especially in those with severe anemia .

complete surgical resection is the only curative treatment for pdac . however , survival rates after curative resection are still less than 20 % [ 2 , 3 ] . local recurrence in the remnant pancreas , multiple liver metastases , and peritoneal dissemination frequently occur even after curative resection . the chance of repeated pancreatectomy for pdac developing in the remnant pancreas is quite low . however , recent advancement of chemotherapy improves survival rates and may lead to an increase in the chance of repeated pancreatectomy . we report two patients with repeated pancreatectomy for pdac developing in the remnant pancreas after pylorus - preserving pancreatoduodenectomy ( pppd ) for invasive pdac .

repeated pancreatectomy for pancreatic carcinoma is extremely rare . we report two such patients who underwent pancreatectomy for carcinoma developing in the pancreatic remnant after pylorus - preserving pancreatoduodenectomy ( pppd ) for invasive pancreatic ductal carcinoma . one patient underwent pppd for invasive pancreatic ductal carcinoma and received adjuvant chemotherapy . follow - up computed tomography ( ct ) demonstrated a low - density mass in the remnant pancreas , which was diagnosed as a carcinoma by endoscopic ultrasound - guided fine - needle aspiration cytology 5 years 10 months after pppd . she underwent curative resection of the remnant pancreas and is alive and well 13 months after the second operation . the other patient underwent pppd for invasive pancreatic ductal carcinoma . follow - up ct showed a low - density mass in the remnant pancreas after 2 years 11 months . he received systemic chemotherapy with s-1 for 3 months . the tumor shrank , and the patient underwent curative resection of the remnant pancreas 3 years 1 month after the initial operation . repeated pancreatectomy may provide a chance of long survival for patients with carcinoma developing in the remnant pancreas after pancreatectomy if the recurrence occurring at long term is limited to the remnant pancreas .

it is clear that while oxygen is essential for life in order to produce chemical energy in the form of atp , paradoxically , the byproduct of its metabolism generates multiple reactive oxygen species ( ros ) that are associated with cellular toxicity . specifically , in regards to neurodegeneration , there is substantial evidence that ros are a major component of diseases including alzheimer 's , parkinson 's , and amyotrophic lateral sclerosis [ 14 ] . while clinical trials aimed at decreasing the burden of oxidative stress have not clearly demonstrated effectiveness , genetic research has found that high levels of antioxidant enzymes prolong life and decrease pathology . in addition , animal models have also indicated that oxidative stress is an important and consistent characteristic of many forms of neurodegeneration . one particular group of proteins that appear to be intimately involved in the neurodegenerative processes is the cysteine - dependent proteins . this group includes various proteases , antioxidant enzymes , kinases , phosphatases , and other types of enzymes as well as other nonenzymatic proteins such as those that use cysteine as a structural component rather than as part of a catalytic site . more research will be needed to firmly establish the extent to which oxidative stress is causal in these diseases , but based on current understanding , therapies to reverse the oxidant - induced modifications of proteins , lipids or , dna are expected to be beneficial . this paper will highlight some selected , yet significant cysteine - dependent enzymatic systems that rely on a proper redox environment for their activity and provide evidence for their redox control in neurodegenerative disease .

evidence of increased oxidative stress has been found in various neurodegenerative diseases and conditions . while it is unclear whether oxidative stress is a cause or effect , protein , lipid , and dna have all been found to be susceptible to oxidant - induced modifications that alter their function . results of clinical trials based on the oxidative - stress theory have been mixed , though data continues to indicate that prevention of high levels of oxidative stress is beneficial for health and increases longevity . due to the highly reactive nature of the sulfhydryl group , the focus of this paper is on the impact of oxidative stress on cysteine - dependent enzymes and how oxidative stress may contribute to neurological dysfunction through this selected group of proteins .

approximately 43,000 new cases of head and neck cancer ( hnc ) are diagnosed each year in the united states . despite changes in treatment regimens ( i.e . , organ preservation protocols and the addition of chemotherapy to primary radiation treatment ) , setting , there has been an increasing interest in trying to understand and maximize patient quality of life ( qol ) . quality of life is a subjective perception by the patient that includes physical , emotional , and social well - being . it is well - established that different subsites within the head and neck have different perceived qol following treatment ; patients with oropharyngeal carcinoma tend to report worse quality of life than do other head and neck cancer patients and have poorer functional outcomes [ 1 , 2 ] . terrell et al . identified a number of factors that have a negative impact on qol including need for gastrostomy and tracheostomy tubes , comorbid medical conditions , addition of chemotherapy to treatment , and need for a neck dissection . a variety of mechanisms have been proposed in the literature to improve patient quality of life , including educational programs , support group meetings , biofeedback therapy , and cognitive behavioral therapy . however , the impact of these interventions has not been extensively studied in head and neck cancer patients . support group therapy is a well - established means of psychosocial intervention in the cancer literature . however , only a handful of studies regarding support group therapy in the head and neck population exist , and the results are mixed [ 4 , 5 ] . the current study was designed to compare hnc patients who participate in a support group to those who do not participate in a support group . we hypothesized that hnc support group patients would do better than their peers who do not participate and that both groups would have lower qol scores than the us population .

objective . to compare quality of life in head and neck cancer ( hnc ) patients following treatment . methods . the short form-36 version 2 ( sf-36v2 ) was utilized to measure patient quality of life . results . for all 8 parameters measured by the sf-36v2 , hnc patients had lower mean scores than the us population means . support group patients had significantly worse scores than us population norms in role - physical , social functioning , and role - emotional . there were no significant differences between support group and control patients for the 8 parameters measured by the sf-36v2 . conclusions . hnc patients report significantly worse quality of life than us population norms in several physical and emotional areas . our study did not demonstrate improved quality of life for support group patients . the increased incidence of oropharyngeal cancer and chemotherapy treatment in the support group patients in our study were factors which were likely to have lowered the overall scores in these patients .

acute myeloid leukemia ( aml ) is a rare disease afflicting annually 34 persons per 100,000 individuals . with a median age at diagnosis of 67 years , this disease is far more common in the elderly . in this age group , aml has a particularly dismal outcome with less than 5 % of the patients being alive 5 years after the diagnosis , as compared to 40 % in the young , . considering that individuals aged 65 in the western world are expected to survive approximately another 20 years , and even those aged 80 three additional years , aml has a devastating impact on the survival of this age group . the reasons for the poor outcomes in the older adults are both patient- and disease - related . advanced age is often accompanied by frailty and comorbidities , which have an important impact on the tolerance these patients have to intensive treatment modalities . in addition , the lower rates of complete remission ( cr ) in the elderly ( 4050 % vs 6070 % in the young ) and the short duration seen in those who are eligible for treatment , point towards a different disease biology in this age group . from a clinical viewpoint , it is far more frequent for elderly patients to have received previous cytotoxic treatment or radiotherapy or to have antecedent hematologic diseases , such as myelodysplastic ( mds ) or myeloproliferative neoplasms . in addition to these clinical features , the cytogenetic profile of elderly patients with aml also differs from that of younger patients , presenting a greater incidence of multiple chromosomal abnormalities . the introduction of new potent sequencing technologies has shed considerable light on the molecular mechanisms of aml pathophysiology , and further reinforced the observation that aml in the elderly is biologically distinct . thus , mutation screening has identified mutations in genes coding for epigenetic regulators , such as tet2 , dmnt3a , idh1/2 , asxl1 and ezh2 , kinases and cell cycle regulators , such as tp53 , npm1 and flt3 and transcription factors , such as runx1 and cebpa , and showed that the cytogenetic and mutational profile of aml in the older adults patients is significantly different from that of younger patients . the methylation patterns seen in them resemble more closely those seen in mds . these unique features of aml in the elderly population urge a fresh approach to these patients .

aml is an aggressive hematological malignancy with highest incidence in the older adults . the adverse features of aml in the elderly , and the frailties and comorbidities frequently present in them , make their management a particularly difficult therapeutic challenge . in this context , it is important to assess carefully patient- as well as disease - associated prognostic features with validated tools . the fittest patients should be considered for curative therapy , such as bone marrow transplantation , whereas low intensity options may be more appropriate for frail patients . here we review how to assess patients with elderly aml and the treatments options available for them .

elderly patients with severe aortic valve stenosis and high operative risk can be treated by transcatheter aortic valve replacement ( tavr ) with equivalent outcome to surgical aortic valve replacement ( savr ) . aortic valve stenosis is the most common valve disease in elderly patients , and tavr is increasingly being performed . according to tavr guidelines , pre - procedural planning requires a contrast - computed tomography ( ct ) from thorax to iliofemoral vessels . due to the higher prevalence of tumours in elderly patients , more potential malignant incidental findings ( pmifs ) if a radiologic pmif appears , the clinician must interpret its significance and the consequence for further treatment . on the one hand , potential malignancies could be diagnosed and treated , but conversely unnecessary diagnostic workup of possibly benign findings could increase costs , threaten patients by invasive diagnostics , and lead to increased anxiety . furthermore , a pmif with unclear significance could influence the decision of the heart team since tavr guidelines do not recommend intervention in patients with an estimated survival below 1 year . the diagnostic workup triggered by the pmif could delay intervention on the aortic valve and thus could raise mortality in patients with severe aortic valve stenosis , and the burden of symptoms of aortic valve stenosis limits quality of life of patients when an intervention with a fast recovery could be performed . it is unknown whether the presence of suspicious pmif with an estimated patient survival of > 1 year correlates with mortality in elderly patients planned for aortic valve replacement . therefore , the purpose of this systematic retrospective observational study is to evaluate the prevalence and relevance of potentially malignant unsuspected pmif with respect to treatment decision , time to treatment , and 2-year survival .

aimsrecently , transcatheter aortic valve replacement ( tavr ) has evolved as the standard treatment in patients with inoperable aortic valve stenosis . according to tavr guidelines , body computed tomography ( ct ) is recommended for pre - procedural planning . due to the advanced age of these patients , multiple radiological potentially malignant incidental findings ( pmifs ) appear in this cohort . it is unknown how pmifs influence the decision by the heart team to intervene and the mortality.methods and resultswe evaluated in a retrospective single - centre observational study 414 participants screened for tavr with dual - source ct between october 2010 and december 2012 . pmifs are common and appeared in 18.7 % of all patients screened for tavr . the decision to intervene by tavr or surgical aortic valve replacement ( savr ) was made by an interdisciplinary heart team and the role of pmif in decision - making and time to treatment with tavr or savr was analysed , retrospectively . the appearance of a pmif vs. no pmif did not significantly influence therapeutic decisions [ odds ratio ( or ) 1.14 ; p = 0.835 ] or time to treatment ( 91 152 vs. 61 109 days , respectively ) . several findings , which are highly suspicious for malignancy , were less likely associated with invasive treatment ( or 0.207 ; p = 0.046 ) . patient survival was evaluated for at least 2 years until january 2014 . two - year survival of patients after tavr or savr , treated according to the heart team decision , was 75 % and independent from the presence of a non - severe ( p = 0.923 ) or severe ( p = 0.823 ) pmif.conclusionthe study indicates that frequently occurring radiologic pmif did not influence 2-year survival after a decision to intervene was made by an interdisciplinary heart team .

yoga is an ancient indian science as well as the way of life , which includes practice of specific posture ( asana ) , regulated breathing ( pranayama ) etc . breath is the dynamic bridge between body and mind and pranayama ( breathing techniques ) is one of the most important yogic practices , which can produce different physiological responses in healthy individuals . pranayama is an art of prolongation and control of breath , which helps to bring the conscious awareness in breathing ; to reshape breathing habits and patterns . the persistent conditioning of breathing pattern of pranayama increases the pulmonary function in healthy individuals . though , there are various pranayamas in yogic practices the bhramari pranayama and om chanting were used as expiratory exercises for bronchial asthma . bhramari pranayama ( humming bee breath ) is one of the yogic practice , which involves sitting in sukhasana ( ease pose ) the subject should inhale through both nostrils and while exhaling produce sound of female humming bee . combination of a , u ( o ) and m , i.e . , om is one of the fundamental symbols used in the yoga tradition , which symbolizes the three states of consciousness i.e . , waking state , dream state and deep sleep respectively . though , the sound of om represents the primal vibration and the om chanting is an important exhalation exercise it was not included in regular breathing exercises to improve the pulmonary function in bronchial asthma . there have been many studies on yoga and its effects on physical functions , autonomic variables , stress etc . , though the popularity of pranayama is increasing in the past few years there is lack of studies on the pranayama especially on bhramari pranayama and om chanting on pulmonary function which had been used as expiratory exercises for bronchial asthma . to the best of our knowledge there is no previous randomized control trail in combination of bhramari pranayama and om chanting on pulmonary functions made us to select this present study with the aims and objective to evaluate the effect of bhramari pranayama and om chanting on pulmonary function in healthy individuals .

background / aim : yoga is an ancient indian science as well as the way of life . pranayama is a part of yoga , which improves pulmonary function in combination of many pranayama , but the aim of our study is to evaluate the effect of only bhramari pranayama and om chanting on pulmonary function in healthy individuals.materials and methods : a total of 82 subjects were randomized into the study group ( sg ) ( n = 41 ) and control group ( cg ) ( n = 41 ) . baseline assessment was performed before intervention for both groups . sg practiced bhramari pranayama and om chanting for the duration of 10 min ( 5 min for each practice ) /day for the period of 6 days / week for 2 weeks and cg did not practice so . after intervention post - assessment was performed for sg ( n = 40 ) and cg ( n = 39 ) . statistical analysis was performed by independent samples t - test and student 's paired t - test with the use of statistical package for the social sciences version 16 ( 2007 , usa ) .results : the result showed a significant improvement in peak expiratory flow ( pef ) , forced expiratory flow ( fef ) 25 % and maximal voluntary ventilation ( mvv ) along with a significant reduction in weight in sg compared with cg in independent samples t - test . significant improvement in slow vital capacity ( svc ) , forced expired volume in 1 s ( fev1 ) along with pef , fef25 % and mvv ; significant reduction in weight and body mass index were observed in sg unlike in cg in student 's paired t - test . no significant changes were found in forced vital capacity , fev1 /svc and fef50 % , between and within the group analysis of sg and cg.conclusion : bhramari pranayama and om chanting are effective in improving pulmonary function in healthy individuals .

one major goal of proteomic profiling is an accurate quantitation of proteins in samples with high complexity and high dynamic range of protein concentrations , such as body fluids ( serum , plasma , csf , etc ) . because high confidence peptide / protein identification and at the same time high confidence quantitation is a highly challenging task , multiple analytical approaches have been developed based on separation of proteins in - gel ( 2de dige ) and/or gel - free platform utilizing various methods of metabolic or chemical labeling . each quantitative platform , including isobaric tags for relative and absolute quantitation ( itraq ) , has strengths and limitations that have been experimentally compared . itraq was developed in the early 2000s to be applied for the multidimensional protein identification technology ( mudpit ) approach in which proteins are fragmented with trypsin or other proteolytic enzyme and subsequently chemically labeled with isobaric tags . this platform became a central technology in modern proteomics research ; it is being widely used in all areas of research with great utility . as much as this approach seems to be straightforward , many aspects of this proteomic platform add sources of variability , and these limit the confidence in the output of protein identification and quantitation . the variability is introduced in multiple steps of sample preparation , efficiency of chemical tagging , performance of instrumentation , and method of acquisition used , as well as software ( algorithms ) and thresholds defined for database searches . importantly , 4-plex and 8-plex tags provide overlapping mass of reporter ions ; however , their balance groups are different , which has been postulated to have an impact on yield of fragmentation in collision induced dissociation ( cid ) leading to bias in quantitation . nevertheless , itraq - based quantitation is an attractive method in global proteomic quantitation . first , it can be used after processing of any sample , e.g . , cell lysates and proteins obtained from organelles , and as such is not limited to only those systems that can accommodate incorporation of stable isotopes during cell culture . third , software for protein identification and quantitation is fairly well developed and tested in numerous experimental settings . recently pichler and co - workers found that peptide labeling with 4-plex tags yields higher identification rates compared to 8-plex tags . this conclusion is of concern since experimental designs using 8-plex allow a much greater level and ease of comparison . for example , a study of one control and seven experimental conditions can be performed in one 8-plex experiment but would require at least three 4-plex experiments ( running the control and up to three experimental samples in each ) . this increases the amount of control sample needed , labor and supplies , and chromatography and mass spectrometry time and likely introduces a source of variability . the goal of this study was to compare experimental ratios of highly complex samples tagged with 4-plex versus 8-plex reagents in controlled ratios . we used proteinpilot 4.0 software for data analysis , which is associated with the absciex 4800 maldi - tof / tof mass spectrometer .

methods for isobaric tagging of peptides , itraq or tmt , are commonly used platforms in mass spectrometry based quantitative proteomics . these two methods are very often used to quantitate proteins in complex samples , e.g . , serum / plasma or csf supporting biomarker discovery studies . the success of these studies depends on multiple factors , including the accuracy of ratios of reporter ions reflecting quantitative changes of proteins . because reporter ions are generated during peptide fragmentation , the differences of chemical structure of itraq balance groups may have an effect on how efficiently these groups are fragmented and thus how differences in protein expression will be measured . because 4-plex and 8-plex itraq reagents do have different structures of balanced groups , it has been postulated that indeed differences in protein identification and quantitation exist between these two reagents . in this study we controlled the ratios of tagged samples and compared quantitation of proteins using 4-plex versus 8-plex reagents in the context of a highly complex sample of human plasma using absciex 4800 maldi - tof / tof mass spectrometer and proteinpilot 4.0 software . we observed that 8-plex tagging provides more consistent ratios than 4-plex without compromising protein identification , thus allowing investigation of eight experimental conditions in one analytical experiment .

syndrome of inappropriate secretion of antidiuretic hormone ( siadh ) is one of the most common causes of hyponatremia in hospitalized patients , with a prevalence as high as 35 % . it is characterized by the impairment of urinary dilution in the absence of any renal disease or any identifiable nonosmotic stimulus that induces antidiuretic hormone ( adh ) release . although siadh has been known to be associated with different pulmonary infections , only rarely has it been reported with influenza . we present a case of hyponatremia associated with influenza , which was subsequently diagnosed as siadh .

context : syndrome of inappropriate secretion of antidiuretic hormone ( siadh ) is a common cause of hyponatremia . although it has been associated with different pulmonary infections , there have been only few case reports describing the association of siadh with influenza.case report : we report a case of siadh in a patient with influenza who was successfully treated with fluid restriction.conclusion : it is essential for clinicians to be aware of the association between influenza and siadh .

imatinib , the first oral bcr - abl and c - kit tyrosine kinases inhibitor approved for cancer , is involved in several drug drug interactions ( ddis ) . according to the summary of product characteristics ( smpc ) of glivec ( novartis europharm limited , camberley , uk ) , cytochrome p-450 ( cyp450 ) the smpc indicates that caution should be taken when administering glivec with inhibitors of the cyp3a4 family or concomitant use of rifampicin or other strong cyp3a4 inducers and imatinib should be avoided . in vitro , imatinib is also a moderate competitive inhibitor of cyp2c9 , 2d6 , and 3a4/5 . this tyrosine kinases inhibitor has also been shown , in vitro and in vivo , to be a substrate for the drug - efflux transporter p - glycoprotein . haouala and colleagues reviewed all the ddis with imatinib reported in the literature or predicted from theoretical considerations . bowlin and colleagues specifically investigated ddis with imatinib that could potentially diminish the efficacy or raise the toxicity level of imatinib . thus , we performed 2 observational studies to identify : ( 1 ) drugs most frequently dispensed simultaneously with imatinib through the french health insurance reimbursement database sniiram ( systme national dinformation inter - rgimes de lassurance maladie ) and then ( 2 ) adverse drug reactions ( adrs ) related to ddis involving imatinib using the french pharmacovigilance database ( fpvd ) .

abstractmany patients treated with imatinib , used in cancer treatment , are using several other drugs that could interact with imatinib . our aim was to study all the drug drug interactions ( ddis ) observed in patients treated with imatinib.we performed 2 observational studies , between the 1st january 2012 and the 31st august 2015 in the midi - pyrnes area ( south western france ) , using the french health insurance reimbursement database and then the french pharmacovigilance database ( fpvd ) .a total of 544 patients received at least 1 reimbursement for imatinib . among them , 486 ( 89.3 % ) had at least 1 drug that could potentially interact with imatinib . paracetamol was the most frequent drug involved ( 77.4 % ) . proton pump inhibitors , dexamethasone and levothyroxine , were found in > 10 % of patients . in the fpvd , among a total of 25 reports of adrs with imatinib recorded in the midi - pyrnes area , 10 ( 40 % ) had potential ddis with imatinib . imatinib was most frequently prescribed by hospital physicians and drugs interacting with imatinib , by general practitioners.our study showed that at least 40 % of the patients treated with imatinib were at risk of ddis and that all prescribers must be cautious with ddis in patients treated with imatinib . during imatinib treatment , we particularly recommend to limit the dose of paracetamol at 1300 mg per day , to avoid the use of dexamethasone , and to double the dose of levothyroxine .

fasciola hepatica ( f. hepatica ) is a foodborne trematode , which is occasionally observed in general practice . f. hepatica was described as the first foodborne trematode that can occur worldwide in the areas where sheep and cattle are raised . humans are its accidental hosts . after ingestion of contaminated water or aquatic plants containing metacercariae , juveniles penetrate the intestinal wall and migrate through the peritoneal cavity to the liver and then enter the bile ducts , and rarely to the gallbladder , where they mature and release eggs . f. hepatica in acute phase can cause dyspepsia , fever , right upper quadrant pain , anorexia , urticaria , respiratory symptoms , jaundice , eosinophilia , and abnormal liver biochemical tests . in chronic phase , f. hepatica can cause biliary colic , intermittent jaundice , fatty food intolerance , cholangitis , and cholecystitis . the diagnosis of f. hepatica is based on the combination of the clinical and radiologic findings , supported by serology . for f. hepatica infection treatment , a single dose of 10 mg / kg triclabendazole is recommended . human s behavioral change can prevent the f. hepatica infection transmission . although the number of reports on humans infected with f. hepatica has increased significantly in recent decades ; the removal of living f. hepatica from biliary tract is rare . here we report a case of a 67-year - old woman who presented with acute cholangitis and three living f. hepatica removed with basket via endoscopic retrograde cholangiopancreatography ( ercp ) .

fasciola hepatica ( f. hepatica ) as a foodborne trematode can occasionally cause hepatobiliary diseases . we report a 67-year - old woman who was referred to our center because of the diagnosis of cholangitis . she was a resident of mountainous area with the history of unsafe water and contaminated vegetables . endoscopic retrograde cholangiopancreatography ( ercp ) was performed as a diagnostic and therapeutic modality for her . three living f. hepatica was removed from biliary tract with a basket via ercp . clinical and laboratory condition of the patient improved after therapy of antibiotics and triclabendazole .

raynaud s syndrome , first described in 1862 , affects between 3 % and 10 % of the population without preference for a certain sex or ethnicity.1,2 it is characterized by alterations in peripheral adrenoceptor activity resulting in vasoconstriction and ischemia of the extremities in response to low temperature or emotional stress.3 this ischemia can cause pain and necrosis of tissues , ultimately leading to amputation if left untreated . traditionally , most patients can be managed with avoidance of cold exposure and emotional stress . however , when conservative management is inadequate , a number of pharmacological , surgical , and behavioral therapies have been used . among a number of medical interventions , other medications such as alpha 1-adrenergic blockers , angiotensin - converting enzyme inhibitors , angiotensin ii receptor blockers , serotonin reuptake inhibitors , nitrates , and phosphodiesterase inhibitors have recently been evaluated in the treatment of raynaud s syndrome.3 for patients who fail to respond to medical treatments , single peripheral nerve blocks have been shown to control the symptoms of ischemia due to raynaud s syndrome.3 another technique that has proven effective in refractory cases of raynaud s syndrome is surgical sympathectomy . in the case presented by greengrass et al,4 regional anesthesia was demonstrated to provide relief for some patients until the removal of the catheter , whereupon a relapse of symptoms occurred and a sympathectomy was performed thereafter .

raynaud s syndrome has been treated medically and invasively , sometimes with regional anesthesia leading up to sympathectomy . we demonstrate that regional anesthesia was in this case a useful technique that can allow some patients to find temporary but significant relief from symptoms of raynaud s syndrome exacerbation . we present a 43-year - old woman with raynaud s syndrome secondary to lupus who was treated with bilateral popliteal nerve block catheters for ischemic pain and necrosis of her feet ; this led to almost immediate resolution of her pain and return of color and function of her feet . while medical management should continue to be a front - line treatment for raynaud s syndrome , regional anesthesia can be useful in providing rapid dissipation of symptoms and may thus serve as a viable option for short - term management of this syndrome .

strongyloides stercoralis is a human intestinal nematode that is considered a common parasitic disease in tropical and subtropical areas . it is endemic in southeast asia , africa , west indies , south america , bangladesh , and pakistan . the ability to replicate in the human host permits autoinfection of s. stercoralis leading to chronic infection . hyperinfection occurs when the parasite load increases and the rhabditiform larvae penetrate the bowel mucosa and finally reaches the organs normally involved in pulmonary autoinfection cycle ( gi tract , peritoneum , and lungs ) . dissemination is defined as larva migrating to end organs not usually involving the normal life cycle of the parasite such as brain and skin . there are very few case reports of hyperinfection or disseminated s. stercoralis infection in immunocompetent patients . we present a case of hyperinfected s. stercoralis infection in an adult male patient presenting with respiratory symptoms .

s. stercoralis infection is very common in south east asian countries including india . chronic infection is very common with symptoms of diarrhea , abdominal pain , nausea , vomiting , anemia , and cough . hyperinfection and dissemination usually occur in immunocompromised patients with symptoms mimicking asthma , copd , or aseptic meningitis . very few cases of hyperinfection and dissemination have been documented in immunocompetent patients . we report this case for its rarity and future references .

the characteristic features are pronounced intracellular and intramicrocystic periodic acid schiff ( pas ) positive secretions . as this carcinoma usually occurs in children and young adults , it was originally referred to as a type of juvenile carcinoma . slow growth and delayed recurrence are characteristic of many of these tumors . prolonged follow - up is needed to assess accurately the biological behavior of this tumor .

secretory carcinoma is a rare form of breast carcinoma which has a predilection for juveniles and young adults ( usually less than 30 years of age ) , becoming progressively less common with advancing age . it is a low grade breast carcinoma which shows distinct features at histology . diagnosis of this carcinoma on fine needle aspiration cytology ( fnac ) is difficult . we report a case of a 62-year - old woman diagnosed to have secretory carcinoma of breast on fnac . histopathological examination confirmed the diagnosis . the recognition of secretory carcinoma is important because the cytological findings can be confused with those of lactating breast . preoperative diagnosis is essential for appropriate surgical therapy . secretory carcinoma is reported to have good prognosis , but surgical therapy with an axillary node dissection is recommended , since axillary metastases have been found in approximately 30 % of the recorded cases .

serum opacity factor ( sof ) was first discovered in 1938 by the australians ward and rudd as a substance produced by group a streptococci that caused serum to become cloudy ( figure 1 ) , hence its name . sof was found to act on a lipoprotein fraction of serum [ 2 , 3 ] and various enzymatic activities were proposed to account for the opacity reaction of sof including those as a cholesterol esterase and apolipoproteinase or aspartic protease . subsequently , sof was found not to be a hydrolase but rather induced opacification of serum by binding to high - density lipoproteins ( hdls ) , displacing apolipoprotein a - i ( apo a - i ) and disrupting the structure of hdl resulting in the formation of large , lipid particles that cause serum to become opaque [ 6 , 7 ] . sof is expressed by a variety of streptococci and staphylococci including both human and animal pathogens . sof is expressed by approximately 50 % of the invasive isolates of the group a streptococcus , streptococcus pyogenes , an important human pathogen that colonizes the human skin and the oral cavity where it may stimulate mild to severe local inflammatory responses resulting in pharyngitis in the throat and impetigo in the skin . in susceptible hosts , these infections can lead to life - threatening complications such as sepsis , necrotizing fasciitis , and toxic shock , or to debilitating sequelae such as rheumatic fever and glomerulonephritis . the adhesion to and subsequent colonization of the host by s. pyogenes have been attributed to a number of surface exposed molecules including sof . furthermore , sof has been found to contribute to the pathogenesis of streptococcal infections in animal models [ 1012 ] and to evoke protective immune responses in humans and animals indicating its potential as a virulence determinant and vaccine candidate . sof is a unique protein exhibiting multiple functions including not only its ability to opacify serum but also an ability to bind to a variety of host proteins such as fibronectin , fibrinogen , and fibulin-1which are involved in bacterial adhesion . this paper will provide an overview of the methods of assaying for sof activity , the structure and function of sof , its prevalence and distribution in bacteria , its role in contributing to the pathogenesis of streptococcal infections , its vaccine potential , and how investigations into the mechanisms whereby sof opacifies serum may lead to therapies to help control atherosclerosis .

serum opacity factor ( sof ) is a virulence determinant expressed by a variety of streptococcal and staphylococcal species including both human and animal pathogens . sof derives its name from its ability to opacify serum where it targets and disrupts the structure of high - density lipoproteins resulting in formation of large lipid vesicles that cause the serum to become cloudy . sof is a multifunctional protein and in addition to its opacification activity , it binds to a number of host proteins that mediate adhesion of streptococci to host cells , and it plays a role in resistance to phagocytosis in human blood . this article will provide an overview of the structure and function of sof , its role in the pathogenesis of streptococcal infections , its vaccine potential , its prevalence and distribution in bacteria , and the molecular mechanism whereby sof opacifies serum and how an understanding of this mechanism may lead to therapies for reducing high - cholesterol concentrations in blood , a major risk factor for cardiovascular disease .

recordings of electrical and mechanical activity in vitro from gastrointestinal smooth muscle segments show rhythmic mechanical activity that is triggered by corresponding rhythmic changes in membrane potential.13 the underlying membrane potential changes are usually composed of two events , starting with a slow rhythmic change ( often denoted as slow waves ) , which serves to depolarize the membrane potential to a sufficient level to elicit a second event , which is the spike or action potential ( figure 1 ) . although in some gastrointestinal smooth muscles slow waves themselves may trigger contractions,4 the usual physiologic trigger for contractions is considered the spike . the depolarizing phase of the spike is predominantly a result of an influx of calcium.2,5 considering the narrow diameter of smooth muscle cells , it had been concluded that activator calcium for contractions in gastrointestinal smooth muscle originated from an influx of calcium across the plasma membrane associated with spikes , rather than a release of calcium from intracellular pools.1,5 after the incubation of gastrointestinal smooth muscle segments in solutions devoid of calcium and containing the chelating agent ethylene glycol tetraacetic acid ( egta ) , normal slow waves and spikes were eliminated , and an alternative rhythmic activity ( prolonged potentials ) develops68 ( figure 1 ) . prolonged potentials may persist for hours in calcium - free solutions and have a voltage excursion similar to the spike3,8 ( figure 1 ) . in several gastrointestinal and visceral smooth muscle preparations , prolonged potentials trigger rhythmic contractile activity710 ( figure 2 ) . considering that preparations can be incubated for hours in solutions containing no added calcium plus egta , it was concluded that gastrointestinal smooth muscle contains an intracellular calcium pool that is released after membrane depolarization . well known that there was no depolarization - sensitive release of intracellular calcium in gastrointestinal smooth muscle . however , this mechanical and electrical activity has now been well described in multiple gastrointestinal and other visceral smooth muscle preparations . possible explanations for the lack of observing contractile activity in calcium - free solutions by others include observation during the period immediately after changing from normal to calcium - free solutions , as it may take time for plateau potentials to develop , and use of single cells , as there appears to be a minimal geometry needed to observe the activity.9,10 these and other explanations for the failure of some to note contractions in gastrointestinal smooth muscle during incubation in calcium - free solution have recently been described.3

for decades , it was believed that the diameter of gastrointestinal smooth muscle cells is sufficiently narrow , and that the diffusion of calcium across the plasma membrane is sufficient , to support contractile activity . thus , depolarization - triggered release of intracellular calcium was not believed to be operative in gastrointestinal smooth muscle . however , after the incubation of muscle segments in solutions devoid of calcium and containing the calcium chelator ethylene glycol tetraacetic acid , an alternative electrical event occurred that was distinct from normal slow waves and spikes . subsequently , it was demonstrated in gastrointestinal smooth muscle segments that membrane depolarization associated with this alternative electrical event triggered rhythmic contractions by release of intracellular calcium . although this concept of depolarization - triggered calcium release was iconoclastic , it has now been demonstrated in multiple gastrointestinal smooth muscle preparations . on the basis of these observations , we investigated whether a rhythmic electrical and mechanical event would occur in aortic smooth muscle under the same calcium - free conditions . the incubation of aortic segments in a solution with no added calcium plus ethylene glycol tetraacetic acid induced a fast electrical event without corresponding tension changes . on the basis of the frequency of these fast electrical events , we pursued , contrary to what has been established dogma for more than three centuries , the question of whether the smooth muscle wall of the aorta undergoes rhythmic activation during the cardiac cycle . as with depolarization - triggered contractile activity in gastrointestinal smooth muscle , it was well known that rhythmic activation of the aorta does not occur in synchrony with the heartbeat . in a series of experiments , however , it was demonstrated that rhythmic contractions occur in the aortic wall in synchrony with the heartbeat and share a common pacemaker with the heart . we conclude that important observations in the vascular system became derivative from those in the gastrointestinal system . the challenging of scientific dogma potentially leads to the expansion of our fundamental knowledge base .

osler first used the term mycotic aneurysm in 1885 to describe a mushroom - shaped aneurysm in a patient with subacute bacterial endocarditis . , mycotic aneurysm is still used for all extracardiac or intracardiac aneurysms caused by infections , except for syphilitic aortitis . the term infected aneurysm , proposed by jarrett and associates , is more appropriate , since few infections involve fungi . mycobacterium and fungi , such as candida albicans and aspergillus , are rare causes of infected aneurysms and only few cases of such multiple chronic granulomatous mycotic abdominal aorta aneurysms have been reported as per our literature search . depending on the location , mycotic aortic aneurysm usually manifests as abdominal pain with or without a pulsatile mass , causing aneurysmal mass effect , chest pain , dysphagia , hoarseness , and the complications include fistula , perforations , bleeding , and rupture . multidetector computerized tomography ( ct ) angiography allows early detection and characterization of abdominal aortic aneurysms . identifying the underlying etiology is important in deciding the appropriate management of the aneurysm .

infective mycotic aneurysm of the aorta is a rare and life - threatening disease . a patient presenting with constitutional symptoms and pulsatile abdominal mass should raise a suspicion of mycotic aneurysm . early detection of aortic mycotic lesions in such patients should play a key role in the treatment of aortic aneurysms . multiple mycotic aneurysms of abdominal aorta in a young male are a rare manifestation of the disease . multidetector computerized tomography ( ct ) is an essential tool in identifying the etiology , pathogenesis , protean manifestations of systemic tuberculosis , and ultimately deciding the course of treatment .

the combined incidence is reported to be 0.03 per 100,000 persons in the united states . the myxoid variant of chondrosarcoma of bony origin is an uncommon entity and its location in the skull is rarer still with incidence as low as 0.16 % , including those arising from its coverings , supporting tissues , and cranial bones . this tumor occurs mainly in the spheno - occipital region . because of the similarity to chordoma , the synonym for it is chordoid sarcoma or parachordoma , and indeed , it is misdiagnosed frequently as such . it is essential to distinguish myxoid chondrosarcoma from chordoma and especially its chondroid variant , as it has a better prognosis when compared to the latter .

the myxoid variant of chondrosarcoma is usually seen in soft tissues where it is known as chordoid sarcoma or parachordoma . rarely , it involves bone and when it does , cranial bones are the preferred location . this tumor is frequently amalgamated with the chondroid variant of chordoma , especially when the lesion occurs in the sphenoid bone / spheno - occipital region , because of their similar clinical presentations , anatomical locations , radiological findings , and mistaken histopathological features . it is essential to distinguish myxoid chondrosarcoma from the chondroid variant of chordoma , because of the different treatment protocol and prognostic importance . we present such a location - based diagnostic dilemma , solved successfully with ancillary immunohistochemistry .

in recent decades , the essential oils and various extracts of plants have been of great interest as they have been the sources of natural products . the most commonly used antioxidant at the present time are butylated hydroxyanisole ( bha ) , butylated hydroxytoluene ( bht ) , propylgallate ( pg ) , and tert - butyl hydroxyl toluene ( tbhq ) . however , they are suspected of being responsible for liver damage and carcinogenesis in laboratory animals [ 3 , 4 ] . therefore , the development and utilization of more effective antioxidant of natural origin are desired . the antioxidant activity of phenolic compounds is mainly due to their redox properties , which can play an important role in absorbing and neutralizing free radicals , quenching singlet and triplet oxygen , or decomposing peroxidase . therefore , an investigation of such antioxidative phenolic compounds in edible plants has been conducted to improve our understanding of their dietary value and potential benefits . pilea microphylla ( pm ) ( family : urticaceae ) is being used as folk medicine to treat several allergies / wounds in and around malaysia peninsular especially penang island . it is reported to possess antibacterial activity , moderate antioxidant activity , and total phenolic content and pm is also used for infertility , inflammations , and womb cleanser . the purposes of this study were to compare the extracting method together and to evaluate pilea microphylla in urticaceae family as new potential sources of natural antioxidant and antimicrobial activities .

a total of 9 plant extracts were tested , using two different kinds of extracting methods to evaluate the antioxidant and antimicrobial activities from pilea microphylla ( urticaceae family ) and including toxicity test . antioxidant activity were tested by using dpph free radical scavenging , also total phenolic contents and total flavonoid contents were determined . toxicity assay carried out by using brine shrimps . methanol extract of method i ( me i ) showed the highest antioxidant activity at 69.51 1.03 . chloroform extract of method i ( ce i ) showed the highest total phenolic contents at 72.10 0.71 and chloroform extract of method ii ( ce ii ) showed the highest total flavonoid contents at 60.14 0.33 . the antimicrobial activity of pilea microphylla extract was tested in vitro by using disc diffusion method and minimum inhibitory concentration ( mic ) . the pilea microphylla extract showed antibacterial activity against some gram negative and positive bacteria . the extracts did not exhibit antifungal and antiyeast activity . the hexane extract of method i ( he i ) was not toxic against brine shrimp ( lc50 value was 3880 g / ml ) . therefore , the extracts could be suitable as antimicrobial and antioxidative agents in food industry .

globally , organophosphorus ( op ) pesticide poisoning is a serious occupational hazard accounting for more than 80 % of pesticide - related hospitalisation . india being an agriculture - based country , op pesticide remains the main agent for crop protection and pest control . it is therefore likely to have adverse effects on farmers who are accidentally over exposed while handling these pesticides . however , because of low cost and easy availability , it has also become an agent of choice for self poisoning . pesticide self - poisoning is responsible in killing approximately 300,000 people worldwide every year and mostly from rural background . in developing countries high mortality could be probably due to lack of hospital services in the vicinity , inadequate transport facility , increased patient to care givers ratio , and finally non - availability of definite antidote . op insecticides inhibit both cholinesterase and pseudocholinesterase activities , as they are irreversible cholinesterase inhibitors . the inhibition of cholinesterase activity leads to accumulation of acetylcholine at synapses , causing overstimulation and disruption of neurotransmission in both central and peripheral nervous systems . the fatal issue is often related to a delay in diagnosis or an improper management . management of severe poisoning is difficult , requiring intensive care and use of atropine and oxime cholinesterase reactivators . key to survival lies in early diagnosis followed by rapid decontamination and definitive therapy which purely lies under the expert domain of emergency medicine . in this article , we report the retrospective analysis of patients with severe op insecticide poisoning in a tertiary care hospital in northern india .

background and aims : organophosphorus ( op ) compound poisoning is one of the most common poisonings in india . the aim of the study was to study the outcomes and predictors of mortality in patients with acute op poisoning requiring mechanical ventilation.methods : a retrospective study was conducted in the intensive care unit and 117 patients were included . diagnosis was performed from the history taken either from the patient or from the patient 's relatives . demographic data , month of the year , mode of poisoning , common age group , duration of mechanical ventilation , time of starting pralidoxime ( pam ) , and mortality were recorded . chi square test , pearson correlation test , and multivariate binary logistic regression analysis was used . data are presented as mean sd.results:91.86 % ( 79/86 ) of cases were suicidal and remaining cases were accidental . duration of mechanical ventilation varied from less than 48 hours to more than 7 days . mortality rate was 33.3 % , 7.2 % , and 100 % in those who required mechanical ventilation for more than 7 days , 5 to 7 days , and 2 to 4 days , respectively . lag time was less than 6 hrs in 13 patients and all of them survived . 17.1 % and 28.1 % patients died in whom pam was started 6 to 12 hrs and 13 to 24 hrs after poisoning , respectively . there was statistically significant positive correlation between lag time of starting of pam with duration of mechanical ventilation and total dose of pam ( p < 0.0001 ) . none of the predictors age , lag time , severity of poisoning , and duration of ventilation were independent predictors of death . overall mortality rate was 18.6 % .conclusion : mortality from op compound poisoning is directly proportionate to the severity of poisoning , delay in starting pam , and duration of mechanical ventilation . death is not dependent on a single factor , rather contributory to these factors working simultaneously .

the goal of the worldwide structural genomics initiative is to determine the 3d structures of proteins on a genomic scale . since 2001 , these efforts have resulted in more than 6772 structure depositions to the pdb ( 1 ) , 3251 of which are from the national institutes of health - sponsored protein structure initiative centers . in order to determine these structures in a high - throughput manner , the psi centers have developed advanced technologies to facilitate these processes , including protein production , crystallization , structure determination , refinement and analysis . the protein structure initiative structural genomics knowledgebase ( psi sgkb ) ( http : //kb.psi-structuralgenomics.org ) was launched in early 2008 with the goal of making the results of the psi initiative widely available to the broad community of biologists ( 2 ) . the psi sgkb provides access to the annotated protein structures , the models that can be leveraged from them , associated functional predictions , experimental protocols and tracking information . the new resource integrates this structural information with relevant scientific information from external data resources in a coherent and contextual format . the psi sgkb also provides the descriptions of a vast array of technologies , protein production protocols and software applications . by making all of these products accessible to the greater community , it is anticipated that the psi sgkb will become an enabling resource for biologists , biochemists , functional genomicists , pharmacologists , educators and physicians .

the protein structure initiative structural genomics knowledgebase ( psi sgkb , http : //kb.psi-structuralgenomics.org ) has been created to turn the products of the psi structural genomics effort into knowledge that can be used by the biological research community to understand living systems and disease . this resource provides central access to structures in the protein data bank ( pdb ) , along with functional annotations , associated homology models , worldwide protein target tracking information , available protocols and the potential to obtain dna materials for many of the targets . it also offers the ability to search all of the structural and methodological publications and the innovative technologies that were catalyzed by the psi 's high - throughput research efforts . in collaboration with the nature publishing group , the psi sgkb provides a research library , editorials about new research advances , news and an events calendar to present a broader view of structural biology and structural genomics . by making these resources freely available , the psi sgkb serves as a bridge to connect the structural biology and the greater biomedical communities .

in 1935 , barach first advocated helium - oxygen gas mixtures ( heliox ) as a therapy for obstructive lesions of the airway . since then , heliox has been shown to be efficacious in the treatment of various disease entities involving narrowed airways . its safety has been demonstrated in both mechanically ventilated and spontaneously breathing patients . combining 70 % helium and 30 % oxygen results in a gas which is much less dense than a nitrogen - oxygen gas mixture ( nitrox ) and has approximately the same viscosity . the therapeutic effects of heliox gas mixtures are believed to relate to its ability to deliver oxygen and gas flow with less turbulence and resistance through narrowed airways . since airway resistance is directly proportional to the density of the gas , the administration of heliox is expected to improve ventilation by decreasing resistance , reducing turbulence and promoting laminar gas flow . although there have been advancements in the treatment of asthma since barach first studied heliox in 1935 , mortality continues to increase . the use of bronchodilators and anti - inflammatory agents have become the standard of care for reactive airway disease and asthma . however , some patients fail to respond to aggressive therapy and require mechanical ventilation . mechanical ventilation may result in turbulent gas flow secondary to high gas velocity which may cause additional difficulty achieving adequate ventilation . heliox may , therefore , be most effective in intubated patients with severe bronchospasm and small diameter airways by decreasing turbulent flow , improving ventilation and limiting barotrauma while therapies targeted to the underlying etiology of the bronchospasm are given time to achieve their effect . several animal and human studies have investigated the effects of heliox on pulmonary function . although results from these studies have been promising , the wide variation between each patient 's biological response to bronchospasm we have developed a pediatric porcine , independent lung ventilation model of severe bronchospasm which allows one of the animal 's lungs to act as a simultaneous control for the contralateral lung . this unique model allows each subject to act as its own control during the same bronchospastic event , thereby minimizing influence from various systemic variable biological responses to acute stress and eliminating the need to compare matched control subjects or different bronchospastic events in the same animal . our hypothesis is that , during mechanical ventilation , the low density heliox gas mixture will increase flow through constricted airways and improve pulmonary mechanics in the lung receiving heliox compared to the lung receiving nitrox .

background : a helium - oxygen gas mixture ( heliox ) has low gas density and low turbulence and resistance through narrowed airways . the effects of heliox on pulmonary mechanics following severe methacholine - induced bronchospasm were investigated and compared to those of a nitrogen - oxygen gas mixture ( nitrox ) in an innovative pediatric porcine , independent lung , mechanical ventilation model.results : all of the lungs showed evidence of severe bronchospasm after methacholine challenge . prospective definition of ' heliox response ' was a 15 % or greater improvement in lung function in the lung receiving heliox compared with the matched lung receiving nitrox . seven out of 10 pigs responded to heliox therapy with respect to resistance and eight out of 10 pigs responded to heliox therapy with respect to compliance and tidal volume ( p < 0.03 ) . after crossover from nitrox to heliox , eight out of eight lungs significantly improved with respect to tidal volume , resistance and compliance ( p < 0.001 ) . after crossover from heliox to nitrox all eight lungs showed a significant increase in resistance and a significant decrease in tidal volume ( p < 0.001 ) .conclusions : in a pediatric porcine model of acute , severe methacholine - induced bronchospasm and independent lung mechanical ventilation , administration of heliox improves pulmonary mechanics , gas flow , and ventilation . administration of heliox should be considered for support of pediatric patients with acute , severe bronchospasm requiring mechanical ventilation through small artificial airways .

the use of electrocautery during polypectomy is widely considered to be the standard of care in resecting polyps 10 mm . in practice , hot polypectomy can aid in both transecting tissue and preventing immediate bleeding through coagulation of small arterial and venous branches 1 . electrocautery also allows for the en bloc resection of larger polyps , believed to reduce the risk of recurrent adenoma . the use of electrosurgical current during endoscopic resection , however , may be suboptimal from a safety standpoint . for example , conventional hot polypectomy carries a risk of delayed bleeding 2 , possibly due to sloughing of coagulum to expose an incompletely coagulated submucosal artery . in addition , cautery - related transmural thermal injury to the bowel wall is a major contributor to procedural adverse events 3 , manifesting in a spectrum of severity from post - polypectomy pain syndrome , to unrecognized perforation at the time of endoscopy , to frank perforation related to transection through the muscularis propria and serosa layers . while electrocautery - aided en bloc resection theoretically may be a more effective strategy for complete resection of all polyp tissue , more than one study has shown local adenoma recurrence at a rate of up to 28 % despite this technique 4 5 . cold snare polypectomy , in contrast , has been widely favored for the resection of smaller polyps since the avoidance of electrocautery clearly reduces post - polypectomy electrocoagulation syndrome , perforation , and delayed bleeding . despite these benefits , cold snare polypectomy for the resection of larger duodenal and colonic polyps has not been explored previously . we hypothesized that endoscopic resection using a cold snare piecemeal technique is feasible for larger polyps . to evaluate our hypothesis , in this first proof - of - principle case series , we assessed the technical feasibility and preliminary safety of cold snare polypectomy for larger duodenal and colonic polyps .

background : endoscopic removal of duodenal and colorectal adenomas is currently considered to be the standard of care for prevention of adenocarcinoma . the use of cautery carries a risk of delayed bleeding , post - polypectomy syndrome , and perforation . we examined the safety and feasibility of removing colonic and duodenal polyps 1 cm using a piecemeal cold snare polypectomy technique . patients : the study included 15 patients with duodenal polyps 1 cm and 15 patients with colonic polyps 1 cm . main outcome measurements : bleeding , perforation , abdominal pain , or hospitalization occurring within 2 weeks of polypectomy . results : between 24 august 2011 and 29 april 2013 , 15 patients had removal of duodenal polyps 1 cm . mean patient age was 64 years and 9/15 patients were male . the mean polyp size was 24 mm ( 10 60 mm ) . all polyps were removed with a cold snare and some required cold biopsy forceps . one patient required hospitalization for gastrointestinal blood loss 7 days post - polypectomy ; this patient was using coumadin . between 27 february 2012 and 30 may 2013 , 15 patients underwent resection of a 1 cm colonic polyp . mean patient age was 68 years and 9/15 were male . the mean polyp size was 20 mm ( 10 45 mm ) . all polyps were primarily removed with a cold snare . none of the patients required hemostatic clips for control of immediate bleeding . one patient presented to the emergency department with abdominal pain 1 day after initial endoscopy . ct scan showed no abnormalities and the patient was discharged . conclusions : cold snare polypectomy for large duodenal and colonic polyps is technically feasible and may have a favorable safety profile compared to standard electrocautery - based endoscopic resection . comparative trials are required to determine the relative safety and efficacy of cold snare techniques for complete and durable resection of large polyps compared to standard hot snare methods .

the etiology of folliculitis is complex and in a given case several factors may contribute including infection , physical irritation , occlusion , other skin diseases and drugs . among drugs , however , the role of the native glucocorticoid , cortisol , as a regulator / dampener of potential inflammatory reactions in the hair follicles is unknown . here we report a case of treatment - resistant folliculitis which resolved after recognition and treatment of low cortisol due to adrenal insufficiency .

a report on a 40-year - old patient with recalcitrant , suppurative folliculitis is presented . after years of unsuccessful treatment with conventional therapies , the patient was diagnosed with adrenal insufficiency with a low level of circulating cortisol . a few weeks after the patient was subjected to substitution therapy with hydrocortisone , his folliculitis resolved . we discuss the role of plasma cortisol level in the pathogenesis of folliculitis .

previous studies of test - retest reliability of muscle strength measurement using a handheld dynamometer ( hhd ) have shown low reliability in measuring the lower limbs and high reliability in measuring the upper limbs1 , 2 . wikholm et al.1 conducted an investigation with 3 examiners and healthy subjects and reported that , while the intraclass correlation coefficient ( icc ) values for measurements of elbow flexor and shoulder external rotator muscles , which have low muscle strength , were 0.768 and 0.932 , respectively , that of measurements of knee extensor muscles , which have high muscle strength , was 0.226 . agre et al.2 conducted an investigation with three examiners and healthy subjects and reported that pearson s product - moment correlation values ranged from 0.19 to 0.96 for the lower extremities , but from 0.88 to 0.94 for the upper extremities . katoh et al.3 developed a method of measurement with an hhd and a belt in order to increase the reliability of lower extremity muscle strength measurement . the icc ( 2 , 1 ) values for measurements of hip adduction , external rotation , and internal rotation , the average strength of which was less than 20 kgf , ranged from 0.70 to 0.83 without a belt and from 0.97 to 0.99 with a belt , suggesting that using a belt increases reliability even if muscle strength is lower than 30 kgf4 ( 300 n5 ) , which was believed to be the hhd measurement limit . the purpose of this study was to develop a method of measuring shoulder joint muscle strength with an hhd and a belt and to investigate its test - retest reliability .

[ purpose ] the aim of this study was to develop a method of measuring isometric shoulder joint muscle strength using a handheld dynamometer with a belt and investigate its test - retest reliability . [ subjects ] the subjects comprised 40 healthy adults . [ methods ] six types of isometric shoulder muscle strength were measured twice , and reliability was assessed . [ results ] the intraclass correlation coefficient ( 1 , 1 ) values ranged from 0.976 to 0.902 . the result of a bland - altman analysis showed differences in the types of errors between measurement items . [ conclusion ] the relative reliability of isometric shoulder muscle measurement using a handheld dynamometer with a belt was high . however , analysis of absolute reliability revealed errors that may affect interpretation of values ; therefore , it was considered that adapting the greater of two measurement values is appropriate .

primary diffuse leptomeningeal gliomatosis ( pdlg ) is a rare condition where tumors grow in the subarachnoid space without an obvious connection to the brain or spinal cord parenchyma . the majority of these neoplasms are astrocytic , often high grade , and the diagnosis is usually made postmortem [ 1 , 2 ] . dissemination of oligodendrogliomas in the subarachnoid space ( leptomeningeal oligodendrogliomatosis ) is usually secondary to invasion of the leptomeninges or ventricular system by a primary intraparenchymal oligodendroglioma [ 3 , 4 ] . in contrast to the well - documented primary leptomeningeal astrocytomas , primary leptomeningeal oligodendrogliomas ( plo ) are rare with only three previously reported cases without parenchymal involvement [ 57 ] . we report a fourth case of plo in this paper .

primary leptomeningeal oligodendrogliomas ( plos ) are rare intracranial malignancies where tumors grow in the subarachnoid space without an obvious connection to the brain or spinal cord parenchyma . adding to the three previously reported cases of plo with no parenchymal involvement we report a fourth case of the same in this paper in a 50-year - old woman presenting with unrelenting headaches . ct scan of her head revealed hydrocephalus and mri revealed diffuse enhancement of her leptomeninges throughout her brain and spine , prominent over the basilar region . biopsy obtained using a frameless stereotactic biopsy showed sharply defined cell borders , clear cytoplasm , and rounded nuclei consistent with an oligodendroglioma . our case suggests that plo can mimic diffuse forms of granulomatous meningitis and should be suspected in patients that clinically and radiographically present like granulomatous meningitis but without blood or csf markers for the same .

lupus nephritis ( ln ) is one of the most severe complications of systemic lupus erythematosis ( sle ) . in recent years , the morbidity and mortality of ln have improved considerably owing to more appropriate use of traditional drugs , such as corticosteroids and cyclophosphamide , and the incorporation of new ones , such as mycophenolate and biologic agents.1 since sle is incurable , medical treatments are lifelong . the type of drug and intensity of dosing are based on clinical and analytical data.2 adherence , defined as the extent to which patients take medications as prescribed by their health care providers,3 has proven to be a challenging issue in the treatment of sle , and nonadherence is usually associated with poor disease control and increased mortality . curiously , suitable adherence is far from achievable in many cases , especially in patients at risk for not taking their medication correctly . the specific physical and psychological characteristics of childhood and adolescence make adherence particularly difficult.4,5 taking into account that approximately 15 % of patients with sle develop their disease during this period , detection of nonadherence is worthwhile in clinical practice.6 the enormous psychological and social impact of the disease and its treatment in young patients demand a comprehensive and multidisciplinary approach.7 however , nonadherence in ln can mimic a refractory form of the disease that confuses doctors and leads to inappropriate treatment with severe side effects . to highlight the importance of adherence in this age group , we describe two patients with ln who did not adhere to their drug schedule . initially , neither patient admitted to nonadherence , and the clinical course was characterized by severe renal and extrarenal flares that were treated using an intensification of immunosuppressive treatment rather than the resumption of the previous regimen .

purposeadherence is a challenging issue in the treatment of systemic lupus erythematosus . nonadherence has been widely addressed in patients with lupus and must be detected quickly to prevent severe complications . the cases we present illustrate the importance of adherence in young adults.case 1a 23-year - old spanish woman diagnosed with severe lupus nephritis 8 years previously achieved renal remission after immunosuppressive treatment with corticosteroids and cyclophosphamide . three years later , she developed a renal flare . her treatment was intensified , and rituximab and mycophenolate mofetil were added . one year later , she was readmitted for a new renal flare . a blood test revealed no detectable levels of mycophenolic acid , and the patient admitted she had not taken her treatment correctly . treatment was resumed . four years later , the patient remains in remission.case 2a 19-year - old spanish woman was diagnosed with nephrotic syndrome due to lupus nephritis . she achieved complete remission after treatment with corticosteroids and cyclophosphamide followed by mycophenolate mofetil . two years later , she developed a severe renal relapse that was treated with corticosteroids , cyclophosphamide , and rituximab . the response to treatment was good . mycophenolic acid was undetectable in blood . the patient admitted that she had often missed doses before this relapse . the renal response has been maintained since she resumed her previous medications 2 years ago.conclusionwe conclude that the frequent and severe relapses of lupus nephritis observed in young patients may actually be due to nonadherence rather than to refractory disease . our cases are typical examples of nonadherence that were discovered after a detailed interview with the patients and their families . we emphasize the need for clinical suspicion of nonadherence when caring for young adults with lupus .

limitations originate from many different factors : too high or too low temperatures / water supply / light intensity , non - optimal mineral composition or soil contamination , mechanic inhibition , pathogen infestation , lack of symbiotic partners , interactions with other plants , parasites or herbivores . these conditions can activate defense responses by which plants can minimize detrimental consequences of stressful conditions for their survival , growth , or propagation . these mechanisms allow plants to occupy even extreme habitats , despite their sedentariness . under field conditions , different stress types usually occur concomitantly , like heat and drought , and the molecular responses can be difficult to separate . response to one stress type can be also antagonistic to another , as adaptation to nutrient - poor substrates might reduce stress by competition . therefore , mechanistic studies of stress effects are mostly performed under controlled laboratory conditions , applying one stress type and distinguishing biotic from abiotic stress . while this resulted in information about signaling cascades , transcription factors , and defense compounds , stress effects on the epigenetic level are expected to allow more permanent changes of gene expression and potentially long - term adaptation that could have evolutionary impact , as chromatin modifications can be mitotically or meiotically heritable . this review will focus on the connection of stress with epigenetic regulation , separated in three levels .

highlights epigenetic control is involved in stress signaling and stress responses . stress can modify epigenetic regulation at many different levels . epigenetic and genetic components of stress responses are connected . epigenetic diversity might be an important factor in stress adaptation and evolution .

glioblastoma multiforme ( gbm ) is a neoplasm with variable features not only histologically but also biologically . gbm is characterized by diverse imaging features , including highly heterogeneous enhancement , reflecting variable disruption of the blood brain barrier ( bbb ) and inherent differences in the vascularity of the tumor . bevacizumab , a monoclonal antibody against vascular endothelial growth factor ( vegf ) , has been used most commonly in combination with irinotecan or other cytotoxic agents as salvage therapy . our case report vividly demonstrates disparate responses to combined biochemotherapy in the same patient with recurrent gbm . two synchronous foci of recurrent disease , one area with enhancement and another one nonenhancing and infiltrative , responded differently to treatment with bevacizumab and irinotecan . this case illustrates the principle of antiangiogenesis mechanisms in the treatment of enhancing gbm , and provides a dramatic example of the heterogeneity of the tumor biology and its different responses to treatment .

glioblastoma multiforme , a neoplasm with variable histological and biological features , is characterized by diverse imaging features , including highly heterogeneous enhancement . this reflects variable disruption of the blood brain barrier and inherent differences in the vascularity of the tumor . experience in treating malignant glioma with antiangiogenic drugs is growing , and the most commonly used , in combination with irinotecan or other cytotoxic agents as salvage therapy , is bevacizumab , a monoclonal antibody against vascular endothelial growth factor.a 42-year - old , right - handed person with recurrent glioblastoma multiforme presented with two synchronous foci of recurrent disease in follow - up : one area with enhancement and another one nonenhancing and infiltrative , which responded differently to treatment with bevacizumab and irinotecan . our example demonstrates the heterogeneous nature of glioblastoma multiforme and is proof of principle for antiangiogenic treatment in selected enhancing , presumably angiogenic forms of glioblastoma multiforme . antiangiogenic treatment may be ineffective in more infiltrative , biologically different lesions .

despite the recent advances in research on religion and health in general ( for reviews , see [ 1 , 2 ] ) , only a few studies have explored the relationship between individual religious involvement and cognitive functioning among older adults [ 36 ] . this study intends to fill this gap in the literature by examining whether religious participation is associated with cognitive functioning among the oldest - old ( 80 years and older ) chinese , if it is , what mediates the association , and whether gender conditions the association . the examination of religion and health association in china has increasingly become an urgent priority . china , the most populous country in the world , is now aging at a rapid speed . according to zeng et al . , the number of the oldest - old population , currently the largest of any nation in the world , may increase by more than 100 million by 2050 . such rapid growth of the oldest - old predicts a future burden of cognitive and functioning disability . therefore , it is increasingly critical to study social factors such as religious participation that might be beneficial to the maintenance of cognitive functioning of older chinese , especially considering the decline of the younger population due to the one - child policy and the possible lack of family and societal care of older adults in china . in the following theoretical background section , then , the cognitive functions of chinese religions are proposed and the conceptual framework that guides this study is outlined . finally , gender differences in religious participation as well as the impact of religious participation on cognitive functioning are discussed .

this study examines if religious participation in china is associated with cognitive functioning among the oldest - old and whether positive psychological feelings and leisure activity engagement explain the association , and gender moderates the association . logistic regressions were used to analyze the chinese healthy longevity survey . a significant negative association between religious participation and cognitive impairment was found among the oldest - old and much of the association was mediated by positive psychological feelings and leisure activities . women reported higher proportion of religious participation , but the cognitive benefits of religious participation were stronger for men . findings indicate that ( a ) religious participation is significantly correlated with cognitive functioning in part because the religious oldest - old are more likely to be optimistic and happy and engage in more cognitively stimulating activities ; ( b ) there might be gender differences in religious participation such that the oldest - old men may engage in religious activities that are particularly relevant to cognitive functioning .

left ventricular pseudoaneurysm is a rare condition because in most instances ventricular free - wall rupture leads to fatal pericardial tamponade . rupture of the free wall of the left ventricle is a catastrophic complication of myocardial infarction , occurring in approximately 4 % of patients with infarcts , resulting in immediate collapse of the patient and electromechanical dissociation . in rare cases the rupture is contained by pericardial and fibrous tissue , and the result is a pseudoaneurysm . the left ventricular pseudoaneurysm contains only pericardial and fibrous elements in its wall - no myocardial tissue . because such aneurysms have a strong tendency to rupture , this disorder may lead to death if it is left surgically untreated .

introduction : left ventricular pseudoaneurysm is a rare condition because in most instances ventricular free - wall rupture leads to fatal pericardial tamponade . rupture of the free wall of the left ventricle is a catastrophic complication of myocardial infarction , occurring in approximately 4 % of patients with infarcts , resulting in immediate collapse of the patient and electromechanical dissociation . in rare cases the rupture is contained by pericardial and fibrous tissue , and the result is a pseudoaneurysm . the left ventricular pseudoaneurysm contains only pericardial and fibrous elements in its wall - no myocardial tissue . because such aneurysms have a strong tendency to rupture , this disorder may lead to death if it is left surgically untreated.case report : in this case report , we present a patient who underwent successful repair of a left ventricular pseudoaneurysm , which followed a myocardial infarction that was caused by occlusion of the left circumflex coronary artery . although repair of left ventricular pseudoaneurysm is still a surgical challenge , it can be performed with acceptable results in most patients .

dj-1 ( ~20 kda ) , also called park7 and cap-1 , is a small conserved protein associated with autosomal - recessive early onset parkinson s disease1,2,3 . the human dj-1 protein contains 189 amino acid residues1,2,3 and acts as a redox sensor , which the thiol group of cysteines of dj-1 can be oxidized to soh , s2oh , and s3oh4,5,6 . it was proposed that dj-1 may prevent reactive oxygen species ( ros ) accumulation by regulating the levels of other antioxidants . furthermore , dj-1 has multiple cellular functions such as transcriptional regulation , protease or redox - dependent chaperone activity , apoptosis and sumoylation5,6,7,8 , all of which have been shown to play a role in skeletal muscle activity . therefore , dj-1 appears to be an important player in skeletal muscle function during the life - span , although its mechanistic roles are yet to be determined . skeletal muscle atrophy has proven to be a significant orthopedic problem in the area of physical therapy9,10,11 . muscle atrophy has generally been reported that immobilization - induced atrophy , especially of physiotherapeutic area , decreased muscle volume via decrease of contractile proteins , resulting in muscle weakness and disorder of activities of daily living ( adl ) 9 , 10 , 12 , 13 . in our previous study , it was demonstrated that cast - immobilization- and undernutrition - induced atrophy are correlated with each other via dj-1 protein in skeletal muscle13 . furthermore , electrical properties such as rheobase and chronaxie are important factors in electrodiagnosis by physiotherapists for measurement of muscle degeneration such as total or partial muscle paralysis14 , 15 . rheobase is measured as the threshold stimulus current for an active response with a long - duration pulse and chronaxie is the pulse width at twice the rheobase threshold current14 , 15 . however , the tendency of change in electrical activities on knockout of dj-1 is not fully understood . therefore , in the present study , the electrical properties of the gastrocnemius muscle of dj-1 knockout ( dj-1 ) and wild - type ( dj-1 ) mice were compared .

[ purpose ] strength - duration ( sd ) curves are used in electrical diagnosis by physiotherapists to confirm muscle degeneration . however , the usefulness of sd curves in comparing muscle degeneration in dj-1 homozygous knockout ( dj-1/ ) and wild - type mice ( dj-1+/+ ) is not yet fully understood . the electrical properties of the gastrocnemius muscles of dj-1/ and dj-1+/+ mice were compared in the current study . [ subjects and methods ] the electrode of an electrical stimulator was applied to the gastrocnemius muscle to measure the rheobase until the response of contractive muscle to electrical stimulation became visible in mice . [ results ] the rheobase of dj-1/ mice showed a significant increase in a time - dependent manner , compared to that of dj-1+/+ mice . [ conclusion ] these results demonstrate that the dj-1 protein may be implicated in the regulation of neuromuscular activity of gastrocnemius muscles of mice .

the raw data for magnetic resonance imaging ( mri ) is measured in k - space , the domain of spatial frequencies , where non - cartesian sampling schemes like spiral or radial scans have received much attention . in contrast to the use of the computationally efficient fast fourier transform ( fft ) for the reconstruction from cartesian grids , the more general sampling trajectories ask for the so - called nonequispaced ffts . on the other hand , , iterative image reconstruction in combination with the nonequispaced fft has been applied to data on spiral k - space trajectories and in the presence of field inhomogeneities . efficient reconstruction procedures for sensitivity encoding with arbitrary k - space trajectories were proposed in . its authors present methods that combine the gridding principles with the conjugate gradient scheme , but mention the long computation times due to their nonoptimised preliminary software . in this paper , we use a similar method , compare the gridding approach and an approach based on an implicit discretisation , where we focus for the reader 's convenience on a simplified signal equation . it turns out that the iterative solution of the latter approach resembles the gridding method in its first iteration . both reconstruction problems are easily solved by our mature software package for the nonequispaced fast fourier transform ( nfft ) [ 8 , 9 ] . for readers not familiar with the nfft the publicly available implementation easily allows for the efficient treatment of large 3d data sets by the use of new sparse matrix storage techniques . moreover , we compare different density compensation weights arising from the discretisation of the underlying integrals . we present numerical results , based on the shepp - logan phantom as well as on data acquired by an mr scanner . the outline of this paper is as follows : section 2 gives a brief introduction to the theory of fourier transform image reconstruction and unifies the two considered approaches in mri . we suggest the conjugate gradient method for the reconstruction problem and show that the solution is efficiently computed by the iterative use of the nonequispaced fft . subsequently , section 3 presents the used k - space trajectories , considers sampling density compensation , and introduces the tested simulated and acquired data sets . section 4 shows our numerical tests emphasising the reconstruction quality with respect to the number of iterations and different density compensation weights . moreover , we give detailed information on the computational requirements of the suggested scheme . finally , a short discussion of our results is contained in section 5 and an introduction to the nonequispaced fft might be found in the appendix .

in magnetic resonance imaging ( mri ) , methods that use a non - cartesian grid in k - space are becoming increasingly important . in this paper , we use a recently proposed implicit discretisation scheme which generalises the standard approach based on gridding . while the latter succeeds for sufficiently uniform sampling sets and accurate estimated density compensation weights , the implicit method further improves the reconstruction quality when the sampling scheme or the weights are less regular . both approaches can be solved efficiently with the nonequispaced fft . due to several new techniques for the storage of an involved sparse matrix , our examples include also the reconstruction of a large 3d data set . we present four case studies and report on efficient implementation of the related algorithms .

attractive smile is a prime asset to a person 's powerful personality and it can be an important factor in the desirable life experiences of a human being . dental esthetics , along with enhancing personality , helps in the general improvement of dental health which is founded on a more ethically sound basis . esthetic dentistry demands attention to the patient 's desires and treatment of the patient 's individual problems . a practicing dentist must be acquainted with multiple factors associated with the esthetic treatment and must be aware of problems that such treatment may elicit or aggravate in the patient . therefore , the patient 's entire personal , familial , social environment along with the local factors must be considered in relation to esthetics . enamel hypoplasia ( eh ) is a defect in tooth enamel that results in less quantity of enamel than normal . traumatic injury to an anterior primary tooth that causes its displacement apically can also interfere with matrix formation or calcification of the underlying permanent tooth which is also called turner 's hypoplasia . it usually manifests as a developmental defect of the permanent successor tooth , range from mild alteration in enamel mineralization in form of simple white or yellow brown discoloration to severe defective formation of enamel with loss of a portion of missing or severe pitting and irregularity of tooth crown , generally affecting one or more permanent teeth in the oral cavity . treatment planning for patients with hypoplasia is related to many factors : the age and socioeconomic status of the patients , the type and severity of disorder and intraoral situation . interdisciplinary approach is used to resolve esthetic problems using a combination of orthodontic , prosthodontic , and restorative treatment . esthetic restoration of anterior teeth has been achieved with complete crowns , porcelain laminate veneers , and acid - etched composite resin restorations . a new therapeutic method named the edge - up technique developed by fischer et al . , has long - term experience with the facet technique , which allows treatment of defects in the anterior area with a maximum preservation of enamel . the name edge - up describes the principles and components of the restoration , edge focusing on the location , and set up aiming at the rebuilding of the incisal part of a tooth . this case report describes a rare treatment modality for turner 's hypoplasia done with a very conservative approach for the esthetic and functional problem of the defect .

this case report describes a rare treatment modality for turner 's hypoplasia done with a very conservative approach for the esthetic and functional problem of the defect . diagnosis was made as turner 's hypoplasia of upper two central incisors with proximal caries . treatment planning was done after considering many factors such as conservation of tooth structure , esthetics , occlusion and economy . tooth preparation was done to receive edge - up , all ceramic partial crowns for both the upper central incisors , using pressable all ceramic material and cemented with resin cement .

critical limb ischemia ( cli ) mainly affects elderly patients with important comorbidities and significant diffuse multilevel vascular lesions [ 1 , 2 ] . these patients are frequently diabetics with neuroischemic limb ulcers , gangrene , and foot sepsis . this specific group is prone to develop an aggressive form of the disease , with more tibial affectation and microcirculatory impairment [ 3 , 4 ] . the risk of limb loss is higher among diabetics and in patients with ischemic ulcers [ 1 , 2 ] . in the absence of a successful revascularization , major amputation and mortality rates of cli patients are substantial . in this context , obtaining at least one patent tibial artery to the foot is usually needed to achieve a sufficient amount of blood flow to cover the healing process requirements and ensure limb salvage [ 59 ] . therefore , infrainguinal revascularization procedures are frequently performed , especially on tibial vessels . according to several studies , tibial endovascular techniques could provide similar clinical outcomes as distal vein bypass surgery with a lower rate of procedure - related complications [ 1012 ] . in many centres , these interventions have been implemented as first line of treatment for cli as it seems more suitable for this frail group of patients because of its lower perioperative adverse event rates . in tibial vein bypass planning , it has been generally accepted that the decision of which tibial outflow vessel should be treated must be taken according to angiographic considerations of the target distal vessel quality , since better patency rates are expected if less diseased runoff artery is used for distal anastomosis . however , the endovascular approach offers the possibility of treating more than one tibial vessel . in addition , data shown in several recent reports suggest that improved clinical outcomes could be achieved when blood flow is directed to the local ischemic area of the foot through its specific source tibial artery using and angiosome anatomical model [ 79 , 13 ] . this revascularization strategy is usually hampered by the seriously affected vascular anatomy of cli patients . in fact , in a large number of patients , the restoration of blood flow to the ulcerated area could only be achieved through distal collateral vessels of the foot like distal peroneal branches or pedal arch . our aim is to analyze the clinical and hemodynamic results of infrapopliteal endovascular procedures applied to cli diabetic patients with ischemic ulcers according to the number of tibial vessels attempted for revascularization , the number of tibial arteries finally achieved to the foot and the local perfusion of the ischemic ulcer obtained after revascularization in order to describe the usefulness of these recent techniques in new reperfusion strategies .

our aim was to describe our experience with infrapopliteal endovascular procedures performed in diabetic patients with ischemic ulcers and critical ischemia ( cli ) . a retrospective study of 101 procedures was performed . our cohort was divided into groups according to the number of tibial vessels attempted and the number of patent tibial vessels achieved to the foot . an angiosome anatomical classification of ulcers were used to describe the local perfusion obtained after revascularization . ischemic ulcer healing and limb salvage rates were measured . ischemic ulcer healing at 12 months and limb salvage at 24 months was similar between a single revascularization and multiple revascularization attempts . the group in whom none patent tibial vessel to the foot was obtained presented lower healing and limb salvage rates . no differences were observed between obtaining a single patent tibial vessel versus more than one tibial vessel . indirect revascularization of the ulcer through arterial - arterial connections provided similar results than those obtained after direct revascularization via its specific angiosome tibial artery . our results suggest that , in cli diabetic patients with ischemic ulcers that undergo infrapopliteal endovascular procedures , better results are expected if at least one patent vessel is obtained and flow is restored to the local ischemic area of the foot .

patients with acute heart failure syndromes ( ahfs ) are usually admitted because of severe systemic congestion that frequently presents with dyspnea . known as the hallmark of ahfs , congestion is mainly due to pulmonary venous hypertension ( world health organization type 2 ) . this has ranged from < 2 % to 7.7 % to 29 % depending on the series . dyspnea is the most common symptom in these patients that implies an elevated pulmonary venous pressure that is often accompanied by increased central venous pressure ( cvp ) and/or peripheral edema . there is substantial evidence that the main driver of morbidity , mortality , and readmission to the hospital is volume overload [ 15 ] . moreover , it is well established that patients who are admitted with ahfs and renal dysfunction have worse outcomes [ 1 , 59 ] . in this paper , we discuss the pathophysiology of ahfs and its contribution to impairment of kidney function . in the end , we approach the current evidence of therapeutic strategies in patients with cardiorenal syndrome in ahfs .

impaired cardiac function leads to activation of the neurohumoral axis , sodium and water retention , congestion and ultimately impaired kidney function . this sequence of events has been termed the cardiorenal syndrome . this is different from the increase in cardiovascular complications which occur with primary kidney disease , that is , the so - called renocardiac syndrome . the present review discusses the pathogenesis of the cardiorenal syndrome followed by the benefits and potential deleterious effects of pharmacological agents that have been used in this setting . the agents discussed are diuretics , aquaretics , natriuretic peptides , vasodilators , inotropes and adenosine 1 receptor antagonists . the potential role of ultrafiltration is also briefly discussed .

the recent re - discovery of human brown adipose tissue ( bat ) ( 14 ) has triggered intense scientific interest in the potential of this tissue as a target against obesity and its metabolic abnormalities . numerous studies investigated the origin , plasticity , and metabolic characteristics of this tissue in animals ( reviewed at ( 5 ) ) . however , these findings must be translated into humans in order for any therapeutic value to be realized . currently , only a handful of studies have reported data from human bat ( 1 , 2 , 4 , 615 ) primarily using samples collected during surgeries ( 2 , 4 , 6 ) , necropsies ( 7 , 12 , 14 ) or using an open biopsy technique ( 1 , 8 , 9 , 13 ) . hampering the effort to study the biology of human bat is the lack of a safe method for the routine sampling of this tissue for research purposes . the bergstrm needle has long been used for non - image guided biopsy of muscles / soft tissues ( 16 ) , while computed tomography ( ct ) -guided biopsy technique is well known and refined over the past 30 years for all types of tissues ( 17 ) . the purpose of this report is to describe a novel positron emission tomography ( pet ) and ct - guided bergstrm needle technique to sample supraclavicular human bat deposit .

brown adipose tissue ( bat ) has been proposed as a potential target tissue against obesity and its related metabolic complications . although the molecular and functional characteristics of bat have been intensively studied in rodents , only a small number of studies have used human bat specimens due to the difficulty of sampling human bat deposits . we established a novel positron emission tomography and computed tomography - guided bergstrm needle biopsy technique to acquire human bat specimens from the supraclavicular area in human subjects . forty - three biopsies were performed on 23 participants . the procedure was tolerated well by the majority of participants . no major complications were noted . numbness ( 9.6 % ) and hematoma ( 2.3 % ) were the two minor complications noted , which fully resolved . thus , the proposed biopsy technique can be considered safe with only minimal risk of adverse events . adoption of the proposed method is expected to increase the sampling of the supraclavicular bat depot for research purposes so as to augment the scientific knowledge of the biology of human bat .

ureteropelvic junction ( upj ) obstruction has been classically treated through the standard open approach with outstanding results . since anderson - hynes ( ah ) reported the first dismembered pyeloplasty , a great number of authors have published excellent results , with overall success rates of 90 - 100 % . their technique respected the basic principles of the open classical approach while providing less morbidity and faster recovery . since then , transperitoneal and retroperitoneal approaches have been described and advocated by several authors , with excellent results . in order to ease laparoscopic repair and decrease surgical time , many alternative time saving maneuvers and even robot assistance have been developed . these alternative techniques helped in bringing the operative time close to that of open surgery and made laparoscopic pyeloplasty a more desirable alternative . we evaluated the transmesocolic technique as a way to reduce operative time and facilitate repair by avoiding colon displacement and compare it with conventional retrocolic laparoscopic pyeloplasty ( rlp ) in cases of left sided ureteropelvic junction obstruction ( upjo ) .

objective : this prospective randomized study was designed to evaluate the feasibility and outcome of transmesocolic laparoscopic pyeloplasty ( tmp ) and compare it with retrocolic laparoscopic pyeloplasty ( rlp ) in pediatric and adolescent patients.materials and methods : between september 2006 to may 2012 , data of pediatric and adolescent patients undergoing laparoscopic pyeloplasty were recorded in a prospective manner . data included age , pelvic volume , presence of stones , aberrant vessels , operative time , analgesics requirement and time to accept oral feeds and drain removal . patients with left side pelviureteric junction obstruction with any size of pelvic volume , with or without renal stones and aberrant vessels were included in the study . patients were assigned into two groups by simple randomization technique . a total of 38 tmp and 41 left sided rlp were performed . median follow - up period for transmesocolic group was 12.5 months ( 9.5 - 62 months ) and 14 months ( 8 - 66 months ) for retro colic group . outcome for this study was adequate drainage on renal scan , improvement in symptom and or resolution of hydronephrosis on ultrasound . statistical analysis was performed using the mann - whitney test.results : the mean patient age was 8.73 years in rlp and 7.73 years in tmp . in rlp group the mean operative time was 75.84 min ( time from port insertion to pyeloplasty ) and 135.4 min ( total operative time ) while it was 44.82 min and 104.82 min respectively in tmp group . compared with classic rlp , tmp cases showed a significant reduction in operative time.conclusions : the transmesocolic approach for left sided pyeloplasty enables a shorter operative time even in the presence of large pelvis , aberrant vessel and stones without increasing morbidity in comparison to rlp approach .

long - term oxygen therapy ( ltot ) is one of the main treatments for patients with stage iv chronic obstructive pulmonary disease ( copd ) and is associated with improved survival ( evidence a , according to the evidence level scheme employed in previous global initiative for chronic obstructive lung disease reports ) .1 other benefits of treatment include hemodynamic improvement in hematological parameters , increased exercise capacity , improved quality of life , and improved mental state.14 the home conditions for use of a complex treatment such as ltot can be far from ideal.5 the recommendations made when prescribing may not be carried out at home , and treatment noncompliance interferes with the effectiveness of ltot.6 a study by hjalmarsen et al7 showed that patients with hypoxemia who did not undergo follow - up supervised by a specialist had worse survival rates than patients who were monitored regularly by specialized staff . in addition , an italian study that evaluated 1504 patients with severe hypoxemia showed that patient compliance can be improved with multiple educational sessions about the need to use ltot.8,9 data from the literature show that prescription compliance in patients receiving ltot is less than ideal , and only 37 % 65 % of patients use the treatment for more than 15 hours a day.1012 the home visit may be a supplement to the doctor s prescription , as a means to follow up on patients receiving ltot , especially for those who can not travel to the hospital or who miss scheduled appointments . home visits are usually well accepted by patients who require stricter control.13 however , the essential components , appropriate professionals , frequency of visits , and minimum duration required to achieve the desired benefits of home visits have not yet been established.14 the home visits generally include interviews , systematic observation , and guided and participatory intervention . the home visit is a way for the health care professional to access the home and living environment of patients ; these professionals seek to educate , prevent , restore , and maintain the health of ltot recipients in the context of their own homes.15 in this regard , the goal of this study was to identify the characteristics of patients receiving ltot who were residing in the municipality of botucatu , brazil , and to develop knowledge regarding the home environments of these patients . these patients received care at the ltot clinic at the clinical hospital of the botucatu school of medicine , universidade estadual paulista . through this , the authors hope to propose intervention measures to improve quality of care and treatment outcomes .

purposelong - term oxygen therapy ( ltot ) is one of the main treatments for patients with chronic obstructive pulmonary disease . patients receiving ltot may have less than optimal home conditions and this may interfere with treatment . the objective of this study was , through home visits , to identify the characteristics of patients receiving ltot and to develop knowledge regarding the home environments of these patients.methodsninety-seven patients with a mean age of 69 plus or minus 10.5 years were evaluated . this study was a cross - sectional descriptive analysis . data were collected during an initial home visit , using a questionnaire standardized for the study . the results were analyzed retrospectively.resultsseventy-five percent of the patients had chronic obstructive pulmonary disease , and 11 % were active smokers . the patients mean pulse oximetry values were 85.9 % plus or minus 4.7 % on room air and 92 % plus or minus 3.9 % on the prescribed flow of oxygen . most of the patients did not use the treatment as prescribed and most used a humidifier . the extension hose had a mean length of 5 plus or minus 3.9 m ( range , 1.516 m ) . in the year prior to the visit , 26 % of the patients received emergency medical care because of respiratory problems . few patients reported engaging in leisure activities.conclusionthe home visit allowed us to identify problems and interventions that could improve the way ltot is used . the most common interventions related to smoking cessation , concentrator maintenance and cleaning , use of a humidifier , and adjustments of the length of the connector hose . therefore , the home visit is a very important tool in providing comprehensive care to patients receiving ltot , especially those who show lack of adequate progress and those who show uncertainty about the treatment method .

complex sphingolipids , including sphingomyelin ( sm ) and glycosphingolipids ( gsls ) , are essential components of intestinal membranes , providing protection and integrity to the mucosa and regulating intestinal digestion and absorption processes . as in other organs , in the intestine , simple sphingolipids / sphingoids , which are intermediates of sphingolipid metabolism , are involved in the control of key cellular events such as survival , proliferation , differentiation , and apoptosis . indeed , the metabolism of complex sphingolipid includes enzymes involved in different signaling pathways , which lead to the formation of bioactive molecules , including ceramide ( cer ) and sphingosine ( sph ) , as well as their 1-phosphorylated derivatives ceramide-1-phosphate ( c1p ) and sphingosine-1-phosphate ( s1p ) . the role and impact of sphingolipids and sphingolipid - mediated signaling emerged in their relevance in intestinal disorders , when aberrations in their metabolism lead to an altered sphingolipid homeostasis . herein , we review our current knowledge on the impact of sphingolipid disequilibrium on intestinal inflammation , focusing on inflammatory bowel disease ( ibd ) .

complex sphingolipids are essential structural components of intestinal membranes , providing protection and integrity to the intestinal mucosa and regulating intestinal absorption processes . the role of sphingolipid signaling has been established in numerous cellular events , including intestinal cell survival , growth , differentiation , and apoptosis . a significant body of knowledge demonstrates that intestinal sphingolipids play a crucial role , as such and through their signaling pathways , in immunity and inflammatory disorders . in this review , we report on and discuss the current knowledge on the metabolism , signaling , and functional implications of sphingolipids in inflammatory bowel disease ( ibd ) , focusing on the different aspects of sphingolipid actions on inflammatory responses and on the potential of sphingolipid - targeted molecules as anti - ibd therapeutic agents .

nephrotic syndrome ( ns ) is characterized by massive proteinuria , hypoalbuminemia , edema and hyperlipidemia with 2 - 3/100,000 annual incidences . steroid has a main role in treatment , but patients who do not have appropriate response to steroid , have a greater chance to attain end stage renal disease ( esrd ) . therefore , detecting early stages of chronic kidney diseases ( ckd ) has greatest importance in treating patients at risk . the available standard biochemical markers are not sensitive enough to determine high - risk patients . however , a variety of factors including response to steroid , hypertension , extent of glomerular sclerosis and interstitial fibrosis have been accepted as prognostic markers of getting esrd . recently , new biomarkers have been introduced to define patients at risk . among these biomarkers , there is few data regarding the role of ngal and cystatin - c in children with ns . in this study , we evaluated serum ngal and cystatin - c in both steroid sensitive nephrotic syndrome ( ssns ) and steroid resistant nephrotic syndrome ( srns ) children . in addition , we evaluated any possible correlation between these two biomarkers and response to steroid .

background : nephrotic syndrome ( ns ) is a major clinical concern in human health , especially in children . despite of the etiology , the prediction of remission in different treatment regimens based on suitable biomarkers is under development . the goal of this evaluation was the demonstration of correlation between serum level of neutrophil gelatinase associated lipocalin ( ngal ) and cystatin - c with kidney function in patients with ns.methods : during the period between september 2008 and december 2011 , 52 patients admitted to st . al zahra university hospital were selected for evaluation . the measured parameters consisted of ngal , cystatin - c , creatinine , albumin , blood urea nitrogen , urine protein , glomerular filtration rate . demographic data were collected and considered in comparisons . comparison between variables and their correlations were examined.results : means of serum ngal and cystatin - c were significantly higher in case than the control group , p < 0.05 . the mean of serum ngal in patients without remission and who achieved remission were 23.09 ( standard deviation [ sd ] 10.11 ) and 36.26 ( sd 20.10 ) ng / ml respectively ; p < 0.05 . serum ngal levels had a correlation with the following factors : systolic blood pressure , diastolic blood pressure ( dbp ) , cystatin - c , remission . linear regression analysis showed a significant correlation between cystatin - c and systolic and dbp.conclusions : based on the results , serum ngal can be used as a prognostic marker for remission . in addition , ngal and cystatin - c are biomarkers of kidney injury in ns .

in spite of the various benefits provided by orthodontic treatment , the retentive surfaces of the appliance make them difficult to clean and are directly responsible for food and biofilm accumulation . imbalances such as gingivitis , gingival hyperplasia and caries may occur during orthodontic treatment , especially when patients do not cooperate with regard to performing the recommended cleaning protocols . in this context , there is an increase in the acidogenic bacterial populations , such as streptococcus mutans and lactobacillus sp in the plaque and saliva . the set formed by retentive niches , added to the deficient oral hygiene and a diet rich in fermentable carbohydrates also favors the increase in the candida albicans population in the oral cavity , particularly if there is caries activity . there are reports in the literature that microorganisms of the oral microbiome adhere firmly to resin materials . it is also known that components present in the matrix of adhesive materials may accelerate bacterial growth , increasing the levels of pathogens extremely harmful to tissues . therefore , the ideal bonding material must be capable of withstanding salivary biochemistry , constant changes in ph , different temperatures , and especially the resident oral microbiota . thus , the importance must be pointed out of maintaining essential properties , such as : hardness , roughness and fluoride release capacity , since these are intimately related to the retention of microorganisms and the maintenance of oral health . in view of the biofilm - composite interaction , which is capable of negatively altering the surfaces of materials for orthodontic bonding , these must have adequate resistance and antimicrobial activity . fluoridated bonding materials have been inserted outstandingly in orthodontics because of their fluoride release capacity , irrespective of the patients ' cooperation . nevertheless , it is important to point out that these materials are recommended as supplementary to and not as substitutes for conventional prophylactic alternatives , since their anticariogenic capacity is still being widely discussed . in view of the context presented , the aim of this study was to evaluate the microbial inhibition capacity of three orthodontic bonding materials , and their fluoride release in vitro . thus , the hypothesis considered in the present study was that bonding materials play a biological influence to orthodontic treatment outcomes . the capacity of the material to release fluoride and prevent microbial contamination can be noted in the prevention and maintenance of the integrity of the oral tissues .

objectivethe aim of this study was to evaluate the antimicrobial and fluoride releasing capacity of 3 bonding materials.material and methodsthirty nine specimens with standardized surface smoothness and dimensions were prepared . the antimicrobial capacity of the materials against s. mutans , l. casei and c. albicans was evaluated by determining the percentage of growth inhibition of these microorganisms in an inoculated medium , obtained by optical density readouts on a spectrophotometer . the potential to interfere in microbial growth on the surface of the studied materials was observed by means of scanning electron microscopy ( sem ) . the fluoride release capacity in ultrapure water for 14 days was analyzed by means of ion chromatography . resultsthe plus group presented the highest percentage of microbial inhibition and the most contamination - free surface . the fuji group presented the best fluoride release capacity.conclusionsthe transbondtm plus color change was the one that presented the best general behavior considering the evaluated aspects .

the differential diagnosis of membrane thickening in renal biopsies includes primary and secondary membranous nephropathy ( mn ) , diabetic nephropathy and amyloidosis . of these , mn is the most common cause of nephrotic syndrome in adults accounting for 20 - 30 % cases . the diagnosis is based on clinical features and characteristic light microscopic findings of diffuse thickening of glomerular capillary wall . however , in early membranous cases , the membrane thickening and spikes may not be obvious . in such situation immunofluorescence ( if ) examination is necessary to differentiate from minimal change disease ( mcd ) where in mn shows granular staining with immunoglobulin g ( igg ) and or c3 . in the absence of availability of fresh tissues or absence of glomeruli in the frozen tissue , the diagnosis of mn can not be confirmed . immunohistochemistry ( ihc ) with c4d has been reported as a novel marker for diagnosis of mn in various published studies . in addition to its diagnostic utility , it also adds insight to pathogenesis of mn . mn is characterized by deposition of immune complexes in sub epithelial region of the glomerular capillary wall . the formation of these in situ immune complexes results in activation of complement which generates formation of c4d . it binds to the epithelial and endothelial cell surfaces and can be used as a marker of complement activation in mn . in this study

background : membranous nephropathy ( mn ) is the most common cause of nephropathy in adults . the diagnosis is based on characteristic light microscopic , electron microscope and immunofluorescence ( if ) findings . in early mn , the light microscopic findings may be difficult to differentiate from minimal chain disease . in the absence of fresh frozen tissue for if , immunohistochemistry with c4d aids in the diagnosis.materials and methods : a total 48 cases of mn diagnosed on renal biopsy were analyzed . the formalin fixed paraffin embedded tissues were stained with routine hematoxylin and eosin stains along with periodic acid - schiff and silver methenamine stains to highlight the basement membrane . fresh frozen tissues were available for if in 40 cases . immunostaining with c4d was done on paraffin - embedded sections by polymer - horse radish peroxidase ( hrp ) technique using polyclonal antiserum to c4d ( biogenex , india ) .results : there were 25 cases of idiopathic mn , 17 cases of class v lupus nephritis and 2 cases were secondary to hepatitis c infection with cirrhosis . the glomerular basement membrane ( gbm ) was diffusely thickened with formation of spikes in 28 cases . in 11 cases the capillary loops were rigid but spikes were not seen and in 9 cases there was no apparent thickening of the basement membrane . all the cases showed diffuse positivity for c4d along the gbm.conclusion : c4d is a reliable method to establish the diagnosis of mn and also a sensitive marker of complement activation reflecting the pathogenesis of mn .

blastic plasmacytoid dendritic cell neoplasm ( bpdcn ) is a rare hematologic malignancy that typically involves the skin , lymph nodes , the peripheral blood and the bone marrow . this tumor expresses cd4 and cd56 with no obvious evidence of b- or t - cell differentiation . since adachi et al . ( 1 ) first described cd4+/cd56 + hematodermic neoplasm in 1994 , several individual cases or small groups of cases of this disease have been reported . relapse frequently occurs within 6 months or less from the initiation of chemotherapy and most patients experience rapid progression that is refractory to conventional chemotherapy . we report here on a case of advanced bpdcn that was initially misdiagnosed as cutaneous lupus erythematosus .

blastic plasmacytoid dendritic cell neoplasm ( bpdcn ) is a rare disease . the prognosis is poor in most cases with rapid progression despite administering chemotherapy . a 67-year - old man complained of skin rashes on his back and this spread to the trunk , face , arms and thighs , and he was initially diagnosed with cutaneous lupus erythematosus according to the skin biopsy . the skin rashes then became aggravated on a trial of low dose methylprednisolone for 3 months . repeated skin biopsy revealed a diffuse infiltration of lymphoid cells with medium sized nuclei , positive for cd4 and cd56 , negative for epstein - barr virus ( ebv ) , indicating a diagnosis of bpdcn . further workups confirmed stage iva bpdcn involving the skin , multiple lymph nodes , the peripheral blood and the bone marrow . he was treated with six cycles of combination chemotherapy consisting of ifosphamide , methotrexate , etoposide , prednisolone and l - asparaginase , and he achieved a partial response . herein we report on a rare case of bpdcn that was initially misinterpreted as cutaneous lupus erythematosus .

studies have shown that most acute coronary syndromes ( acs ) result from the rupture of unstable plaques and subsequent thrombus formation ( 1 , 2 ) . the risk of atherosclerotic plaque disruption and thrombosis is thought to be closely related to plaque composition rather than the severity of an actual luminal stenosis ( 3 - 5 ) . therefore , it is of paramount clinical importance to elucidate the composition of coronary atherosclerotic plaques . the atherosclerotic plaque imaging is the arterial wall imaging ( 6 , 7 ) . atherosclerosis is a systemic disease of the vessel wall that occurs frequently in the aorta and in the carotid , coronary and peripheral arteries . the formation and development of the atherosclerotic plaque is at the arterial intima . a number of publications ( 8 - 10 ) showed that vivo and ex vivo mr imaging can characterize the composition of great vessels , such as carotid and aortic atherosclerotic plaques . however , imaging the coronary artery wall with magnetic resonance in vivo is challenging due to the cardiac and respiratory motion artifacts , smaller size and tortuous course . currently , bright blood technique is usually used in imaging human coronary artery in vivo ( 11 ) . although the black blood technique was used in human coronary artery studies in vivo ( 12 - 14 ) , only coronary wall thickening could be delineated but the compositions of coronary atherosclerotic plaque were not identified . poor spatial resolution is another limitation for mri when identifying coronary atherosclerotic plaque composition in vivo . but the studies were minimal and the procedure was complicated , the coronary artery was dissected from heart ( 15 , 16 ) . recent study demonstrated that ex vivo mri imaging can classify the human coronary atherosclerotic plaques ( 17 ) . the general purpose of the present study is to investigate the feasibility and optimize imaging protocol for ex vivo porcine and human coronary artery wall using mri , thus , potentially directing vivo mr vessel wall imaging techniques for characterizing coronary atherosclerotic plaques .

objectiveto optimize the mr imaging protocol for coronary arterial wall depiction in vitro and characterize the coronary atherosclerotic plaques.materials and methodsmri examination was prospectively performed in ten porcine hearts in order to optimize the mr imaging protocol . various surface coils were used for coronary arterial wall imaging with the same parameters . then , the image parameters were further optimized for high - resolution coronary wall imaging . the signal - noise ratio ( snr ) and contrast - noise ratio ( cnr ) of images were measured . finally , 8 human cadaver hearts with coronary atherosclerotic plaques were prospectively performed with mri examination using optimized protocol in order to characterize the coronary atherosclerotic plaques.resultsthe snr and cnr of mr image with temporomandibular coil were the highest of various surface coils . high - resolution and high snr and cnr for ex vivo coronary artery wall depiction can be achieved using temporomandibular coil with 512 512 in matrix . compared with histopathology , the sensitivity and specificity of mri for identifying advanced plaques were : type iv - v ( lipid , necrosis , fibrosis ) , 94 % and 95 % ; type vi ( hemorrhage ) , 100 % and 98 % ; type vii ( calcification ) , 91 % and 100 % ; and type viii ( fibrosis without lipid core ) , 100 % and 98 % , respectively.conclusiontemporomandibular coil appears to be dramatically superior to eight - channel head coil and knee coil for ex vivo coronary artery wall imaging , providing higher spatial resolution and improved the snr . ex vivo high - resolution mri has capability to distinguish human coronary atherosclerotic plaque compositions and accurately classify advanced plaques .

carcinoma of the gallbladder is more common in women and usually seen in patients older than 50 years of age . it is more common in the white population than the black and in western countries than the mediterranean . although areas of squamous differentiation is seen in adenocarcinoma , pure primary squamous cell carcinoma is rarely reported and accounts for less than 1 % of all gallbladder malignancies . some researchers have stated that squamous cell carcinoma originates from pre - existing squamous metaplasia of the gallbladder epithelium , while others concluded that it originates from squamous differentiation of neoplastic cells of adenocarcinoma . we present a pure case of squamous cell carcinoma with some areas of squamous metaplasia in the vicinity of the invasive tumor . another purpose of this case presentation was to emphasize on the vague clinical presentation of gallbladder carcinoma .

squamous cell carcinoma of the gallbladder is rare and constitutes only 0.5 - 3 % of all malignancies of this organ . most of the reported cases have had a component of adenocarcinoma . we report a 70-year - old man who presented with acute onset right upper quadrant pain . he operated on based on a presumptive diagnosis of acute cholecystitis according to clinical and ultrasonographic findings . histopathological examination of the infiltrating mass of the gallbladder revealed well differentiated keratinized squamous cell carcinoma invading full wall thickness . thorough evaluations revealed no other primary site for the tumor . pure primary squamous cell carcinoma of the gallbladder is rarely reported . clinicians and pathologists must be aware of its vague clinical presentations .

the absence of heart sounds on auscultation at the pre - cordial area , confusion during the diagnosis of acute cholecystitis , acute appendicitis and splenetic lesion on the basis of clinical examination raises the suspicion of one rare condition , the situs inversus totalis . this rare condition is characterized by total transposition of thoracic and abdominal viscera , and the predicted incidence is one in 10,000 among the general population . [ 14 ] during the embryological development , a 270 degree clockwise rotation instead of normal 270 degree anti - clockwise of the developing thoraco - abdominal organs results in mirror image positioning of the abdominal and thoracic viscera . the association of situs inversus totalis with syndromes such as kartagener 's syndrome , cardiac anomalies , spleen malformations and other such clinical entities makes the clinical scenario extremely challenging for the concerned anaesthesiologist . this rare condition is well described by a few surgical and medical journals , but the anaesthetic implications and considerations have not been thoroughly explained by any anaesthesia speciality journal . we are reporting a case of situs inversus totalis who was operated for symptomatic cholelithiasis , with an aim of thorough discussion of the anaesthetic considerations and implications associated with such anatomical abnormalities .

situs inversus totalis is a rare condition with a predicted incidence of one in 10,000 among the general population , the aetiologic factors for which are still not completely understood . in a patient with situs inversus totalis , not just the diagnosis of any acute abdomen pathology is difficult due to distorted anatomy and transposition of thoraco abdominal viscera but equally challenging is the anaesthetic management during the respective surgical procedure . we are reporting a patient who had situs inversus totalis and was operated for open cholecystectomy . the present case report lays an emphasis on the potential difficulties during anaesthetic management and its various implications .

brugada syndrome ( brs ) is recognized as an important cause of sudden cardiac death ( scd ) occurring in individuals at a relatively young age . brs is an inherited cardiac arrhythmia condition , characterized by coved st elevation and j point elevation of at least 2 mm in at least two of the right precordial electrocardiogram ( ecg ) leads ( v1 - 3 ) 1 ) . it is a familial condition that displays an autosomal dominant mode of transmission . in the majority of patients , brs is caused by mutations in the cardiac sodium channel gene scn5a , which encodes the -subunit of the sodium channel . there are fewer reports of pediatric brs than adult because brs usually develops as arrhythmia in adulthood .

brugada syndrome is a rare channelopathy associated with the scn5a gene that causes fatal ventricular arrhythmias . this case of brugada syndrome , in which ventricular tachycardia ( vt ) was provoked by high fever , is the first report in a korean child . the boy had retinoblastoma of his left eye diagnosed at 16 months of age . after chemotherapy , he contracted a catheter - related infection with a high fever up to 41 leading to monomorphic vt . this was characterized as having right bundle branch block morphology , superior axis deviation , and a heart rate of 212/min . direct current cardioversion recovered the vt to sinus rhythm after a lack of response to amiodarone and lidocaine . a second attack of vt that was not controlled by cardioversion , however , responded to lidocaine . the baseline electrocardiogram showed a long pr interval and qrs duration , and the patient 's grandfather had a history of brugada syndrome . a mutation in scn5a was identified in this patient , his father , and his grandfather . the patient was treated with quinidine and followed up for 1 year .

urinary stones are rarely seen in the urethra and are usually encountered in men with urethral stricture or diverticulum . urethral diverticula can present in many ways , including recurrent urinary tract infections ( utis ) , dysuria , increased urinary frequency , urgency , and hematuria . in addition to causing the symptoms above , diverticula also can be complicated with stones or malignancy , both of which can lead to bladder outlet or urethral obstruction . stone formation has been reported to occur in 1 % to 10 % of patients with urethral diverticula . urinary stasis and chronic infection have been identified as the causes of calculi formation within urethral diverticula . the case of a woman with a giant calculus in a urethral diverticulum is reported .

abstracturethral diverticula with calculi have a low incidence as reported in the literature . diverticulum of female urethra is rare , often discovered due to associated complications . we report a case of diverticulum of the female urethra containing giant calculi in a 62-year - old multiparous woman . she consulted with our office due to dysuria and a hard , painful periurethral mass in the anterior vagina wall . the diverticulum was approached surgically by a vaginal route , and local extraction of the calculi and subsequent diverticulectomy successfully treated the condition.diagnosis of a complicated diverticulum can be easily achieved if one possesses a high degree of clinical symptoms .

accidental ingestion of foreign bodies like coins , fish bones , plastic toy parts , batteries and needles are common in toddlers and pre - school children . the battery cells are potentially hazardous as they cause chemical mucositis and because of their capability to generate electric current . the mucosal damage starts early and may lead to life - threatening complications in long - standing cases .

a computer lithium battery cell was impacted in the cricopharynx of a 1 year and 9 month - old child . the battery cell was safely removed with the pediatric flexible oesophagoscope under anesthesia without trauma to the surrounding structures . the lithium battery cell is potentially dangerous due to its ability to cause chemical damage to the mucosa and cause early inflammation and edema leading to dysphagia and respiratory obstruction . hence , it should be promptly extracted without delay to prevent catastrophe . the toddler recovered uneventfully in the immediate post - operative period and was followed - up for the last 1 year without any complication . to the horizon of our knowledge , no previous case was reported with computer battery cell in the cricopharynx of a toddler in eastern india . in conclusion , parent education is important in the early detection of foreign bodies and their interventions .

wound infection could result in prolonged hospital stay , increased trauma care , and high treatment costs if not properly attended to . gram - negative bacteria have been reported to be the major etiologies of wound infections . [ 13 ] extended - spectrum beta - lactamases ( esbl ) are -lactamases capable of conferring bacterial resistance to the penicillins , first , second , and 3gcs , and aztreonam ( but not the cephamycins or carbapenems ) and are usually encoded on plasmids which frequently carry genes encoding resistance to other classes of antibiotics . members of the enterobactericeae family are fast emerging as important agents for the spread of esbl genes and strains of k. pneumoniae , k. oxytoca , and e. coli have been reported . a considerable geographical spread of these lactamase - producing bacteria is being reported and is becoming a global problem in treating infections with 3gc antibiotics . that esbls are encoded on plasmids and are , therefore , easily transmissible from one organism to another is a therapeutic challenge for physicians as resistance genes for other antimicrobials such as aminoglycosides , tetracyclines , and trimethoprim / sulfamethoxazole are often present on the same plasmid , [ 68 ] thereby contributing further to the narrowing of the already limited treatment alternatives of choice of antibiotics . there is currently scanty data on esbl - producing organisms from wound infections in nigeria and we have not come across documented report on the association of esbl - producing bacilli with orthopedic wound infections in the orthopedic ward of the oauthc , ile - ife , nigeria . we carried out a study to investigate the incidence of esbl - producing gram - negative bacteria in orthopedic wound infections here in ile - ife , nigeria , and to determine the possible genetic medium of transfer of the esbl - gene in vitro .

background : extended - spectrum beta - lactamase ( esbl ) -producing gram - negative bacteria are emerging and impacting significantly on the management of patients and hospital costs . besides , they are not being routinely sought after in diagnostic laboratories thus contributing to treatment failure.materials and methods : bacterial isolates from wounds of 45 patients were identified using commercial identification kits and antibiotic susceptibility was evaluated by the bauer - kirby method . screening and phenotypic confirmation of esbl production were done as prescribed by the clinical and laboratory standards institute . the conjugation experiment was performed by the mating assay in broth between the esbl producers and e. coli atcc 25922 as the recipient.results : out of 102 gram - negative bacteria isolated , 36 were positive for esbl mainly of the enterobacteriaceae family ( 33 ) and the rest were oxidase - positive bacilli ( 3 ) . the predominant bacteria were klebsiella spp . and e. coli . others were serratia rubidae , citrobacter freundii , morganella morgannii , proteus spp . , providencia stuartii , and enterobacter spp . there was a significant association between treatment with third - generation cephalosporins ( 3gcs ) and isolation of esbls ( p=0.0020 ) . the esbl producers were multiply resistant and moderately sensitive to colistin . the conjugation experiment showed that the esbl gene was transferred horizontally and tetracycline , cotrimoxazole , nitrofurantoin , gentamicin , and aztreonam resistance genes were co - transferred . no mortality was recorded but the mean length of stay in the hospital was 82 days.conclusion : the development and spread of esbl among gram - negative bacteria and possible horizontal transfer calls for concern , especially in view of treatment failure , high treatment cost , and consequent discomfort to patients .

benign prostatic hyperplasia ( bph ) is one of the most common diseases in men of middle age and over in korea . its importance and frequency are rapidly increasing as the result of increases in the elderly population , increases in the accessibility of westernized diets , increases in desires for improvements in quality of life , and other medical , social , and economical changes . the early treatment chosen most often for bph is pharmacotherapy , but it is not appropriate for some patients . when the side effects of pharmacotherapy , such as dry mouth and orthostatic hypotension , are severe , patients may choose surgical treatment instead . also , in cases accompanied by repetitive urinary tract obstruction , infection , bladder stone , renal failure , and gross hematuria , surgery is considered first rather than medical therapy . up to now , transurethral resection of the prostate ( turp ) was the standard surgical method , but turp can have complications such as postoperative bleeding , urethral stricture , urinary incontinence , retrograde ejaculation , and transurethral resection ( tur ) syndrome . . photoselective vaporization of the prostate ( pvp ) by use of a laser was attempted as a minimally invasive treatment in order to reduce these side effects . recently , pvp using an 80 w potassium - titanyl - phosphate ( ktp ) laser or 120 w lithium triborate ( lbo ) laser , which produces high energy , has been introduced and used . according to several studies , pvp was also reported to significantly reduce operation time , hospitalization period , and urethral foley catheter indwelling duration and to reduce complications by reducing the amount of bleeding [ 5 - 7 ] . in particular , the operation time becomes longer and complication rates increase after the operation compared with turp if the prostate size is large . still , because most previous studies dealt with patients with large prostates and analyzed the surgery results by comparison with turp , it is not clear whether pvp results differ depending on prostate volume [ 6,8,10 - 13 ] . therefore , in the present study , we divided patients who underwent pvp at our hospital into 2 groups : those with prostate volumes of less than 60 cc and those with volumes of 60 cc or greater . the two groups were compared in order to examine the utility and stability of pvp depending on prostate volume .

purposethis study was conducted to perform a comparative analysis of the efficacy and safety of photoselective vaporization of the prostate ( pvp ) for treatment of benign prostatic hyperplasia ( bph ) in men with a prostate volume greater than 60 cc.materials and methodsthe clinical data of 249 men with symptomatic bph who underwent pvp between january 2006 and june 2008 were retrospectively analyzed . all patients were classified into two groups according to their prostate volume ( group a , < 60 cc ; group b , 60 cc ) . the preoperative evaluation included a digital rectal exam , urinalysis , prostate - specific antigen levels , international prostate symptom score ( ipss ) , quality of life ( qol ) score , maximal flow rate ( qmax ) , postvoid residual urine volume ( pvr ) , and transrectal ultrasonography . the total operative time , used energy ( kj ) , urethral foley catheter indwelling period , and the number of hospital days were recorded afterward . the ipss , qol score , qmax , and pvr were evaluated at 1 , 3 , 6 , and 12 months postoperatively.resultsin both groups , significant improvements in the subjective and objective voiding parameters were achieved and these improvements were sustainable for at least 1 year with minimal complications . during the follow - up period , the pvr in group b significantly increased . retrograde ejaculation and urethral stricture were the common complications in both groups . there was no significant difference in the incidence rate.conclusionspvp is safe and efficacious , with durable results for men with symptomatic bph and large prostate volumes .

the current standard of care for newly diagnosed glioblastoma ( gbm ) remains surgical resection followed by radiotherapy with concurrent temozolomide ( rt / tmz ) and then maintenance temozolomide for at least six months . the addition of chemotherapy introduced new questions regarding biological response of the tumor and the surrounding brain . pseudoprogression is a phenomenon of subacute imaging changes in human glioma subsequent to radiochemotherapy suggestive of progression , with or without associated clinical sequelae , which resolve spontaneously without further therapy . some authors suggest that it likely reflects an inflammatory tissue reaction after a local treatment secondary to vascular and oligodendroglial injury , whereas others associate it with an exaggerated response to effective therapy [ 2 , 6 , 7 ] . the incidence of pseudoprogression , time of occurrence , and its impact on prognosis remain poorly defined . incidence has been reported to vary between 12 % and 64 % in different series , and this phenomenon commonly occurs in the first 3 months after radiochemotherapy , occasionally persisting for up to six months after treatment [ 2 , 5 ] imaging changes suggestive of pseudoprogression consist of an increase in gadolinium enhancement on t1-weighted images and peritumoral edema [ 5 , 8 ] . despite technical advances in perfusion magnetic resonance imaging ( mri ) and positron emission tomography ( pet ) , no imaging technique is yet validated for detection of pseudoprogression and has not been incorporated into the latest response assessment criteria [ 911 ] . specifically p53 overexpression , o ( 6 ) -methylguanine - dna methyltransferase ( mgmt ) promoter methylation status , ki67 indices , and isocitrate dehydrogenase 1 ( idh1 ) mutation have been reported as potential biomarkers for detecting pseudoprogression . the response of brain tumors is classically reported using macdonald criteria based on the two - dimensional measurement of the enhancing area on ct or mri , in conjunction with clinical assessment and corticosteroid dose . however , this response evaluation has important limitations since posttreatment contrast enhancement in brain tumors is nonspecific and may not always be considered as a true surrogate of tumor response . differentiation between pseudoprogression and real progression is critical for making decisions on future therapy and for predicting the prognosis in clinical practice . the purpose of this study was to clarify the frequency of pseudoprogression after radiochemotherapy in a cohort of portuguese patients with glioblastoma , by comparing rano with the classical macdonald evaluation .

introduction . the aim of this study was to determine the frequency of pseudoprogression in a cohort of glioblastoma ( gbm ) patients following radiotherapy / temozolomide ( rt / tmz ) by comparing macdonald criterial to response assessment in neuro - oncology ( rano ) criteria . the impact on prognosis and survival analysis was also studied . materials and methods . all patients receiving rt / tmz for newly diagnosed gbm from january 2005 to december 2009 were retrospectively evaluated , and demographic , clinical , radiographic , treatment , and survival data were reviewed . updated rano criteria were used for the evaluation of the pre - rt and post - rt mri and compared to classic macdonald criteria . survival data was evaluated using the kaplan - meier and log - rank analysis . results and discussion . 70 patients were available for full radiological response assessment . early progression was confirmed in 42 patients ( 60 % ) according to macdonald criteria and 15 patients ( 21 % ) according to rano criteria . pseudoprogression was identified in 10 ( 23.8 % ) or 2 ( 13.3 % ) patients in macdonald and rano groups , respectively . cumulative survival of pseudoprogression group was higher than that of true progression group and not statistically different from the non - progressive disease group . conclusion . in this cohort , the frequency of pseudoprogression varied between 13 % and 24 % , being overdiagnosed by older macdonald criteria , which emphasizes the importance of rano criteria and new radiological biomarkers for correct response evaluation .

ureteropelvic junction ( upj ) obstruction is the most common form of upper urinary tract obstruction in children . the variations in renal arterial supply are best understood when embryology of the renal vasculature is considered . multiple renal arteries have been reported to occur in approximately 30 % of cases , with a preponderance on the left side . with respect to the presence of multiple renal arteries , by a study of sampaio et al . , an inferior accessory or aberrant artery was found to cross anteriorly to the upj in 6.8 % of the cases . in few specimens did this inferior accessory artery pass close to the upj . therefore , the presence of an anomalous vessel crossing the upj and causing obstruction is a very rare finding . we describe a 36-year - old woman with hydronephrosis due to upj obstruction by an aberrant renal artery and review the literature in brief .

ureteropelvic junction obstruction is usually intrinsic and is most common in children . aberrant renal arteries are present in about 30 % of individuals . aberrant renal arteries to the inferior pole cross anteriorly to the ureter and may cause hydronephrosis . to the best of our knowledge , although there are some papers about aberrant renal arteries producing ureteropelvic junction obstruction , there is no report of a case which is diagnosed by the new modalities , such as computed tomography angiogram ( cta ) or magnetic resonance angiogram ( mra ) . we describe a 36-year - old woman with right hydronephrosis . kidney ultrasonogram and excretory urogram revealed right hydronephrosis . cta and mra clearly displayed an aberrant renal artery and hydronephrosis . the patient underwent surgical exploration . for the evaluation of hydronephrosis by an aberrant renal artery , use of cta and mra is advocated .

the discovery of biomarkers useful for the early detection of epithelial ovarian cancer ( eoc ) has been complicated by several factors : ( i ) there are different histological subtypes of eoc that have very unique genetic alterations , ( ii ) the tissues and serum samples available for biomarker discovery are frequently collected from patients in later stages of the disease , and ( iii ) the expected sensitivity and specificity required for a biomarker to detect eoc is high due to the lower disease incidence and high risk surgical interventions . despite these obstacles , proteomic studies profiling potential biomarkers for eoc have the potential to increase our knowledge about this disease , leading to improvements in clinical disease management . glycoproteins account for 80 % of the proteins located at the cell surface and in the extracellular environment . therefore , strategies to identify glycoproteins that have tumor - specific glycosylation changes could lead to the discovery of novel diagnostic and therapeutic markers . in our present study , we are targeting the neutral n - linked glycan structure known as bisecting glycosylation that is amplified in ovarian cancer tissues , focusing on membrane proteins . membrane proteins play pivotal roles in regulating signaling pathways , and these proteins can frequently be found both on the cell surface and in circulation due to enzyme release making them ideal potential biomarkers . bisecting glycosylation , added by the glycosyltransferase known as gnt - iii , is normally expressed on glycoproteins in the brain and kidney . the functional effects of amplified bisecting glycosylation on the growth and spread of ovarian cancer have not been determined previously . in this manuscript , we have identified membrane proteins with bisecting glycosylation from human primary endometrioid and serous ovarian cancer tissues and determined the glycan structures from these proteins using mass spectrometry methods . functional annotation of this data demonstrates that membrane proteins with bisecting glycosylation in ovarian cancer have significant functions including : cell adhesion , control of immune responses , regulation of protein transport , and participation in signaling pathways such as notch , wnt , and tgf . also , our glycan structural analysis from primary ovarian tumor tissues demonstrates that gnt - iii overexpression in human ovarian cancer produces bisected n - linked glycans that have dramatic reductions in branching and extensions and may be useful as a biomarker for the development of therapeutic and diagnostic advances .

biomarkers capable of detecting and targeting epithelial ovarian cancer cells for diagnostics and therapeutics would be extremely valuable . ovarian cancer is the deadliest reproductive malignancy among women in the u.s . , killing over 14 000 women each year . both the lack of presenting symptoms and high mortality rates illustrate the need for earlier diagnosis and improved treatment of this disease . the glycosyltransferase enzyme gnt - iii encoded by the mgat3 gene is responsible for the addition of glcnac ( n - acetylglucosamine ) to form bisecting n - linked glycan structures . gnt - iii mrna expression is amplified in ovarian cancer tissues compared with normal ovarian tissue . we use a lectin capture strategy coupled to nano - esi rplc ms / ms to isolate and identify the membrane glycoproteins and unique glycan structures associated with gnt - iii amplification in human ovarian cancer tissues . our data illustrate that the majority of membrane glycoproteins with bisecting glycosylation are common to both serous and endometrioid histological subtypes of ovarian cancer , and several have been reported to participate in signaling pathways such as notch , wnt , and tgf .

, changes in oral cavity may lead to increased susceptibility to dental caries , periodontitis , xerostomia , and dental erosion , due to frequent vomiting during pregnancy . periodontal infections have been considered as a risk factor for pre - term birth , low birth weight , infant mortality or growth delay . pathogenic bacteria involved in the inflammation of periodontal tissues can decrease the blood supply of the placenta . the oral health practices of pregnant women can enormously affect the oral health of their children . behavioural factors such as irregular or no dental visits , poor oral hygiene , and high frequency of sweets consumption , which cause poor maternal oral health , are considered to play important role in the future oral health of their children [ 5 , 6 ] . cariogenic bacteria in mothers mouth have been demonstrated to have a positive correlation with occurrence and severity of early childhood caries in their children . dental caries can be controlled if parents start dental care of their infants as soon as tooth eruption begins in their oral cavity . parents are responsible for taking care of their infants teeth by brushing two times daily , using a smear of fluoridated toothpaste [ 5 , 6 ] . many studies have shown that pregnant women mostly have a negative attitude towards the importance of oral health care and dental treatment during pregnancy [ 710 ] . oral health professionals may utilize the pregnancy period as an opportunity to improve oral health of future mothers , and consequently promote the oral health of their children . maintaining oral health in pregnancy is very important . because pregnant women have regular health check - ups before , during , and after pregnancy , health providers such as midwives have a great opportunity to provide appropriate oral health instructions [ 11 , 12 ] . oral health promotion via educational programs may help decrease non - desirable changes in pregnant women s mouths and improve their quality of life . therefore , oral health should be integrated into health promoting strategies , especially in countries with less - developed public dental care . the aim of the current study was to evaluate the effect of an educational intervention on the oral health attitude and practices among the junior midwifery students of tehran university of medical sciences in 2010 .

objective : midwives may play an important role in oral health promotion of pregnant women , whom they are in close contact with . our aim was to evaluate an educational intervention on the oral health attitude and practices among the junior midwifery students of tehran university of medical sciences in 2010.materials and methods : the junior midwifery students were divided into intervention ( n=29 ) and control ( n=33 ) groups . the intervention group was first educated about general oral health , oral hygiene practices during pregnancy , and tooth brushing and flossing on models . subsequently , the students performed role playing to ensure they understood the aforementioned lessons correctly . before and three months after the training course the students filled out a validated self - administered questionnaire and a simplified plaque index was recorded . statistical analysis was done by mann - whitney test and linear regression models.results : before the intervention , the mean scores of attitude in general oral health for the intervention and control groups were 5.8 and 5.4 , respectively , which improved to 8.9 and 5.4 after the intervention ( p < 0.001 ) . the mean score of oral health attitude in pregnancy was 20.4 in the intervention group and increased to 30.9 ( p < 0.001 ) . the intervention group demonstrated much better oral health practices in pregnancy and lower plaque index score after the intervention.conclusion : the promising finding about attitude and practice improvement in midwifery students after participating in a short course on oral health promotion in pregnancy shows the necessity to enrich their training program by including this subject .

liver metastases from colorectal carcinoma ( crc ) commonly form nodular lesions in the liver parenchyma . however , there have been reports of unusual cases of metastatic liver tumors from crc that predominantly extend along the intrahepatic bile duct . such unusual tumors generally mimic intrahepatic cholangiocarcinoma ( ihcc ) clinically , radiographically , and pathologically . importantly , it remains unclear whether anatomical or partial hepatectomy is more suitable to treat such tumors . herein , we report a case of liver metastasis from crc presenting as an intrabiliary growth , and discuss the clinicopathological considerations that inform selection of the surgical procedure for such tumors .

liver metastases from colorectal carcinoma commonly form nodular lesions in the liver parenchyma . we report a case of liver metastasis from rectal adenocarcinoma that extended predominantly into the bile duct . a 62-year - old japanese man underwent low anterior resection for rectal adenocarcinoma 9 years ago . approximately 3 years later , he underwent radiofrequency ablation therapy for a metastatic liver tumor . nine years after surgery , a tumor in liver segment iii exhibiting intrabiliary extension was discovered ; it was unclear if this was a metastatic liver tumor or intrahepatic cholangiocarcinoma . accordingly , we performed a left hepatectomy with lymph node dissection . the tumor was negative for cytokeratins 7 and 20 , and was histologically similar to the primary rectal adenocarcinoma ; it was diagnosed as rectal carcinoma metastasis . the patient has survived for 3 years after the hepatic surgery , for 9 years after radiofrequency ablation therapy , and for 12 years after the primary surgery . this case shows that liver metastasis from colorectal carcinoma can present as a predominantly intrabiliary growth that mimics intrahepatic cholangiocarcinoma on imaging . moreover , our case provides evidence for the superiority of anatomical hepatectomy over partial hepatectomy for metastatic liver tumors with intrabiliary growth arising from rectal adenocarcinomas .

toll - like receptors ( tlrs ) recognize conserved pathogen - associated molecular patterns ( pamps ) of bacteria , viruses , yeast , fungi , and parasites . at least 13 tlr genes exist in mammals , and functional ligands have been identified . tlrs 19 are expressed in both mice and humans , whereas tlrs 1013 are expressed only in mice . a tight control of the tlr pathway is essential for maintaining homoeostasis , since overactivation of tlrs has been linked to various infectious and inflammatory diseases . tlr engagement leads to the activation of the transcription factor nuclear factor b ( nf-b ) , which regulates the induction of proinflammatory cytokines such as tumor necrosis factor ( tnf ) , interleukin-1 ( il-1 ) , and interleukin-6 ( il-6 ) . it can also activate members of the mitogen - activated protein kinase ( mapk ) family including p38 and c - jun n - terminal kinase ( jnk ) . these kinases are involved in the transcription of genes and regulate mrna stability . a tight regulation of these pathways results from post - translational modification processes . activation of tlr - mediated signaling by various agonists does not always involve a straightforward lock - and - key mode of ligand - receptor binding . the extracellular domains of all tlrs share important structural features , yet mediate responses to widely different agonists , pointing out that more complex interactions are involved . many additional proteins are required for the activation of tlr - mediated signaling by their agonists , including coreceptors and docking molecules on the cell surface and binding catalysts that promote certain interactions , such as heat shock proteins [ 46 ] . in addition to the essential contribution by coreceptors and accessory interaction partners , most tlrs also operate as homo- or heterodimers .

toll - like receptors ( tlrs ) are known to be expressed by innate immune response cells and to play a critical role in their activation against foreign pathogens . it was recently suggested that tlrs have an important role in the crosstalk between neurons and glial cells in the central nervous system ( cns ) . tlr signaling was reported to be associated with a yin - yang effect in the cns . while tlr signaling was linked to neurogenesis , it was also found to be involved in the pathogenesis of neurodegenerative diseases . this paper will focus on tlr signaling in glial cells in neurodegenerative diseases such as alzheimer 's disease , prion diseases , amyotrophic lateral sclerosis , and parkinson 's disease . understanding the pattern of tlr signaling in the glial cells may lead to the identification of new targets for therapeutic application .

recently , the cesarean delivery rate has been reported to be steadily increased in the united states [ 13 ] . approximately , one - third of births in the united states are now via cesarean delivery . the increase has been observed to be among women of all ages and race / ethnicities , in every state , and across all gestational ages . many theories have been proffered to explain this trend , including a decrease in vaginal births after cesarean delivery ( vbac ) , decreased vaginal births of breech presentation , and increased prevalence of high risk pregnancies such as advanced maternal age and some subjective indications during labor such as nonreassuring fetal status and arrest of dilation [ 1 , 2 ] . although cesarean delivery rates that are too low are associated with increased adverse events , cesarean delivery rates higher than the risk - adjusted expected rate for an institution have not been shown to improve maternal or neonatal outcomes , but they do add cost and unnecessary intervention . therefore , the examination of cesarean delivery rate concerning perinatal outcomes is very important for obstetricians . to date , however , there have not been sufficient observations concerning the cesarean delivery rate in japanese populations . in this study , we examined which specific factors contributed to the increase in cesarean delivery rate at our hospital over a 10-year period .

objective . we examined which specific factors contributed to the increase in cesarean delivery rate at our hospital over a 10-year period . methods . from january 2002 to december 2012 , data on the japanese singleton deliveries at 22-week gestation managed at japanese red cross katsushika maternity hospital were collected . potential factors associated with the increasing cesarean delivery rate were selected according to previous studies . in this study , the incidences of intrauterine fetal demise , umbilical artery ph < 7.1 , and severe perineal laceration were calculated for each year . results . the cesarean delivery rate at our institution increased significantly during the study period ( 17.3 % in 2002 versus 23.4 % in 2012 , p < 0.01 ) . during the study period , the cesarean delivery rates in the cases of nulliparity , preterm delivery , low birth weight ( < 2,500 g ) , previous cesarean deliveries and breech presentation were increased significantly . the incidence of intrauterine fetal demise and low umbilical artery ph was significantly decreased , and a negative correlation was found between the cesarean delivery rate and the incidence of low umbilical artery ph for each year ( r = 0.92 , p < 0.01 ) . conclusion . at our institute , the neonatal outcomes seemed to be improved associated with the increased cesarean delivery rate between 2002 and 2012 .

walking disorders , which constitute one of the major problems in hemiplegic patients , are a result of weakness of the affected side of the body1 and the relatively posterior location of the center of gravity , which limits their movements and reduces the risk of falls2 . treadmill walking is well known as an effective intervention for increasing walking ability , stability of the lower extremity , muscle strength , balance , and re - recognition of motor control required for the walking pattern3 . underwater therapy helps improve physical functioning for a better quality of life by utilizing the properties of water . hydrostatic pressure , buoyancy , friction , and viscous resistance are important water properties , and underwater resistance , in particular , is 12 times greater than overground resistance . exercising in water helps achieve an acquired symmetrical gait and limits unnecessary movement , thereby affecting not only energy efficiency but also muscle strength and endurance5 . recently , a few studies investigated the effects of treadmill exercise in restricted water depth on improvement of muscle strength and gait velocity . moreover , previous studies have proved that underwater treadmill walking training ( utwt ) is beneficial for weight bearing in the stance phase , which improves both gait and postural control in patients with hemiplegia6 . several studies have been conducted on the effects of utwt on balance and gait . however , a quantitative evaluation of isokinetic muscle strength in hemiplegic patients has not been studied sufficiently . therefore , the purpose of this study was to compare the effects of utwt and those of overground treadmill walking training ( otwt ) on peak knee flexion and extension torques .

[ purpose ] this study investigated the effects of underwater treadmill walking training on the peak torque of the knee in hemiplegic patients . [ subjects and methods ] thirty - two subjects , who were randomly allocated to an experimental group ( n=16 ) and a control group ( n=16 ) , performed underwater treadmill walking training and overground treadmill walking training , respectively , for 30 minutes / session , 3 sessions / week , for 6 weeks . an isokinetic dynamometer was used to assess the peak torque . [ results ] the subjects in the experimental group showed an increase in the peak knee extension torque compared to the control group . [ conclusion ] the results suggested that underwater treadmill walking training has a greater effect on peak knee extension torque at velocities of 60/sec and 120/sec than overground treadmill walking training .

the coexistence of anxiety and depression with medical illness is a topic of considerable clinical and research interest . depression is a serious mental health problem , with significant consequences in terms of human suffering , lost productivity , and even loss of life . corticotropin - releasing factor 1 ( crf 1 ) receptor antagonists have been sought since the stress - secreted peptide ( adrenocorticotropin - releasing hypothalamic peptide ) was isolated in 1981 . although evidence is mixed concerning the efficacy of crf 1 receptor antagonist as antidepressants , crf 1 receptor antagonist might be novel pharmacotherapies for anxiety and addiction . two well - characterized receptor subtypes , crf 1 and crf 2 , have been identified . these g - protein - coupled receptors are widely distributed throughout the central and peripheral nervous systems . clinical evidence supports the hypothesis that overproduction of crf 1 may underlie the pathology of depression , anxiety , and stress - related disorders and suggests that crf 1 receptor antagonists could be useful for the treatment of these conditions . to reduce the overall cost associated with the discovery and development of a new drug , the computer - aided molecular design methods have been identified as the most promising candidates to focus on the experimental efforts in modern medicinal chemistry . pharmacophore mapping is one of the major elements of drug design in the absence of structural data of the target receptor . with the aim of providing useful pharmacophoric information for the future efforts in the development of more potent molecules in the series of phenylpyrazinones and to get insight into the structural and molecular properties , the ligand - based 3d - qsar study was performed using pharmacophore techniques with phase module from schrodinger , new york [ 6 , 7 ] .

pharmacophore modelling - based virtual screening of compound is a ligand - based approach and is useful when the 3d structure of target is not available but a few known active compounds are known . pharmacophore mapping studies were undertaken for a set of 50 n3-phenylpyrazinones possessing corticotropin - releasing factor 1 ( crf 1 ) antagonistic activity . six point pharmacophores with two hydrogen bond acceptors , one hydrogen bond donor , two hydrophobic regions , and one aromatic ring as pharmacophoric features were developed . amongst them the pharmacophore hypothesis aadhhr.47 yielded a statistically significant 3d - qsar model with 0.803 as r2 value and was considered to be the best pharmacophore hypothesis . the developed pharmacophore model was externally validated by predicting the activity of test set molecules . the squared predictive correlation coefficient of 0.91 was observed between experimental and predicted activity values of test set molecules . the geometry and features of pharmacophore were expected to be useful for the design of selective crf 1 receptor antagonists .

the mental foramen ( mf ) is situated on the anterolateral aspect of the body of mandible . variations of the mental foramen are often encountered ranging from difference in shape and positions [ 46 ] to presence of accessory foramen or even complete absence in some cases [ 8 , 9 ] . knowledge of its position , shape , and size is important for performing anesthetic block prior to clinical procedures in lower anterior teeth and to preserve integrity of the mental nerve trunk in surgical interventions [ 10 , 11 ] . as the mental foramen is an important anatomical landmark to facilitate surgical , local anesthetic , and other invasive procedures , the present study is aimed at assessing morphological and morphometric features of mental foramen with reference to surrounding landmarks .

background . as the mental foramen ( mf ) is an important landmark to facilitate surgical , local anesthetic , and other invasive procedures , the present study was aimed to elucidate its morphological features and morphometric parameters with reference to surrounding landmarks . material and method . 105 dry adult human mandibles of unknown sex were observed for position , shape , and number of mental foramina . their size was measured using a digital vernier caliper and statistically analyzed by mean and standard deviations ( sd ) . results . in most cases ( 74.3 % ) , the mf was oval in shape and situated on the longitudinal axis of the 2nd premolar tooth ( 61 % on right side and 59.1 % on left side ) . the mean distance for the right and left sides was measured from various landmarks . conclusion . prior knowledge of mental foramen variations helps surgeons in planning surgery in that region to avoid nerve damage and also enable effective mental nerve block anesthesia .

peripheral facial nerve palsy ( fnp ) can result from idiopathic ( primary ) or detectable ( secondary ) causes . secondary causes include systemic viral or other infections , trauma , ischemia , tumor , and extrinsic compression.1 however , secondary fnp by external compression has rarely been reported.2,3,4,5 therapeutic endoscopy lasts significantly longer than diagnostic endoscopy , and therefore , the left facial nerve may be compressed by the pillow and mouth piece band during the procedure ( fig . 1 ) . we encountered a very rare complication of peripheral fnp during therapeutic endoscopy . , the mouth piece band should not be too tight and a soft pillow should be replaced with the hard pillow currently used .

peripheral facial nerve palsy ( fnp ) is a mononeuropathy that affects the peripheral part of the facial nerve . primary causes of peripheral fnp remain largely unknown , but detectable causes include systemic infections ( viral and others ) , trauma , ischemia , tumor , and extrinsic compression . peripheral fnp in relation to extrinsic compression has rarely been described in case reports . here , we report a case of a 71-year - old man who was diagnosed with peripheral fnp following endoscopic submucosal dissection . this case is the first report of the development of peripheral fnp in a patient undergoing therapeutic endoscopy . we emphasize the fact that physicians should be attentive to the development of peripheral fnp following therapeutic endoscopy .

aplasia cutis is a condition in which localized or generalized areas of skin are absent at birth . bullous aplasia cutis congenita is a subtype rarely seen in its initial form ; in most cases , it is found as a flat scar once the bullae have already reabsorbed . in some cases , there is underlying neural tube defects . there are only 17 cases reported in the literature including the one discussed in this paper .

aplasia cutis congenita is a rare condition characterized by the absence of skin and sometimes other underlying structures such as bone or dura . it can be a part of various syndromes and can be associated with multiple genetic diseases , malformation patterns , or a combination of all . it is even considered as a form frustre of a neural tube defect in several literatures . bullous aplasia cutis congenita is a clinical subtype of the condition , with extremely few cases reported in the literature . it presents as a cystic or bullous lesion at birth , which eventually transforms into an atrophic , flat scar covered by a thin epithelium . some cases present with a dark collar hair sign around the lesion , which can be even more indicative of an underlying neural tube defect . management remains controversial and depends on the characteristics of the lesion , but conservative treatment is usually chosen .

optic disc pits ( odps ) are congenital anomalies of the optic nerve head , first described by wiethe1 in 1882 as black cavities on the optic nerve head observed in one eye of a 62-year - old woman . the prevalence of odp is estimated to be one in every 11,000 patients.2,3 in about 70 % of cases , the odps are located on the temporal side of the disc and 85 % 90 % are unilateral.4,5 visual acuity is usually unaffected unless the odps are associated with macular pathology , such as macular detachment , retinoschisis - like separation , outer layer macular hole , and retinal pigment epithelial atrophy . macular detachment develops in one - third to two - thirds of patients , which may occur in childhood or later , the mean being at 30 years of age.6,7 vascular abnormalities such as colobomas and epipapillary membranes may also be associated . it is assumed that fluid passes through the odp and enters the sensory retina creating a schisis - like separation.810 however , the source of the fluid is controversial . two major possible sources have been proposed : vitreous cavity or cerebrospinal fluid.1114 other possible sources are abnormal vessels or vasculature with increased vascular permability.15 some authors have suggested a rhegmatogenous etiology with a small hole or tear in the membrane overlying the pit , which supports the notion that fluid leaks from the vitreous cavity.16,17 based on this hypothesis , our therapeutic approach was to seal the theoretical communication between the vitreous cavity and the retina with autologous platelet concentrate ( apc ) , which has been shown to promote tissue healing and successful results in macular hole surgery,1822 in order to address the etiology of the maculopathy . the purpose of the present study was to evaluate the anatomical and functional results obtained with pars plana vitrectomy ( ppv ) plus apc and gas tamponade as treatment of odp - related maculopathy .

purposeto evaluate the anatomical and functional results obtained with pars plana vitrectomy ( ppv ) plus autologous platelet concentrate ( apc ) as a treatment for macular detachment associated with optic disc pit ( odp ) .methodswe performed a prospective interventional study of 19 eyes of 19 consecutive patients with posterior macular detachment due to odp . all patients underwent ppv , posterior hyaloid peeling , fluid air exchange , injection of 0.05 ml of apc over the odp and 15 % perfluoropropane ( c3f8 ) endotamponade . postoperative measures included face - up positioning for 2 hours and then avoidance of the face - up position during the ensuing 10 days . all patients underwent complete ophthalmologic examination and optical coherence tomography preoperatively at 1 month , 3 months , 6 months , 9 months , and 12 months postoperatively and then annually . outcome measures were best corrected visual acuity ( bcva ) by logmar , improvement of quality of vision , macular attachment , and resolution of intraretinal schisis - like separation.resultspreoperatively , the median bcva was 0.70 ( range : 0.301.70 ) and all patients showed improved visual acuity after surgery ; bcva was 0.22 ( range : 0.070.52 ) at 12 months follow - up . all patients showed complete reabsorption of intraretinal fluid ( median time : 3.5 months [ range : 28 months ] ) and macular attachment at the end of follow - up ( median : 60 months [ range : 12144 months ] ) , with stable or improved visual acuity . no reoperations were needed and no major adverse events were recorded.conclusionfor macular detachment associated with odp , the combination of ppv , posterior hyaloid peeling , apc , and c3f8 tamponade is a highly effective alternative technique with stable anatomical and functional results .

substantial surgical skills are required to perform an arthroscopic procedure without risking iatrogenic injury of articular cartilage and within the routine time scheduled for the operation [ 16 , 17 , 20 , 23 ] . learning arthroscopic skills takes considerable time and implicates an increased risk of surgical errors during the early stages of the learning curve when operating on patients [ 4 , 17 , 24 ] . the traditional learning model where the trainee is supervised continuously by the surgeon attempts to minimize these surgical errors . however , as the training time for acquiring arthroscopic skills is being reduced [ 8 , 12 ] and demands from society for high - quality healthcare increase , initiatives have been taken to train basic skills away from the operating room [ 8 , 12 ] . training arthroscopic surgical skills preferably is performed with actual instrument handling . the theory that states skilled motor behavior relies on accurate predictive models of our body and the environment we interact with ( eg , instruments ) supports this approach [ 5 , 14 , 28 , 33 , 34 ] . these predictive models are stored in our central nervous system . to do a certain task , a key feature in this theory is that these predictive models are tuned , updated , and learned by providing feedback from our sensory organs ( vision and proprioception ) . traditionally , cadaveric material has been used as a substitute for live patients [ 10 , 20 ] . its importance is evident ; however , disadvantages are the availability of cadaveric material and preparation time . two types of simulators have been introduced to overcome the disadvantages of cadaveric material : anatomic bench models [ 25 , 32 ] and virtual reality systems [ 4 , 15 , 17 , 26 , 35 ] . however , it is unclear if these simulators qualify as suitable training means for arthroscopic skills . we therefore addressed the following questions : ( 1 ) do commercial simulators have construct ( times to perform tasks ) and face validity ( realism ) , and ( 2 ) is the perception of usefulness ( educational value and user - friendliness ) related to level of experience ?

backgroundsome commercial simulators are available for training basic arthroscopic skills . however , it is unclear if these simulators allow training for their intended purposes and whether the perception of usefulness relates to level of experience.questions/purposeswe addressed the following questions : ( 1 ) do commercial simulators have construct ( times to perform tasks ) and face validity ( realism ) , and ( 2 ) is the perception of usefulness ( educational value and user - friendliness ) related to level of experience ? methodswe evaluated two commercially available virtual reality simulators ( simulators a and b ) and recruited 11 and nine novices ( no arthroscopies ) , four and four intermediates ( one to 59 arthroscopies ) , and seven and nine experts ( > 60 arthroscopies ) to test the devices . to assess construct validity , we recorded the median time per experience group for each of five repetitions of one identical navigation task . to assess face validity , we used a questionnaire to judge up to three simulator characteristic tasks ; the questionnaire asked about the realism , perception of educational value , and perception of user-friendliness.resultswe observed partial construct validity for simulators a and b and considered face validity satisfactory for both simulators for simulating the outer appearance and human joint , but barely satisfactory for the instruments . simulators a and b had equal educational value according to the participants . user - friendliness was judged better for simulator b although both were graded satisfactory . the perception of usefulness did not differ with level of experience.conclusionsour observations suggest training on either simulator is reasonable preparation for real - life arthroscopy , although there is room for improvement for both simulators.clinical relevancethese simulators provide training in surgical skills without compromising patient safety .

blood is the specimen of choice for obtaining genomic dna for most large scale epidemiological studies [ 1 , 2 ] . however , such studies might need alternative sources when study subjects are reluctant to provide a blood sample or when only a self - administered collection protocol is logistically or economically feasible . this buccal cell collection can be performed by a buccal swab or mouth wash procedure . a few studies compared these methods in terms of dna - yield . most of these studies found that mouthwash procedures provide more yield and higher - quality dna than buccal swab methods [ 24 ] . nevertheless , dna collection with the use of buccal swabs has many advantages such as light weight postage , cost effective processing for long - term archiving , and easy obtain ability from widely dispersed participants , it is comfortable for the patient and tasteless . moreover , collecting buccal cells rather than blood may be especially appropriate in a pediatric setting . furthermore buccal swab methods provide sufficient dna for polymerase chain reactions in which only nanogram quantities of dna are needed [ 5 , 6 ] . however , little is known about factors that influence the amount and purity of dna , obtained from buccal cell collection protocols . knowledge of these factors is of great importance to optimize the yield of this method . in blood , predictors of variation in dna yield are age , daily smoking status , high - density lipoprotein cholesterol , systolic blood pressure , triglycerides , history of acute myocardial infarction ( mi ) and possibly diabetes mellitus [ 7 , 8 ] . determinants of dna yield from whole blood samples may not be the same as for buccal samples . results from studies that focused on determinants of dna yield in buccal cells are inconsistent and considered only a few factors while as far as we know , no study has focused on drug use as a determinant of dna yield and no study has assessed determinants of dna purity [ 1 , 9 , 10 ] . therefore , we conducted a study to assess which factors determine the amount and purity of dna in a self - administered , non - invasive and relatively inexpensive buccal cell collection procedure .

buccal cells are an important source of dna in epidemiological studies , but little is known about factors that influence amount and purity of dna . we assessed these factors in a self - administered buccal cell collection procedure , obtained with three cotton swabs . in 2,451 patients dna yield and in 1,033 patients dna purity was assessed . total dna yield ranged from 0.08 to 1078.0 g ( median 54.3 g ; mean 82.2 g sd 92.6 ) . the median uv 260:280 ratio , was 1.95 . samples from men yielded significantly more dna ( median 58.7 g ) than those from women ( median 44.2 g ) . diuretic drug users had significantly lower purity ( median 1.92 ) compared to other antihypertensive drug users ( 1.95 ) . one technician obtained significantly lower dna yields . older age was associated with lower dna purity . in conclusion , dna yield from buccal swabs was higher in men and dna purity was associated with age and the use of diuretics .

in 2014 , the average maternal age was 31 years , and the fertility rate was estimated at 1.4 children per woman1 , 2 , 3 . in fighting a declining birth rates and aging population , more women are expected to enter the workforce to support financial infrastructure of japan . however , older maternal age and subsequent high rates of primiparity may affect health outcomes among children . in japan , 9.6 % of infants are classified as low birth weight ( lbw ) . this percentage is greater than the average among organisation for economic co - operation and development countries . additionally , the prevalence of lbw infants has been increasing : from 5.2 % in 1980 to 9.6 % in 20126 . this trend is concerning , because lbw infants are at increased risk for non - communicable disease during adulthood . studies focusing on the developmental origin of health and disease hypothesis4 , 5 suggest that maternal starvation due to malnutrition during pregnancy alters the epigenetic expression of metabolic genes in the fetus6 , 7 . according to a 2014 national nutrition survey , the same survey also reported that the average energy intake among women aged 1849 years is 1,700 kcal per day , which is considerably less than the energy requirement for women , even those with a sedentary lifestyle8 . additionally , japanese nutrition surveys conducted in 1982 and 2012 revealed that the proportion of underweight women has increased from 12.1 % to 21.8 % among women in their 20 s and from 8.2 % to 17.1 % among women in their 30 s , respectively9 . being underweight is of serious concern in women of reproductive age , because maternal undernutrition directly reduces the supply of nutrients to the fetus10 . we recently found that a maternal underweight status increased the risk of having a lbw infant11 . because fertility rates have been decreasing , in this study , we focused on the effects of primiparity and poor nutritional status among japanese women on fetal health . specifically , we investigated both individual and combined effects of primiparity and underweight on the birth of lbw infants . the result of present study may be useful for public health strategy to help women and children stay healthy contributing to the workforce to support the financial infrastructure of japan .

this study aimed to examine the effects of parity and pre - pregnancy body mass index ( bmi ) on low birth weight ( lbw ) infants among japanese women . participants included 1,518 mothers ( mean age 34.0 years ) of singleton full - term infants in 2011 . the incidence of lbw infants was 7.5 % in primiparous women with bmi < 18.5 ( group a ; n=239 ) , 4.0 % in multiparous women with bmi < 18.5 ( group b ; n=124 ) , 6.0 % in primiparous women with 18.5bmi < 25 ( group c ; n=715 ) , and 1.8 % in multiparous women with 18.5bmi < 25 ( group d ; n=440 ) . a multivariable logistic regression model revealed that mothers in group a were more likely to deliver a lbw infant [ odds ratio ( or ) 6.41 , 95 % confidence interval ( ci ) , 2.6515.49 ] than were mothers in group d. being both underweight ( or 1.8 , 95 % ci : 1.053.11 ) and primiparous ( or 3.41 , 95 % ci : 1.826.44 ) were independently associated with lbw infants . this study demonstrated that the characteristics of primiparous and underweight in mothers are additively associated with lbw infants .

the evolution of multi - cellular eukaryotic organisms from single - celled ancestors was one of the most significant transitions in the evolution of life on earth . it enabled the emergence of larger and more complex eukaryotes that could resist predation , evolve specialized tissues and higher order biological capacities , and colonize new environments . multi - cellularity evolved independently in several eukaryotic lineages and , in terms of the number of cell types per organism , animals ( the metazoa ) include the most complex multi - cellular eukaryotes ( rokas , 2008 ) . a key mediator of metazoan multi - cellularity is the extracellular matrix ( ecm ) , a multi - component , proteinaceous network that bridges between cells , contributes to their spatial arrangements by binding cell - surface adhesion receptors , and supports cell survival , differentiation , and tissue organization ( hynes , 2009 ) . the advantages of increased organism size for more efficient use of nutrients and escape from predation might have acted as selection pressures for the evolution of ecm , and increases in ocean oxygen levels around 850 million years ago likely provided a favorable environment for these changes ( rokas , 2008 ) . here , we discuss the adhesome of basal metazoa , the modern animals that provide a window on the earliest - evolving ecm components , and consider the expansion of adhesome complexity that occurred in the deuterostome / chordate lineage .

we present a perspective on the molecular evolution of the extracellular matrix ( ecm ) in metazoa that draws on research publications and data from sequenced genomes and expressed sequence tag libraries . ecm components do not function in isolation , and the biological ecm system or adhesome also depends on posttranslational processing enzymes , cell surface receptors , and extracellular proteases . we focus principally on the adhesome of internal tissues and discuss its origins at the dawn of the metazoa and the expansion of complexity that occurred in the chordate lineage . the analyses demonstrate very high conservation of a core adhesome that apparently evolved in a major wave of innovation in conjunction with the origin of metazoa . integrin , cd36 , and certain domains predate the metazoa , and some ecm - related proteins are identified in choanoflagellates as predicted sequences . modern deuterostomes and vertebrates have many novelties and elaborations of ecm as a result of domain shuffling , domain innovations and gene family expansions . knowledge of the evolution of metazoan ecm is important for understanding how it is built as a system , its roles in normal tissues and disease processes , and has relevance for tissue engineering , the development of artificial organs , and the goals of synthetic biology .

intervertebral disc degeneration ( idd ) is a highly relevant individual and socioeconomic burden , which is associated to various morphological and functional disturbances . the gradual progression of the disease and the structural features , e.g . , the degradation of proteoglycans with subsequent desiccation of the disc extracellular matrix , the ingrowth of blood vessels and the loss of intervertebral disc ( ivd ) height , can be addressed in close detail and predispose idd for regenerative strategies . direct injection of growth factors , viral vectors and cells , each alone or in combination , seek to stimulate proliferation and production of extracellular matrix . reasonable chances of success of these methods , however , are questionable [ 4 , 5 ] . low oxygen and ph within the avascular disc represent a hostile environment for cell metabolism [ 2 , 6 , 7 ] . conversely , vascularization must not be promoted as it accelerates degeneration [ 8 , 9 ] . furthermore , aberrant mechanical stimuli may activate catabolic remodelling , cell death and tissue breakdown [ 1013 ] . to reestablish a loading regime that enhances the anabolic response of resident and implanted cells and to trigger biological mechanisms of self - healing , biodegradable substitutes were designed according to the natural ideal of the ivd . as the restoration of disc height is assumed to be essential for nucleus replacements , sufficient quantities of hydrogels are intended to be injected into the ivd for an immediate restoration of disc mechanics . hyaluronic acid or polysaccharide - based hydrogels , such as gellan gum - based hydrogels , were proven to adequately support the growth and extracellular matrix deposition of cells and might therefore be suited as nucleus replacements [ 1719 ] . to retain avascularity of cartilaginous tissues , functionalization of scaffolds with anti - angiogenic peptides was suggested . to gain deeper knowledge on future research directions , the purpose of this study was to investigate newly developed hydrogels as nucleus replacements for the biomechanical restoration and biological regeneration of the disc . the effect of functionalization on the efficiency of hydrogels was evaluated using anti - angiogenic peptides and bone marrow derived mononuclear cells .

purpose regenerative strategies aim to restore the original biofunctionality of the intervertebral disc . different biomaterials are available , which might support disc regeneration . in the present study , the prospects of success of two hydrogels functionalized with anti - angiogenic peptides and seeded with bone marrow derived mononuclear cells ( bmc ) , respectively , were investigated in an ovine nucleotomy model . methodsin a one - step procedure iliac crest aspirates were harvested and , subsequently , separated bmc were seeded on hydrogels and implanted into the ovine disc . for the cell - seeded approach a hyaluronic acid - based hydrogel was used . the anti - angiogenic potential of newly developed vegf - blockers was investigated on ionically crosslinked metacrylated gellan gum hydrogels . untreated discs served as nucleotomy controls . 24 adult merino sheep were used . after 6 weeks histological , after 12 weeks histological and biomechanical analyses were conducted.resultsbiomechanical tests revealed no differences between any of the implanted and nucleotomized discs . all implanted discs significantly degenerated compared to intact discs . in contrast , there was no marked difference between implanted and nucleotomized discs . in tendency , albeit not significant , degeneration score and disc height index deteriorated for all but not for the cell - seeded hydrogels from 6 to 12 weeks . cell - seeded hydrogels slightly decelerated degeneration.conclusionsnone of the hydrogel configurations was able to regenerate biofunctionality of the intervertebral disc . this might presumably be caused by hydrogel extrusion . great importance should be given to the development of annulus sealants , which effectively exploit the potential of ( cell - seeded ) hydrogels for biological disc regeneration and restoration of intervertebral disc functioning .

a distinct phenotype within this group is cerebellar ataxia associated with hypogonadotropic hypogonadism ; this association has been found in two diseases , gordon holmes ( ghs ) and boucher neuhauser syndromes . ghs ( mim 212840 ) is a rare phenotype , first described in 1907 by holmes , and comprises adolescence or early adulthood age of onset , isolated idiopathic hypogonadotropic hypogonadism and progressive neurodegenerative manifestations including cognitive impairment , dysarthria , cerebellar ataxia . recently , mutations in genes involved in ubiquination ( rnf216 , otud4 , stub1 ) were identified in families with ghs . margolin et al . identified mutations in the rnf216 gene either alone or in combination ( digenic mutations ) with mutations in otud4 as a cause of ghs . we report two patients with ghs caused by a novel rnf216 mutation as the first follow up report on rnf216-related ghs , and show interfamilial variability of phenotype supporting the previously reported rnf216-related cases . our study includes 2 out of 9 brothers of a consanguineous middle eastern parents ( figure 1 ) , presented with poor development of secondary sexual characteristics and ataxia .

gordon holmes syndrome ( ghs ) is a distinct phenotype of autosomal recessive cerebellar ataxia , characterized by ataxia , dementia , reproductive defects and hypogonadism ; it has been recently found to be associated with rnf216 mutation . we performed whole - exome sequencing and filtered the resulting novel variants by the coordinates of the shared autozygome . we identified a novel splicing variant in rnf216 that is likely to abolish the canonical splice site at the junction of exon / intron 13 ( nm_207111.3 : c.2061g > a ) . we herein report two patients with ghs caused by a novel rnf216 mutation as the first follow up report on rnf216-related ghs , and show interfamilial variability of phenotype supporting the previously reported rnf216-related cases .

stroke is characterized by a sudden , non - convulsive , focal neurological deficit caused by a brain lesion stemming from a non - traumatic vascular mechanism due to arterial or venous embolism leading to cerebral ischemia or hemorrhage2 . the most common manifestations of stroke are sensory , cognitive and motor impairments , such as hemiparesis , spasticity , an abnormal movement pattern3 and physical deconditioning4 , 5 . any force exerted on the jaws should be identified as a triggering factor of a functional imbalance in the masticatory system6 . according to saliba et al.7 , upper limb impairment is one of the most common complaints of stroke survivors with hemiparesis . it is estimated that 70 % of such individuals suffer residual disability that compromises dexterity during activities of daily living8 . individuals with hemiparesis exhibit slow movements during activities that involve the upper limbs , such as reaching and grasping , due to limited range of motion , segmented movements and a lack of coordination among the joints4 , 9 . normal upper limb function involves the capacity for directed reach , grasping and manipulation of objects , which make up the motor skills required for the performance of activities of daily living6 that allow an individual to lead an independent life with self - esteem8 . the execution of proper oral hygiene , for example , requires adequate motor control of the upper limbs9 . compromised upper limb function exerts an impact on the degree of disability experienced by stroke survivors , with a significant influence on functional performance and negative consequences regarding personal , familial and social relationships as well as quality of life10 . despite the gradual return of motor function resulting from a combination of spontaneous recovery and physical therapy , the use of the paretic limb is often less than its normal potential in daily living11 . depending on the degree of upper limb impairment , the maintenance of adequate oral health among stroke survivors can be hindered3 , 8 . moreover , inadequate oral hygiene can compromise both oral health and quality of life . considering the high prevalence rates of functional limitations to the paretic arm7 , the aim of the present study was to evaluate the relationship between upper limb impairment and oral health impact in individuals with hemiparesis stemming from a stroke .

[ purpose ] the aim of the present study was to evaluate the relationship between upper limb impairment and oral health impact in individuals with hemiparesis stemming from a stroke . [ subjects and methods ] the study subjects were conducted with a sample of 27 stroke survivors with complete or partial hemiparesis with brachial or crural predominance . the 14-item short version of the oral health impact profile was used to evaluate perceptions of oral health . the brazilian version of the stroke specific quality of life scale was used to evaluate perceptions regarding quality of life . [ results ] a statistically significant association was found between the upper extremity function subscale of the ssqol - brazil and the impact of oral health evaluated using the ohip-14 , with a strong correlation found for the physical pain subscale , moderate correlations with the functional limitation , psychological discomfort , physical disability , social disability and social handicap subscales as well as a weak correlation with the psychological disability subscale . analyzing the ohip-14 scores with regard to the impact of oral health on quality of life , the most frequent classification was weak impact , with small rates of moderate and strong impact . [ conclusion ] compromised upper limb function and self - perceived poor oral health , whether due to cultural resignation or functional disability , exert a negative impact on the quality of life of individuals with hemiparesis stemming from a stroke .

the global pharmaceutical industry has grown at a tremendous pace reaching up to $ 956 billion and is expected to rise to nearly $ 1.2 trillion in 2016 , representing a compound annual growth rate of 36 percent the world over ( 1 ) . with this aggressive growth and ever increasing competition the marketing strategies of pharmaceutical and some dental / medical equipment companies are becoming ethically questionable ( 24 ) . although the pharmaceutical industry is sponsoring a lot of research worldwide , the major portion of their budget is allocated to promotional activities ( 4 , 5 ) . the usual promotional activities are obliging doctors by minor gifts , like stationery items , donating equipments , kits and even invitations for dinners , or sponsoring participation in seminars and training programs . this brings about a conflict between the physician s financial interest and the welfare of the patient ( 413 ) . in medicine , awareness of the ethical implications of such gifts has been raised for the past few decades and a code of ethics has been formulated for interaction between medical practitioners and pharmaceutical companies . in dentistry , the need to realize the ethical implications of such interactions is greater than medicine because of the more active involvement of device industry and material manufacturers . the interactions of dentists include those with pharmaceutical , biotech , medical device and research equipment industry . however , with the growing competition amongst the pharmaceutical industry , device industry and material manufacturers , the unethical marketing practices are also growing . the present study was undertaken to assess the attitudes and practices of fresh dental graduates , faculty members and private practitioners in dentistry towards pharmaceutical gifts , and consequently the need for implementation of guidelines and a code of ethics in the dental fraternity in pakistan . another purpose of this study was to assess the difference in perception of fresh graduates , residents , faculty members and private practitioners .

interaction of pharmaceutical companies ( pc ) with healthcare services has been a reason for concern . in medicine , awareness of the ethical implications of these interactions have been emphasized upon , while this issue has not been highlighted in dentistry . this study undertook a cross - sectional rapid assessment procedure to gather views of dentists in various institutions towards unethical practices in health care and pharmaceutical industry . the purpose of this study was to assess the need for the formulation and implementation of guidelines for the interaction of dentists with the pharmaceutical and device industry in the best interest of patients.a group of 209 dentists of lahore including faculty members , demonstrators , private practitioners and fresh graduates responded to a questionnaire to assess their attitudes and practices towards pharmaceutical companies marketing gifts.the study was conducted during 2011 and provided interesting data that showed the pharmaceutical industry is approaching private practitioners more frequently than academicians and fresh graduates . private practioners accepted the gifts but mostly recognized them as unethical ( over 65 % ) . both groups considered sponsoring of on - campus lectures as acceptable ( over 70 % ) .respondents are not fully aware of the ethical demands which are imperative for all health care industries , and there is a dire need of strict guidelines and code of ethics for the dentist s interaction with the pharmaceutical and device industry so that patient interest is protected .

many adolescents often lack strong and stable relationships with their parents or other adults which are necessary to openly discuss reproductive health concerns . therefore , many teenagers do not have access to reliable information regarding their rh needs . in most cultures , parents and family members are an influential source of knowledge , beliefs , attitudes , and values for children and young people . parents often have the power to guide children 's development in sexual health matters , encouraging them to practice reasonable sexual behavior and develop good personal decision making skills [ 13 ] . researches indicated that increased parent - child communication leads to a raised awareness and reduction in risk taking behaviors . however , when young people feel unconnected to home and family , they may become involved in activities that put their health and wellbeing at risk [ 1 , 5 , 6 ] . even though parents are main sources of information on rh issues studies have shown that only 46 % , 20 % , and 20 % of parents in usa , lesotho , and ethiopia , respectively , had discussed such issues with their adolescents . in china , only one - third of female youths talked to their mothers about sexual matters [ 1 , 79 ] . as a result , most adolescents ' patchy knowledge on rh issues often comes from information shared by their same sex peers , who may or may not be well informed . this can lead to misinformation and the persistence of damaging myths , making young people vulnerable to unprotected sex , unwanted pregnancy , sexually transmitted diseases , and unsafe abortions . the consequences of adolescent sexual behavior are an enormous burden both for the adolescent and for society . the problem is not that teens are sexually active but rather that they are inadequately prepared and guided in developing responsible sexual behaviors . the family , the major socializer of other behaviors , is not powerful in shaping adolescents ' sexual behavior because of the socio - cultural , religious beliefs and sense of morality barriers affecting discussion of sexual and reproductive health issues with their adolescents [ 79 ] . factors affecting parent - adolescent discussion of a country should be taken into account during planning of rh programs . therefore , this study was conducted to assess factors that affect parent - adolescent discussion on rh issues with their adolescents in harar town , harari region , ethiopia , in may 2010 .

background . open family discussion on reproductive health ( rh ) issues often leads to increased awareness on rh matters and reduces risky behaviors among adolescents . this study was conducted to assess factors affecting parent - adolescent discussion on rh issues in harar , ethiopia . methods . a cross - sectional survey using face to face interview supplemented with focus group discussion ( fgd ) was conducted on 751 randomly selected parents of 1019-year - old adolescents . data was analyzed using spss version 15 . results . more than one - fourth ( 28.76 % ) of parents reported discussing rh issues with their adolescents during the last six months . in the logistic regression , parents who have demonstrated good rh knowledge and positive attitude towards rh were almost six times and seventy percent ( aor 5.69 , 95 % ci : 3.678.82 ; aor 1.70 , 95 % ci : 1.082.68 ) higher in discussing rh with their adolescents than their counterparts , respectively . conclusion . parent - adolescent discussion about rh issues rarely occurs and is bounded by lack of knowledge , sociocultural norms , and parental concern that discussion would encourage premarital sex . reproductive health programs should target on improving awareness of parents and addressing sociocultural norms surrounding reproductive health issues .

increasing data support a role of gut microbiota and dietary ingestion of phosphatidylcholine ( pc or lecithin ) in the pathogenesis of atherosclerosis.1 , 2 pc is the major dietary source of choline , which often is found in the western diet , such as red meat , eggs , and meat products . production of trimethylamine noxide ( tmao ) by gut microbiota metabolism of dietary pc has been associated with the development of atherosclerosis in animals and in humans.1 , 2 , 3 increased levels of plasma tmao are associated with an enhanced number of diseased major coronary vessels,1 as well as increased risk of major adverse cardiac events in patients undergoing elective coronary angiography.3 , 4 peripheral artery disease ( pad ) is a common manifestation of systemic atherosclerosis and is associated with significantly increased cardiovascular death and mortality.5 , 6 it affects over 27 million people across europe and north america.7 an estimated 8.5 million americans aged 40 years carry the diagnosis of pad.8 despite its association with high prevalence and extremely poor prognosis , pad remains undiagnosed and rarely receives attention in the scientific literature compared to patients with coronary artery disease ( cad ) and other atherosclerotic conditions.7 , 9 to date , predictors of mortality and underlying pathophysiology in patients with pad are not well defined , which may be a contributing factor to why the mortality risk and ischemic amputations in pad patients remained high.10 therefore , there is a need to find new prognostic markers that may provide insight into underlying pathophysiology , improve longterm clinical risk prediction incremental to traditional risk factors , and suggest avenues for therapeutic development in pad . the primary objective of this study was to determine the clinical prognostic value of plasma tmao levels in a contemporary cohort of patients with established but stable pad .

backgroundproduction of the proatherogenic metabolite , trimethylamine noxide ( tmao ) , from dietary nutrients by intestinal microbiota enhances atherosclerosis development in animal models and is associated with atherosclerotic coronary artery disease in humans . the utility of studying plasma levels of tmao to risk stratify in patients with peripheral artery disease ( pad ) has not been reported.methods and resultswe examined the relationship between fasting plasma tmao and allcause mortality ( 5year ) , stratified by subtypes of pad and presence of coronary artery disease in 935 patients with pad who underwent elective angiography for cardiac evaluation at a tertiary care hospital . median plasma tmao was 4.8 mol / l ( interquartile range , 2.98.0 mol / l ) . elevated tmao levels were associated with 2.7fold increased mortality risk ( fourth versus first quartiles , hazard ratio 2.86 , 95 % ci 1.823.97 , p < 0.001 ) . following adjustments for traditional risk factors , inflammatory biomarkers , and history of coronary artery disease , the highest tmao quartile remained predictive of 5year mortality ( adjusted hazard ratio 2.06 , 95 % ci 1.363.11 , p < 0.001 ) . similar prognostic value for elevated tmao was seen for subjects with carotid artery , non carotid artery , or lower extremity pad . tmao provided incremental prognostic value for allcause mortality ( net reclassification index , 40.22 % ; p < 0.001 ) and improvement in area under receiver operator characteristic curve ( 65.7 % versus 69.4 % ; p=0.013 ) .conclusions tmao , a proatherogenic metabolite formed by gut microbes , predicts longterm adverse event risk and incremental prognostic value in patients with pad . these findings point to the potential for tmao to help improve selection of highrisk pad patients with or without significant coronary artery disease , who likely need more aggressive and specific dietary and pharmacologic therapy .