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cardiovascular disease ( cvd ) is leading to mortality among patients who were in developed countries . in the early of 20 century , < 10 % of the world 's deaths were attributed to cvd . the half of deaths in developed countries and 25 % of deaths in developing countries were due to coronary vascular disease . one way to improve the cardiac patient 's ability is cardiac rehabilitation program that was begun in 1960 for the first time . the aim of this program was the secondary prevention of coronary heart disease ( chd ) , re - admissions to hospital and deaths from cardiovascular events . cardiac rehabilitation programs are generally including interventions for the management of disease and smoking cessation , correction of nutrition status and physical activity . diet has been recognize as a risk factor in preventing and reducing the risk of heart disease . , reported that food guide for outpatients with heart failure are important in two aspects , awareness about nutrition and food and modification of diet quality . in recent years , the posterior and anterior dietary patterns are used to study of the relationship between food , nutrition , and chronic diseases . one of them is dietary diversity score ( dds ) . to assessment of dds according to us department of agriculture 's food guide pyramid , five main groups , including grains , vegetables , fruits , meat , and meat substitutes and dairy products are used , and each of these five groups is divided into several subgroups . dds was used to assessment of diet quality in several disease for instant , a cross - sectional study that was conducted in 2006 among 581 tehranian adults with hypercholesterolemia , ( hypertriglyceridemia and low - density lipoprotein cholesterol were diagnosed according to atp iii guidelines of the national cholesterol education program ) showed that higher values of dds was associated with lower cvd risk factors . the role of oxidative stress and obesity in the etiology and prevalence of cvds is well known . assessed the association between dietary diversity and antioxidant markers and revealed that oxidative stress was inversely associated with dietary diversity . a study that was done in 2011 showed that overweight stunted children consumed food with low dietary diversity and high dietary energy density , also in another study that was conducted among 289 healthy female students , which was selected randomly from isfahan university of medical sciences revealed that low body mass index ( bmi ) and waist circumference was associated with high dds , so concluded that dds was reversely correlate with abdominal adiposity and obesity among female students . dds was assessed in a different disease , but no study has evaluated dds before and after nutrition counseling among patients undergoing cardiac rehabilitation , so this study was designed to examine this purpose .

background : dietary diversity score ( dds ) measurement was used to assessment of diet quality in different disease like cardiovascular disease . one way to improve the cardiovascular patient 's ability is cardiac rehabilitation program that include exercise training , nutrition consultation and psychological treatment . no study was designed to compare the dds before and after dietary consultation among cardiac rehabilitation patients , so this study was designed to examine this purpose.methods : subjects were participated in the 2-month cardiac rehabilitation program . all patients that completed the cardiac rehabilitation program and 2 dietary records ( before and after nutritional counseling in cardiac rehabilitation program ) enrolled in study . kant et al method was used for scoring dietary diversity . data were analyzed using the statistical package for social sciences ( spss version 20 ) . wilcoxon test were used to compare dds score for each subgroup and pair sample t test was used to compare total dds after and before nutrition counseling . p < 0.05 was considered as statistically significant.results : the differences between dds of grain , fruit , vegetable and meat before and after nutrition counseling were not significant ( p = 0.635 , p = 0.423 , p = 0.826 , p = 0.207 respectively ) , but differences of dds for dairy and total dds before and after nutrition counseling were significant ( p = 0 , p = 0.001 ) .conclusions : dietary diversity was increased after nutrition counseling among patients with cardiac disease .

congenital candidiasis ( cc ) is rare and usually caused by intrauterine candidial infection and manifests within first 6 days of life . it may be localized involving only skin or generalized resulting in respiratory distress , meningitis , sepsis , and death . a total of 10 - 35 % of the women suffer from candidial vagintis during pregnancy , but less than 1 % of them develop candidial chorioamnionitis that can affect the fetus . this is why cc is so rare and only 100 cases have been reported in the literature so far .

congenital candidiasis ( cc ) is a rare disease with less than 100 cases being reported in the literature . it presents within six days of life with manifestations ranging from localized skin disease to systemic involvement in the form of respiratory distress , sepsis , and death . we report a neonate who presented with diffuse pustular eruption on erythematous background involving face , trunk , and palms within 24 h after birth . candida albicans was identified in 10 % potassium hydroxide ( koh ) smear and culture from the pustules . intravenous fluconazole and topical ketoconazole were given and the condition improved completely in two weeks . cc is rare and needs to be differentiated from other conditions presenting with pustular lesions at birth in order to avoid complications . early diagnosis and prompt treatment of this condition is important as untreated cases carry a mortality rate of 8 - 40 % .

epiretinal membrane ( erm ) formation reflects a number of pathological changes occurring in vitreoretinal junctions . retinal glial cells , fibrous astrocytes , and mller cells proliferate and migrate from neurosensory retina , through surface and breaks of the internal limiting membrane ( ilm ) . in most cases , the disease is idiopathic but it can also be seen in eyes following retinal surgery , like vitrectomy or extracapsular lens extraction , in uveitic eyes or following vascular retinal diseases [ 14 ] . the epiretinal membrane itself is defined as a fine , semitranslucent , nonvascular , fibrocellular membrane on the inner retinal surface along the ilm [ 1 , 2 , 5 ] . affected patients may present with variable degrees of decrease in visual acuity ( va ) and disturbing metamorphopsia or micropsia . pars plana vitrectomy with membrane peeling is the current standard treatment for surgical removal of erm , with reported rates of visual improvement ranging between 67 % and 82 % . in addition , removing the ilm has been suggested as a measure to prevent cellular reproliferation . furthermore , a number of recent reports are dealing with an interesting correlation of macular function and morphology using sd - oct and microperimetry . disruptions of the photoreceptor inner and outer segment band seem to be a potential predictor for poor visual recovery in eyes having undergone macular surgery and some patients also seem to have paracentral microscotomas after membrane and ilm peeling . however , the induction of a potential mechanical trauma by using end - gripping forceps in areas of epiretinal membrane and ilm peeling resulting in potential functional or morphological damage has not yet been addressed . the aim of the present study was to analyze the correlation between morphological changes of the outer retina , such as ez ( ellipsoid zone ) and elm ( external limiting membrane ) , and functional parameters , such as retinal sensitivity and visual acuity in the fovea and in the area of erm and ilm peeling , whether the manual peeling using forceps during surgery has an influence on postoperative functional outcome or not . in order to be able to identify these specific areas all operations were video - documented .

purpose . to assess functional and morphological alterations following video - documented surgery for epiretinal membranes . methods . forty - two patients underwent video - documented 23-gauge vitrectomy with peeling of epiretinal ( erm ) and inner limiting membrane ( ilm ) . patient assessment was performed before and 3 and 6 months including best corrected visual acuity ( bcva ) , slit lamp biomicroscopy , sd - oct , and central 2 and 18 microperimetry . in addition , all video - documented areas of peeling on the retinal surface were evaluated postoperatively using an additional focal 2 microperimetry . retinal sensitivity and bcva were correlated with morphological changes ( ez and elm ) in the foveal region and in regions of membrane peeling . results . overall , bcva increased from 0.6 ( 0.2 ) to 0.2 ( 0.2 ) logmar after 6 months with an increase in retinal sensitivity ( 17.9 2.7 db to 26.8 3.1 db , p < 0.01 ) . we observed a significant correlation between the integrity of the ez but not of the elm and the retinal sensitivity , overall and in peeling areas ( p < 0.05 ) . however , no significant correlation between alterations in the area of peeling and overall retinal sensitivity regarding visual acuity gain could be observed after 6 months ( p > 0.05 ) . in contrast , overall postoperative retinal sensitivity was significantly decreased in patients with a visual acuity gain lower than 2 lines ( p < 0.05 ) correlating with ez defects seen in oct . conclusions . mechanical trauma of epiretinal membrane and ilm peeling due to the use of intraocular forceps may affect the outer retinal structure . nevertheless , these changes seem to have no significant impact on postoperative functional outcome .

motor branch or recurrent branch of the median nerve , also called as the thenar branch , innervates the intrinsic muscles of the thumb ( abductor pollicis brevis , opponens pollicis , and the superficial head of the flexor pollicis brevis ) . it has an important role in the movements of the thumb and thus in many activities of the hand . accordingly , hand surgeons pay attention not to injure the motor branch while performing carpal tunnel surgery . herein , a rare anatomic variation regarding the motor branching of the median nerve is being reported .

we present a 62-year - old female patient who had an anatomic variation in the median nerve of the left hand . during surgery for releasing the left carpal tunnel , an abnormally high level of origin of the thenar muscular branch of the median nerve was detected , at 2.5 cm above the proximal border of transverse carpal ligament . it traveled between the medial side of the flexor carpi radialis tendon and median nerve and entered the carpal tunnel . after exiting the carpal tunnel distally , the nerve , was noted to course towards the thenar area . such variations in the median nerve should be kept in mind while performing carpal tunnel release .

catatonia was first described by kahlbaum in 1874 , as a brain disorder , which has cyclic , alternating and progressive course . over the years , understanding about catatonia has increased and it is now well - known that besides the primary psychiatric disorders , catatonia is associated with many neurological and medical disorders . catatonia in adolescents has been reported to be associated with affective , psychotic , autistic , developmental , drug induced and medical conditions . further , as in adults , catatonia in children and adolescents also responds to benzodiazepines and electroconvulsive therapy ( ect ) . however , the literature on the use of ect in adolescents with catatonia is limited . in this case report , we present a case of catatonic schizophrenia , treated with ect and review the literature on the use of ect in adolescent catatonia .

there is lot of skepticism about the use of electroconvulsive therapy ( ect ) in children and adolescents . however , available literature suggests that use of ect can be at times life - saving in adolescents , especially those presenting with severe catatonia . we treated a 16-year - old female who presented to us with catatonia with a course of nine ects , with which she showed marked improvement . review of the literature suggests that ect should be considered as the second line treatment in the management of catatonia in adolescents .

neuroepithelial cells , which constitute the wall of the neural tube , proliferate by repeating symmetric cell division , where each neuroepithelial cell divides into two neuroepithelial cells ( progenitor expansion phase , figure 1 ; alvarez - buylla et al . , 2001 ; fishell and kriegstein , 2003 ; fujita , 2003 ; gtz and huttner , 2005 ; miller and gauthier , 2007 ) . as the wall of the neural tube becomes thicker , neuroepithelial cells elongate and become radial glial cells , which have cell bodies in the ventricular zone , and radial fibers reaching the pial surface ( figure 1 ) . radial glial cells were previously thought of as specialized glial cells that guide neuronal migration . later , it was found that radial glial cells undergo asymmetric cell division , where each radial glial cell divides into two distinct cell types , a radial glial cell and an immature neuron or a basal progenitor ( neurogenic phase , figure 1 ; malatesta et al . , 2000 immature neurons migrate outside of the ventricular zone along radial fibers into the cortical plate , where these cells become mature neurons , whereas basal progenitors migrate into the subventricular zone ( svz ) , proliferate further and give rise to more neurons . radial glial cells give rise to many different types of neurons , initially deep layer neurons and then superficial layer neurons later , by repeating asymmetric cell division . radial glial cells also give rise to oligodendrocytes and ependymal cells and finally differentiate into astrocytes ( gliogenic phase , figure 1 ) . initially , neuroepithelial cells undergo repeated self - renewal by symmetric division ( progenitor expansion phase ) . as development proceeds , neuroepithelial cells elongate to become radial glial cells , which have cell bodies on the inner side ( called the ventricular zone ) of the neural tube and radial fibers that reach the outer surface after the production of neurons , some radial glial cells give rise to oligodendrocytes and ependymal cells . both neuroepithelial cells and radial glial cells are considered embryonic neural stem / progenitor cells . if neural stem / progenitor cells are prematurely depleted , not only is the total number of cells reduced but also later - born cell types are lacking , indicating that the maintenance of neural stem / progenitor cells until the final stage of development is essential to produce the proper number of cells and the full diversity of cell types ( hatakeyama et al . , 2004 ) . notch signaling has been shown to play an important role in the maintenance of neural stem / progenitor cells ( fortini , 2009 ; kopan and ilagan , 2009 ; pierfelice et al . , 2011 ) . here we review the recent progress on the mechanism and role of notch signaling in neural development .

in neural stem / progenitor cells , expression of the notch effector hes1 , a transcriptional repressor , oscillates with a period of 23 h by negative feedback , and hes1 oscillations induce the oscillatory expression of the proneural gene neurogenin2 ( ngn2 ) and the notch ligand gene delta - like1 ( dll1 ) . dll1 oscillation leads to the mutual activation of notch signaling between neighboring cells , thereby maintaining a group of cells in the undifferentiated state . not all cells express hes1 in an oscillatory manner : cells in boundary regions such as the isthmus express hes1 in a sustained manner , and these cells are rather dormant with regard to proliferation and differentiation . thus , hes1 allows cell proliferation and differentiation when its expression oscillates but induces dormancy when its expression is sustained . after hes1 expression is repressed , ngn2 is expressed in a sustained manner , promoting neuronal differentiation . thus , ngn2 leads to the maintenance of neural stem / progenitor cells by inducing dll1 oscillation when its expression oscillates but to neuronal differentiation when its expression is sustained . these results indicate that the different dynamics of hes1 and ngn2 lead to different outcomes .

urinary bladder metastasis from solid tumors is rare and represents 2 % of all bladder neoplasms . direct extension from the cervix , prostate and colon is not unusual but metastasis from a distant organ is extremely rare . breast cancer represents as a primary site in about 2.5 % cases of all metastatic bladder cancer . breast cancer commonly metastasizes to the lung , bone , liver , lymph nodes and skin ; less frequently it involves the brain , adrenal glands , ovary , spleen , pancreas , kidney , thyroid and heart . there are reports on unusual sites of breast cancer metastases ; the urinary bladder and retroperitoneum is considered one of these unusual sites .

breast carcinoma is the most common nondermatologic cancer diagnosis in women . common metastatic sites include lymph nodes , lung , liver , and bone . breast carcinoma metastatic to the bladder has been reported only sporadically . most patients were symptomatic breast cancer with evidence of disseminated disease at the time of diagnosis . metastasis usually occurred many years after diagnosis , and the prognosis was poor . we report a case of breast caricinoma metastasizing to the urinary bladder and retroperitoneum , which presented initially with acute renal failure . patient was treated with bilateral per cuteneous nephrostomies and chemotherapy . starting from this clinical case we review the available literature on this issue . patients with breast cancer presenting with urinary symptoms should be examined for possible bladder metastasis .

exposed root surfaces in the anterior region may have several consequences : impaired aesthetics , increased risk of root caries , and hypersensitivity . whereas circularly denuded root surfaces ( facial / oral and interproximally recessions ) due to periodontitis respond neither completely nor predictively to surgical coverage attempts , there are several techniques that are successfully used to treat facial recessions : for example , coronally advanced and lateral positioned flaps , free gingival and connective tissue grafts ( ctg ) , and guided tissue regeneration . ctg according to the envelope technique is an established method with favorable long - term stability . although a decent number of clinical studies investigating and comparing the efficacy of different root coverage techniques do exist [ 3 , 6 ] , data on patient - centered outcomes are scarce . however , for a technique aiming at aesthetical improvement patient - centered outcomes , that is , the question whether a patient actually notices aesthetic improvement should be regarded as main outcome variables . thus , structured reviews addressing root coverage techniques have explicitly stated that clinical trials addressing patient - centered outcomes ( aesthetics and postsurgical morbidity ) are required [ 3 , 6 ] . the concept of oral health - related quality of life ( ohqol ) may be an approach to address patient - centered outcomes . the ohip ( oral health impact profile ) questionnaire is one of several instruments which have been developed to measure ohqol . is the most comprehensive questionnaire to assess ohqol and able to measure patients ' problems and symptoms . it is well suited to characterize oral problems and symptoms because the questionnaire items were developed through interviews with patients . as a result , it is a standardized , internationally accepted instrument which was translated into several languages ( e.g . , german : ohip - g49 ) . hence , the objectives of this prospective longitudinal clinical pilot study were the evaluation of the effect on the oral health impact profile ( ohip ) and patient - centered results of the envelope technique for ctg .

purpose . the aim of this prospective longitudinal clinical pilot study was the evaluation of the effect on the oral health impact profile ( ohip ) and patient - centered results of the envelope technique for connective tissue graft ( ctg ) . methods . sixteen patients ( 11 females ) 24 to 71 years of age ( 42.6 11.1 ) received ctg that had been harvested from the palate and grafted using the envelope technique . prior to and 3 months after surgery , all patients were examined clinically , completed the ohip - g49 questionnaire , and were asked to judge the results of surgery . results . mean baseline recession depth of 2.5 0.8 mm was reduced by 1.2 0.9 mm ( p < .001 ) . root coverage amounted to 48 39 % . in 5 of 16 defects complete root coverage was achieved . pain at the donor site was more pronounced than at recipient site regarding prevalence ( 8/6 ; p = .007 ) , intensity ( 2.1 2.3/1.1 1.9 [ visual analogue scale ] ; p = .016 ) , and duration ( 1.4 2.3/0.8 1.4 days ; p = .042 ) . baseline ohip ( 15.7 12.1 ) was decreased by 3.6 8.5 three months after surgery ( p = .139 ) . thirteen patients ( 81 % ) would undergo ctg surgery for similar reasons again . conclusions . root coverage using ctg according to the envelope technique provided improvement of ohip as early as 3 months after surgery . over all , patients were reasonably satisfied with the surgical technique and its results .

rosette forming glioneuronal tumor ( rgnt ) a rare slowly growing tumor affecting mainly the young adults which has been included as one of the glioneuronal tumors in the 2007 version of the world health organization ( who ) classification of central nervous system tumors . the neoplasm is composed of distinct neurocytic rosettes , perivascular pseudorosettes and an astrocytic component mostly pilocytic astrocytoma . the cytomorphology of this rare entity has been described only in a few isolated case reports . here , we are addressing the potential role of cytology for the diagnosis of rgnt as well as the close differential diagnoses which can cause difficulties during squash smear cytological examination .

rosette forming glioneuronal tumor ( rgnt ) is a recently recognized and extremely rare glioneuronal tumor occurring in the fourth ventricle . it is crucial for the cytopathologist to be aware of this entity as it can be easily mistaken for more common neoplasms occurring at this site . we present here the cytology of such a rare case of rgnt that was misdiagnosed as ependymoma . the varying cytological features of this entity , as well as the common diagnostic difficulties encountered in cytology , are highlighted in this report .

disability due to chronic pain ( dcp ) results in absence from work and is a major public health concern in japan and many western countries.14 various screening tools have been developed to identify chronic pain subgroups and comorbid factors.57 a widely used powerful tool is the start back tool ( start ) , a 9-item screening tool that was developed as a prognostic indicator of lower back pain ( lbp ) . items 14 evaluate physical factors and items 59 assess psychosocial factors ( figure 1 ) .5,8 the start score is often used by primary care physicians in england to make clinical decisions.5 specifically , the start results indicate the subgroup that an lbp patient falls into , which helps determine which treatment strategies may be most effective . the start has been shown to be particularly effective for individual patient management in the physiotherapy setting . patients who underwent start testing and subsequent targeted therapy had higher clinical and cost efficacy than patients who did not undergo start testing and were treated with usual care strategies.5 we previously translated the start into japanese,9 and this version was linguistically validated in a general cross - cultural adaptation process.1012 we also evaluated the reliability and validity of the start into japanese in a large number of japanese patients with lbp.13 the lower back was the most common site of chronic pain and accounted for 65 % of all cases of reported chronic pain in a japanese epidemiological study.1 however , chronic pain often originates in places other than the lower back , and a generic screening tool is needed to help effectively manage chronic pain from all sites . one such tool is the generic version of the start back 5-item screening tool ( start - g ) , a modified version of the 9-item start.8 the start 9-item screening tool provides an easy way to stratify patients into three subgroups according to the probability of a poor prognosis or pain chronicity . these categories are defined as low risk , medium risk , and high risk ( figure 2 ) .8 on the other hand , the use of start - g ( 5-item ) screening tool has not yet been established . the start - g has also not been validated for evaluating chronic pain in a large group of japanese subjects . therefore , the current study was performed to examine the validity of start - g in such a population using cross - sectional data obtained from start - g surveys administered online .

objectivethe generic start back 5-item screening tool ( start - g ) is used to manage chronic pain in the lower back and elsewhere . this study evaluated the validity of the japanese version of this generic screening tool.materials and methodsjapanese participants between the ages of 20 and 64 years completed online surveys regarding pain . survey reliability was assessed with internal consistency , as calculated using cronbach s alpha coefficients . spearman s correlation coefficients were used to evaluate concurrent validity between the start - g score and standard reference questionnaires . associations between start - g scores and the presence of a disability due to chronic pain ( dcp ) were analyzed using receiver operator characteristic ( roc ) curves.resultsanalyses ultimately included data obtained from 52,842 japanese participants ( 54.4 % male ) with a mean ( standard deviation ) age of 47.7 ( 9.4 ) years . approximately 1.5 % of participants had dcp , and the mean start - g score was 1.2 ( 1.4 ) . the cronbach s alpha coefficient was 0.71 , indicating an acceptable reliability . the start - g score moderately correlated with the pain numerical rating scale ( nrs ) score ( spearman s correlation coefficient : r = 0.34 ) . when the start - g threshold was set at 4 , the sensitivity and specificity of the dcp predictive model were 65.8 % and 82.4 % , respectively , and the area under the roc was 0.808.conclusionthe start - g was internally consistent and was able to distinguish between subjects with and without a dcp . therefore , the start - g can reliably be used in the japanese population to identify patients with dcp .

these comorbidities might lead to the overuse or misuse of antipsychotic drugs , which has been suggested to increase mortality in this patient population . recognizing the increased use of polypharmacy in elderly patients with dementia , the centers for medicaid and medicare services ( cms ) encourages health care providers to seek alternative approaches in treating these individuals . some of the non - pharmacological treatment approaches include consistency in caregivers , individualization of routine care , and selection of activities that are appropriate for the patient s cognitive abilities . aromatherapy and essential oils have been used medicinally for thousands of years in china , israel , egypt , europe , and ancient greece , and they should be investigated as an additional non - pharmacologic approach in this patient population . lavender ( lavandula angustifolia ) contains the active compounds linalyl acetate and -linalool which have been used for their sedative , analgesic , and anxiolytic properties as alternative therapy in the treatment of pain , anxiety , and stress [ 57 ] . lavender may exert anxiolytic effects by inhibiting voltage gated calcium channels primarily in the neurons of the hippocampal region . additional studies indicate that autonomic arousal is suppressed with the use of lavender . a recent meta - analysis conducted by perry et al . examined 15 randomized controlled trials that evaluated the effects of lavender on anxiety and mood . the authors concluded that due to the lack of conclusive evidence of the effects of lavender on behavioral issues , further studies are warranted to fully evaluate its potential as an alternative therapy . furthermore , a double - blind randomized trial comparing oral lavender to placebo showed that the former was both efficacious and safe for the relief of anxiety disorder not otherwise specified without causing adverse drug events . additionally , a small multi - center study evaluated the effects of lavender aromatherapy on 24 nursing home patients who suffered from anxiety and disturbed sleep patterns . the nursing staff s perceptions of the patient s behaviors including mood , activity , sleep quality , and unrestfulness were recorded as well as any changes in medication use . it was found based on the nursing perceptions that 40 % ( n = 10 ) of the patients had a good / very good response to the lavender aromatherapy intervention . while existing evidence shows promising results , data on the use of lavender in treating behavioral issues in the elderly population , especially those with dementia , needs to be elucidated . our study s purpose was to evaluate the effects of diffused lavender in decreasing the occurrence of behavioral issues in a geriatric population with dementia .

abstract objectives : to evaluate the effects of diffused lavender on the frequency of behavioral issues [ bis ] , defined as a composite of restlessness / wandering [ rw ] , agitation [ agt ] , anger [ ang ] , and anxiety [ anx ] in an adult day care center . secondary objectives evaluate systematic differences on the frequency of bis between age cohorts , gender , and individual behaviors . design : pre - post quasi - experimental study . setting : private nonprofit adult day care center for patients with dementia . participants : elderly patients older than 65 years of age with a clinical diagnosis of dementia , who require daytime monitoring . intervention : lavender aromatherapy twice a day for 20 min during a two - month period during active clinic days . measurements : behavioral issues were recorded using the behavior / intervention monthly flow record during the pre- and post - intervention periods . results : there was no significant difference on frequency of bis between pre - intervention and post - intervention periods ( p = .06 ) . there was a significant difference between pre - intervention and post - intervention total number of agt occurrences ( 129 vs. 25 ; p value < .01 ) . there was no significant difference between age cohorts for computed difference of rw , ang , and anx issues . there was a significant difference between age cohorts for computed difference of agt ( p value = .04 ) as the 7085 age cohort showed less agitation compared to the 85100 age cohort . conclusion : the use of diffused lavender twice daily has shown to reduce the frequency of agitation in elderly patients with dementia , especially in the 7085 age cohort . though diffused lavender did not show statistical differences in the frequency of other behaviors ( restlessness / wander , anger , anxiety ) , the study population may have been too small to find a difference .

the main public health strategy for containing influenza is annual vaccination , which is recommended for the elderly and others belonging to risk - factor categories , which present the highest morbidity and mortality , as reported by the world health organization ( who ) recommendations . influenza viruses are constantly changing , mainly as a result of so - called `` antigenic drift `` , which consists of the continuous , spontaneous modification of viral surface composition , and regards hemagglutinin ( ha ) and neuraminidase ( na ) proteins . for this reason , the vaccine composition has to be adapted annually to integrate viral strains as similar as possible to the epidemic strains . the degree of similarity or difference between the circulating viruses and the viruses included in the vaccines is often referred to as `` vaccine match `` or `` vaccine mismatch `` . vaccine effectiveness , i.e . the ability to prevent influenza cases , is determined both by the degree of vaccine matching and by the characteristics of the subjects immunized , such as their age and health status . the degree of antigenic drift and the frequency of drifted viruses in circulation can change from one season to another , in comparison with each of the strains included in the seasonal flu vaccine . since 1973 , surveillance systems have enabled the who to issue recommendations for the composition of influenza vaccines . careful analysis of epidemiological data based on the antigenic identification of strains , pathogenic potential and transmissibility is a valuable means of evaluatevaluating the persistence and dissemination of new influenza strains [ 2 - 4 ] . since 1999 , the who has issued two different sets of recommendations every year : one for the northern and one for the southern hemisphere ; these recommendations are issued several months before the influenza season begins , in order to allow timely production of the upcoming seasonal influenza vaccine in conformity with the manufacturers ' recommendations . even when circulating influenza viruses are mildly or moderately drifted in comparison with the vaccine , available evidence suggests that people may still receive some protective benefit from vaccination .

summarythe main public health strategy for containing influenza - related disease is annual vaccination , which is recommended for the elderly and others belonging to risk - factor categories , who present the highest morbidity and mortality , as reported by the world health organization ( who ) recommendations.the availability of different influenza vaccine formulations makes the choice of the best immunization strategy a challenge for stakeholders and public health experts.heterogeneity in at - risk categories included in national influenza vaccine recommendations still exists , in particular among european countries . broader consensus is expected , which should positively impact on influenza vaccination coverage.the availability of quadrivalent vaccines , containing both influenza b lineages , offers the potential to improve protection by overcoming the drawbacks of wrongly predicting which b lineage will predominate in a given year .

antibiotics are well known to alter neuronal functioning , with penicillin being the best studied on not only a clinical level but on a basic science level as well . after multiple reports emerged on the probable relation between high dose penicillin and seizure , detailed animal studies emerged that showed toxic doses of penicillin given intravenously could induce myoclonic jerks at the spinal level , and could be abolished by penicillinase administration . given the wide spread use of structurally related antibiotics that share the beta lactam ring structure of penicillin , clinicians need to be aware of the potential for secondary neurotoxic effects . this report describes reversible frequent myoclonic jerks of the extremities during intravenous administration of nafcillin with piperacillin .

a 66-year - old male receiving intravenous piperacillin and nafcillin for a post - surgical wound infection developed intermittent myoclonic jerks of all four extremities that disappeared after discontinuation of these two medications . in addition there was a mild yet definite intermittent encephalopathic effect ; head computed tomography examination as negative and there was no prior history for seizure or myoclonus . these two beta lactam ring antibiotics are structurally similar to penicillin , which is well known to induce not only myoclonus but also seizure activity by reducing the gamma - aminobutyric acid ( gaba ) induced inhibitory currents by inducing an open chloride channel block of the gaba type a receptors within the brain . clinicians need to be fully aware of the potential epileptogenic effects of piperacillin , nafcillin , and related antibiotics .

pain is defined as an unpleasant sensory and emotional experience arising from any part of the body . it is associated with actual or potential tissue damage or described in terms of such damage by international association for the study of pain . it is an experience and in this respect , it differs from nociception . nociception is called a neural process that provides transduction and transmission of a noxious stimulus to the brain via pain pathways . the pain arises from a complicated interaction between signaling systems , modulation of higher centers , and individual perception . the whole human population experiences pain in varying degrees and daily routine is affected negatively . pain may be occurred acutely or chronically related with various disturbances such as lesions , traumatic injury , tumors , inflammatory diseases , parkinson 's disease , and diabetes . since different mechanisms involve in the pathophysiology of acute and chronic pain and even nociceptive and neuropathic pain , the management strategies and current drug classes also vary . although there are too many analgesic agents , there are certain problems such as tolerability , tolerance , abstinence syndrome , insufficiency , possible drug interactions , and side effects . thereby , the development of new analgesic compounds is still going on . in this respect , the development and the use of imidazoline receptor ligands have gradually drawn attention since the role of imidazoline receptors in pain modulation was identified . for instance , various ligands which bind to imidazoline-2 ( i2 ) receptors , the imidazoline receptor subtype which is predominantly involved in pain modulation , have been synthesized 2- ( 4,5-dihydroimidazole-2-il ) quinoline hydrochloride ( bu224 ) , 2- ( 2-benzofuranyl ) -2-imidazoline hydrochloride ( 2-bfi ) , 4-chloro-2- ( imidazoline-2-yl ) isoindoline ( rs-45041 ) , etc . , in last decades and all of them have been reported to exhibit antinociceptive properties as discussed in this review . whereas the single use of imidazoline receptor ligands is effective in tonic and chronic pain , combined usage of other analgesic drugs such as morphine and clonidine is also effective in the potentiation of both acute and chronic pain conditions such as neuropathic pain . in fact , it is known that the i2 receptor agonism is one the mechanisms of neuropathic pain control , and the ligands that use this mechanism are in the phase 2 and phase 3 studies . in this review , we document the role of i2 receptors and ligands in antinociception and the relevant experimental studies performed by various researchers .

pain is an unpleasant experience and effects daily routine negatively . although there are various drugs , many of them are not entirely successful in relieving pain , since pain modulation is a complex process involving numerous mediators and receptors . therefore , it is a rational approach to identify the factors involved in the complex process and develop new agents that act on these pain producing mechanisms . in this respect , the involvement of the imidazoline receptors in pain modulation has drawn attention in recent years . in this review , it is aimed to focus on the imidazoline receptors and their ligands which contribute to the pain modulation . it is demonstrated that imidazoline-2 ( i2 ) receptors are steady new drug targets for analgesics . even if the mechanism of i2 receptor is not well known in the modulation of pain , it is known that it plays a role in tonic and chronic pain but not in acute phasic pain . moreover , the i2 receptor ligands increase the analgesic effects of opioids in both acute and chronic pain and prevent the development of opioid tolerance . so , they are valuable for the chronic pain treatment and also therapeutic coadjuvants in the management of chronic pain with opiate drugs due to the attenuation of opioid tolerance and addiction . thus , the use of the ligands which bind to the imidazoline receptors is an effective strategy for relieving pain . this educational forum exhibits the role of imidazoline receptors and ligands in pain process by utilizing experimental studies .

shafer in 1983 introduced the term ameloblastic carcinoma ( ac ) to describe ameloblastomas in which there had been histological malignant transformation . it is currently defined as a rare odontogenic malignancy that combines the histological features of ameloblastoma with cytological atypia , even in the absence of metastases . although this lesion represents a separate entity , differentiating it from ameloblastoma has been often challenging to pathologists . recent study targets the different expression pattern of immunohistochemical markers in order to differentiate a case of ac from ameloblastoma . a wide range of epithelial - associated factors are implicated in the relative aggressive biological behaviour of the odontogenic epithelium while only a few studies have investigated non - epithelial factors . myofibroblasts and cancer - associated fibroblasts are important components of the tumour stroma . in fact the presence of stromal myofibroblasts has been linked to the biological behaviour of both benign and malignant tumours . in a recent case study , we attempted to differentiate ac from ameloblastoma on the basis of difference in expression pattern of alpha smooth muscle actin ( alpha - sma ) .

abstractbackgroundthe aim of the present article is to report a case of ameloblastic carcinoma and use a marker alpha smooth muscle actin as a tool to differentiate cases of ameloblastic carcinoma from that of ameloblastoma.methodscase study reporting a case of ameloblastic carcinoma ( ac ) with expression of alpha smooth muscle actin ( alpha - sma ) as a marker for emergence of stromal myofibroblasts . the expression of myofibroblasts was also compared with that of ameloblastoma.resultsdifference between the two lesions in the pattern of expression of alpha smooth muscle actin was also observed . there was increase in the number of myofibroblasts in the stroma of ac while in ameloblastoma , it was comparatively less . secondly , few areas of the carcinomatous ameloblastic island also exhibited a mild positivity towards alpha smooth muscle actin.conclusionsincrease in number of stromal myofibroblast may be taken as a predictor for carcinomatous transformation . further studies with greater sample size can validate the use of alpha - sma as a marker to differentiate ameloblastic carcinoma from ameloblastoma .

near - infrared spectroscopy ( nirs ) offers a new monitoring tool to be used in critically ill patients . nirs measures the saturation of hemoglobin in the skeletal muscle and serves as an index of perfusion . we have studied the value of tissue hemoglobin oxygen saturation ( sto2 ) in a number of settings , including intensive care unit ( icu ) shock resuscitation , predicting outcomes in the emergency department ( ed ) , and to better understand massive transfusion ( mt ) .

introductionthe purpose of the present review is to review our experience with near - infrared spectroscopy ( nirs ) monitoring in shock resuscitation and predicting clinical outcomes.methodsthe management of critically ill patients with goal - oriented intensive care unit ( icu ) resuscitation continues to evolve as our understanding of the appropriate physiologic targets improves . it is now recognized that resuscitation to achieve supranormal indices is not beneficial in all patients and may precipitate abdominal compartment syndrome.resultsover the years , icu technology has provided physicians with specific physiologic parameters to guide shock resuscitation . throughout this time , the tissue hemoglobin oxygen saturation ( sto2 ) monitor has emerged as a non - invasive means to obtain reliable physiologic parameters to guide clinicians ' resuscitative efforts . sto2 monitors have been shown to aid in early identification of nonresponders and to predict outcomes in hemorrhagic shock and icu resuscitation . these data have also been used to better understand and refine existing resuscitation protocols . more recently , use of nirs technology to guide resuscitation in septic shock has been shown to predict outcomes in high - risk patients.conclusionssto2 is an important tool in identifying high - risk patients in septic and hemorrhagic shock . it is a non - invasive means of obtaining vital information regarding outcome and adequacy of resuscitation .

post - kala - azar dermal leishmaniasis ( pkdl ) is a dermal manifestation of leishmania donovani infection and often follows resolution of clinical visceral leishmaniasis ( vl ) . however , it may also manifest without prior history of vl in a small minority of patients . pkdl is characterized by macular , papular , or nodular lesions or a mixture of them . it is quite common in sudan ( occurring in > 50 % of patients with vl ) , where it may occur concurrently or follows immediately after an episode of vl and heals spontaneously in majority of patients , whereas in the indian subcontinent it occurs in 220 % of patients , 6 months to several years after an episode of vl . in a recent trial the prevalence of confirmed pkdl cases was 4.4 per 10 000 individuals and 7.8 if probable cases were also considered . several treatment regimens have been recommended for the treatment of pkdl in india , for example , 120 days of parenteral sodium stibogluconate ( 20 mg / kg body weight ) or three courses of 20 daily infusions of amphotericin b with an interval of 20 days in between the courses . these inordinately long parenteral regimens invariably lead to either nonacceptance or poor compliance . in the last decade two new antileishmanial compounds , miltefosine and paromomycin , have been approved for the treatment of vl in india . there is a report about the efficacy of miltefosine at a higher dose 50 mg tid for 60 days ( with a need to extend to 90 days if required ) in small number of pkdl patients in bangladesh . of all the antileishmanial drugs , paromomycin is considerably cheaper and is produced in india . in this study

background . post - kala - azar dermal leishmaniasis ( pkdl ) plays an important role in maintaining endemicity of visceral leishmaniasis and its transmission . treatment regimens for pkdl are toxic and require 3 - 4 months of hospitalization . these long and arduous regimens result in extensive noncompliance . there is an urgent need to develop a safe , effective , and acceptable regimen for the treatment of pkdl . paromomycin ( pm ) has been recently approved in india for treatment of visceral leishmaniasis ( vl ) ; hence we tested its efficacy in patients with pkdl . methods . in this exploratory study , 31 patients with pkdl aged 10 years and above were administered pm 11 mg / kg daily intramuscularly for 45 days and followed up for one year . results . out of 31 patients , 7 patients were lost to followup at 1 year and 9 ( 37.5 % ) got cured with complete disappearance of lesion , while 15 ( 62.5 % ) showed no improvement by per protocol analysis . conclusion . cure rate with 45 intramuscular injections of pm was unacceptably low though there was no serious side effect of the drug . whether paromomycin can be used in multidrug therapy to shorten the duration of treatment should be the next logical step for investigation .

alopecia areata ( aa ) is common cause of reversible hair loss afflicting approximately 1 to 2 % of the general population . a wide range of clinical presentations can occur , from a single patch of hair loss to complete loss of hair on the scalp ( alopecia totalis , at ) or over the entire body ( alopecia universalis , au ) . the cause of aa is unknown , although there is evidence to suggest that the link between lymphocytic infiltration of the follicle and the disruption of the hair follicle cycle in aa may be provided by a combination of factors , including cytokine release , cytotoxic t - cell activity , and apoptosis . it is also considered that a disequilibrium in the production of cytokines , with a relative excess of proinflammatory and th1 types , vs. anti - inflammatory cytokines may be involved in the persistence of aa lesions , as shown in human scalp biopsies . tumor necrosis factor - alpha ( tnf- ) is a multifunctional proinflammatory cytokine which has been implicated in the pathogenesis of several chronic inflammatory disorders with an autoimmune component . this cytokine is synthesized in epidermal keratinocytes along with several other cytokines and is known to be a very potent inhibitor of proliferation . the changes in serum tnf- levels were found in many diseases , such as psoriasis and systemic lupus erythematosus . in some of these diseases , serum tnf- concentration correlated with activity and intensity of the disease , and although it is well known that multiple cytokines simultaneously play role in aa , many authors have measured only one particular cytokine . our study has focused only on tnf- because there are only a few studies that have measured the serum levels of this cytokine with controversial results . therefore , the aim of our study was to evaluate serum levels of tnf- in aa patients and control subjects , and also to assess the difference between the localized and extensive forms of the disease such as at and au .

background : alopecia areata ( aa ) is a common form of localized , nonscarring hair loss . it is characterized by the loss of hair in patches , total loss of scalp hair ( alopecia totalis , at ) , or total loss of body hair ( alopecia universalis , au ) . the cause of aa is unknown , although most evidence supports the hypothesis that aa is a t - cell - mediated autoimmune disease of the hair follicle and that cytokines play an important role.aims : the aim of the study was to compare the serum levels of tumor necrosis factor - alpha ( tnf- ) in patients with aa and the healthy subjects and also to investigate the difference between the localized form of the disease with the extensive forms like at and au.materials and methods : sixty patients with aa and 20 healthy controls were enrolled in the study . forty - six patients had localized aa ( laa ) , and 14 patients had at , au , or at / au . the serum levels of tnf- were measured using enzyme - linked immunoassay techniques.results : serum levels of tnf- were significantly higher in aa patients than in controls ( 10.31 1.20 pg ml vs 9.59 0.75 pg / ml , respectively ) . there was no significant difference in serum levels of tnf- between patients with laa and those with extensive forms of the disease.conclusion : our findings support the evidence that elevation of serum tnf- is associated with aa . the exact role of serum tnf- in aa should be additionally investigated in future studies .

leptin deficiency or dysfunction is one of the main causes for insulin resistance ( ir ) and lipid metabolism disorders [ 1 , 2 ] . it has been found that the majority of type 2 diabetes patients have higher levels of body fat , but normal or increased leptin in the plasma [ 36 ] , indicating leptin resistance ( lr ) . certain levels of leptin effectively could stimulate amp - activated protein kinase ( ampk ) to phosphorylate acetyl - coa carboxylase ( acc ) , which in turn reduces the acc activity , decreases fatty acid synthesis , and increases the oxidation of fatty acid ( fa ) , consequently , maintaining the balance of lipid metabolism in the body . studies have shown that even one week of a high fat diet can cause leptin to increase rapidly , leading to fat accumulation in peripheral tissue ir . obese persons with high serum leptin levels tend to experience a downregulation of leptin receptor in hypothalamus , adipose tissue , and liver , which causes peripheral tissues to become lr and promotes lipid accumulation [ 1113 ] . excessive lipid deposition in nonfat tissue has been known to have a toxic effect on cells and to reduce sensitivity to insulin , eventually leading to diabetes and metabolic syndrome . moreover , type 2 diabetes and liver steatosis often coexist [ 1517 ] , but the causal mechanism is unclear . the possible trigger for type 2 diabetes might be related to leptin resistance , which further inhibits the liver ampk - acc signaling pathway and causes liver and systemic metabolic disorders . exercise can reduce body fat by increasing energy consumption and improve the leptin resistance [ 18 , 19 ] . previous studies have shown that exercise could upregulate the expression of leptin receptor and induce changes of the jak - stat3 signaling pathway in the hypothalamus and peripheral tissues in leptin - resistant rats [ 20 , 21 ] . after exercise , normal rats experienced increased skeletal muscle growth , increased activity of the liver ampk and malonyl - coa decarboxylase ( mcd ) pathways , and decreased activity of acc , which further increased fatty acid oxidation and reduced glyceride synthesis . our previous study suggested that chronic and acute exercise could both reduce obesity and decrease blood sugar level in type 2 diabetic rats as well as improve the phosphorylation and gene expression related to improved skeletal muscle ; ampk1/2 and its subunits ( ampk1 , ampk2 ) reduced acc phosphorylation . it is unknown , however , whether exercise affects the liver leptin - ampk signaling pathway or whether it can improve liver lipid metabolism . in our present study , a type 2 diabetic rat model , given a high fat diet and a low dose of stz , was used to address this question . acute and chronic exercise variables were chosen to study whether exercise could affect protein expression and protein phosphorylation involved in the liver leptin - ampk - acc signaling pathway . the relationship between the liver leptin - ampk - acc signaling pathway and lipid metabolism , as well as the effect of acute and chronic exercise on that pathway , was investigated .

aim . to investigate the effects of acute and chronic exercise on glucose and lipid metabolism in liver of rats with type 2 diabetes caused by a high fat diet and low dose streptozotocin ( stz ) . methods . animals were classified into control ( con ) , diabetes ( dc ) , diabetic chronic exercise ( dce ) , and diabetic acute exercise ( dae ) groups . results . compared to con , the leptin levels in serum and liver and acc phosphorylation were significantly higher in dc , but the levels of liver leptin receptor , ampk1/2 , ampk1 , and acc proteins expression and phosphorylation were significantly lower in dc . in addition , the levels of liver glycogen reduced significantly , and the levels of tg and ffa increased significantly in dc compared to con . compared to dc , the levels of liver ampk1/2 , ampk2 , ampk1 , and acc phosphorylation significantly increased in dce and dae . however , significant increase of the level of liver leptin receptor and glycogen as well as significant decrease of the level of tg and ffa were observed only in dec . conclusion . our study demonstrated that both acute and chronic exercise indirectly activated the leptin - ampk - acc signaling pathway and increased insulin sensitivity in the liver of type 2 diabetic rats . however , only chronic and long - term exercise improved glucose and lipid metabolism of the liver .

zhigancao , glycyrrhizae radix et rhizoma praeparata cum melle , originates from the processed dried roots or rhizomes of glycyrrhriza uralensis fisch . it is most frequently used in traditional chinese medical formulary to harmonize all drugs and detoxify the adverse effects of herbs . clinically , it treats disorders such as shortness of breath , fatigue , epigastria and abdominal pain , musculoskeletal and smooth muscle cramp and pain , and diarrhea . due to the numerous bioactive compounds in it such as terpenoids , saponins , polysaccharides , and flavonoids , zhigancao has been reported to possess anti - inflammatory activities , antioxidative [ 3 , 4 ] , neuroprotective , antiallergic , anticonvulsant activities , and so forth . two chalcone derivatives in figure 1 , isoliquiritin apioside ( ila ) and isoliquiritin ( il ) , which are important ingredients in zhigancao , are selected to research their pharmacokinetics . il has been reported to have shown various pharmacological activities such as antiangiogenic effect dependent upon antitube formation , antidepressant - like effects in mice induced by forced swimming and tail suspension , and inhibitory effects on tyrosinase . the bioavailability of drugs is the cornerstone for extending their in vitro biological functions to humans in vivo . the flavonoid glycosides show low oral bioavailability possibly because of the extensive conjugation of the free hydroxyl groups [ 1214 ] or / and glycosides hydrolysis to the aglycones in the intestinal lumen [ 1416 ] . the pharmacokinetic study of ila and il is essential for us to comprehend the bioavailability of two analytes after an oral administration of zhigancao extrat . to my knowledge , ila and il quantification method ( lc - ms / ms ) has been performed to study pharmacokinetics of multiple licorice flavonoids after an oral dose of xiaochaihu - tang to rats , but lc - ms / ms method is simply not available in most laboratories . in this study , we established the hplc method which was highly selective and sensitive for simultaneous quantification of ila and il in rat plasma . the method was used to explore the possible pharmacokinetics of ila and il after an oral administration of zhigancao extract .

a sensitive hplc method was developed for the quantitative determination of isoliquiritin apioside ( ila ) and isoliquiritin ( il ) in rat plasma . after protein precipitation with acetonitrile , chloroform was used to separate lipid - soluble impurities from the plasma samples and remove acetonitrile . a chromatography was carried out on diamonsil c18 ( 150 4.6 mm ; 5 m ) analytical column , using a mobile phase consisting of water ( containing phosphoric acid 0.1 % , v / v ) ; acetonitrile ( 72 : 28 , v / v ) at a flow rate of 1.0 ml / min . the wavelength - switching technology was performed to determine ila and il at 360 nm and wogonoside ( internal standard , is ) at 276 nm . the calibration curves of ila and il were fairly linear over the concentration ranges of 0.0603.84 g / ml ( r = 0.9954 ) and 0.0754.80 g / ml ( r = 0.9968 ) , respectively . the average extract recoveries of ila , il , and is were all over 80 % . the precision and accuracy for all concentrations of quality controls and standards were within 15 % . the lower limit of quantification ( lloq ) was 0.060 g / ml for ila and 0.075 g / ml for il . the method was used in pharmacokinetic study after an oral administration of zhigancao extract to rats .

consumption of green tea is inversely associated with risk for cardiovascular diseases and stroke,1 as well as with lower cardiovascular and total mortality.2 improvement of endothelial function is thought to be one major mechanism for these beneficial effects . green tea improved flow - mediated dilation in chronic smokers3 and in healthy individuals.4 a meta - analysis indicates that green and black tea ingestion increases endothelial - dependent vasodilation.5 because endothelial dysfunction is characterized by reduced availability of nitric oxide ( no ) , interventions able to stimulate vascular no production represent a promising tool in the prevention of cardiovascular diseases . the catechin epigallocatechin-3-gallate ( egcg ) represents the most potent physiologically active tea compound in vitro . egcg has been shown to induce vasodilatory effects in isolated blood vessels in various studies.612 besides an no - dependent mode of action , other no - independent mechanisms for egcg - induced vasodilation were also proposed . to elucidate conclusively whether egcg - induced vasodilation is dependent on no , we studied effects of egcg in isolated aortic rings of endothelial no knockout ( enos ) mice compared with wild type controls .

abstract : the underlying mechanisms for the vasodilating effects of the tea catechin epigallocatechin-3-gallate ( egcg ) are still not fully understood . besides nitric oxide ( no ) -dependent effects , other modes of action are discussed . to elucidate whether the no pathway is a prerequisite in mediating vasodilating effects , we investigated egcg - induced vasorelaxation in isolated aortic rings of endothelial nitric oxide knockout ( enos/ ) mice . vasodilation to acetylcholine was fully prevented in aortic rings of enos/ mice , confirming lack of vascular no production . vasodilation to the exogenous no donor sodium nitroprusside was preserved in enos/ mice aortic rings . low concentrations of egcg ( 515 m ) resulted in strong vasorelaxation in aortic rings of wild type mice , whereas it was completely absent in enos/ mice . in corroboration , relaxation in response to green tea was significantly inhibited in aortic rings of enos/ mice . these results demonstrate that egcg - induced vasodilation strongly relies on functional no synthase in endothelial cells and subsequent stimulation of no production in vessels .

non - alcoholic fatty liver disease ( nafld ) is a major cause of chronic liver disease globally , and is characterized by a spectrum of steatosis , inflammation and fibrosis . non - alcoholic steatohepatitis ( nash ) is a more severe form of nafld , and is characterized by lobular inflammation and hepatocyte ballooning ; 1,2 furthermore , nash is presumed to lead to cirrhosis in a quarter of the afflicted patients . the growth of nafld as an epidemic is related to increasing prevalence of obesity and sedentary life - style . the traditional risk factors for nafld include age , sex , central obesity leading to insulin resistance , and development of metabolic syndrome . furthermore , genetic predisposition is also presumed to have a role , given the differences noted amongst different ethnic groups.3,4 in the united states , the prevalence of nafld is gradually increasing and is currently estimated to affect one - third of adults.15 moreover , nash is predicted to be the leading cause of liver transplant in the coming years . despite the growing prevalence , however , the treatment options remain extremely limited . until recently , nafld was believed to be a disease of the industrialized world , primarily related to sedentary life - style . studies have suggested a wide amount of diversity in prevalence based on country of interest . the average prevalence in europe is 2030 % and in china appears to be 524 % .1,5 in india , the prevalence is estimated to be between 1632 % .5 this is believed to be due to the increasing industrialization of these nations , along with changes in life - style and diet . furthermore , recent studies have also suggested that nash / nafld can also affect seemingly non - obese asians.6,7 this has come to be known as the asian paradoxas a disease that is associated with high bmi in the western world may not predict accurately the risk of developing nafld in the asian world.68 in this review , we look specifically at south asians afflicted with nafld . south asia is a growing epicenter for industrialization and changing life - styles , and also increasing prevalence of nafld . the south asian region includes the countries of india , nepal , bhutan , bangladesh , sri lanka , maldives , pakistan and afghanistan . the importance of gaining a better and complete understanding nafld in this region is essential in view of its growing population and immigration to western nations . in this review , we describe the prevalence of nafld in south asians and further describe the nafld phenotype with respect to lean nafld as well as the burden of hepatocellular carcinoma ( hcc ) in south asia .

abstractnon - alcoholic fatty liver disease ( nafld ) and non - alcoholic steatohepatitis ( nash ) are national and global epidemics . the disease is characterized by a spectrum of liver steatosis ( fat deposition ) , inflammation ( in nash ) and fibrosis . nafld and specifically nash can lead to cirrhosis , which carry risks of progression to portal hypertension and hepatocellular carcinoma ( hcc ) . nash is also associated with higher mortality from cardiovascular causes . most of the data for nafld has been obtained from the perspective of developed nations , although the disease is increasing and threatening to reach epidemic proportions across the world . emerging data is notable for high prevalence of nafld in south asian populations , presumably resulting from a combination of underlying genetic polymorphisms and changes in socio - economic status . it is also notable that an asian paradox has been defined for nafld based upon the observation of lower than pre - defined body mass index ( bmi ) , otherwise termed as lean nafld , among this population . yet , data remains limited in regards to the characteristics of nafld / nash in this population . in this article , we present a review of the literature and discuss the prevalence , associated risk factors and burden of hcc in south asians with nafld .

world - wide , 13 million people develop sepsis each year , and as many as 4 million people have died . in 1996 , there were 4.774 patients admitted to a teaching hospital in surabaya , indonesia , and 504 patients were diagnosed as having sepsis , with a mortality rate of 70.2 % . in a study at a teaching hospital in yogyakarta , indonesia , there were 631 cases of sepsis in 2007 , with a 48.96 % mortality rate . a global effort is needed to improve the therapeutic management of sepsis because of its high prevalence and mortality rate . the therapeutic management of sepsis , including septic shock , requires a comprehensive and systematic approach that includes a diagnostic method , the initiation of empirical antibiotic use and administration of supportive therapy . empirical antibiotic therapy must also consider the site of infection , the common pathogen that caused sepsis and antibiotic sensitivity based on local patterns of antibiotic resistance . failed to define the source of infection will potentially lead to wrong pathogen identified , and will also lead to inappropriate antibiotic selection . the global escalation in both community- and hospital - acquired antimicrobial - resistant bacteria is increasingly compromising effective antimicrobial therapy , particularly when it comes to empiric antimicrobial selection . the appropriate use of an empirical antibiotic is critical to decrease the mortality rate of sepsis and should be started within 1 - 2 h after the diagnosis of severe sepsis . in this study , we analyzed the pattern of antibiotic use in septic patients and the pattern of microbial resistance based on the results of various cultures of microbial specimens from the sepsis patients . the information gained will be critical as a reference for pathogen identification , selection of empirical antibiotic therapy , and policies to control antibiotic resistance , especially in sepsis patients .

background : the appropriate selection of empirical antibiotics based on the pattern of local antibiotic resistance can reduce the mortality rate and increase the rational use of antibiotics.aims : we analyze the pattern of antibiotic use and the sensitivity patterns of antibiotics to support the rational use of antibiotics in patients with sepsis.materials and methods : a retrospective observational study was conducted in adult sepsis patient at one of indonesian hospital during january - december 2011 . data were collected from the hospital medical record department . descriptive analysis was used in the processing and interpretation of data.results : a total of 76 patients were included as research subjects . lung infection was the highest source of infection . in the 66.3 % of clinical specimens that were culture positive for microbes , klebsiella pneumoniae , escherichia coli , staphylococcus hominis were detected with the highest frequency . the six most frequently used antibiotics , levofloxacin , ceftazidime , ciprofloxacin , cefotaxime , ceftriaxone , and erythromycin , showed an average resistance above 50 % .conclusions : the high use of antibiotic with a high level resistance requires a policy to support its rational use . local microbial pattern based on site infection and pattern of antibiotics sensitivity test can be used as supporting data to optimize appropriateness of empirical antibiotics therapy in sepsis patients .

the leptomeninges are composed of the pia and arachnoid mater connected by strands termed arachnoid trabeculae . in the young , the leptomeninges and dura mater have been traditionally thought to contain few , if any , inflammatory cells , and any increase in cellularity is potentially equated to a pathologic condition , including inflicted trauma [ 1 , 2 ] . at present , we do not know what constitutes normal cellularity of infant leptomeninges and if inflammatory or iron containing cells should be present at all in non - forensic settings . however , when indeed present under suspicious circumstances , they are often linked to inflicted trauma , such as in cases of the shaken baby syndrome . in order to recognise and characterise the pathologic findings in infant brains , it is important to have an understanding of the normal constituents of the various intracranial compartments . while some studies in the past , largely in rodent pups , have sought to evaluate and characterise the leptomeningeal cellular constituents , up until now , a rigorous analysis of the inflammatory cellular constituents of the leptomeninges has not been performed in human late - foetal and infant brains . this characterisation will serve as a baseline for comparison with brains of similarly aged children in forensic settings . therefore , in addition to determining the inflammatory cellular composition and presence of iron in foetal and infant leptomeninges associated with natural disease processes and in the absence of physical trauma beyond that accompanying vaginal birth , this study aims to formulate a basis of comparison of leptomeningeal cellular constituents in forensic settings , based on rigorous histological analyses of hospital - derived autopsies .

objectivesnotwithstanding the lack of definitive evidence from studies conducted to date , inflammatory infiltrates and iron deposition in the leptomeninges are routinely used as forensic markers of traumatic brain injury . we investigated the presence of these forensic markers of trauma in neonates and infants , with the objective of determining their suitability for use in forensic cases.methodsleptomeninges derived from non - traumatic deaths were studied . thirty - three cases were divided into groups 1 and 2 , according to set age groups . inflammatory cells and iron in these groups were quantified.resultscd45 , cd68 and cd163 positive inflammatory cells were identified in the leptomeninges of sections of the cerebellum , brain stem and cortex of all 33 cases of non - traumatic infant deaths surveyed in this study . there were no significant differences between the two groups . iron was found in the leptomeninges in several cases , even those without recent haemorrhage . overall within the two subgroups , the numbers of inflammatory cells and iron containing cells were not significantly different.conclusionthese findings demonstrate that inflammatory cells and iron in the leptomeninges can be found in natural and non - traumatic conditions . further , two cases with no reported neuropathology demonstrated the presence of inflammatory cells and iron . thus , cautious interpretation of the presence of inflammatory cells and iron containing cells in forensic paediatric cases is recommended .

their occurrence was first described in 1670 by thilesus . however , at that time fistulas were a common complication of chronic and untreated cholecystitis . according to a 2005 study , 226 cases have been reported in total , with fewer than 25 in the last 50 years . the reduced incidence in current times can be attributed to more rapid diagnosis and treatment with antibiotics or surgery . although occurring in acalculous cholecystitis and carcinoma of the gallbladder , fistulas are still most commonly associated with gallstones [ 3 , 4 ] . obstruction of the cystic duct leads to an increase in gallbladder pressure and reduced perfusion with necrosis , which consequently causes gallbladder perforation . the contents of the gallbladder may then empty into the peritoneal cavity and an abscess may form or a fistula may develop through adherence to the duodenum , colon or abdominal wall , often via the fundus of the gallbladder . the right upper quadrant is the most common location for the exit tract of the fistula , but locations such as the gluteal region , umbilicus and right groin have also been documented . cholecystocutaneous fistulas are most often seen in elderly women over the age of 60 , likely due to coexistent disease and non - specific symptoms interfering with diagnosis .

cases of cholecystocutaneous fistulas are now a rare occurrence as a result of rapid diagnosis and treatment . we present a case of cholecystocutaneous fistula developing after the removal of a percutaneous drain for the treatment of acute cholecystitis . re - occurring infection and presence of gallstones led to fistulization of the gallbladder fundus and the development of a tract along the path created by the drain . the patient presented with re - occurring right upper quadrant abdominal pain , purulent discharge from the fistulous opening and expulsion of multiple gallstones . she underwent laparoscopic cholecystectomy and fistula excision .

angiogenesis , the formation of new vessels from existing vessels , plays an important role in pathological conditions in various organs . pathological angiogenesis in the eye is the most common cause of blindness in all age groups . retinopathy of prematurity ( rop ) occurs in children , diabetic retinopathy ( dr ) in young adults , and age - related macular degeneration ( amd ) in the elderly . it is important to understand the mechanism of underlying pathological neovascularization to identify new targets to treat these diseases . vascular endothelial growth factor ( vegf ) is thought to be the major angiogenesis factor in rop , dr , and amd . recently , some evidence indicates that chronic inflammation is also implicated in the pathogenesis of retinal neovascularization [ 4 , 5 ] . the high - mobility group box-1 ( hmgb1 ) protein was initially discovered as a nuclear chromatin - binding protein that stabilizes nucleosome formation and facilitates transcription . hmgb1 can be actively secreted by various cell types , including activated monocytes and macrophages , and endothelial cells , after inflammatory stimuli [ 7 , 8 ] . extracellular hmgb1 functions as a proinflammatory cytokine [ 6 , 9 ] and exhibits angiogenic effects [ 10 , 11 ] . hmgb1 signals through the receptor for advanced glycation end products ( rage ) leading to the activation of the transcription factor nuclear factor kappa b ( nf-b ) and induces the expression of various leukocyte adhesion molecules proinflammatory cytokines , chemokines , and angiogenic factors [ 6 , 9 ] . in a previous report , increased levels of hmgb1 were found in vitreous samples from patients with proliferative dr , and hmgb1 expression was upregulated in the retinas of diabetic mice . ethyl pyruvate ( ep ) is derived from pyruvate by the addition of an aliphatic ester group and is more stable and safer than pyruvate in inhibiting the generation of reactive oxygen species ( ros ) and inflammation . moreover , ep inhibits tumor angiogenesis and intracerebral hemorrhage - induced angiogenesis [ 16 , 17 ] . however , the pathogenic role of hmgb1 and the effect of its inhibitor , ep , in pathological retinal neovascularization have remained uncertain . in the present study , we examined whether ep has a preventive effect against pathological retinal neovascularization and inhibits hmgb1 expression in a mouse model of oxygen - induced retinopathy ( oir ) .

retinal pathogenic angiogenesis in the eyes is a causative factor in retinopathy of prematurity , diabetic retinopathy , and age - related macular degeneration . this study was designed to examine the pathogenic role of the high - mobility group box-1 ( hmgb1 ) protein and the inhibitory effect of ethyl pyruvate ( ep ) , a well - known antioxidant substance , in retinal pathogenic angiogenesis in mice with oxygen - induced retinopathy ( oir ) , one of the animal models of proliferative ischemic retinopathy . the oir mouse model was used for our in vivo studies . the mice were exposed to 75 % oxygen from postnatal day 7 ( p7 ) to p11 , after which the mice were brought to room air and intraperitoneally injected with ep ( 50 mg / kg , or 100 mg / kg ) for five days . at p17 , the mice were perfused with fluorescein isothiocyanate - dextran , and flat - mounted retinas were used to measure nonperfused and neovascular tufts . in oir mice , an intraperitoneal injection of ep reduced the nonperfused retinal area in the treatment group and significantly reduced the retinal neovascular tufts . in addition , ep inhibited the overexpression of hmgb1 in the retinas of oir mice . these data suggest that ep could serve as an innovative pharmaceutical agent to prevent retinal neovascularization through inhibiting hmgb1 expression .

reed 's syndrome refers to the onset of uterine leiomyomas with cutaneous leiomyomas , the latter occurring segmentally or affecting a particular dermatome , that are classified into type 1 and 2 . type 1 is caused by a novel postzygotic segmental mutation ; type 2 reflects an additional postzygotic loss of heterozygosity of the gene locus responsible for cutaneous leiomyomatosis in an initially heterozygous embryo . loss of heterozygosity is a genetic process when a heterozygous cell becomes homozygous or hemizygous by loosing the corresponding wild - type allele . this phenomenon can be regarded as a precondition for tumor growth in type 2 cases , the segmental manifestation is more distinctive with additional disseminated disease because of a germline mutation with heterozygosity of all somatic cells outside the strongly affected area . a subset of individuals with reed 's syndrome is predisposed to develop papillary renal cell carcinoma . herein , we report such rare occurrence of familial myomatosis cutis et uteri with type 2 segmental variety .

reed 's syndrome or familial myomatosis cutis et uteri , an autosomal dominant inherited condition with incomplete penetrance , is characterized by multiple cutaneous and uterine leiomyomas . [ 1 ] uterine leiomyomas usually commence earlier compared to that in the general population and cutaneous leiomyomas may precede , follow or occur concurrently . few patients may have associated renal cell carcinoma . herein we report a case of a 50-year - old female with multiple , painful cutaneous leiomyomas and who had undergone hysterectomy owing to large uterine fibroids . her 18-year - old daughter also has uterine fibroids .

dna double - strand breaks are extremely toxic dna lesions that arise from a variety of sources , including ionizing radiation , radiomimetic drugs [ 2 , 3 ] , oxidative stress [ 4 , 5 ] , abortive or inhibited topoisomerase reactions , and immunological processes such as v ( d ) j and class - switch recombination . thus , dsb repair is a critical process to which mammalian cells have devoted enormous resources , creating a complex network of repair systems that are intricately linked with cell cycle control and survival / death pathways . remarkably , molecular mechanisms of dsb repair in mammalian cells almost completely eluded researchers for decades , until the implication of ku autoantigen in 1994 unleashed a cascade of investigations by which the major players and primary mechanistic details of dsb rejoining were rather rapidly defined . much of the seminal work elucidating these repair systems has taken advantage of defined dsb substrates , either constructed in vitro or formed in cells by site - specific nucleases . these defined dsbs typically have canonical 5-phosphate and 3-hydroxyl termini suitable for further processing by exonucleases , polymerases , and ligases . thus , this experimental approach , while extremely powerful , bypasses an important step in repair , namely , the cleanup of the chemically modified termini and/or damaged bases that accompany most dsbs formed in a natural or clinical environment . several enzymes have been described that are capable of resolving various end modifications , and their specificity and cofactor requirements have been determined in some detail . a limited number of studies have been directed toward distinguishing which of these enzymes are actually used for repair in cells , and much work remains to be done in this area . other cellular studies , however , suggest that resolution of damaged ends , especially those with complex or multiple modifications , can be a critical and in some cases rate - limiting step in repair . this paper will attempt to summarize current knowledge of the molecular mechanisms for resolution of damaged dsb ends in mammalian cells and the biological consequences of that processing . studies based on other organisms such as yeast are included only insofar as they provide insight into questions for which no comparable mammalian data are available .

most dna double - strand breaks ( dsbs ) formed in a natural environment have chemical modifications at or near the ends that preclude direct religation and require removal or other processing so that rejoining can proceed . free radical - mediated dsbs typically bear unligatable 3-phosphate or 3-phosphoglycolate termini and often have oxidized bases and/or abasic sites near the break . topoisomerase - mediated dsbs are blocked by covalently bound peptide fragments of the topoisomerase . enzymes capable of resolving damaged ends include polynucleotide kinase / phosphatase , which restores missing 5-phosphates and removes 3-phosphates ; tyrosyl - dna phosphodiesterases i and ii ( tdp1 and tdp2 ) , which remove peptide fragments of topoisomerases i and ii , respectively ; and the artemis and metnase endonucleases , which can trim damaged overhangs of diverse structure . tdp1 as well as ape1 can remove 3-phosphoglycolates and other 3 blocks , while ctip appears to provide an alternative pathway for topoisomerase ii fragment removal . ku , a core dsb joining protein , can cleave abasic sites near dna ends . the downstream processes of patching and ligation are tolerant of residual damage and can sometimes proceed without complete damage removal . despite these redundant pathways for resolution , damaged ends appear to be a significant barrier to rejoining , and their resolution may be a rate - limiting step in repair of some dsbs .

cerebral palsy includes a group of nonprogressive movement disorders due to brain lesions or abnormalities in early development . its prevalence of 2 per 1000 newborns overall rises to 77 per 1000 preterms born at below 28 0/7 weeks of gestation [ 2 , 3 ] . a major cause is cystic periventricular leukomalacia ( cpvl ) comprising necrosis and subsequent cyst formation of the periventricular white matter : 60100 % of children with cpvl develop cerebral palsy [ 46 ] . although the etiology and pathogenesis of cpvl remain unelucidated , several perinatal risk factors appear involved . chorioamnionitis is thought to provoke a fetal inflammatory response syndrome associated with increased fetal cytokines that may lead to neonatal brain injury . several studies indicate that the cytokines can themselves damage white matter without bacteremia being required [ 815 ] . an important predictor of chorioamnionitis is preterm prelabor rupture of membranes ( pprom ) . chorioamnionitis is quite common and often subclinical : fever and inflammatory marker elevation are rare in the early stages , making diagnosis difficult . against this background the risks of prematurity from immediate delivery have to be balanced against those of ascending intrauterine infection and its probable consequences . moreover subclinical chorioamnionitis is believed to cause pprom . at a gestational age below 34 0/7 weeks , half the gynecologists in australia and new zealand preferred to induce labor , while the other half chose conservative management . a cochrane review from 2010 found no evidence about which strategy is favorable . despite a lack of randomized studies new british and german guidelines advise active management before 34 weeks and active management between 34 and 36 weeks . zurich university hospital has hitherto favored conservative management , delaying delivery until clinically mandatory , on the grounds that the higher mortality and morbidity of newborns at lower gestational age are proven whereas the effect of increasing cpvl risk by prolonging pregnancy remains unknown . the more limited objectives of the present study were to identify the risk factors for pvl in the conservative pprom management setting and determine whether prolonging gestation outweighs the risk of cpvl due to chorioamnionitis .

objective . to identify the risk factors for cystic periventricular leukomalacia ( cpvl ) and their implications for deciding between immediate delivery and conservative management of preterm prelabor rupture of the membranes ( pprom ) . methods . the following risk factors were compared between cpvl infants and 6440 controls : chorioamnionitis , sex , gestational age ( ga ) , birth weight , pprom , and pprom - delivery interval . factor impact on cpvl risk and clinical decision - making was determined by multivariate logistic regression . results . overall cpvl prevalence ( n = 32 ) was 0.99/1000 births . all cpvl infants but one were born < 34 weeks of gestation and were < 2500 g ; 56 % had histological chorioamnionitis versus 1.1 % of controls ( or 35.9 ; 95 % -ci 12.6102.7 ) . because chorioamnionitis is a postnatal diagnosis , logistic regression was performed with prenatally available factors : pprom - delivery interval > 48 hours ( or 9.0 ; 95 % -ci 4.120.0 ) , male gender ( or 3.2 ; 95 % -ci 1.47.3 ) . ga was not a risk factor if birth weight was included . risk decreased with increasing fetal weight despite a prolonged pprom - delivery interval . conclusion . pprom - delivery interval is the single most important prenatally available risk factor for the development of cpvl . immediate delivery favors babies with chorioamnionitis but disfavors those with non infectious pprom . in the absence of clinical chorioamnionitis fetal weight gain may offset the inflammatory risk of cpvl caused by a prolonged pprom - delivery interval .

recent work has demonstrated the importance of the abdominal muscles in ensuring sufficient spine stability to prevent buckling and enhance function2 , 3 . the curl - up , performed as an abdominal exercise , has been shown to produce reasonable levels of activity in the rectus abdominis ( ra ) muscle while minimizing the resultant spine load and has been incorporated into several low back fitness programs4 . the use of unstable surfaces underneath the subject for stability training of the injured low back is becoming more popular4 . swiss balls have been incorporated into strength - training regimens and can reportedly be used to more effectively train the musculoskeletal system . performing strength exercises on swiss balls has been advocated based on the belief that a labile surface will provide a greater challenge to the trunk musculature , increase the dynamic balance of the user , and possibly train users to stabilize their spines to prevent and treat injury5 . studies have been conducted to document the loads imposed on the spine during various abdominal exercises6 , but the effect of unstable surfaces has not been examined . we believe that there is a clinical need to understand the effects of using unstable surfaces to challenge the muscular system during the curl - up exercise . recent evidence regarding the conservative management of low back pain suggests that the restoration of neuromuscular control in the transverse abdominis ( tra ) , together with minimal contraction of other superficial oblique , internal , and external abdominal muscles , is essential for effective treatment during the early stages of rehabilitation7 , 8 . previous studies have demonstrated that performance of the abdominal hollowing exercise in particular is far more effective than performance of general core - stabilizing techniques in improving the cross - sectional area of the tra9 , 10 . the abdominal hollowing exercise is designed to emphasize deep local muscle activity while minimizing the activity of the more superficial global muscles . although many studies on the effect of the abdominal hollowing exercise in rehabilitation programs have been performed , none have examined the combined effect of the abdominal hollowing exercise and curl - up exercise on an unstable surface . therefore , the purpose of this study was to investigate the effects of the abdominal hollowing exercise on trunk muscle activity during the curl - up exercise on an unstable surface by measuring electromyography ( emg ) activity .

[ purpose ] the purpose of this study was to investigate the effects of the abdominal hollowing exercise on trunk muscle activity during the curl - up exercise on an unstable surface by measuring electromyography ( emg ) activity . [ subjects ] fourteen young healthy adults ( nine male , five female ) voluntarily participated in this study . [ methods ] each subject was asked to perform a curl - up exercise on two supporting surfaces ( stable and unstable surfaces ) combined with the abdominal hollowing exercise on an unstable surface . the muscle activities of the rectus abdominis ( ra ) , external oblique ( eo ) , internal oblique ( io ) , and transverse abdominis ( tra ) were measured using surface emg during performance of the curl - up exercise . [ results ] the emg activity of the ra and eo was significantly higher on an unstable surface than on a stable surface during the curl - up exercise . the emg activities of the tra and io were greater in combination with the abdominal hollowing exercise on an unstable surface than during the curl - up exercise on both a stable and unstable surface . [ conclusion ] these findings suggest that the local trunk muscle activity during the curl - up exercise is more strongly affected by combination with the abdominal hollowing exercise than by performance on an unstable supporting surface .

inadvertent bleb may form as a result of a fistula which allows aqueous to flow from the anterior chamber into the subconjunctival space . most conjunctival blebs follow episodes of scleritis , accidental penetrating injury or ocular surgical procedures ( cataract surgery , scleral fixated intraocular lens implantation , scleral tunnel lensectomy , and cyclophotocoagulation ) . spontaneous filtering blebs are rare and have been observed with few systemic disorders ( scleroderma ) , ocular abnormalities ( terrien 's marginal degeneration and axenfeld syndrome ) , or with systemic conditions , such as familial craniofacial dysmorphism with spontaneous bleb formation [ 6 , 7 ] known in lebanon as traboulsi syndrome . we present the anterior segment imaging and treatment in a case that provides new insights into the pathophysiology of traboulsi syndrome .

purposeto report the ultrasound biomicroscopy ( ubm ) and surgical findings in a subject with a syndrome of ectopia lentis , spontaneous filtering blebs , and craniofacial dysmorphism ( traboulsi syndrome ) .methodscase report , using a 40-mhz ubm wide - field anterior segment scan and anterior segment optical coherence tomography ( oct ) .resultsa 16-year - old orphan girl presented with visual loss to the level of 6/60 ( 20/200 ) bilaterally . she had a central corneal opacification with retrocorneal fibrosis . the anterior chamber was flat with a very poorly dilating pupil . the lens was central in location . perilimbal conjunctival blebs were bilateral with an intraocular pressure of 8 mm hg . ubm and anterior segment oct revealed chronic apposition of the iris to the cornea with angle closure , delineation of the bleb tract and rarefaction of the zonules . the girl had abnormal facial features ( a beaked nose and long face ) with normal chromosomal studies , negative fluorescent in situ hybridization study for velocardiofacial syndrome and an absence of signs suggesting marfan syndrome . under general anesthesia , attempts at deepening the anterior chamber with sodium hyaluronate 3 % led to a spontaneous dislocation of the lens into the anterior chamber , facilitating its aspiration . deepening of the angle was found after lens removal . retrocorneal fibrosis persisted after surgery , but the bleb height decreased . best corrected visual acuity did not improve from the preoperative level beyond 6/60 ( 20/200 ) because of central retrocorneal fibrosis.conclusionsearly surgical removal of the lens is necessary in this syndrome to avoid irreversible corneal and trabecular meshwork damage in chronic apposition of the iris to the cornea . ubm can help in the delineation of the bleb tract and document resolution of angle closure after surgery .

cloacogenic carcinomas ( ccs ) are relatively common neoplasms of the anal canal and are thought to arise from cloacogenic remnants at this site . histological and ultrastructural studies have indicated that these neoplasms may also arise from transitional cloacogenic epithelium lining the anal ducts or from the basal layer of anal squamous epithelium . outside the anal canal , it has been postulated that these tumors arise from cloacogenic embryologic remnants , squamous metaplastic epithelium , or totipotential basal cells . we report a patient with cc of the recto - sigmoid junction presenting as intraabdominal abscess . for this reason ,

cloacogenic carcinoma ( cc , basaloid carcinoma ) generally occurs around the dentate line , rarely it can arise from the other sides of the colon . there are only 5 cases of cc located outside the anal canal in the literature . the first occurrence of a cc presents as intraabdominal abscess . we describe a 23-year - old male patient who was admitted with fever and severe abdominal pain . computed tomography imaging showed diffuse wall thickening about 1011 cm above the rectosigmoid junction , intraabdominal abscess and a soft tissue lession covering the pelvis with a size of 8 8.5 cm including cystic necrotic areas . we performed hartman procedure since the mass was nonresectable . histopathological examination showed cc . in total , three times radiotherapy and a concurrent three - drug regimen of irinotecan , fluorouracil and folinic acid chemotherapy were administered for 6 weeks . as a result , the patient was lost because of multiple organ dysfunction syndrome that developed 3 months after radio - chemotherapy .

wilms tumor is the most common primary malignant renal tumor in children , accounting for 6 % of all pediatric malignant tumors 1 , however , it is very rare in adults , with an incidence of about 0.2 per million per year in the usa and europe 2 . only approximately 300 well - documented cases of adult invasion of the renal vein is present in about 12 % of cases . up to 4 % of patients with wt have tumor thrombus involving the vena cava , and the incidence of cardiac involvement is about 0.8 % to 1 % 4 , 5 . in adults , tumor extension into the vena cava and the right side of the heart only one case of an adult with caval involvement has been reported in the english - language literature 6 . in this report , a case of favorable histology wt with invasion of the inferior vena cava and extension to the right atrium is discussed with a review of the literature .

wilms tumor ( wt ) occurs infrequently in adults . even rarer is adult wt with extension by direct intravascular spread into the right side of the heart . the present report describes a partially differentiated wt with intracaval and intracardiac extension in a 54-year - old man . the morphologic and immunohistochemical findings confirmed the diagnosis .

many studies provide evidence pointing to a clear role of vitamin d in the pathogenesis of autoimmune diseases , especially autoimmune thyroid diseases ( aitds ) , as vitamin d deficiency is linked with high levels of anti - thyroid antibodies , abnormal thyroid function , increased thyroid volume , and increased tsh levels [ 14 ] . nevertheless , at the present time vitamin d levels above 30 ng / ml are considered sufficient and confer protection from bone disease , whereas lower levels induce elevation of parathyroid hormone and are associated with other hazardous systemic effects . however , it is unclear whether low vitamin d levels are closely associated with the development of autoimmune thyroid disease . some case - control studies have suggested that lower serum vitamin d levels or a higher prevalence of vitamin d insufficiency existed in patients with aitds compared with that in healthy controls [ 1 , 2 , 6 , 7 ] . however , another study reported no significant association between serum vitamin d levels and thyroid autoimmunity . thus , we aim to estimate the associations between vitamin d deficiency and/or insufficiency and autoimmune thyroid diseases , especially to clarify the relationship between vitamin d and serum thyroid autoantibody , in a relative rather than quantitative manner by comparing levels of vitamin d in a chinese population .

objectives . some evidence has pointed out that vitamin d plays a significant role in reducing the incidence of autoimmune diseases , especially autoimmune thyroid diseases . the authors aimed to examine the relationship between circulating 25-hydroxyvitamin d and thyroid autoantibody in a population - based health survey of xinjiang chinese population . subjects and methods . a total of 1714 chinese adults were analyzed . 25 ( oh ) d , anti - thyroid antibodies , and thyroid function were measured . results . the prevalence of vitamin d insufficiency was 28.3 % in hans and 9.3 % in uyghurs , and the prevalence of vitamin d deficiency was 61.6 % in hans and 87.6 % in uyghurs . overall prevalence of tgab positivity was 6.2 % ( 0.9 % males ; 5.3 % females ) . in female subjects , mean serum 25 ( oh ) d levels were significantly lower in hans and uyghurs compared with males , and the difference was statistically significant . importantly , after adjusting for age and ethnicity , a negative correlation ( r = 0.121 , p = 0.014 ) was recognized between 25 ( oh ) d and tgab levels only in female subjects . conclusion . vitamin d insufficiency and deficiency are prevalent among chinese adults . low serum 25 ( oh ) d is related to the presence of tgab in females . the causal effect of low vitamin d level on thyroid autoimmunity should be studied further more .

asthma and copd have been regarded as two distinct disease entities that often overlap.13 asthma and copd overlap has a prevalence of 15 % 20 % in patients with obstructive airway disease ( asthma or copd ) 46 and is associated with significant health status impairment,4 increased exacerbations,5 and increased hospitalizations.6 in 2014 , the global initiative for asthma ( gina ) and the global initiative for chronic obstructive lung disease ( gold ) issued a joint document describing that asthma - copd overlap syndrome ( acos ) is characterized by persistent airflow limitation with several features usually associated with both asthma and copd.7 the clinical phenotypes and underlying mechanisms of acos have attracted interest during recent years . however , acos remains somewhat controversial , and there is no consensus on the best definition of acos.8,9 the clinical phenotypes , including biomarkers , of acos remain elusive . inflammatory biomarkers , such as fractional exhaled nitric oxide ( feno ) , blood eosinophils , and allergen - specific immunoglobulin e ( ige ) , are sometimes used to distinguish between asthma and copd.7 typically , asthma is characterised by inflammation predominantly involving eosinophils , whereas copd is characterized by inflammation by neutrophils.1,2 feno and blood eosinophil count have been considered as biomarkers of local and systemic eosinophilic inflammation , which increase in patients with asthma.10,11 total serum ige and antigen - specific ige levels are also elevated in those with allergic asthma.12 however , the significance of these inflammatory biomarkers in diagnosis of acos remains unclear . we conducted a cross - sectional study to 1 ) analyze prospectively collected data from a japanese copd registry and 2 ) compare copd patients with and without acos , focusing on inflammatory biomarkers , to investigate clinical phenotypes of acos .

backgroundthe clinical phenotypes and underlying mechanisms of asthma - copd overlap syndrome ( acos ) remain elusive . this study aimed to investigate a comparison of copd patients with and without acos , focusing on inflammatory biomarkers , in an outpatient copd cohort.methodswe conducted a cross - sectional study analyzing prospectively collected data from the ishinomaki copd network registry . all participants were diagnosed with copd , confirmed by using spirometry , and were aged 4090 years and former smokers . patients with features of asthma including both variable respiratory symptoms and variable expiratory airflow limitation were identified and defined as having acos . then , the inflammatory biomarkers such as fractional exhaled nitric oxide level , blood eosinophil count and percentage , total immunoglobulin e ( ige ) level , and presence of antigen - specific ige were evaluated.resultsa total of 257 patients with copd were identified , including 37 ( 14.4 % ) with acos . patients with acos tended to be younger , have a shorter smoking history , and use more respiratory medications , especially inhaled corticosteroids and theophylline . mean fractional exhaled nitric oxide level was significantly higher in those with acos than in those without acos ( 38.5 parts per billion [ ppb ] vs 20.3 ppb , p < 0.001 ) . blood eosinophil count and percentage were significantly increased in those with acos ( 295/mm3 vs 212/mm3 , p=0.032 ; 4.7 % vs 3.2 % , p=0.003 , respectively ) . total ige level was also significantly higher , and presence of antigen - specific ige was observed more frequently in patients with acos . receiver operating characteristic curve analysis indicated that the sensitivity and specificity of these biomarkers were relatively low , but combinations of these biomarkers showed high specificity for acos diagnosis.conclusionthese results provide evidence that these inflammatory biomarkers can be used to support the diagnosis of acos .

the prevalence of as ranges from 2 % to 9 % of aged population over 65 years old , and it is increasingly diagnosed in the contemporary era of aging society.1 ) given no established medical treatment to improve prognosis of as patients , decision to proceed with corrective surgery is crucial . progression of as is usually longitudinally followed using transthoracic echocardiography , and the estimation of effective orifice area of aortic valve ( eoaav ) is considered the most important parameter to monitor as patients.2 ) eoaav is calculated by the transvalvular pressure gradient ( tpg ) and transvalvar flow , and tpg is associated with systemic vascular resistance ( svr ) .3 ) in the presence of systemic hypertension or peripheral arterial disease , svr increases and this svr alteration might possibly change the parameters that are frequently used to determine as severity . this hypothesis is corroborated by notion that high left ventricular ( lv ) afterload can result in paradoxical low - flow , low - gradient severe as , highlighting the notion that lv afterload should be considered in terms of assessing severe as.4 ) furthermore , in contrast to traditional belief that blood pressure was thought to be decreased in case of severe as , recent studies reported that hypertension is common even in severe as patients and one of the important risk factors of significant as.1 ) therefore , consideration of hypertension is a commonly encountered clinical situation in estimating as severity.5 ) the aim of this study was to investigate the impact of lv afterload on the assessment of as severity .

backgroundaortic stenosis ( as ) is increasingly diagnosed in current aging society . echocardiography is the most important tool in the assessment of as and its severity . however , load - dependency of doppler measurement could affect the accuracy of as severity assessment . we tried to evaluate the impact of afterload on the assessment of as severity by modification of afterload using pneumatic compression ( pcom ) .methodsforty patients diagnosed as moderate or severe as [ effective orifice area of aortic valve ( eoaav ) by continuity equation of < 1.5 cm2 ] were consecutively enrolled . patients with severely uncontrolled hypertension , severe left ventricular ( lv ) dysfunction , and other significant valve disease were excluded . comprehensive echocardiography was performed at baseline to assess as severity . then , pneumatic compression of the lower extremities by 100 mmhg was applied to increase lv afterload . after 3 minutes , echocardiography was repeated to assess as severity.resultsmean blood pressure was significantly increased under pcom ( p < 0.001 ) , while heart rate remained unchanged . peak aortic valve velocity ( vmax ) was slightly , but significantly decreased under pcom ( p = 0.03 ) . however , doppler velocity index and eoaav by continuity equation were not affected by pcom.conclusionas severity assessment by echocardiography was not dependent on the change of lv afterload imposed by pcom . av vmax was slightly decreased with lv afterload increment , but these changes were too small to alter treatment plan of as patients . eoaav and doppler velocity index are more stable parameters for as severity assessment .

migraine is typically characterized by a pulsating headache with or without aura , nausea , and vomiting . the drugs commonly used in acute migraine attacks are sumatriptan ( which is one of the triptans chemically grouped under serotonin agonists ) and ergot alkaloids , while propranolol and calcium channel blockers are used prophylactically . however , recently topiramate ( tpm ) , an anti - epileptic drug , has gained popularity as a first line drug for use in prophylaxis of migraine . the use of tpm for epilepsy and migraine has been approved by the us food and drug administration ( fda ) and it also has a number of off - label indications , such as bulimia nervosa , alcohol dependence , smoking , and possibly a depressive phase in bipolar disorders . the most significant adverse effects associated with tpm include psychomotor slowing , difficulty in concentration , somnolence , and fatigue . additional non - specific central nervous system ( cns ) adverse effects are dizziness , confusion , and memory problems . the dose and duration - dependent use include renal stones , weight loss , and paresthesia . recently , evidence has been accumulating on a rare but serious adverse event on tpm - induced acute myopia with acute angle - closure glaucoma ( aacg ) both as spontaneous case reports and case series [ 47 ] . warning was , therefore , issued by the fda in 2004 , regarding its potential to induce aacg as a precaution for practicing physicians . the world health organization ( who ) has estimated that india has a 1 % prevalence of blindness . of the estimated 8.9 million blind in india , 12.8 % are due to glaucoma . while there is population - based data available on primary glaucoma from south asia , especially india , data on secondary drug - induced glaucoma are lacking , except for spontaneous reports . the authors report an observation of a case , where a female patient developed aacg after 8 days , following tpm 25 mg / day , once a day ( od ) , for 3 days as an adverse reaction to tpm .

introductionthis case report adds supportive evidence to the development of acute angle - closure glaucoma ( aacg ) , a rare but serious adverse effect following the use of topiramate ( tpm ) for a severe headache.case reporta 25-year - old female reported with severe headache , suspected to be migraine , and was started on tpm 25 mg / day on the first day . however , she presented at the emergency clinic of a hospital with sudden blurring of vision and colored halos 5 days after stopping the drug , i.e . , day 8 . she was subjected to ophthalmic examination and was diagnosed with aacg . the intraocular pressure ( iop ) was found to be elevated and she was hence started on acetazolamide 500 mg instantly , maintained on tablet acetazolamide 250 mg four times a day ( qid ) , pilocarpine 2 % eye drops qid , travoprost 0.004 % once a day ( od ) , and dorzolamide 2 % eye drops three times a day ( tid ) . after a week s treatment , there was rapid improvement with return of iop to normal.conclusiontpm-induced aacg is a rare serious adverse event leading to blindness but is preventable , when diagnosed early and by instituting appropriate treatment .

total joint arthroplasty , in particular tha , has had a revolutionary role in improving the quality of life . the use of bone cement for the implant stability versus biologic fixation with bone ingrowth in cementless tha has been a controversial issue for years . while immediate cement fixation in very old people or in those with poor bone stock might provide a quicker return to daily activity , cementless implants have gained more popularity over the years . the relative superiority of cementless acetabular component over cemented ones is nowadays a well - accepted fact . the femoral stem , however , has very good long - term reports both in cemented and cementless forms . efforts to decrease the rate of loosening have included the use of newer materials , improvement in the design of the implant ; and modification of operative techniques . after the midterm follow - up results of cementless tha , the long - term results with impressive survival rates , are being reported more and more . the purpose of this study is to evaluate the efficacy and prosthesis survival in an iranian society , with its unique cultural lifestyle and social differences from western societies .

background : cementless hip prosthesis was designed to provide biologic fixation , without the use of cement . the second generation components have shown more reliable bone ingrowths and survival rates . we are reporting a midterm result of two designs of cementless prosthesis in a unique culture with different social habits and expectations.methods:52 primary cementless total hip arthroplasty in 42 patients with the mean age of 48.8 years were retrospectively studied . two groups of prosthesis had been implanted : harris - galante ii ( hgii ) in 15 and versys - trilogy ( v - t ) in 37 hips , both from zimmer company . the patients were assessed clinically , radiographically and with harris hip score , sf36 , womac , and mactar questionnaires , with 65 months ( 26 - 136 ) mean follow-up.results : all the v - t prostheses had survived well . eight of hg ii were revised by the last follow - up in 19 - 102 months . all had undergone acetabular revision and 2 combined with femoral revision . broken tines of hgii cups were seen in 4 radiographs . the 65 months overall survival was 96.2 % for femoral and 84.6 % for acetabular components . 90 % had good or excellent harris hip scores . the functional scores were poorer in the hg ii group . pain relief and improved walking were the two main patients expectations fulfilled in 97.6 % and 92.8 % , respectively.conclusions : the outcome of cementless total hip arthroplasty ( tha ) is satisfactory and comparable with the literature based on the results of function and survival of this small comparative group . the use of hgii acetabular component should be abandoned .

noninvasive prenatal testing ( nipt ) is becoming increasingly popular in the united states , with increasing advocacy in the medical community . some obstetricians one recent study concluded that cfdna testing had significantly lower false positive rates and higher positive predictive values for trisomy 21 and 18 than standard screening with serum analytes 2 . the quadruple serum screen ( quad screen ) has been favored for reasons that it is far less expensive than cfdna . we present a case where the quad screen was very helpful in management of a highrisk pregnancy in a patient with negative cfdna , allowing timely introduction of thromboprophylaxis and fetal surveillance . our case also suggests a possible therapeutic role for prophylactic doses of enoxaparin on placental function .

key clinical messagenoninvasive prenatal testing ( nipt ) is becoming increasingly popular with some offering it as a primary screen option in all patients in place of serum screening . serum screening offers insight into placental function , which nipt does not . abnormal levels of analytes in the serum screen have been associated with pregnancy complications .

prior to the genome era , compositional signatures ( 1 ) or sequence alignments ( 2 ) were used to delineate the phylogenetic patterns across organisms . the availability of entire genome sequences has sparked a further development of methods for phylogenetic reconstructions on a genome - wide scale . following this long tradition in molecular evolution , similar methods were expanded to encompass complete genome information , based on either compositional patterns ( 3,4 ) or concatenated alignments of orthologs ( 5,6 ) . more recently , methods that exploit the entire gene complement of completely sequenced genomes have been developed . these include phylogenies based on patterns of conservation of gene order ( 7 ) , gene fusion events ( 8 ) , gene content ( 7,913 ) , protein folds ( 12 ) , and average ortholog similarity ( 14 ) . only a few of these approaches were successful in resolving difficult cases , such as correctly grouping pathogens having highly reduced genomes with their free - living relatives and clustering proteobacteria into a monophyletic group ( 7,9,14 ) . in addition , most of the above mentioned methods are ( i ) not scalable to hundreds of species ( e.g . concatenated alignments ) , ( ii ) unable to place correctly species with reduced genomes ( 13 ) and ( iii ) strongly affected by the number and phylogenetic proximity of species ( e.g . gene order ) ( 15 ) . herein , we define a new composite measure termed genome conservation , which expresses both the conservation of sequence and gene content between two genomes . this value is derived from the sum of alignment scores between all proteins for every pair of organisms . larger genomes tend to share more genes , irrespective of their phylogenetic distance ( 9 ) . thus , a higher conservation score can result from a higher number of shared genes , rather than from phylogenetic proximity . to counterbalance this effect the genome conservation method is naturally adjusted for missing genes and for gene lengths . if a gene is absent in one of the compared genomes , its contribution to the similarity is zero . however , if this absence is a direct result of reductive evolution and difference in genome sizes , absence of this gene would be calibrated by the normalization scheme described below . the gene length is taken into account in the summation of the blast scores : longer genes generate greater alignment scores and thus , would be more important contributors than shorter genes . thus , the final similarity is based on both gene content and average sequence similarity of genes , with the adjustment for gene length .

species evolutionary relationships have traditionally been defined by sequence similarities of phylogenetic marker molecules , recently followed by whole - genome phylogenies based on gene order , average ortholog similarity or gene content . here , we introduce genome conservation a novel metric of evolutionary distances between species that simultaneously takes into account , both gene content and sequence similarity at the whole - genome level . genome conservation represents a robust distance measure , as demonstrated by accurate phylogenetic reconstructions . the genome conservation matrix for all presently sequenced organisms exhibits a remarkable ability to define evolutionary relationships across all taxonomic ranges . an assessment of taxonomic ranks with genome conservation shows that certain ranks are inadequately described and raises the possibility for a more precise and quantitative taxonomy in the future . all phylogenetic reconstructions are available at the genome phylogeny server : < > .

hyperplasia refers to tissue growth into the oral cavity , located over the alveolar ridges or the soft tissues of the vestibular sulcus . its etiology is multifactorial , but some irritative factors are more commonly associated , such as periodontal disease , poor oral hygiene , smoking , and poor denture fitting . the treatment of this kind of lesion includes elimination of the causing factors and surgical removal of the lesion . if the causal factor persists , the tissue becomes more fibrous over time [ 2 , 3 ] . the most common techniques used for removing the hyperplastic lesion are surgical scalpel , electrical scalpel , carbon dioxide laser , erbium : yag laser , neodymium : yag laser , and diode laser . the co2 laser is an appropriate option for surgical procedures in soft tissues since it operates at a wavelength of 10.6 n , which is within the medium range of the electromagnetic infrared spectrum . this wavelength is absorbed by tissues with high water content [ 4 , 5 ] . this energy is transformed into heat , causing cell rupture from water boiling ; therefore , tissues with high water content suffer less damage . many advantages of the co2 laser include the possibility of minimal bleeding , decreasing edemas , flexibility of the wound healing tissue , reduced postoperative pain , and no need of a conventional suture [ 610 ] . these positive aspects of the use of a co2 laser has allowed an improvement in maxillofacial surgeries . despite some disadvantages of co2 laser , such as the delay in the initial repair chronology due to heat necrosis [ 11 , 12 ] , this technique provides suitable repair without scar formation and constitutes an alternative to the conventional incision and suture method .

the aim of this study was to present a case report of the surgical removal of hyperplasia in the oral cavity , using carbon dioxide ( co2 ) laser radiation and rehabilitation with a complete denture . epulis fissuratum occurs in complete denture patients , because a constant irritative action induces the mucosa to grow under poorly fitting dentures . these lesions must be removed , and to avoid a relapse , new complete dentures should be made to maintain healthy surgical tissues . the clinical sequence presented in this case shows a completely edentulous patient with epulis fissuratum on the lower alveolar ridge extending to the vestibular sulcus of the anterior region of mandible . immediate complete dentures were made prior to the lesion removal with co2 laser radiation , providing satisfactory results in oral function and tissue health .

bone dysplasias are characterized by the replacement of normal bone with fibrous tissue containing abnormal bone or cementum.1 familial gigantiform cementoma , which is a subgroup of osseous dysplasias , is a rare condition of the jaw ( table 1 ) .2,3,4 its true incidence is unknown , as is the gender and ethnic predispositions . the etiology is also unclear , but it is believed to have a genetic component . the familial form is reported as an autosomal dominant trait with variable expression.5,6 the condition may be asymptomatic ; in these cases , the lesions are detected radiographically as an incidental finding . the familial form presumably differs from the non - familial form clinically and pathologically.7 ehlers - danlos syndrome ( eds ) is a group of disorders affecting connective tissues , causing primarily dermatological and joint disorders . the prevalence of the condition varies between 1:10,0008 and 1:150,000.9 eds is an autosomal dominant inherited disorder , which can be primarily diagnosed on clinical findings and family history.10,11,12,13 the classical symptoms of eds are joint hypermobility , skin hyperextensibility , fragile and soft skin , the presence of atrophic scars , and easy bruising.10 at least 15 subtypes of the syndrome have been described to date . eds type viii ( periodontitis type ) is characterized with severe periodontitis leading to precocious loss of permanent teeth and alveolar bone resorption.11 the periodontal problems begin with puberty and mostly lead to loss of teeth before the age of 30.10 the facies characteristics are hypertelorism , widening of nasal bridge , and narrow face.12 the present case report is the first known describing concurrent familial gigantiform cementoma and eds in a single patient . the aim of this report is to discuss the oral management of patients diagnosed with both familial gigantiform cementoma and eds .

ehlers - danlos syndrome is an autosomal dominant hereditary disorder of connective tissue , while familial gigantiform cementoma is a condition that usually manifests as multiple radiopaque cementum - like masses throughout the jaws . this case report discusses the oral management and prosthetic rehabilitation of two patients presenting familial gigantiform cementoma with ehlers - danlos syndrome .

cervical cancer is a major health challenge with approximately 530,000 news cases and 270,000 deaths annually worldwide despite remarkable advances in screening and prevention through the development of human papillomavirus ( hpv ) vaccine . while the majority of cervical cancer cases can be potentially cured with surgery , chemoradiation or a combination of these strategies , treatment options for recurrent or metastatic disease are limited to pelvic exenteration or palliative chemotherapy . a recent phase iii trial evaluating the combination of cisplatin , paclitaxel and bevacizumab ( monoclonal antibody against vascular endothelial growth factor receptor ) in the first - line treatment of metastatic disease elicited a 50 % response rate and median overall survival ( os ) of approximately 17 months ( tewari et al . , 2014 ) . despite these relatively positive data that led to the approval of the first targeted therapy for this disease ( bevacizumab ) , the median progression - free survival of 8 months demonstrates the aggressive behavior of this disease . hence , there is an urgent need to advance the understanding of the molecular abnormalities driving cervical cancer pathogenesis that could lead to novel targeted therapies . comprehensive genomic profiling of metastatic tumors is an increasingly relevant tool to identify somatic alterations leading to additional therapeutic options and a better understanding of tumor molecular pathogenesis . herein , we describe the first three cases of cervical carcinoma harboring fgfr3tacc3 fusions revealed by a next - generation sequencing assay able to detect all classes of genomic alterations including gene fusions . the fusion of the fibroblast growth factor receptor gene 3 ( fgfr3 ) with the transforming acidic coiled - coil containing gene ( tacc3 ) has been described in glioblastoma multiforme , bladder urothelial carcinoma , and non - small cell lung cancer ( wu et al . , 2013 ) . while fgfr mutations have been described in cervical carcinomas , the fgfr3tacc3 fusion has not been reported previously ( cappellen et al . , 1999 ) . this fusion resulting in fgfr pathway activation provided the rationale for treating one of the patients with a fgfr tyrosine kinase inhibitor ( tki ) in a clinical study setting and other molecular alterations involving the pi3k / akt / mtor pathway hold the potential to inform treatment decisions .

cervical cancer epitomizes the success of cancer prevention through the human papillomavirus ( hpv ) vaccine , but significant challenges remain in the treatment of advanced disease . we report the first three cases of cervical carcinoma harboring an fgfr3tacc3 fusion , which serves as a novel therapeutic target . the fusion , identified by comprehensive genomic profiling , activates the fgfr pathway that has been implicated in hpv - driven carcinogenesis . one of the patients whose tumor contained the fgfr3tacc3 fusion was treated with an investigational fgfr tyrosine kinase inhibitor . concomitant molecular alterations involving the pi3k / akt / mtor and raf / mek pathways were also identified and suggest other treatment strategies that deserve investigation . this case series highlights the role of comprehensive genomic profiling in the identification of new therapeutic targets and in targeted therapy selection for patients with cervical cancer .

atherosclerotic disease of the coronary arteries is one of the most common causes of mortality and morbidity . despite all the methods of diagnosis and the new strategies in the treatment of patients , cardiovascular diseases ( cvds ) are considered as the most important cause of mortality in iran over the last decade.1 a number of known risk factors have been recognised for this disease , but less known factors such as trace elements may have a role in the progress of atherosclerosis.2 the serum level of copper ( cu ) and oxidants like free radicals have also been considered in coronary artery disease ( cad ) .34 several studies show that atherosclerosis is characterised with fatty fibrous plaques , localised in intima . endothelial damage is the most important factor in the atherosclerotic process.5 the main effect of these factors on the endothelium is oxidative stress , lipid peroxidation and the formation of free radicals . cu and cvd may be associated directly , through a direct effect on the vascular endothelium , or indirectly through lipoprotein metabolism . copper ions can convert the superoxide and the hydrogen peroxide into the highly harmful hydroxyl radical that can damage to endothelium.6 the aim of this study is investigation about relationship between serum levels of cu and the severity of atherosclerosis measured by syntax score .

background : atherosclerotic disease is the most important cause of mortality in the world . oxidation is an important pathway in the pathogenesis of coronary artery disease ( cad ) through oxidation of low - density lipoprotein ( ldl ) and free radical formation . copper ( cu ) is an essential micronutrient for enzymes that catalyse ldl oxidation reactions . therefore , an evaluation of cu in the atherosclerotic disease is important.materials and methods : in this study , 334 subjects without recent cardiac event and history of collagen vascular or infectious disease were investigated . all patients divided into four groups to evaluate severity of cad according to syntax scoring system . all groups were matched in cardiovascular risk factors.results : the serum level of cu was significantly higher in total atherosclerotic groups than normal group ( p value = 0.001 ) and significantly increased with severity of atherosclerosis.conclusion : the finding indicated that the serum level of cu is higher in atherosclerotic patients and it increases with severity of atherosclerosis . therefore , it may be possible that the basic relationship exist between serum cu level and atherosclerosis and an association between cu level and severity of atherosclerosis .

coccygodynia , first described by simpson in 1859 , is disabling pain in the coccyx that is usually provoked by sitting or changing from a sitting to a standing position . this tail bone pain may radiate rostrally to the sacrum or lumbar spine or laterally to the buttocks . patients may rarely present with associated rectal pain or radicular symptoms one third of patients have associated back pain , contributing to misdiagnosis1,2,23,24 ) . due to unfamiliarity with this condition by spine specialist compounding the problem , most neurosurgeons and orthopedic spine surgeons are uncomfortable treating coccygodynia due to lack of surgical training with coccygectomy . fortunately , the knowledge to properly diagnose and surgically treat chronic refractory coccygodynia may be easily acquired . diagnosis is based on the history and physical exam , supplemented by imaging findings and local injection of the coccyx . to raise awareness among our neurosurgical colleagues on coccygodynia and surgical treatment , we review the literature on coccygectomy and describe the surgical technique based on our extensive experience at university of california , davis medical center ( ucdmc ) .

objectivea review of the literature on coccygectomy and our patients was performed to assess the effectiveness of coccygectomy for chronic refractory coccygodynia.methodsan english language pubmed search was conducted with the terms `` coccygodynia `` and `` coccygectomy `` from january 1980 to january 2012 . we retrospectively reviewed the medical records and performed telephone questionnaire on 61 patients who underwent coccygectomy at ucdmc between 1997 and 2009.resultsthere were 28 case series from 1980 to 2012 for a total of 742 patients who underwent coccygectomy following failed conservative management . the mean age ranged from 26.4 to 52.8 years . the most common cause was direct trauma ( 58.5 % ) with a male : female ratio of 1:5.2 . most patients ( 84 % ) had a good to excellent outcome after coccygectomy . the most common complication is wound infection ( 10.0 % ) . the overall complication rate was 13.3 % . similarly , 84.6 % of patients from our own surgical case series reported good to excellent outcomes with 11.5 % wound infection.conclusioncoccygectomy is an effective treatment for chronic refractory coccygodynia . the surgery isrelatively simple to perform but precaution must be taken to avoid wound infection .

recent advances in computer hardware and software have greatly extended the time scales that can be covered by biomolecular simulations . these longer time scales ( beyond nanoseconds ) one important characteristic of these force fields is the ability to accurately model the formation of salt bridges , or pairs of amino acids whose oppositely charged side - chains are within hydrogen - bonding distance in proteins . however , it has long been suspected that the forces between oppositely charged amino acids are overly attractive in molecular dynamics ( md ) simulations with current biomolecular force fields , and there have been a number of efforts to reduce this artifact in the improvement of various force fields . previous theoretical studies have analyzed the contribution of salt bridges to protein or protein protein complex stability , using both implicit and explicit modeling of solvation . others have studied salt bridges using amino acid analogues , often employing biasing techniques in the simulations . more recently , a comprehensive comparison of force field / water model combinations was conducted for salt bridge interactions between the amino and carboxyl groups of zwitterionic amino acids , using extensive simulations in explicit solvent on the microsecond time scale . here , we evaluated six biomolecular force fields for their ability to accurately model the strengths of salt bridges between the side - chains of oppositely charged amino acids by unbiased , microsecond - scale md simulations in explicit solvent . in particular , we directly compared current amber , charmm , and opls force fields in simulations of association between the side - chain analogues of three different pairs of amino acids , arg / asp , lys / asp , and his ( + ) /asp . we further tested one of the pairs , arg / asp , by simulating association of blocked amino acid dipeptides . in addition , we evaluated the influence of the solvent model on the strengths of the salt bridges by simulating the side - chain analogue pairs using a selection of different force field / water model combinations . to our knowledge , our microsecond - scale simulations provide the most extensive sampling of salt bridge formation to date , yielding thousands of association / dissociation events , permitting quantitative comparisons , both between the force fields and with experiment . our results reveal considerable variability among the current force fields in terms of the resulting strengths of salt bridge interactions , as well as differences from experimental data .

recent advances in computer hardware and software have made rigorous evaluation of current biomolecular force fields using microsecond - scale simulations possible . force fields differ in their treatment of electrostatic interactions , including the formation of salt bridges in proteins . here we conducted an extensive evaluation of salt bridge interactions in the latest amber , charmm , and opls force fields , using microsecond - scale molecular dynamics simulations of amino acid analogues in explicit solvent . we focused on salt bridges between three different pairs of oppositely charged amino acids : arg / asp , lys / asp , and his ( + ) /asp . our results reveal considerable variability in the predicted ka values of the salt bridges for these force fields , as well as differences from experimental data : almost all of the force fields overestimate the strengths of the salt bridges . when amino acids are represented by side - chain analogues , the amber ff03 force field overestimates the ka values the least , while for complete amino acids , the amber ff13 force field yields the lowest ka value , most likely caused by an altered balance of side - chain / side - chain and side - chain / backbone contacts . these findings confirm the notion that the implicit incorporation of solvent polarization improves the accuracy of modeling salt bridge interactions .

depression is a common mental disorder , with an estimated global burden of 350 million . lifetime prevalence rates range from approximately 3 % to 16.9 % , with most countries falling somewhere between 8 % and 12 % . depressive disorder is diagnosed when the patient suffers from depressed mood , loss of interest and enjoyment , and reduced energy leading to increased fatigability and diminished activity for at least 2 weeks along with other common symptoms such as reduced concentration and attention , reduced self - esteem and self - confidence , ideas of guilt and unworthiness , blank and pessimistic views of future , ideas or acts of self - harm or suicide , disturbed sleep , and diminished appetite . if there is a history of at least one hypomanic , manic , or mixed affective episode in the past , then the depressed person is diagnosed to have bipolar depression . unipolar depressive disorders were ranked fourth in 2004 and will rise to the first place by 2030 in terms of the global burden of all diseases . bipolar disorder affected an estimated 29.5 million individuals worldwide in 2004 , according to the world health organization . if the current trends for demographic and epidemiologic transition continue , it is estimated that by the year 2020 , the burden of depression will increase to 5.7 % of the total burden of disease and it would be the second leading cause of disability - adjusted life years . the distinction between unipolar and bipolar depression remains a challenging clinical problem , particularly when bipolar individuals present in the depressive phase and they may easily be mistaken for unipolar depression . patients with bipolar depression who are assumed to have unipolar depression will receive inappropriate therapy that can increase the risk of manic switch or cycle acceleration . measures to clinically recognize or at least to suspect the kind of disorder in the early stage can greatly improve diagnosis and management of such disorders , with more appropriate treatment selection which will help in long - term care of these groups of people . we are yet to know the details of the biological processes involved in these clinical conditions and the different factors associated . this study was undertaken with the objective of comparing the sociodemographic variables associated with unipolar and bipolar depression groups . it also aimed at assessing the degree of depression among the unipolar and bipolar groups .

introduction : early diagnosis and management of depression is important for better therapeutic outcome . strategies for distinguishing between unipolar and bipolar depression are yet to be defined , resulting improper management . this study aims at comparing the socio - demographic and other variables between patients with unipolar and bipolar depression , along with assessment of severity of depression.materials and methods : this cross sectional study was conducted in a tertiary care psychiatry hospital in north - east india . the study included total of 330 subjects selected through purposive sampling technique from outpatient department after obtaining due informed consent . mini - international neuropsychiatric interview ( m.i.n.i . ) version 6.0 and beck depression inventory ( bdi ) were applied . statistical package for social sciences ( spss ) version 16.0 was applied for analysis.results : bipolar group had onset of illness at significantly younger age with more chronicity ( 32.85 11.084 ) . mean bdi score was significantly higher in the unipolar depressive group.conclusion : careful approach in eliciting symptom severity and associated socio demographic profiles in depressed patients may be helpful in early diagnosis of bipolar depression .

stroke is defined as rapidly developing symptoms and/or signs of focal and global loss of cerebral function lasting for at least 24 hours with no apparent cause other than of vascular origin . therefore , effective risk factor intervention represents the most appropriate to reduce stroke morbidity and mortality . while some risk factors such as hypertension and atrial fibrillation have been recognized as independently related to stroke occurrence , the predictive role of lipid profile has not yet been well established , similar to that reported in myocardial infarction [ 25 ] . many of the previous clinical investigations have suggested that increased serum cholesterol is a risk factor for ischemic stroke . the present study was designed to evaluate the lipid profile levels of patients who had experienced an acute stroke during the first 24-hour and to compare these levels in different patients suffering from the stroke , either hemorrhagic or ischemic , and healthy individuals .

backgroundchanges in the lipid profile have been suggested as a risk factor for developing ischemic stroke . their role in intra - cerebral hemorrhage , however , is not clear . the present study was designed to evaluate the lipid profile levels of patients who had experienced an acute stroke during the first 24-hour and to compare these levels in different patients suffering from the stroke , either hemorrhagic or ischemic , and healthy individuals.methodsin this cross - sectional study , 258 consecutive patients with acute stroke admitted to the neurology department of our center during september 2006 and september 2007 were studied . as for the control group , 187 apparently healthy subjects living in the same community and matched for age and sex were selected . lipid profile was measured and compared between the three groups.resultsin the patients group , 65 suffered from hemorrhagic stroke ( group 1 ) and the other 193 had ischemic stroke ( group 2 ) . except for tg values , there was no significant difference among the ischemic and hemorrhagic lipid profile . age , cholesterol , and ldl influenced the risk of developing an ischemic stroke ; tg was not reported as a risk factor or a protective one . while the comparison of data retrieved from patients suffering from hemorrhagic strokes with the controls , revealed ldl as the risk factor contributing to the development of ich whereas tg was reported as a protective factor.conclusionit could be concluded that ldl level can be considered as a risk factor for both ischemic and hemorrhagic cerebral events .

dna , with its building block dna bases that store the genetic information , is indispensable in protein biosynthesis . investigations on long - distance charge transfer through dna are of ongoing interest . moreover , the interaction of excited triplet states of aromatic carbonyl compounds with dna bases is also of interest for biophysical and biochemical studies . these studies may serve as a useful strategy for understanding structure and function of the bases in dna . in the present study , we want to extend the investigations on the interactions between an aromatic ketone derivative , 3,3,4,4-benzophenone tetracarboxylic acid , with selected dna bases . 3,3,4,4-benzophenone tetracarboxylic acid along with 4-benzophenone monocarboxylic acid ( 4-bc ) are derivatives of benzophenone , and their structures are similar . to get an idea about the kinetics of triplet bptc , the previous work on 4-bc should be considered ; however , studies on the photochemical reaction of 4-bc are challenging because of an existing overlap in the spectra of triplet , ketyl radical , and ketyl radical anion between 380 and 720 nm . although the overlapped spectra of these radicals with similar molar extinction coefficients are comparable , the formation of these radicals also depends on the type of quenchers and radical quantum yields . therefore , the various absorptions of the radicals need to be considered carefully when measuring reaction rate constants . in our experiments , we have employed different approaches to analyze these kinetic behaviors . in this paper , we present the kinetics of the photoreaction of triplet bptc with various dna bases in aqueous solution . the ph - dependence of the quenching reaction rate constants is investigated thoroughly for all quenchers . in addition , from cyclic voltammetric measurements , we propose a proton - coupled electron transfer ( pcet ) by means of a stepwise mechanism from thymine to triplet bptc .

the kinetics of triplet state quenching of 3,3,4,4-benzophenone tetracarboxylic acid ( bptc ) by dna bases adenine , adenosine , thymine , and thymidine has been investigated in aqueous solution using time - resolved laser flash photolysis . the observation of the bptc ketyl radical anion at max = 630 nm indicates that one electron transfer is involved in the quenching reactions . the ph - dependence of the quenching rate constants is measured in detail . as a result , the chemical reactivity of the reactants is assigned . the bimolecular rate constants of the quenching reactions between triplet bptc and adenine , adenosine , thymine , and thymidine are kq = 2.3 109 ( 4.7 < ph < 9.9 ) , kq = 4.0 109 ( 3.5 < ph < 4.7 ) , kq = 1.0 109 ( 4.7 < ph < 9.9 ) , and kq = 4.0 108 m1 s1 ( 4.7 < ph < 9.8 ) , respectively . moreover , it reveals that in strong basic medium ( ph = 12.0 ) a keto enol tautomerism of thymine inhibits its reaction with triplet bptc . such a behavior is not possible for thymidine because of its deoxyribose group . in addition , the ph - dependence of the apparent electrochemical standard potential of thymine in aqueous solution was investigated by cyclic voltammetry . the e/ph 59 mv / ph result is characteristic of proton - coupled electron transfer . this behavior , together with the kinetic analysis , leads to the conclusion that the quenching reactions between triplet bptc and thymine involve one proton - coupled electron transfer .

when angiotensin - converting enzyme-2 ( ace2 ) was serendipitously discovered ten years ago , neither of the two groups at the centre of its discovery [ 1 , 2 ] could have guessed at the disproportionate number of distinct roles it plays in biology , from cardiovascular regulation to viral infection . as so often happens in modern biological research two independent approaches converged on the same discovery , to give us ace2 or angiotensin - converting enzyme homologue ( aceh ) , back in 2000 . over the past ten years our knowledge of this protein 's role in the body has increased exponentially , resulting in recombinant ace2 protein entering clinical trials back in 2009 . this paper will focus on what we currently know about ace2 and its regulation , highlighting some of the gaps and discrepancies that still remain in our knowledge .

the renin - angiotensin system ( ras ) is a critical regulator of hypertension , primarily through the actions of the vasoactive peptide ang ii , which is generated by the action of angiotensin - converting enzyme ( ace ) mediating an increase in blood pressure . the discovery of ace2 , which primarily metabolises ang ii into the vasodilatory ang- ( 1 - 7 ) , has added a new dimension to the traditional ras . as a result there has been huge interest in ace2 over the past decade as a potential therapeutic for lowering blood pressure , especially elevation resulting from excess ang ii . studies focusing on ace2 have helped to reveal other actions of ang- ( 1 - 7 ) , outside vasodilation , such as antifibrotic and antiproliferative effects . moreover , investigations focusing on ace2 have revealed a variety of roles not just catalytic but also as a viral receptor and amino acid transporter . this paper focuses on what is known about ace2 and its biological roles , paying particular attention to the regulation of ace2 expression . in light of the entrance of human recombinant ace2 into clinical trials , we discuss the potential use of ace2 as a therapeutic and highlight some pertinent questions that still remain unanswered about ace2 .

with attention to the role of diet or medical nutritional therapy on chronic disease , the dietary pattern approach , which involves diet quality indices , has been suggested as a powerful tool because of the complexity of diets [ 1 - 3 ] . in recent decades , several indices have been developed and validated , including the diet quality index ( dqi ) , healthy eating index ( hei ) , mediterranean diet score , healthy diet indicator ( hdi ; based on the world health organization dietary guidelines ) , alternate hei ( ahei ; including american dietary guidelines ) , and dqi - international ( dqi - i ; developed for worldwide national dietary guidelines ) . the diet quality indices may be used as a quick assessment to evaluate compliance to healthy dietary guidelines and dietary changes after diet education . there have been several studies that have shown an association between diet quality indices and chronic diseases , especially cancer and cardiovascular diseases . some research has also demonstrated an association of diet quality indices with obesity and diabetes [ 12 - 15 ] . however , there have been few studies assessing the relationship between diet quality indices and glycemic control , and on which indices might serve as an appropriate tool to assess diet quality in patients with type 2 diabetes following diet education . in this study , we tried to determine the relationship between the diet quality indices including hdi , ahei , and dqi - i , and glycemic indices in korean patients with type 2 diabetes , independent of adiposity and energy intake . then , we also tried to determine which indices were appropriate for assessment of diet quality after dietary education in patients with type 2 diabetes .

the present study was performed to evaluate the relationship between dietary quality indices including the diet quality index - international ( dqi - i ) , alternate healthy eating index ( ahei ) , and healthy diet indicator ( hdi ) and glycemic status in korean patients with type 2 diabetes . a total of 110 consecutive outpatients with type 2 diabetes who visited 2 university hospitals in seoul and seongnam from april 2004 to november 2006 were enrolled as subjects . at the time of enrollment , anthropometric parameters , dietary habits , experience of exercise , and metabolic parameters were obtained . experienced registered dietitians collected one - day dietary intake using the 24-hour recall method . the mean scores for dqi - i , ahei , and hdi were 68.9 8.2 , 39.4 8.9 , and 5.0 1.3 , respectively . after adjustment for age , body mass index , and energy intake , dqi - i and hdi were found to have a significant correlation with hemoglobin a1c ( hba1c ) ( r = -0.21 , p < 0.05 ; r = -0.28 , p < 0.05 ) , fasting plasma glucose ( r = -0.21 , p < 0.05 ; r = -0.23 , p < 0.05 ) , and postprandial 2-h glucose ( r = -0.30 , p < 0.05 ; r = -0.26 , p < 0.05 , respectively ) . however , ahei did not have a significant correlation with hba1c . in conclusion , the dqi - i and hdi may be useful tools in assessing diet quality and adherence to dietary recommendations in korean patients with type 2 diabetes . future research is required to determine whether the dietary quality indices have predictive validity for dietary and glycemic changes following diet education in a clinical setting .

the synthesis methods and the use of nanostructures for various applications have been a very lucrative topic in the last decade . these efforts have lead to discoveries of unknown phenomena and/or new approaches to explain with precision the observed experimental and theoretical facts from the macro / micro world . when all is said and done , the issues in nano - sized devices ( individual or arrays ) and basic impediments in device operation have not been addressed largely due to not having a perception of end - user requirements , leaving the device s operational bottlenecks unaddressed . this is true for two well - researched opto - electronic materials gan- and zno - based devices like light - emitting diodes and photodetectors . in the case of gan , more emphasis was given to high crystal quality growth , epitaxy , and understanding the mg h complex in determining the p - doping that eventually lead a lone scientist , s. nakamura at nichia chemical industries , japan , to invent the first working solid state blue laser . in case of zno , the large part of the investment from university and industry arenas is still devoted to realizing the p - type doping along with some initial success from m. kawasaki s group at tohoku university , japan that recently demonstrated the first zno p zno is emerging as a potential candidate due to its direct wide bandgap and its ability to tailor electronic , magnetic , and optical properties through doping and alloying . one significant property that has brought zno and its alloys with mg to the forefront of a flurry of research activity is the large exciton binding energy ( 60 mev when compared to 25 mev for gan ) for use in uv lasers . zno has been widely reported as a visible - blind uv sensor over a wide range of applications in military and non - military arenas that includes missile plume detection for hostile missile tracking , flame sensors , uv source monitoring , and calibration . however , recent research in nanostructures of zno has proved that the reduced dimensions have the potential to provide more untapped properties if harnessed in a systematic manner . many simple fabrication techniques , devices , and applications have been demonstrated and reproduced . zno nanoscale structures such as one - dimensional nanowires are attracting more attention because of their enormous potential as fundamental building blocks for nanoscale electronic and photonic devices due to the enhanced sensitivity offered by quantum confinement effects . in this work , we address the prominent defect - related property ( could be sum or individual defects due to non - crystallinity , surface charge imbalance , or substrate to film interface strains ) that affects the electrical properties of the ensuing device . the phenomenon of persistent photoconductivity ( ppc ) is a situation in which a photo - induced current in the device continues to flow even after the exciting photon source is turned off . ppc is a major issue in device operation that became a topic of intense research interest during development of gan and algan photodetectors . the motivation of the present work is to understand the origin of ppc in zno by employing a simple device configuration consisting of a metal semiconductor metal structure . ppc is very difficult to observe in bulk materials and needs to be measured at very low temperature , which in turn complicates the carrier transport mechanisms , thus limiting the ability to extract and interpret the exact cause of the problem . this phenomenon is observable in both macro and nanostructured films ; however , the effects are more prominent in nanostructured materials due to singularity in their joint density of states , thus allowing a bulk phenomenon to be observable clearly even at room temperature .

the phenomenon of persistent photoconductivity is elusive and has not been addressed to an extent to attract attention both in micro and nanoscale devices due to unavailability of clear material systems and device configurations capable of providing comprehensive information . in this work , we have employed a nanostructured ( nanowire diameter 3065 nm and 5 m in length ) zno - based metal semiconductor metal photoconductor device in order to study the origin of persistent photoconductivity . the current voltage measurements were carried with and without uv illumination under different oxygen levels . the photoresponse measurements indicated a persistent conductivity trend for depleted oxygen conditions . the persistent conductivity phenomenon is explained on the theoretical model that proposes the change of a neutral anion vacancy to a charged state .

elimination of vertical transmission of hiv is a global priority , yet progress remains marred by severe disparities across regions . while it is almost a reality in developed country settings , in many resource - poor settings , only an estimated 15 % to 30 % of eligible women complete the prevention of mother to child transmission ( pmtct ) cascade . weak health systems , unreliable infrastructure , breakdowns in supply chains and lack of health staff contribute to insufficient service coverage , but it is increasingly clear that many barriers to achieving universal access for pmtct occur outside of formal health services . each setting will have its own specific mix of barriers to pmtct uptake , adherence and retention that reflect prevailing behavioural norms , cultural beliefs and the policy environment . understanding context - specific barriers is the first step to addressing them , followed by design of interventions that are informed by the evidence base yet tailored to each setting . this paper presents work commissioned by the elizabeth glaser pediatric aids foundation ( egpaf ) that aimed to identify and synthesize research findings on community - based approaches used in developing country settings to overcome barriers to pmtct enrolment , retention and successful outcomes . the goal was to identify which interventions work , why they may do so and what knowledge gaps remain , focussing on the following four priority outcomes within the egpaf community initiative : increased uptake of hiv care and treatment services among pregnant women and vertically infected children ; improved retention of individuals enrolled in prevention for vertical transmission and care and treatment programmes ; enhanced adherence of pregnant and lactating women , their partners and children to arv prophylaxis and/or antiretroviral treatment ( art ) and/or other care regimens ; strengthened psychosocial wellbeing of pregnant and lactating women and children enrolled in care and treatment programmes . increased uptake of hiv care and treatment services among pregnant women and vertically infected children ; improved retention of individuals enrolled in prevention for vertical transmission and care and treatment programmes ; enhanced adherence of pregnant and lactating women , their partners and children to arv prophylaxis and/or antiretroviral treatment ( art ) and/or other care regimens ; strengthened psychosocial wellbeing of pregnant and lactating women and children enrolled in care and treatment programmes .

introductionnumerous barriers to optimal uptake of prevention of mother to child transmission ( pmtct ) services occur at community level ( i.e . , outside the healthcare setting ) . to achieve elimination of paediatric hiv , therefore , interventions must also work within communities to address these barriers and increase service use and need to be informed by evidence . this paper reviews community - based approaches that have been used in resource - limited settings to increase rates of pmtct enrolment , retention in care and successful treatment outcomes . it aims to identify which interventions work , why they may do so and what knowledge gaps remain.methodsfirst , we identified barriers to pmtct that originate outside the health system . these were used to construct a social ecological framework categorizing barriers to pmtct into the following levels of influence : individual , peer and family , community and sociocultural . we then used this conceptual framework to guide a review of the literature on community - based approaches , defined as interventions delivered outside of formal health settings , with the goal of increasing uptake , retention , adherence and positive psychosocial outcomes in pmtct programmes in resource - poor countries.resultsour review found evidence of effectiveness of strategies targeting individuals and peer / family levels ( e.g . , providing household hiv testing and training peer counsellors to support exclusive breastfeeding ) and at community level ( e.g . , participatory women s groups and home - based care to support adherence and retention ) . evidence is more limited for complex interventions combining multiple strategies across different ecological levels . there is often little information describing implementation ; and approaches such as community mobilization remain poorly defined.conclusionsevidence from existing community approaches can be adapted for use in planning pmtct . however , for successful replication of evidence - based interventions to occur , comprehensive process evaluations are needed to elucidate the pathways through which specific interventions achieve desired pmtct outcomes . a social ecological framework can help analyze the complex interplay of facilitators and barriers to pmtct service uptake in each context , thus helping to inform selection of locally relevant community - based interventions .

the incidence of malignant melanoma has been increasing by 2.6 % annually over the last decade , with approximately 76,790 new cases resulting in 9,480 deaths in 2013 . additionally , melanoma is one of the most common forms of cancer in young adults and represents a significant health concern , particularly in terms of years of life lost . a key prognostic indicator of melanoma is the depth of the lesion in millimeters at the time of diagnosis . melanoma in situ , which is confined to the epidermis , is considered completely curable . however , once melanoma has progressed and metastasized to other parts of the body , effective treatment is limited . therefore , melanoma prognosis and cure rates can be dramatically improved by early diagnosis when the lesion is thinnest . clinical signs of early melanoma are often ambiguous ; even the most experienced dermatologist may have difficulty identifying and differentiating it on a clinical basis from other pigmented lesions , such as atypical nevi . as a result of this clinical need , diagnostic tools have been developed to aid the clinician in deciding whether a lesion is suspicious enough to require biopsy . handheld epiluminescence microscopy or dermoscopy is a common modality used to inspect the pigment network pattern at the epidermodermal junction zone and to evaluate it for indicators of malignant transformation . more recently , the advent of computer - based systems provides sophisticated functionalities allowing for software algorithms to analyze specific features of lesions relevant to predicting malignancy . in addition , diagnostic aids for mole mapping , such as total body photography , improve the ability to longitudinally monitor patients who have too many moles to otherwise track for clinically significant changes . emerging technologies , such as in vivo reflectance confocal microscopy , optical coherence tomography , and even infrared imaging are currently being investigated to determine their utility for noninvasive diagnosis of melanoma . this article summarizes the currently available modalities used to aid in the detection of melanoma in conjunction with full body skin examinations .

melanoma is a malignancy of melanocytes or pigment - producing cells located predominantly in the skin . it is less common than other skin cancers but causes the greatest number of skin cancer - related deaths worldwide . the incidence of melanoma continues to increase and early detection is the most promising means of decreasing morbidity and mortality . currently , physicians perform routine skin cancer screenings for melanoma without the benefit of imaging devices more advanced than handheld magnifiers or dermatoscopes . however , it is possible that the diagnosis of melanoma may be improved with technology that provides diagnostic discrimination beyond what is possible on routine inspection . this article reviews current and emerging technologies to aid in the diagnosis of melanoma . ultimately , these advances may enhance the early diagnosis of melanoma .

leishmaniasis is a vector - borne disease caused by obligate intramacrophage protozoan parasites of the genus leishmania [ 1 , 2 ] . the infecting leishmania species determines the clinical presentation of disease , of which there are three dominant clinical forms : cutaneous leishmaniasis ( cl ) , mucocutaneous leishmaniasis ( mcl ) , and visceral leishmaniasis [ 1 , 2 ] . in bolivia , the etiological agent of both , cl and mcl is leishmania ( viannia ) braziliensis , formerly known as the l. braziliensis complex . while cl is characterized by single or multiple ulcerated dermal lesions , mcl which develops as a complication of l. ( v. ) braziliensis cl in 5 % 20 % of patients from parasite dissemination to the upper respiratory tract mucosa , involving the nasal , pharyngeal , and laryngeal mucosa , leads to extensive tissue destruction [ 5 , 6 ] . cl either heals spontaneously or promptly responds to antimonial therapy but mcl usually evolves chronically and is difficult to treat . then , amphotericin b ( amb ) is an alternative for patients who fail to respond to pentavalent antimonial therapy . it has been known that amb potentiates the antimicrobial and tumoricidal activities of macrophages , either directly or via induction of cytokines such as tumor necrosis factor- ( tnf- ) and interleukin-1 ( il-1 ) , as well as generation of a respiratory burst [ 10 , 11 ] . apart from these effects , little is known about the mechanisms associated with the efficacy of this compound in the treatment of mcl . therefore , it was of interest to determine the participation of other soluble factors , apart from tnf- , in amb - treated mucocutaneous leishmaniasis , keeping in mind that activation of the infected macrophages to kill intracellular parasites is carried out through a cell - mediated response that requires the classic features of antigen presentation and production of il-12 by macrophages and activation of th1 lymphocytes with production of interferon- ( ifn- ) to activate the macrophages . the present study was aimed at elucidating the participation of critical soluble factors associated with amb treatment that could alleviate , in future , the collateral effects of this arduous treatment by combining immunochemotherapy with lower doses of drug . in the present investigation , we present evidence for an exacerbated th1 immune response in mcl treated with amb , manifested by an elevated synthesis of ifn- which directly relates to a great increase in il-12 production .

in an attempt to investigate the effects of treatment of human leishmaniasis , the cytokines produced by peripheral blood mononuclear cells ( pbmcs ) of patients with cutaneous leishmaniasis ( cl ) and mucocutaneous leishmaniasis ( mcl ) under treatment with amphotericin b were determined during the active disease from cocultures of cells and leishmania ( viannia ) braziliensis antigens . pbmc of these patients exhibited a nonsignificant marginal increased production of tnf- upon antigen stimulation . however , under the same antigenic stimulus , patients with active mcl presented higher ifn- production compared to patients with cl . this increased ifn- production was accompanied by a drastically augmented il-12 synthesis from cells of mcl patients . the highlighted t cell responses could be relevant for sound control measures of protozoan infections with emphasis on the combined usage of immunoenhancing agents and antiprotozoal drugs .

cervicitis is defined clinically by the presence of either mucopurulent discharge or easily induced bleeding at the endocervical os , more subtle signs include edema of the cervical ectropion ( edematous ectopy ) and the presence of an elevated number of polymorphonuclear leukocytes , as detected by gram staining of a smear of endocervical secretions under high - power magnification1 . other organisms include : herpes simplex virus ( hsv ) , human papillomavirus ( hpv ) and trichomonas vaginalis . hsv serological testing should be considered for people presenting for a sexually transmitted disease evaluation , especially for those people with multiple sexual partners and people with hiv infection . herpes cervicitis becomes important when observed in a woman of reproductive age group because of the risk of neonatal infections resulting from exposure to hsv in the genital tract during delivery . hsv is shed asymptomatically from multiple anatomical sites and shedding , like exposure , is a significant risk for transmission . non - neoplastic diseases are predominantly inflammatory however there are few publications on the subject compared to neoplastic diseases of the cervix . common causes include chemical irritations secondary to douching or local trauma produced by pessaries and intrauterine contraceptive devices .

infection with genital herpes simplex virus ( hsv ) remains a common viral sexually transmitted disease , often subclinical and a major worldwide problem of women of reproductive age group . herpes cervicitis is an unusual presentation of herpes simplex virus infection in females . the finding of herpes cervicitis on routine pap smear of an asymptomatic woman on intrauterine contraceptive device still further supports the need for increased awareness on the possibility of herpes simplex virus infection among women , particularly those on intrauterine contraceptive device . the index case is a 28 years old nigerian female who was referred to our special treatment clinic on account of an abnormal pap smear cytology which was in keeping with herpes cervicitis . there was no history of genital ulcer in this patient ; however elisa for hsv 2 igm was positive in her . we therefore describe a case of herpes cervicitis in an asymptomatic woman on intrauterine contraceptive device . this case highlights to clinicians the need to be aware of the possibility of this association and to carry out relevant investigations so as to identify and treat these patients appropriately . therefore , there is a need to put in place adequate public health intervention strategy to prevent genital herpes in women of reproductive age group with a view to preventing the possibility of congenital herpes in subsequent pregnancy .

dipeptidyl peptidase4 ( dpp4 ) inhibitors belong to a novel class of antidiabetic agents that increase the incretin hormones , glucagonlike peptide1 ( glp1 ) and glucosedependent insulinotropic polypeptide ( gip ) . sitagliptin is the first dpp4 inhibitor in japan , where it has been available for approximately 2 years . the oral diabetes drugs that were available for clinical use before this were sulfonylureas , biguanides , thiazolidines , glucosidase inhibitors ( gi ) and glinides . however , blood glucose can not actually be well controlled in many type 2 diabetes patients with these drugs , and improved glycemic control in a greater number of diabetic patients is anticipated with sitagliptin , given its novel mechanism of action . japanese people have genetically low insulin secretory capacity , and sulfonylurea drugs are the most commonly used drug therapy for type 2 diabetes . in monotherapy , sitagliptin is expected to be effective for a wide range of diabetes patients , as well as cases of secondary sulfonylurea failure , but there are currently no reported results on the efficacy and safety of sitagliptin in large numbers of patients in actual clinical practice . the study group of the diabetes committee has carried out several observational studies in kanagawa , such as looking at the prevalence of diabetic complications ( neuropathy and nephropathy ) . our committee carried out a retrospective , observational study of sitagliptin , which was given to type 2 diabetes patients in the community by the diabetes specialists of our committee . a largescale analysis of the efficacy and safety of sitagliptin monotherapy and combination therapy for 12 weeks in actual clinical practice , in which the primary outcome was glycated hemoglobin ( hba1c ) , is reported .

abstract ( j diabetes invest , doi : 10.1111/j.20401124.2012.00221.x , 2012 ) aims / introduction : to determine the efficacy and safety of sitagliptin monotherapy and combination therapy in japanese type 2 diabetes patients after 3 months therapy.materials and methods : a retrospective , observational study of 741 type 2 diabetes patients was carried out ; 110 received sitagliptin monotherapy , and 631 received combination therapy with sitagliptin when other oral medications were insufficient . the primary outcome measure was glycated hemoglobin ( hba1c ) measured at 0 , 4 and 12 weeks of sitagliptin therapy.results : in the monotherapy and combination therapy groups , hba1c decreased significantly after 12 weeks . target hba1c ( < 7 % ) was achieved in 39.1 % overall . on logistic regression analysis , baseline hba1c was the strongest contributing factor for achieving target hba1c ; baseline body mass index and duration of diabetes were also significant factors . a total of 82 patients ( 11 % ) were unresponsive to sitagliptin . these patients baseline body mass index was significantly higher and their baseline hba1c was significantly lower than those of patients who responded to sitagliptin . the most commonly coadministered drugs were sulfonylureas ( 508 patients ) . in these patients , the dose of sulfonylurea decreased with time . in 66 patients whose sulfonylurea dosage was reduced when sitagliptin was started , hba1c and bodyweight decreased significantly after 12 weeks . a total of 24 patients receiving sulfonylureas had mild hypoglycemia , but none discontinued sitagliptin.conclusions : sitagliptin was effective and safe as both monotherapy and combination therapy in japanese type 2 diabetes patients . when sulfonylureas were ineffective , sitagliptin improved glycemic control . in patients whose sulfonylurea dose was reduced at the start of sitagliptin , blood glucose improved and bodyweight decreased after 12 weeks .

abdominal obesity , characterized by preferential accumulation of intra - abdominal adipose tissue ( iat ) , contributes to cardiovascular and metabolic risk beyond the risk defined by body mass index [ 1 , 2 ] thus , prevention of abdominal obesity is key to reducing cardiometabolic risk . preferential iat accumulation , as measured by iat adjusted for percent body fat or iat to subcutaneous abdominal adipose tissue ( sat ) ratio , depends on genetic factors ( e.g . , ethnicity or gender ) , smoking , and the hormonal milieu ( e.g . , postmenopausal status ) [ 5 , 6 ] . the iat compartment is highly active during changes in balance between energy intake ( food consumption ) and energy expenditure ( physical activity ) . rapid iat accumulation occurs in acute overfeeding experiments , and preferential reduction of iat volume is characteristic of immediate and acute weight loss , but mitigated after 1214 weeks of intervention . we have shown that lack of regular moderate physical activity ( not meeting physical activity guidelines for healthy adults ) is associated with preferential iat accumulation in midlife women , independent of age , menopausal status , income , smoking , and percent body fat , suggesting that a sustained change in lifestyle may affect preferential iat accumulation . however , physical activity may not be the only lifestyle target for preventing iat accumulation . although energy intake is linked to iat in laboratory studies , no population - based studies have been conducted and no studies have determined whether or not energy intake is associated with preferential iat accumulation , independently of physical activity . moreover , there have been no studies that examined whether these relationships are moderated by ethnicity or menopausal status in midlife women . answers to these questions are important because they can inform the design of lifestyle interventions aimed at decreasing cardiometabolic risk by decreasing preferential accumulation of iat in midlife women .

we have previously shown that physical activity predicts intra - abdominal adipose tissue ( iat ) , but it is unknown whether energy intake predicts iat independently of physical activity in a community - based , naturalistic environment . the association of energy intake with iat was explored cross - sectionally in women , recruited between 2002 and 2005 for a study of fat patterning in midlife . iat at l4-l5 vertebral interspace was assessed by computed tomography , energy intake by the block food frequency questionnaire , and physical activity by the kaiser physical activity survey . linear regression models were used for the principal analyses . among the 257 women , 48 % were african american and 52 % were caucasian . women were 52 3 years old , and 49 % were postmenopausal . every 500 kcal increase in energy intake was associated with a 6 % higher iat ( p = 0.02 ) , independent of physical activity ( p = 0.02 ) , after adjustment for ethnicity , menopausal status , age , smoking , income , and dxa - assessed percent body fat . energy intake had a significant interaction with ethnicity ( p = 0.02 ) , but not with physical activity . models using the iat to subcutaneous abdominal adipose tissue ratio as an outcome had similar associations . in conclusion , self - reported ei was associated with preferential iat accumulation in midlife women , independent of physical activity . this association was significantly stronger in caucasian than african american women . future longitudinal studies are needed to explore lifestyle predictors of iat accumulation during the menopausal transition .

primary carcinoma of the extrahepatic bile duct is a rare tumor that represents less than 1.0 % of all malignant neoplasms and less than 3.0 % of all the tumors of the gastrointestinal system1 ) . most malignant tumors generated in the biliary tract are adenocarcinomas , and adenosquamous carcinoma is rare ( 3.0~4.7 % ) . adenosquamous carcinoma consists of two malignant components : one is glandular and the other squamous2 , 3 ) . in one previous report on patients with extrahepatic adenosquamous carcinoma of the biliary tract , patients were treated with surgical resection . the overall 1-year , 3-year and 5-year survival rates were 57 % , 26 % and 16 % , respectively , and the median survival was 13 months2 ) . when used for the management of advanced cholangiocarcinoma , adjuvant external beam radiotherapy ( ebrt ) followed by surgical resection with or without intraluminal radiotherapy ( ilrt ) is feasible , but the effect of radio - therapy alone has not been established4 ) . in korea , adenosquamous carcinoma of the papilla of vater and the liver has been reported , but there have been no previous reports on adenosquamous carcinoma of klatskin 's tumor5 , 6 ) . we report here on a case of a patient with adenosquamous carcinoma of klatskin 's tumor , and this was confirmed by endoscopic biopsy .

most malignant tumors originating from the biliary tract are adenocarcinomas , and adenosqamous carcinoma of klatskin 's tumor is a very rare finding . an 83-yr - old man was admitted to our hospital because of jaundice . the abdominal computed tomography and magnetic resonance cholangiopancreatography revealed wall thickening and luminal stenosis of both the intrahepatic duct confluent portion and the common hepatic duct . these findings were compatible with klatskin 's tumor , bismuth type iii . considering the patient 's old age , palliative combined modality therapy was performed . after percutaneous transhepatic biliary drainage , biopsy was performed via percutaneous transhepatic cholangioscopy . the histopathologic findings showed adenosquamous carcinoma . external radiotherapy and intraluminal brachytherapy through the endobiliary y - type stent were then done . nine months after the radiotherapy , the laboratory findings and the abdominal computed tomography revealed biliary obstruction and progressive hepatic metastasis . the combined modality therapy of external radiotherapy , intraluminal brachytherapy and stenting assisted him to live a normal life until he finally experienced biliary obstruction .

microwave imaging has received significant attention in the research community during the last couple of decades as a modality that potentially could improve the diagnostics of , for example , breast cancer tumors . today the research has come to the stage where early clinical trials have been and are being performed , [ 36 ] . the results from the clinical work are promising , but further development of the measurement systems as well as of the image reconstruction algorithms remains before the technique can be considered for daily clinical practice . when performing microwave tomography the aim is to quantitatively reconstruct the dielectric parameters in the region under test . the image reconstruction algorithm utilizes measured data that are compared against a corresponding numerical simulation of the system , and the dielectric profile is iteratively updated based on the difference between the simulation and the measurement . even though this comparison requires a realistic numerical model for the best accuracy , most of the published works have used 2d models together with a calibration procedure to enable the comparison with experimental data . largely , this can be attributed to a significant increase in the computational load when moving from 2d to three - dimensional ( 3d ) modeling . furthermore it is usually not possible to create realistic antenna models in 2d , except for line source antennas . by using a 2d model to solve the inverse scattering problem inaccuracies this problem has been identified by the research community , and , with the ever increasing computational resources available these days , the focus is now more and more turning to solving the full 3d problem . recent works using 3d algorithm have been reported in [ 711 ] . in this paper we show several examples where images have been reconstructed from scattering data in order to discuss and illustrate the need for accurate modeling of the antenna system and its geometry to enable robust image reconstruction . the aim is also to get an understanding of what accuracy we could realistically expect in the reconstruction and how it is affected by various modeling errors . examples of targets placed in a surrounding of air are studied , and in an effort to approach more biologically relevant settings we have studied examples where the antenna system was entirely immersed in water . our reconstruction algorithm , described in , is based on fdtd modeling to solve the forward scattering problem and the adjoint maxwell 's equations to compute gradients used in an iterative optimization procedure . the theoretical background of our work is described including fdtd methods with the minimization procedure . , the forward modeling is investigated , and the corresponding imaging results originating from experimental data are presented and discussed . and finally the conclusions are drawn in section 5 .

nonlinear microwave imaging heavily relies on an accurate numerical electromagnetic model of the antenna system . the model is used to simulate scattering data that is compared to its measured counterpart in order to reconstruct the image . in this paper an antenna system immersed in water is used to image different canonical objects in order to investigate the implication of modeling errors on the final reconstruction using a time domain - based iterative inverse reconstruction algorithm and three - dimensional fdtd modeling . with the test objects immersed in a background of air and tap water , respectively , we have studied the impact of antenna modeling errors , errors in the modeling of the background media , and made a comparison with a two - dimensional version of the algorithm . in conclusion even small modeling errors in the antennas can significantly alter the reconstructed image . since the image reconstruction procedure is highly nonlinear general conclusions are very difficult to make . in our case it means that with the antenna system immersed in water and using our present fdtd - based electromagnetic model the imaging results are improved if refraining from modeling the water - wall - air interface and instead just use a homogeneous background of water in the model .

the ovaries are the most common sites affected , but endometriosis can also involve the gastrointestinal tract , urinary tract , chest , and soft tissues . endometriosis of the chest is uncommon , and the diagnosis is usually established on clinical grounds . endometrial tissue may involve the pleura by migrating from the peritoneal cavity to the pleural cavity through diaphragmatic defects or via microembolization . pleuritic chest pain , pneumothorax , pleural effusions , or cyclic haemoptysis can occur with pulmonary involvement [ 35 ] .

chest pain is a rare sign of thoracal endometriosis associated with endometrioma of the tubo - ovarian endometrioma . we report the case periodic episodes of chest pain concurrent with menstruation in a 35-year - old female , in which ovarian endometrioma was diagnosed and left - sided oophorectomy was performed . after surgery , patient underwent medical treatment which included a gn - rh agonist and a combined oral contraceptive . in the follow - up period , there was no evidence of chest pain .

radicular back pain is an important public health issue that can result in long term disability and poor quality of life . conservative therapy is the initial treatment of choice , but fails to provide relief in a substantial number of patients . central and foraminal stenosis with entrapment of descending and/or exiting nerve roots is a common cause of radicular pain , with an estimated incidence of 8 to 11 % 1 2 3 . spinal stenosis of the thoracic vertebrae is less common than that of the cervical and lumbar regions . in our experience , patients tend to be older and are more commonly male . due to the close proximity to thoracic and abdominal organs , open surgical operations can be difficult and carry a greater risk of complications due to the requirement of a transthoracic approach . the most efficacious intervention for thoracic stenosis refractory to conservative management is uncertain at this time . here we report on our experience with 12 patients diagnosed with thoracic radiculopathy due to central or foraminal stenosis treated with endoscopic laminoforaminoplasty via a small incision , of less than one inch .

background : spinal stenosis of the thoracic spine is less common than that of the cervical and lumbar regions . due to the close proximity to thoracic and abdominal organs , surgical operations can be difficult and carry a greater risk of complications . the most efficacious intervention for thoracic stenosis , whether central or foraminal , refractory to conservative management is uncertain . we aimed to evaluate the efficacy of endoscopic laminoforaminoplasty ( elfp ) in the treatment of thoracic radiculopathy.methods : twelve patients with radicular pain involving the lower thoracic levels ( at or below t6 ) were treated with elfp.results : seven of twelve patients showed marked improvement in pain scores . average follow - up scores were 2.9 and 12.08 on the visual analog scale ( vas ) and oswestry disability index , respectively . the significance was 0.005 between the pre and post surgical data . one patient with moderate symptoms , two with severe symptoms , and two with crippling symptoms did not report significant improvement on vas or oswestry . no complications were encountered.conclusions : endoscopic laminoforaminoplasty offers an alternative to fusion or conventional laminotomy with similar success rates . patients additionally benefit from a decrease risk of complications , short hospital stay , and faster recovery .

multiple sclerosis ( ms ) is an inflammatory disease characterized by damage to the myelin sheath surrounding neurons in the central nervous system ( cns ) . this damage may be progressive , or it may wax and wane with periods of relapse and remission . motor , somatosensory , visual , cognitive , and psychiatric deficits may occur in ms patients depending on the location and size of the focal demyelination in the cns . cognitive impairments may manifest in the early phases of the clinical course of ms.1 in fact , the prevalence of cognitive deficits in ms patients ranges from 43 % 70 % .2 cognitive impairments may prevent patients from being able to perform activities of daily living . studies have shown that patients with cognitive deficits tend to avoid social activities , have higher rates of unemployment , and have difficulties in performing routine household chores . as such , the quality of life for these patients becomes further compromised as the degree of cognitive impairment increases.3 due to the limited treatment options for ms,4 it is critical to understand what agents may worsen clinical symptoms . cigarette smoking may trigger ms,5 facilitate the transformation of a clinically isolated syndrome into ms,6 increase ms relapse frequency,7 and promote progression of the disease.8 however , smoking is also known to increase cognitive performance via its effects on nicotinic acetylcholine receptors.9,10 even though it is understood that smoking affects the clinical course of ms , there are no studies that have investigated the relationship between smoking and cognitive impairment in ms patients . on the other hand , there are many studies evaluating ms patients , and the relationship between cannabis use and cognitive impairment.11,12 cigarette smoking exerts both positive and negative effects on cognition , and due to the high prevalence of cognitive impairment in ms patients , it is imperative to elucidate the effects of smoking on cognition in these patients . in this study we examined the potentially deleterious effects of heavy smoking on mentation in patients with ms .

purposealthough smoking is known to cause various symptoms in multiple sclerosis ( ms ) patients , there have been no reports regarding the relationship between smoking and cognitive impairment in ms . studying the effects of cigarette smoking in ms patients is imperative as there is a high prevalence of cognitive impairment in ms patients . in this study we examined the potentially deleterious effects of heavy smoking on mentation of patients with ms.patients and methodsms patients receiving care at the neurology clinic at bezmialem vakf university , between the ages of 1865 years who have at least graduated elementary school were included in the study . the brief repeatable battery of neuropsychological tests ( brb - n ) is a commonly used method to assess cognitive function in ms patients and was utilized in our study . patients that smoked for at least 10 pack - years were considered heavy smokers.resultsall the patients were stratified into two groups : heavy smokers ( n=20 ) and nonsmokers ( n=24 ) . for heavy smokers , their cognitive functioning was more impaired than that of nonsmokers ( p=0.04 , 2=4.227 ) . for patients with cognitive impairment , 78.9 % of the paced auditory serial addition test and 63.2 % of the symbol digit modalities test scores were found to be lower.conclusionprevious reports have suggested that smoking increases the frequency of relapse among individuals with relapsing - remitting ms and accelerates disease progression in patients with progressive ms . according to the results of our study , heavy smokers had increased cognitive impairment when compared to nonsmokers . extensive studies are necessary to further elucidate the relationship between smoking and cognitive impairment in ms patients .

glomerular disease , characterized by focal and segmental glomerulosclerosis histology ( fsgs ) , is a challenging disease to treat due to its frequent relapsing unremitting course and high rate of progression to end - stage renal disease ( esrd ) . for unclear reasons , fsgs has a rising incidence , now becoming a common cause of glomerular disease in both children and adults worldwide . although only a minority of those affected by fsgs have a family history of this lesion , the study of hereditary forms has helped inform our understanding of the molecular pathogenesis of fsgs . mutations in actn4 , trpc6 and cd2ap are all rare causes of fsgs , although never quantified in the literature . in contrast , several recent studies suggest that mutations in the inf2 gene account for a significant proportion of hereditary cases . inf2 belongs to the formin family , a group of heterogeneous actin binding proteins that regulate a variety of cytoskeleton - dependent cellular processes . moreover , inf2 has been implicated in individuals with charcot - marie - tooth disease who manifest fsgs as part of this syndrome . we previously reported inf2 as a cause of autosomal dominant fsgs in 11 of 93 families screened . initial screening of the entire gene revealed disease - causing mutations only in exons 2 to 4 . in this study , we expand on our initial report by mutational analysis of the dna sequence encoding the diaphanous inhibitory domain ( did ) of inf2 in a total of 215 probands from autosomal dominant fsgs families and also in 281 individuals with apparent sporadic disease . known autosomal dominant fsgs genes including actn4 , trpc6 and cd2ap were also screened in 213 probands for comparison .

mutations in the inverted formin 2 gene ( inf2 ) have recently been identified as the most common cause of autosomal dominant focal and segmental glomerulosclerosis ( fsgs ) . in order to quantify the contribution of various genes contributing to fsgs , we sequenced inf2 where all mutations have previously been described ( exons 2 to 5 ) in a total of 215 probands and 281 sporadic individuals with fsgs , along with other known genes accounting for autosomal dominant fsgs ( actn4 , trpc6 and cd2ap ) in 213 probands . variants were classified as disease - causing if they altered the amino acid sequence , were not found in control samples , and in families segregated with disease . mutations in inf2 were found in a total of 20 of the 215 families ( including those previously reported ) in our cohort of autosomal dominant familial nephrotic syndrome or fsgs , thereby explaining disease in 9 percent . inf2 mutations were found in 2 of 281 individuals with sporadic fsgs . in contrast , actn4 and trpc6-related disease accounted for 3 and 2 percent of our familial cohort , respectively . inf2-related disease showed variable penetrance , with onset of disease ranging widely from childhood to adulthood and commonly leading to esrd in the third and fourth decade of life . thus , mutations in inf2 are more common , although still minor , monogenic cause of familial fsgs when compared to other known autosomal dominant genes associated with fsgs .

phenylketonuria ( pku ; omim 261600 ) is defined as an autosomal recessive genetic inborn error of phenylalanine ( phe ) metabolism ( 1 ) . insufficiency in the hepatic specific enzyme , phenylalanine- 4-hydroxylase ( pah ) ( ec 1.14.16.1 ) leads to hyperphenylalaninemia that is associated with the pku ( 1 ) . deficiency of the pah enzyme results in the elevation of phe concentration in blood and biological fluids that is approximately above 2 mg / dl ( 120 mol / l ) in the pre - treatment condition ( 1 - 4 ) . the prevalence of pku among patients institutionalized for mental retardation varies from 1 % to 3 % ( 4 - 6 ) . the frequency of pku varies from high incidence in turkey ( about 1 in 2600 births ) to low incidence in japan ( about 1 in 125000 births ) ( 7 ) . overall , the incidence of pku among caucasians is about 1 in 10,000 , giving a carrier frequency of about 1 in 50 to 1 in 70 ( 7 ) . the incidence of pku in iranian population has been expected at 1 in 3627 live births ( 8 ) . genetic overall diversity in iranian populations is very high and comparable to the other populations from the south caucasus region , anatolia and europe ( 9 ) . it has been shown that iranian azerbaijanis with a population of about 15 to 20 million are more related to the georgians in comparison to other iranian groups ( 9 ) . the finding of derenko et al ( 2013 ) is based on maternal genetic structure on the mitochondrial dna studies ( 9 ) . however , this result may change based on paternal genetic structure and y - chromosome tracing . west azerbaijan province with a population of about 3 million is in north - west of iran and closely related to turks . regarding to a relatively high incidence of pku alleles in iranian population as well as high rate of consanguineous marriages in iran ( 10 ) , this study was carried out for mutation analysis of the pah gene in west azerbaijan province of iran .

objective ( s ) : phenylketonuria ( pku ) is a genetic inborn error of phenylalanine ( phe ) metabolism resulting from insufficiency in the hepatic enzyme , phenylalanine hydroxylase ( pah ) , which leads to elevated levels of phe in the blood . the present study was carried out for mutation analysis of the pah gene in west azerbaijan province of iran.materials and methods : a total of 218 alleles from 40 pku families were studied using restriction fragment length polymorphism - polymerase chain reaction ( rflp - pcr ) method.results : the frequencies of ivs10 - 11 , s67p , r261q , r252w , ivs11nt-1 g > c , r408q , and q232q mutations were 28 ( 35 ) , 17 ( 21.25 ) , 15 ( 18.75 ) , 3 ( 3.75 ) , 3 ( 3.75 ) , 2 ( 2.5 ) , and 1 ( 1.25 ) , in cases group , and 51 ( 23.4 ) , 31 ( 14.2 ) , 27 ( 12.4 ) , 6 ( 2.75 ) , 6 ( 2.75 ) , 4 ( 1.83 ) , and 2 ( 0.92 ) in total group , respectively . the mutations of r243q , 364delg , l333f , 261x , i65 t , and r408w were not detected in our samples.conclusion : it can be concluded that the ivs10 - 11 mutation has the highest frequency in the tested population . to our knowledge , this report is the first in its own kind and provides better understanding of the genetic heterogeneity , the origin and distributions of pah mutations in west azerbaijan province of iran .

parkinson 's disease ( pd ) is one of the most common neuro - degenerative disorders characterized by tremor , bradykinesia , rigidity and postural instability as well as several nonmotor features including dementia and depression . the exact pathophysiology of the disease is largely unknown though oxidative stress and mitochondrial dysfunction are generally believed to play a critical role . in fact , several epidemiologic studies have demonstrated an increased risk of dementia , another neuro - degenerative disorder , among patients with chronic autoimmune inflammatory diseases . psoriasis is a common immune - mediated skin disorder with an estimated prevalence of 24 % in the adult population . patients with psoriasis are well - known to have a high prevalence of comorbidities , especially metabolic syndrome and cardiovascular diseases . chronic inflammation is believed to play a pivotal role for this increased risk as several studies have illustrated the unfavorable effect of oxidative stress and inflammatory cytokines on endothelial function , resulting in premature atherosclerosis . in light of chronic inflammation thus , we conducted a systematic review and meta - analysis of observational studies to investigate if the risk of pd is increased in patients with psoriasis compared with nonpsoriasis participants .

background : patients with psoriasis might be at a higher risk of developing parkinson 's disease ( pd ) as a result of the detrimental effect of chronic inflammation on the neuronal tissue . this meta - analysis aimed to investigate this risk by comprehensively reviewing all available data.methods : we conducted a systematic review and meta - analysis of cohort and case control studies that reported relative risk , hazard ratio , odds ratio , or standardized incidence ratio comparing the risk of pd in patients with psoriasis versus subjects without psoriasis . pooled risk ratio and 95 % confidence interval ( ci ) were calculated using random - effect , generic inverse variance methods of dersimonian and laird.results : three retrospective studies and one case control study met our eligibility criteria and were included in this meta - analysis . the pooled risk ratio of pd in patients with psoriasis versus participants without psoriasis was 1.38 ( 95 % ci , 1.151.66 ) . the statistical heterogeneity was low with an i2 of 35 % .conclusions : our meta - analysis demonstrated a statistically significant increased risk of pd among patients with psoriasis .

even though there have been continual advances in neonatal care and a decline in mortality of preterm infants in the past several decades , the incidence of severe long - term sequelae such as chronic lung disease and neurodevelopmental disability in survivors remains high , particularly in newborns delivered at early gestational ages . it is an important public health issue as rates of preterm birth are rising in many countries . so , prevention and management of preterm birth continue to be a major challenge worldwide . cervical incompetence is a known risk factor for preterm birth and is considered responsible for 5 % of extremely preterm deliveries ( < 28 weeks ) . the cervix plays a fundamental role in supporting a pregnancy and cervices of women with cervical incompetence show pathological dilation and shortening , leading to miscarriage or preterm birth . different management strategies have been tried to prolong pregnancy and prevent preterm birth , including cervical cerclage . while some studies support this technique , others have failed to demonstrate benefits . infection and ensuing chorioamnionitis , bleeding and ruptured membranes are the most concerning complications associated with cervical cerclage . of these complications associated with cervical incompetence when intrauterine infection occurs , the neonate is at significant risk for respiratory distress syndrome ( rds ) , retinopathy of prematurity ( rop ) , neonatal necrotizing enterocolitis ( nec ) , bronchopulmonary dysplasia ( bpd ) , interventricular hemorrhage ( ivh ) , periventricular leukomalacia ( pvl ) , early - onset sepsis ( eos ) and even mortality . however , whether these complications caused by cervical cerclage and cervical incompetence itself could be associated with adverse neonatal outcomes remains unknown based on very little information . the objective of the present study was to analyze whether maternal cervical incompetence with or without cerclage was associated with postnatal morbidity and mortality in preterm neonates with birth weight < 2000 g , this information may help their mothers make an informed decision about whether to undergo cervical cerclage procedure from neonatologist s perspective .

objective : this study aimed to determine the impact of maternal cervical incompetence ( with or without mcdonald cerclage ) on mortality and morbidity of preterm infant with birth weight < 2000g.methods:581 neonates were eligible for this study , 79 with cervical incompetence and 502 without it ( control ) . incidences of neonatal respiratory distress syndrome ( rds ) , bronchopulmonary dysplasia ( bpd ) , intraventricular hemorrhage ( ivh ) , neonatal necrotizing enterocolitis ( nec ) , retinopathy of prematurity ( rop ) , periventricular leukomalacia ( pvl ) , severe asphyxia , small for gestational age ( sga ) , early - onset sepsis ( eos ) , and mortality were compared between the two groups.findings : mean gestational age was earlier in cervical incompetence group than in control ( 30.22.1 vs 30.71.9 , p < 0.05 ) . except lower frequency of sga , there were no significant differences in the incidences of rds , bpd , rop , pvl , ivh , nec , eos , severe asphyxia and mortality between the two groups . infants with no cerclage had a higher prevalence of rds ( 21/66 vs 9/13 , p < 0.05 ) compared to cerclage group due to lower mean gestational age ( 30.682.1 vs 28.61.4 , p < 0.01 ) and birth weight ( 1519.5274.6 vs 1205.8204.4 , p < 0.001 ) , and clinical neonatal outcomes of the elective cerclage were similar to emergency cerclage in cervical incompetence groups.conclusion : maternal cervical incompetence was not associated with postnatal adverse neonatal outcomes . lower mean gestational age was a major risk associated with higher prevalence of rds in preterm neonates with no mcdonald cerclage , and emergency cerclage did not predict poor clinical neonatal outcomes .

monoclonal immunoglobulin deposition disease , ( midd ) is a systemic disease characterized by non - fibrillar , congo red negative deposition of monoclonal immunoglobulins in the various organs of the body . midd is of three types depending on the composition of the deposits : light chain deposition disease ( lcdd ) , heavy chain deposition disease ( hcdd ) and light and heavy chain deposition disease ( lhcdd ) . of these three types , lcdd is usually seen in association with multiple myeloma or other lymphoproliferative disorders , and presents with renal involvement in the form of proteinuria and renal insufficiency . microscopic hematuria is seen in 60 % of the cases , while gross hematuria is rare . we hereby present a young male who developed gross hematuria and rapidly progressive renal failure and was diagnosed to have non - myeloma related lcdd .

monoclonal immunoglobulin deposition disease ( midd ) is an uncommon disease with a peak incidence between the 5th and 6th decades of life . it is characterized by non - fibrillar , congo red negative deposition of monoclonal immunoglobulins in various organs , including in the kidneys . midd can be of three types depending on the composition of the deposits , and includes light chain deposition disease ( lcdd ) , heavy chain deposition disease and light and heavy chain deposition disease , of which lcdd is the most common . renal involvement is a universal finding in midd , and is in the form of renal insufficiency , microscopic hematuria and nephrotic range proteinuria . gross hematuria is a rare occurrence . renal biopsy usually shows nodular sclerosing glomerulopathy on light microscopy and diffuse linear staining of glomerular and tubular basement membrane on immunofluorescence microscopy . we report a young male who presented with rapidly progressive renal failure and gross hematuria and was diagnosed as lcdd with nodular glomerulopathy and crescents on renal biopsy .

assessment of functional capacity is important for identifying the physical implications of stroke , since it is currently considered the main cause of serious long - term disability in adults1 , impairing physical , psychological , and social functions2 . after a stroke , individuals remain with several residual impairments , especially those related to motor function , which lead to reduced functional ability3 . in this sense , instruments that adequately capture several aspects of disability progression / regression are essential within clinical settings , implement more specific and effective disability management4 . the use of functional tests is sometimes impossible during rehabilitation , due to the need for specialized equipment , expertise and space . in this sense , it is already known that aerobic capacity assessed on a treadmill , by analyzing the oxygen consumption ( vo2 ) is the gold standard measure of functional performance for disabled individuals5 . however , the widespread utilization of this method is limited by expertise , associated with the need for the use of specific and expensive equipment6 . on the other hand , an easy assessment , such as the six - minute walking test ( 6mwt ) , which is routinely used to assess functional walking capacity of stroke individuals4 , 7 , 8 requires only a chronometer and a 30-meter corridor to be performed9,10,11 . the establishment of valid and simple ways to use alternative measures of functional capacity after stroke would be , therefore , clinically relevant . the use of a simple tool for the assessment of functional capacity may allow clinicians to obtain clinically useful methods to estimate an important outcome , which can determine the degree of constraint imposed by the stroke , as well as its importance , by being a factor in diagnosis , prognosis , and a strong predictor of mortality12 . an easily administered questionnaire was developed to assess functional capacity by the prediction of oxygen consumption ( vo2 ) without the need for maximal cardiopulmonary exercise testing13 . the duke activity status index ( dasi ) is a short , simple questionnaire that can be administered to patients with physical limitations . it has been previously validated with physiological measurements , such as vo2 in cardiac patients14 , 15 . although it was originally designed to evaluate patients with cardiovascular diseases , the dasi has also been shown to be valid and appropriate for the assessment of functional capacity of disabled individuals , such as those with moderate to severe chronic obstructive pulmonary disease ( copd ) 16 . in order to allow for its clinical use in individuals with stroke , this study investigated the associations between the dasi scores and valid and extensively used functional capacity measures ( distance covered and oxygen consumption obtained during the 6mwt ) . therefore , the specific research question for this study was : are there significant associations between the dasi scores and the distance covered and relative vo2 during the 6mwt in individuals with chronic stroke ?

[ purpose ] the aim of this study was to investigate the associations between self - reported and valid performance - based measures of functional capacity in individuals with chronic stroke . [ subjects and methods ] self - reported measures of functional capacity of 31 individuals with chronic stroke were assessed by the duke activity status index scores , whereas performance - based measures were assessed by the distance covered ( in meters ) and oxygen consumption ( relative oxygen consumption , in mlkg1min1 ) during the six - minute walking test . [ results ] the subjects had a mean age of 58.613 years and a mean time since the onset of stroke of 28.315.1 months . they had a mean duke activity status index of 27.314.4 , mean distance covered of 325.2140.2 m , and mean relative oxygen consumption of 9.62.3 mlkg1min1 . significant , positive , and moderate to good correlation coefficients were found between the duke activity status index scores and the distance covered during the six - minute walking test ( r=0.68 ) . significant , positive , and fair associations were also found between the duke activity status index scores and relative oxygen consumption values obtained during the six - minute walking test ( r=0.45 ) . [ conclusion ] the findings of the present study support the clinical use of the duke activity status index as a tool to assist in clinical evaluations of functional capacity of individuals with chronic stroke .

recently , the belgian government issued a bill regulating the organisation of and minimal requirements for specialist breast units ( kb , 2007 ) . the criteria were much based on a eusoma ( european society of mastology ) position paper ( eusoma , 2000 ; perry , 2001 ) , a text which was adopted in a resolution on breast cancer by the european parliament . this implied that criteria for accreditation were defined based on minimal standards to ensure high quality of care for women with breast cancer . a lot of attention was given to case load per surgeon and the limit of at least 150 newly diagnosed cases of primary breast cancer per year per centre was subject to much debate . a survey on caseload and surgery for some cancers ( one of them breast cancer ) was published recently by kce ( federal expertise centre for health care ) , an advisory committee of experts that provides scientific evidence to guide decision making in health issues by the government . this survey supports an association between caseload and improved outcome ( vrijens et al . , 2009 ) . we believe , however , that caseload as a surrogate marker of quality of care is inferior to a direct audit of outcome of treatment . . therefore prospective registration of relevant clinical , treatment - related , and follow - up data is mandatory and is indeed one of the eusoma recommendations for specialised breast units . the eusoma consensus group published guidelines setting out the objectives which loco - regional treatment in breast cancer should meet and to determine the outcome measures to these objectives . in this way each centre with good prospective registration is able to set its outcome against these guidelines as an objective quality control ( rutgers , 2001 ) . we report on the feasibility of such a prospective registration of treatment outcome and discuss the results relative to the outcome of breast cancer care as published in the flemish cancer registry ( van eycken and de wever , 2006 ) .

aim : criteria for future accreditation of breast cancer centres in belgium will be mainly based on the case load per surgeon or per centre . we would like to argue that the prospective collection of relevant data and the analysis of treatment related outcome derived from these data is feasible and should be the ultimate criterion for quality assessment and thus for accreditation since outcome is a more direct measurement of quality.methods : data were prospectively collected on 715 invasive non metastatic breast cancers between 2002 and 2007 treated according to standard , best - evidence protocols in the setting of a large district hospital . univariate and multivariate survival analysis were performed and compared to national and international databases.results : 5 year disease - free survival ( dfs ) and overall survival ( os ) in our series were respectively 77 and 84 % . in the multivariate analysis of dfs , only her-2-neu status ( her-2-neu positivity being associated with a poor prognosis ) and age ( older age being a worse prognostic factor ) were statistically significant prognostic factors . for os , her-2-neu , age , and positive nodes were statistically significant prognostic factors . the outcome is comparable to other data sets.conclusion : centres dedicated to the care of women with breast cancer have the moral duty to produce outcome based results of their treatment . this report shows that such a collection of data is feasible and can be imposed as a prerequisite for accreditation . we also argue that outcome based data of treatment are a more solid base for quality assurance than case load .

traditionally , this has been via the abdominal or vaginal routes . in the present era , hysterectomies are undertaken using minimal access techniques . total laparoscopic hysterectomy ( tlh ) is performed entirely by the laparoscopic route , including closure of the vaginal vault , with the uterus being removed vaginally or by morcellation . today , lap hysterectomy is a safe and feasible technique to manage benign uterine pathology as it offers minimal postoperative discomfort , shorter hospital stay , rapid convalescence , and early return to the activities of daily living . considerable technical advances in this procedure have occurred during the last few years . in our study , we have modified the steps and started with the ligation of the uterine artery at its origin from the internal iliac artery on both sides causing transient uterine ischemia as most blood enters the uterus through these vessels especially its ascending branch . the hypothesis of this study proposes that , soon after occlusion , blood within the myometrium clots and the myometrium becomes hypoxic . the aim of this study was to compare conventional tlh to prior uterine artery ligation at its origin .

we compared the duration of surgery , blood loss , and complications between patients in whom both uterine arteries were ligated at the beginning of total laparoscopic hysterectomy ( tlh ) and patients in whom ligation was done after cornual pedicle . using a prospective study in a gynecologic laparoscopic center , a total of 52 women who underwent tlh from june 2013 to january 2014 were assigned into two groups . in group a , uterine arteries were ligated after the cornual pedicles as done conventionally . in group b , tlh was done by ligating both uterine arteries at the beginning of the procedure . all the other pedicles were desiccated using harmonic scalpel or bipolar diathermy . uterus with cervix was removed vaginally or by morcellation . the indication for tlh was predominantly dysfunctional uterine bleeding and myomas in both groups . in group a , the average duration of surgery was 71 minutes , when compared to 60 minutes in group b ( p < 0.001 ) . in group a , the total blood loss was 70 ml , when compared to 43 # x2009 ; ml in group b ( p value < 0.001 ) . there were no major complications in both groups . to conclude , prior uterine artery ligation at its origin during tlh reduces the blood loss and surgical duration as well as the complications during surgery .

staphylococcus aureus is an important food - borne pathogen involved in a variety of invasive diseases ( 1 ) . it produces many toxins as well as non - toxic enzymes and can facilitate bacterial attack and proliferation in the body of host ( 2 ) . some strains produce staphylococcal enterotoxins ( ses ) that can cause food poisoning if food containing preformed se is ingested . symptoms of staphylococcal food poisoning ( sfp ) have a rapid onset ( 2 to 6 h ) and may include vomiting , stomach pain and diarrhea ( 3 ) . enterotoxins from s. aureus strains can be classified into 18 serological types : a - u ( except s , f and t ) ( 2,4 - 9 ) . the ses are a group of heat stable and pepsin resistant exotoxins encoded by genes in the chromosome , pathogenicity island , phages or plasmids ( 2 ) . for production of sufficient amount of toxin to cause intoxication symptoms , 10 cfu / ml or cfu / g enterotoxigenic strains of bacteria are needed ( 10 ) . ses are low molecular weight proteins ( mw 26.900 29600 kd ) ( 11 ) . sea is a leading cause of food intoxication ( 12 ) and is an extremely potent gastrointestinal toxin , as little as 100 ng is sufficient to cause symptoms of intoxication ( 13 ) . milk and milk products have frequently been implicated in staphylococcal food poisoning and contaminated raw milk is often involved ( 2 , 3 ) . s. aureus mastitis is a serious problem in dairy production and infected animals may contaminate bulk milk . human handlers , milking equipment , the environment and the udder and teat skin of dairy animals are other possible sources of bulk milk contamination ( 3 , 14 ) . surveys to detect classical enterotoxins and to identify enterotoxin genes in s. aureus from milk and milk products have been conducted in many counties including italy , norway , turkey , brazil and iran ( tehran ) ( 16 - 20 ) . however , there are no published reports about presence of sea gene in milk and its products in tabriz - iran . therefore , this study was conducted to investigate the presence of sea gene of s. aureus in organic milk and cheese using pcr method in tabriz - iran .

background and objectivesstaphylococcal food poisoning is a gastrointestinal disease , which is caused by consumption of contaminated food with enterotoxins produced by staphylococcus aureus ( ses ) . milk and its products are known sources of food borne diseases . this study was carried out to evaluate the prevalence of enterotoxigenic s. aureus strains in organic milk and cheese in tabriz - iran.materials and methodsa total of 200 samples ( 100 milk samples and 100 cheese samples ) were collected from farms and milk collection points in tabriz - iran . the samples were cultured and identified by standard bacteriological methods , then pcr was performed to detect sea gene.results and conclusionstaphylococcus aureus was found in 27 % of all samples ( milk and cheese ) . results of pcr showed that 12.96 % of s. aureus isolates possessed sea gene . it suggested the potential public health threat of s. aureus resulting from contamination of dairy products . so , efforts are required to improve safety standards for preventing staphylococcal food poisoning .

along with the increase in the prevalence of type 1 diabetes mellitus ( t1 dm ) the number of patients with chronic vascular complications will rise significantly [ 13 ] . many trials have also shown that the main determinants of the vessel damage in the course of diabetes are hyperglycemia and diabetes duration [ 79 ] . diabetic microangiopathy means worsening of the quality of life and causing disability in patients with t1 dm [ 10 , 11 ] . it is particularly harmful when it concerns the youngest population , which often becomes debilitated already at the beginning of the adulthood . moreover , vascular complications are also seen in children and adolescents with t1 dm who suffer for more than 5 years , and the progression in this group is often more rapid than in adults [ 3 , 12 , 13 ] . in the oxford regional prospective study ( orps ) , it has been shown that about 25 % of children with t1 dm develop diabetic retinopathy within 5 years of the disease duration , but already as many as 60 % and 80 % after 10 years and 15 years , respectively . the results from our studies have also shown that after 5 years of diabetes duration , albuminuria was detected in 29 % and nonproliferative retinopathy in 27 % of children and adolescents with t1 dm [ 12 , 14 ] . in the same study we have demonstrated that apart from the duration of diabetes , main factors influencing the development and progression of chronic vascular complications in children and adolescents with t1 dm are growth factors , including vascular endothelial growth factor ( vegf ) and angiogenin . however , tgf-1 has not yet been studied in this context . tgf-1 belongs to a group of factors responsible for growth , differentiation and migration of cells , creation and degradation of the extracellular matrix , and apoptosis [ 15 , 16 ] . in addition , it stimulates the formation of blood vessels and participates in wound healing and repair by increasing the production of extracellular matrix proteins . however , its adverse activity has been shown in breast cancer , myocardial infarction , rheumatoid arthritis , osteoporosis , diabetic nephropathy , and retinopathy [ 1719 ] . this cytokine is present in five different isoforms , three of which , that is , tgf-1 , tgf-2 , and tgf-3 , are coded by different genes . out of these the best known is tgf-1 , produced by dendritic cells , leukocytes , and nk cells . despite extensive research on biology , genetics , and function of tgf-1 , therefore , we have assumed that it would be worth evaluating serum levels of tgf-1 in different groups of children and adolescents , depending on the duration of t1 dm and the presence of vascular complications . thus , the aim of our study was to evaluate the relationship between serum tgf-1 levels and t1 dm duration in children and adolescents with t1 dm with and without vascular complications .

the aim of this study was to evaluate the relationship between serum transforming growth factor 1 ( tgf-1 ) concentrations and the duration of type 1 diabetes mellitus ( t1 dm ) in children and adolescents . one hundred and sixteen patients with t1 dm and 19 healthy controls were examined . serum tgf-1 concentrations were measured using the cytometric bead array ( cba ) . a positive association between the time of diabetes duration and higher serum tgf-1 concentrations was observed . similarly , the prevalence of microvascular complications , such as retinopathy and nephropathy , increased with the duration of diabetes . logistic regression analysis showed that serum tgf-1 concentrations and the duration of the disease are independent risk factors of microangiopathy development . higher serum tgf-1 concentrations were associated with a significant risk of microangiopathy development after 10 years of t1 dm duration . in the successive years of the disease , the effect was even stronger . the results of our study indicate that serum tgf-1 concentrations are one of the factors that may have an impact on the progression of vascular complications in children and adolescents with t1 dm .

according to the international headache society ( ihs ) , classical trigeminal neuralgia ( tn ) is defined as a unilateral disorder characterized by brief electric shock - like pains , abrupt in onset and termination , limited to the distribution of one or more divisions of the trigeminal nerve . this is different from symptomatic tn , which is defined by ihs as pain indistinguishable from classical tn but caused by a demonstrable structural lesion other than vascular compression . patients often describe the pain as attacks or paroxysms , which may last for a few seconds to 2 min . interestingly between paroxysms there is a refractory period in which the pain can not be triggered and the patient is asymptomatic . the intensity of the pain is severe and the quality is usually described as electric shock - like , sharp , stabbing , or shooting . the pain might be triggered spontaneously or by light touch in a specific area or simply by eating or talking . tn is considered to be a rare disease with an annual incidence of 5.9/100,000 women and 3.4/100,000 men in the usa . the incidence increases with age and tends to be higher in women at all ages with a male to female ratio of 2:3 . the trigeminal nerve root entry zone has been found to be compressed by an aberrant loop of artery or vein , which ultimately leads to demyelination of the trigeminal nerve . furthermore , it has been demonstrated that tn is more common in patients with multiple sclerosis and an elevated relative risk has been associated with hypertension ( htn ) , particularly among women . it has been suggested that patients with tn have arterial tortuosity , which may lead to increased arterial pulse pressure waveforms secondary to vascular stiffness . however , very few studies have explored the relationship between htn and tn [ 2 , 4 ] . therefore , the objective of this study was to determine the prevalence of htn in patients diagnosed with classical tn and describe the characteristics of classical tn including age , gender and race among the patient population seen at the orofacial pain and oral medicine center at the usc school of dentistry ( usc ofp - om center ) in los angeles , california , usa between june 2003 and august 2007 .

it is unclear whether hypertension ( htn ) is a predisposing factor for the development of trigeminal neuralgia ( tn ) . the purpose of this study was to determine the prevalence of htn in tn patients and controls at the usc orofacial pain and oral medicine center . a retrospective chart review was conducted from a database of over 3,000 patient records from 2003 to 2007 . we identified patients diagnosed with tn with or without htn . a total of 84 patients ( 54 females ; 30 males ) between the ages of 33 and 93 years were diagnosed with tn ; 37 % had tn with htn and 32 % of controls had htn . the increased prevalence of htn in the tn patients was not statistically significant ( p = 0.50 ) . since , both tn and htn are seen in the elderly , it is likely that htn is simply a co - existing condition in patients with tn and not a risk factor for its development .

acute lymphoblastic leukemia ( all ) is a hematological malignant disorder caused by excessive production of leukocytes and is the most common malignancy in children , representing 2530 % of all childhood malignancies . great improvements have been made in all treatment , with successful long - term survival rates of approximately 80 % over the past four decades.1,2 despite the significant success rate , the remaining 20 % of patients still present treatment failure . furthermore , surviving patients often present significant levels of toxicity , which warrants the need of new treatment strategies.3 all chemotherapy regimen consists of the following phases : remission - induction , consolidation , and continuation phase . other treatments such as radiation therapy , steroids , and bone marrow or stem cell transplantations can also be included . among the major drugs used during treatment phases are glucocorticoids , anthracyclines , vincristine and l - asparaginase ( l - asp ) , which has been used for a long time in all treatment.4,5 asparaginases are enzymes derived mainly from bacteria and the three enzymes that have been used are derived from escherichia coli ( e. coli - asparaginase ) , a pegylated form of native e. coli - asparaginase ( peg - asparaginase ) , and an erwinia chrysanthemi - derived asparaginase ( erwinia - asparaginase ) .6,7 a great improvement in patients overall survival was achieved by l - asp administration , making it an essential drug in all treatment protocols79 ; however , several side effects , caused by l - asp toxicity , encourage an open debate among oncologists regarding the optimal dosage and formulation of l - asp . thus , this review presents an overview on l - asp data and focuses on cellular mechanisms underlying resistance and the efficacy of different asparaginase formulations in childhood all treatment .

great improvements have been made in acute lymphoblastic leukemia ( all ) treatment in the past decades , especially due to the use of l - asparaginase ( l - asp ) . despite the significant success rate , several side effects mainly caused by toxicity , asparaginase silent inactivation , and cellular resistance , encourage an open debate regarding the optimal dosage and formulation of l - asp . alternative sources of asparaginases have been constantly investigated in order to overcome hypersensitivity clinical toxicity . additionally , genomic modulation as gene expression profiling , genetic polymorphisms , and epigenetic changes is also being investigated concerning their role in cellular resistance to l - asp . understanding the mechanisms that mediate the resistance to l - asp treatment may bring new insights into all pathobiology and contribute to the development of more effective treatment strategies . in summary , this review presents an overview on l - asp data and focuses on cellular mechanisms underlying resistance and alternative therapies for the use of asparaginase in childhood all treatment .

continuous ambulatory peritoneal dialysis ( capd ) is an important treatment option for patients with end - stage renal disease . although the rate of peritonitis has declined in recent years because of improvements in capd techniques , peritonitis remains the leading cause for discontinuation of capd . rothia muciliaginosa ( r. mucilaginosa ) is a component of the normal flora of the mouth and respiratory tract and is usually associated with dental plaques , cavities , and periodontal diseases . it appears that the presence of an indwelling vascular catheter and previous treatment with ciprofloxacin increase the risk of invasive infection with rothia . although cases of peritoneal dialysis ( pd ) -associated peritonitis caused by r. mucilaginosa have been reported worldwide , no korean cases have been reported . to the best of our knowledge , this is the first case report of peritonitis due to r. mucilaginosa as a single pathogen in korea . herein , we describe a case of pd - associated peritonitis caused by r. mucilaginosa that was cured after a 2-week course of intraperitoneal antibiotic therapy .

rothia muciliaginosa ( r. mucilaginosa ) is a facultative , gram - positive coccus that is considered to be part of the normal flora of the mouth and respiratory tract . there are sporadic reports of the organism causing endocarditis in patients with heart valve abnormalities , as well as meningitis , septicemia , and pneumonia associated with intravenous drug abuse . however , it is an unusual pathogen in cases of peritoneal dialysis ( pd ) -associated peritonitis . although r. mucilaginosa is generally susceptible to penicillin , ampicillin , cefotaxime , imipenem , rifampicin , and glycopeptides , there are no guidelines for the treatment of pd - associated peritonitis . herein , we report a case of pd - associated peritonitis due to r. mucilaginosa that was resolved with intraperitoneal antibiotic treatment .

the greatest association of helicobacter pylori ( h. pylori ) infection is with peptic ulcer disease . recently , the association between h. pylori and the development of gastric cancer is more clearly established than before , and by the announcement of the japanese society for helicobacter research , h. pylori eradication should be undertaken in all subjects who are infected [ 1 , 2 ] . the treatment to eradicate h. pylori by a triple therapy using a proton pump inhibitor ( ppi ) , amoxicillin ( ampc ) and clarithromycin ( cam ) was approved and covered by insurance in japan in november , 2000 . in february 2003 , the eradication therapy went into broad use as a result of the eradication guidelines of the japanese society for helicobacter research . the initial eradication rate was good at about 90 % , but a decline in eradication rate attributable to an increase in cam resistance was pointed out . consequently , the japanese society for helicobacter research conducted sensitivity surveillance from 2002 through 2006 in order to determine the prevalence of h. pylori drug resistance in japan . the results revealed that the cam resistance rate from 2002 to 2003 was 18.9 % , followed by 21.1 % in 20032004 , 27.7 % in 20042005 . the reports also demonstrated that the cam resistance rate in japan since 2003 exceeded 20 % , the condition the maastricht iii consensus report recommends the triple therapy using ppi , ampc and cam . in such a situation ( cam resistance rate > 20 % ) , it is recommended that drug sensitivity tests be carried out prior to eradication , but in japan sensitivity testing is not common because eradication therapies other than the ppi , ampc , and cam triple therapy are not approved for the first - line eradication therapy . in this study , we conducted a retrospective analysis of the status of eradication rate by ppi , ampc , and cam in our hospital in japan , where the rate of cam resistance is high .

a triple therapy based on a proton pump inhibitor ( ppi ) , amoxicillin ( ampc ) , and clarithromycin ( cam ) is recommended as a first - line therapy for helicobacter pylori ( h. pylori ) eradication and is widely used in japan . however , a decline in eradication rate associated with an increase in prevalence of cam resistance is viewed as a problem . we investigated cam resistance and eradication rates over time retrospectively in 750 patients who had undergone the triple therapy as first - line eradication therapy at nagoya city university hospital from 1995 to 2008 , divided into four terms ( term 1 : 19972000 , term 2 : 20012003 , term 3 : 20042006 , term 4 : 20072008 ) . primary resistance to cam rose significantly over time from 8.7 % to 23.5 % , 26.7 % and 34.5 % while the eradication rate decreased significantly from 90.6 % to 80.2 % , 76.0 % and 74.8 % . based on the ppi type , significant declines in eradication rates were observed with omeprazole or lansoprazole , but not with rabeprazole . a decrease in the h. pylori eradication rate after triple therapy using a ppi + ampc + cam has been acknowledged , and an increase in cam resistance is considered to be a factor . from now on , a first - line eradication regimen that results in a higher eradication rate ought to be investigated .

clefts of the anterior and posterior arch of the atlas are rare , but well - documented congenital anomalies [ 1 , 2 ] . several reports attributed the aetiology of os odontoideum to an either embryologic , traumatic or vascular basis [ 35 , 8 ] . we describe the unusual case of a combined midline cleft of the anterior and posterior arch of the atlas associated with os odontoideum leading to atlantoaxial instability with acute myelopathia after a minor trauma .

we report on the case of a 15-year - old adolescent who presented with a transient paraplegia and hyposensibility of the upper extremities after sustaining a minor hyperflexion trauma to the cervical spine . neuroimaging studies revealed atlantoaxial dislocation and ventral compression of the rostral spinal cord with increased cord signal at c1/c2 levels caused by an os odontoideum , as well as anterior and posterior arch defects of the atlas . the patient underwent closed reduction and posterior atlantoaxial fusion . we describe the association of an acquired instability secondary to an os odontoideum with an anteroposterior spondyloschisis of the atlas and its functional result after 12 months . the rare coincidence of both lesions indicates a multiple malformation of the upper cervical spine and supports the theory of an embryologic genesis of os odontoideum .

the population of republic of korea is aging at an unprecedented fast rate . and per capita medical utilization due to geriatric illness has increased since 2002 in accordance with an aging society . among geriatric diseases in women , there are some diseases related to menopause in this aging society.1 average menopause age and average life expectancy is 49.7 and 85.5 , respectively in korean women , which means that they almost suffer from postmenopausal symptoms for two - fifth of their lives . the postmenopausal period in women has increased in accordance with increase in average life expectancy . therefore , healthcare and management for postmenopausal women has become important issues recently.2 incidence of alzheimer 's disease , one of postmenopausal diseases , rapidly increases after 65 years old in women , which is 1.5 to 3 times higher than men 's incidence . and cognitive function is decreased more when bone loss is occurred fast , which implies that there is a strong relevance between endogenous estrogen and alzheimer 's disease.3 appropriate brain action is controlled by estrogen in women . therefore , disorder in mood , memory , and cognitive function can be happened when estrogen level is dropped under estrogen setting point : for some reason , or at any time or at any age , the brain 's estrogen levels are decreased below estrogen setting point which defined as brain 's estrogen requirement level needed to modulate the brain activity.3 cholinesterase inhibitors , donepezil , rivastigmine , n - methyl - d - aspartate ( nmda ) -glutamate receptor , and memantine , are mainly used for the treatment of alzheimer 's disease generally . although these drugs can improve cognitive function of patients with alzheimer 's disease temporally , adverse effects and toxicity can be occurred in case of long - term use . because of these problems , interests toward hormone therapy and cell therapy have been increased.1 cell therapy can compensate the defects and limitations of existing chemical medicines and become newly developed treatment for alzheimer 's disease . besides alzheimer 's disease , it can be used as treatment for other perimenopausal symptoms . therefore , we will figure out trend of studies about cell therapy for alzheimer 's disease .

we are rapidly becoming an aging society , with the ongoing increase in challenges of the elderly . the age - related cognitive decline in accordance with aging society is of major importance in public health . recent studies have proved the impacts of sex - steroid hormone on the brain ; compliant with aging , menopause and decrease in estrogen have an effect on the occurrence and prevention of alzheimer 's disease . a new hypothesis states that alzheimer 's disease is a postmenopausal dementia , and is a negative form of estrogen deficiency . in this review article , we reckoned the cause of postmenopausal alzheimer 's disease . we further investigated new cell therapies for postmenopausal alzheimer 's disease , which are under development in some pharmaceutical companies . one remedy is cell therapy that inhibits the amyloid beta formation , and the other is the umbilical cord blood derived mesenchymal stem cell therapy .

the recent medical developments , including the increased use of chemotherapy drugs , white blood cell stimulants , and broad spectrum antibiotics , have improved the prognosis and life span of pediatric patients with neoplastic diseases . consequently , these patients often face lengthy periods of low immunity , undergo longer hospital stays , and there is a greater chance that they will require central venous catheterizations , urinary catheterizations , endotracheal intubations , and intravenous feeding tubes . these factors moreover put patients at an increased risk of contracting nosocomial infections ( nis ) and substantially increase morbidity and mortality rates as well as treatment costs [ 13 ] . nosocomial infections in patients with malignancies can be caused by bacteria , fungi , and viruses and can occur in the bloodstream ; urinary , respiratory , and digestive tracts ; as well as soft tissues . the previous studies have been done among both adult and pediatric patients with neoplastic diseases reporting a high risk of nis [ 47 ] and showing incidence rates of nis ranging from 1.08 to 1.77 times/100 days of hospitalization [ 811 ] . in addition , the previous studies among pediatric patients with neoplastic diseases found that nis were associated with the use of devices [ 611 ] . for example , a us surveillance among pediatric patients with neoplastic diseases found that bacteremia occurred 6.6 times/1000 days of central venous catheterization , urinary tract infections 4 times/1000 days of urinary catheterization , and pneumonia 2.9 times/1000 days of endotracheal intubation . causal organisms related to nis vary according to settings and study populations . in germany , simon et al . identified gram - positive bacteria as the common causal organism of nis ( 83.3 % ) among pediatric patients with central venous catheterization . in contrast , a study by frank et al . in israel found gram - negative bacteria ( 54.3 % ) more common than gram - positive bacteria ( 36.6 % ) among children and adolescents in intensive care settings . most nis have a significant effect since they lengthen hospital stays , increase mortality , and increase complications [ 811 ] . at present , studies of nis in pediatric patients with neoplastic diseases are under reported in thailand .

background . pediatric patients with neoplastic diseases are more likely to develop nosocomial infections ( nis ) . nis may prolong their hospital stay , and increase morbidity and mortality . objectives . the objectives of this study were to determine : ( 1 ) the incidence of nis , ( 2 ) sites of nis , ( 3 ) causal organisms , and ( 4 ) outcomes of nis among pediatric patients with neoplastic diseases . methods . this study was a prospective cohort study of pediatric patients with neoplastic diseases who were admitted to the chiang mai university hospital , thailand . results . a total of 707 pediatric patients with neoplastic diseases were admitted . forty - six episodes of nis in 30 patients were reported ( 6.5 nis/100 admission episodes and 7 nis/1000 days of hospitalization ) . patients with acute lymphoblastic leukemia had the highest number of nis ( 41.3 % ) . the most common causal organisms were gram - negative bacteria ( 47.1 % ) . patients who had undergone invasive procedures were more likely to develop nis than those who had not ( p < .05 ) . the mortality rate of patients with nis was 19.6 % . conclusion . pediatric patients with neoplastic diseases are more likely to develop nis after having undergone invasive procedures . pediatricians should be aware of this and strictly follow infection control guidelines in order to reduce morbidity and mortality rates related to nis .

in europe , many countries will be confronted with aging populations in the coming decades . for example , it is estimated that in 2020 , 28 % of the french population will be over 60 . a great way to resolve partially this difficulty is to encourage old people to be cared for in their own homes . this strategy presents two main advantages : the elderly want to stay at home as long as possible ; they keep the privacy they do not want to lose , it is less expensive than a place in a collective accommodation . the elderly want to stay at home as long as possible ; they keep the privacy they do not want to lose , it is less expensive than a place in a collective accommodation . it aims to help professional home - care teams in their job by thinking up innovative software technologies , more precisely : by increasing the number of old people looked after in their homes with an adaptive and nonintrusive remote assistance , by reassuring family circle . the system ensures that the monitored person is secure ; so , people around him feel at ease , andby contributing towards its democratization . the use of simple elements ( e.g . , basic sensors ) minimizes the initial cost of a monitoring system . we made a study of systems having the same aim the following section describes three well - known and relevant european systems in the home - care domain . these systems focus on individuals ( they are user - centred ) : a system surveys only one person ; thus , there is a duplication for each individual looked after . nevertheless , patterns of monitored people could be used to estimate the status of someone in relation to their community or to integrate new comings . by increasing the number of old people looked after in their homes with an adaptive and nonintrusive remote assistance , by reassuring family circle . the system ensures that the monitored person is secure ; so , people around him feel at ease , and by contributing towards its democratization . the use of simple elements ( e.g . , basic sensors ) minimizes the initial cost of a monitoring system . we propose a multiagent system that is able to generalize , which builds a classification of monitored people . an indicator is data about daily activities , positions , and physiological information . in a first step , the agent applies a local - classification method and obtains an incomplete patterns ' partition . next , the partial partitions are compared with each other in order to build a complete classification . we conceived an open system : new people or / and new indicators bring in new agents or / and new patterns . in section 3 , we present the architecture of the system and how it runs . this dynamically updated classification has the following three main uses : to find certain similarities with the existing tools for evaluating the dependence dependence grid of the social services , for example , to get global statistical data about old people looked after in their own homes , andto generate specialized alarms depending on the detected event . once the classification is set up and people status is known , decisions can be taken to personalize the process of monitoring someone activated sensors , generated alarms , and danger zone . these aspects are discussed in the last section . to find certain similarities with the existing tools for evaluating the dependence dependence grid of the social services , for example , to get global statistical data about old people looked after in their own homes , and to generate specialized alarms depending on the detected event . once the classification is set up and people status is known , decisions can be taken to personalize the process of monitoring someone activated sensors , generated alarms , and danger zone .

this research takes place in the s ( ma ) 2d project which proposes software architecture to monitor elderly people in their own homes . we want to build patterns dynamically from data about activity , movements , and physiological information of the monitored people . to achieve that , we propose a multiagent method of classification : every agent has a simple know - how of classification . data generated at this local level are communicated and adjusted between agents to obtain a set of patterns . the patterns are used at a personal level , for example to raise an alert , but also to evaluate global risks ( epidemic , heat wave ) . these data are dynamic ; the system has to maintain the built patterns and has to create new patterns . so , the system is adaptive and can be spread on a large scale .

castleman 's disease ( cd ) or giant lymph node hyperplasia is a rare disorder first explained by castleman et al . , in 1954 . it can be unicentric or multicentric and mostly involves mediastinum ( 60 % ) , retroperitoneum ( 11 % ) , and axilla ( 4 % ) . multicentric castleman 's disease ( mcd ) is manifested by generalized lymphadenopathy , hepatosplenomegaly , and polyclonal hypergammaglobulinemia , high erythrocyte sedimentation rate ( esr ) , anemia , thrombocytopenia , and constitutional symptoms . human herpes virus 8 ( hhv-8 ) infection has been identified in nearly 100 % of hiv - positive and 50 % of hiv - negative mcd patients . this virus predisposes patients to much higher risk of other malignancies , including kaposi 's sarcoma ( ks ) ( 13 % ) and non - hodgkin 's lymphoma ( 18 % ) . kaposi 's sarcoma is a vascular neoplasm with a compound and unknown histogenesis in which most of the spindle cell lesions express cd31 and cd34 . castleman 's disease is histologically divided into three types : hyaline vascular type or angiofollicular type , plasma cell ( pc ) type , and mixed type . co - incidence of mcd with ks and some common features of them led us to report this case . it is unknown whether ks is a consequence of immunosuppression caused by mcd or ks is a clinical feature of mcd .

castleman 's disease ( cd ) or giant lymph node hyperplasia is a rare disorder that can be unicentric or multicentric . multicentric castleman 's disease ( mcd ) is manifested by generalized lymphadenopathy , hepatosplenomegaly , polyclonal hypergammaglobulinemia , hematological abnormality , and constitutional symptoms . human herpesvirus 8 ( hhv-8 ) infection is present in nearly 100 % mcd associated with hiv-1 infection , but in about 50 % of cases of hiv negative . herein , we report a 77-year - old man with systemic involvement and skin lesions on the anterior aspect of both legs in the previous site of saphenous vein angioplasty . co - existence of mcd with kaposi 's sarcoma ( ks ) led us to present this rare case .

acute encephalopathy can result from various causes , including stroke , seizure , metabolic disturbance , toxic material , and infection.1 - 4 hashimoto 's encephalopathy ( he ) is also one of the causes of treatable encephalopathy . since the first report of brain et al.,1 there have been more than 100 patients reported with he , which has also been termed steroid - responsive encephalopathy with autoimmune thyroiditis ( sreat ) in a recent report.2,5 he or sreat is known to be associated with autoimmune thyroid disease ( aitd ) . however , to our knowledge steroid - responsive encephalopathy associated with subacute thyroiditis has never been reported . here we report a case of steroid - responsive recurrent encephalopathy that manifested simultaneously with subacute thyroiditis .

backgroundsteroid - responsive encephalopathy associated with subacute thyroiditis has , to our knowledge , not been reported previously.case reporta 49-year - old woman was found collapsed and brought to our institution with decreased mentality , dysarthria , and gait disturbance . brain magnetic resonance imaging and angiography were normal but blood tests revealed thyroid - autoantibody - negative thyrotoxicosis . results of a 99mtechnetium - pertechnetate scan were compatible with the thyrotoxic phase of subacute thyroiditis . 14 - 3 - 3 proteins were detected in cerebrospinal fluid . her mental status began to improve from the day following steroid administration . recurrent encephalopathy was found 2 months after the initial admission , which was also effectively treated with steroid.conclusionswe speculate that steroid - responsive recurrent encephalopathy associated with subacute thyroiditis is a subtype of hashimoto 's encephalopathy , and consider that steroid treatment should not be delayed in suspected patients .

evaluation of athletic hip pain routinely includes radiographs and magnetic resonance imaging ( mri ) . computed tomography ( ct ) is applied at some centers and in certain clinical scenarios . although mri ( arthrogram ) alone can clearly define changes to labrum or cartilage , osseous pathology may be underappreciated . we present the case of an unrecognized osteoid osteoma in a patient with femoral acetabular impingement ( fai ) , cam morphology , and labral injury to emphasize the need to maintain a high index of clinical suspicion for this atypical cause of hip pain .

femoro - acetabular impingement is a common cause of hip pain in young athletes . evaluation typically includes radiographs and magnetic resonance imaging . it is important to appreciate uncommon diagnoses and the role of complimentary imaging . this clinical vignette emphasizes the need complete imaging with ct in select case of atypical hip pain.we present a 19-year old soccer player who underwent seemingly successful arthroscopic fai surgery but returned with pain . computed tomography ( ct ) revealed osteoid osteoma of the lesser trochanter . the lesion was successfully treated with percutaneous ct guided radiofrequency ablation .

despite its world - wide omnipresence in soil , a. fumigatus had been considered asexual until studies of an aspergillus - like anamorph isolated from brazilian soil revealed a heterothallic breeding system , and the teleomorph neosartorya fumigata was described . we describe the first reported case of acute respiratory distress syndrome ( ards ) attributed to neosartorya udagawae . the mold grew rapidly in culture of both sputum and bronchoalveolar lavage ( bal ) fluid from a previously healthy 43-year - old woman with ards , which developed as the consequence of an acute febrile illness that progressed over 5 days . but despite appearance of fluffy white , non - sporulating mold on a variety of culture media , the colonies did not produce conidiophores , and phenotypic identification was not possible . the conidia of n. udagawae require longer incubation in the laboratory to germinate , and misidentification of neosartorya sp . n. udagawae has been emerging as a cause of invasive infections in humans , but our case is the first report of ards associated with neosartorya infection and describes a new clinical entity .

we describe the first reported case of acute respiratory distress syndrome ( ards ) attributed to neosartorya udagawae infection . this mold grew rapidly in cultures of multiple respiratory specimens from a previously healthy 43-year - old woman . neosartorya spp . are a recently recognized cause of invasive disease in immunocompromised patients that can be mistaken for their sexual teleomorph , aspergillus fumigatus . because the cultures were sterile , phenotypic identification was not possible . dna sequencing of its , calmodulin and -tubulin genes supported identification of neosartorya udagawae . our case is the first report of ards associated with neosartorya sp . infection and defines a new clinical entity .

peripheral odontogenic tumors demonstrate histological characteristics of their intraosseous counterparts , but occur solely in the soft tissue covering the tooth - bearing portion of the mandible and maxilla . these lesions are also known as extraosseous odontogenic tumors , soft - tissue odontogenic tumors , or odontogenic tumors of the gingiva . odontogenic myxoma ( om ) is a rare , benign odontogenic mesenchymal tumor arising from the embryonic connective tissue associated with the tooth - forming apparatus . it was first described by rudolf virchow as myxofibroma in 1863 and was later renamed as odontogenic myxoma by thoma and goldman in 1947 . the evidence for its odontogenic origin arises from its almost exclusive location in the tooth - bearing areas of the jaws , its occasional association with missing or unerupted teeth , and the presence of odontogenic epithelium . it is a slow - growing but locally invasive neoplasm , usually occurring in the second or third decade of life . the occurrence of om in the maxilla is rare as compared to the mandible and most reports show a slight predilection for females . oms are central lesions occurring in the jaw bones , commonly present as a painless swelling . pain , displacement of teeth , and paresthesia are uncommon , thus the lesion can reach considerable size before the patient becomes aware of its presence and seeks treatment . histologically , the tumor closely resembles the mesenchymal portion of a developing tooth . the tumor is not encapsulated and is composed of haphazardly arranged stellate , spindle - shaped , and round cells in an abundant loose myxoid stroma that contains only a few collagen fibrils . the treatment of this lesion involves surgical enucleation and curettage , which are the favored techniques . because of its infiltrative character , this lesion is difficult to be curetted and this explains its high recurrence rate . cryotherapy as an adjunct procedure to curettage can be used to minimize the risk of recurrence . intraoral soft - tissue myxoma is an extremely rare lesion and only few reports are available in the literature . in this article , a rare case of peripheral myxoma of anterior maxilla in a 41-year - old female patient is reported with emphasis on review of relevant literature .

odontogenic myxoma comprises 3 - 6 % of all odontogenic tumors . odontogenic myxomas are relatively rare benign mesenchymal tumors found exclusively in the tooth - bearing areas of the jaw and are usually located centrally in the mandible . soft - tissue localization is rarely seen and is classified as peripheral myxoma . peripheral myxoma is slow growing and less aggressive , as compared to the central myxoma . it has a low recurrence rate . till date , only few cases of maxillary gingival myxomas are reported in the literature . here , we present an unusual case of primary peripheral odontogenic myxoma occurring in the gingiva of anterior maxilla in a 41-year - old female patient .

according to the european association of urology guidelines on urinary incontinence , concerning the treatment of female stress urinary incontinence ( sui ) , the retropubic insertion of a midurethral synthetic sling ( mus ) gives equivalent patient - reported cure of sui at 12 months , when compared to colposuspension . these guidelines also report that midurethral synthetic sling inserted by either the transobturator ( to ) or retropubic ( rp ) route gives equivalent patient - reported outcome at 12 months . with an obvious trending towards less and less invasive surgical options , single - incision vaginal slings ( sis ) have emerged . they require very limited intracorporeal dissection , proposing to further increase safety of suburethral slings , without jeopardizing the success rates reported by conventional rp and to access . these sis outcomes are comparable with conventional mus at short - term follow - up [ 35 ] . although sparse , two - year follow - up studies are available and seem to maintain steady success rates over this time [ 6 , 7 ] . longer follow - up time reports are needed , to ensure that , in the long run , these sis offer constant success rates . the objective of this study is to describe the outcome of women treated with mini - arc at a mean follow - up of 45 months , based on a baseline population which has already been reported in a short - term paper , after adequate long - term follow - up evaluation . previously considered cured and improved patients were evaluated to access if their condition remains stable , as reflected in a subjective satisfaction evaluation .

single - incision slings were introduced in the surgical treatment of female stress urinary incontinence ( sui ) to lessen the morbidity associated with traditional midurethral slings . however , long - term reports on patient satisfaction are still scarce . this study describes the outcome of women treated with mini - arc at a mean follow - up of 45 months . in a previous report on 105 women with 15-month mean follow - up , 84 ( 80 % ) were found cured and 12 ( 11 % ) improved . now , with a mean follow - up of 45 months , cured / improved patients were reassessed by telephone and completed patient global impression of improvement ( pgi - i ) , patient global impression of severity ( pgi - s ) , rated their improvement in a 0100 scale , and answered if they would recommend the procedure . at 45-month follow - up , 73 women cured / improved were available for evaluation . over 80 % of the cured patients rated the improvement of sui by the pgi - i as very much better or much better , reported their urinary tract condition to be normal on pgi - s , and described their improvement > 70 % . ninety percent would recommend this procedure to a friend . the improved - patient population is very small ( n = 7 ) . this study shows that the majority of patients cured / improved after mini - arc placement maintain a high degree of satisfaction at a long - term evaluation .

the perivascular epithelioid cell tumors ( pecomas ) are a family of related mesenchymal neoplasms that include angiomyolipoma , lymphangiomyomatosis , and clear cell ' sugar ' tumor of the lung ( 1 ) . in 1991 , investigations of hmb-45 ( gp100 ) immunoreactivity and the presence of premelanosomes in both clear cell ' sugar ' tumors ( ccsts ) of the lung and the epithelioid clear cell component of angiomyolipoma ( aml ) of the kidney and liver were published ( 2 - 6 ) . first proposed a cellular link among these unusual mesenchymal lesions and lymphangiomyomatosis ( lam ) ( 7 ) . soon after , the same group suggested the descriptive term ' perivascular epithelioid cell ' ( pec ) for the distinctive cell type found in these three lesions , and hypothesized that pecs may originate from the walls of blood vessels based on the observation that these cells are frequently and intimately related to such structures ( 8 ) . most of the patients with lesions of the pecoma family are female , and some patients also show coexistence of the tuberous sclerosis complex ( tsc ) ( 9 ) . although there are strong associations between the tsc , aml , and lam , this association is much less clear for the rare pecomas ( 10 ) . malignant pecomas are extremely rare , and they have been reported to occur in the uterus , broad ligament , prostate , small intestine , rectum , skull base , and heart ( 11 - 16 ) .

we present a case of perivascular epithelioid cell tumors ( pecomas ) in the abdominal cavity at the falciform ligament . a 30-yr - old korean man visited to hospital for the evaluation of a growing , palpable abdominal mass . he had felt the mass growing over 6 months . there was no family or personal history of tuberous sclerosis . the resected specimen showed a mass of 8.07.05.5 cm in size . histological examination showed sheets of spindle - to - epithelioid cells with clear - to - eosinophilic cytoplasm . immunohistochemically , tumor cells were positive for hmb-4 ( gp100 ) and smooth muscle actin . they were also positive for the s-100 , which is a marker of neurogenic and melanocytic tumors . patient was treated with radical resection of tumor without any adjuvant therapy . he is well and on follow - up visits without tumor recurrence .

plants have been used for therapeutic applications ever since man has been concerned about his health . for centuries , the world has depended on the useful possessions of plants as a source of medicines . ethnobotanical investigations done in the last few decades had discovered the analgesic properties of plants mentioned in the traditional information . the exploration for new analgesic compounds from the enormous arrays of medicinal plant resources is growing . this is because such information may hold guarantee for the finding of new therapeutic agents capable of inhibiting , decreasing , or relieving pain . plants characterize a huge natural supply of valuable compounds that might achieve as lead for the expansion of novel drugs . the exploration of the effectiveness of plant - based drugs used in the traditional medicine has been given great considerations because they are cheap and have little side effects , and , according to world health association ( who ) , about 80 % of the world population still relies chiefly on plant - based drugs . one of these medicinal plant species that has dramatic pharmaceutical values is leonurus cardiaca l. . leonurus cardiaca , commonly known as motherwort , is a member of the lamiaceae family that has been consumed in asian countries as a traditional remedy against nervous and functional cardiac disorders [ 6 , 7 ] . it is a perennial herb prevalent in europe , usually found in country areas throughout the plains and hills , as well as in east asia to the himalayas and eastern siberia , northern africa , and north america . motherwort consists of the aerial portions of leonurus cardiaca collected through the flowering time and dried at 35c and , according to european pharmacopoeia 7th edition , must encompass a minimum of 0.2 % flavonoids expressed as hyperoside . in the aerial parts of leonurus cardiaca , there are ingredients belonging to the group of terpenes , including monoterpenes such as iridoids , diterpenes of clerodane , furanolabdane , and labdane types , triterpenes including ursolic and oleanolic acids [ 11 , 12 ] , nitrogen - containing compounds such as leonurine and stachydrine , and phenylpropanoids such as lavandulifolioside , as well as flavonoids , phenolic acids , volatile oils , sterols , and tannins . pharmacological reports have established antimicrobial [ 10 , 19 ] , antioxidant [ 15 , 16 ] , and anti - inflammatory effects , as well as the effects of the herb on the heart and circulatory system . sedative and hypotensive properties since pharmacological studies are limited , the use of motherwort is mainly based on traditional suggestions . analgesic drugs are one of the most products that are used in numerous diseases for alleviating the pain . most analgesic drugs , accessible in the market , exhibit an extensive range of adverse effects including gastrointestinal disorders , kidney problems , and other unwanted effects . this situation highlights the need for advent of safe , novel , and effective analgesic compounds . the aim of the present study was to investigate the analgesic activities of aerial part of leonurus cardiaca using three analgesic tests in mice .

leonurus cardiaca , commonly known as motherwort , is a member of the lamiaceae family . it has a number of interesting biological activities , for example , sedative and hypotensive , antioxidant , anti - inflammatory , and antimicrobial activities . the aim of the present study was to investigate the effect of alcoholic extract of aerial part of leonurus cardiaca on nociceptive response using formalin , tail flick , and hot plate tests in mice . the acute treatment of mice with an ethanolic extract at doses of 500 and 250 mg / kg by intraperitoneal administration produced a significant antinociceptive in the first and second phases of formalin test , respectively . the hot plate and tail flick tests showed an increase in the antinociceptive effect at dose 500 mg / kg . these results suggest that leonurus cardiaca possesses central and peripheral antinociceptive actions .

approximately 40 % of all non - hodgkin lymphomas ( nhls ) occur in extranodal locations . primary nhls of the gastrointestinal tract are rare , accounting for only 14 % of malignancies arising in that area . primary gastric lymphoma ( pgl ) accounted for 6875 % of patients with primary gastrointestinal tract nhl [ 4 , 5 ] . there was a slight predominance of males with pgl ( male : and female , 1.1 : 1 ) . pgl diagnoses reached their peak incidence in individuals between the ages of 50 to 60 years . the most common presenting symptoms included epigastric pain , epigastric discomfort , anorexia , weight loss , nausea , vomiting , and gastrointestinal bleeding . systemic b symptoms occurred in 12 % of pgl patients [ 4 , 5 ] . extranodal marginal zone b - cell lymphoma of the mucosa associated lymphoid tissue ( malt ) type accounted for 4048 % of pgl cases [ 4 , 5 ] . according to pathological classification , currently , high - grade stage i / ii pgl can be treated with chemotherapy followed by radiotherapy , and advanced stage pgl is usually treated with chemotherapy only [ 6 , 7 ] . low - grade stage i / ii helicobacter pylori ( + ) malt lymphomas can be treated with antibiotic therapy . treatment failure with h. pylori eradication can be managed with radiation therapy . in this study , we aimed to determine the clinical characteristics of patients with pgl who were referred to our clinic over the last 12 years . we also aimed to evaluate patient survival and prognostic factors affecting survival and the effect of combined surgical and conservative treatment .

objectives . the aim of this study was to evaluate clinical characteristics , prognostic factors , survival rates , and treatment modalities in patients with primary gastric lymphoma ( pgl ) . methods . we retrospectively reviewed and analyzed data from patients treated for pgl in our clinic from 1998 through 2010 . staging was performed using the lugano staging system . overall and disease - free survival ( os and dfs ) were calculated from the date of diagnosis . results . we identified 79 patients . thirty - seven patients ( 47 % ) were male . the median age at presentation was 57 ( 1885 ) years . the median follow - up time was 41 ( 952 ) months . thirty patients ( 38 % ) underwent surgery , 74 ( 92 % ) received chemotherapy , and 18 ( 23 % ) received radiotherapy . the five - year os and dfs rates were 91.2 % and 83.9 % , respectively , in patients with stage i / ii or iie disease and 70.6 % and 65.5 % , respectively , in patients with stage iv disease ( p = 0.02 for both rates ) . treatment modality ( surgical or conservative ) had no impact on os or dfs in early stages . in a multivariate analysis , poor performance status , advanced stage , and high ldh levels were significant bad prognostic factors for dfs , while advanced stage , poor performance status , and age > 60 years were significant bad prognostic factors for os . conclusion . surgery provides no advantage for survival over conservative treatment ; thus , conservative treatment modalities should be preferred initially at early stages of pgl .

a fundamental barrier to fulfilling the emerging health policy mandate in the united states for monitoring the quality and outcomes of pac is the absence of standardized , patient - centered outcome data that can provide policy officials and managers with outcome data across different diagnostic categories , over time , and across different settings where pac services are provided ( wilkerson and johnston , 1997 ) . recently , the national committee on vital and health statistics ( ncvhs ) ( 2002 ) made recommendations on the potential for standardizing data collection and reporting for the purposes of quality assurance as well as for setting future research and health policy priorities in the u.s . the ncvhs ( 2002 ) was unanimous in stressing two major goals : to put functional status solidly on the radar screens of those responsible for health information policy , and to begin laying the groundwork for greater use of functional status information in and beyond clinical care the ncvhs project used the term functional status very broadly to cover both the individual 's ability to carry out activities of daily living ( adls ) and the individual 's participation in various life situations and society . within pac , functional outcome instruments have been developed and are widely used for various applications and for use in specific settings . examples include the functional independence measure ( fim ) for acute medical rehabilitation ( guide for the uniform data set for medical rehabilitation , 1997 ; hamilton , granger , and sherwin , 1987 ) , the minimum data set ( mds ) for skilled nursing and subacute rehabilitation programs ( morris , murphy , and nonemaker , 1995 ) , the outcome and assessment information set for home health care ( oasis ) ( shaughnessy , crisler , and schlenker , 1997 ) and the short form-36 ( sf-36 ) for ambulatory care programs ( ware and kosiniski , 2001 ) . if one looks carefully at the content of these instruments , it becomes apparent that substantial variations exist in item definitions , scoring , metrics , and content coverage , resulting in fragmentation in outcome data available for use across different pac settings ( haley and langmuir , 2000 ) . differences in conceptual frameworks used to construct each instrument , the inability to translate scores from one instrument to another , and the lack of outcome coverage and precision to detect meaningful functional changes across settings , severely limit the field 's ability to measure and analyze recovery through the period of pac service provision . if the pac field is to achieve the goal of comprehensive functional outcome assessment and quality monitoring for different patient diagnostic groups across different pac settings , efforts are needed to develop functional outcome assessments that are applicable across a continuum of post - acute services and settings . to our knowledge , no studies exist that have directly compared the content and operating characteristics of functional outcome instruments commonly used in pac to examine their relative merits for monitoring outcomes across care settings . in this article , therefore , we report the results of a direct empirical comparison of the fim , oasis , mds , and the physical function scale ( pf-10 ) of the sf-36 , focusing on three aspects of each : instrument content , range of coverage , and measurement precision . the objective of this comparative analysis is to evaluate the commonly held assumption that there exist fundamental deficiencies in the current armamentarium of setting - specific outcome instruments that prevents their applicability for more comprehensive patient - centered functional outcome assessment across diagnoses , over time , and across different settings where pac is provided . in response to identified deficiencies in existing instruments , we also discuss the potential utility of contemporary measurement techniques , such as item response theory ( irt ) methods and computerized adaptive technology ( cat ) , to yield functional outcome instruments better suited for outcome monitoring across pac settings .

there is a growing health policy mandate for comprehensive monitoring of functional outcomes across post - acute care ( pac ) settings . this article presents an empirical comparison of four functional outcome instruments used in pac with respect to their content , breadth of coverage , and measurement precision . results illustrate limitations in the range of content , breadth of coverage , and measurement precision in each outcome instrument . none appears well - equipped to meet the challenge of monitoring quality and functional outcomes across settings where pac is provided . limitations in existing assessment methodology has stimulated the development of more comprehensive outcome assessment systems specifically for monitoring the quality of services provided to pac patients .

neuralgic amyotrophy ( na ) is an uncommon neuropathy first described in 1948 by parsonage and turner . typically , the earliest manifestation of this disease is a sudden onset of severe and sharp pain in the shoulder lasting for 24 weeks , mostly followed by a sudden weakness and gradual atrophy of the muscles innervated by the c56 or other nerve roots in the vicinity . rare manifestations include isolated or concomitant affection of other peripheral motor nerves derived from the cervicobrachial plexus , such as the phrenic or laryngeal nerves [ 2 , 3 , 4 , 5 ] . very rarely , bilateral pareses of the diaphragm or laryngeal palsies had been observed [ 6 , 7 , 8 ] . although the pathogenesis of na is unknown , an idiopathic autoimmune process triggered by an unspecific infection is presumed . infections of the respiratory tract , trauma or surgery of the shoulder often precede the onset of na . besides the idiopathic form , a hereditary autosomal dominant form caused by a mutation in the sept9 gene on chromosome 17q25 has recently been described . in the majority of patients , the course of na is benign , with recovery of muscle function within weeks to months . however , 25 % of the patients are not able to return to work after 3 years . the diagnosis of na relies on a characteristic history of severe pain in the shoulder , followed by pain relief and subsequent brachial palsies . chest x - ray and cerebrospinal fluid analysis should be obtained to rule out a direct viral or bacterial infection , or a mechanical compression of the brachial plexus . plexus mri usually reveals no pathological findings , although t2 hyperintensities may occasionally be observed . corticosteroids seem to accelerate the recovery of na patients and are recommended in the early stages of the disease ; however , there are no randomized controlled treatment studies of na conducted to date . we report an unusual case of na presenting with simultaneous , bilateral phrenic nerve palsies and vocal cord paresis as the predominant symptoms , with partial gradual recovery after 2 months . written informed consent was obtained from the patient for publication of this case report and any accompanying images .

backgroundneuralgic amyotrophy ( brachial plexus neuropathy , brachial plexus neuritis , or parsonage - turner syndrome ) is an uncommon inflammatory condition typically characterized by acute and severe shoulder pain followed by paresis with muscle weakness and atrophy of the upper limb or shoulder girdle . we report an unusual clinical manifestation of neuralgic amyotrophy , namely bilateral phrenic nerve palsy with concomitant laryngeal paresis.case reporta 55-year - old male presented with orthopnea and aphonia after an episode of bilateral shoulder pain preceded by an upper respiratory tract infection . spirometry , chest x - ray and videolaryngoscopy revealed bilateral and simultaneous paresis of the diaphragm and the vocal cords . clinical examination at admission and at the 2-month follow - up did not show upper limb weakness or atrophy , except for a mild atrophy of the right supraspinatus muscle . an electromyography of the upper limb muscles and nerve conduction studies did not reveal signs of denervation . analysis of the cerebrospinal fluid and an mri of the neuraxis were unremarkable . after treatment with prednisolone , vocal cord function markedly improved within 8 weeks , whereas paresis of the diaphragm persisted.conclusionshoulder pain followed by diaphragmatic paralysis with dyspnea and hoarseness may be a manifestation of neuralgic amyotrophy even if upper limb or shoulder girdle palsies are absent .

in recent years , great emphasis has been placed on the role of arterial stiffness and central blood pressure ( bp ) as independent predictors of the development of cardiovascular ( cv ) diseases [ 13 ] . consequently , the assessment of arterial stiffness and central hemodynamics is recommended as additional tests for the clinical evaluation of hypertensive patients ( based on history , physical examination , and findings from routine laboratory tests ) , particularly for those at risk of cv complications . regional and local arterial stiffness may be measured directly and noninvasively , at various sites along the arterial tree , by assessing pulse wave velocity ( pwv ) and augmentation index ( ai ) . the most widely employed methods for evaluating pulse waveforms are those based on applanation tonometry and transfer functions , although recently oscillometric ambulatory blood pressure monitoring ( abpm ) devices using specific algorithms for pulse wave analyses have been proposed for assessing arterial stiffness [ 69 ] . at present , oscillometry is an affordable technique and may allow a comfortable , accurate , repeated , and prolonged estimation of arterial stiffness and central hemodynamics over the 24 hours in daily life conditions . the most recent studies seem to indicate reliability and feasibility of ambulatory arterial stiffness evaluation based on analysis of brachial oscillograms [ 10 , 11 ] . in the present study we aimed at assessing the feasibility of determining central bp and various indices of arterial stiffness over the 24 hours by a noninvasive , clinically validated technology of pulse wave analysis based on oscillometric bp measurements , integrated in an ambulatory bp ( abp ) monitor [ 10 , 12 ] . potential differences in arterial hemodynamics and stiffness were sought between healthy normotensive volunteers and hypertensive patients evaluated in a real - life context .

objective . central blood pressure ( bp ) and vascular indices estimated noninvasively over the 24 hours were compared between normotensive volunteers and hypertensive patients by a pulse wave analysis of ambulatory blood pressure recordings . methods . digitalized waveforms obtained during each brachial oscillometric bp measurement were stored in the device memory and analyzed by the validated vasotens technology . averages for the 24 hours and for the awake and asleep subperiods were computed . results . 142 normotensives and 661 hypertensives were evaluated . 24-hour central bp , pulse wave velocity ( pwv ) , and augmentation index ( ai ) were significantly higher in the hypertensive group than in the normotensive group ( 119.3 versus 105.6 mmhg for systolic bp , 75.6 versus 72.3 mmhg for diastolic bp , 10.3 versus 10.0 m / sec for aortic pwv , 9.7 versus 40.7 % for peripheral ai , and 24.7 versus 11.0 % for aortic ai ) , whereas reflected wave transit time ( rwtt ) was significantly lower in hypertensive patients ( 126.6 versus 139.0 ms ) . after adjusting for confounding factors a statistically significant between - group difference was still observed for central bp , rwtt , and peripheral ai . all estimates displayed a typical circadian rhythm . conclusions . noninvasive assessment of 24-hour arterial stiffness and central hemodynamics in daily life dynamic conditions may help in assessing the arterial function impairment in hypertensive patients .

polycystic ovary syndrome ( pcos ) , one of the most common endocrine disorders occurring during reproductive age , is characterized by ovulatory dysfunction , biochemical or clinical hyperandrogenism , and polycystic ovaries . its prevalence ranges from 5 % to 20 % depending on the diagnostic criteria used [ 2 , 3 ] . pcos is currently considered a syndrome with metabolic consequences that could affect women 's health during different stages of reproductive age . several studies have highlighted that the risk for maternal , neonatal , and obstetric complications may be increased in women with pcos [ 57 ] . gestational diabetes mellitus ( gdm ) is the most commonly reported pregnancy complication in women with pcos . pregnant women with pcos have been reported to develop insulin resistance and impaired -cell function . this pathogenic mechanism may be associated with glucose intolerance , resulting in a greater incidence of gdm in women with pcos . observational studies have revealed an association between pcos and gdm , hypertension during pregnancy , and preterm birth . however , these studies are limited by significant heterogeneity , which indicates that the reliability of the finding of increased risk of pregnancy and adverse birth outcomes in women with pcos could be compromised [ 9 , 10 ] . therefore , properly designed studies should be performed before formulating recommendations for pregnant women with pcos . determining the risk for gdm and adverse birth outcomes in women with pcos is important for preventive intervention through screening in the early stage of pregnancy . we conducted a large historic cohort study of pregnant women , including those who conceived spontaneously and through assisted reproductive technology , to assess the risk for gdm and adverse birth outcomes among chinese women with pcos .

objective . to examine the association of polycystic ovary syndrome ( pcos ) in early pregnancy with gestational diabetes mellitus ( gdm ) and adverse birth outcomes . methods . in this retrospective cohort study including 2389 pregnant women , the medical records of 352 women diagnosed with pcos were evaluated . outcomes included gdm , preterm birth , low birth weight , macrosomia , and being small and large for gestational age . multivariable logistic regression models were used to examine the association of the risk for gdm and adverse birth outcomes with pcos after adjusting for confounders . results . women previously diagnosed with pcos had a higher risk of gdm ( adjusted odds ratio [ or ] 1.55 , 95 % confidence interval [ ci ] : 1.142.09 ) . a strong association was seen between pcos and preterm birth ( adjusted or 1.69 , 95 % ci : 1.082.67 ) . on stratified analysis , the adjusted or for gdm among women with pcos undergoing assisted reproductive technology was 1.44 ( 95 % ci : 1.031.92 ) and among women with pcos who conceived spontaneously was 1.60 ( 1.182.15 ) . no increased risk for other adverse birth outcomes was observed . conclusions . women with pcos were more likely to experience gdm and preterm birth .

there is an increased incidence of major and minor congenital abnormalities in infants born to epileptic mothers ( 6 - 7 % compared with 2c3 % in the general population ) . sodium valproate is a popular drug because of its broad range of anticonvulsant effects and relative freedom from sedative and behavioral effects . exposure to valproic acid during first trimester can result in the constellation of minor craniofacial anomalies and major organ malformations in human fetuses . here , we report a case of a 3-month - old baby with facial dysmorphism , as a case of fetal valproate syndrome ( fvs ) based on the phenotype and maternal use of valproic acid during the antenatal period .

antenatal use of anticonvulsant valproic acid can result in a well - recognized cluster of facial dysmorphism , congenital anomalies and neurodevelopmental retardation . in this report , we describe a case with typical features of fetal valproate syndrome ( fvs ) . a 26-year - old female with epilepsy controlled on sodium valproate 800 mg / day since 3 years , gave birth to a male child with characteristic features of fvs . she also had 3 spontaneous first - trimester abortions during those 3 years . sodium valproate , a widely used anticonvulsant and mood regulator , is a well - recognized teratogen that can result in facial dysmorphism , craniosynostosis , neural tube defects , and neurodevelopmental retardation . therefore , we strongly recommend avoidance of valproic acid and supplementation of folic acid during pregnancy .

stakeholders in public health research are researchers , funding agencies , organizations hosting research activities , policymakers , health managers , professionals in the health care system , patients and the community as well as the healthcare industry . it is important to understand the perceptions and views of various stakeholders on priorities in public health research to maximize the benefits of research1 . involvement of various stakeholders apart from researchers is crucial to align the research initiatives with policies and public health programmes2 . it is particularly important in view of low public health research funding and low public health research output3 . the need for better collaboration between researchers and policymakers to enhance the use of research has been reported14 . in uk , these efforts were successful in addressing needs of various stakeholders1 . in canada , the study that evaluated the interactions between researchers and decision makers identified three models of decision maker involvement namely formal supporter , responsive audience , and integral partner4 . there is a lack of data regarding involvement of policymakers in the public health research prioritization in india . health is a state subject in india , therefore , public health programmes are delivered by the state health systems . state level stakeholders who are actively involved in the implementation of public health programmes are one of the most important stakeholders in identifying public health research agenda that would lead to direct programmatic benefits . in this context , it is important to understand the public health priorities as perceived by these stakeholders . in india , department of health research ( dhr ) was constituted in 2007 with the mandate to serve as an apex department for medical , allied basic sciences , clinical and public health research in the country . the dhr mandate is to translate the innovations into products/ processes and to introduce these innovations into public health service through health systems research , and to strengthen the coordination between various stakeholders to increase the use of research findings in practice of public health5 . a two day consultative meeting was organized by the dhr in september 2011 to bring the state government officials and public health researchers together on the same platform . a survey was conducted prior to the two day consultation in august , 2011 to obtain perspectives of state government health system stakeholders regarding public health research priorities in various indian states . the survey also covered public health researchers from leading public health organizations in india to understand their views . an exploratory study was conducted to generate information that could serve as a basis for discussion in the meeting . the major objective of the meeting was to identify the key public health research priorities as perceived by state officials and researchers .

public health research has several stakeholders that should be involved in identifying public health research agenda . a survey was conducted prior to a national consultation organized by the department of health research with the objective to identify the key public health research priorities as perceived by the state health officials and public health researchers . a cross - sectional survey was done for the state health officials involved in public health programmes and public health researchers in various states of india . a self - administered semi - structured questionnaire was used for data collection . overall , 35 state officials from 15 states and 17 public health researchers participated in the study . five leading public health research priorities identified in the open ended query were maternal and child health ( 24 % ) , non - communicable diseases ( 22 % ) , vector borne diseases ( 6 % ) , tuberculosis ( 6 % ) and hiv / aids / sti ( 5 % ) . maternal and child health research was the leading priority ; however , researchers also gave emphasis on the need for research in the emerging public health challenges such as non - communicable diseases . structured initiatives are needed to promote interactions between policymakers and researchers at all stages of research starting from defining problems to the use of research to achieve the health goals as envisaged in the 12th plan over next five years .

in recent years , the efficacy of endovascular treatment after the administration of intravenous recombinant tissue plasminogen activator ( rt - pa ) has been demonstrated in several studies ( 1 - 5 ) . in fact , the number of patients undergoing endovascular treatment after intravenous rt - pa administration has been increasing . in addition , carotid artery stent placement during endovascular treatment is performed in selected patients in clinical practice . however , strong evidence that supports the effectiveness of emergent stenting treatment is unavailable . patients who undergo emergency stent placement are recommended to receive antiplatelet therapy to prevent in - stent thrombosis ( 6 ) , but only a few studies have reported the use of these drugs after carotid artery stenting and intravenous rt - pa administration ( 7,8 ) . we herein report our experience with acute antiplatelet therapy in three stroke patients who underwent emergency carotid artery stent placement after intravenous rt - pa administration .

we herein report three ischemic stroke patients who underwent emergency carotid artery stenting after receiving intravenous tissue plasminogen activator ( t - pa ) treatment . all patients received antiplatelet medications immediately before stent placement for loading as well as dual antiplatelet therapy after stenting . under high - dose and dual antiplatelet therapy , none of the three patients showed symptomatic intracranial hemorrhaging . however , one case showed reocclusion of the placed stent after acute thrombosis . as a result , new treatment strategies for the use of antiplatelet agents during emergency stent placement must be developed , particularly for patients who have received intravenous t - pa therapy .

hemophilia a , a deficiency in the activity of coagulation factor ( f ) viii , is an x - linked bleeding disorder with an approximate incidence of one in 5,000 male infants.1,2 absence or reduction of the fviii protein affects secondary hemostasis , which manifests as induced or spontaneous bleeding depending on the severity of the disease . the severity of hemophilia is classified depending on the patient s baseline plasma level of fviii . coagulation factor levels are often expressed as a percentage of factor activity or as international units . one international unit ( iu ) one hundred percent ( 100 iu / dl ) is the average amount of activity for a person without hemophilia . severe hemophilia is characterized by a fviii level of < 1 % ( 1 iu / dl ) . iu / dl ) result in moderate hemophilia , and levels between 5 % and 40 % ( 540 while one - half of all hemophilia cases have severe deficiency , moderate and mild factor deficiencies correspond to 10 % and 40 % of cases , respectively.3,4 the correlation between factor levels and the severity of bleeding is not perfect , but in general , clinical phenotype corresponds to the factor level . the hallmark clinical presentation of severe hemophilia a is spontaneous , traumatic , and excessive soft tissue , muscle , body cavity , and joint bleeding . annual treatment cost of severe fviii deficiency is several hundred thousand us dollars and bleeding - related complications often result in greater severity of disease , poor quality of life , surgical interventions for severe joint destruction , and shortened life span.5

hemophilia a , a deficiency in the activity of coagulation factor ( f ) viii , is an x - linked bleeding disorder with an approximate incidence of one in 5,000 male infants . bleeding - related complications often result in greater severity of disease , poor quality of life , surgical interventions for severe joint destruction , and shortened life span . with the availability of plasma - derived and recombinant fviii products , the benefits of primary prophylaxis were demonstrated and is now the standard of care for patients with severe factor deficiencies . current hemophilia research is focusing on the creation of new factor replacement therapies with longer half - lives ; accessing alternative mechanisms to achieve desired hemostasis and enhance bypassing activity ; and limiting the immunogenicity of the protein . pegylation involves the covalent attachment of polyethylene glycol ( peg ) to a protein , peptide , or a small molecule drug . peg effectively increases the molecular weight and size of the protein by creating a hydrophilic cloud around the molecule . this molecular change may reduce susceptibility of the molecule to proteolytic activity and degradation . it is also believed that pegylation changes the surface charge of the protein that ultimately interferes with some receptor - mediated clearance processes . the half - life of pegylated factor is more prolonged when compared to non - pegylated full - length recombinant fviii . the dawn of a new era in the care of hemophilia patients is upon us with the release of recombinant fviii products with extended half - lives , and products with even more extended half - life will become available in a very short time . with all the promise of these new agents , many questions still remain .

traditionally , clinical microbiologists handle and read routine bacterial culture plates on the open laboratory bench . at the beginning of each shift , stacks of inverted plates are removed from incubators and set on the benchtop . throughout the day this work includes collecting plates from different incubators , inspecting media for bacterial growth , examining colony morphology , isolating pure cultures , performing biochemical testing on isolates , preparing media for antimicrobial susceptibility testing ( ast ) , interpreting ast , and discarding or archiving old culture plates . this work also includes reviewing notes from the previous days interpretations of any growth and deciding the next step in analysis and/or reporting for these cultures . the plates are eventually returned to their incubator ( s ) , and the same process recommences the following day . with the advent of digital imaging , digital technology has recently been applied in the clinical microbiology laboratory to perform digital plate reading ( dpr ) in some laboratory settings . the dpr approach is similar to the aforementioned manual reading process , but is highly modified . with dpr , technologists still read plates , but they can now do so virtually without physically touching the culture plate . dpr today in the clinical laboratory consists of a digital camera juxtaposed or attached to an incubator which , through automation , moves the culture plate to the camera for the image to be captured . the incubator and dpr combination allow for continuous incubation of cultures and scheduled digital image capture of those plates . dpr is typically combined with a middleware system that resides between the image capture system and the laboratory information system . these middleware systems have functionality that can present to the technologist images of the cultures plates not only from a single culture but other cultures where there is perhaps growth from other sources . , the technologist can perform the work that has historically been relegated to the open bench ; dpr and middleware solutions allow images to be captured , colonies to be circled , zones to be measured , annotations to be made , and next steps to be planned . with dpr , the time required for collecting and collating plates can be reduced , and software enables stored images to be referenced when working up a culture . the duration at which the cultures are at suboptimal incubation temperature ( i.e . , physically on the counter ) is reduced , and the productivity of the technologist is improved . with dpr the ability to incorporate computer aided tools and image analysis to support this review aims to discuss the advantages and challenges associated with dpr and explores some of the existing platforms that incorporate this technology into an overall solution for total laboratory automation ( tla ) within the clinical laboratory space .

digital plate reading ( dpr ) is increasingly being adopted as a means to facilitate the analysis and improve the quality and efficiency within the clinical microbiology laboratory . this review discusses the role of dpr in the context of total laboratory automation and explores some of the platforms currently available or in development for digital image capturing of microbial growth on media . the review focuses on the advantages and challenges of dpr . peer - reviewed studies describing the utility and quality of these novel dpr systems are largely lacking , and professional guidelines for dpr implementation and quality management are needed . further development and more widespread adoption of dpr is anticipated .

primitive neuroectodermal tumors ( pnets ) are highly malignant embryonal neoplasms of bone and soft tissues accounting for 4 % 17 % of all pediatric soft tissue tumors . metastasis at presentation is quite common , with central pnets metastasizing to cranium and leptomeninges while peripheral pnets ( ppnets ) disseminating to lungs , bone , liver , and lymph nodes . primary pulmonary pnet is known to metastasize to pancreas , adrenal gland and ovaries while it metastasizing to brain is exceedingly rare .

primitive neuroectodermal tumors ( pnets ) are highly malignant neoplasms of embryonal origin manifesting in children and adolescents , rarely seen in adults . carcinoma lung with hemorrhagic metastasis to the brain is very common , but primary lung pnet with hemorrhagic brain metastasis is extremely uncommon . we hereby report a 29-year - old female diagnosed as pnet lung was treated with vincristine , adriamycin , and cyclophosphamide alternating with ifosfamide plus etoposide followed by radiotherapy ( rt ) . after 9 months , she developed hemorrhagic brain metastasis from pnet lung confirmed from tissue immunohistology postcraniotomy . received palliative whole brain rt followed by oral pazopanib resulting in significant improvement in performance status . a thorough review of literature reveals that our case may be the second case of primary lung pnet with hemorrhagic brain metastasis and also the first to be exhibited oral pazopanib resulting in a significant therapeutic effect to be reported in world literature till date .