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[ "overall , neuropsychiatric symptoms in pd have been shown to be negatively associated with cognitive performance . although anxiety and depression are often related and coexist in pd patients , recent research suggests that anxiety rather than depression is the most prominent and prevalent mood disorder in pd [ 5 , 6 ] . yet , anxiety affects quality of life in those living with parkinson 's disease ( pd ) more so than overall cognitive status , motor deficits , apathy , and depression [ 13 ] . however , few studies have specifically investigated the relationship between anxiety and cognition in pd .", "seventeen pd patients with anxiety and thirty - three pd patients without anxiety were included in this study ( see table 1 ) . thus , all participants who scored within a depressed ( hads - d > 6 ) range were excluded from this study , in attempt to examine a refined sample of pd patients with and without anxiety in order to determine the independent effect of anxiety on cognition . a cut - off score of > 8 on the anxiety subscale of the hads ( hads - a ) was used to identify pd cases with anxiety ( pda+ ) , while a cut - off score of < 6 on the hads - a was used to identify pd cases without anxiety ( pda ) . self - reported hads was used to assess anxiety in pd and has been previously shown to be a useful measure of clinical anxiety in pd . the neurological evaluation rated participants according to hoehn and yahr ( h&y ) stages and assessed their motor symptoms using part iii of the revised mds task force unified parkinson 's disease rating scale ( updrs ) . in a similar way ten patients in this study ( 5 pd with anxiety ; 5 pd without anxiety ) were taking psychotropic drugs ( i.e. , benzodiazepine or selective serotonin reuptake inhibitor ) . the ability to retain learned verbal memory was assessed using the logical memory subtest from the wechsler memory scale - iii ( lm - i z - score , lm - ii z - score , % lm retention z - score ) . the mini - mental state examination ( mmse )", "as expected , the pda+ group reported significant greater levels of anxiety on the hads - a ( u = 0 , p < 0.001 ) and higher total score on the hads ( u = 1 , p < 0.001 ) compared to the pda group ( table 1 ) . participants were split into lpd and rpd , and then further group differences were examined between pda+ and pda. importantly , the groups remained matched in age , disease duration , updrs - iii , dde , h&y stage , and depression but remained significantly different on self - reported anxiety . logical memory i immediate recall test ( u = 176 , p = 0.059 ) showed a trend that the pda+ group had worse new verbal learning and immediate recall abilities than the pda group . however , logical memory ii test performance ( u = 219 , p = 0.204 ) and logical memory % retention ( u = 242.5 , p = 0.434 ) did not differ between groups . there were no group differences for tmt - a performance ( u = 256 , p = 0.62 ) ( table 2 ) ; however , the pda+ group had worse performance on the trail making test part b ( t(46 ) = 2.03 , p = 0.048 ) compared to the pda group ( figure 1 ) .", "this study is the first to directly compare cognition between pd patients with and without anxiety . more specifically , we found that pd patients with anxiety were more impaired on the trail making test part b which assessed attentional set - shifting , on both digit span tests which assessed working memory and attention , and to a lesser extent on the logical memory test which assessed memory and new verbal learning compared to pd patients without anxiety . taken together , the findings confirmed our hypothesis that anxiety negatively influences attentional set - shifting and working memory in pd . these findings suggest that anxiety in pd may reduce processing capacity and impair processing efficiency , especially in the central executive and attentional systems of working memory in a similar way as seen in young healthy adults [ 26 , 27 ] . considering many previous studies have investigated the influence of depression on cognition in pd without accounting for the presence of anxiety and the inconsistent findings reported to date , we recommend that future research should try to disentangle the influence of anxiety versus depression on cognitive impairments in pd . considering the growing number of clinical trials for treating depression , there are few if any for the treatment of anxiety in pd ." ]

[ "as small non - coding rnas regulate gene expression and tumorigenesis , they may represent a novel cancer therapy . mirnas regulate a broad range of biological processes including timing of development , cell cycle progression , stem cell self - renewal , differentiation , cancer initiation , cancer cell proliferation , metastasis and apoptosis [ 511 ] . they include sirna ( small interfering rna ) , mirna ( microrna ) , pirna ( piwi - interacting rna ) and snorna ( small nucleolar rna ) . small non - coding rnas are transcribed into mrna but remain untranslated in eukaryotic cells . mirnas regulate gene expression and play important roles in the onset and progression of tumorigenesis . although the current treatment of radiation therapy , chemotherapy and hormone therapy slow mammary gland tumor growth , prolong survival and improve the quality of patients life , metastatic breast cancer still remains incurable due to our limited understanding of the molecular mechanisms through which tumorigenesis and metastasis occur .", "the first study about the altered expression of mirnas in human breast cancer patients and human breast cancer cell lines was reported in 2005 by lorio et al . , mirna gene copy number gain / loss and mirna gene mutation have been observed in breast cancer resulting in the aberrant expression of mirna . although the tendency for a global decrease of mirna expression in human cancers originally suggested a general tumor suppressor function of mirnas , subsequent studies showing the aberrant expression of specific mirnas in breast cancer suggest mirna - specific roles in breast cancer onset and progression . wang et al . collected 68 patients with newly diagnosed breast cancer and examined the expression of selected mirnas in tumor and adjacent non - tumor tissues . unlike mrna , mirnas are transcribed but never translated . some mirnas are transcribed from non - coding regions between genes , deriving from independent transcription unit .", "herein we summarize the recent literature and research progress on the mechanism by which mirnas regulate the breast cancer cell cycle and cellular proliferation ( fig . many distinct mirnas have been shown to regulate breast cancer cell proliferation , apoptosis , cancer stem cell expansion , and tumorigenesis . the understanding of how mirnas are involved in breast cancer through regulating the cell cycle remains rudimentary . in addition to cell - cycle control , breast tumor onset and progression and breast tumor stem cells are also regulated by distinct mirnas .", "the discovery that non - coding rnas regulate cscs widens our understanding of cscs , and may provide potential novel strategies for breast cancer therapy . emerging evidence has demonstrated the importance of cscs in cancer initiation , cancer metastasis and drug resistance . the involvement of mirnas in regulating tumor formation by cscs or tumor - initiating cells ( t - ic ) has been widely investigated . cscs are believed to be one of the most promising targets for cure of cancer .", "deletion of chromosome 6q , including region 6q14-q16 , is frequently observed in breast cancer . the small non - coding snorna u50 is a candidate tumor suppressor gene in the 6q14 - 16 region , playing a role in the development and/or progression of breast cancer . the identification of the expression signature of these non - coding small rnas in breast cancer subtypes , and an understanding of their functional significance to oncogene expression , tumor initiation and tumor cell metastasis may shed important new perspectives on the role of these non - coding small rnas in breast cancer . high - throughput deep sequencing identified a group of small rnas matching pirna sequences in human breast cancer tissues and breast cancer cell lines . genomic deletion and transcriptional downregulation of snorna u50 was detected in breast cancer cell lines . emerging evidence indicates that pirna expression occurs in somatic cells [ 57 , 58 ] and piwil2 expression has been identified in human breast cancer cells . the study of these non - coding small rnas in human cancer is just starting .", "small non - coding rna - based diagnostic and therapeutic applications for human cancer are expected in the near future . although tumor - targeted delivery and local administration are still major challenges to the practical application of gene therapy for cancer , mirna - based cancer therapeutic approaches are being established and tested in animal models . kim et al . recently reported significant anti - tumor effect of virus - mediated delivery of mir-145 combined with 5-fu to treat breast cancer . intranasal delivery of let-7 and intravenous delivery of mir-34a mimics for non - small - cell lung cancer treatment and a virus - mediated delivery of mir-26a for liver cancer treatment in mouse model demonstrate the promise of mirna for treatment of cancer . synthetic mirna mimics or mirna expression vectors have been successfully applied to restore or overexpress mirna in vitro . chemically modified lna anti - sense mirna inhibitor and other approaches have been used to block mirna function in cells .", "experimental evidence has shown specific mirnas regulating the initiation , progression , metastasis and drug resistance of breast cancer via control of the cell cycle , altering cellular proliferation , altering cellular apoptosis and/or controlling the population of tumor stem cells . dysregulated dysregulated expression of mirnas has implicated components of the non - coding genome as either oncogenes or tumor suppressors of breast cancer . a specific subset of dysregulated mirnas in breast cancer cells may serve as targets for gene therapy either alone or as an adjuvant treatment to current clinical protocols for breast cancer patients . the circulating mirnas have the potential to serve as novel diagnostic and prognostic biomarkers for breast cancer . mirna expression has also been observed in cancer associated fibroblasts ( caf ) and in the systemic circulation [ 65 , 66 ] ." ]

[ "the aim of the current study was to evaluate the role of the pigtail catheter drainage in outpatient management of patients with early onset severe ohss . in this study we established the efficacy and safety of pigtail catheter drainage in the management of severe / critical ohss in patients who underwent in vitro fertilization and embryo transfer at our centre between 1999 and 2001 on both inpatient and outpatient basis . pigtail catheters have been used for drainage in various clinical situations . in a previous study we described the use of percutaneous placement of a pigtail catheter for drainage of ascites caused by severe / critical ohss ( abuzeid et al . , 2003 ) . ohss is a serious complication of ovulation induction , occurring in 1 - 10% of in vitro fertilization patients ( rizk and aboulghar , 1991 ; brinsden et al . , 1995 ) . this iatrogenic condition has a spectrum of clinical and laboratory manifestations ranging from mild to severe , even life - threatening conditions ( rizk et al . , 1990 ) . among the serious manifestations of ohss are ascites and pleural effusion ( rizk and smitz , 1992 ) . human chorionic gonadotrophin is thought to play a crucial role in the development of ohss ( rizk et al .", "this is a retrospective study that included all patients who underwent in vitro fertilization and developed severe or critical ohss by the golan classification ( golan et al . , 1989 ) in the period between 2004 and 2009 . all 33 patients were offered treatment using pigtail catheter insertion as an alternative to trans - vaginal paracentesis . all patients underwent an ultrasound evaluation which documented the presence of severe ascites and bilateral ovarian enlargement . all patients presented with shortness of breath , marked abdominal distension , nausea , weight gain and lower abdominal pain . any patient with critical ohss according to the golan classification , or those in whom the presenting symptoms and signs did not completely subside after drainage of ascitic fluid and iv fluid replacement , were admitted to the hospital for observation and further management .", "our data include the number of patients requiring early versus late placement of pigtail catheter , mean amount of ascitic fluid drained immediately after pigtail placement , number of days of pigtail catheter drainage and the number of days between oocyte retrieval and the onset of severe ohss symptoms requiring pigtail placement . these three patients were admitted to the hospital immediately after insertion of the pigtail catheter for management of severe pleural effusion and careful observation . demographic data including mean age ( years ) , duration of infertility ( years ) , bmi ( kg / m2 ) and aetiology of infertility are illustrated in table i. ovarian stimulation data including number of treatment days , total dose of recombinant follicle stimulating hormone , hormone serum levels , endometrial thickness , number of follicles and number of patients receiving only 5000 iu of human chorionic gonadotrophin is illustrated in table ii . table iii also illustrates the number of patients who underwent coasting , number of patients who received prophylactic hespan on day of egg retrieval . values are expressed as mean + standard deviation values are expressed as mean + standard deviation : rfsh = recombinant fsh ; hmg = human menopausal gonadotropins ; hcg = human chorionic gonadotropin ; e2 = estradiol values are expressed as mean + standard deviation three patients ( 9% ) required an early placement of a pigtail catheter while 30 patients ( 91% ) had late placement of the catheter ( table iii ) . four patients ( 12% ) required hospital admission for 1 - 7 days ( 3 + 2.7 ) , three for associated severe pleural effusion requiring thoracentesis .", "therefore , we embarked on the current study to evaluate the role of pigtail catheter drainage in outpatient management of patients with severe ohss syndrome . in the current study we demonstrated that patients who were diagnosed very early with severe ohss can be managed safely and effectively on outpatient basis using pigtail catheter drainage , iv fluid replacement and careful monitoring . the placement of a pigtail catheter resulted in a safe and effective outpatient management of the majority of patients with severe ohss . patients with critical ohss and those with persistence of symptoms of severe ohss despite insertion of a pigtail catheter and drainage of ascitic fluid should be admitted to the hospital for inpatient management . drainage of ascitic fluid in patients with severe / critical ohss is an important step in the management of this condition ( rizk , 2010 ) . however , outpatient management of this potentially fatal condition requires clear understanding that rapid deterioration may occur , which may necessitate hospitalization and intensive treatment of a critically ill patient ( rizk , 2006 , 2010 ) . our previous study confirmed the safety and effectiveness of the pigtail catheter for the management of severe ohss . in a previous study we reported the use of percutaneous pigtail catheter for drainage of ascites in severe ohss as an alternative to repeated paracentesis ( abuzeid et al . , 2003 ) ." ]

[ "congenital adrenal hyperplasia ( cah ) refers to a group of autosomal recessive disorders caused by an enzyme deficiency which leads to defects in biosynthesis of steroid precursors . however , the non classical cah variant is more common with a prevalence rate of 1 in 1000 . depending on the severity and degree of 21 hydroxylase deficiency , the clinical spectrum may vary from mild form of non classical cah to classic cah . it also helps in maintaining normal levels of precursors by suppressing adreno cortico trophic hormone ( acth ) . during childhood , the management is largely focused on achieving normal growth and attaining appropriate final adult height .", "johns medical college hospital , bangalore by the department of endocrinology on patients diagnosed to have cah and seen in the outpatient clinic between january 2012 and october 2012 . during this period 17 ohp levels between 1 ng / ml and 12 ng / ml were considered appropriate ; values below 1 ng / ml suggested suppression and over treatment and values above 12 ng / ml suggested under treatment . all patients underwent biochemical testing for 17 hydroxy progesterone ( 17 ohp ) levels for assessment of adequacy of therapy . bone age assessment with left hand and wrist data regarding demography , clinical presentation at time of diagnosis , treatment details , height sds and bmi were collected . bmi was calculated for all patients and obesity was defined using who charts as values above 95th percentile .", "29 patients were included in the study of which 22 were females ( 76% ) and 7 were males ( 24% ) . based on the cross sectional data collected , 11 patients were adults ( age > 18 ) and 18 patients were children ( 62% ) . among the males , the non classical cah ( nccah ) patients presented in adulthood with complaints of irregular cycles and hirsutism ; they had no features of virilisation . most adult classic cah patients with complaints of hirsutism were treated with either spironolactone or finasteride .", "short stature was seen in one third of patients on therapy and the average final adult height among patients with classic cah was 142.37 , which was significantly lower than the mean adult height for females in our population . the typical presentation of male babies were with adrenal crisis between the 3 and 6 week of life . around 20% of female patients with classic cah we report the phenotypic features of a cohort of patients with cah being evaluated and managed in a tertiary centre in southern india . in this series , were identified and appropriately treated only after late adolescence even when genital ambiguity was present since birth . the mean final adult height of 157.5 cm for those with nccah was better than their classic cah counterpart . obesity and hypertension were not found to be significantly higher in this cohort of cah patients . one third of patients had suppressed 17 ohp levels suggestive of over replacement therapy which may also contribute to the reduction in the final adult stature ." ]

[ ", we hypothesized that pentoxifylline , due to its anti - inflammatory and immunosuppressive activity , may affect autoimmune diabetes . consequently , we decided to investigate whether pentoxifylline treatment could prevent the development of mlds - induced diabetes in mice . it has been shown that some drugs such as pentoxifylline ( ptx ) have immunomodulatory and anti - inflammatory activity , which might represent a potential preventive therapy for autoimmune diseases . ptx has been successfully used for the treatment of experimental autoimmune diseases including experimental autoimmune myocarditis ( eam ) ( 11 ) , experimental autoimmune encephalomyelitis ( 12 ) , and adjuvant arthritis ( 13 ) . in the present study drugs that increase the levels of camp , tend to reduce the production of proinflammatory mediators and increase the production of anti - inflammatory mediators by immune cells ( 8) . in recent years , the potential of ptx as an immunomodulatory and anti - inflammatory agent gained interest as it has been shown to effectively suppress the synthesis of tnf- and other pro inflammatory cytokines such as ifn - and il-12 in vitro and in vivo ( 9 - 10 ) .", "subsequently , the mice were allocated to three therapeutic groups ( n=7 per group ) ( normal control group , mlds group ( diabetic control group ) and treatment group ) . treatment with ptx ( 100 mg / kg / day for 21 days , ip ) non - fasting blood sugar level was measured in 0 , 7 , 14 and 21 days after streptozotocin induced diabetes by using a glucometer ( accu - chech active).the blood samples were obtained from the tail vein of non - fasted mice ( 14 ) . before mice were euthanized , blood was collected from each mouse on day 21 in heparinized tubes . diabetes was induced by multiple low - dose of streptozotocin ( mlds ) injection in male c57bl/6 mice . subsequently , the macrophage cell content was depleted by incubation of the cell suspension in tissue culture dishes at 37c ( air+5% co2 ) to allow these cells to adhere to the bottom of the culture dishes . the blood samples were obtained from the tail vein of non - fasted mice , and glucose was measured using a glucometer ( accu - chech active ) . mice were euthanized and their splenic tissues were removed on day 21 for cytokine assay and mtt test .", "streptozotocin ( stz ) , citrate buffer , pentoxifylline ( ptx ) , rpmi 1640 , l - glutamine , dimethylsul- foxide ( dmso ) , concanavalin a , mtt ( ( 3-(4,5-dimethyl - thiazolyl)-2,5-diphenyl - tetrazolium bromide ) ) and fetal calf serum fetal were purchased from sigma - aldrich ( st.louis , mo ) .", "male c57bl/6 mice , weighing 20 to 25 g , were housed in a room with a 12-hr light / dark cycle .", "subsequently , the mice were allocated to three therapeutic groups ( n=7 per group ) ( normal control group , mlds group ( diabetic control group ) and treatment group ) . treatment with ptx ( 100 mg / kg / day for 21 days , ip ) was initiated in treatment group when they were considered diabetic . at the same time , the control groups received saline vehicle alone with the same schedule . diabetes was induced by multiple low - dose of streptozotocin ( mlds ) injection in male c57bl/6 mice . stz was dissolved in 0.1 m citrate buffer ( ph 4.5 ) and injected intraperitoneally ( ip ) , within 10 min of preparation , at a dose of 40 mg / kg / day for 5 consecutive days . mice were considered diabetic when their non - fasting blood glucose level was > 250 mg / dl ( 14 ) . the blood samples were obtained from the tail vein of non - fasted mice , and glucose was measured using a glucometer ( accu - chech active ) .", "non - fasting blood sugar level was measured in 0 , 7 , 14 and 21 days after streptozotocin induced diabetes by using a glucometer ( accu - chech active).the blood samples were obtained from the tail vein of non - fasted mice ( 14 ) .", "before mice were euthanized , blood was collected from each mouse on day 21 in heparinized tubes .", "subsequently , the macrophage cell content was depleted by incubation of the cell suspension in tissue culture dishes at 37c ( air+5% co2 ) to allow these cells to adhere to the bottom of the culture dishes . the splenocytes ( 510cells / ml ) were treated with 2 g / ml concanavalin a for 72 hr , and cell supernatants were collected , then the levels of il-10 , il17 and ifn - were measured by elisa kits according to the manufacturers instructions . remaining free floating cells were seeded on culture dishes at a density of 510cells / ml in rpmi 1640 with 10% fetal calf serum , and 2 mmol / l l - glutamine . mice were euthanized and their spleens were removed on day 21 for cytokine production assay . a single cell suspension was obtained by passing it through a 200-mesh net and hemolyzed by the buffer solution containing 1 mmol / l tris hcl and 1% nh4cl ( ph 7.2 ) . after aseptic removal , spleens were placed in cold hanks solution and teased apart with a pair of forceps and a needle .", "mouse splenic lymphocytes ( 110cells / ml ) were incubated in the absence or presence of concanavalin a ( 1.25 g / ml ) in a 96-well flat - bottom microculture plat in triplicate for 72 hr . thirty microliters of 5 mg / ml mtt ( ( 3-(4,5-dimethylthiazolyl)-2,5-diphenyl - tetrazolium bromide ) ) in pbs was added to each well , and the plate was incubated at 37c for 4 hr . the plate was then centrifuged and followed by removal of medium . after incubation at 37c for 5 min , absorbance was measured spectro - photometrically at 490 nm . the stimulation index si ) was calculated according to the following formula : si= od concanavalin a ( con a ) stimulated lymphocyte proliferation / od spontaneous lymphocyte proliferation without con a.", "one - way analysis of variance ( anova ) followed by tukey s test were used for multiple comparisons between groups .", "all stz - induced diabetic mice with ptx treatment remained hyperglycemic on day 14 , and no significant difference in blood glucose levels was demonstrated between ptx and mlds(diabetic control group ) group . ptx prevented the mlds - induced reduction in plasma insulin , indicating a possible protective effect of ptx against -cell damage . effect of pentoxifylline treatment on plasma levels of insulin ( * p<0.05 ) treatment of mice with ptx significantly decreased mlds - induced production of ifn- and il-17 , while increased il-10 as compared with those in mlds group ( diabetic control group ) ( p<0.05)(figure 3 ) . however , the levels of glucose in diabetic mice were significantly reduced after treatment with ptx ( p<0.05 ) , for 21day , when compared to the values of diabetic control mice ( figure 1 ) . effect of pentoxifylline treatment on blood glucose levels ( * p<0.05 ) to evaluate -cell function in terms of insulin release , we measured the plasma insulin levels on day 21 ( figure 2 ) . effect of pentoxifylline on productions of ifn il-10 and il-17 of diabetic murine splenocytes induced by con a ex vivo ( * p<0.05 versus diabetic control group ) the stimulation index ( si ) in treatment group with ptx showed a significant decrease as compared with that in mlds group ( diabetic control group ) ( p<0.05)(figure 4 ) .", "all stz - induced diabetic mice with ptx treatment remained hyperglycemic on day 14 , and no significant difference in blood glucose levels was demonstrated between ptx and mlds(diabetic control group ) group . however , the levels of glucose in diabetic mice were significantly reduced after treatment with ptx ( p<0.05 ) , for 21day , when compared to the values of diabetic control mice ( figure 1 ) . ptx prevented the mlds - induced reduction in plasma insulin , indicating a possible protective effect of ptx against -cell damage . effect of pentoxifylline treatment on blood glucose levels ( * p<0.05 ) to evaluate -cell function in terms of insulin release , we measured the plasma insulin levels on day 21 ( figure 2 ) .", "treatment of mice with ptx significantly decreased mlds - induced production of ifn- and il-17 , while increased il-10 as compared with those in mlds group ( diabetic control group ) ( p<0.05)(figure 3 ) . effect of pentoxifylline on productions of ifn il-10 and il-17 of diabetic murine splenocytes induced by con a ex vivo ( * p<0.05 versus diabetic control group )", "the stimulation index ( si ) in treatment group with ptx showed a significant decrease as compared with that in mlds group ( diabetic control group ) ( p<0.05)(figure 4 ) . effects of pentoxifylline on the proliferation of splenic lymphocytes induced by con a after 72 hr ( * p<0.05 )", "more importantly , the present data demonstrated that ptx could increase serum insulin concentrations in type 1 diabetic mice . previous studies have also shown that ptx lowers blood glucose levels in diabetic animals ( 23 ) , and the results from the present studies also indicated that ptx possessed an anti - hyperglycemic property . the present study shows that ptx is not only able to inhibit the release of proinflammatory cytokines ( ifn - and il-17 ) , but can also increase the production of anti - inflammatory cytokines ( il-10 ) . since ptx has been found to be able to inhibit the release of proinflammatory cytokines ( 33 ) , and favor th2 response ( 34 ) , it may indirectly interfere with the induction of inos . streptozotocin ( stz ) is a pancreatic cell toxin that induces inflammation of the islets by immune cells when it is given in multiple low doses ( 16 ) . , mlds induced c57bl/6j mice were chosen to evaluate the anti - hyperglycemic activity of ptx and investigate the immunotherapeutic molecular mechanisms of how ptx attenuated the development of t1d . our findings are consistent with previous studies , showing that ptx treatment prevented lymphocyte proliferation .", "in summary , results of the present work demonstrated that the suppressive effect of the ptx treatment on t1d was accompanied by decreased blood glucose level , increased plasma insulin level , suppression of t cell proliferation , down - regulation of th1 and th17 cytokines ( ifn - and il-17 ) and increase in the production of il-10 in supernatant of splenic culture of the treated mice . it seems that pentoxifylline treatment has a therapeutic effect against mlds - induced diabetes in mice ." ]

[ "determinar a presena de anticorpos ige especficos para superantgenos estafiloccicos e o grau de sensibilizao mediada por esses , assim como se esses esto associados gravidade da asma em pacientes adultos .", "estudo transversal incluindo asmticos adultos em acompanhamento ambulatorial em um hospital universitrio tercirio no rio de janeiro ( rj ) . os pacientes foram alocados consecutivamente em dois grupos de gravidade da asma segundo critrios da global initiative for asthma : asma leve ( al ) , com asmticos leves intermitentes ou persistentes , e asma moderada ou grave ( amg ) .", "foram includos 142 pacientes no estudo : 72 no grupo al ( mediana de idade = 46 anos ; 59 do sexo feminino ) e 70 do grupo amg ( mediana de idade = 56 anos ; 60 do sexo feminino ) . na amostra geral , 62 pacientes ( 43,7% ) apresentaram resultados positivos para dosagens de anticorpos ige antitoxinas estafiloccicas : enterotoxina ( tx ) a , em 29 ( 20,4% ) ; txb , em 35 ( 24,6% ) ; txc , em 33 ( 23,2% ) ; e toxic shock syndrome toxin ( tsst ) , em 45 ( 31,7% ) . as mdias das dosagens sricas de anticorpos ige especficos anti - txa , txb , txc e tsst foram , respectivamente , de 0,96 u / l , 1,09 u / l , 1,21 u / l , e 1,18 u / l .", "a presena de anticorpos ige sricos anti - txa , txb , txc e tsst , foi detectada em 43,7% nessa amostra de pacientes , mas no houve associao estatisticamente significativa entre seus resultados qualitativos ou quantitativos e gravidade clnica da asma .", "therefore , we investigated a population of asthma patients treated at a university hospital in the city of rio de janeiro , brazil , and having no risk factors for increased staphylococcal colonization or infection in order to correlate the clinical severity of asthma with the presence of staphylococcal toxin - specific ige antibodies and degree of ige - mediated sensitization . \n staphylococcus aureus is a gram - positive bacterium that can colonize the human skin and respiratory tract . the most important are toxic shock syndrome toxin ( tsst ) , staphylococcal enterotoxin a ( sea ) , seb , sec , sed , see , seg , seh , and sei , the activities of which include superantigen activity , pyrogenicity , and potentiation of lethality of other toxins . \n\n\n\n america , there have been no studies correlating staphylococcal superantigens with the severity of asthma .", "consecutive patients were divided into two groups according to the clinical severity of asthma based on the global initiative for asthma criteria \n\n\n : the mild asthma ( ma ) group , comprising patients with mild intermittent or persistent asthma ; and the moderate or severe asthma ( msa ) group . according to the global initiative for asthma this was a cross - sectional study including adult patients clinically and functionally diagnosed with asthma and receiving outpatient treatment at the clementino fraga filho university hospital , located in the city of rio de janeiro , brazil . between 2009 and 2013 , the criteria for inclusion in the present study were as follows : being an adult patient clinically and functionally diagnosed with asthma , \n\n\n regardless of the presence of rhinitis and positive skin test results to aeroallergens . , \n\n\n asthma severity can be evaluated on the basis of the treatment required in order to control the disease . patients with mild asthma are defined as those requiring only rescue medication , low - dose inhaled corticosteroids / leukotriene receptor antagonists , or a combination of the two .", "consecutive patients were divided into two groups according to the clinical severity of asthma based on the global initiative for asthma criteria \n\n\n : the mild asthma ( ma ) group , comprising patients with mild intermittent or persistent asthma ; and the moderate or severe asthma ( msa ) group . according to the global initiative for asthma this was a cross - sectional study including adult patients clinically and functionally diagnosed with asthma and receiving outpatient treatment at the clementino fraga filho university hospital , located in the city of rio de janeiro , brazil . between 2009 and 2013 , the criteria for inclusion in the present study were as follows : being an adult patient clinically and functionally diagnosed with asthma , \n\n\n regardless of the presence of rhinitis and positive skin test results to aeroallergens . , \n\n\n asthma severity can be evaluated on the basis of the treatment required in order to control the disease . patients with mild asthma are defined as those requiring only rescue medication , low - dose inhaled corticosteroids / leukotriene receptor antagonists , or a combination of the two .", "procedures included the following : clinical history taking ; physical examination ; routine tests ( including blood count , esr measurement , determination of total ige levels , parasitological stool examination , chest x - rays , and sinus x - rays ) ; pulmonary function tests ( spirometry and pef measurement ) ; skin prick tests to aeroallergens ; and determination of serum levels of ige antibodies ( to sea , seb , sec , and tsst ) . spirometry was performed with a spirometer ( jaeger , wrzburg , germany ) , in accordance with the american thoracic society guidelines \n\n\n and the reference values proposed by knudson et al . \n skin tests to aeroallergens were performed with the use of the puncture technique and standard antigens . \n for determination of serum levels of staphylococcal toxin - specific ige antibodies , an immunoassay system ( immunocap 100 ; phadia , uppsala , sweden ) was used . \n a finding of obstruction and positive bronchodilator test results with reversal or significant improvement were consistent with asthma . \n\n\n for pef measurement , a peak flow meter ( mini - wright afs ; clement clarke international , essex , england ) was used , the reference values being those proposed by nunn and gregg . \n ", "in order to compare numerical variables , we used the student 's t - test or the mann - whitney test , as appropriate , through the analysis of the kolmogorov - smirnov and shapiro - wilk coefficients . in order to compare categorical variables the sample size was calculated in order to provide a power of 80% , and values of p < 0.05 were considered statistically significant . , we used the chi - square test or fisher 's exact test , as appropriate .", "all participating patients gave written informed consent , and the treatment provided to those who declined to participate in the study was in no way affected by their decision . the present study was approved by the research ethics committee of the federal university of rio de janeiro clementino fraga filho university hospital .", "a total of 142 patients were studied . of those , 72 ( 17 with mild intermittent asthma and 55 with mild persistent asthma ) were allocated to the ma group and 70 ( 53 with moderate asthma and 17 with severe asthma ) were allocated to the msa group . table 3frequency of ige - mediated sensitization to staphylococcal toxins in the study population , by asthma severity . table 4serum levels of staphylococcal toxin - specific ige antibodies in the study population , by asthma severity . as can be seen in tables 3 and \n , there were no statistically significant differences between the two groups regarding the frequency of ige - mediated sensitization and serum levels of staphylococcal toxin - specific ige antibodies . \n", "there were statistically significant differences between the two groups of patients in the present study regarding their clinical and sociodemographic characteristics ( including age , bmi , and prevalence of rhinitis ) . our finding of a higher prevalence of rhinitis in the ma group suggests that atopy was more common in the ma group than in the msa group , supporting the concept that atopic manifestations tend to be less common in asthma patients with disease that is more severe . \n\n\n\n with regard to the lung function parameters assessed in the present study , absolute and percent predicted pef our primary objective was to evaluate the influence of serum levels of staphylococcal toxin - specific ige antibodies and their association with asthma severity , meaning that this was not a population prevalence study of ige sensitization in asthma patients and healthy individuals in our region . if that had been the case , a much larger sample size would have been required , and it would have been impossible to obtain that in a single - center study . recent studies have established a relationship between obesity - induced changes in the gastrointestinal and respiratory microbiome and the etiopathogenesis of obesity - related asthma . \n\n\n\n\n our finding of a significantly higher bmi in the msa group is consistent with the literature , obesity having been reported to be a risk factor for and an aggravator of asthma ." ]

[ "the purpose of the study was to determine the effectiveness of nursing interventions based on family needs on family satisfaction level of hospitalized patients in the neurosurgery intensive care unit of al - zahra hospital in 2010 . the aim of this study was to analyze the satisfaction of the families of icu patients . the results showed that most of the family satisfaction was related to the communication and patient care and the lowest level of satisfaction was about the ability of staff to patients family comfort . this clinical trial was performed with respect to the existing gap for a study carried out for investigating the interventions for the satisfaction of the patients in the special care units and their families in iran .", "the statistical research community was the families of hospitalized patients in neurosurgery intensive care unit of al - zahra ( sa ) hospital , isfahan , iran from may to september 2010 . with respect to inclusion criteria , the families of 64 patients were selected with simple sampling . after obtaining the informed consents from the hospitalized patients , by using the envelopes , which were prepaid by using a table of random numbers , they were divided into two groups ( intervention and control ) . johnson questionnaire for the satisfaction of the family of icu patients was used to measure the family satisfaction . obtaining the written informed consent , completion of the questionnaires about demographic information and the families satisfaction were performed in the second day of hospitalization of the patients in icu in both groups . the interventions were performed in the second and the third day of hospitalization of the patient in the neurosurgery icu by the researcher in the morning shift for the intervention group . the inclusion criteria was included as the following cases : to be a first - degree member of the family , to be older than 18 years , willing to participate in the study , having the power to speak and write in farsi , to be hospitalized one day before the study , lack of physical or mental problem in the family member , no responsibility for the care of another patient , introduced as the first person responsible for the patient care .", "the findings did not show statistically significant difference in the demographic characteristics of the intervention and control groups , such as : age ( p < 0.99 ) , gender ( p < 0.79 ) , marital status ( p < 0.41 ) , educational level ( p < 0.12 ) and relation with patient ( p < 0.54 ) . as shown in table 1 comparison of mean satisfaction score ( 100 * ) of participants in the intervention and control groups the mean of satisfaction score changes of the studied subjects in the intervention and control groups after intervention , there was no significant difference in the mean satisfaction score before the intervention in the intervention and control groups ( p > 0.05 ) . the mean satisfaction score after the intervention in the intervention group was significantly more than the control group ( p < 0.001 ) . the mean satisfaction score in the intervention group after the intervention was significantly higher than before the intervention ( p < 0.001 ) . there was no significant difference in the mean satisfaction score in the control group before and after the intervention ( p > 0.05 ) ( table 2 ) .", "however , the study of steele et al . indicated that clinical training had no impact on the family satisfaction of the patient hospitalized in the icu the results of the present study showed that the nursing interventions based on the family needs increased the patient s family satisfaction in the neurosurgery intensive care unit of al - zahra hospital . study , the results showed that performing the training based on the patients family needs in the icu , decreased the anxiety and increased their satisfaction . in the study of myhren et al . indicated that effective communication of the staff with the families of icu patients would increase their satisfaction . in the study by rosher and robinson , it showed that involving the families in patient care led to increase their satisfaction than before the intervention . due to the differences in the study design , study population , the number of samples and methods of intervention , it would be difficult to compare the results . in chien et al . the mentioned results were consistent with the results of this study , because all of these interventions were some parts of the interventions performed in this study . . therefore , there was no statistically significant difference in the satisfaction level in the control and intervention group .", "in this study , it was shown that the use of nursing interventions based on family needs ( confidence , support , information , proximity and convenience ) had significant impact on the family satisfaction of the patient hospitalized in intensive care unit . they should be based on the family investigation and recognition and their priority needs should be determined in order to cause the greatest satisfaction . this study only examined the effect of nursing interventions in the first days of hospitalization on the satisfaction of the families but the effects on the patient s entire hospitalization period has not been assessed . by performing other researches in this field consequently , the increase in family satisfaction of patients can reduce the stress disorders and improve their mental state and ultimately better support of the patient by the family . , it would be possible to compare the differences in the effects of nursing interventions based on the needs of families in the early days and the whole period of the patient s hospitalization . the findings of this study could be a basis for performing further studies about family needs of the patients in the icu especially with the different forms of culture and economy . the icu nurses must also accept their role in the care of patient s family members ." ]

[ "accordingly , the objective of the present study is to examine the impact of peplau therapeutic communication model on anxiety and depression in patients who were candidate for coronary bypass surgery . coronary artery disease is the most cardiovascular disorder as a health problem in developing and developed countries . in fact , heart surgery significantly influences on the quality of life of patients with cardiovascular diseases . since nursing is a practical discipline based on professional knowledge , it is necessary to use knowledge infrastructure to develop new approaches in clinical practice . hospitalization and a complex surgery such as heart surgery is a stressful process leading to depression in patients . one of the surgical procedures for the treatment of cardiovascular patients is coronary artery bypass surgery . cardiovascular diseases are among the most widespread chronic diseases in most countries . according to forecasts ,", "this is a clinical trial with pre / post testing scheme examined the impact of independent variable ( peplau therapeutic communication ) on the dependent variables ( anxiety and depression ) . the depression and anxiety of patients in both groups were assessed using the hospital anxiety and depression scale ( hads ) at baseline and then two and four months after surgery . due to the lack of access to error rate to calculate the sample size , 10 patients were selected as pilot ( with a depression and anxiety score of 10 or more based on the hospital anxiety and depression scale ) . after performing tests , the place of each meeting was determined with the consent of the patient . at all meetings , the researcher used verbal and nonverbal communication skills to communicate with patients . to ensure the correct application of therapeutic communication skills , a self - control researcher - made tool approved by experts was used . z12+z12s12+s22x1x22 the inclusion criteria were : being in a bypass list , having moderate to severe depression and anxiety scores , no history of mental illness , interesting in participating in the study ( i.e. the tendency of the patient and his family to participate in the intervention ) , lack of previous bypass surgery , aged between 35 and 70 years , ability to communicate verbally and ability to speak persian . the population consisted of all patients who were candidates for coronary artery bypass referred to the research environment on non - emergency basis . data were collected using the hospital anxiety and depression scale ( kanter et al . ) .", "the ethical issues considered in this study include an adequate explanation for the patients and their permission to participate in the study , the lack of any compulsion for patients to participate in the study , refusing to disclose secrets or private matters of patients and confidentiality of information , announcing the results without names and personal details . furthermore , the present study was registered with the irct2013072214110n1 code in clinical trial center ( irct.ir ) . this study was approved by the ethics committee of the jondi shapoor medical university of ahvaz with rec.1392.58 code .", "moreover , the depression level in the intervention group four months after the intervention was decreased compared to the control group ( f=20.58 , p=0.000 ) . however , no significant difference was found between two groups in terms of hospital depression two months after intervention ( p=0.61 ) ( table 5 ) . moreover , the anxiety level in the intervention group two and four months after the intervention was decreased compared to the control group ( f=38.37 , p=0.000 ; f=11.58 , p=0.000 ) ( table 3 ) . as shown in table 4 , the mean depression in the intervention group was reduced after the surgery . the mean postoperative depression in the control group was increased . as shown in table 2 , anxiety was reduced in the intervention group , while postoperative anxiety in the control group was increased . the hospital anxiety in the intervention group in fact , the hospital depression in the intervention group was reduced after the therapeutic communication . the results showed significant differences between experimental and control groups in terms of depression level immediately after surgery , two and four months after surgery after adjustment for post - test scores by eliminating the effect of pre - test . the results showed significant differences between experimental and control groups in terms of anxiety level immediately after surgery , two and four months after surgery after adjustment for post - test scores by eliminating the effect of pre - test .", "according to the results , peplau 's therapeutic communication is effective in reducing anxiety and depression in patients who were candidate for coronary artery bypass . accordingly , to improve the nurse - patient communication and establish more effective therapeutic communication processes which improves clinical basis and can have a positive impact on the treatment and discharge processes and rehabilitation of patients , especially in patients with chronic diseases , training courses should be included in in - service courses to train and introduce medical team with simple and inexpensive communication skills . furthermore , there is evidence that workshops on communication skills for health team can improve health outcomes and satisfaction of patients . depression and anxiety are the most important preventive factors in cardiovascular diseases causing disease rejection by the patient and reduce the incentive to treat and increase the likelihood of disease recurrence [ 25 - 27 ] .", "", "to write this article not contributed any financial resources and costs are the responsibility of the authors .", "", "all rights of this article reserved is owned by the ahvaz jundishapur university of medical sciences ." ]

[ "antigenic analysis of select isolates was performed at the centers for disease control and prevention ( cdc ) in atlanta , georgia , by using the hemagglutination inhibition ( hi ) assay and postinfection ferret antisera ( 11 ) . sixty - four patients in nepal that met us department of defense enrollment criteria ( 9 ) for influenzalike illness were evaluated by using onsite rapid influenza tests ( optical immunoassay rapid diagnostic tests , thermo electron corp . throat swab specimens were collected within the first 72 hours of onset of symptoms , routed through the armed forces research institute for medical sciences in bangkok , thailand , and shipped on dry ice to brooks city base in san antonio , texas , for clinical characterization and diagnosis using traditional culturing techniques and monoclonal antibody staining ( 10 ) . ha nucleotide sequences for all 26 nepal isolates depicted in the phylogenetic analysis are available from genbank under accession nos . rna was extracted from 48-hour shell vial cultures ( 10 ) by using the magnapure lx ( roche molecular , mannheim , germany ) and rna isolation kit ii ( roche molecular ) according to the manufacturer 's protocols . for reverse transcription - polymerase chain reaction ( rt - pcr ) amplification ,", "throat swab specimens were collected within the first 72 hours of onset of symptoms , routed through the armed forces research institute for medical sciences in bangkok , thailand , and shipped on dry ice to brooks city base in san antonio , texas , for clinical characterization and diagnosis using traditional culturing techniques and monoclonal antibody staining ( 10 ) . antigenic analysis of select isolates was performed at the centers for disease control and prevention ( cdc ) in atlanta , georgia , by using the hemagglutination inhibition ( hi ) assay and postinfection ferret antisera ( 11 ) . sixty - four patients in nepal that met us department of defense enrollment criteria ( 9 ) for influenzalike illness were evaluated by using onsite rapid influenza tests ( optical immunoassay rapid diagnostic tests , thermo electron corp .", "ha nucleotide sequences for all 26 nepal isolates depicted in the phylogenetic analysis are available from genbank under accession nos . three - dimensional ha protein structures were generated by using molmol ( 12 ) and the swiss - pdb viewer programs ( 13 ) . rna was extracted from 48-hour shell vial cultures ( 10 ) by using the magnapure lx ( roche molecular , mannheim , germany ) and rna isolation kit ii ( roche molecular ) according to the manufacturer 's protocols . for reverse transcription - polymerase chain reaction ( rt - pcr ) amplification , the ha1 amplicon ( 1177 bp ) was sequenced by using the h3-f7 and h3r-1184 pcr primers ( described above ) and 2 additional internal oligonucleotides , h3r-466 ( 5-ggt - gca - acc - aat - tca - atc-3 ) and h3f-282 ( 5-cag - caa - ctg - tta - ccc-3 ) . 5 l rna was added to a 50-l master mixture containing 1 reaction buffer , 1.6 mmol / l mgso4 , 1 enzyme mixture , and 400 nmol / l primers ( h3-f7 , 5-act - atc - att - gct - ttg - agc-3 and h3r-1184 , 5-atg - gct - gct - tga - gtg - ctt-3 ) by using the superscript iii one - step rt - pcr system ( invitrogen , carlsbad , ca , usa ) . nucleotide sequencing was performed by using the big dye terminator v3.1 kit and analyzed by using an abi 3100 genetic analyzer ( both from applied biosystems , foster city , ca , usa ) according to the manufacturer 's specifications .", "unrooted phylogenetic analysis of ha1 hemagglutinin nucleotide sequences from 26 nepal isolates and h3n2 vaccine and reference strains . was observed in 24 of 26 nepal isolates and represents a genetic marker for the dominant lineage of h3n2 viruses during the 20042005 season . all 4 amino acid changes observed within most of these outbreak isolates are present within a / california/7/04 , a variant strain selected as the h3n2 vaccine strain for the 20052006 influenza season . *", "clinical evaluations and throat specimens were obtained from 64 patients from 3 refugee camps in southeastern nepal ( figure 1 ) . none had previously been vaccinated against influenza and of the 64 specimens collected , 42 ( 66% ) tested positive for influenza a by culture . of the 64 patients , 61 were refugees from bhutan , 1 was a foreign aid worker from japan , and 2 were nepalese nationals . the green circle shows the location of 3 bhutan refugee camps where the outbreak occurred in early july 2004 . most of the patients were < 10 years of age ; 36 were male and 28 were female .", "hi was performed by using postinfection ferret antisera with reference antigens that included the 20042005 h3n2 vaccine seed strain ( a / wyoming/03/2003 ) and the 20052006 southern hemisphere h3n2 vaccine strain ( a / wellington/1/2004 ) . when compared with a / wyoming/03/2003 , 4 of 9 nepal isolates showed 4-fold lower titers ( 1:320 versus 1:1,280 hi units ) than that allowed for homologous titer of the reference antisera . six of 9 nepal isolates were antigenically distinct when compared with the a / wellington/1/2004 strain and showed a 4-fold ( 1:160 versus 1:640 ) reduction in titer to ferret antisera ( table 1 ) . * test antigens are considered antigenically different from the reference strain if hi titers show a 4-fold difference . a", "unrooted phylogenetic analysis of ha1 hemagglutinin nucleotide sequences from 26 nepal isolates and h3n2 vaccine and reference strains . was observed in 24 of 26 nepal isolates and represents a genetic marker for the dominant lineage of h3n2 viruses during the 20042005 season . rt - pcr - based molecular subtyping showed that all 42 specimens were the h3n2 influenza subtype .", ", we describe the genetic analysis of the ha proteins from viruses obtained from an early season outbreak and compare them to current vaccine strains . our findings emphasize the importance of continued molecular surveillance for characterizing emerging influenza drift variants . the 4 substitutions described represent a growing lineage of influenza a ( h3n2 ) viruses characterized since july 2004 ." ]

[ "the aim of this paper is to investigate differences in how obesity relates to indicators of physiological dysregulation in men and women of diverse populations . we examine how elevated weight and obesity ( using an indicator that considers both bmi and waist circumference ) relate to having levels defined as clinical risk for cardiovascular , metabolic , and inflammatory markers in three aging societies that are now relatively similar in life expectancy but that differ in the timing of the epidemiological transition and obesity epidemic , history of economic development , socioeconomic levels , general lifestyle habits , health behaviors , and health care systems : the us , england , and taiwan . this comparison will lead to an improved understanding of how obesity might be differentially related to health and mortality across cultures and lifestyles . rising levels of obesity are becoming a worldwide phenomenon and are increasingly identified as a health problem across the globe [ 14 ] . comparative studies of the links between obesity and health outcomes and risk factors for obesity comparing western and non - western countries indicate important differences in the causes and consequences of obesity .", "we use data from three nationally representative samples : the us national health and nutrition examination survey ( nhanes , 20032006 ; n = 3855 ) , the english longitudinal study of ageing ( elsa , 2004 - 2005 ; n = 9139 ) , and the social environment and biomarkers of aging study ( sebas ) in taiwan ( 2000 ; n = 1023 ) . we examine multiple covariates in our investigation of the relationship between obesity and biological risk . we use logistic regression models to determine the odds of having at - risk levels of a specific biomarker for obese men and women among the three populations . for all countries , ordinary least squares ( ols ) regression models were used to determine the relationship between the summary measures of biological risk and the composite measure of obesity and adiposity . sebas is drawn from a follow - up survey of the survey of health and living status of the near elderly and elderly in taiwan ( also known as the taiwan longitudinal study of aging ( tlsa ) ) , a nationally representative survey of taiwanese adults ( including institutionalized individuals ) collected in 1989 , 1993 , 1996 , 1999 , and 2000 . in 2000 , a subsample of individuals was randomly selected for inclusion in sebas .", "the size of the effects of the obesity categories is reduced on the 8-indicator summary measure in both england and the us , indicating the strong link between crp and obesity . the predicted values indicate that the us has the highest biological risk score within each respective weight category among men and women of the same age and lifestyle behaviors . with the exception of women in the normal bmi and high waist group , england has the second highest biological risk score within each weight category , followed by taiwan . among 65-year - old women with the noted lifestyle behaviors and with a normal bmi and high waist only very obese women have a higher alternate biological risk summary score ( 08 ) . in taiwan , obese and normal bmi and high waist women exhibit higher alternate biological risk summary scores compared to their normal bmi and normal waist counterparts , except when smoking status , physical activity , and use of hypertensives are included . figures 1(a ) and 1(b ) illustrate the predicted alternate biological risk score ( 08 ) for each weight category for men and women ( respectively ) aged 65 who are nonsmokers , do not engage in physical activity , and are currently taking antihypertensive medication . both among the obese and very obese , the average bmi is higher in the us and england compared to taiwan . being obese or very obese is also related to a higher biological risk summary score ( 09 ) for men in the us and england .", "this study observes three general findings about how biological risk is associated with obesity in three countries that differ in lifestyle and culture . our finding of the biological risks associated with obesity among older taiwanese adults underscores the growing concern for risks associated with obesity in countries rapidly undergoing modernization . in comparing the biological risk of obese individuals among the three countries , we are able to use these international comparisons to our advantage to examine how differences in modernization influence the health of older adults in different populations the country differences in the links between obesity and physiological dysregulation are particularly marked when comparing obesity among taiwanese older adults relative to westernized populations , such as the us and england . this suggests that despite the greater use of medications to treat hypertension in the us , obesity among americans is associated with greater overall biological risk than the other two countries . first , obesity is associated with physiological dysregulation in all countries with differences in the links between specific indicators of biological risk and obesity . further examination of these relationships over time and across other countries will contribute to our understanding of the potential factors responsible for these country - specific variations in biological risk , as obesity becomes increasingly more prevalent and older adults in various countries live more years with obesity and increased adiposity ." ]

[ "male macroprolactinomas ( mprl ) are usually revealed by headaches , visual troubles and gonadal insufficiency . however , in some very rare cases it can be a primary presentation or appear after radiotherapy or medical treatment used for tumors destroying the sellar floor and/or the skull base . our aim was to analyze sm frequency among male mprl deemed to be very invasive tumors , to report our cases and analyze the circumstances under which the dangerous neurological complication appeared . suppurative meningitis ( sm ) , a life - threatening condition , is scarcely observed in subjects with macro tumors secreting prolactin ( prl ) and in other pituitary tumors ( pt ) . this destruction leads to cerebral spinal fluid ( csf ) leak , which can act as an entry portal for organisms predisposing to meningitis .", "that one was based on prl , growth hormone ( gh ) , insulin growth hormone ( igf1 ) , cortisol , adrenocorticotropic hormone , testosterone , follicle stimulating hormone , luteinizing hormone , thyroid stimulating hormone and free thyroxin . in this retrospective study , we analyzed 82 subjects with mprl to look for symptoms , clinical signs and biological proof of sm . , we took into account medical history , clinical examination , routine exploration , csf analysis and hormonal assessment . radiological assessment was based on cerebral computed tomography scan and/or magnetic resonance imaging ( mri ) .", "three were first hospitalized in the department of infectious diseases for typical symptoms and signs of sm ; that one was proved by csf biochemical analyses . the fourth one was hospitalized in our department for the fourth episode of sm which was proved by csf analysis after lumbar puncture .", "then , the pt was treated with dopamine agonists that were successful on prl ( 25 ng / ml ) and on tumor size [ figure 1 ] . after a follow - up of 7 years , cerebral mri showed a pt invading cavernous sinuses , the sphenoid sinus and the brain [ figure 1 ] . hormonal assessment [ table 1 ] demonstrated high prl with gonadotroph deficit . ( a ) before bromocriptine ; ( b ) after treatment , bromocriptine intake and sm disappearance tumor size , hormonal assessment of our 4 patients , and bromocriptine dose used to reduce tumor volume and normalize prolactin . the pt was secreting prl [ table 1 ] . that one was normalized by bromocriptine and the tumor size was significantly reduced .", "cerebral mri showed a pt invading cavernous sinuses , the sphenoid sinus and the brain [ figure 1 ] . hormonal assessment [ table 1 ] demonstrated high prl with gonadotroph deficit . then , the pt was treated with dopamine agonists that were successful on prl ( 25 ng / ml ) and on tumor size [ figure 1 ] . after a follow - up of 7 years , invasive and aggressive pituitary tumor destroying the sella floor , responsible for suppurative meningitis ( sm ) in a 22-year - old man . ( a ) before bromocriptine ; ( b ) after treatment , bromocriptine intake and sm disappearance tumor size , hormonal assessment of our 4 patients , and bromocriptine dose used to reduce tumor volume and normalize prolactin .", "the previous ones were proved in 1984 , 1988 and 1990 . clinical examination confirmed the meningeal syndrome and noticed rhinorrhea . cerebral mri showed an invasive and multidirectional pt measuring 47 mm 40 mm 30 mm destroying the sella floor and filling the sphenoid sinus [ figure 2 ] . large invasive tumor destroying the sella floor , responsible for suppurative meningitis in a 49-year - old man . the pt was secreting prl [ table 1 ] . that one was normalized by bromocriptine and the tumor size was significantly reduced . ( a ) before medical treatment ; ( b ) liquification of the tumor after bromocriptine", "a man aged 25 , with a history of chronic otitis and arrested puberty , was diagnosed as a multidirectional prolactinoma destroying the sella floor and measuring 30 mm 30 mm 30 mm [ figure 3 ] . the pituitary tumor filling the sphenoid sinus before bromocriptine ( a ) and after bromocriptine ( b ) sm was sensitive to antibiotics . under dopamine agonists prl was normalized and the tumor volume decreased .", "a 29-year - old man was sent to our unit for a prolactinoma revealed by epilepsy crises . mri showing a large tumor invading cavernous sinuses , the brain and sphenoid sinus ( a ) . the pt was very large ( 68 mm 50 mm 50 mm ) and multidirectional with an extension to the chiasm , cavernous sinuses , posterior and nasal areas [ figure 4 ] . after 3 months he had rhinorrhea , then one episode of sm sterilized by antibiotics . after dopamine agonists ( b ) the tumor size was reduced the table 1 shows tumor sizes , hormonal parameters and bromocriptine dose which was used to treat the 4 prolactinomas .", "if this attitude fails , surgical repair is recommended although the reparation may represent a great challenge because of the many potential sites of the csf around the tumor . if surgical repair in not feasible some authors recommend a vaccination against pathogens of the upper respiratory tract such as streptococcus pneumonia , haemophilus influenza and neisseria meningitidis to prevent sm . the most difficult differential diagnosis with meningitis occurring in people with pt is pituitary apoplexy , which mimics perfectly bacterial meningitis symptoms . the true microbial meningitis secondary to pt is an exceptional phenomenon compared to pituitary apoplexy , which is relatively more frequent . to our best knowledge we find only one case concerning gh adenoma treated by somatostatin 's analogs . a case of recurrent meningitis which appeared many years after neurosurgery was observed in nelson syndrome too . contrary to many authors and in agreement with ciatto , we think the association of pituitary adenoma and meningitis is more common than it is generally supposed as we observed it in nearly 5% of our male mprl . curiously sm was not reported in mixed pt and gonadotroph adenomas which are usually very large and very invasive .", "the described cases emphasize the necessity of an early diagnosis and treatment of large and invasive pt , especially male mprl . medical treatment , which is now the gold standard for prolactinomas , should be gradual and well monitored to avoid rhinorrhea or otorrhea which can lead to potentially fatal bacterial meningitis . three revealed the pt , and one was observed after medical treatment . in 2 cases" ]

[ "we report a series of 300 patients operated for lumbar dissectomy by destandau endospine system . many studies have not been reported in literature for lumbar discectomy by destandau endospine system .", "a total of 300 patients suffering from lumbar disc herniations were operated between january 2002 and december 2008 . the results were evaluated by macnab 's criteria after a minimum followup of 12 months and maximum up to 24 months . technique comprised localization of symptomatic level followed by insertion of an endospine system devise through a 15 mm skin and fascial incision . endoscopic discectomy is then carried out by conventional micro disc surgery instruments by minimal invasive route .", "the complications observed were discitis and dural tear in five patients each and nerve root injury in two patients . based on modified macnab 's criteria , 90% patients had excellent to good , 8% had fair , and 2% had poor results . 90% patients were able to return to light and sedentary work with an average delay of 3 weeks and normal physical activities after 2 months .", "", "the advantages of use of minimal invasive spinal surgical techniques in treatment of lumbar disc herniation is small incision , limited tissue disruption , enhanced visualization due to better magnification and illumination , shorter hospital stay , and faster recovery time.13 among many posterior spinal endoscopic systems used for disc surgery , destandau endospine system and foley and smith 's metrx system are seen as viable alternatives to open disc surgery.46 the aim of this study was to present results in 300 patients operated by edoscopic discectomy and to discuss technical points to shorten the learning curve .", "a total of 475 patients suffering from different type and level of lumbar disc herniation with radiculopathy and degenerative lumbar canal stenosis were operated between january 2002 and december 2008 . the inclusion criteria were patients having lumbar disc prolapse with unilateral radiculopathy , on clinical evaluation , positive straight leg raise or femoral stretch test , and identification of a single nerve root lesion on mri . however , in present study , none of the patients opted for surgery at 6 weeks after completion of conservative treatment . modified macnab 's grading was as follows : excellent - no pain / restriction of activity and being able to do all activities ; good - occasional pain with relief of presenting symptoms and returning to work with some modification ; fair - some improved functional capacity but still handicapped or unemployed ; and poor results - having objective symptoms of root involvement or repeat surgery at the index level . wound was inspected for any drainage or evidence of infection . complains about fever , backache , and leg discomfort", "at final follow - up , 90% patients were relieved of sciatica and were satisfied with procedure . causative factor for dural tears in present study were as follows : three patients had dural rent due to forceful retraction of dura and nerve root by dural and nerve root retractor . this happened when kerrison rongeur was used to open the tight recess resulting in dural tear and nerve root injury . this was observed in patients in whom there was significant posterolateral herniation resulting in tenting of dura and nerve root at recess . in this situation , authors have found gentle mobilization of nerve root and dura by nerve root hook or approaching and debulking the offending disc through axilla before proceeding with retraction of nerve root and discectomy .", "posterior paraspinous process endoscopic access to lumbar disc herniation requires creation of working space where no or little space existed before . microendoscopic dissectomy ( med ) combines standard microsurgical technique with an endoscope , enabling the surgeons to address all types of disc herniations including decompression of nerve root and lateral recess . chemonucleolysis was reported by smith.15 nonetheless , based upon various randomized clinical trials , the efficacy of chemonucleolysis compared with more traditional and open procedures for the operative treatment of lumbar disc herniations remained speculative.16 the use of percutaneous nucleotomy , laser discectomy , and intradiscal electrothermal annuloplasty ( idet ) compared with microdiscectomy remains unclear , and it is attributed to the lack of high - quality studies.17 conclusions about the efficacy of some of the aforementioned minimally invasive procedures ( e.g. , chemonucleolysis , apd , idet ) were questionable with regard to disc - related pathology.18 therefore , lumbar microdiscectomy remained the gold standard for addressing a herniated or sequestrated intervertebral disc ; however , a movement toward more minimally invasive approaches that would yield superior outcomes , while minimizing excessive soft and bony tissue removal and minimizing soft tissue trauma , were sought . as such , however , the endospine system has been excellent modality to address discogenic radiculopathy and to decompress lumbar canal stenosis . with proper patient selection , discectomy and adequate nerve root decompression by doing foraminotomy or opening a lateral recess stenosis by minimally invasive technique can be achieved with this system ." ]

[ "this article will draw a conceptual model based on patients source of information , perceived benefits , perceived risks , and medical tourism destination image with available literature that will be helpful to mangers to draw their future course of action for competitive advantage and at the same time fulfill the gap in available literature . accounts detailing size and market of the industry are large in number yet there is scarcity of literature detailing about role and significance of different variables and linking them to form conceptual and theoretical framework which reflects decision making of international patients for taking part in medical tourism . medical tourism is illustrated as occurrence in which individuals travel abroad to receive healthcare services ( 1 ) . the prime driving factors in medical tourism are increased medical costs , increased insurance premiums , increasing number of uninsured or partially insured individuals in developed countries , long waiting lists for procedures in countries having public healthcare system , availability of high quality services at affordable price , and cheaper airfare . increased communication and internet access in developing countries after thorough review it was found that there is huge gap in literature available in medical tourism . are other supporting factors , which help patients to develop awareness about international travel for medical care ( 47 ) .", "thailand for example attracts more patients from developed countries because of already established quality tourism infrastructure offer excellent accommodation and hospitality services to international patients ( 81 ) . despite offering excellent medical care to international patients by hospitals in india most of the international patients visit india worry about accommodation quality , food hygiene , and personal safety ( 82 , 83 ) . print media play an important role in promotion and advertising medical tourism in major source countries , publish attractive and evidence based stories in their different segments related to health and travel . most of the hospitals in india provide medical care services to international patients are certified by jci which has reputation for hospital safety and regulatory management and recognized worldwide ( 49 ) . quality of medical services is one of the aspects which drive medical tourism high towards success . collaboration with prestigious hospitals in us and europe in also indicate seriousness towards providing quality services to patients by medical tourism hospitals at different destination ( 21 , 78 ) . distinguishing that major market drivers such as lack of health insurance and unaffordability are influencing patients to take procedures abroad , websites of brokerages predominantly display the comparative cost charts and price schedules . image formation agents are the factors which control the perception and evaluation of image ( 13 ) . researchers addressed amount and diversity of information sources that expose individuals including information related to destination acquired through visiting particular place . various studies performed on destination selection behavior of tourists explored that with combination of other different factors , information sources explored by individuals determined certain destinations as possible alternatives ( 1317 ) .", "image formation agents are the factors which control the perception and evaluation of image ( 13 ) . researchers addressed amount and diversity of information sources that expose individuals including information related to destination acquired through visiting particular place . print media play an important role in promotion and advertising medical tourism in major source countries , publish attractive and evidence based stories in their different segments related to health and travel . various studies performed on destination selection behavior of tourists explored that with combination of other different factors , information sources explored by individuals determined certain destinations as possible alternatives ( 1317 ) . consumer behavior studies have already established the effects of source of information on purchase behavior ( 18 ) . magazines like forbes and wall street journal analyzed the business aspect of medical tourism as brokers assertively marketed medical tourism to consumers , employers , and insurers ( 38 ) .", "the above mention discussion clearly indicates that process of image formation is not just emphasis on physical attributes of destination but also depends on benefits or consumption values of product or service consumers hold in their minds . literature revealed that not every physical attribute of a destination has influence on image formation process . literature revealed that many researchers made distinction between physical and beneficial aspect of a product . conditional value. the decision making of consumer choice behaviour can be based on all five or any of the five consumption values . sheth , newman and gross ( 1991 ) developed a theory known as theory of consumption values , which focuses on consumption values of products and services ( 45 ) . benefits offered by a product or service are considered as consumption value of the same ( 44 ) .", "most of the citizens of yemen do not obtain resources to go for leisure travel at different parts of the world therefore traveling to foreign country for medical services provide chance to explore new territory , meet new people , and experience different social culture ( 27 , 50 ) . many researchers found in their studies that patients were highly motivated to travel to a particular destination due to emotional attachment with doctor , hospitals or destination ( 6 , 50 ) . such as , many omani patients visit shiraz in iran for treatment due to religious and cultural familiarity ( 52 ) . senior male members of the household consider it as opportunity to increase their reputation in society . availing expensive and prestigious medical care service in foreign countries and the associated sacrifices with it would make stories full of pride to tell to others ( 51 ) . conditional value can be considered as major factor pushes patients to travel abroad because medical needs are crucial and considered as unavoidable so have great conditional value . although availability of literature explain social value in medical tourism is less , little available literature clearly define the social value factor with - in the patient groups especially from less developed regions . however , the concept of social value and epistemic value may not be associated with patients from developed regions . most of the hospitals in india provide medical care services to international patients are certified by jci which has reputation for hospital safety and regulatory management and recognized worldwide ( 49 ) . medical tourism destinations offer very low price for medical services to international patients in comparison to developed countries , and most of the time price of a procedure in india and other asian destination is equal to 1/10 of price in us or european countries ( 4 , 4648 ) .", "apart from physical - health and service related risks , every destination have its own associated risks ; risks of terrorism , crime , and personal safety are associated with medical tourism destination due to falling in middle and lower middle - income countries in development status ( 63 ) . financial risks , service quality risks , socio - psychological risk , natural disasters and car accident risk , and perceived risks is defined as perception of an individual about the probability that a particular action will lead them to a situation exposed with danger more than acceptable limit , and will lead to influence travel decision - making ( 53 ) . security and safety at the destination is major issue of concern by the potential travelers . in travel decision , patients may vulnerable to many risks if consider to take medical services at medical tourism destinations . researchers consider terrorism and kidnapping of rich patients and unstable economy of the destination as other risks associated with medical related travel .", "according to researchers , destination image is the total of ideas , beliefs , and impressions individuals possess about the attributes of destination and or activities available at a destination after processing information from various sources over a period of time ( 39 , 65 ) . thailand for example attracts more patients from developed countries because of already established quality tourism infrastructure offer excellent accommodation and hospitality services to international patients ( 81 ) . despite offering excellent medical care to international patients by hospitals in india most of the international patients visit india worry about accommodation quality , food hygiene , and personal safety ( 82 , 83 ) . after thorough literature review authors identified four dimension of cognitive medical tourism destination image based of different attributes projected by different medical tourism destinations , as ; medical amenities , general infra - structure , destination image as overall imagery picture individual obtains in his mind ( 66 ) . in the early studies on travel , researchers used the concept of stereotypic image of a travel destination ( 67 , 68 ) . later on , to understand the destination image formation process researchers developed an alternative framework and argued destination image consist of two components i.e. attribute based and holistic ( 66 ) . attribute based component refers to the perception of individual based on destination features and holistic component refers to imaginary mental image of destination . later on ,", "prominent databases ( 2013 , 2014 , 2015 ) have been searched to obtain desire literature related to medical tourism including science direct , utmj.org , nih.gov , nchu.edu.tw , palgrave - journals , medretreat , biomedcentral and so on and the keywords used are medical tourism , information sources , medical travel , health travel and so on . google search was performed to get latest data related to medical tourism . to know in detail about the variables used in the framework scientific research databases the key words used to find out research variables as well as relationship between researches variables were destination image , destination information sources , beneficial image , perceived travel risks , cognitive image , affective image , consumption values and so on . to obtain data about medical tourism various types of available literature were reviewed such as industry reports , market research reports , media reports and internet sources , however for identification and explanation of variables scientific literature published in reputed journals only were included .", "the theory of planned ( tpb ) is an established and comprehensively tested model details the relationship between beliefs , attitude , intention , and actual behavior of consumers ( 85 ) . the model is perfectly applied in a variety of studies including leisure and tourism travel , and hospitality ( 36 , 8688 ) . based on above discussion it could be assumed that image of medical tourism destination will positively influence visit intention of international patients . conceptual framework international patients travel decision making these research studies emphases on the factors such as motivations , information sources , attitudes , and visit intentions , thus authors argue that attitudinal theory provides a sound foundation to understand travel intentions of international patients and underpin the conceptual model discussed in this article . it could be assumed that medical tourism information sources will have positive influence on perceived travel benefits of international patients . whereas , information sources of medical tourism will negatively influence perceived travel risks of international patients . , there is significant theoretical and empirical link between cognitive destination image and behavioral intention ( 100 ) .", "literature reveals about associated benefits and risks related to travel abroad for medical purposes but do not conceptualize it in the process of decision - making . though , there has been advance in explaining different factors play important roles in international patients travel , however , there is scarcity of literature conceptualizing these factors into a framework and test it empirically . the article is a sincere effort by authors to establish conceptual framework which explains decision - making process of international patients . sources of information in medical tourism play significant role in development of attitude as well as intention , has already been established in consumer behavior . the proposed framework will encourage future researchers to test different variables empirically and establish the model of international patients travel behavior . however , need is to test its significance in medical tourism decision - making process .", "ethical issues ( including plagiarism , informed consent , misconduct , data fabrication and/or falsification , double publication and/or submission , redundancy , etc . ) have been completely observed by the authors ." ]

[ "this review highlights three rtk signaling pathways involved in head and neck squamous cell carcinoma ; egfr , the type 1 insulin - like growth factor receptor ( igf-1r ) and the hepatocyte growth factor ( hgf ) receptor ( met ) . this short review will explore the relative contribution of each signaling axis to disease progression , potential modes of cross - talk , and targeted clinical approaches under investigation for disease management . squamous cell carcinoma of the head and neck ( hnscc ) is a heterogeneous disease that includes tumors arising from the mucosal epithelial surface of the oral cavity , oropharynx , hypopharynx , and larynx . although these tumors originate within different anatomic sites within the upper aerodigestive tract , they are histologically identical ( 95% of hnscc are squamous cell carcinomas ) , share common etiologic risk factors and overlapping metastatic target site profiles ( reviewed in [ 13 ] ) . these findings suggest a strong etiologic role for rtk dysregulation in this type of tumors . given this association , patients with head and neck squamous cell cancers are well positioned to benefit from existing and future molecular targeted agents directed against oncogenic rtks such as egfr ( reviewed in ) . dysregulation of ~30 rtks are associated with neoplastic transformation and cancer progression [ 2325 ] .", "erlotinib is a selective inhibitor of the egfr that also shows antitumor activity in hnscc comparable to standard combination chemotherapy . gefitinib ( iressa ) is a small molecule tki - targeted to the intracellular active site for phosphorylation that has been tested in clinical trials involving hnscc patients , as a single agent or in combination with radiation treatment . cetuximab has been approved for use in combination with radiation for treating patients with locally advanced hnscc and as monotherapy for patients with recurrent hnscc . cetuximab enhances the effects of many standard cytotoxic agents , including cisplatin ( the conventional platinum - fluorouracil chemotherapeutic ) , and in combination with chemotherapy it can elicit antitumor responses in tumors that previously failed to respond to that chemotherapy . cetuximab is a valuable treatment option in head and neck patients as it synergizes with current treatment modalities . accordingly , significant effort has focused on egfr signaling as a therapeutic target for treating hnscc patients .", "it remains to be determined whether cellular cross - talk between igf-1r and egfr has an important role in determining the biological aggressiveness of hnscc or resistance to egfr - targeted therapies . however , the efficacy of igf-1r - targeted therapy for treating patients with hnscc , particularly cross - talk with egfr , warrants further investigation . to date , the effect of blocking oncogenic igf-1r and egfr signaling have been studied more extensively in breast cancer cell lines [ 7375 ] . however , only igf resulted in the phosphorylation of both receptors . using a mouse xenograft model for hnscc , treatment with antibodies against igf-1r , egfr or several monoclonal antibodies and tkis for igf-1r have been tested in preclinical studies and early phase clinical studies . another promising rtk under preclinical and clinical evaluation for head and neck cancers includes the igf-1r ( reviewed in [ 66 , 67 ] ) . these studies will be critical for evaluating whether the use of anti - igf-1r and egfr - targeted treatments will be more effective than single - agent modalities for treating patients with hnscc .", "arq197 ( arqule ) is a nonatp - site competitive , selective small molecule inhibitor of the met intracellular region . the met receptor is a single pass transmembrane protein that upon binding its ligand hgf also known as scatter factor - promotes increased cell proliferation , survival and motility ( reviewed in [ 78 , 79 ] ) . subsequent activation of the mapk and jun - n - terminal kinase ( jnk ) pathways is responsible for the mitogenic and motogenic properties of met / hgf signaling resulting in invasive growth , depending on the physiological setting . overall , met , and hgf - targeted therapies have been well tolerated in clinical trials with negligible toxicities . although their efficacy for treating a variety of solid tumors is increasingly recognized , we await results of preclinical and clinical trials for head and neck cancer that are ongoing . increased met signaling in human cancers can be the result of enhanced ligand - binding ( autocrine and paracrine ) , met overexpression or missense mutations that often induce constitutive kinase activity , failure of met down regulation and interactions with other cell surface receptors such as egfr ( reviewed in [ 8284 ] ) . met is overexpressed in 84% of hnscc patient samples .", "resistance to cetuximab has been associated with the coexpression of the truncated egfr mutant , egfrviii with wild - type egfr . the apparent cooperation between igf-1r and egfr in promoting hnscc pathogenesis as well as resistance to egfr - targeted therapy , suggests an advantage to cotargeting these signaling axes for the treatment of head and neck cancers . to date , the effect of blocking oncogenic igf-1r and egfr signaling have been studied more extensively in breast cancer lines . accumulating evidence suggests that human papilloma virus ( hpv ) 16 status ( hpv+ ) is an important prognostic factor associated with a favorable outcome in a subset of head and neck cancers , including oropharyngeal and tonsilar cancers . since met has been reported to promote invasive and angiogenic effects in the tumor microenvironment , the use of hgf / met inhibitors may afford a means of impairing tissue colonization as well as tumor vascularization in head and neck cancer patients . igf-1r mediates resistance to anti - egfr therapy in primary glioblastoma through the continued activation of the pi3k / akt survival pathway .", "targeted therapies that block egfr , met , and igf-1r signaling in head and neck cancers continue to show promising results in preclinical studies and clinical trials . however , it is difficult to predict which patients are most likely to benefit from these therapeutics and potential side effects during long - term in vivo use . given the interplay between these rtk signaling pathways and the mediocre results obtained with monotherapy regimens thus far , clinical trials will be required to determine how egfr- , met- , and igf-1r - targeted therapies can be used in combination in order to definitively abrogate their common downstream oncogenic signaling networks . although gaps in our knowledge concerning the role of met and igf-1r in head and neck tumorigenesis , as well as acquired resistance to antiegfr therapies remain to be addressed , efforts to translate current information towards clinical applications continue to be impressive ." ]

[ "the second set of cultures was treated with tq ( 0.01 , 0.1 , 1 , and 10 m ) on the eighth div for 4 consecutive days to investigate the effect of tq on the survival of dopaminergic neurons . cultures were treated with 1 m of tq ( a concentration that significantly protected dopaminergic neurons in mpp - treated cultures ) on the eighth div and co - administered with mpp ( 10 m ) on the tenth div for 2 days . on the twelfth div , the fourth set of cultures was concomitantly treated with tq ( 0.01 , 0.1 , 1 , and 10 ) , and 10 m of mpp on the tenth div for 48 h. dopaminergic neurons were identified immunocytochemically by staining tyrosine hydroxylase . the ldh release is proportional to the number of damaged or destroyed cells.11,12 lysotracker deep red ( life technologies , invitrogen , grand island , ny , usa ) is a red fluorescence dye used for labeling acidic organelles in live cells including autophagolysosomes . the ldh activity was calculated from the slope of the decrease in optical density at 334 nm over a 3 min - time period . the third set of cultures was treated with 10 m of mpp on the tenth div for 48 hours ( h ) . the medium was exchanged on the first day in vitro ( div ) and on the third div . on the fifth div , the jc-1 red : green ratio is used to estimate changes in m.13 the jc-1 was dissolved in dmso and further diluted in dmem ( 10 g / ml final concentration ) .", "this in vitro study was conducted in the chemistry and biochemistry institute , university of veterinary medicine , vienna , austria between june and august 2013 in accordance with the guidelines of the european union council ( 86/609/eu ) for the use of laboratory animals . the work does not require approval from the ethics committee as it used mouse embryos under the fifteenth day of gestation . primary mesencephalic cell cultures were prepared from c57/b16 embryos according to radad et al.10 to summarize , embryonic mouse mesencephala were dissected on the fourteenth day of gestation and cut into small pieces in a drop of dulbecco s phosphate - buffered saline ( dpbs ) ( invitrogen , darmstadt , germany ) , 2 ml of 0.2% trypsin solution ( invitrogen , darmstadt , germany ) and 2 ml of 0.02% dnase i solution ( roche , berlin , germany ) were added and the tissue was subsequently incubated in a water bath at 37c for 7 minutes ( min ) . serum - free supplemented dmem was used for feeding from the sixth div , and subsequently replaced every second day . the medium was exchanged on the first day in vitro ( div ) and on the third div . on the fifth div , the tissue pellet was triturated 2 - 3 times with a fire - polished pasteur pipette , each time 0.02% dnase i ( invitrogen , darmstadt , germany ) was included in the medium .", "the second set of cultures was treated with tq ( 0.01 , 0.1 , 1 , and 10 m ) on the eighth div for 4 consecutive days to investigate the effect of tq on the survival of dopaminergic neurons . four sets of cultures were treated as follows : the first set of cultures was treated with dmso and kept as untreated controls . the fourth set of cultures was concomitantly treated with tq ( 0.01 , 0.1 , 1 , and 10 ) , and 10 m of mpp on the tenth div for 48 h. the third set of cultures was treated with 10 m of mpp on the tenth div for 48 hours ( h ) . a stock solution of tq ( sigma aldrich , hamburg , germany ) ( 10 mm ) was prepared in dimethyl sulfoxide ( dmso ) .", "the reaction product was developed in a solution of diaminobenzidine ( 1.4 mm ) in pbs containing 3.3 mm hydrogen peroxide and stained cells were counted with a nikon inverted microscope in 10 randomly selected fields per well at 10x magnification . cultures were washed 3 times with pbs and incubated with 5% horse serum ( vectastain abc elite kit , biozol diagnostica vertrieb gmbh , eching , germany ) for 90 min to block nonspecific binding sites . to determine the number of thir in cultures cultures were rinsed carefully with phosphate buffered saline ( pbs , ph 7.2 ) at the end of each treatment and fixed in 4% paraformaldehyde for 45 min at 4c . after washing with pbs , cells were permeabilized with 0.4% triton x-100 for 30 min at room temperature . , cells were sequentially incubated with anti - th primary antibody overnight at 4c , biotinylated secondary antibody ( vectastain ) , and avidin - biotin - horseradish peroxidase complex ( vectastain ) for 90 min at room temperature and washed with pbs between stages .", "the ldh activity was calculated from the slope of the decrease in optical density at 334 nm over a 3 min - time period . cellular injury was quantitatively assessed by measuring the activity of lactate dehydrogenase ( ldh ) released from damaged cells into the culture medium . the decrease of nadh was spectrophotometrically ( novaspec ii , ge healthcare europe gmbh , freiburg , germany ) monitored . the reaction was initiated by mixing 0.2 ml of cell - free supernatant ( diluted 1:1 with aqua dest . ) with potassium phosphate buffer containing - nicotinamide adenine dinucleotide ( nadh ) and sodium pyruvate ( 0.18 and 0.62 mm in potassium phosphate buffer ) in a final volume of 0.5 ml in 1 ml cuvettes .", "cultures were treated with 1 m of tq ( a concentration that significantly protected dopaminergic neurons in mpp - treated cultures ) on the eighth div and co - administered with mpp ( 10 m ) on the tenth div for 2 days . on the twelfth div , 5,5,6,6-tetrachloro-1,1,3,3-tetraethylbenzimidazolyl - carbocyanine ( jc-1 ) is a lipophilic cationic dye that selectively enters into mitochondria . in healthy cells with high mitochondrial membrane potential ( m ) lysotracker deep red ( life technologies , invitrogen , grand island , ny , usa ) is a red fluorescence dye used for labeling acidic organelles in live cells including autophagolysosomes . the dye remains in the monomeric from with green fluorescence in case of apoptotic or damaged cells . the jc-1 red : green ratio is used to estimate changes in m.13 the jc-1 was dissolved in dmso and further diluted in dmem ( 10 g / ml final concentration ) .", "tq - thymoquinone , mpp - 1-methyl-4-phenylpyridinium summary of the neuroprotective effect of tq against mpp treatment in primary mesencephalic cell culture . cultures treated with mpp showed a significant decrease in red : green fluorescence ratio of jc-1 by around 17% compared with untreated controls ( figure 4a ) . however , co - treatment of mpp - treated cultures with 1 m tq from the eighth - twelfth div significantly increased m as it increased the red : green fluorescence ratio of jc-1 by around 24% compared with mpp - treated cultures ( figure 4a ) . treatment with tq improves the morphology of thir neurons compared to mpp - treated cultures . div - day in vitro , sem - standard error of mean , mpp - 1-methyl-4-phenylpyridinium , tq - thymoquinone the tq increased lysotracker deep red fluorescence and the red : green fluorescence ratio of jc-1 , and decreased mpp - induced apoptotic cell death in primary mesencephalic cell culture . th - tryosine hydrolase , thir - tyrosine hydroxylase immunoreactive , div - day in vitro , sem - standard error of mean , mpp - 1-methyl-4-phenylpyridinium , tq - thymoquinone the tq attenuated mpp - induced ldh increase in primary mesencephalic cell culture .", "tq - thymoquinone , mpp - 1-methyl-4-phenylpyridinium summary of the neuroprotective effect of tq against mpp treatment in primary mesencephalic cell culture . cultures treated with mpp showed a significant decrease in red : green fluorescence ratio of jc-1 by around 17% compared with untreated controls ( figure 4a ) . however , co - treatment of mpp - treated cultures with 1 m tq from the eighth - twelfth div significantly increased m as it increased the red : green fluorescence ratio of jc-1 by around 24% compared with mpp - treated cultures ( figure 4a ) . treatment with tq improves the morphology of thir neurons compared to mpp - treated cultures . div - day in vitro , sem - standard error of mean , mpp - 1-methyl-4-phenylpyridinium , tq - thymoquinone the tq increased lysotracker deep red fluorescence and the red : green fluorescence ratio of jc-1 , and decreased mpp - induced apoptotic cell death in primary mesencephalic cell culture . th - tryosine hydrolase , thir - tyrosine hydroxylase immunoreactive , div - day in vitro , sem - standard error of mean , mpp - 1-methyl-4-phenylpyridinium , tq - thymoquinone the tq attenuated mpp - induced ldh increase in primary mesencephalic cell culture .", "in the present study , tq was investigated to ascertain whether it protected mesencephalic dopaminergic neurons against mpp - induced cell death through activation of enzymatic degradation , preservation of mitochondrial function , and inhibition of apoptotic cell death . clearly , mpp was found to significantly decrease the survival of dopaminergic neurons and increase the release of ldh into the culture medium . the mpp toxicity involves its selective uptake by dopaminergic neurons through the dopamine transporter and inhibition of mitochondrial complex i activity with subsequent mitochondrial depolarization.14 in parallel , the use of jc-1 fluorescence dye in our current study showed that mpp significantly decreased the m of cultured cells as indicated by the decreasing red : green fluorescence ratio of jc-1 .", "whenever a manuscript contains material ( tables , figures , etc . ) which is protected by copyright ( previously published ) , it is the obligation of the author to obtain written permission from the holder of the copyright ( usually the publisher ) to reproduce the material in neurosciences . please submit copies of the material from the source in which it was first published ." ]

[ "non - union usually can definitely diagnosed within a year of fracture fixation with the same being achieved within 3 months at times . after non - union has been established , intervention is inevitable . we report a case of non - union of the fracture of the neck of the femur , who refused additional procedures after his non - union had been established . there are however , complications unique to femoral neck fractures which are almost impossible to predict . non - union and avascular necrosis the femoral head often leads to healing complications , while the more predictable prosthetic replacements are associated with poorer function and significant complications . the treatment of these fractures depends on the age of the patient , fracture displacement , bone quality , timing of surgery and activity level of the patient . the decision to proceed in the management of failed fixation is based on the careful consideration of various factors . in young patients displaced fractures in healthy , active patients are best treated by reduction and internal fixation .", "a 38-year old male businessman reported to the out door department of our hospital with a history of a fall from height . clinical and radiological examination revealed a displaced fracture of the neck of the femur which was graded as garden type 4 ( fig . twenty - six months into the post operative followup the patients pain subsided and radiographs started showing signs of union . a radiograph taken 32 months after the fixation showed full union . onward the patient complained of persistent but mild groin pain on ambulation which was assisted . the patients conservative line was continued till 1 year when his symptoms continued and radiologically there was no progress . at this point the patient was operated within 24 h. intraoperatively the garden alignment index was used as a yardstick of acceptable reduction .", "non - union after femoral neck fracture can be defined as a lack of radiographic evidence of union 6 months after the fracture . delayed or non - union often manifests as continued pain with weight bearing beyond 3 months post fixation . incidence of non - union of femoral neck fractures has been reported to be between 2 and 22% and generally becomes apparent within 1 year [ 69 ] . if failure is due to technical errors , revision open reduction and internal fixation may be adequate . the preferred treatment for symptomatic non - unions in the elderly is prosthetic replacement . in the young active patients ," ]

[ "granuloma faciale ( gf ) is an uncommon , benign , inflammatory skin disorder of unknown etiology . we present a patient with multiple lesions of gf and its response to topical tacrolimus . the disease is notoriously resistant to therapies and often tends to relapse when treatment is discontinued . it is characterized by single or multiple , grey - brown or violaceous nodules or plaques primarily occurring on the face and occasionally at extra - facial sites .", "a 35-year - old female presented to our department with a 5 year history of single , asymptomatic , grey - brown pigmented , nodule over the left cheek [ figure 1 ] . two years later similar lesions appeared on the forehead , both arms and upper back . six sessions of cryotherapy were performed once monthly after which she developed erythema and itching over the plaques and discontinued treatment . the lesions showed 40 - 50% improvement after 3 months of therapy [ figure 1 ] . after treatment residual lesion after three months of tacrolimus application general physical and systemic examination was normal .", "carbon dioxide laser has also been used in a case of recurrent gf . surgical excision has been performed with often unsatisfactory results . our patient experienced a relevant improvement within 3 months of treatment with tacrolimus ointment after no response with intra lesional steroids , dapsone and cryo therapy . in conclusion several medical and surgical modalities like topical and intralesional corticosteroids , cryotherapy , pulsed dye laser , puva , systemic corticosteroids , dapsone and antimalarials have been tried with variable success rates . , the previous reports and our observation suggest that topical tacrolimus may be a well - tolerated , efficacious therapy for gf ." ]

[ "chronic myelomonocytic leukaemia ( cmmol ) is a rare disease with an incidence of 0.370.72 per 100 000 population . the median age at diagnosis varies between 65 years and 75 years [ 14 ] . the radical treatment is allogeneic stem cell transplantation , although this treatment is unsuitable for most patients because of their advanced age [ 6 , 7 ] . several case reports have indicated that excess surgical stress causes an acute blastic crisis , which contributes to a poor outcome [ 9 , 10 ] . the median survival of patients with cmmol is 1520 months [ 5 , 6 , 8 ] .", "hence , we decided to apply a surgical anti - inflammatory treatment in consideration of an acute blastic crisis . he died on 10 february 2013 because of cardiac arrest , following haemorrhagic shock and cardiovascular failure due to cmmol . , he visited a nearby general internal medicine clinic for the evaluation of left lower quadrant abdominal pain . after we consulted an internal medicine specialist , we planned a surgical procedure to clean the inflamed region in his mouth . on the day before the surgery a 68-year - old man complained of having a reduced appetite for approximately 5 months and weight loss during the previous 4 months . on 12 may 2012 we diagnosed right mandibular osteomyelitis , based on these clinical features . on 11 july 2012 ,", "in all patients with cmmol , every effort must be made to use the least invasive procedure possible . in the present patient , our deepest concerns were to have a proper balance between invasiveness and healing , and to avoid evoking an acute blastic crisis [ 9 , 10 ] . the surgery was necessary to improve his oral environment and to prevent further infection and more pain . because cmmol is associated with a risk of acute blastic crisis and a poor prognosis , any surgical procedure in these patients must be considered on a case - by - case basis . our most important goal was to alleviate the patient 's discomfort by using a minimally invasive procedure to eliminate infection . based on haematology results , the oral surgery did not trigger the acute blastic crisis of cmmol in this patient .", "" ]

[ "in a recent issue of critical care , we presented a series of 13 patients undergoing post - cardiotomy extracorporeal membrane oxygenation ( ecmo ) with bivalirudin - based anticoagulation . however , we think that a word of caution should be added to our recently published experience . owing to its pharmacological profile the use of bivalirudin for cardiopulmonary bypass ( cpb ) and ecmo is a feasible option .", "", "" ]

[ "the purpose of this study was to assess lv ejection fraction ( lvef ) using 64-slice as a byproduct of mdct coronary examination and to compare efficacy of technique with 2d - tte in a heterogeneous patient population . also , review the role of mdct lv function with a relation to evolution in the technology of coronary mdct imaging . a component of operator dependence and poor contrast between blood and myocardium are considerable limitations of this technique . cardiac magnetic resonance imaging ( mri ) recently we observed increasing tendency for utilizing low radiation dose , prospective gating for coronary angiography , thus limiting possibility of volumetric assessment of ventricular function . mdct has a potential of being utilized as tool for the combined assessment of the coronary anatomy and lv function . in addition , ventricular wall motion can be assessed visually by the use of cine loop displays of multiple cardiac phases .", "study included 113 patients referred for 64-slice mdct coronary angiography for evaluation of coronary artery disease . the image acquisition was caudocranial for post - coronary artery bypass grafting ( cabg ) patients and craniocaudal for the rest of the patients . apart from the routine contraindications , patients with pacemaker and ventricular septal defect were excluded from the study as successful segmentation of the lv blood pool is not possible in these patients due to artifacts and incorrect segmentation by software . no complications encountered in any of the patients . retrospectively , ecg - correlated image reconstruction was performed . patients with absolute contraindication to contrast or radiation were excluded from the study . in patients with relative contraindications such as atopy , asthma , and renal failure scan was performed if the benefit of examination outweighed the risk in such patients . patients with arrhythmias and ectopic heart beats were excluded as stable heart rate is required for ct coronary angiogram . diastolic and systolic axial image sets were then transferred to the scanner 's workstation - ge advanced workstation advantage windows 4.4 p. image data were evaluated with a prototype version of a commercially available program ( auto ejection fraction , circulation ; ge medical solutions ) that performs a fully automatic segmentation of the blood volume in the lv by defining the mitral valve plane and the lv .", "the mean lvef calculated by fully automated software based on cta data was 58.93 5.43% with maximum number of patients having an ef range of 61 - 65% . in our study using the fully automated software , the pearson 's regression analysis showed a good interstudy correlation , with a correlation coefficient of 0.503 ( p < 0.001 ) . in our study , 86 ( 76.1% ) were males and 27 ( 23.9% ) were females . bland - altman analysis showed a trend towards mdct resulting in slightly higher values for lvef when compared with echo ; however , this observation was not statistically significant . the mountain plot analysis reinforced that ef measured by ct correlated well with that measured by echo . the mean heart rate of the patients at the time of scan was 61.5 8.6 bpm with maximum patients having a heart rate range of 61 - 70 bpm . the most common coronary risk factor association was hypertension , accounting for 77.9% of the cases .", "mdct coronary angiography has emerged as a valuable technique for the evaluation of coronary artery disease in patients with low to intermediate pretest probability of ischemic heart disease . utilizing analytic software , gated volumetric ct data can be processed to provide quantitative functional analysis of the lv in patients with coronary artery disease . our study confirms useful complementary functional information in coronary cta datasets , using fully automated analysis software for rapid assessment of lvef . emerging new applications of echography in the form of 2d and 3d speckle - tracking echo certainly will have a greater role to play in the future noninvasive assessment of the myocardial function . in conclusion going forward with changing trends in ccta imaging , it is conceivable that number of patients undergoing cta with retrospective gating will substantially be reduced , thus limiting the functionality to a small group of patients ." ]

[ "therefore , it was our objective to assess the potential antimicrobial activity of aristolochia bracteolata using a bioassay - guided fractionation , in order to produce pure compound that can act as the lead compound in developing new , safe , and effective drug to replace the use of the harmful crude plant material . \n moraxella catarrhalis is a gram - negative , aerobic diplococcus human mucosal pathogen which causes middle ear infections in infants and children [ 13 ] , and it is one of the three major causes of otitis media along with streptococcus pneumonia and haemophilus influenzae . although moraxella catarrhalis is frequently found as a commensal of the upper respiratory tract , recently it has emerged as a genuine pathogen and is now considered an important cause of upper respiratory tract infections in healthy children and elderly people , lower respiratory tract infections in adults with chronic obstructive pulmonary disease [ 1 , 5 ] , and hospital - acquired pneumonia . it is used in traditional medicine as a gastric stimulant and in the treatment of cancer , lung inflammation , dysentery , and snakebites . it is still extensively used in india and in traditional chinese medicine for slimming , menstrual symptoms , and rheumatism . it is also widespread used in sudan and other african countries as one of the most effective herbal remedies for infectious diseases .", "in addition to a sea urchin ( anthocidaris crassispina ) derived bacillus sp . which obtained from the laboratory in medical plants garden , nagasaki university.(c)fungal strains : the fungal strains used were aspergillus niger ( nbrc 33023 ) , penicillium crustosum ( nbrc 33015 ) , schizophyllum commune ( nbrc 30749 ) , trichophyton concentricum ( nbrc 31068 ) , and candida albicans ( nbrc 10108 ) . fungal strains : the fungal strains used were aspergillus niger ( nbrc 33023 ) , penicillium crustosum ( nbrc 33015 ) , schizophyllum commune ( nbrc 30749 ) , trichophyton concentricum ( nbrc 31068 ) , and candida albicans ( nbrc 10108 ) . the air - dried powdered whole plant ( 200 g ) was exhaustively extracted with cold maceration method with sufficient quantity of 70% methanol for 7 days at room temperature . a 100 l suspension of test microorganism was added to individual tubes and incubated at 37c for 24 h. the mic of the compound was defined as the lowest concentration that inhibited the visible bacterial growth and the mbc was defined as the lowest concentration that prevented the growth of the organism after subculture onto antibiotic - free plates . dilutions ranging from 1.56 to 400 g / ml of the compound were prepared in tubes including broth and dmso 10% ( v / v ) , in addition to one negative control ( broth + dmso 10% v / v + test microorganism ) to ensure that the final concentration of dmso in the assays did not interfere with the bacterial growth and one sterility control ( broth + dmso 10% v / v + test compound ) . standard strains : moraxella catarrhalis ( gtc 01544 ) , klebsiella pneumoniae ( atcc 13883 ) , escherichia coli ( k12 ) , salmonella typhimurium ( atcc 14028 ) , streptococcus pyogenes ( atcc 19615 ) , streptococcus agalactiae ( atcc 13813 ) , staphylococcus epidermidis ( atcc 12228 ) , neisseria lactamicus ( atcc 23970 ) , enterobacter cloacae , ( atcc 23355 ) , bacillus subtilis ( atcc 6633 ) , staphylococcus aureus ( 209p ) , and pseudomonas aeruginosa ( ifo 3445).clinical strains : moraxella catarrhalis , bacillus cereus , aeromonas hydrophila , salmonella typhi , vibrio cholerae , and yersinia enterocolitica . \n standard strains : moraxella catarrhalis ( gtc 01544 ) , klebsiella pneumoniae ( atcc 13883 ) , escherichia coli ( k12 ) , salmonella typhimurium ( atcc 14028 ) , streptococcus pyogenes ( atcc 19615 ) , streptococcus agalactiae ( atcc 13813 ) , staphylococcus epidermidis ( atcc 12228 ) , neisseria lactamicus ( atcc 23970 ) , enterobacter cloacae , ( atcc 23355 ) , bacillus subtilis ( atcc 6633 ) , staphylococcus aureus ( 209p ) , and pseudomonas aeruginosa ( ifo 3445 ) . clinical strains : moraxella catarrhalis , bacillus cereus , aeromonas hydrophila , salmonella typhi , vibrio cholerae , and yersinia enterocolitica .", "bioassay - guided fractionation of the identified plant may lead to standardized extract or isolated bioactive lead compounds as the new drug . this study showed clearly that the excellent effect of aristolochia in treating such diseases is due to the toxic compound aa-1 . this highlights the importance of m. catarrhalis in discovering the cellular target of aa-1 and the mechanism of aa-1 toxicity . although aa-1 is highly effective in killing m. catarrhalis , it is ineffective against the other microorganisms tested .", "although aa-1 had strong activity against m. catarrhalis , it had a narrow spectrum of activity than expected based on the activity of the crude extract from which it was isolated or from its traditional usage . using bioassay - guided fractionation technique , the present study directly linked the antibacterial activity of aristolochia bracteolata to the aa-1 . this may be the result of synergism between different compounds in the complex extracts or may be due to placebo effect ." ]

[ "several infections , particularly infective endocarditis , have been reported to show positive findings on anca tests ; furthermore , their clinical features have been acknowledged to mimic anca - associated vasculitis , which may lead to a misdiagnosis and inappropriate treatment ( 2,3 ) . we herein report a patient with an infected thoracic aortic aneurysm mimicking anti - proteinase 3-antineutrophil cytoplasmic antibody ( pr3-anca)-associated vasculitis . anti - neutrophil cytoplasmic antibodies ( ancas ) correlate well with a wide spectrum of vasculitis manifestations , including wegener 's granulomatosis , microscopic polyangiitis , and churg - strauss syndrome , all of which are commonly referred to as anca - associated vasculitis ( 1 ) . vegetations in the descending aorta , which were detected using transesophageal echocardiography , contributed to the diagnosis in this case . however , to our knowledge , infected aortic aneurysms have not been reported to show positive findings on anca tests .", "a transesophageal echocardiographic image of the descending aorta after the antibiotic treatment , with the sectioning plane at 90. many oscillating masses have disappeared . on the 54th hospital day , she underwent endovascular aortic repair ( evar ) of the aneurysm ( fig . her pr3-anca titer has normalized . a contrast - enhanced computed tomographic image after endovascular stent graft repair . one year after the procedure , she continues to take oral antibiotics ; no complications related to stent - graft deployment or recurrent infections have been encountered . she also had a history of orbital mucosa - associated lymphoid tissue lymphoma , which was in remission after treatment with only radiation therapy . 5 ) , but contrast - enhanced ct revealed that the aneurysm remained unchanged in form . a nontender hemorrhagic macular on the sole of the foot ( a ) .", ", we herein reported an unusual case of infected descending aortic pseudoaneurysm with luminal pathognomonic oscillating vegetation and with serological findings and clinical features mimicking pr3-anca - associated vasculitis . in this case , an infected aortic aneurysm exhibited elevated the patient 's pr3-anca level , and its clinical course mimicked pr3-anca - associated vasculitis . the presence of pr3-anca may have been falsely positive in the present patient . to our knowledge , this is the first report of an infected aortic aneurysm with a positive pr3-anca test and clinical features mimicking anca - associated vasculitis .", "" ]

[ "we explored the relationship between vitamin d and endometriosis in a double - blind , randomized clinical trial looking at the effect of vitamin d supplementation on cessation of pain in proven endometriosis after laparoscopic diagnosis and treatment . endometriosis is a prevalent cause of infertility , pelvic pain , dysmenorrhea , and dyspareunia in reproductive - age women . although an indirect relationship between vitamin d and endometriosis has been reported in multiple studies , here has been no published randomized clinical trial on endometriosis and vitamin d treatment in women . its diagnosis is by inspection of the pelvis during laparoscopy . in women with pelvic pain and infertility ,", "this randomized , double - blind clinical trial was performed in a single tertiary university hospital from nov 2014 to feb 2016 . to find patients with endometriosis , we did laparoscopy for various indications , including ovarian cyst , infertility , pelvic pain , and dysmenorrhea . the laparoscopies were done by 2 gynecologic laparoscopic surgeons ; both were involved in each operation and they recorded the severity of endometriosis according to the revised american society for reproductive medicine ( asrm ) classification . in the patients with endometriosis in the second menses after laparoscopic diagnosis and treatment , the vas test was repeated . eligible patients were assigned by simple randomization to receive either vitamin d or placebo . in the vitamin d group ( d group ) , we prescribed oral vitamin d 50 000 iu / weekly for 12 weeks ( capsule d - vigel , vitamin d3 50 000 iu , daana pharma co. tabriz - iran ) and in the placebo group ( p group ) we prescribed 1 capsule of placebo ( daana pharma co. tabriz - iran ) weekly for 12 weeks . four weeks after the end of the intervention ( 24 weeks after surgical treatment ) , the vas test was repeated for the 2 groups . women aged 1540 years with proven endometriosis by laparoscopy and a vas test score of 3 or more for dysmenorrhea and/or pelvic pain at second menses after operative laparoscopy . , a data collection form was completed by a physician , including the reason for laparoscopy , and the severity of pelvic pain and dysmenorrhea were estimated using a visual analogue scale test ( vas test ) , with a score of 0 being no pain and a score 10 being the worst pain ever experienced .", "women aged 1540 years with proven endometriosis by laparoscopy and a vas test score of 3 or more for dysmenorrhea and/or pelvic pain at second menses after operative laparoscopy .", "eligible patients were assigned by simple randomization to receive either vitamin d or placebo . in the vitamin d group ( d group ) , we prescribed oral vitamin d 50 000 iu / weekly for 12 weeks ( capsule d - vigel , vitamin d3 50 000 iu , daana pharma co. tabriz - iran ) and in the placebo group ( p group ) we prescribed 1 capsule of placebo ( daana pharma co. tabriz - iran ) weekly for 12 weeks . patients with vitamin d treatment in the last 6 months prior to surgery ; patients with known systemic diseases ( e.g. , hypertension , diabetes , coronary , renal , and hepatic diseases ) ; patients with known malignancy ; patients with hormonal treatment , including oral contraceptive pills , in the last 6 months . after authorization by the university ethics committee , four weeks after the end of the intervention ( 24 weeks after surgical treatment ) , the vas test was repeated for the 2 groups .", "we used the paired - samples t test for comparing quantitative normal data between before and after treatment in each group and the pearson chi - square test for matching and comparing categorical variables between the 2 groups . due to the small sample size we used the ks test ( one - sample kolmogorov - smirnov test ) for normality of data distribution , levine s test for equality of variances and independent samples , and the t test for equality of means for comparing quantitative normal data between the 2 groups . , we conducted mann - whitney non - parametric analysis between the 2 groups and wilcoxon signed ranks test for comparing before and after treatment data in each group . this study was funded and supported by iran university of medical sciences ( iums ) , grant no .", "the remaining 39 cases were randomly assigned in vitamin d ( n=19 ) or placebo treatment ( n=20 ) groups . we did 146 laparoscopies for different indications in gynecologic patients , and endometriosis was diagnosed in 75 . at the second menses after diagnostic and therapeutic laparoscopy , 40 cases met the inclusion criteria for our study . one patient in the placebo group became pregnant at the third month after the operation and discontinued placebo treatment . at the end of the study , we had 19 patients in each group ( figure 1 ) . the mean pelvic pain score in the vitamin d group was 4.053.45 and 4.824.1(p=0.513 ) in the placebo group . before laparoscopy , the mean dysmenorrhea pain score in the vitamin d group was 7.372.61 and in placebo group it was 6.423.04 ( p=0.325 ) . table 2 shows a comparison between the 2 groups for severity of pelvic pain and/or dysmenorrhea at different time points ( before laparoscopy , in second menses after laparoscopy , and at 24 weeks after laparoscopy ) . at the second menses after laparoscopy , there was no significant difference between the 2 groups for pelvic pain ( p=0.583 ) and dysmenorrhea ( p=0.365 ) , and at 24 weeks after laparoscopy there was no significant difference between mean pain scores in the 2 groups . mean pelvic pain at 24 weeks after laparoscopy in the vitamin d group was 0.841.74 and in placebo group it was 0.681.70 ( p=0.513 ) . mean dysmenorrhea was 2.102.33 in the vitamin d group and 2.732.84 in the placebo group ( p=0.45 ) . table 1 shows a baseline comparison between the 2 study groups for general characteristics , reason for laparoscopy , severity of endometriosis , and severity of dysmenorrhea and pelvic pain . causes of laparoscopy in women with endometriosis diagnosed by laparoscopy were dysmenorrhea ( n=28 ) , ovarian cyst ( n=23 ) , chronic pelvic pain ( n=19 ) , and infertility ( n=9 ) . in some patients , there was more than 1 reason for laparoscopy .", "in this double - blind , randomized clinical trial , at 24 weeks after laparoscopic treatment of endometriosis there was no significant difference between effect of vitamin d3 ( cholecalciferol ) and placebo on severity of dysmenorrhea and/or pelvic pain . this is the first clinical trial on women with endometriosis to explore the possible relationship between vitamin d treatment and relief of endometriosis - related pain . the samples were not assessed for existing endometriosis . because low levels of serum vitamin d are common in healthy italian pre - menopausal women , these results only show that vitamin d was effective in relieving dysmenorrhea at least for 2 months after treatment in women with or without endometriosis and also in women with or without vitamin d deficiency .", "there may be a relationship between vitamin d and pathogenesis of endometriosis , but in our study vitamin d was not effective in treatment of endometriosis - related pain . the first limitation of this study is the high prevalence of vitamin d deficiency in our country and worldwide , meaning that a high percentage of our samples may have had vitamin d deficiency , which may have affected the results of our research . future studies should assess the serum levels of vitamin d before enrolling study subjects , and those with vitamin d deficiency should be excluded . larger clinical trials are needed to determine the possible effects of vitamin d supplementation in endometriosis treatment . further clinical trials are needed on the role of vitamin d treatment for endometriosis - related pain .", "the first limitation of this study is the high prevalence of vitamin d deficiency in our country and worldwide , meaning that a high percentage of our samples may have had vitamin d deficiency , which may have affected the results of our research . further clinical trials are needed on the role of vitamin d treatment for endometriosis - related pain . future studies should assess the serum levels of vitamin d before enrolling study subjects , and those with vitamin d deficiency should be excluded ." ]

[ "the aim of this study was to compare the apical sealing and gap formation of ah \n plus / gutta - percha with epiphany system . the null hypotheses tested were as follows : ( 1 ) there is no \n difference in apical microleakage or ( 2 ) apical gap formation among the experimental \n groups and ( 3 ) there is no correspondence between apical microleakage and the presence \n of gaps . in addition , the opportunity was taken to assess \n the effect of the association of epiphany primer and ah plus / gutta - percha on apical \n sealing and gap formation .", "classification of the types of gaps : ( b ) type 1 : \n gap between dentin / sealer ( pointer ) ; air voids were present within the sealer \n ( open arrow ) ; ( b ' ) - silver penetration was evident along the dentin / sealer \n interface , into dentinal tubules in a reticular form and granular aspect on the \n dentin surface ( arrowhead ) ; ( c ) type 2 : gap between sealer / cone ( pointer ) - \n cohesive fracture of the sealer ( open arrow ) ; ( c ' ) - the area marked in figure \n c at higher magnification : silver deposition into the dentinal tubules in a \n reticular form and granular aspect within the sealer layer ( arrowhead ) could be \n seen ; ( the sealer thickness was indicated between black / white arrowheads . \n the replicas were covered with carbon to \n investigate the presence of gaps at the dentin / sealer and sealer / cone interfaces , as \n described previously , using secondary electrons ( se ) mode . scanning electron microscopy ( sem ) micrographs using back scattered electrons \n ( bse ) mode and corresponding energy dispersive spectroscopy ( eds ) spectrum of \n agno3 leakage : ( a ) - the apical 5 mm of the root canal filling \n divided into 1 mm - regions . after endodontic access , \n the real working length ( rwl ) was established 1 mm short of the apical foramen . gp = gutta - percha ; d = dentin impressions of polyvinyl siloxane ( aquasil , ulv , dentsply detrey ) were \n made of the interfaces and the surfaces replicated with epoxy resin \n ( epon - thin , buhler ) . lc with \n accessory gutta - percha cones was performed until the entirely filled root canal .", "after endodontic access , \n the real working length ( rwl ) was established 1 mm short of the apical foramen . thirty - nine lower single - rooted human premolars with straight root canals and fully \n developed apices ( local ethics committee approval 177/05 ) were cleaned and submitted \n to 18.5 kgy gamacell radiation ( nuclear energy research institute , so paulo , \n sp , brazil ) , and stored in saline solution at 4c . the endodontic sealers were \n prepared according to the manufacturer 's instructions and the cold lateral \n condensation filling technique ( lc ) was used according with the following \n description : three coats of nail polish were applied to \n external root surfaces except for the apical 2 mm . a \n crown - down technique was used ( up to k - file # 50 ) under constant irrigation with 0.5% \n naocl . the teeth were randomly ( http://www.random.org ) divided into \n 3 experimental groups ( n=11 ) . the smear layer was removed with 17% edta ( 5 ml ) and 0.5% naocl ( 5 \n ml ) followed by saline \n solution ( 15 ml ) .", "lc with \n accessory gutta - percha cones was performed until the entirely filled root canal . a size b finger spreader ( dentsply maillefer , ballaigues , switzerland ) \n was then inserted into the canal to a level approximately 1 mm short of rwl . an iso # 50 master gutta - percha cone was lightly coated with ah plus sealer ( ah \n plus ; dentsply detrey , konstanz , germany ) and placed into the \n canal to rwl . the \n excess gutta - percha was removed with a heated plugger and then compacted \n vertically .", "adhesive - modified technique was used for bonding ah plus to intraradicular dentin . a \n paper point soaked with epiphany primer was used to etch dentin ( 30 s ) and the excess \n was removed with paper points .", "the coronal surface of the root filling was \n light - cured for 40 s ( 600 mw / cm ) .", "the positive controls ( n=3 ) were left unfilled and coated as described earlier . the \n negative controls ( n=3 ) were filled and totally coated , including the apical \n foramina . then , specimen preparation followed the protocol 1 for apical microleakage \n analysis using scanning electron microscopy / energy dispersive spectroscopy ( sem / eds ) ; \n or the protocol 2 for gaps analysis using sem according to the following \n description : the silver - impregnated teeth \n were rinsed and placed in photodeveloper ( 8 h ) in fluorescence light to reduce the \n silver ions into metallic silver . \n next , all teeth \n were immersed in a 50-wt% aqueous silver nitrate solution ( agno3 , ph7.0 ) \n in the darkness that was buffered using naoh 0.1 n for 24 h at 37c . lake bluff , \n il , usa ) , longitudinally sectioned in an isomet 1000 precision saw ( buehler ) at low \n speed ( 200 rpm ) with a water - cooled diamond blade .", "scanning electron microscopy ( sem ) micrographs using back scattered electrons \n ( bse ) mode and corresponding energy dispersive spectroscopy ( eds ) spectrum of \n agno3 leakage : ( a ) - the apical 5 mm of the root canal filling \n divided into 1 mm - regions . each 1 mm region was classified \n according to the following scores : 0 ( absence of leakage in both interfaces ) and 1 \n ( presence of leakage in at least one of the interfaces ) . in figures 1d and 1e pointer at the detected metallic silver ; ( b ) area \n ( 300 m ) scanned for the existence of silver and \n respective eds spectrum ( arrow ) and ( c ) - in detail , punctual eds confirmation \n of its exact location . the eds ( inca software , oxford , uk , england ) was performed in \n lower magnification within a pre - determined area ( 300 m ) ( figure 1b ) , and in a higher magnification , the \n identification of silver was made punctually to determine its exact location ( figure 1c ) . the apical 5 mm \n of the root canal filling were divided into 5 regions of 1 mm to evaluate \n microleakage by sem leo stereoscan 440 ( leo electron microscopy ltd . , cambridge , \n england ) using back scattered electrons ( bse ) mode ( figure 1a ) .", "classification of the types of gaps : ( b ) type 1 : \n gap between dentin / sealer ( pointer ) ; air voids were present within the sealer \n ( open arrow ) ; ( b ' ) - silver penetration was evident along the dentin / sealer \n interface , into dentinal tubules in a reticular form and granular aspect on the \n dentin surface ( arrowhead ) ; ( c ) type 2 : gap between sealer / cone ( pointer ) - \n cohesive fracture of the sealer ( open arrow ) ; ( c ' ) - the area marked in figure \n c at higher magnification : silver deposition into the dentinal tubules in a \n reticular form and granular aspect within the sealer layer ( arrowhead ) could be \n seen ; ( the sealer thickness was indicated between black / white arrowheads . \n the replicas were covered with carbon to \n investigate the presence of gaps at the dentin / sealer and sealer / cone interfaces , as \n described previously , using secondary electrons ( se ) mode . impressions of polyvinyl siloxane ( aquasil , ulv , dentsply detrey ) were \n made of the interfaces and the surfaces replicated with epoxy resin \n ( epon - thin , buhler ) . as the gaps were not \n continuous , for each 1 mm - region , two interfaces were analyzed ( figure 2a ) and classified as : type 0 : both interfaces were \n gap - free , type 1 : gap at dentin / sealer interface ( figure 2b ) , type 2 : gap at sealer / cone interface ( figure 2c ) , and type 3 : both types of gaps present . scanning electron microscopy ( sem ) micrographs using secondary electrons ( se ) \n and back scattered electrons ( bse ) mode of the replica and the section of the \n same specimen , respectively . therefore , \n for each experimental group , 11 replicas were prepared ; 55 regions were evaluated and \n accordingly classified .", "the absence of leakage \n is associated with the absence of gap ; leakage up to the 1 millimeter \n is associated with type 1 ; and more extensive leakage is associated with types 1 \n and 2 frequency and type of gaps in the apical 5 mm of root canal fillings percentage of regions with gaps . there was a significant interaction between epiphany and the type of \n gap ( p<0.003 ) and for this group , there were more type 1 regions . the ordinal logistic regression analysis demonstrated that there was no statistically \n significant difference ( p>0.05 ) among the groups tested and types of gaps over \n the logit of microleakage . the correspondence analysis also showed the association between microleakage \n and both types of apical gaps ( figure 3 ) .", "recently some studies have shown similar results between ah plus and epiphany on apical \n sealing ability using the fluid filtration method . this study has shown that the presence of apical gaps at the sealer / dentin or \n sealer / cone interfaces had an effect on apical microleakage . consistent with these \n studies , our results indicate that the epiphany system is as effective as ah \n plus / gutta - percha in preventing microleakage based on the chemical tracer penetration \n analysis by sem and the use of epiphany primer does not reduce the microleakage of ah \n plus . nevertheless , other researches pointed out that the epiphany system provided the \n greatest resistance to the movement of fluids or dye leakage \n test , when compared to epoxy \n resin - based root canal sealers , but others have just indicated the opposite . stress generated \n during the polymerization shrinkage of epiphany sealer has probably influenced the \n integrity loss at the sealer / dentin interface . these results agree with those of previous studies in which , microleakage markers were \n used to evaluate apical sealing of the same endodontic sealers . the second hypothesis could also explain the inefficacy \n of epiphany primer in improving the sealing capacity of ah plus .", "the presence \n of gaps had an effect on apical microleakage for all materials . comparing the materials , \n epiphany system presented more regions containing gaps between the dentin and the sealer \n ( type 1 ) . in view of these findings , it may be concluded that none of the tested materials completely sealed the apical 5 mm . \n clinically , it can be suggested that ah plus would \n provide a better apical seal .", "this study was partially supported by capes ( coordenao de \n aperfeioamento de pessoal de nvel superior)/institutional \n qualification program ( pqi n : 0090/03 - 4 ) ." ]

[ "we report a case of pndm caused by a novel p.h186d heterozygous mutation in the kcnj11 gene whose treatment was successfully transitioned from insulin to oral sulfonylurea . encoding the sulfonylurea receptor 1 ( sur1 ) of atp - sensitive potassium ( katp ) channel , which has a key role in insulin secretion in glucose metabolism , are the most common causes and account for approximately 40% of all cases of pndm12 ) . mutations in the glucokinase ( gck ) and insulin ( ins ) genes have also been reported in patients with pndm . neonatal diabetes mellitus ( ndm ) presenting within the first 6 months of life includes permanent neonatal diabetes mellitus ( pndm ) , which require lifelong therapy , and transient neonatal diabetes mellitus ( tndm ) where the condition shows remission during infancy but relapses in adolescence . almost all cases of neonatal diabetes have monogenic etiology in contrast to the autoimmune diabetes presenting in children beyond 6 months of age . therefore , in many patients with pndm with kir6.2 and sur1 mutations , insulin therapy can be replaced by oral sulfonylureas which offer more improvement in glycemic control and better quality of life35 ) .", "genetic study for neonatal diabetes using genomic dna extracted from peripheral lymphocyte was done at 4.5 years of age , and a novel heterozygous mutation of the kcnj11 gene located on chromosome 11p15.1 and encoding kir6.2 , c.556c > g ( p.his186asp ) , was found ( fig . transition of treatment from insulin to sulfonylurea was attempted at the age of 4.8 . before the trial , although there were several hypoglycemic events , insulin injection for glucose control after the infancy period could not be stopped . blood glucose was well controlled without episodes of hypoglycemia and the hba1c has been lower than during insulin injection ( fig .", "early su therapy at disease onset can permit insulin hypersensitivity and maintained basal insulin secretion , then provide long - term remission in animal subset14 ) . allowing for the potential beneficial effect on neurodevelopmental outcome and glycemic control , empiric tiral of su before genetic testing in neonatal diabetes patients can be considered15 ) . in conclusion , as the mutation type , severity of mutation , and duration of the diabetes are the major factors affecting the success of switching to su , early genetic analysis and trial of sulfonylurea is important in the management of neonatal diabetes . therefore , molecular diagnosis in neonatal diabetes may help identify patients that are likely to respond to oral sulfonylureas . ndm is a monogenic form of diabetes that presents within the first 6 months of life . mutations in the glucokinase ( gck ) , insulin ( ins ) genes have also been reported in patients with pndm . pearson et al.3 ) reported the responses to sulfonylurea according to mutation types in diabetic patients caused by kcnj11 mutation . treatment response is not expected in patients with mutations in other genes , such as glucokinase gene , foxp3 , and ipf1 ." ]

[ ", we aimed to compare the plasma creatinine levels with spot urine il-18 levels following radiocontrast administration . recent studies have reported that urine levels of il-18 ( a pro - inflammatory cytokine ) , kidney injury molecule-1 , and neutrophil gelatinase - associated lipocalin ( ngal ) levels are important for early detection of rin . some reports have shown that il-18 levels start to increase within 46 h and peak at 12 h in patients with acute renal injury . in this study radiocontrast - induced nephropathy ( rin ) can lead to acute renal failure ( arf ) , which may require dialysis therapy . increases in serum creatinine levels are useful for detecting rin . in the majority of patients , patients at risk for radiocontrast nephropathy are recommended to use nonionic iso - osmolar or nonionic low osmolar contrast agents .", "twenty patients ( 11 males and 9 females ) underwent diagnostic and therapeutic contrast - enhanced examinations at the department of internal medicine from january 2009 to march 2009 . after radiocontrast agent administration , the same prophylactic treatment was continued ( 1 ml / kg / h ) for 6 h. during this time , hydration and urine output were followed by monitoring the intake and release of fluids . spot urine il-18 levels were measured before and 6 and 24 h after radiocontrast administration with a human il-18 elisa kit ( biosource invitrogen human il-18 , california ) . patient demographic characteristics a precontrast - enhanced examination of serum blood urea nitrogen ( bun ) , creatinine , na , k , cl , ca , p , creatinine clearance was analyzed and they were repeated at 24 , 48 , and 72 h following contrast administration . patients with no history of kidney disease , plasma creatinine values < 1.2 mg / dl , gfr60 ml / min , nondiabetic , no urinary infection , and no decompensated heart failure were included . urinary il-18 levels were measured with a human il-18 elisa kit ( biosource invitrogen human il-18 , carlsbad , ca , usa ) .", "serum creatinine levels increased after radiocontrast administration compared with precontrast levels , although the result was not statistically significant [ table 2 ] . plasma creatinine levels in patients before and after radiocontrast agent administration compared with precontrast urine spot il-18 levels , postcontrast 6 and 24 h urinary levels of il-18 increased significantly ( p=0.048 and p=0.028 , respectively ; table 3 ) . a tendency for postcontrast 24-h urinary il-18 levels to increase a slight increase in creatinine levels occurred at 48 h after radiocontrast administration but they fell to precontrast values at 72 h. a slight increase in plasma creatinine levels at 24 and 48 h following radiocontrast administration was observed compared with precontrast values , but it was not statistically significant ( p=0.052 and p=0.285 , respectively ) [ table 2 ] . spot urine il-18 levels in patients before and after radiocontrast agent administration plasma creatinine levels and spot urine il-18 were weakly but positively correlated with those during the precontrast period , although this finding was not statistically significant ( r=0.246 , p=0.126 ) . similarly , postcontrast 24-h plasma creatinine levels and spot urine il-18 levels were weakly but positively correlated , although this result was also not statistically significant ( r=0.254 , p=0.276 ) . there was no difference between pre- and postcontrast values of serum blood urea nitrogen ( bun ) , creatinine , na , k , cl , ca , p , and creatinine clearance .", "the most common definition of rin is plasma creatinine levels of 0.5 mg / dl or higher 72 h after contrast administration or 25% higher than the basal plasma creatinine level . spot urine il-18 levels at sixth hour following radiocontrast administration suggesting that it may be an earlier parameter for identifying kidney injury . one of the limitations of this study is that there are other early biomarkers of acute kidney injury such as ngal and kim-1 . plasma creatinine levels began to rise within 24 h in 80% of the patients with rin , peaking at 4872 h , and returning to baseline after 2 weeks . another limitation is that urine il-18 measurement was indexed to serum creatinine instead of urine creatinine since serum creatinine is considered to be a better and commonly used marker in the diagnosis of acute kidney injury . in conclusion ," ]

[ "given its high biocompatibility and well known safety profile and the anti - adhesive capabilities , ha and its composites represent an attractive , non - antibiotic , option to mitigate the impact of biofilm - related infections in various clinical settings including implant - related infections . aim of this review is to provide an update of the current evidence concerning ha ability to reduce / prevent bacterial adhesion and biofilm formation . adhesion is a necessary first step in microbial colonization and pathogenesis and provides a good theoretical target for new preventive and treatment strategies 12 . hyaluronic acid constitutes one of the main components of extracellular matrices . because of its biological properties , ha has several clinical applications ( aesthetic surgery , dermatology , dentistry , orthopedics and opthalmology ) 27 . extensive studies on the chemical and physicochemical properties of ha and its physiological role in humans , together with its versatile properties , such as its biocompatibility , non - immunogenicity , biodegradability , and viscoelasticity , have proved that it is an ideal biomaterial for medical and pharmaceutical applications 28 , 29 . among its various properties , in fact , peri - prosthetic joint infection ( pji ) remains one of the most feared complications in orthopaedic surgery and among the first reasons for implant failure 6 .", "both these experimental studies show the ability of the dac hydrogel to significantly reduce bacterial adhesion and biofilm formation of common bacterial pathogens , thus potentially providing an effective protection of the implant ; however , these data also point out how , in the clinical setting , in the absence of an adequate immune response from the host and/or of sufficient local levels of antibiotics , a passive antiadhesive coating 18 like ha can be overcome by the remaining bacteria in a time - dependent manner . 50% in comparison to the untreated controls , while a combination of the hydrogel with either antibacterial resulted in a larger reduction of biofilm formation ( approximately 75 to 80% in comparison with untreated controls ) . the impact of slime dispersants and anti - adhesives on in vitro biofilm formation on iols was further investigated by kadry and co - workers 37 , using a staphyloccous epidermidis wild strain , isolated from a patient with endophtalmitis ; the authors reported the ability of hyaluronan to reduce bacterial adhesion to iols to 30% , compared with untreated control cells . more recently , the in vitro antiadhesive and antibiofilm activity of hyaluronic acid towards bacterial species commonly isolated from respiratory infections was investigated by drago et al . 31 investigated the potential bacteriostatic effect of hyaluronic acid in different concentrations and molecular weight on oral and non - oral microorganisms ( staphylococcus aureus , propionibacterium acnes , actinobacillus actinomycetemcomitans , pavotella oris and porphyromonas gingivalis ) with potential application in dentistry surgery ; the results showed that different hyaluronan solutions exerted varied bacteriostatic effects on all the bacterial strains .", "very recently a multicentre european study confirmed the efficacy of intravesical administration of combined hyaluronic acid and chondroitin sulphate ( cs ) for the treatment of female recurrent urinary tract infections 51 . several studies have also reported the beneficial effect of topical ha in chronic urinary tract infections ( uti ) . several clinical local applications of ha to reduce the impact of biofilm - related infections have been reported , in different clinical settings , with favourable results and no adverse events .", "to overcome at least some of these limits , possible loading of hyaluronic - based hydrogels with antibiotics is technically feasible and has been proposed by different authors 59 - 62 , being a possible option for future developments and large scale clinical applications , provided that regulatory requirements can be met . considering the pathogenesis of implant - related infections , any protection offered by a fully biocompatible antiadhesive barrier , like ha and some of its derivatives , could be extremely useful to reduce the tremendous burden of implant - related infections . although to date no surface modification has been reported to be able to fully prevent bacterial adhesion and biofilm formation 55 , available data show that hyaluronic acid has a proven in vitro antiadhesive / antibiofilm effect against some of the most common pathogens and it has been used safely , alone or in combination with other polymers , with satisfactory results in different conditions associated with biofilm - related chronic infections . while antibacterial coatings to mitigate the occurrence of implant- and biofilm - related infections are regarded as one of the most needed technology , currently only few and insufficient options are available for clinical use in orthopedics and trauma surgery 18 . clinical data in various applications , including dentistry , urology , wound management , dermatology and orthopedics , allow to consider the potential use of ha as a protective coating barrier of implants particularly safe and feasible on a large scale basis ." ]

[ "hence , this short term study was undertaken to detect the incidence of mdr , xdr , and pdr bacterial isolates in a tertiary care hospital of central india . in the last two decades , there were so much increase of infectious diseases that the standard of public health in many parts of the world is equivalent to preantibiotic era . presently , antimicrobial resistance ( amr ) poses a major threat to patient 's treatment as it leads to increased morbidity and mortality , increased hospital stay , and severe economic loss to the patient and nation [ 3 , 4 ] . in 2011 , who declared combat drug resistance : no action today , no cure tomorrow . . in recent years as per standardized international terminology created by european centre for disease control ( ecdc ) and centre for disease control & prevention ( cdc ) , atlanta , the multidrug - resistant ( mdr ) , extensively drug - resistant ( xdr ) , and pandrug - resistant ( pdr ) bacteria have been well defined . resistant ( xdr ) was defined as nonsusceptibility to at least one agent in all but two or fewer antimicrobial categories ( i.e. , bacterial isolates remain susceptible to only one or two antimicrobial categories ) . multidrug resistant ( mdr ) was defined as acquired nonsusceptibility to at least one agent in three or more antimicrobial categories . extensively drug", "the bacterial strains were isolated from different clinical samples and were identified by conventional methods . antibiotic susceptibility test of bacterial strains was done by kirby bauer disc diffusion method as per clinical laboratory standard institute ( clsi ) guidelines . this short term cross - sectional study was conducted in the department of microbiology from 15th of april to 15th of july , 2014 . an increase in diameter of 5 mm with ceftazidime plus clavulanic acid as compared to ceftazidime disk alone was considered positive for esbl detection . methicillin resistant staphylococcus aureus ( mrsa ) strains were detected by meca - mediated oxacillin resistance using cefoxitin disk ( 30 g ) on mueller hinton ( mh ) agar plate inoculated with test strains as per standard disk diffusion recommendations and incubated at 3335c for 1618 hours . extended spectrum -lactamases ( esbl ) producing strains were detected by combined disk method using ceftazidime ( 30 g ) and ceftazidime plus clavulanic acid ( 30 g plus 10 g ) .", "no vancomycin intermediate staphylococcus aureus ( visa ) , vancomycin resistant staphylococcus aureus ( vrsa ) , or vancomycin resistant enterococci ( vre ) were isolated . the commonest mdr strains were detected from e. coli 79/250 ( 31.6% ) , followed by klebsiella pneumoniae 75/250 ( 30% ) . out of 200 klebsiella pneumoniae strains isolated , 75 ( 37.5% ) and 25 ( 12.5% ) were detected as mdr and xdr , respectively . out of 42 acinetobacter and other nonfermenter species isolated , 19 ( 45.2% ) and 8 ( 19% ) were mdr and xdr strains , respectively . amongst 250 gnb - mdr strains isolated ,", "unless and until multidrug resistant organisms are detected and their incidence is known , the strategies for their control can not be adopted properly in healthcare setup . hence , detection , prevention of transmission of mdros by following infection control practices , antimicrobial surveillance , and stewardship are need of the hour . the limitation of this study is that this is a single center study for only three - month period in a tertiary care hospital in central india . to reflect the trend of infections caused by mdr and xdr strains of bacteria in the region , a multicenter study involving all types of healthcare setups for a minimum period of one year there is paucity of data regarding mdros in health care setup not only in india but also worldwide . the problem is that the bacteria are developing resistance at a much faster pace than the new drug development . regarding public health attention , mdros are described as superbugs having very limited treatment options . for some mdros the clinical and financial burden to patients and health care providers for mdros is really challenging .", "we hereby conclude that early detection and close monitoring of mdr , xdr , or even pdr bacterial strains must be started by all clinical microbiology laboratories to reduce the menace of antimicrobial resistance which is now a global problem ." ]

[ "ureterocele is a congenital urinary abnormality characterized by the presence of an intrabladder hernia or cystic ballooning of the lower end of a ureter lying between the mucosa and muscle of the bladder . usg and voiding cystourethrography ( vcug ) are essential initial procedures for a child suspected of having a ureteral anomaly . the abnormality leads to urinary retention and recurrent urinary tract infection ( uti ) , which can cause irreversible damage to the kidney . ureteroceles can have different clinical presentations , such as antenatal hydronephrosis , uti , vesicoureteral reflux ( vur ) , bladder outlet obstruction , prolapsed urethral mass , etc .", "she was a follow - up case of right - sided hydroureteronephrosis with pyonephrosis with percutaneous tube ( pcn ) insertion done on the right side . a 5-year - old female child was referred to our department for tc - diethylene triamine pentaacetic acid ( dtpa ) scan . an usg of the abdomen was done in the radiology department of our hospital to find out the cause of this persistent photopenia in the ub . a large photopenia was noted in the suprapubic region in the urinary bladder ( ub ) during dynamic [ figure 1 ] as well as delayed static images acquired till 4 h [ figure 2a d ] . faint visualization of radiotracer was noted through the pcn tube after removal of clamp [ figure 2b , bold arrow ] . tc - dtpa scan was done in our department with right pcn tube in situ .", "repeat usg revealed the cause of photopenia in ub in our case to be an intravesical ureterocele . on reviewing the literature we found that tc - dtpa scan is useful in the evaluation of renal function in patient with known ureteroceles . however , in our case on finding the photopenia in the ub on tc - dtpa scan , intravesical ureterocele was detected on usg . usg is an easy method to perform , noninvasive , and probably the best imaging modality for making the diagnosis . most of the patients with ureterocele are classically diagnosed during the investigation for uti , asymptomatic hydronephrosis , and abdominal mass . although the age of diagnosis is decreasing , uti is still the most common clinical presentation of ureterocele in 50% of the patients promoting physician to make the thorough evaluation of the urinary system .", "", "" ]