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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 .", "", "" ]

[ "therefore , this study evaluated the impact of vertebral fractures on the quality of life of healthy , community - dwelling women aged 65 years or older using the qualeffo . the assessment of hrqol has been used as a measure complementary to bone mineral density to evaluate and monitor the burden of osteoporosis on a patient 's daily life ( 3 ) . health - related quality of life ( hrqol ) is a multidimensional concept that defines a person 's health based on specific aspects , such as physical , emotional , and social functioning and general welfare ( 1 ) . there are several instruments that can be used to assess the quality of life of individuals with osteoporosis , including the osteoporosis assessment questionnaire , the quality of life questionnaire for osteoporosis ( optqol ) , the osteoporosis quality of life questionnaire , and the questionnaire of the european foundation for osteoporosis ( qualeffo ) ( 4 - 7 ) .", "we calculated the least significant change with 95% confidence to be 0.033 g / cm for the spine , 0.047 g / cm for the femoral neck , and 0.039 g / cm for the total femur . according to the classification criteria of the iscd ( international society of clinical densitometry ) , the lowest t - score among the three sites ( lumbar spine , femoral neck , and total femur ) was used to classify each participant as having osteoporosis , osteopenia , or normal bone density . thus , the individuals with t - scores that were 2.5 standard deviations or more below the scores for healthy controls for the peak bone mass were diagnosed with osteoporosis , individuals with t - scores between 2.5 and 1.0 standard deviations below the scores for healthy controls were diagnosed with osteopenia , and individuals with t - scores greater than 1.0 standard deviation below the scores for healthy controls were classified as normal ( 26 ) . this study was performed using the framework of the so paulo ageing & health study ( spah ) , which was a population - based , cross - sectional study ( 9 ) . the identification of vertebral fractures was performed by two individuals with experience in the field of analyzing vertebral fractures . bedford , ma , usa , discovery model ) in the following regions : lumbar spine , femoral neck , and total femur . radiographs of the lumbar and thoracic spine centered on l2 and t7 , respectively , were obtained for all participants , with 40 \" between the tube and the film .", "the inclusion and exclusion criteria were the same as those of the core study ( 9 ) . this study was performed using the framework of the so paulo ageing & health study ( spah ) , which was a population - based , cross - sectional study ( 9 ) . all of the individuals were apparently healthy and showed no evidence of malabsorption , chronic diarrhea , hepatic disease , severe chronic diseases , or cancer .", "quality of life was assessed through individual interviews using the validated qualeffo with 41 questions covering five domains : pain ( 5 questions ) , physical functioning ( 17 questions ) , social functioning ( sevn questions ) , general health perception ( three questions ) , and mental functioning ( nine questions ) ( 7 ) . the total score for each domain was obtained by summing the scores of all questions for that domain and submitting this sum to a linear transformation to a scale ranging from 0 to 100 , where 0 corresponds to the worst hrqol and 100 to the best hrqol .", "they were blinded to each other 's assessments , and when the results conflicted , a consensus between the two individuals was reached . the identification of vertebral fractures was performed by two individuals with experience in the field of analyzing vertebral fractures . the agreement between the assessments of the two individuals was 96% , and the kappa coefficient was 0.82 . radiographs of the lumbar and thoracic spine centered on l2 and t7 , respectively , were obtained for all participants , with 40 \" between the tube and the film . each identified fractured vertebra was assigned a grade based on the genant sq scale , where mild ( grade 1 ) corresponds to a 20 - 25% reduction in the anterior , middle , and/or posterior height ; moderate ( grade 2 ) corresponds to a 26 - 40% reduction in any height ; and severe ( grade 3 ) corresponds to a reduction of over 40% in any height .", "the weight of each participant ( without shoes and wearing only light clothing ) was measured to the nearest 0.25 kg using a double - beam balance scale . the height ( without shoes ) of each participant was measured to the nearest 0.1 cm with a wall - mounted stadiometer . the body mass index ( bmi ) was calculated by dividing the participant 's weight ( kilograms ) by her height squared ( square meters ) , and the subjects were categorized using the following cutoff points proposed by the world health organization ( who ) : normal weight = bmi<25 ; overweight = 25bmi<30 ; and obese = bmi30 ( 20 ) .", "physical activity was classified as ( a ) low , does not even perform housework ; ( b ) moderate , performs regular housework , walks irregularly , and gardens ; and ( c ) high , performs regular physical activity aside from her daily routine at least twice a week for 30 min ( 22 ) . regarding concomitant diseases , those mentioned at the time of the interview were noted , as well as those diagnosed during the physical examination . systemic arterial hypertension ( sah ) was defined as a history of hypertension with the use of antihypertensive drugs or a systolic blood pressure>140 mmhg and/or diastolic blood pressure>90 mmhg , which was measured with a standard sphygmomanometer with the subject seated for at least 5 minutes prior to the measurement ( 23 ) . women who had had two or more falls in the last 12 months were defined as chronic fallers ( 21 ) . information regarding health , lifestyle and risk factors for osteoporosis / fractures was obtained through individual interviews . participants taking oral hypoglycemic agents or insulin or those with fasting blood glucose levels126 mg / dl were considered to be diabetic ( 24 ) .", "we calculated the least significant change with 95% confidence to be 0.033 g / cm for the spine , 0.047 g / cm for the femoral neck , and 0.039 g / cm for the total femur . according to the classification criteria of the iscd ( international society of clinical densitometry ) , the lowest t - score among the three sites ( lumbar spine , femoral neck , and total femur ) was used to classify each participant as having osteoporosis , osteopenia , or normal bone density . bedford , ma , usa , discovery model ) in the following regions : lumbar spine , femoral neck , and total femur . anatomically abnormal vertebrae were excluded from the analysis of the lumbar spine only if they were clearly abnormal and were not assessable within the resolution of the system or if there was a difference in the t - score of more than 1.0 between the vertebra in question and adjacent vertebrae , as recommended by the international society for clinical densitometry ( iscd ) ( 25 ) . thus , the individuals with t - scores that were 2.5 standard deviations or more below the scores for healthy controls for the peak bone mass were diagnosed with osteoporosis , individuals with t - scores between 2.5 and 1.0 standard deviations below the scores for healthy controls were diagnosed with osteopenia , and individuals with t - scores greater than 1.0 standard deviation below the scores for healthy controls were classified as normal ( 26 ) . the precision of the bmd measurements was determined based on standard iscd protocols ( 26 ) . the bmd was measured by dual x - ray absorptiometry ( dxa ) using hologic densitometry equipment ( hologic inc .", "the sample size of 180 was based on a standard deviation of 15% ( 27 ) for the total qualeffo score and a two - sided 5% significance level . the study had 95% power to detect a difference of 10 points in the total qualeffo score . the associations between the qualeffo scores and potential determinants of quality of life were assessed using the wilcoxon rank - sum test or the kruskal - wallis test . the results for the quantitative variables are expressed as the mean ( standard deviation ) , and results for the qualitative variables are described by the absolute and relative ( % ) frequencies . demographic characteristics and the qualeffo results were compared between women with and without fractures using the mann - whitney - wilcoxon test for quantitative variables and the chi - square test for qualitative variables . correlations between continuous variables and the qualeffo questionnaire data were tested using the spearman correlation coefficient ( rs ) . generalized linear models with gamma distributions and logarithmic link functions were performed to determine the influence of the vertebral fractures on the qualeffo score .", "this study was conducted in compliance with the ethical principles of the helsinki declaration ( 2008 ) and local applicable laws and regulations . this study was approved by the local ethics and research committee ( research protocol 1110/07 ) .", "similarly , the physical function domain of the qualeffo was inversely related to the bmi ( rs = -0.24 , p = 0.001 ) . in this domain , women classified as obese were found to have lower scores than women classified as overweight or normal [ 70.7 ( 19.3 ) vs. 76.1 ( 16.1 ) vs. 81.4 ( 17.4 ) , respectively , p = 0.002 ] . finally , lower scores for the physical function domain were found among women with low physical activity compared with those with moderate or high activity [ 49.6(24.9 ) vs. 75.1(18.1 ) vs. 80.7(12.6 ) , respectively , p = 0.002 ] ( table 3 ) . a generalized linear model with gamma distributions and logarithmic link functions was developed to identify patient characteristics that were related to the total and physical function domain scores of the qualeffo . the demographic , anthropometric and clinical data for all participants in the study , grouped based on the presence ( vertebral fracture ) or absence of vertebral fractures ( no vertebral fracture ) , are shown in table 1 . the presence of at least one fracture was associated with a worse total qualeffo score , independent of age , bmi classification and physical activity level ( p = 0.030 ) . the presence of obesity was negatively associated with the total qualeffo score ( p = 0.001 ) . likewise , the presence of at least one fracture was negatively associated with the physical function domain , independent of these same variables ( p = 0.041 ) ( table 4 ) . no difference was observed regarding the other qualeffo domains ( pain , social functioning , health perception , and mental functioning ) ( table 2 ) .", "this study was the first study conducted in brazil that specifically assessed the impact of vertebral fractures on the quality of life in older , community - dwelling women using a specific questionnaire . in this study our study is the first in brazil to conduct a thorough assessment of the relationship between quality of life and vertebral fractures . although the clinical relevance of vertebral fractures is well established , these results are important for assessing the burden of this disease and reinforce the need to reduce the underdiagnosis and undertreatment of these fractures . the results of this study also highlight the need for awareness of the importance of maintaining proper weight and promoting changes in lifestyle through physical activity and dietary control . , we demonstrated that the presence of vertebral fractures in this population is related to worse hrqol , particularly with respect to physical functioning . the assessment of quality of life in relation to the qualeffo pain domain was similar in women with and without vertebral fractures in our study .", "this study was supported by fundao de amparo e pesquisa do estado de so paulo ( fapesp ) # 03/09313 - 0 ; conselho nacional de cincia e tecnologia ( cnpq ) # 305691/2006 - 6 ( rmrp ) and # 119601/2009 - 5 ( lf ) ; federico foundation grants ( rmrp ) ; and coordenao de aperfeioamento de pessoal de nvel superior ( capes ) ( jbl , cpf ) ." ]

[ ". however , the needs for admission and general anesthesia and their associated costs have made this option less favorable . in the outpatient setting , endometrial sampling is an effective and acceptable method for obtaining endometrial samples for histopathological assessment [ 3 , 4 ] . inadequate sampling is more problematic in postmenopausal women , for whom up to 68% of endometrial samples are reported to be inadequate . in our institution , the only sampling tool available to perform the outpatient sampling procedure is the uterine explora model i - mx120 ( http://www.coopersurgical.com/ ) ( figure 1 ) . dilatation and curettage ( d&c ) has been widely considered to be the method of choice for obtaining endometrial samples for histopathological evaluation the purpose of this study is to compare the effectiveness of the explora model i tool with the conventional d&c technique for obtaining adequate endometrial samples that are capable of providing specific and informative histopathologic diagnoses . the majority of women with menorrhagia , postcoital bleeding , intermenstrual bleeding , or postmenopausal bleeding ultimately undergo diagnostic hysteroscopy with endometrial sampling as part of their assessment , particularly if symptoms persist or pelvic imaging suggests a uterine abnormality . the advantages of using explora rather than d&c as a sampling device include a reduction in hospitalization costs , extra convenience for the patient and physician , and the minimal complications of the procedure . in addition , the device is sterile and disposable ( one - time use ) .", "two hundred seventy - four samples ( 21.6% ) were obtained by conventional d&c in the surgical theater , while the remaining 996 samples ( 78.4% ) were obtained by senior obstetrics and gynecology residents who used a standardized biopsy technique in the outpatient procedure rooms . during the usage of the explora model after obtaining the approval of our institutional review board , all endometrial samples received at the histopathology department in king khalid university hospital ( kkuh , riyadh , ksa ) between january 2007 and december 2010 were included in this study . a total of 1270 endometrial samples were included ( table 1 ) . the age , gravidity , parity , menstrual history , uterine size , hysteroscopy findings ( when available ) , and the presence or absence of any cervical abnormality were recorded on the request forms , which were reviewed by the investigators . for each of the two methods used ( explora model i and d&c ) , the numbers and percentages of inadequate samples and age group clustering were calculated and statistically analyzed . the pathologists who interpreted the endometrial samples were blinded to the instrument or method used to obtain the samples . an inadequate sample was defined as consisting of only blood , cervical mucus , endocervical epithelium , or blood with fragments of endometrial glands or stroma insufficient for histopathological assessment and diagnosis . i , the syringe provided with the instrument was used to create a negative pressure , and the explora was rotated as it was withdrawn . after withdrawal , the tip was cut off , and the tissue was placed in 10% buffered formalin saline fixative and was sent for pathological examination .", "of the 73 samples with a diagnosis of endometrial hyperplasia , 50 ( 68.5% ) were diagnosed by d&c , and 23 ( 31.5% ) were diagnosed using the explora sampler . however , of the 18 samples with a diagnosis of endometrial cancer , the rates of detection were similar between the two methods . the detection rates of endometrial hyperplasia and carcinoma using both methods were assessed and calculated . 82.6% were from women 45 years of age and older ( i.e. , postmenopausal ) compared to 17.4% in premenopausal women ; the age difference was significant ( p < 0.0001 ) . of the 1270 endometrial samples obtained , 253 samples ( 19.9% ) were scored as inadequate . of these samples , the explora sampler was used to collect 224 samples ( 88.5% ) , whereas 29 samples ( 11.5% ) were obtained by d&c ( figure 2 ) . . age group clustering ( i.e. , numbers of premenopausal and postmenopausal women ) of inadequate sample results was also calculated ( figure 3 ) . of the 253 inadequate samples , thus , the insufficient tissue percentage was higher with the explora ( 17.6% ) than with d&c ( 2.2% ) , which was a statistically significant difference ( p < 0.0001 )", "our own findings revealed that the rate of obtaining inadequate samples using the explora was much higher ( 17.6% ) than the rates reported in the literature . self - contained instruments have been developed and the prototype of this class of endometrial samplers is the pipelle . the pipelle has been shown to have a diagnostic accuracy comparable to that of vabra aspiration and the novak curettage while causing less pain [ 911 ] . many techniques for obtaining an endometrial sample without the need for curettage have been described in the literature . however , the vabra aspirator and novak biopsy curette , although widely available and relatively inexpensive , have several disadvantages , including the need for an electric vacuum pump to perform the aspiration in the former technique and the pain caused by both methods . as a result of these drawbacks , smaller inexpensive and , less hazardous and more inexpensive and convenient outpatient sampling methods have replaced the traditional , in - hospital , endometrial curettage . however , it is essential to ensure that outpatient endometrial sampling is quantitatively adequate and comparably accurate to conventional dilatation and curettage . adequacy can be measured by comparison of either outpatient biopsy with curettage histological evaluation or outpatient biopsy with the results of pathological examination of hysterectomy specimens [ 3 , 4 ] .", "this retrospective study suggests that traditional d&c produces better endometrial sample adequacy than the explora technique . this finding indicates that clinicians performing endometrial sampling would benefit from more experience and training using the explora technique . additional studies comparing the adequacy of samples obtained with different endometrial sampling techniques and devices are warranted . furthermore , we recommend using the d&c procedure when the explora - obtained samples are inconclusive or when the use of the explora sampler is accompanied by ultrasound findings that are suspicious of endometrial hyperplasia or carcinoma ." ]

[ "the present paper aims to contribute basic sedimentological data from a barely studied region ( eirunep , 2.000 km sw manaus ; fig . we demonstrate that there is no evidence for a long - lived lake ( sensu gorthner , 1994 ) or any marine influx . conversely , we document a well - structured , aggrading fluvial system of late miocene age , which is in agreement with the sedimentation model and chronology proposed by latrubesse et al . 1a ) , which is supposed to be placed at the south - eastern margin of the pebas system ( wesselingh and ramos , 2010 ) . the geological and ( palaeo-)biological evolution of lowland amazonia during neogene and quaternary times remains fascinating since the early days of natural sciences ( for summaries of research history see e.g. , loczy , 1963 and wesselingh , 2008 ) .", ". uncertainties in its definition , its stratigraphical and geographical extent as well as its depositional environments basically reflect the ongoing debate about amazonia s history through neogene times . the studied sections are located along the juru and tarauac river , ne respectively se of the city eirunep ( state of amazonia , western brazil ; 245 km s of benjamin constant ; fig . comprises more than 1000 m thick , largely pelitic sandy alternations with lignitic intercalations and covers a huge part of western amazonia ( fig . ", "the sections were vertically logged by visual inspection of the lithofacies ( including colour , grain size , bedding planes , sedimentary structures , macrofossil content ) . for lithofacies coding the scheme of miall ( 1996 ) an in - depth taxonomic examination of the obtained microfossils ( including the sieve fractions < 250 m ) will be subject of further studies . an application of the architectural element concept ( miall , 1996 ) was only loosely possible . additionally the outcrops were mapped laterally as far as possible . due to poor outcrop conditions for micropalaeontological investigations bulk samples ( 12 kg ) were taken from all outcrops . for preliminary stable isotope analyses ( o , c ; 18 samples ) two or three ostracod valves ( 4060 g ; cyprideis spp . ) from earlier sampling campaigns were used ( collected by m.i.r ) . for analyses", "the rare ( a matter of preservation ? ) mollusc and ostracod record indicates at least at the beginning ( 4 ) aquatic life in the abandoned channel . above , a crevasse splay ( 7 ) points to rising proximity of the active channel . up - section ( 1124 ) , plentiful ostracod and mollusc faunas ( especially in the lower part : 1117 ; compare ramos , 2006 ) indicate the return to an aquatic environment and the abandonment of the crevasse channel . mn9 and mn 14 yielded many fish , gastropod and bivalve ( sphaeriids ) remains as well as abundant ostracod valves ( cyprideis spp . ) . earlier reports of fossil material and facies : ramos ( 2006 ) mentioned the following ostracod taxa : c. aqualica , c. graciosa , c. lacrimata , c. longispina , c. pebasae , c. purperae , cytheridella sp . , darwinula fragilis as well as additional vertebrate and crab findings . , darwinulids , cypria sp . , ilyocypridids ) and fish bones . several ( aq22a/1 ) respectively rare ( aq22b/1 ) cyprideis spp . these beds are assigned to the formation of a floodplain pond , which was inhabited by opportunistic ostracods , freshwater bivalves and fishes .", "we observed : ( a ) a large proportion of overbank deposits , ( b ) laterally extensive , heterogeneous , fine - grained avulsion deposits ( including crevasse splays ) , ( c ) predominantly sandy channel deposits , which change laterally and vertically rapidly into overbank deposits as well as ( d ) lacustrine and coaly deposits . some sandy point bars ( of secondary channels ? ) indicate subordinate lateral sediment accretion . these comprise pelite sand - alternations of levee , crevasse splay and crevasse channel deposits . the mollusc fauna , recorded from floodplain pond / lake deposits , is dominated by sphaeriids and the pachychilid sheppardiconcha ( fig . decimetre - thick , clay silt beds with rich ostracod and mollusc faunas indicate the presence of short - lived , shallow ponds or lakes within the floodplain ( floodbasin ; e.g. , fig . macroforms , generated within the active channel include lateral accretion deposits ( sandy point bars ; figs . 2 and 4 ) and undifferentiated sandy bedforms ( stacked dune fields ? ; fig . ( 2007 , 2010 ) compared the depositional environment of the late miocene solimes fm . in acre with i.e. , the quaternary megafans of the chaco plain and the pantanal wetland ( iriondo , 1993 ; horton and decelles , 2001 typical freshwater ostracods ( darwinulids , ilyocyprinids , cypria , cytheridella ) are associated with diverse species of cyprideis .", "sedimentological observations derived from outcrops around eirunep ( south - western part of the state of amazonia ) document various subenvironments of a fluvial system ( upper part of the solimes formation , late miocene ) . beside sandy channel deposits , there is not any indication for a long - lived lake ( lake pebas ) or any marine influx in this region during the late miocene . the main part comprises overbank sediments of levees , crevasse splays / channels / deltas , abandoned channels , backswamps and floodplain paleosols . based on the lithofacies and the general geological setting , this system can be possibly related to an anastomosing river style ." ]

[ "with increasing availability , widened indications , and technical refinements of computed tomography ( ct ) and magnetic resonance imaging ( mri ) , the number of incidentally discovered adrenal lesions , such as adrenal incidentalomas and incidental adrenal enlargement , is increasing . in a recent study by tang et al . it should be emphasized that the term incidental adrenal enlargement represents the way the lesion was detected ( incidentally ) , rather than the etiology or diagnosis . this study aimed to determine the primary clinical presentation that most frequently leads to the discovery of adrenal enlargement , to evaluate clinical characteristics and functional status of these patients , and to analyze risk factors for functional lesions . it is a common term for a variety of adrenal disorders , but its cause must be properly assessed so that patients needing treatment , such as those with hormone hypersecretion or malignant disease , can receive appropriate care . however , there is a lack of literature on functional status and its follow - up to provide comprehensive insight to these findings . this indicated that incidental adrenal enlargement had a significant prevalence and has become a common clinical problem . patients with incidental adrenal enlargement were evaluated in a tertiary referral hospital with endocrinological departments in china . , among a total of 564 eligible ct studies ( patients undergoing ct without prior known malignancy , trauma , or endocrine disease ) , adrenal hyperplasia was detected in 64 cases , giving a prevalence of 11.3% .", "this retrospective study included 578 patients with adrenal imaging features showing adrenal enlargement who were hospitalized at the department of endocrinology in pla general hospital ( beijing , china ) between january 1993 and july 2013 . the ct imaging technique used was not standardized due to the various clinical indications . however , to be included in their entirety on a maximum of 5 mm section thickness , the upper limit of normal was set as 10 mm for the body of the gland and 5 mm for each limb as documented by vincent et al . . patients were classified as having incidental adrenal enlargement when abdominal imaging was performed for indications unrelated to adrenal disease . data retrieved included patient demographics , final functional diagnosis , adrenal imaging features , and concomitant diseases . patients with diseases known to cause adrenal enlargement , such as known endocrine disorders which could affect adrenal size , trauma , and underlying malignancy , were excluded . among all enrolled patients , 78 presented with incidental adrenal enlargement . the type of enlargement , based on subjective evaluation of the adrenal glands , was recorded as either smooth or nodular .", "of 578 patients with adrenal enlargement , 78 cases ( 13.49% ) were detected incidentally . nodular adrenal enlargement ( or 7.306 ; 95% ci , 1.72728.667 ; p = 0.006 ) was the risk factor for functional lesions . primary hyperaldosteronism 6 ( 7.69% ) , metastatic 1 ( 1.28% ) , the primary cancer was gastric cancer . predominant complaints included low back pain ( 10.26% ) and abdominal pain ( 3.85% ) . in addition , there were 30 ( 38.46% ) cases in which the lesions were incidentally detected during hospitalization for underlying diseases , such as diabetes mellitus , hypertension , and coronary heart disease , among others . biochemical and functional evaluation revealed that 54 ( 69.23% ) cases were nonfunctional and 12 ( 15.38% ) were subclinical cushing syndrome ( scs ) ; among these patients , 10 cases were diagnosed as aimah , the other 2 were diagnosed as adenomas , and they were all confirmed by pathology results . every 2 years , the numbers of total cases were 17 , 11 , 14 , 24 , 33 , 31 , 54 , 55 , 114 , and 225 , respectively . in addition , the proportion of incidental adrenal enlargement gradually increased ( 0 , 0 , 0 , 4.17% , 3.03% , 7.32% , 9.26% , 7.27% , 14.04% , and 21.33% ) .", "as outlined above , incidental adrenal enlargement is detected with increasing frequency , most likely due to widespread increase in cross - sectional imaging , and is gradually emerging as a common clinical problem . our study shows that the proportion of incidental adrenal enlargement has gradually increased by year . 's study aimed to explore prevalence , while the present study aimed to evaluate functional status . our results indicate that , for the elderly patients , it is essential to place emphasis on these incidental findings .", "incidental adrenal enlargement is a frequent radiographic finding and it is accompanied by diverse clinical factors that require proper diagnostic evaluation and management . in functional evaluation ," ]

[ "we decided to transfer health knowledge to families through altering this information to childish poems and teaching children at kindergartens . in this method the outcome of transferring health knowledge through childish poems has been assessed in this study . the findings from studies in this field have encouraged other experts to apply similar methods to conduct their research projects , allahverdipour and bashirian , onyango - ouma and mwangagain from the influence of children in order to teach different parts of their society[1316 ] . despite the researcher 's trends in using novel methods in this field , , we try to raise families health knowledge about infectious diseases by a method that uses children as health agents . pursuing the goal of improved health literacy requires more alliances between health and education sectors to improve literacy levels in the population . infectious diseases are still the leading cause of mortality in children less than 60 months in developing countries .", "also , they were asked to come to the kindergartens personally one more time when it is required ( to answer to the post test ) . then , we asked our kindergarten tutors to teach children seven musical poems about hydatid cyst , antibiotic misuse , botulinum toxin in home - canned foods , dysentery , the importance of sixth tooth , brucellosis and tetanus . in this step , children were not allowed to take home these texts , but they were asked to sing the poems at home and want their parents to re - write the poems on a paper and give them the papers to take to the kindergarten . in this study , we use the method of interventional pre and post series to conduct our research . in addition , we defined knowledge mark ( km ) as a parent mark in both the pre - test and/or post - tests . among 35 kindergartens in hamadan , we selected 7 kindergartens by simple random method . then , a poet transfers these conceptions to childish poems for the first time ( appendix 1&2 ) . in the process of preparing an accurate questionnaire , at first 30 questions with three choices of we asked the parents of the sample survey to participate in a pretest by answering to a questionnaire when they are in the kindergartens . our methodology is briefly explained as follows . at first , a sub specialist in pediatric infectious diseases provides seven short texts about health and common pediatric infectious diseases prevention . the parents ( either father or mother , the one who is responsible to take her / his child ) of all five to six year old children of the selected kindergartens are asked to participate in the survey and a verbal consent is obtained from those who accepted .", "the sample data consists of 103 parents who provided solutions to both the pre- and post - test question survey . of the participants 77 were female and 26 male . from the level of education point of view in addition , we define knowledge mark ( km ) as a parent mark in both the pre - test and/or post - test stages . the mean km shows a significant increase ( 5.01 ) from 13.62 in the pre - test to 18.63 in the post - test ( table 2 ) . \n the results of the survey show a significant difference between the correct answers in both pre - test and post - test stages ( fig . 1 ) . the frequency of correct answers to the tests \n table 1 shows the mean of the correct answers in the pre - test stage is 59.22 while the same figure for the post - test step is 81 ( p < 0.001 ) .", "confirm our hypothesis about the role of children in raising family 's knowledge on health . we showed that children , additionally to what christensen mentioned , are able to affect their family 's health status directly . they can improve their family 's health as little teachers in health . health has been the concern of poets such as fiona sampson for years , however , these poems never had educational purposes . the results of this study . it should be taken into consideration that brucellosis is an endemic disease in hamadan and people have been educated in different ways about this disease in recent years . although the lowest contrast between pre - test and post - test correct answers belongs to a question about botulism , the overall assessment shows that parent 's knowledge about this topic has been promoted significantly ( p<0.001 , table 1 ) . the significant difference between the pre - test and post - test km , based on the results of table 2 , is the sign of successful knowledge transfer through childish poems .", "this study 's results suggest that health knowledge transfer to families through childish poems is an applicable method that has many advantages . by applying this joyful , cost - effective and easy - to - use method however , it should be taken into consideration that this method is applicable for families with trainable children , for teaching in larger scales more general ways should be added to this method . moreover , the simplicity of poems and expressing the topics in a less elaborative form are the key factors that affect the successfulness of this way .", "" ]

[ "septic arthritis of the shoulder is uncommon in adults . it is a surgical emergency as joint destruction occurs rapidly and can lead to significant morbidity and mortality .", "a 43 years old male came to our outpatient department with complaints of pain and stiffness of his left shoulder . on examination , his shoulder movements were severely restricted . further evaluation with mri revealed septic arthritis of left gleno - humeral joint for which emergency arthroscopic debridement was done .", "septic arthritis of shoulder may not present with classical clinical features . hence , a through clinical and radiological evaluation will help us prognosticate and treat accordingly thereby preventing complications like septic shock , osteomyelitis .", "we report an unusual presentation of shoulder septic arthritis in a 43 years old man with no other clinical signs and symptoms of classical septic arthritis . patients with septic arthritis usually develop moderate to severe joint pain , warmth , tenderness , effusion , restricted active and passive motion , and sometimes redness .", "based on preoperative and intraoperative culture report , a definitive diagnosis of polymicrobial septic arthritis of the shoulder was established and patient was treated with combination antimicrobial treatment . a 43-year - old man presented to the orthopaedic outpatient clinic with 2 months history of pain and limited range of motion in his left shoulder . arthroscopic lavage of the joint was done and articular fluid sent for repeat aerobic and anaerobic culture . susceptibility of the isolate was determined with the disk diffusion method and it was susceptible only to colistin .", "our experience with this patient highlights the importance of maintaining high index of suspicion for septic arthritis in immunocompromised patients presenting with atypical shoulder pain associated with stiffness . in the setting of suspected septic arthritis , septic arthritis of the shoulder is very often due to hematogenous spread and diagnosis is often clinical . septic arthritis of the shoulder is more common in immunocompromised patients and intravenous drug abusers . in this case report , the patient had atypical clinical symptoms and is immunocompromised and his primary source of infection seems to be hematogenous . we strongly recommend early imaging studies in immunocompromised patients presenting with shoulder pain and practitioners should avoid loosely diagnosing as shoulder pain with associated stiffness as frozen shoulders .", "the case also challenges the practice of routine shoulder depomedrol steroid injection , in the setting of secondary frozen shoulder , atleast in immunocompromised individuals . the case highlights the importance of establishing anatomical and pathological diagnosis using mri in patients with shoulder pain instead of loosely diagnosing them as impingement or frozen shoulder . septic arthritis of shoulder may not present with classic clinical features . a through clinical and radiological evaluation should be executed and treatment initiated promptly to prevent complications like septic shock and osteomyelitis . primary idiopathic frozen shoulder is a rare condition and secondary frozen shoulder cases are often due to underlying shoulder pathology ." ]

[ "split - liver transplantation ( slt ) is an attractive alternative procedure to expand the donor pool in patients waiting for liver transplantation . we describe an uncommon late biliary complication that occurred after slt and was successfully treated by a multidisciplinary approach . the standard split - liver procedure for a child and an adult ( adult / pediatric split liver ttransplantation , a / p slt ) , by splitting segment ii - iii for pediatric recipient and segment i - iv - v - vi - vii - viii for an adult , is an accepted surgical option with good results both for the adult and for pediatric recipient . the challenge of this procedure is represented by a preoperative radiological assessment of the biliary anatomy often unavailable at the donor 's hospital . , slt requires a precise knowledge of the liver anatomy [ 3 , 4 ] .", "we decided to perform a permanent intraoperative obliteration of the dilated intrahepatic ducts by a percutaneous embolization using a nonresorbable agent . with a fluoroscopic guidance through the transhepatic access we positioned a 5-french polyethylene catheter inside the ducts , preliminary flushed by a nonionic dextrose solution . after this procedure the patient was submitted to a percutaneous transhepatic cholangiography ( ptc ) showing a complete obstruction of segments vi and vii biliary branches near the duct - to - duct biliary anastomosis ( figure 1 ) . the anastomotic stricture was treated by stenting the main biliary duct during an endoscopic retrograde cholangiopancreatoghaphy ( ercp ) without any evidence of intrahepatic biliary dilatation . an intraoperative cholangiography was performed through the biliary drain confirming a bile duct dilatation at the level of segments vi and vii . we supposed that the segmentary bile duct branch of posterior segments vi and vii draining in the left bile duct was unidentified and tied at the time of the in situ split - liver procedure during the parenchymal transection .", "little is known about the use of cyanoacrylate compounds , and unlike european countries the use of glubran has not been approved by the food and drug administration yet . chemical bile duct embolization treatment could represent a valuable solution to treat uncommon biliary complications . the percutaneous interventional technique represents an effective valuable approach to reduce mortality and morbidity in the treatment of biliary complications after liver transplantation ." ]

[ "this review will synthesize the data detailing the response of rr to ionizing radiation ( ir ) and will provide a perspective on the use of rr inhibitors as radiosensitizers in the treatment of human cancers . over the years , many groups have explored the use of rr inhibitors as chemotherapeutics in their own right , or as adjuncts to dna damaging molecules , particularly in hematologic malignancies . while this area looks promising , this subject will not be reviewed here . in addition , the discovery of new rr inhibitors with increased potency and improved binding characteristics has produced a significant increase in interest in this area . what should be clear is that rr is involved in the cellular response to ir and targeting it is both rational and likely desirable in enhancing the treatment of cancers with ir . given the pivotal role of rr in dna synthesis and repair , many studies have investigated the effect of dna damaging agents , including ir , on rr and its subunits .", "given the findings of these studies , concurrent cisplatin and radiotherapy became the standard of care in locally advanced cervical cancer , spelling the end of hu use in the treatment of cervical cancer . recent studies have examined its use in progressive meningioma in combination with 3d - conformal radiotherapy and adjuvant chemotherapy . in one trial , the majority of these trials have occurred in cervical cancer , most commonly in locally advanced disease . in particular , there were a number of prospective randomized controlled trials in the 1970s and 1980s that examined the effect of hu plus radiotherapy vs. radiotherapy alone . in addition to its study in cervical carcinoma , hu has also been extensively investigated in other cancers , particularly head and neck . hydroxyurea ( hu ) is a hydroxylated analog of urea and was the first rr inhibitor to be extensively studied .", "the purpose of their study was to assess the safety / tolerability , pharmacokinetics , and clinical activity of triapine three times weekly in concert with once weekly cisplatin and pelvic radiation in 11 patients with gynecologic malignancies . in spite of the mixed clinical data for hu , there is sufficient proof of concept to suggest that a rr inhibitor can be efficacious as a radiosensitizer in human cancers . the promising results from this phase i trial prompted a phase ii trial which is now underway . the most effective temporal relationship between triapine dosing and ir is similar to that seen with hu in earlier pre - clinical studies .", "as outlined in the review above , the story began with the study of hu in combination with ir in a number of pre - clinical trials in the 1960s , leading to a large amount of interest in the clinic , culminating with the gog adopting hu and ir as its standard of care in locally advanced cervical cancer . while its success in this arena was short the recent advances in the understanding of rr biology and the development of new inhibitors places us at an important crossroads in the story of rr inhibitors . it will be interesting to follow the development of the field in the next 510 years , particularly with the clinical trials of triapine in cervical cancer , and hopefully at least one of the many rr inhibitors being studied will eventually bring additional therapeutic benefit to patients in the near future . there are sufficient data to provide proof of concept for the target from a biological standpoint , however clinical trials to this point have not been wholly convincing .", "the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest ." ]

[ "the study of long bones and the cells of the bone marrow is central to a myriad of research disciplines , including , but not limited to , bone biology , cancer biology , immunology , hematology , and biomechanics . all of these disorders represent active areas of research with the goal of identifying new preventative measures and treatment regimens to reduce morbidity and mortality . to research the plethora of roles of the bone and the bone marrow , both under physiologic and pathologic conditions the bone is a highly dynamic organ that together with the cartilage forms the skeleton to provide mechanical support against loading and protection of the internal organs . the dissection protocol outlined here is suitable for all long bone analyses including ex vivo imaging , histology , histomorphometry , and strength testing , among others . , it is critical for researchers to have a simple and efficient standardized method for dissection of the mouse long bones for rapid processing of large in vivo experiments . similarly , a standardized bone marrow isolation method with high bone marrow cell recovery and low inter - user variability is important for experimental analysis such as fluorescence - activated cell sorting ( facs ) or quantitative pcr ( qpcr ) as well as downstream applications such as primary cell culture of bone marrow cells .", "suspend the bone marrow in appropriate solution ( e.g. , pbs , culture media , facs buffer ) and proceed with experimental protocol ( dna , rna , or protein isolation , facs analysis , or primary cell culture ) . for any applications that require the bone to remain intact ( histology , histomorphometry , biomechanical testing , etc . ) , proceed with standard in - house protocols ( as in ) . to isolate bone marrow , proceed to section 2 . using the forceps , pull back the skin and cut the quadriceps muscle anchored to proximal end of the femur to expose the anterior side of the femur and pin out from the leg , placing the pin at a 45-degree angle from the board . with the blade of the scissors against the posterior side of the femur , cut the hamstrings away from the knee joint . pull back the skin and the hamstring muscles anchored to proximal end of the femur to expose the posterior side of the femur and pin out from the leg , placing the pin at a 45-degree angle from the board . with the forceps , hold the distal end of the femur , just above the knee joint . guide the blades of the scissors on either side of the femoral shaft towards the hip joint , being careful not to cut into the femur itself . after reaching the femoral head , indicated by the scissors opening slightly , cut any remaining connective tissue attaching the long bone to the mouse at the knee . remove any additional muscle or connective tissue attached to the femur and the tibia . pull the entire leg bone , including femur , knee , and tibia , up and away from the body , carefully cutting away the connective tissue and muscle connecting the leg to the skin .", "overextend the ankle joint and again use the scissors in a twisting motion to dislocate the tibia . grasping the distal end of the tibia , taking care not to sever the tendons , pull the tibia up and away from the body and the pin board . twist the scissors with the top blade of the scissors moving directly over the femoral head to dislocate the femur , being careful not to snap the bone below the femoral head . grasp the top of the femoral shaft with the forceps , cut the soft tissue away from the femoral head to release it from the acetabulum . pull the entire leg bone , including femur , knee , and tibia , up and away from the body , carefully cutting away the connective tissue and muscle connecting the leg to the skin . cut any remaining connective tissue attaching the long bone to the mouse at the knee . remove any additional muscle or connective tissue attached to the femur and the tibia .", "using the forceps , grasp the femur with the patella facing away and the proximal end ( femoral head ) down . if the tibial epiphysis is intact , guide the scissors up the tibia shaft to the condyles . gently overextend the knee joint and use the scissors in a twisting motion to dislocate the tibia and femur . remove any additional muscle or connective tissue attached to the tibia using forceps , scissors , and kimwipes . grasp the tibia with the anterior side facing away and the distal end ( ankle end ) down .", "the bones should appear white and there should be a large visual pellet in the larger tube . verify that the bone marrow has been spun out of the bones by visual inspection . suspend the bone marrow in appropriate solution ( e.g. , pbs , culture media , facs buffer ) and proceed with experimental protocol ( dna , rna , or protein isolation , facs analysis , or primary cell culture ) . push an 18 g needle through the bottom of a 0.5 ml microcentrifuge tube . place the long bones ( maximum of 2 femurs and 2 tibiae ) into the tube , knee - end", "the bone marrow isolation procedure preserves the sterility of the bone marrow space , has low handling to reduce contamination , and does not require cutting of the long bone , thus reducing loss of bone marrow yield . the protocol described here is optimized for rapid dissection of the mouse femur and tibia with a minimum of damage to the bone tissue . the image demonstrates the integrity of both the calcified bone and cellular bone marrow for histologic analysis . the representative histomophometric micoct 3d reconstruction ( figure 1a - b ) demonstrates that both the cancellous bone and cortical shell are maintained that allows for accurate quantitation of the standardized structural parameters for bone histomorphometry , including trabecular number , thickness , and spacing ; bone volume ; and cortical thickness , among other measures . , this procedure can be used to isolate bone marrow for primary cell culture of bone marrow cells , including osteoclasts and osteoblasts ( figure 2a - b ) . this bone marrow is suitable for many downstream applications , including flow cytometry and pcr analyses . in addition", "this method maintains the high structural and cellular integrity of the bones and bone marrow and has low handling time , minimizing the likelihood of user - induced fracture or bone scoring that may influence downstream analyses . we present a simple and efficient method for removal of mouse hind long bones and subsequent bone marrow isolation . in addition , the centrifugation method for isolating bone marrow does not require cutting the bone to expose the bone marrow space or fluid to flush the bone marrow , reducing potential points of contamination . moreover , the centrifuge technique is relatively high - throughput with lower hands - on time than other methods , thus reducing processing time . high variation is inherent to in vivo mouse studies due to high mouse - to - mouse phenotypic variation . in order to maximize the research impact of expensive and labor - intensive mouse studies , it is critical to minimize technical experimental error . this protocol can be widely applied to many research fields , including investigation of the bone tissue itself or interrogation of the cells of the bone marrow .", "" ]

[ "tuberculosis ( tb ) is a major health issue in developing countries with over two billion people being infected with tuberculosis bacilli world wide ( 1 ) . although tb was recently regarded primarily as a disease of the developing countries it is now also on the increase in developed countries such as the united kingdom , mainly as a result of globalisation as well as an increase in immunosuppressed patients . figures by the health protection agency ( hpa ) show that the cases of tb in the uk increased by 5.5% in 2009 when compared to those in 2008 ( 2 ) .", "this caucasian patient presented to the emergency department with sudden pain localised to the ulnar aspect of her wrist . the patient agreed to a repeat biopsy and excision of the necrotic bone ( figure 4 ) . ap xray of the wrist showing destruction of the ulnar styloid consistent with a bony infection . ultrasound showed a synovial tumour on the dorso - medial aspect of the wrist ( figure 1 ) .", "tuberculous involvement of the ulna is uncommon and tends to be more common in the diaphysis . although localisation of the tuberculous infection in the bone without joint involvement can occur , this is rare ( 3 ) . a high index of suspicion of tb is important to obtain the correct diagnosis . in chronic soft tissue and bony infection the diagnosis of tb may not be evident from the history and examination and indeed no obvious risk factors may be present as in our case . in our patient the infection could have been contracted at a much younger age , when she was caring for patients infected with tuberculosis , and remained latent ." ]

[ "the value of the ketogenic diet ( kd ) has been recognized in the treatment of epilepsy , although the exact mechanisms by which it exerts its effect remain an enigma . cancer cells need high levels of ros for the induction of angiogenesis and the production of tumor growth factors , thus , through this mechanism the kd can be protective . one of the most intriguing and active fields of research is the effect of a high - fat caloric - restricted diet on the survival of brain tumors cells . the fact that the kd is considered a proven therapy with relatively few adverse affects and wide clinical experience , particularly in children , led to recent studies investigating new potential uses for other neurological disorders . neuroprotection can contribute to the anticonvulsant effect , but it may have other effects as well , which can lead to other clinical uses of the kd .", "the major metabolic effect of the kd is in supplying the brain with an increased amount of free fatty acids . the beneficial effect of the kd on cognition , alertness , and mood is well recognized , and clinical experience shows that in many times it is not less important than the anticonvulsant effect . the potential neuroprotective effect of the kd was what motivated investigations into its potential as a treatment option in other neurologic disorders . there are increasing numbers of reports that ketosis achieved by starvation or administration of a kd has a consistent neuroprotective effect after various brain injuries in animal models . a factor that can be crucial for the application of the kd in medical conditions other than intractable epilepsy is the inherent difficulties in its use ." ]

[ "the endotracheal tube ( ett ) should be placed at the optimal level to avoid inadvertent complication . the purpose of this study was to determine whether surface anatomical landmarks can be used to predict the mid - tracheal level in adult patients . although chest radiography and bronchoscopy are considered an accurate method , they are not always feasible and the costs are considerable . considering the individual variation in the length of the trachea , using fixed depths or marks on the ett may result in inadequate placement of the ett . to reduce the risk of single lung ventilation or vocal cord injury , the segment between the proximal edge of the cuff and the ett tip should be placed at the mid - trachea level . if the length of the trachea can be predicted at bedside before intubation , the ett can be placed at a safe depth for each patient . if the ett is too deep , it increases the risk of unintended single lung ventilation . there are many methods for determining the appropriate depth of ett in adults ; fixed insertion depth according to sex ( 23 and 21 cm from the upper incisors in adult males and females , respectively ) , the use of depth marks on the ett , suprasternal palpation of the ett tip or cuff , and bilateral auscultation . on the other hand , if the ett is too shallow , it may cause vocal cord injury by the ett balloon or accidental extubation .", "neck computed tomography ( ct ) images of adults obtained between 2009 and 2014 were reviewed by a single reviewer after obtaining approval form seoul national university hospital institutional review board ( july 17 , 2015/no . in addition , poor ct image quality , absent sagittal ct images , ct images that did not cover the entire trachea , or ct images taken in neck hyperextension ( boidin angle > 130 on scout view ) or hyperflexion ( boidin angle < 110 on scout view ) position were also excluded . patients with laryngeal , tracheal , or thoracic abnormalities , tracheostomy or significant tracheal deviation caused by mass lesions were excluded .", "cc = cricoid cartilage , extcc - ssn = the surface distances from the cricoid cartilage to the suprasternal notch , extssn - msj = the surface distances from the suprasternal notch to the manubriosternal junction , msj = manubriosternal juction , ssn = suprasternal notch , vc = vocal cord , tracheal length = a + b + c + d. the ideal position of endotracheal tube ( ett ) to minimize the risk of endobronchial intubation and vocal cord injury . cc = cricoid cartilage , ett = endotracheal tube , msj = manubriosternal juction , mtl = the level of the middle of the trachea , ssn = suprasternal notch , vc = vocal cord . levels of subglottic and tracheal airway segments that include the vocal cords ( vc ) , the cricoid cartilage ( cc ) , and the carina were identified using the method described by sirisopana et al . the mid - point between the proximal edge of the cuff and the ett tip was matched to the level of the middle of the trachea ( mtl ) , which was calculated from the tracheal length . the vocal cords were identified as the most cranial level of the upper airway , with a teardrop shape below the laryngeal ventricle . anatomic level of suprasternal notch ( ssn )", "the relationships between surface measurements and the mid - tracheal level were analyzed with bland the correlations between age , height , weight , and tracheal length were analyzed using linear regression .", "extcc - ssn = the surface distances from the cricoid cartilage to the suprasternal notch , mtl = the level of the middle of the trachea . extcc - ssn = the surface distances from the cricoid cartilage to the suprasternal notch , extssn - msj = the surface distances from the suprasternal notch to the manubriosternal junction , mtl = the level of the middle of the trachea . altman plots of female ( left ) and male ( right ) patients showing the agreement between the mid - tracheal level ( mtl ) and the surface the surface distance from the cricoid cartilage from the suprasternal notch . altman plots showing the agreement between the mid - tracheal level ( mtl ) and the surface measurements of surface anatomical landmarks .", "this study showed that mid - tracheal level could be estimated by the surface distance between the cc and the ssn ( extcc - ssn ) . compared with males , extcc - ssn more accurately predicts the mid - tracheal level in females . in clinical practice , physicians can use extcc - ssn to determine the depth of ett so that the segment between the proximal edge of the cuff and the ett tip lies at the mid - tracheal level . the mid - tracheal level , which is considered the optimal depth of ett , can be predicted by the surface distance between the cc and ssn in adults , especially in females . therefore , the position of the neck should be considered when determining the optimal depth of the ett ." ]

[ "the relative novelty of these practices and roles , complicated by the pace of change in technical possibility and regulation , mean that there is still uncertainty about how to conceptualise embryo donation , not just in terms of systematic ethics but as a sociomoral practice in everyday social life and morality ( banks , scully , and shakespeare 2006 ) . from a sociological perspective , and also to understand more generally how everyday morality deals with unprecedented ethical dilemmas , it is important to examine which conceptualisations emerge as salient and how they are stabilised and used . even if using human embryos for stem cell research is deemed permissible , ethical issues continue to emerge as new social practices and roles develop around the act of embryo donation . similarly , hesc research , to which the embryo may be given , is a domain of biomedical practices and not an entity . as such , hesc research is not a subject with which a gift relationship can be established ( unlike , for instance , an organ recipient ) .", "understanding the social and ethical meanings that are emerging for the practices associated with embryo donation calls for a detailed empirical examination of people s reasoning behind donation decisions . the scarcity of data on donor rationales means there is a corresponding lack of information on contextual and other factors that influence donor decisions and how these can be related to the evaluations of theoretical ethics . , we not only collect empirical data to help understand the emerging moral meaning of a new practice , but also give an example to show how empirical data can be used to question and then refine the conceptual basis of bioethical theory . the authors of this paper have been involved in a series of linked qualitative studies of practices of embryo donation , first in the united kingdom ( researcher haimes and colleagues ) , then switzerland ( scully , rehmann - sutter , and porz ) , and in a smaller pilot project in china ( mitzkat , rehmann - sutter , and haimes ) . we then look in more detail at the implications of our findings for one area of potential ethical concern : the possible role of gratitude in making embryo disposition decisions . in this way", "participants who chose to donate their surplus embryos to research had a background premise that donation is fundamentally permissible because embryos do not have the sort of ontological or moral status that would forbid it . it will be important to clarify this , and to identify best practices for maximising patient comprehension of the research goals , because if ( as our material indicates ) the type of research to which people donate is a relevant factor in their moral evaluation , then the question of whether they fully understand its nature is ethically crucial . as we have seen , some of our participants reasoned that if their embryo was not going to be used for pregnancy , then donating it to a good endeavour ( research ) would be more meaningful than simply discarding it . ( we want to be quite clear here that we are not arguing that failure to use an ivf embryo in pregnancy actually is a moral wrong , only that some of our participants said that in their case they felt so . ) across all three studies the commonest rationale for opting to donate was a willingness to contribute to potentially curative medical research . study there was an added imperative to donate surplus embryos to research as there had been a lot of press coverage about the hoped - for curative outcomes of stem cell science : ", ". it will be important to clarify this , and to identify best practices for maximising patient comprehension of the research goals , because if ( as our material indicates ) the type of research to which people donate is a relevant factor in their moral evaluation , then the question of whether they fully understand its nature is ethically crucial . across all three studies the commonest rationale for opting to donate was a willingness to contribute to potentially curative medical research . study there was an added imperative to donate surplus embryos to research as there had been a lot of press coverage about the hoped - for curative outcomes of stem cell science : i think the research is very important , like it was in the news a while ago to say that [ the senior clinician ] was successful in stem cell research and that s what you need in order to provide medical assistance in the future , so i m all for it . donation of their spare embryos to research was therefore seen as a morally good act , based on a kind of ethical arithmetic in which simple disposal produced zero good from the surplus embryo , while donation had the potential to do good by supporting research . as one u.k .", "as we have seen , some of our participants reasoned that if their embryo was not going to be used for pregnancy , then donating it to a good endeavour ( research ) would be more meaningful than simply discarding it . ( we want to be quite clear here that we are not arguing that failure to use an ivf embryo in pregnancy actually is a moral wrong , only that some of our participants said that in their case they felt so . ) our interpretation of their statements is that they felt they had ( inadvertently ) done something wrong in creating life but then not using that life as intended in pregnancy , and that donation to a good endeavour would in some way make up for this wrong . then , their donation decision appears to have been driven in part by what we could call a reparative urge .", "the scientists would do with their embryo , which was articulated either as disapproval of specific types of research ( e.g. , not if it s for cloning ) or as a more general unwillingness to relinquish responsibility of the embryo to unknown others . in both sets of reasoning , therefore , participants were expressing unease about the loss of control over what would happen to their embryo . approximately half of the swiss participants who were interviewed turned out to have decided against donation and instead have their surplus cryopreserved embryo(s ) destroyed . the two chinese interviewees who had opted against donation also did so because of reservations about lack of knowledge of exactly what the embryos would be used for , explicitly mentioning the fear that they would be donated to ( i.e. , used to generate pregnancy in ) other women . none of these explicitly used the moral status of the embryo as the fundamental basis for rejecting donation to research . in addition , two of the swiss participants gave financial reasons , that is , they expressed anger that they would not be compensated for giving up their embryo and that through donation researchers were getting something for nothing . study , speculation about why some people might refuse to donate raised concerns about what might be done with the embryos and whether a baby would be developed through experimentation ; others wondered if refusers were worried that another infertile couple would receive their embryos and have a baby when they , the embryo providers , failed to do so . sample contained only two actual refusers , who objected on the grounds of possible use in animal research ( haimes and taylor 2009 ; hug 2008 ) .", "these observations provide material for an empirically grounded bioethics of the ivf stem cell interface ( franklin 2006 ) . in the rest of this paper , we consider a single aspect in detail : the potential problem of gratitude influencing informed consent . empirically , the main reasons given by our participants for donation were : ( 1 ) to avoid the waste of a precious resource , ( 2 ) to give something back to research , and ( 3 ) to compensate for a perceived moral wrong . in none of the three countries did our participants indicate that their decision arose out of any sense of gratitude to the physician who had given them ivf treatment . participants wanted to do something with the surplus embryo that would be of benefit to research and medical treatment for infertility , but this was not directly associated with the physician who provided it originally . indeed , some of our interviewees were critical of aspects of their own ivf treatment , while still wanting to support the infertility research enterprise overall . in this context , it should be remembered that about half the swiss participants interviewed in fact chose not to donate , primarily out of anxiety about losing control over the fate of their embryos , but also in some cases because it meant researchers were getting something for nothing .", "to summarise : our interpretation of the material suggests that donors reasons for donating were not connected in any straightforward way to either gratitude or indebtedness . for some people a generally positive stance toward biomedical science means that donation is a good use of a valuable resource . with some of the swiss participants , we also identified a reparative urge coming from a sense of moral unease , and here donation seems to offer a route through which the urge to make reparation can be satisfied . the reparative urge foregrounds a different set of ethical questions about the sociomoral meaning of the generation of spare embryos and the act of donation . in addition , as we discussed earlier , the generation of surplus embryos is still an unfamiliar social practice and the role of the embryo donor is one that lacks widespread cultural recognition . in the swiss context of legal exceptionalism , then , producing one of these culturally unfamiliar entities may more readily be understood as something " ]

[ ", we discuss the etiology of pediatric mtc and currently available therapeutic modality for the cancer . sporadic mtc is very rare ; the vast majority of mtc diagnosed in the childhood is hereditary . the early onset of mtc in hereditary syndromes makes it an important endocrine disease that is increasingly managed by pediatric providers [ 1012 ] . in this review thyroid cancer is the most common endocrine neoplasia which accounts for about 1% of human cancers .", "ret encodes a receptor tyrosine - kinase which is expressed in the neural crest - derived cell types , including thyroid parafollicular cells , neuronal cells , and adrenal medullary chromaffin cells . in these cell types , ret plays a central role in regulating cell proliferation , growth , differentiation , migration and survival . in humans activation of different downstream signaling pathways is associated with different clinical features of ret mutant thyroid cancers , as observed in men2 syndromes discussed below . ret is one of the first receptor tyrosine - kinases ( rtks ) that have been found to play a role in neoplasia , being most well - known as a key etiological factor for thyroid cancer [ 6 , 24 ] . activating mutations of ret of note , the hirschprung disease is closely associated with men2a , demanding a genetic screening for men2a for children with familial hirschsprung 's disease .", "the men2a subtype , accounting for 9095% of the men type 2 cases , is a highly penetrant , autosomal dominant endocrine tumor syndrome characterized by the development of mtc in > 90% of ret mutation carriers . in association with mtc in addition , rare variants of men2a are also associated with cutaneous lichen amyloidosis and hirschsprung disease [ 35 , 36 ] . thus , apart from the genetic testing of ret mutations in children born to a parent with men2b , early diagnosis of men2b remains challenging . therefore , it is often difficult to determine fmtc based upon a family history and only careful genetic screening can distinguish between inherited and sporadic forms of mtc .", "mtc cells secrete the polypeptide hormone , calcitonin , and the glycoprotein carcinoembryonic antigen ( cea ) , and these are used as diagnostic biomarkers for mtc . serum calcitonin is the primary biochemical marker used for detection , staging , postoperative management , and prognosis for mtc patients . mtc is most commonly diagnosed by immunohistochemical staining of fine - needle aspiration of a new thyroid nodule for calcitonin , chromogranin a , or cea . characterization of additional molecular pathways responsible for mtc development may allow the discovery of therapeutic targets that can be exploited to induce reduction of tumor size , disease stabilization , and symptomatic improvement [ 7782 ] . therefore , there is a critical need for more effective therapies for patients with advanced mtc . this classification may be used to predict phenotype , to recommend the timing of prophylactic thyroidectomy and the extent of surgical intervention , and to begin biochemical screening for pheochromocytoma and hyperparathyroidism . the standard treatment for mtc is surgical removal of all thyroid tissue including the posterior capsule [ 39 , 62 ] .", "due to limited adjuvant treatment options , adequate surgical treatment is critical for initial control of the disease and prophylactic thyroidectomy is recommended for children with men2a and men2b at an early age , sometimes during infancy . mtc and the men type 2 syndromes are rare but significant endocrine diseases that are increasingly encountered by pediatricians . our understanding of mtc has been greatly increased by the discovery of ret and the genotype genetic tests according to the established guidelines should be performed whenever diagnosis of mtc is made . emerging newer treatments are expected to better treat this rare but life - threatening malignancy ." ]

[ "this paper presents a complete 3d framework for updating multimodal preoperative images with respect to surgical brain deformations , due to brain shift and successive resections , followed and quantified using imr images . we take into account successive deformations based on a linear elastic biomechanical model which is deformed using fem or xfem , depending on the type of deformation occurring between the pair of imr images under consideration , namely , brain shift or resection . while avoiding mesh adaption or remeshing , and because of the similarity between cracks in mechanical parts and cuts in tissue , we proposed the use of xfem for handling cut , resection , and retraction in the updating of preoperative images . we present the state - of - the - art of resection modeling for preoperative image update . in section 3 , we describe our basic strategy for updating preoperative images based on successive intraoperative images . in section 4 , we give detail about our methods and algorithms . in section 5 , one solution is to bring over the high - quality preoperative multimodality images into the intraoperative configuration of the brain using a nonrigid registration technique [ 710 ] . our approach is modular , and is applied iteratively each time a new intraoperative image is acquired .", "the objective of a surgical simulator is to provide an interactive manipulation with force feedback of the anatomical part to be operated using various surgical instruments . in order to model a large range surgical procedures , the methods described above have been all developed using an fem - based biomechanical model for intraoperative image registration . among studies that take into account resection for preoperative image update , one should distinguish two categories . jebkov and kuhlen have applied nonlinear xfem for simulating cut , and have shown that xfem is successfully efficient for such purpose . hagemann et al . developed a 2d method for modeling brain deformation between a preoperative mr image and a postoperative mr image , the postoperative image showing a complete resection .", "the biomechanical model is thus built based on structures visible in the 1st imr image , instead of in the preoperative images , and the structures used in the model are limited to the ones visible in the intraoperative image . except for the rigid registration between the preoperative images , the biomechanical model , and the 1st imr image , this simplified approach allows us to discuss , illustrate , and test all key aspects of the system . we make a simplification of the approach just presented , by using the 1st imr image as a substitute for the preoperative images . even though the issues involved in the update of preoperative images will need to be addressed in a operational image update system , the present strategy of deforming the imr images remains useful for calibration purpose , even in the operating room . the resulting displacement field of the biomechanical model is finally used to warp the set of preoperative images in their current state of updating . in addition , part of the biomechanical model is cut , using xfem , to model resection .", "it thus requires specific techniques , and we use the meshing software tool isosurf ( http://svr-www.eng.cam.ac.uk/~gmt11/software/isosurf/isosurf.html ) . our goal is to model the boundaries of healthy - brain and tumor regions as two connected surfaces meshes . however , while there exist sophisticated segmentation algorithms that could be used [ 5052 ] , in particular for extracting the whole - brain region ( skull and external cerebrospinal fluid masked out ) , the segmentation of the tumor region is still challenging . as mentioned above , the biomechanical model is built , in the present context , from the 1st imr image rather than from the preoperative images . thanks to the use of xfem instead of fem for modeling discontinuities , this biomechanical model can be built offline before the operation starts and does not need to be repeated ( through remeshing ) during the surgery . with respect to fem - based approaches , this section details the different methods that are commonly used for updating preoperative images in presence of brain shift and resection . the rigid registration that we use is the point - based landmark transform available in vtk ( http://www.vtk.org/ ) . we use the fem - software tool metafor ( http://metafor.ltas.ulg.ac.be/ ) developed in our mechanical - engineering department , to which we have added an xfem module .", "in addition , the deformed 4th imr images , using the xfem- and the fem - based deformations of the biomechanical model , show the same similarity , computed based on the modified hausdorff distance , with the 5th imr . in this section , we apply our methods , respectively , of brain shift and resection ( imr images are acquired with the 0.5 tesla intraoperative ge signa scanner of the brigham and women 's hospital , boston , usa . consequently , we do not model explicitly the removal of tissue , but we model directly the deformation resulting from it , without introducing any tissue discontinuity . using the surface displacement field of the healthy - brain region boundary , we compute the deformation of the biomechanical model via fem . then , using the resulting volume displacement field , we warp the part of the 2nd imr image corresponding to the whole - brain region , in the same way as we did in the case of for brain shift . although this comparison between fem and xfem should be done on more patient cases , we suggest that , in first approximation , fem could be used for modeling resection cases with small brain deformations . using fem for modeling resection is equivalent to ignoring the presence of resection on intraoperative images . to illustrate the comparison between fem and xfem results , we choose the 3rd resection modeling of the second patient case", "to understand if the modified hausdorff distance increases everywhere in the whole - brain region for the brain shift and 1st resection modeling of the second patient case , we compute the modified hausdorff distance in the neighborhood of the tumor region ( in the same way as explained for table 1 ) , and observe the improvement of the alignment within the tumor region and its neighborhood . as opposed to the values of the modified hausdorff distances in table 1 , the values for the images nonrigidly registered in table 2 increase through the successive resection modeling . this amplification error is due to the fact that , after having modeled brain deformation between a pair of imr images , the deformed biomechanical model is not in perfect alignment with the second image of the pair . since , for the subsequent deformation modeling , the surface landmarks are initialized based on the deformed biomechanical model , this can thus ampliy a misregistration error . this indicates that the nonrigid registration enhances the alignment of the two imr images within the tumor region and its neighborhood , which is in fact the location requiring the best modeling accuracy . the goal of the nonrigid registration is , however , to deform the preoperative images . by warping ik for each deformation modeling if the nonrigid registration is responsible for the increase of the misalignment of the two imr images everywhere in the whole - brain region , or if this effect is localized , we compute the modified hausdorff distance in the region and neighborhood of the tumor only ( volume region that extents by 25 mm the tumor region segmented in i1 for both patient cases ) . this allows one to evaluate the propagation , that is , the amplification , of alignment error on the results . however , the modified hausdorff distance increases for the 3rd resection modeling of the first patient case , as well as for the brain shift modeling of the second patient case . to understand", "we developed a complete 3d framework for serial preoperative image update in the presence of brain shift followed by successive resections . the nonrigid registration technique used an homogeneous linear elastic biomechanical model , driven by the deformations of whole - brain and internal tumor region boundaries for brain shift modeling , and healthy - brain region boundary for resection modelings , tracked between successive imr images . the biomechanical model was deformed using fem for brain shift modeling , and fem or xfem for resection modeling , depending upon whether some brain tissues were previously resected or not . we showed that our nonrigid registration technique improved the alignment of the successive imr images for most of the deformation modeling of both patient cases . when our nonrigid registration failed , it still improved the alignment locally , that is , within the tumor region and its neighborhood ." ]

[ "has reviewed prospective studies investigating the possible protective effects of the dietary intake of n-3 pufa on prostate cancer development.16 fasano et al also has reviewed a lot of in vivo and in vitro experimental studies providing strong indications of the anti - tumor action of n-3 pufa against lung cancer.17 the purpose of this review is to discuss the potential role of n-3 pufa in gastrointestinal ( gi ) cancer development . the contribution to human health of the specific fatty acid ( fa ) composition of the diet has received considerable attention in the literature . we believe that increased consumption of n-3 pufa may lower the risk of gi cancer development via various chemopreventive activities . a lot of studies suggest that n-3 pufa , as diet - dependent factors , may be critical to preventing disease backed up with authentic antioxidative and anti - inflammatory actions . especially , n-3", "the excellent tolerability and safety profile of n-3 pufas combined with other health benefits , particularly cardiovascular , make n-3 pufas an attractive candidate for prevention and treatment of crc.9 moreover , it is reported that n-3 pufa supplemented parenteral nutrition can reduce inflammation and improve immune function in patients following esophageal cancer surgery20 and n-3 pufa - containing diet may be beneficial to patients with esophageal cancers who receive chemoradiation therapy ( crt ) by reducing crt toxicity.21 in contrast to other gi cancer , little work has so far been performed on the influence of n-3 pufa in oesophageal adenocarcinogenesis and neoplastic progression.22 there is a need for appropriately powered randomized - controlled studies to assess the long - term benefit of n-3 pufa . gastric cancer ( gc ) is the fourth most common cancer worldwide , and almost two thirds of affected individuals will die of their disease . similar findings have been reported for studies of growth of human crc cell lines such as hct26 , ht-29 , hct116 , and dld-1 grown as xenograft tumors in immunecompromised mice.9 n-3 pufas are likely to have multifaceted roles in both prevention and treatment of crc . the preventive effect of n-3 pufa has been demonstrated in a number of carcinogen - induced models like aom and dimethylhydrazine ( dmh)-induced rat model and apc mouse models relevant to prevention of crc including ours .", "esophageal cancer is a tumor that has increased in incidence more than 7-fold over the past several decades . esophageal cancer is ranked as the sixth leading cause of cancer death worldwide . according to the increasing incidence of gastroesophageal reflux disease ( gerd ) , suggests that negative associations between n-3 pufa intake and the risk of esophageal adenocarcinoma.19 higher in - takes of n-3 pufa [ cases vs. population controls ; or=0.46 , 95% ci=0.220.97 , 4th vs. 1st quartiles of intake ] was associated with a lower risk of barrett s esophagus . in contrast , higher trans - fat intakes were associated with increased risk ( or=1.11 ; 95% ci=1.031.21 per g / day ) . moreover , it is reported that n-3 pufa supplemented parenteral nutrition can reduce inflammation and improve immune function in patients following esophageal cancer surgery20 and n-3 pufa - containing diet may be beneficial to patients with esophageal cancers who receive chemoradiation therapy ( crt ) by reducing crt toxicity.21 in contrast to other gi cancer , little work has so far been performed on the influence of n-3 pufa in oesophageal adenocarcinogenesis and neoplastic progression.22 there is a need for appropriately powered randomized - controlled studies to assess the long - term benefit of n-3 pufa .", "gastric cancer ( gc ) is the fourth most common cancer worldwide , and almost two thirds of affected individuals will die of their disease . some studies about the association of n-3 pufa and gastric disease suggests a protective effect of n-3 pufa on gastric cancer . recently , correa et al . suggests that docosahexanoic acid ( dha ) inhibits helicobacter pylori ( h. pylori ) growth in vitro and mice gastric mucosa colonization.23 \n h. pylori are recognized as a major etiological factor in chronic active gastritis , gastric duodenal ulcers and gastric cancer . it has been proposed that pufa hold an inhibitory effect on bacterial growth via disruption of cell membrane leading to bacteria lysis.24 mohamed also shows that n-3 pufa reduced iodoacetamide - induced gastritis in rats through decrease of malondialdehyde ( mda ) , gastrin , and nitric oxide ( no ) and normalization of mucosal glutathione.25 especially , it is reported that the erythrocyte composition of dha was found to be negatively linked to risk of gastric cancer , of well - differentiated adenocarcinoma.26 application of a diet enriched with n-3 pufa delayed tumor growth in a mouse xenograft model.27 \n in vitro studies have shown that n-3 pufa inhibited macrophage - enhanced gastric cancer cell migration and attenuated matrix metalloproteinase ( mmp)-10 expression through erk and stat3 phosphorylation28 and inhibited the growth of human gastric carcinoma cell via apoptosis and combination with 5-fluorouracil has synergetic effect in inhibiting the proliferation of gastric cancer cells.29 moreover , n-3 pufa are beneficial for preventing oxidative stress - induced apoptosis by inhibiting apoptotic gene expression and dna fragmentation of gastric epithelial cells.30 on the other hand , dha induced apoptosis of gastric cancer cells by inducing the expression of apoptotic genes in gastric cancer cells.31 although a large body of literature spanning numerous cohorts from many countries and with different demographic characteristics does not provide evidence to suggest a significant association between n-3 pufa and stomach cancer incidence,32 further studies are needed to investigate action of n-3 pufa relevant to antitumor effects in the stomach .", "there is also evidence suggesting improved efficacy and/or tolerability of conventional colon cancer chemotherapy when administered with n-3 pufa.9 epidemiological studies about the association of dietary fat and cancer suggests a protective effect of n-3 pufa and a promoting effect of n-6 pufa on cancer . the excellent tolerability and safety profile of n-3 pufas combined with other health benefits , particularly cardiovascular , make n-3 pufas an attractive candidate for prevention and treatment of crc.9 the preventive effect of n-3 pufa has been demonstrated in a number of carcinogen - induced models like aom and dimethylhydrazine ( dmh)-induced rat model and apc mouse models relevant to prevention of crc including ours . dietary administration of one or both of the main n-3 pufa in rodent models of colorectal carcinogenesis has been demonstrated to reduce colorectal tumor size and multiplicity , compatible with crc chemopreventive activity.33 in meta - analyses of prospective cohort studies that evaluated the association between fish consumption or n-3 fatty acids and colorectal cancer incidence or mortality , the pooled relative risks for colorectal cancer incidence were 0.960.97 ( 95% confidence interval : 0.92 , 1.00 ) for each extra occurrence of fish consumption per week.34 in a population - based prospective study on the association of n-3 pufa and cancer , there was an inverse relationship between marine n-3 pufa intake and the risk of colorectal cancer , but this association was only statistically significant in the proximal site of the large bowel.35 cockbain et al.9 has reviewed a lot of in vitro and in vivo experimental studies and epidemiological observations providing strong indications of the cancer treatment and prevention of n-3 pufa against colorectal cancer .", "n-3 pufa , especially , epa and dha , have been shown to have multiple anti - tumor actions . n-3 pufa appear to down - regulate epidermal growth factor receptor ( egfr ) , protein kinase c ( pkc ) , ras , and nf-b , insulin like growth factor ( igf ) , which are important cell signaling mediators often found to be elevated in carcinogenesis . hence , the fat-1 transgenic mouse is a valuable in vivo system for elucidating the role of n-3 pufa in carcinogenesis . it is known that resolvins exhibit antineoplastic activity via anti - inflammatory and inflammation resolution activity in animal models of acute inflammation . besides these multiple anti - tumor actions secondly , n-3 pufa induces cancer cell apoptosis via modulation of peroxisome proliferator - activated receptors ( ppars ) , the bcl-2 family , and nf-b cell signaling .", "hence , the fat-1 transgenic mouse is a valuable in vivo system for elucidating the role of n-3 pufa in carcinogenesis . the fat-1 mouse model allows carefully controlled studies to be performed in the absence of restricted diets , which can create confounding factors that limit studies of this nature.55 several studies using fat-1 mice model indicate that balancing the tissue n-6/n-3 ratio could exert a significant effect on gi cancer development . recently , the engineered n-3 pufa desaturase transgenic mice ( fat-1 mice ) , which can endogenously synthesize n-3 pufa in their tissues , allows carefully controlled studies to be performed in the absence of potential confounding dietary factors.45 the synthesis of n-3 pufa is achieved through the expression of the fat-1 transgene encoding for an n-3 desaturase , which utilizes n-6 pufa as substrate . recently , mohammed et al.50 suggested the beneficial effects of n-3 pufa for chemoprevention of pancreatic cancer using fat-1 mice .", "manson et al . has started the vitamin d and omega-3 trial ( vital ) , a large randomized , double - blind , placebo - controlled , 22 factorial trial of vitamin d and n-3 pufa supplements in the primary prevention of cancer among a multi - ethnic population of 20,000 u.s . men aged 50 and women aged 55.56 we expect that new findings in combination consumption of n-3 pufa with other nutrients will provide new approaches to public health implications with regard to prevention of gi cancer through dietary and lifestyle interventions . gi cancer incidence and mortality are increasing in the eastern world and a high n-6 to n-3 pufa ratio in the western style diet may be a contributing factor . there is much evidence to suggest that higher consumption of dietary n-3 pufa is associated with a lower risk of gi cancer in animal models and humans . especially , recent studies suggest that endogenous n-3 pufa delay the progression of colon and stomach cancer and elevating n-3 pufa may be an important strategy to delay / prevent gastrointestinal cancer in high - risk patients via various mechanisms mediating cancer prevention by n-3 pufa ( fig . 2 ) . in addition , using n-3 pufa in combination with other agents with complementary antitumor action may improve their efficacy in gi cancer prevention . recently ," ]

[ "individuals diagnosed with 46xy dsd show an overlap in clinical and biochemical parameters which emphasizes the need for comprehensive evaluation with a multidisciplinary approach . sexual development in males is a multistep process , implying a delicate network of molecular events that directs the bipotential gonad to differentiate into testis ( sex determination ) and consequent differentiation of internal and external genitalia in the presence of testicular hormones ( sex differentiation ) . charmian quigley and frank french proposed new grading system for the phenotypic features in ais based on prader classification for cah . ovotesticular dsd ( ot - dsd ) is a rare condition marked by the presence of both ovarian and testicular tissue in an individual while congenital bilateral anorchia ( cba ) is characterized by the complete absence of testicular tissue in genotypic males .", "this is an ambispective study where all new and old follow - up patients diagnosed with 46xy dsd , being managed at endocrine opd in a period of 16 months ( june 2014october 2015 ) were included . testosterone levels were measured before and 2448 h after the last injection of a series of three intramuscular injections of hcg on alternate days ( < 1-year - old , 500 units ; 110 years , 1000 units ; > 10 years , 2000 units ) . abdominopelvic ultrasound was done for the localization of gonads ( magnetic resonance imaging ( mri ) also , when required ) . for patients on follow - up , previous records were reviewed to establish a diagnosis as they were on medication while in new patients , samples were collected and hormonal measurements included serum luteinizing hormone , follicle - stimulating hormone , testosterone , androstenedione ( a ) , cortisol , dehydroepiandrostenedione , and plasma adrenocorticotropic hormone levels by electrochemiluminescence immunoassay using commercial kits ( roche , germany ) . testosterone : androstenedione ( t : a ) and testosterone : 5 dht ( t:5dht ) ratios were calculated as and when required to rule out 17 beta hsd deficiency and 5 alpha reductase deficiency respectively . external masculinization score ( ems ) were calculated based on the external genitalia of patients . the short - term human chorionic gonadotropin ( hcg ) stimulation test was carried out to check the functioning of testicular tissue . 5dht was measured using radioimmunoassay ( immunotech ; prague , czech republic ) after extraction from other hormones with diethyl ether and celite chromatography .", "on first evaluation , 11 patients had presented with the primary complaint of ambiguous genitalia , three ( who were being reared as female ) with primary amenorrhea , three with undescended gonads and one with fever and vomiting . clinical profile of patients patient s.1 reared as female presented with primary amenorrhea , delayed development of secondary sexual characteristics and unambiguous female genitalia . the patient is kept on antihypertensives , but no definitive diagnosis could be made as the baseline hormonal reports are missing . with the help of clinical , biochemical and radiological evaluation , the presenting complaints , clinical , hormonal , and radiological findings are summarized in table 1 .", "the inability of bipotential gonad to differentiate into testis results in testicular dysgenesis or agenesis which occurs due to the disruption of various genetic factors involved in the process of sex determination . in our study , four patients were diagnosed with pgd , one with cgd , one with ot - dsd , and two with testicular agenesis or cba . in the absence of gonadal development , the diagnosis of 46xy dsd needs to be confirmed by cytogenetic , hormonal , radiological , and genetic tests . the pediatrician , endocrinologist , surgeon , psychologist , and clinical geneticist need to work as a team for multifaceted management of these patients . phenotype varies depending on the degree of genetic , hormonal and anatomic defect . at times , in spite of all the tests a definitive diagnosis may not be possible . there is overlap in the clinical , hormonal and anatomic profile of different subsets of 46xy dsd . patients with cgd usually present with unambiguous female genitalia due to the absence of gonadal steroid production while in pgd , the external phenotype depends upon the degree of testicular tissue present . in our study , out of four patients with pgd , three ( s.2 , s.3 , and s.5 ) presented with ambiguous genitalia and one with undescended gonad ( s.4 ) . in such cases , corrective surgeries are done if required , and testosterone supplementations are given at pubertal age . patients with cais may present with primary amenorrhea in adolescence or inguinal swellings in infants . discordance between genetic ( xx or xy ) , gonadal ( testis or ovaries ) , external genital ( vulva or penis ) , and internal sex ( wolffian or mullerian ducts ) results in dsd . in humans ,", "this study was supported by department of biotechnology , ministry of science and technology ( bt / pr7681/med/12/597/2013 ) and indian council of medical research ( dhr / gia/1/2014 ) , new delhi , india .", "" ]

[ "herein , we chronologically assessed the source , patient demographics , and antimicrobial susceptibilities of mrsa - positive isolates from the hospital and community setting over a 5-year period in university hospital waterford a tertiary referral hospital with the primary microbiology laboratory for 4 acute hospitals , serving a total catchment area of almost 500,000 people . urinary tract infection ( uti ) is a frequent cause of morbidity both in the community and in the hospital setting . methicillin - resistant sa ( mrsa ) is widespread in many irish hospitals and is increasingly seen in community health care units such as nursing homes . globally , it is considered that there has been an epidemic of mrsa within health care institutions . bacteriuria with sa is hypothesized to occur through a number of mechanisms that includes catheterization , urologic procedures , or seeding of the genitourinary tract including nephrologically excreted bacteria in overt bacteremia . bacteremia itself is associated with bacteriuria in patients infected with sa , which suggests that bacteremia is an important precursor for bacteriuria in some patient groups . sa is an opportunistic pathogen affecting both immune competent and immunocompromised individuals , frequently resulting in significant morbidity", "we considered a separate episode as a urine specimen culturing mrsa at least 6 months following a previous positive culture . the microbiology laboratory in university hospital waterford processes all inpatient urines in the catchment area of almost 500,000 , excluding 2 small private elective inpatient institutions . it also processes all urine samples sent from the community ( i.e. , all samples from general practice and nursing homes ) and all specimens from the catchments emergency departments . that is , those in whom there was clinical suspicion of sepsis or invasive infection , teicoplanin and vancomycin were also tested for sensitivity profiling . in order to obtain further clinical information from our patient group , we also assessed those patients who had an mrsa - positive swab ( usually from groin , nose , or perineum ) , those who had documented mrsa bacteremia , and we analyzed their demographic details . laboratory diagnosis of mrsa bacteriuria was performed using accredited microbiological microscopy analysis with culture identification criteria and standardized susceptibility testing protocols . resistance rates were then calculated for the pathogen 's susceptibility to 5 commonly used antimicrobial agents ciprofloxacin , coamoxiclav , flucloxacillin , nitrofurantoin , and trimethoprim . for unwell patients ,", "mrsa = methicillin resistant staphylococcus aureus , mssa = methicillin sensitive staphylococcus aureus , sa = staphylococcus aureus . inpatient trends in sa mrsa = methicillin resistant staphylococcus aureus , mssa = methicillin sensitive staphylococcus aureus , sa = staphylococcus aureus . mrsa = methicillin resistant staphylococcus aureus , mssa = methicillin sensitive staphylococcus aureus , sa = staphylococcus aureus . regarding the clinical stance of patients within the cohort , 9 patients ( 7% ) with mrsa - positive urine cultures had a documented history of mrsa bacteremia at that time .", "our study would suggest that when it comes to urine - colonizing mrsa eradication , or for treating a patient who is not critically unwell , oral therapy with nitrofurantoin or trimethoprim would be a suitable first - line agent , as none of the patients in our cohort were resistant to both trimethoprim and nitrofurantoin . in the unwell or septic patient , vancomycin or teicoplanin the impact of mrsa is considerable ; in ireland , approximately 40% to 50% of isolates sa recovered from bloodstream infections are methicillin resistant . despite available publications and guidelines on the management of mrsa skin - colonized patients , little has been published on the colonization of urine from patients with indwelling urinary catheters . some studies have documented that eradication of asymptomatic bacteriuria is not required before nonurologic procedures , such as arthroplasty but s. aureus is the most pathogenic of all staphylococci and this study did not include patients with mrsa bacteriuria . the european association of urology guidelines outlines that colonization with microorganisms is a special risk factor for urological procedures ( http://uroweb.org/guideline/urological-infections/ ) , and furthermore , that an indwelling catheter is one of the most important risk factors for complications . there is little information relevant to other genitourinary procedures , but any intervention with a high probability of mucosal bleeding should be considered as a risk for post - procedure sepsis and treatment of mrsa bacteriuria should be considered . the identification of an mrsa isolate in a urine culture has important ramifications for patients , both in the community and in the hospital setting ." ]

[ "acquired angioedema ( aae ) , an acquired deficiency of c1esterase inhibitor , is a medically treatable condition which can cause severe abdominal pain mimicking an acute surgical abdomen . this disorder is strongly associated with chronic lymphocytic leukemia ( cll ) and other indolent lymphoplasmacytic disorders .", "we describe a patient with known cll who developed incapacitating , recurrent severe abdominal pains , culminating in partial bowel resection .", "wider appreciation of the possibility of aae , particularly in patients with lymphoproliferative disorders , could lead to preventive therapy and spare unnecessary surgery .", "acquired angioedema ( aae ) is due to acquired deficiency of c1 inhibitor ( c1inh ) , resulting in excessive complement and bradykinin activities . this is important because aae can be effectively treated medically , but delayed diagnosis can lead to unnecessary diagnostic procedures , therapeutic interventions , or life - threatening complications , well - illustrated by our case . conversely , when patients with known lymphoproliferative disease manifest compatible symptoms , aae should be expeditiously considered . blood vessel permeability is increased ; thus , angioedema occurs . just as with hereditary angioedema ( hereditary c1inh deficiency ; hae ) , common clinical manifestations are skin swelling , laryngeal edema , and/or abdominal pain.1,2 aae often occurs in the context of lymphoplasmacytic disorders , such as monoclonal gammopathy of unknown significance ( mgus ) , non - hodgkin s lymphoma , or chronic lymphocytic leukemia ( cll).1,3 among 32 patients with aae , castelli found that 13 ( 40% ) had mgus and 9 ( 28% ) had lymphoproliferative disease.3 therefore , all cases of aae should be evaluated for the possibility of underlying lymphoplasmacytic disorder .", "a 78-year - old woman with atherosclerotic vascular disease was transferred to our hospital with abdominal pain and underwent emergent laparotomy . one year earlier , she had been diagnosed with rai stage i cll which had been observed without treatment . two months earlier , she presented with severe abdominal pain , nausea , and vomiting . over the next 8 weeks , she had six emergency room and/or hospital admissions for identical symptoms . lymphocytosis and lymphadenopathy improved and c1inh activity increased to 110% . over 3 years of follow - up , abdominal symptoms never recurred .", "approximately 145 cases have been reported of aae,3 and this is one of four cases that we have diagnosed in the last decade with abdominal pains from aae with associated cll . table 1 shows characteristics of patients with cll and aae we have seen ( some briefly mentioned in a prior report).4 this is our only case to undergo surgery , allowing unique and dramatic demonstration of massive bowel edema visible radiographically , on surgical inspection and on histopathology . commonly used for prophylaxis are anti - fibrinolytic drugs or the attenuated androgen danazol , which increases c1inh synthesis at low cost.10 in conclusion , earlier suspicion for aae in our known cll patient could have spared her the morbidities of recurrent abdominal pains , hospitalizations , morbid interventions , and bowel resection ." ]

[ "", "", "distal clavicle fractures associated with partial and complete coracoclavicular ligament disruption are potentially unstable , and non - operative treatment of these fractures is associated with a high non - union rate.[13 ] partial ligament disruptions ( conoid or trapezoid ) retain some inherent stability , and should be distinguished from complete dual ligament disruptions that result in an uncommon and highly unstable subgroup the purpose of this study was ( 1 ) to analyze the overall and comparative clinico - radiological outcomes ( radiographic and ultrasonographic ) of surgical treatment of distal clavicle fractures associated with complete coracoclavicular ligament disruption , and ( 2 ) to identify and analyze radiographic patterns of fracture and comminution that are associated with this injury . additionally , a combination of this implant with some form of coracoclavicular fixation using sutures / anchors / endobutton devices ( tightrope , arthrex , fl , usa ) has been recently described for use in the highly unstable fracture subgroup . however , comparative clinico - radiological outcomes of the two techniques are lacking in literature .", "the hospital records of all patients who were surgically treated for lateral clavicle fractures between 2005 and 2008 at three hospitals were retrospectively evaluated to identify the study group . surgical treatment of an unstable distal clavicle fracture with a joint - spanning implant ( group 1 ) . inclusion criteria for this study was defined as : ( i ) acute , isolated , non - comminuted and comminuted fractures of the lateral clavicle , ( ii ) complete disruption of both coracoclavicular ligaments , confirmed on radiographs and at surgery , ( iii ) absence of concomitant or pre - existing subacromial pathology ( rotator cuff tears , acromial undersurface degeneration ) , ( iv ) surgical treatment with either a joint - spanning implant alone ( group 1 ) , or combination of a joint - sparing implant and coracoclavicular fixation with either endobutton device , suture anchor , or coracoid cerclage ( group 2 ) [ figures 1a and b ] , and ( v ) follow - up period of at least 6 months for radiographic evidence of union . ( hk : hook plate , cl : clavicle , m : medial fragment , l : lateral fragment , arrow : fracture line , ac : acromion , h : humeral head , co : coracoid process ) surgical treatment of an unstable distal clavicle fracture with a joint - sparing implant and coracoclavicular ligament reconstruction using endobutton device ( group 2 ) . pre - operative radiographs of the study group were obtained and analyzed with a graphic analysis software ; fracture lines were traced to identify involvement of the acromioclavicular joint , lateral fragment integrity , and presence / absence of comminution .", "ten patients were operated using a joint - spanning implant ( group 1 ) and 5 were operated using a joint - sparing implant technique ( group 2 ) . overall and group.specific clinico.radiological outcomes and fracture patterns clinical outcomes : the mean cs was marginally higher in group 2 , while the mean sst score was marginally higher in group 1 ; none of these differences were statistically significant . the mechanism of injury was a direct impact to the ipsilateral shoulder sustained during a fall ; in 8 patients , the fracture was sustained during a cycling - related sporting activity ( competitive or recreational ) . the average age of the patients in the study group was 34.5 years ( range , 20 to 57 years ) . reoperation rates related to implant removal were significantly higher ( p < 0.05 ) in group 1 patients ( 90 % ) as compared to group 2 ( 0% ) . the mean follow - up period was 26.1 months ( range , 12 to 40 months ) .", "the present study is the first study that describes overall and comparative outcomes ( clinical , radiographic , and ultrasonographic ) of surgical treatment of an uncommon lateral clavicular bony - ligamentous injury with joint - spanning and joint - sparing implants . . lateral clavicle fractures with complete disruption of the coracoclavicular ligaments should be regarded as a distinct entity that is perhaps biomechanically and prognostically different from similar fractures with partial ligament disruption . in addition , four radiographic patterns of bone injury were identified to develop guidelines for choice of implants in these injuries . clinical outcomes and union rates after operative treatment of this injury", "a combination of a locking distal radius plate with coracoclavicular ligament reconstruction resulted in stable fixation and significantly lower reoperation rates , and should be used preferentially in lesser comminuted fractures ( types 1 and 2 ) ." ]

[ "results revealed a deep vein thrombosis in the common femoral vein as well as in the superficial femoral vein ( fig . acute or sub - acute inflammation was diagnosed given the perfusion image of soft tissue in the left hip area as well as the blood pool image ( fig . a 68-year - old woman visited the clinic with the chief complaints of pain , swelling , and a warm sensation in her left thigh for over 2 days prior to her visit . she had undergone a left bipolar hemiarthroplasty following a hip fracture 24 days prior to the current visit and was wearing compression stockings to prevent the occurrence of a deep vein thrombosis .", "thrombosis is the leading cause of death in those with polycythemia vera and has been associated with high morbidity as well . thromboembolism is one of the major complications of hip surgery and contributes to its poor prognosis . it has been reported that patients with polycythemia vera present with various complications related to thrombosis due to excessive blood viscosity1 ) . aspirin was administrated ( 100 mg daily ) and early exercise and active movements were recommended for the patient in order to lower the risk of venous thromboembolism . in the current case report , a patient with polycythemia vera exhibited clinical symptoms and signs of a postoperative infection following bipolar hemiarthroplasty due to femoral neck fractures . the potential for a deep vein thrombosis requires continuous thought and attention regarding relevant examinations for patients at high risk for thrombosis as well as for embolism ( e.g. , polycythemia vera ) ." ]

[ "brachial plexus surgery using the da vinci surgical robot is a new procedure . to evaluate the advantages and the restrictions of the technique , a cadaveric study of supraclavicular and axillary approaches was conducted . a wide experience in open brachial surgery of the brachial plexus , reported that lower brachial plexus exposure was easier from the axillary working area and a more wide range of motion was achieved to manipulate the robotic tools compared to the supraclavicular exposure for lower part of the brachial plexus . we found that the axillary approach was useful and advantageous for lower roots , particularly for thoracic outlet syndrome ( tos ) . this report will focus on the evaluation of axillary robotic approach as the advantages and disadvantages of supraclavicular robotic intervention have been widely discussed in the literature . the subclavian artery was seen in front of the truncus and was positioned to the posterior of the working space . the plexus was exposed thoroughly from t1 to c7 levels . in this surgical setting , the operating surgeon , who has", "although liverneaux et al . reported techniques and results of upper brachial plexus injury intervention via robotic surgery with a supraclavicular approach , they described the disadvantages as a narrow working space and difficulty to expose the c7 vertebra [ 1 , 5 , 12 ] . to our knowledge , this report is the first to objectively describe robotic axillar brachial plexus exposure . theoretically , a minimally invasive transthoracic approach can obviate these problems , enabling complete resection of the offending portion of the first rib without neurovascular complication . however , we believe that the avoidance of a classic incision leads to significant patient satisfaction for cosmetic reasons and we believe that demand for this procedure from a select group of patients justifies the exploration of alternative ways to avoid classic brachial plexus exposure . the development of robot - assisted surgery has revealed new perspectives in peripheral nerve microsurgery . minimally invasive the development of robotic - assisted minimally invasive techniques began in urology , general surgery , and gynecology because of the generally large working spaces available in the abdomen for these types of surgeries [ 14 ] . , respectively , reported successful results of robotic en bloc first rib resection for tos treatment via transthoracic and transaxillary approaches [ 9 , 11 ] .", "robotic surgery will be used routinely in the future for brachial plexus surgery and particularly for tos that is caused by bone and/or soft tissue . however , newer dedicated surgical instruments need to be developed and further studies should be conducted to evaluate in vivo application and results of this novel approach . this report presents our initial experience with robot - assisted axillary exposure of the brachial plexus region . in our opinion" ]

[ "therefore , the present study aimed to explore the concept of spirituality from the perspectives of iranian healthy elderly people . the central question of the paper was what characterizes the spirituality in the iranian healthy older people ? the main strengths of the present study are that it focuses on the spiritual life of healthy elderly people . thus , recognizing and understanding the spiritual and religious behaviors within the context of cultural influence by a qualitative research is critical for nurse and other health - care providers . spiritual health is a dimension of health that is portrayed as the validation of life in relation to god , fellow human beings , and the environment . older people have particular spiritual needs that are distinct from those of others , particularly in times of ill health and death and dying . have turned into a subject of large interest for researchers in medicine , nursing , gerontology , physical health and mental health disciplines , often in conjunction with complementary and alternative medicine .", "in this research , a qualitative approach was adopted using conventional content analysis of unstructured interviews carried out with 17 healthy elderly people in tehran in 2010 - 2011 . it is worth noting that spirituality is underpinned by personal and cultural context in any community ; therefore , qualitative research is the best method to study cultural context - bound subjects . all participants were shia muslims . in order to achieve the wide range of experiences and perceptions of elderly participants , some field notes writing and 21 interviews were conducted according to emerged codes and categories from data . the first researcher communicated with each of the participants to describe the purpose of research and research questions . the findings and explanations of this study were reviewed by two supervisors who were associate professors in nursing having a good background in qualitative research methodology . also , maximum variation of sampling established the conformability and credibility of the data . based on the participants preference , the interviews were performed in a private room at the house of elderly , park , worksite , or mosque , using an individual semi - structured interview format and this was primarily the main method for data collection . this study provided sufficient descriptive data for researchers to criticize whether the findings were transferable that established applicability . interview query consisted of open - ended questions to allow respondents thoroughly to describe their opinions , perceptions , and experiences .", "in this research , a qualitative approach was adopted using conventional content analysis of unstructured interviews carried out with 17 healthy elderly people in tehran in 2010 - 2011 . it is worth noting that spirituality is underpinned by personal and cultural context in any community ; therefore , qualitative research is the best method to study cultural context - bound subjects .", "criteria for selection were having age above 65 , living with family , not having any cognitive problems , not having any physical limitation in adl , and willingness to participate in the study . the study consisted of 17 healthy elders within the age range of 65 - 86 . initially purposeful sampling was used and continued with purposeful sampling according to the codes and categories emerged from data .", "in order to achieve the wide range of experiences and perceptions of elderly participants , some field notes writing and 21 interviews were conducted according to emerged codes and categories from data . the first researcher communicated with each of the participants to describe the purpose of research and research questions . the interview was scheduled according to the participant 's agreement . based on the participants preference , the interviews were performed in a private room at the house of elderly , park , worksite , or mosque , using an individual semi - structured interview format and this was primarily the main method for data collection . the participants were asked to describe one day of their life and then to explain their own experiences and perceptions about spirituality in elderly adults . what is your experience concerning the spirituality in later age? and what is the meaning of spirituality in your experience ? interview query consisted of open - ended questions to allow respondents thoroughly to describe their opinions , perceptions , and experiences .", "data were collected and analyzed over a six - month -- period in 2009 . in the first phase , subcategories and their domains in the data were identified and classified into categories . the coding process was iterative , and categories evolved ( inserted , deleted and combined ) as re - readings were completed and analyses progressed . in the second phase , the subcategories and domains were regrouped into major categories . all interviews were conducted in a single session , at the request and preference of participants , except for two cases that took two sessions . each interview was transcribed verbatim and analyzed before the next interview was done , so that each interview supplied bearing for the next . coding was carried out line by line , and comparative analysis of the quotations was carried out . each interview session ranged from 30 minutes to 90 minute with an average of 55 minutes .", "credibility was recognized through prolonged engagement with the participants , field note writing , the participants revisions using member checking procedure , and peer checking . the findings and explanations of this study were reviewed by two supervisors who were associate professors in nursing having a good background in qualitative research methodology . also , maximum variation of sampling established the conformability and credibility of the data . this study provided sufficient descriptive data for researchers to criticize whether the findings were transferable that established applicability .", "informed consent form was obtained from the participants who agreed to participate in the study according to the provisions of the declaration of helsinki . other ethical issues in this study included the assurance of confidentiality and anonymity of the participants and their responses . all participants were aware of the purpose of the study , and their participation in the study was optional . permission to conduct this study was obtained from the ethics committee of tarbiat modares university .", "these categories and their subcategories represent the main factors influencing the spirituality in iranian elderly people . ( female ) the elderly participants lived experiences disclosed the subcategory of faith , a way to happiness in life . ( female ) thus , it can be concluded that all of the participants rose early to start their religious acts of devotion , prayers , and worship in their home or mosque . saying prayer as a calming factor , beneficence as a way to god , loss of psychological and spiritual support , and faith , a way to happiness , emerged from the participants experiences . the participants of the study were 11 males and 10 females , within the age range of 65 - 86 . main categories and subcategories one of the main categories that emerged from data analysis was spiritual health . four subcategories ; three main categories emerged from the data and 3 - 4 distinctive subcategories within each category were identified . five participants were illiterate , four were primary degree holders , eight had a diploma , two had bachelor degrees , and two had msc degree in human sciences . in terms of their occupation status , two were employees , 13 were pensioners , two was manual worker , and three were housewives .", "( female ) the elderly participants lived experiences disclosed the subcategory of faith , a way to happiness in life . four subcategories ; saying prayer as a calming factor , beneficence as a way to god , loss of psychological and spiritual support , and faith , a way to happiness , emerged from the participants experiences . one of participants described that having strong faith was very important over the elderly life and adopting a healthy life style depended mostly on their faith and beliefs . also many of the participants considered the prayer time as an opportunity for purification which made them more tolerant to the adversities and has a calming effect on them . the one who has strong faith and beliefs is always happy and confident . in my opinion also , they stressed that faith will lead them to a sense of physical and mental welfare and happiness . ", "that wishing for and seeking help from god can help the elderly people to deal better with life difficulties , disperses and stresses . this desire results in god 's attention to elderly and also creates sense of trust in older adults . spiritual beliefs was a main category that emerged from the participants lived experiences of spiritual concept and this category was further subcategorized into three subcategories including seeking help from god in difficulties , only god 's power over life and death , and some statements said by participants are : i really believe in having trust in god . when i m trapped in a complicated situation doing good deeds is the god 's will . regarding the subcategory of seeking help from god in difficulties , the participants believed , i believe that this is god who helps me and i only trust in god . ( male ) one participant believed that spirituality was a vital component of older people lives .", "another most important category that emerged was religious practice with three distinctive subcategories including : saying prayers , reciting quran , and going to mosque , religious ceremonies and pilgrimage . for example one participant said that participating in religious settings and ceremonies led her to find new friends and got her out of loneliness . we go to quran classes on friday mornings also.(male ) i have so much interest for pilgrimage and saying daily payers at the earliest recommended time when call for prayer is announced . the majority of the participants indicated that they had good knowledge of quran , said prayers regularly , and went to mosque for religious and social activities . ( female ) thus , it can be concluded that all of the participants rose early to start their religious acts of devotion , prayers , and worship in their home or mosque . i go to the religious rites with the my friends and peers , and i want to get out of loneliness .", "the findings are significant as they reveal that the living experiences of saying prayer as a calming factor , beneficence as a way to god , loss of psychological and spiritual support , and faith , a way to happiness , are the most important domain and subcategory of spiritual health of elderly people , which can positively affect their health . on the other hand spiritual health this qualitative study describes the concept of spirituality and its impression on iranian elderly people daily living behaviors . the practical relevance of this study may conduct future work to further explicate and clarify the linkages between spirituality and physical and mental health and life style . future research should focus on the effects of spirituality on elderly people lifestyle domains and on the development of valid and reliable instruments to measure these effects . future empirical research and new methods of investigation such as concept analysis , grounded theory , and action research are needed to develop the new models of caring for management of this group . in the life style area , the present study has demonstrated that one of the most important factors that help elderly in confronting with difficulties was seeking help from god .", "future research should focus on the effects of spirituality on elderly people lifestyle domains and on the development of valid and reliable instruments to measure these effects . future empirical research and new methods of investigation such as concept analysis , grounded theory , and action research are needed to develop the new models of caring for management of this group . in the life style area , it is important to conduct such research in different samples , such as unhealthy elderly people ( frail , ill , and sick elderly people ) .", "it can reduce mental distress and induce inner peace and hopefulness . because of the significant influence of spirituality on all domains of health of elderly people , it is critically important that health care providers understand how spirituality can considerably influence elderly people throughout their life . these findings will assist health professionals such as nurses , physicians , and social workers to recognize the spiritual needs and value the role of spirituality in promoting health and well - being among elderly people from different religions and cultures worldwide . also , the findings of this study made it clear that spirituality has a considerable effect on the health and life of iranian elderly people and is a major supportive resource for their physical and psychosocial health . spiritual health , spiritual beliefs , and religious practice intentionality were the main components of concept of spirituality in this group experiences . in summary , we found that elderly people describe several elements in their illustration of spirituality in healthcare settings ." ]

[ "two of them , catheter angiography and computed tomographic angiography ( cta ) , are based on the detection of contrast enhancement of cerebral vessels . in these examinations , , we performed a dynamic evaluation of contrast enhancement of the cerebral and extracranial arteries in patients with bd and control subjects with the use of the 40-s series of ctp scans . the aim of this prospective study was to characterize stasis filling phenomenon in the diagnosis of bd . to achieve this an analysis of stasis filling in a dynamic series of computed tomographic perfusion ( ctp ) can provide valuable information on the interpretation of cta results and relation of this phenomenon to brain perfusion . we also confronted stasis filling pattern with ctp findings to assess the relevance of this phenomenon to brain perfusion . when cta was proposed as the new imaging technique in the diagnostics of bd , a consensus on its interpretation criteria has not been reached .", "initial causes of coma were intracerebral hemorrhage ( n = 16 ) , subarachnoid hemorrhage ( n = 11 ) , cerebral edema ( n = 2 ) , and ischemic stroke ( n = 1 ) . the elapsed time between the onset of bd symptoms and the radiological examination ranged between 6 and 48 h. delay was sometimes caused by a prolonged initial observation due to prior use of sedatives and sometimes the limited availability of an angiographic team . the majority of patients became actual organ donors . we examined 67 patients who fulfilled clinical bd criteria according to the national regulations ( coma , apnea , and no brainstem reflexes ) . the examination protocol consisted of cta , followed by ctp and catheter angiography . finally , 30 ( 44.8 % ) patients , in whom analysis of ctp series enabled us to identify contrast - enhanced intracranial arteries , were enrolled in the study . the population consisted of 18 men and 12 women with a median age of 54.5 years ( range , 2284 years ) . decompressive craniectomy was performed in 19 ( 63 % ) included patients . among 37 excluded patients , the patients were normoventilated and mean arterial blood pressure ( mabp ) maintained at greater than 80 mmhg .", "then cta was carried out in three phases , which were manually programmed with fixed delays of 25 , 40 , and 60 s after contrast injection . injection of 80 ml of iodinated contrast medium at a flow rate of 4 ml / s . we used siemens sensation 64 ( siemens ag , erlangen , germany ) to perform cta . all cta and aortocervical angiography examinations in bd patients were performed using the same methodology as described previously [ 4 , 5 ] .", "cbf and cbv values were measured in circular 2.53.5-cm rois placed in the cortical regions of the frontal , temporal , occipital lobes , and basal nuclei of both hemispheres with exclusion of major blood vessels . therefore , the lack of venous outflow in bd patients was not an obstacle , and calculation of cbf and cbv was feasible in all cases . this artery was visible in all control examinations ( contralateral artery to the clipped aneurysm was always chosen ) and 23 examinations of bd patients . among the remaining seven examinations in six cases , the only opacified cerebral artery was aca and in one case pca ( see table 1 ) . we used the same scanner siemens sensation 64 ( siemens ag , erlangen , germany)to perform ctp in both groups . in bd patients , the time interval between cta and ctp ranged from 1 to 15 min . rois are positioned in the distal segment of mca ( arrowhead ) and in the superficial temporal artery ( arrow ) in bd patients , the same dynamic series of scans were used for measurements of cerebral blood flow ( cbf ) and cerebral blood volume ( cbv ) with the multimodality workplace and syngo ve40a software package ( siemens ag , erlangen , germany ) .", "we registered 3050 s series with a frequency of 2 f / s visualizing head and neck area with the use of a digital subtraction technique . according to the national guidelines , a typical femoral approach was used in all cases . after positioning a pigtail 45-f catheter in the ascending aorta , 30 ml of contrast was injected at a flow rate of 15 ml / s . cerebral circulatory arrest was diagnosed in two situations : non - filling of intracranial vessels with preserved flow in the external carotid arteriesstasis filling delayed , weak , and persistent opacification of the proximal cerebral arterial segments , without opacification of the cortical branches or venous outflow non - filling of intracranial vessels with preserved flow in the external carotid arteries stasis filling delayed , weak , and persistent opacification of the proximal cerebral arterial segments , without opacification of the cortical branches or venous outflow we used two angiographic systems : fluorospot top and axiom artis ( siemens ag , germany ) . angiography was performed with a delay of 15 min to 3 h after ctp .", ", the following parameters were measured : baseline density : ct density on the first scanenhancement at 20 , 30 , and 40 s : difference between density at the time point of 20 , 30 , and 40 s and baseline densitypeak enhancement : difference between the highest density and baseline densityc / e peak ratio : ratio of peak enhancement in a cerebral artery to peak enhancement in the superficial temporal arterytime to peak : period of time in seconds from the time when the first image was acquired to the time when the highest density was reacheddelay of cerebral peak : period of time in seconds from peak enhancement in the superficial temporal artery to the peak enhancement in the cerebral artery baseline density : ct density on the first scan enhancement at 20 , 30 , and 40 s : difference between density at the time point of 20 , 30 , and 40 s and baseline density peak enhancement : difference between the highest density and baseline density c / e peak ratio : ratio of peak enhancement in a cerebral artery to peak enhancement in the superficial temporal artery time to peak : period of time in seconds from the time when the first image was acquired to the time when the highest density was reached delay of cerebral peak : period of time in seconds from peak enhancement in the superficial temporal artery to the peak enhancement in the cerebral artery in bd patients , the additional recorded data were values of cbf , cbv , and results of catheter angiography classified as non - filling or stasis filling . in addition , for bd patients , we registered initial cause of coma and the presence of craniectomy . for each extracranial and cerebral roi in the ctp series", "whitney test was used for the analysis of differences between the groups because the distributions of most of the quantitative variables were significantly different from the normal distribution ( p < 0.05 , shapiro ", "a statistically insignificant trend was found in the analysis of tdcs in bd patients with subarachnoid hemorrhage ( sah ) and intracerebral hemorrhage ( ich ) . we revealed a tendency to longer time to peak and longer delay of cerebral peak in the group with sah compared to the group with ich ( see table 5 ) . . 7distribution of cerebral / extracranial peak ratio values in bd patients and controls variables calculated from dynamic ctp series in bd patients vs. controls values expressed as median ( interquartile range ) distribution of cerebral / extracranial peak ratio values in bd patients and controls analyzing the influence of demographic and clinical features on dynamic ct parameters , we revealed significant differences in time to peak and delay of peak enhancement in cerebral arteries between subgroups of bd patients with and without craniectomy . in the subgroup with craniectomy , time to peak and delay of cerebral peak were shorter in comparison to the subgroup without craniectomy ( see table 4 ) . 6distribution of peak enhancement in cerebral and extracranial arteries in bd patients and controls time ", "recently revealed a potential efficacy of ctp for assessing brain death . in this material , stasis filling , as specific angiographic pattern of cerebral circulatory arrest , is a consequence of two major factors : raised intracranial pressure ( icp ) and high cerebrovascular resistance ( cvr ) . heartbeat driven slow propagation of contrast column in proximal cerebral arteries is possible . in the present study , these findings clearly show that stasis filling is not an indicator of any residual brain perfusion but only ineffective propagation of contrast in cerebral vessels ; thus , it does not preclude diagnosis of brain death . was revealed in studies using a transcranial doppler ( tcd ) [ 11 , 12 ] . the term stasis filling for describing a delayed , weak , and persistent intracranial opacification in patients with bd was used for the first time by kricheff et al . in 1978 .", "the major drawback of this study is a consequence of performing ctp shortly after cta in bd patients . the influence of residual contrast injected for cta was reflected by higher baseline density in the cerebral and extracranial arteries , higher and earlier peak enhancement , and shorter time to peak in the extracranial vessels in bd patients compared to controls . however , this contrast contamination should not significantly change values of delay of cerebral peak or c / e peak ratio as they were calculated on the basis of both cerebral and extracranial tcds .", "it led to the conclusion that delayed and weak opacification of cerebral arteries do not necessarily mean the presence of cerebral perfusion , thus does not preclude diagnosis of bd . in this study , we assessed the characteristic features of intracranial filling in bd patients delay and weakness of cerebrovascular opacification .", "" ]

[ "gastric cancer is the second most frequent neoplasm of the alimentary tract after the large intestine . 5,103 people in poland were affected by it in 2008 . the case - to - death ratio of around 1 indicates unfavourable prognosis as to recovery from this disease [ 1 , 2 ] . the existence of gastric cancer metastasis to the ureter has been described twice in the literature to date . this poor result is determined by the fact that it is rarely ( only in around 8% ) detected in the form of early gastric cancer , in the mildly symptomatic or asymptomatic phase . in most patients", "the patient underwent surgery on 10.05.2010 and intraoperatively , besides the expected neoplastic tumour of the left ovary with infiltration of the ureter , numerous neoplastic foci were also found : a sigmoid colon tumour , a caecum tumour , a tumour of the body of the stomach and two single tumours in the omentum . to lauren ) , type i ( acc . to goseki ) , of a stomach adenocarcinoma with a g2 malignancy degree , with occupation of the whole thickness of the stomach wall , with the following immunohistochemical characteristics : ck7(+++ ) , ck20(++ ) , ca125(+ ) , mucicarmine(+ ) . , histopathological confirmations were obtained of the metastatic character of the foci in the ovary , caecum and sigmoid colon . a female patient , age 67 , was diagnosed at the district hospital ( 22.04 - 30.04.2010 ) because of intensified symptoms of left - sided renal colic . based on the conducted usg and single - phase computed tomography tests of the abdominal cavity and the pelvis , dilation of the ureter", "the beginning of the symptomatic disease as a left - sided renal colic is , in itself , a previously unreported case . the dissemination of a neoplasm with extremely rarely encountered symptomatology described above is an interesting experience which we wanted to share . the literature often presents , as characteristic of gastric cancer , blood - borne metastasis to the ovary , termed a krukenberg tumour . treatment of gastric cancer in the disseminated phase of the disease aims at extension of life and achieving a good palliative effect ." ]

[ "eosinophilic gastritis is an extremely rare disease that is characterized by eosinophilic infiltration of the various layers of the gastrointestinal tract in the absence of any definite causes of eosinophilia . the disease has to be distinguished from generalized eosinophilic disorder presenting with involvement of other organs . these symptoms are associated with eosinophilic infiltration of the various layers of the gastrointestinal tract . patients with eosinophilic gastritis have diverse symptoms , including abdominal pain , emesis , abdominal distension , and weight loss .", "currently , she is being treated with 30 mg / day prednisone and is showing considerable clinical improvement . the symptoms had been recalcitrant to treatment with proton pump inhibitors , fasting , and fluid . , she had undergone esophagogastroduodenoscopy ( egd ) , which revealed multiple focal ulcerative lesions with diffuse discoloration and edematous change of the rugae in the gastric fundus , cardia , and upper body ( fig . eosinophilic gastritis was diagnosed according to the clinical pictures , laboratory findings , and endoscopic findings . a 52-year - old female patient visited another hospital because of epigastric pain and tenderness . although she was treated with a broad - spectrum anthelmintic ( albendazole ) , antibiotics , proton pump inhibitor , and prokinetic agent during the next 5 days , her symptoms became worse .", "this case highlights the reality of eosinophilic gastritis presenting as necrotizing gastritis , and that endoscopy and histopathological examination of the biopsies are the most useful tools for the diagnosis of eosinophilic gastritis presenting as necrotizing gastritis . eosinophilic gastroenteritis is an uncommon and rarely reported disorder characterized by eosinophilic infiltration of the various tissue layers of the digestive tract in the absence of any definite causes of eosinophilia , without eosinophilic infiltration in other organs . eosinophilic gastritis should be considered in the differential diagnosis in patients with necrotic gastritis who do not respond to empirical treatment . lymphoma of the stomach , gastric cancer , and crohn disease involving the stomach may demonstrate endoscopic features similar to those of eosinophilic gastritis ." ]

[ "in this review , we discuss current knowledge of the expression , regulation , and function of caspase-14 . see introduction for details . since the cloning of caspase-14 in the late nineties , it has become clear that this protease is a unique member of the caspase family . the signaling cascades involved in epidermal barrier formation are largely unknown , but the many proteases that seem to be involved are currently being intensively studied . the skin is the largest organ of the body and protects the organism against external physical , chemical , and biological insults such as wounding , uvb radiation , and microorganisms .", "the expression pattern of caspase-14 is unique among the caspases , as it is present mainly in cornifying epithelia , such as the epidermis , the hassall 's bodies of the thymus , and the forestomach of rodents ( lippens et al . , 2000 , 2005 ; the expression of caspase-14 in the hassall 's bodies of the thymus and in the forestomach of rodents is somewhat expected , as they are cornifying structures and express the typical late differentiation markers , such as profilaggrin and loricrin , which are also found in the epidermis ( laster and haynes , 1986 ; favre , 1989 ; jarnik et al . , 1996 ) . in skin , caspase-14 is expressed only in the differentiating and cornifying layers of the epidermis and the hair follicle ( lippens et al . , 2000 ; in addition , caspase-14 is not expressed in the noncornifying keratinocytes of the sweat gland or the mouth epithelium ( lippens et al . , 2000 ; this could indicate that the occurrence of a soft stratum corneum and the caspase-14 gene are associated during evolution .", "identification of additional substrates and determination of the cleavage sites will provide more insight into the preferred recognition sequence of caspase-14 in the context of a protein . these data indicate that during skin homeostasis , the caspase-14activating protease is not a caspase , separating caspase-14 activation from the apoptotic and inflammatory caspase cascades that could be detrimental to epidermal integrity . this implies that the main biological function of caspase-14 is exercised in the stratum corneum , as proven by the phenotype of the caspase-14deficient mice ( see the next section ) . activation of caspases is induced by dimerization , ( auto-)proteolytic cleavage at asp residues , and/or conformational changes ( lamkanfi et al . , 2003 ) .", "thus , we conclude that apoptotic caspases are not involved in the physiological keratinocyte cell death program leading to cornification . keratinocytes can die by two different processes : apoptotic cell death induced by damaging agents such as uvb , chemicals , and cytotoxic cytokines or by a continuous process of differentiation leading to the formation of corneocytes . although almost all procaspases are constitutively expressed in the epidermis , only caspase-14 has consistently been shown to be activated during epidermal cornification ( eckhart et al . caspase-14 is expressed mainly in the spinous , granular , and cornified layers of wild - type mice and is absent in caspase-14deficient mice . furthermore , caspase-14deficient epidermal cells can undergo classical apoptosis , which genetically demonstrates that caspase-14 is dispensable for the apoptosis of keratinocytes . during development , caspase-14 protein expression is detectable from embryonic day ( e ) 15.5 on , and its processing is observed from e17.5 ( hu et al . , 1998 ; van de craen et al . , 1998 ; fischer et al . , 2005 ) , which coincides with stratum corneum formation and establishment of the epidermal barrier . caspase-14 is active in the dehydrating environment of the cornified layer , where it has an important function in formation of the epidermal barrier leading to protection against uvb and water loss ( denecker et al . , 2007 ) .", ", it would be interesting to elucidate whether caspase-14 is down - regulated in junb / c - jun deficient mice . the absence of caspase-14 in psoriatic plaques may lead to the formation of a defective barrier and , therefore , to the aggravation of psoriatic lesions . treating the parakeratotic plaques of patients with a vitamin d3 analogue results in the up - regulation of caspase-14 and , caspase-14 activation in tumors has not been shown , and so it might not be responsible for the tumor phenotype . psoriasis is an autoimmune disease characterized by the uncontrolled proliferation of keratinocytes and impaired cornification , which results in the aberrant presence of nuclei in the cornified layer , also called parakeratosis . presumably , the ectopic caspase-14 expression is caused by the changed transcriptional activity in these epithelial tumors .", "recent evidence sheds light on the crucial role of caspase-14 in the skin , but several major questions remain . this is not surprising , as it has been known for a long time that serine proteases are of major importance in epidermal homeostasis . determination of the in vitro conditions for caspase-14 activity that mimic stratum corneum conditions , together with the generation of caspase-14deficient mice , led to the identification of ( pro)filaggrin as the first known physiological caspase-14 substrate . importantly , caspase-14 seems to be involved in the correct processing of filaggrin preceding its degradation into free hygroscopic amino acids , which might explain its role in the prevention of water loss from the epidermis . activation of caspase-14 occurs most probably at the interface between the granular and cornified layer , implicating a role for caspase-14 in the stratum corneum ." ]

[ "gossypiboma ( retained surgical sponge ) describes a mass of cotton or sponge that is left behind in the body cavity during a surgical operation . in fact , surgical sponges without opaque markers are the leading cause for the difficulty of a correct diagnosis . here , we present a case in which a foreign body , gauze without radiopaque markers , was left behind during a procedure that involved the removal of an intrapelvic tumor . after a computed tomography ( ct ) these foreign bodies can often mimic tumors or abscesses when detected clinically or with radiation . scan had revealed information leading to an inaccurate diagnosis , an accurate diagnosis of gossypiboma was successfully made using endoscopic ultrasound - fine - needle aspiration ( eus - fna ) .", "a 60-year - old female patient was referred with an unexpected detection of an intrapelvic tumor during a routine ct scan . the ct scan revealed a 45 mm tumor in the patient 's pelvis [ figure 1a and b ] , which was diagnosed as a gastrointestinal stromal tumor ( gist ) , a chronic expanding hematoma or leiomyoma . a forward - view eus ( tgf - uc260j , olympus optical co. , tokyo , japan ) identified a low echoic lesion when scanned from the sigmoid colon . examination of the fna specimen revealed a foreign body ( string of gauze ) displaying macrophage cells and necrotic tissue [ figure 3 ; hematoxylin and eosin , original magnification 40 ] . during the surgery , histological examination of the tissue adjacent to the foreign body revealed granuloma formations with fragmented silken threads [ figure 4 ; hematoxylin and eosin , original magnification , 100 and 200 ] . fna was performed with a 22-gauge needle ( ezshot2 , olympus optical co. , tokyo , japan ) by using the forward - view eus [ figure 2 ] .", "radiologists using findings from a ct scan , initially and incorrectly diagnosed the lesion as gist with fibrosis . however , it can be difficult to diagnose the disorder with ct scans in cases without gas bubbles . in the case described in this paper , a correct diagnosis was obtained using this method . in summary , this is the first known case report diagnosing gossypiboma by eus - fna . there were case reports using oblique - viewing cla echoendoscopes to evaluate lesions proximal to the sigmoid colon , but advancement of the cla echoendoscope beyond the sigmoid required the use of an overtube or a guide wire previously placed with a colonoscope . the application of eus using curved linear array ( cla ) endoscopes in the lower gi tract has been limited to the rectum and distal sigmoid colon because of the oblique - viewing optics . the eus - fna procedure revealed a segment of string in a fixed foreign body in the pelvis ." ]

[ "to demonstrate the usefulness of enhanced depth imaging optical coherence tomography ( edi - oct ) in investigating choroidal lesions inaccessible to ultrasound sonography .", "in a 60-year - old woman with an asymptomatic choroidal nevus , normal oct was used to observe the macula and edi - oct to image the choroidal nevus that was inaccessible to ultrasound . the exact location of the lesion in the choroid and the dimensions of the nevus were measured .", "the lesion was located in the superior macula , and the nevus was homogeneous in its reflectivity . we observed a thickened choroid delineated by the shadow cone behind it , measuring 1,376 325 m in the larger vertical cut and 1,220 325 m in the larger horizontal cut in an image with a 1:1 pixel mapping and automatic zoom .", "edi - oct appears to be an excellent technique for measuring choroidal nevi and all choroidal lesions accessible to oct imaging by depicting their exact location in the choroid , their dimensions , and their demarcation from the surrounding healthy tissue , thus allowing for a more efficient and accurate follow - up .", ", we report a case of a flat choroidal nevus inaccessible to ultrasound sonography that was evaluated by edi - oct . choroidal nevus is the most common tumor of the ocular fundus , present in 7% of the white population [ 1 , 2 ] . despite its benign nature , it presents a risk of visual loss and visual field loss , and can rarely transform into malignant melanoma . optical coherence tomography ( oct ) and ultrasonography have been used for imaging choroidal nevi . recently", "we employed this technique to image the location of the nevus in the choroid and obtain its dimensions as a reference measure for the follow - up examination ( fig . the diameter of the nevus was calculated based on the presence of a shadow cone created by the lesion 's lateral borders . edi - oct is a new technique that consists of positioning a heidelberg sd - oct close enough to the eye in order to obtain an inverted image , averaged for 100 scans . the advantage of this technique is that the sensitivity of the imaging in deeper tissue layers is increased , and thus the obtained measurements are more accurate .", "it is a reproducible examination that allows depiction of the exact location of the nevi in the choroid , their dimensions and their demarcation from the surrounding healthy tissue . to date , the software available for sd - oct does not allow for objective measures . edi - oct appears to be an excellent technique for evaluating flat choroidal nevi that are inaccessible to ultrasound sonography and accessible to oct imaging , displaying simultaneously the lesion and the retinal changes . the subjective measures obtained are useful upon comparison with the follow - up images . in order to limit the possibility of bias we believe that this technique is clinically useful and , together with color fundus photography , can provide a more efficient and accurate follow - up of choroidal nevi . , these follow - up images must be obtained and compared with the same sd - oct machine .", "" ]

[ "paradoxically , recent researches demonstrated the dark side of nrf2.4 cancer cells acquire a growth advantage by eliminating keap1-mediated negative control of nrf2 , which leads to activation of the nrf2-dependent defense response.4 constitutive upregulation of nrf2 has been found in many types of cancers , including skin , breast , prostate , lung , head and neck , and endometrial cancer.5 overexpressed nrf2 provides a growth advantage for cancer cells by protecting those cells from oxidative stress and anticancer agents , thus contributing to chemoresistance.5 in this review , we summarize the therapeutic development of nrf2 inhibitors that enhance the efficacy of the current cancer treatments . kelch - like ech - associated protein 1 ( keap1)-nuclear factor e2-related factor 2 ( nrf2 ) is a major cellular pathway that protect normal cells against oxidative and xenobiotic damage.1 nrf2 is an essential transcription factor for antioxidant and detoxification genes and is crucial for the chemopreventive effect of various phytochemicals against carcinogenesis . representative chemopreventive agents that induce nrf2 include carotenoids , curcumins , cyclic lactones , diterpenes , dithiolethiones , epithionitriles , flavonoids , indoles , isothiocyanates , organosulfides , and phenols.2,3 accumulating evidences have demonstrated that phytochemicals can protect cells from oxidative stress related diseases including inflammatory , cardiovascular , and neurodegenerative diseases and cancer , through nrf2-dependent responses .", "nrf2 is a basic leucine zipper transcription factor with 7 domains from neh1 to neh7 . nrf2 translocates into the nucleus and binds to an antioxidant response element ( are ) as a heterodimer with musculo - aponeurotic fibrosarcoma ( maf ) to recruit a transcriptional coactivator and promote thetranscription of various cytoprotective genes that are associated with antioxidant and detoxification enzymes . upon recovery of cellular redox homeostasis , keap1 translocates to the nucleus to dissociate nrf2 from the are resulting in degradation of nrf2.11 the btb domain has a cys151 residue and is responsible for nrf2 ubiquitination through binding to cullin e3 ubiquitin ligase ( cul3)-based ubiquitin e3 ligase ( fig . neh1 has dna binding motifs.6 neh3 , neh4 , and neh5 have domains involved in the transactivation of nrf2 target genes by binding coactivators .", "the are - bearing genes that are regulated by nrf2 in humans have been studied using microarray analysis of genes induced by chemopreventive agents or knockout of keap1 in human cell lines.2 these genes can be categorized into 5 groups : antioxidant genes ( gclc , gclm , gpx2 , gsr , slc7a11 , srxn1 , and txnd1 ) , nadph - generating enzymes ( g6pd , me1 , and pgd ) , metal - binding proteins ( fth1 , ftl , mt1 , and mt2 ) , drug - metabolizing enzymes and drug transporters ( akr1b1 , akr1b10 , akr1c1 , akr1c2 , akr1c3 , akr1c4 , cbr1 , gstm3 , mrp2 , nq1 , and ptgr1 ) , and stress response proteins ( gadd45 , hmox1 , hsp40 , and hsp70).2 knockdown of keap1 in human keratinocytes resulted in upregulation of 23 mrnas while akr1b1 , akr1b10 , and akr1c1 were induced to the greatest extent , showing increases of between 12- and 16-fold indicating that aldo - keto reductases could be useful biomarkers for nrf2 activation.12 as keap1 is responsible for inhibitor kappa b ( ib ) kinase beta ( ikk- ) ubiquitination , upregulation of some of these genes could be attributable to the increase of nuclear factor - kappa b ( nf-b ) activity.13 expression profiling in mice has revealed that nrf2 regulates approximately 100 genes and that two - thirds of nrf2-target genes are not involved in detoxication or antioxidation . instead , many of the target genes are associated with inflammation and immunity proteins.2 nrf2 binds to ares in promoter regions of various genes that regulate the cellular response to oxidative and xenobiotic stress . nrf2 target genes include antioxidant genes and phase ii enzymes such as heme oxygenase-1 ( ho-1 ) , nad(p)h : quinone oxidoreductase 1 ( nqo1 ) , glutathione s - transferase ( gst ) , and glutathione peroxidases .", "as p62 could block binding between nrf2 and keap1 , p62 contributes to the activation of nrf2 target genes in response to oxidative stress creating a positive feedback loop.23 nrf2 is also involved in autophagy by inducing p62 which is a receptor for autophagic degradation . the aryl hydrocarbon receptor ( ahr ) is a transcription factors that mediates the biological effects of its xenobiotic ligands including dioxin.14 the ahr activates the transcription of nqo1 and other genes through the xenobiotic - responsive element ( xre).15 ahr induces the direct binding of nrf2 to promoters or indirectly produces reactive intermediates that trigger the nrf2 signaling pathway.16 the cross - talk between nf-b and nrf2 is more complex . previous studies have suggested that the function of this negative regulation is to prevent the formation of antioxidant environment , which could hinder the induction of apoptosis by p53.21 in contrast , direct targets of p53 could upregulate nrf2 activity .", "the association of nrf2 overexpression and chemoresistance has been reported in many cancers including non - small cell lung cancer , stomach cancer , endometrial cancer , and osteosarcoma.2427 overexpression of nrf2 target genes was also found in a variety of solid tumors.28 ho-1 overexpression was found in brain cancer , prostate cancer , and renal cancer.29,30 nqo1 is known to be overexpressed in hepatoblastoma , colon cancer , breast cancer , and non - small cell lung cancer.31 several mechanisms have been proposed for the activation of keap1-nrf2 signaling in cancer . hypermethylation of the keap1 promoter was found in 47% of lung cancer patients and this feature was associated with poor outcome.42 epigenetic regulation of keap1 was also found in malignant glioma , colon cancer , and breast cancer.4345 mutation of egfr , kras , braf , myc , and the bcr - abl fusion can activate nrf2 , resulting in enhancement of ros detoxification and other oncogenic roles of nrf2 , including chemoresistance.3941 furthermore , posttranslational modifications can activate the keap1-nrf2 signaling pathway .", "in addition to the upregulation of cytoprotective genes , constitutive expression of nrf2 may confer a survival advantage to cancer cells by promotion of cell proliferation , chemoresistance and inhibition of apoptosis . chemoresistance to these drugs can be explained by high expression of antioxidant nrf2 target genes.4 another mechanism of chemoresistance is the induction of the drug efflux pump family , which includes the mdr , by nrf2.53 some drugs , including hdac inhibitors , oxaliplatin , and proteasome inhibitors can induce nrf2 and thus decrease the effectiveness of chemotherapy.5456 p53 inhibits the activation of nrf2 target genes by direct interacting with are - containing promoters or activating p21.21 considering that p53-induced apoptosis requires the accumulation of ros , increased activity of antioxidant genes by nrf2 in cancer cells can inhibit p53 dependent apoptosis .", "in light of the data presented in this review , nrf2 is an attractive molecular target for the inhibition of cancer . in contrast to nrf2 activators , including numerous phytochemicals , only a small number of nrf2 inhibitors have been identified ( table ) . luteolin was found to be a potent nrf2 inhibitor.62 in that study , luteolin significantly sensitized a549 cells to the anticancer drugs oxaliplatin , bleomycin , and doxorubicin indicating the potential application of luteolin as a natural sensitizer in chemotherapy .", "however , it will be necessary to understand the molecular regulation of nrf2 and identifying the individualized status of nrf2 expression . it must be kept in mind that chemopreventive agents including various phytochemicals can induce chemoresistance and tumor progression by activating the keap1-nrf2 pathway . constitutively expressed nrf2 can promote cancer cell proliferation and protect cells against oxidative stress and therapeutic agents ." ]

[ "a 3-year - old male , known to have isolated speech delay , presented to the emergency department with severe body aches and inability to walk . few days prior to his presentation , the child started to have flu - like symptoms in the form of rhinorrhea and low - grade fever . the creatine kinase and serum transaminase levels continued to improve gradually over the following days , with slow improvement in the clinical condition .", ", this could be the first presentation of lipin-1 mutation that causes recurrent rhabdomyolysis in children . the most common complication of rhabdomyolysis is kidney damage . in recent large pediatric studies reported by mannix a thorough literature review was done searching for high creatine kinase levels in patients with acute rhabdomyolysis . in 2014 , a case report described a pediatric patient with mcardle disease who developed rhabdomyolysis with a high 6-digit creatine kinase level reaching 500 000 the prognosis of lipin-1 deficiency is poor , with up to one - third of patients dying during an episode of rhabdomyolysis . in about 60% of patients with recurrent rhabdomyolysis , in our case , the child developed extremely high creatine kinase levels that were not reported in the literature . the mainstay for the prevention and treatment of acute kidney injury is early and aggressive volume resuscitation ." ]

[ "the donors were selected based on these inclusion criteria : myopic spherical refractive error ranging from 0.5 d to 10.00 d with no astigmatism or astigmatism less than 0.5 d ; healthy eyes free from significant systemic and ocular diseases ; and ability to understand the content of the consent form and willingness to undergo serological testing . a depth of 160 m was chosen for implantation in all patients due to uncertainty in refractive outcomes , the novelty of the nomograms , and so the surgeon could have adequate tissue in the cap for later enhancement with surface ablation if required . postoperative corneal haze and folds were graded at every follow - up time point using the scale described by nakamura et al and the corneal folds grading atlas.12,13 on postoperative day 15 and onward , the following assessments were performed : uncorrected visual acuity , best - corrected visual acuity ( bcva ) , retinoscopy for residual refractive error , topography using orbscan(bausch & lomb - technolas , munchen , germany ) and sirius ( schwind eye - tech solutions , kleinostheim , germany ) , anterior segment optical coherence tomography ( optovue , fremont , ca ) , clinical photography , specular microscopy ( tomey , japan ) , dry eye assessment ( schirmer 's i ) , and aberrometry ( itrace ; tracey technologies , houston , tx ) . the tissue culture medium is a commercially available medium used for semen processing in reproductive biology ( cryocell india pvt ltd , new delhi , india ) . patients were examined postoperatively on days 1 and 15 and at 1 , 3 , and 6 months .", "the tissue culture medium is a commercially available medium used for semen processing in reproductive biology ( cryocell india pvt ltd , new delhi , india ) . two types of solutions ( washing solution and cryopreservation solution ) were prepared . the washing solution comprised 10 ml of phosphate - buffered saline ( 1 ) , 200 l of penicillin streptomycin ( 100 ) , and 200 l of amphotericin b ( 100 ) . the medium contains sodium chloride , potassium chloride , magnesium sulfate , anhydrous potassium phosphate monobasic , calcium chloride , anhydrous sodium bicarbonate , hepes , glucose , sodium pyruvate , sodium lactate , phenol red , and human albumin in company - specified compositions . the cryopreservation solution comprised 9 ml of tissue culture media ( cryobank wash media ) and 1 ml of 20% dimethyl sulfoxide ( dmso ) .", "the cryovials containing the lenticules were transferred in canisters and frozen in liquid nitrogen at a controlled cooling rate that gradually brought down the temperature from 4c to 196c and stored in long - term storage containers ( ibp ; indian oil corporation limited , nasik , india ) . was added slowly to make a final volume of 1 ml freezing solution containing 10% human tissue culture medium and 10% dmso . the lenticules were then transferred into a cryovial and resuspended in 500 l medium containing 10% tissue culture media . using a liquid dropper , a stock freezing solution containing 10% human tissue culture medium and 20% dmso ( sigma - aldrich , st louis , mo ) extracted lenticules were washed twice for 10 minutes each in the washing solution ( fig .", "on the day of surgery , the tissue was transported from the cryobank to the hospital in a liquid nitrogen container . the vials containing frozen tissue were gradually thawed by rubbing them between the palms or keeping them at room temperature for 5 to 10 minutes until the frozen medium inside the vial was liquefied . the lenticule was then transferred into a petri dish and washed twice with balanced salt solution for 5 minutes each to remove the cryoprotectant agents .", "a depth of 160 m was chosen for implantation in all patients due to uncertainty in refractive outcomes , the novelty of the nomograms , and so the surgeon could have adequate tissue in the cap for later enhancement with surface ablation if required . patients were examined postoperatively on days 1 and 15 and at 1 , 3 , and 6 months . postoperative corneal haze and folds were graded at every follow - up time point using the scale described by nakamura et al and the corneal folds grading atlas.12,13 on postoperative day 15 and onward , the following assessments were performed : uncorrected visual acuity , best - corrected visual acuity ( bcva ) , retinoscopy for residual refractive error , topography using orbscan(bausch & lomb - technolas , munchen , germany ) and sirius ( schwind eye - tech solutions , kleinostheim , germany ) , anterior segment optical coherence tomography ( optovue , fremont , ca ) , clinical photography , specular microscopy ( tomey , japan ) , dry eye assessment ( schirmer 's i ) , and aberrometry ( itrace ; tracey technologies , houston , tx ) . in addition , 5% hypertonic saline drops ( hypersol-5 ; jawa pharmaceuticals , india ) were prescribed 6 times per day for 1 week to reduce endothelial stress and to aid in lenticule clearing . postoperatively , a topical steroid ( 1% prednisolone acetate ; allergan , irvine , ca ) was prescribed for 3 months in a tapering dosage . a slit - lamp examination was performed to check for lenticule clarity , position , and wound healing .", "table 2 provides the details of donors and lenticules used for fili in the 9 eyes treated . demographic details of patients who underwent fili ( 7 patients , 9 eyes ) details of donors and lenticules used for fili ( n = 9 ) on day 1 , in the first 2 consecutive eyes , the implanted lenticules had mild to moderate descemet membrane folds that resolved spontaneously within 1 week . figure 2 shows serial clinical photographs and anterior segment optical coherence tomography of the eye treated with fili at day 15 and at 6 months post - fili showing clear lenticules with good centration . higher order aberrations ( hoa ) did not show a significant increase in root mean square values postoperatively in the 8 hyperopic eyes ( p > 0.05 ) . all eyes had central corneal steepening with a mean change in anterior keratometry of 3.5 d in the central 3-mm zone . figure 4 illustrates the epithelial thickness map of an eye treated with fili at 6 months . figure 3 illustrates changes in anterior and posterior curvature post - fili in an eye , over time .", "following establishment of one such tissue bank , we wanted to explore the possibility of use of such cryopreserved refractive lenticules for potential treatment of hyperopia and study the feasibility , safety , efficacy , and reproducibility of this new treatment . the preliminary results of fili in hyperopia indicate that this may be a better technique than hyperopic lasik for moderate hyperopia in terms of stability , regression , aberrations , and postoperative dry eye . the potential advantages of cryopreservation of refractive lenticules have been largely described for use in the same patient , in the event of future ectasia or presbyopia by restoring corneal volume.3 with the increasing number of eyes undergoing relex smile for myopia , and thus , the extracted lenticules as a by - product , it may be a novel idea to preserve these lenticules on a long - term basis using cryopreservation for potential future use and research . further studies with a larger cohort and modification of the surgical technique with a goal of reducing postoperative astigmatism and refining nomograms are suggested to determine the long - term safety and refractive effects on the cornea and establish the technique as a valid option to treat hyperopia ." ]

[ "the purpose of the study was to compare the prognostic value of biomarkers and cytokines versus clinical severity scores and improved death risk prediction . . indicated that strem-1 was more accurate than pct and crp in the diagnosis of sepsis , but others showed that the prognostic utility of serum strem-1 in septic shock was inferior to that of pct . there have been some biomarkers and cytokines used in both the clinical practice and laboratory including soluble triggering receptor expressed on myeloid cells-1 ( strem-1 ) , procalcitonin ( pct ) , n - terminal probrain natriuretic peptide ( nt - pro - bnp ) , c - reactive protein ( crp ) , interleukin-6 ( il-6 ) , and interleukin-10 ( il-10 ) . crp is a widely used biomarker to discriminate the inflammatory response to sepsis . il-6 and il-10 are important proinflammatory and anti - inflammatory cytokines during sepsis course . trem-1 is a recently discovered member of the immunoglobulin superfamily of receptors that is specifically expressed on the surfaces of neutrophils and monocytes . strem-1 is a soluble form of trem-1 and is upregulated when exposed to infectious diseases . pct is a polypeptide consisting of 116 amino acids and is the precursor of calcitonin ; it was proven useful to identify nonsystemic inflammatory response syndrome and was firstly used in sepsis .", "a total of 102 patients with sepsis from single centre hospital intensive care unit were enrolled from december 2010 to august 2012 according to the 2001 international sepsis definition conference . serum was collected at these same time points and pct , strem-1 , nt - pro - bnp , crp , il-6 , and il-10 levels were determined in the end . we compared the characteristics of survivors versus nonsurvivors using univariate analysis and used receiver operating characteristics ( roc ) curves to evaluate prognostic value of the biomarkers and cytokines predicted 28-day mortality . those variables with p values less than 0.05 on univariate analysis were then entered into a multivariate logistic regression analysis to further identify the independent predictors of 28-day mortality . demographic and disease data of patients included age , gender , chief complaints for admission , vital signs , length of stay in icu , infection sites , microorganisms , routine blood test results , liver and kidney functions , coagulation indicators , blood gas analysis , acute physiologic assessment and chronic health evaluation ( apache ) ii scores , and sequential organ failure assessment ( sofa ) scores . exclusion criteria included : age younger than 18 years , preexisting thyroid disease and lung cancer that influence procalcitonin levels , patients with acute coronary syndromes and renal dysfunction , and patients staying in icu less than 24 hours . these were recorded on 3 days ( days 1 , 3 , and 5 ) .", "serum pct , strem-1 , il-6 , and nt - pro - bnp levels showed a decrease trend in the survival group ( p < 0.05 ) , but there was no decrease tendency in the nonsurviving group for these four biomarkers ; strem-1 even had a increase trend ( p < 0.05 ) . serum pct , strem-1 , il-6 levels of patients in the nonsurvival group were significantly higher than those in the survival group on day 1 ( p < 0.001 ) . serum pct , strem-1 , and il-6 levels in the nonsurvival group were higher than those in the survival group on days 1 , 3 , and 5 ( p < 0.01 ) . there was no difference in nt - pro - bnp levels on day 1 ( p > 0.05 ) , but later the nt - pro - bnp levels in the nonsurvival group were higher than those in the survival group on days 3 and 5 ( p < 0.05 ) . the apache ii and sofa scores of patients in the nonsurvival group were higher than those of patients in the survival group ( p = 0.000 , p = 0.000 , resp . ) , ( table 1 ) . serum crp levels in both surviving and nonsurviving groups had decrease tendency ( p < 0.05 ) ( figure 2 ) .", "previous study has indicated that the iteraction of trem-1 and interact adaptor protein dap12 can stimulate neutrophil and monocyte - mediated inflammatory response via the triggering and release of pro - inflammatory cytokines and chemokines . recently , pct , strem-1 , crp , and nt - pro - bnp cytokines were widely used to diagnose sepsis and reflect the severity , but the results were not the same . our research firstly discovered that strem-1 and pct had the equal prognostic ability for sepsis mortality and were superior to other parameters . we concluded that nt - pro - bnp may predict sepsis 28-day mortality in different stages . the present study showed that the serum levels of strem-1 and pct in nonsurvival group were higher than those in the survival group ; meanwhile , they decreased in survival group , but stayed in high levels even increased in the nonsurvival group during sepsis time course . apache ii and sofa scores have been widely used to validate mortality risk stratification . in our study , we used roc and logistic regression model to search for the best predictor .", "in summary , elevated serum strem-1 and pct levels provide superior prognostic accuracy to other biomarkers . combination of serum strem-1 and pct levels and sofa score can offer the best powerful prognostic for sepsis mortality . in the future , in order to improve the accuracy of the prognosis of sepsis , the combination of novel biomarkers and traditional markers of sepsis , reflecting different aspects of sepsis , is an attractive advice and is worthy of further investigation ." ]

[ "the first tt in hot conditions ( tth-1 ) was not preceded by any outdoor riding in hot conditions ; tth-2 was preceded by 5 d in hot ambient conditions , and tth-3 was preceded by 13 d in the heat . the cyclists performed 3 tt in hot ambient conditions ( tth , see following section ) . nine male competitive cyclists participated in this study . their mean sd age , height , and body mass were 33.3 7.5 yr , 184 4 cm , and 77.3 7.0 kg , respectively . the cyclists were allowed to drink water and energy drinks ad libitum before and during the tt . during tt , the participants spent a minimum of 4 hd outside ( average temperature , 34c 3c ; relative humidity , 18% 5% ) but slept , rested , and ate indoors in an air - conditioned facility . cyclists had 36 h ( i.e. , two nights ) of rest after arrival in qatar before performing tth-1 , allowing for recovery from travel fatigue . body mass losses were estimated from the changes in body weight from before to after tth ( seca 769 ; seca , hamburg , germany ) ( precision , 0.1 kg ) .", "the first tt in hot conditions ( tth-1 ) was not preceded by any outdoor riding in hot conditions ; tth-2 was preceded by 5 d in hot ambient conditions , and tth-3 was preceded by 13 d in the heat . the cyclists performed 3 tt in hot ambient conditions ( tth , see following section ) . nine male competitive cyclists participated in this study . their mean sd age , height , and body mass were 33.3 7.5 yr , 184 4 cm , and 77.3 7.0 kg , respectively . the cyclists were allowed to drink water and energy drinks ad libitum before and during the tt . during tt , the participants spent a minimum of 4 hd outside ( average temperature , 34c 3c ; relative humidity , 18% 5% ) but slept , rested , and ate indoors in an air - conditioned facility . cyclists had 36 h ( i.e. , two nights ) of rest after arrival in qatar before performing tth-1 , allowing for recovery from travel fatigue . body mass losses were estimated from the changes in body weight from before to after tth ( seca 769 ; seca , hamburg , germany ) ( precision , 0.1 kg ) .", "nine male competitive cyclists participated in this study . their mean sd age , height , and body mass were 33.3 7.5 yr , 184 4 cm , and 77.3 7.0 kg , respectively . they had a maximal oxygen consumption ( vo2max ) of 4.8 0.2 lmin ( oxycon pro ; viasys healthcare , germany ) with a peak power output of 418 16 w ( protocol , 25-w increase every minute from 100 w until exhaustion ) , corresponding to a performance level of 4 ( i.e. , well - trained cyclist ( 7 ) ) . the participants were northern european residents having had no exposure to environmental temperatures above 10c for the last 4 months before the study ( i.e. , november to march ) . all cyclists were experienced with performing tt in cold - to - temperate conditions ( < 25c ) and provided their written informed consent to participate in this study . they were encouraged to maintain a constant sleep routine throughout the protocol and remain hydrated ( table 1 ) . the protocol conformed to the recommendations of the declaration of helsinki and was approved by an independent ethics committee . they trained 14 h 40 min 4 h 40 min per week before the acclimatization and 13 h 1 min 1 h 6 min during heat acclimatization .", "the first tt in hot conditions ( tth-1 ) was not preceded by any outdoor riding in hot conditions ; tth-2 was preceded by 5 d in hot ambient conditions , and tth-3 was preceded by 13 d in the heat . cyclists had 36 h ( i.e. , two nights ) of rest after arrival in qatar before performing tth-1 , allowing for recovery from travel fatigue . relative humidity was 30% 8% during ttc and 13% 1% , 16% 2% , and 12% 3% during tth-1 , -2 , and -3 , respectively . on the basis of the ideal gas law ( pv = nrt ) adapted to a mixture of ideal gases ( dry air and humid air ) the cyclists performed 3 tt in hot ambient conditions ( tth , see following section ) . the cyclists were allowed to drink water and energy drinks ad libitum before and during the tt . during tt , the participants spent a minimum of 4 hd outside ( average temperature , 34c 3c ; relative humidity , 18% 5% ) but slept , rested , and ate indoors in an air - conditioned facility . the time difference between denmark and qatar is only 2 h , which should not induce significant jet lag ( 34 ) . on the day of the tt the outdoor ttc and tth were respectively performed in denmark and qatar as multilap looping circuits at sea level on flat terrain ( maximal elevation difference , 10 m ) .", "body mass losses were estimated from the changes in body weight from before to after tth ( seca 769 ; seca , hamburg , germany ) ( precision , 0.1 kg ) . power output and speed during the tt were measured with powertap wheel sets ( powertap , madison , wi ) logged continuously on garmin devices ( garmin 705 edge ) and afterwards extracted with the software trainingpeaks and exported in 1-hz resolution for subsequent average by 10% of the tt . in addition , rectal temperature was continuously recorded during tth-1 and tth-3 via a telemetric sensor ( precision , 0.01c ; vitalsense ; mini mitter , respironics , herrsching , germany ) inserted the length of a gloved index finger beyond the anal sphincter . hr was continuously recorded during all tt via a chest strap ( polar team system 2 ; polar electro , kempele , finland ) . rectal temperature was measured at the end of each tt by a clinical thermometer ( precision , 0.1c ; depth , approximately 2 cm ) . all powertap wheel sets were measured within 10 w from a power2max power meter ( power2max , berlin , germany ) , and each rider used the same equipment during the tt .", "continuously recorded data ( power , hr , and temperature ) were coded in 10% increments of the tt and analyzed via two - way repeated - measures anova ( four conditions 10 times ) . in addition , total time was analyzed via one - way repeated - measures anova . anova assumptions were verified preceding all statistical analyses ; logarithmic transformations and greenhouse geisser corrections were applied where appropriate . in case of post hoc comparisons , reported p values were adjusted for multiple comparisons using a bonferroni correction ( i.e. , correction for six potential comparisons between conditions ) . effect sizes are described in terms of partial eta - squared ( ; with 0.06 representing moderate difference and 0.14 , large difference ) . data are presented as mean sd along with the mean differences ( 95% confidence interval ) .", "the post hoc analysis showed that hr was significantly elevated during tth-1 as compared with that during both ttc and tth-3 during the first 20% of the tt ( all p < 0.05 ) . speed ( table 1 ) followed a similar pattern of evolution with significantly lower speeds during tth-1 than those during ttc , followed by increases from tth-1 to tth-2 and from tth-2 to tth-3 ( all p < 0.001 ) . rectal temperature continuously recorded during tth-1 and tth-3 showed an increase during the tt ( = 0.93 , p < 0.001 ) and was higher during the first 80% of tth-1 than that during tth-3 ( fig .", "the post hoc analysis showed that hr was significantly elevated during tth-1 as compared with that during both ttc and tth-3 during the first 20% of the tt ( all p < 0.05 ) . speed ( table 1 ) followed a similar pattern of evolution with significantly lower speeds during tth-1 than those during ttc , followed by increases from tth-1 to tth-2 and from tth-2 to tth-3 ( all p < 0.001 ) . rectal temperature continuously recorded during tth-1 and tth-3 showed an increase during the tt ( = 0.93 , p < 0.001 ) and was higher during the first 80% of tth-1 than that during tth-3 ( fig .", "speed ( table 1 ) followed a similar pattern of evolution with significantly lower speeds during tth-1 than those during ttc , followed by increases from tth-1 to tth-2 and from tth-2 to tth-3 ( all p < 0.001 ) . there was a large ( = 0.88 ) and significant condition effect on the time to complete the tt ( table 1 ) ( p < 0.001 ) . the time to complete ttc ( 66 min 13 s 3 min 26 s ) and tth-3 ( 65 min 37 s 3 min 44 s ) was not significantly different ( 0.6 ( 2.5 to + 1.4 ) min , p > 0.999 ) but was significantly shorter than tth-1 ( 77 min 17 s 6 min 26 s ) and tth-2 ( 69 min 25 s 4 min 37 s ) ( all p < 0.01 ) . speed during tth-3 was similar to that during ttc ( + 0.4 ( 0.5 to + 1.7 ) kmh , p = 0.797 ) .", "average power output was significantly lower in tth-1 than that in ttc ( 48 ( 67 to 30 ) w , p < 0.001 ) . power output during tth-3 was lower than that during ttc in one segment of the tt only ( i.e. , 70% , fig . ttc was significantly ( p < 0.05 ) higher than tth-1 , tth-2 , and tth-3 , respectively .", "the post hoc analysis showed that hr was significantly elevated during tth-1 as compared with that during both ttc and tth-3 during the first 20% of the tt ( all p < 0.05 ) . rectal temperature continuously recorded during tth-1 and tth-3 showed an increase during the tt ( = 0.93 , p < 0.001 ) and was higher during the first 80% of tth-1 than that during tth-3 ( fig . 2 , hr significantly increased during the tt ( = 0.67 , p < 0.001 ) relative to testing conditions ( = 0.24 , p < 0.001 ) . 2 ) , leading to an overall higher temperature during tth-3 than that during tth-1 ( + 0.3c ( 0.1c0.5c ) , = 0.63 , p = 0.019 ) . however , final rectal temperature ( table 1 ) was significantly higher after the tth than that after ttc ( all p < 0.001 ) ( fig .", "the current study is the first to determine the effects of acute heat exposure and heat acclimatization on performance and pacing during outdoor cycling tt in experienced cyclists . consequently , the decrease in air density noted in hot ambient conditions is likely to partially attenuate the performance decrement associated with development of hyperthermia during outdoor cycling . in the current study , these decrements were progressively restored with heat acclimatization , despite core temperature in all tt in the heat increasing significantly more than that in cool conditions . the cyclists wore thermal clothing in ttc including long tights , long sleeves , and gloves , which limited the evaporative and convective power of the environment , whereas they wore short tights and a jersey with short sleeves in the heat ( except one cyclist who was consistently using white long sleeves ) . our data showed that the decrement in cycling performance was progressively restored as the cyclists acclimatized . from an average power decrement of 16% 5% on the first day of heat exposure ( tth-1 )", "the cyclists wore thermal clothing in ttc including long tights , long sleeves , and gloves , which limited the evaporative and convective power of the environment , whereas they wore short tights and a jersey with short sleeves in the heat ( except one cyclist who was consistently using white long sleeves ) . therefore , the different relations between the environment and speed and power output could be partly related to a temperature effect on air density , as the aerodynamic drag of a cyclist is related to air density and temperature ( 3,9,17 ) . for example , at an air temperature of 11c , the temperature reported to optimize laboratory cycling capacity ( 14 ) , air density is approximately 1.245 kgm at sea level . in contrast consequently , the decrease in air density noted in hot ambient conditions is likely to partially attenuate the performance decrement associated with development of hyperthermia during outdoor cycling . in the current study , , air density drops to approximately 1.165 kgm at a temperature of 30c , reducing the drag force by approximately 6% . air density was 9.4% lower during tth-3 ( 1.131 kgm ) than that during ttc ( 1.249 kgm ) , representing a power economy of almost 8% ( 22 ) . thus , despite the slightly lower power output in tth-3 than that in ttc ( 3% ) , the average speeds were not significantly different . our data showed that the decrement in cycling performance was progressively restored as the cyclists acclimatized . from an average power decrement of 16% 5% on the first day of heat exposure ( tth-1 )", "consequently , the cyclists seem to have finished all tt at a similar relative intensity , as suggested by hr and the similar core temperatures recorded upon completion but at a higher power output as acclimatization progressed . of note , the slightly higher hr in tth may be attributable to higher skin blood flow , as suggested by the higher core temperature , although the cyclists were wearing thermal clothing in ttc , which would also have lead to increase in skin temperature and blood flow . our data showed that the decrement in cycling performance was progressively restored as the cyclists acclimatized . from an average power decrement of 16% 5% on the first day of heat exposure ( tth-1 ) our data showed that mean power output during tth-1 decreased by 16% 5% in unacclimatized cyclists . however , a comparison of the magnitude of improvement in performance after heat acclimatization , relative to the initial decrement in performance associated with the first exposure to heat stress , has yet to be examined . this confirms that well - prepared athletes reach high core temperatures while exercising in the heat , asymptomatic of heat illness ( 4 ) , and that there is no absolute critical temperature threshold set at 40c ( 11 ) . in the current study , despite the decrease in power output ( fig .", "the different relations between the environment and speed and power output could be partly related to a temperature effect on air density , as the aerodynamic drag of a cyclist is related to air density and temperature ( 3,9,17 ) . for example , at an air temperature of 11c , the temperature reported to optimize laboratory cycling capacity ( 14 ) , air density is approximately 1.245 kgm at sea level . the cyclists wore thermal clothing in ttc including long tights , long sleeves , and gloves , which limited the evaporative and convective power of the environment , whereas they wore short tights and a jersey with short sleeves in the heat ( except one cyclist who was consistently using white long sleeves ) . however , the evaporative capacity of the environment is improved with higher air velocities , reducing heat stress and dehydration during outdoor cycling compared with indoor laboratory - based experiments ( 28 ) . in the current study , in contrast , air density drops to approximately 1.165 kgm at a temperature of 30c , reducing the drag force by approximately 6% . air density was 9.4% lower during tth-3 ( 1.131 kgm ) than that during ttc ( 1.249 kgm ) , representing a power economy of almost 8% ( 22 ) . consequently , the decrease in air density noted in hot ambient conditions is likely to partially attenuate the performance decrement associated with development of hyperthermia during outdoor cycling . in the current study , thus , despite the slightly lower power output in tth-3 than that in ttc ( 3% ) , the average speeds were not significantly different . therefore , it can not be ruled out that overall performance may be optimized in a slightly warmer temperature than in the ttc conditions of the current study .", "the novel findings of this investigation are that competitive cyclists performing an outdoor tt undertake their effort at the same power output , irrespective of the environmental conditions or previous experience . furthermore , our data seem to confirm that sustainable power output is related to a given relative intensity ( 24 ) , which is partly reflected in the maintenance of hr within a certain range . finally , because of the reduction in air density associated with cycling in hot ambient conditions , speed was not different between tth-3 and ttc . consequently , non heat - acclimatized cyclists are incapable of sustaining this absolute effort . however , the decrement in power output is partly recovered after 1 wk of heat acclimatization and almost fully restored after 2 wk ." ]

[ "luminous transmittance ( \n v ) , ir transmittance within the 7801400 nm range ( \n a ) , ir transmittance within the 7802000 nm range ( \n n ) , ir reflectance within the 7802000 nm range ( r \n n ) , ir absorptance within the 7802000 nm range ( a \n n ) , the level of protection ( shade number ) is determined on the basis of luminous transmittance ( the higher protection level correlates with the higher level of ir radiation blocked and appropriately lower vis light transmittance ) . protection level consists of a code number ( e.g. , 4 ) for ir filters and a shade number ( e.g. , 3 , 5 , 7 ) calculated according to the following equation : \n ( 1 ) \n where \n v \n = luminous transmittance . for the particular level of protection , the mean ir transmittance within the 7801400 and 7802000 nm ranges as well as the ir reflectance and absorptance within the 7802000 nm range are determined . the following coefficients were analysed : \n luminous transmittance ( \n v),ir transmittance within the 7801400 nm range ( \n a),ir transmittance within the 7802000 nm range ( \n n),ir reflectance within the 7802000 nm range ( r \n n),ir absorptance within the 7802000 nm range ( a \n n),shade number ( n ) . \n the aim of the present study was to compare the optic properties of protective filters manufactured by taking advantage of the interference technology and those coated with a single metallic layer reflecting ir radiation . the coefficients characterizing their optic parameters , allowing to assess the protective properties within the vis and ir spectrum range were compared .", "for comparative analysis of the metallic reflective filters available in the market versus the interference filters developed by the authors , the following samples were prepared for the tests : \n off the shelf metallic reflective filters on a polycarbonate base ( flat parallel plate of 50 mm diameter and 2 mm thickness with a metallic layer of copper ( cu ) protection levels : 4 - 3 , 4 - 5 , 4 - 7);interference filters on a polycarbonate base ( flat parallel plate of 50 mm diameter with interference coating made up of the following materials : aluminium , h4 latio3 substance and silicon dioxide ) . \n off the shelf metallic reflective filters on a polycarbonate base ( flat parallel plate of 50 mm diameter and 2 mm thickness with a metallic layer of copper ( cu ) protection levels : 4 - 3 , 4 - 5 , 4 - 7 ) ; interference filters on a polycarbonate base ( flat parallel plate of 50 mm diameter with interference coating made up of the following materials : aluminium , h4 latio3 substance and silicon dioxide ) . the protection levels , luminous transmittance and symbols used for marking the tested filters are presented in table 1 . \n 4 - 70.1604 - 7interferencenote : protection level consists of code number ( 4 ) for infrared filters and shade number ( 3 , 5 , 7 ) calculated according to equation ( 1 ) . \n characteristics of the filters.symbolluminous transmittance v ( % ) protection levelfilter typecu 4 - 314.1334 - 3metallic reflectiveitf 4 - 39.0824 - 3interferencecu 4 - 52.0214 - 5metallic reflectiveitf 4 - 51.4704 - 5interferencecu 4 - 70.3534 - 7metallic reflectiveitf", "luminous transmittance \n ( 2 ) \n ir transmittance within the 7801400 nm range \n ( 3 ) \n ir transmittance within the 7802000 nm range \n ( 4 ) \n ir reflectance within the 7802000 nm range \n ( 5 ) \n ir absorptance within the 7802000 nm range \n ( 6 ) \n the factor before integrals corresponding to the value of the measurement step at the measurement of spectral characteristics . the aforementioned coefficients were calculated from the following equations [ 1012 ] : \n luminous transmittance \n ( 2 ) \n\n where ( ) = spectral transmittance , v( ) = spectral visibility function of the average human eye for daylight or night vision , s \n d65( ) = spectral energy distribution of standard illuminant d65 ; \n ir transmittance within the 7801400 nm range \n ( 3 ) \n\n where ( ) = spectral transmittance ; \n ir transmittance within the 7802000 nm range \n ( 4 ) \n\n where ( ) = spectral transmittance ; \n ir reflectance within the 7802000 nm range \n ( 5 ) \n\n where ( ) = spectral reflectance ; \n ir absorptance within the 7802000 nm range \n ( 6 ) \n\n where r \n n = ir reflectance within the 7802000 nm range , \n n = ir transmittance within the 7802000 nm range . spectral transmittance was measured with incident radiation falling normally on the filter surface in the visual centre ( defined as in ) . for spectral reflectance since the minimum averaging time of the cary 5000 spectrophotometer was 0.0125 s , the values of transmittance or reflectance were measured 125 times for a given wavelength . the measurements were taken every second owing to the high absorption of investigated filters within the nir region . optical properties of the filters were measured with a cary 5000 spectrophotometer ( varian , australia ) . the spectrophotometer enabled transmittance or reflectance of optical radiation within the vis and nir spectrum to be recorded with 1 nm steps and 0.001% resolution level . the photomultiplier tube and lead sulphide detector were used for vis and nir spectrum , respectively .", "infrared transmittance within the 7801400 and 7802000 nm range , infrared reflectance within the 7802000 nm range and infrared absorptance within the 7802000 nm range . transmittance and reflectance characteristics of the studied filters.note : cu 4 - 3 = metallic reflective filter ; itf 4 - 3 = interference filter ; cu 4 - 5 = metallic reflective filter ; itf 4 - 5 = interference filter ; cu 4 - 7 = metallic reflective filter ; itf 4 - 7 = interference filter . \n table 2 presents the values of coefficients determined on the basis of equations ( 3)(6 ) . \n", "the values of \n a and \n n for interference filters are lower even by an order of magnitude than those obtained for the metallic reflective filters . the levels of the ir absorptance for metallic reflective filters and interference filters of 4 - 3 and 4 - 5 protection class are similar . for the highest of the investigated protection levels 4 - 7 for instance , the mean value of ir transmittance within the 7802000 nm range for interference filters with protection level 4 - 5 ( one of the most common protection levels used in the metallurgic industry ) equals 0.006% and is significantly lower than the maximum acceptable value specified in , which is 10.6% . reduction of filter heating as a result of exposure to ir radiation is important . as it follows from comparative analysis of the optic properties of filters taking advantage of the interference technology and filters coated with a single metallic layer reflecting ir radiation , the interference filters provide a more effective blocking of ir radiation in comparison with the currently used protective filters . the selection of filter protection level is dependent on the temperature of the radiation source . the above findings are important for selection of a filter appropriate for the radiation source .", "" ]

[ "this retrospective observational study was conducted using electronic medical records from the south central veterans affairs health care network ( visn 16 ) , one of the largest of the 23 visns in the veterans health administration ( vha ) . dollars according to the medical care services component of the consumer price index ( 27,28 ) . utilization and costs were considered diabetes related if they were associated with diagnoses of any of the following : diabetes , macrovascular complications , or microvascular complications . medication use during the first cycle was categorized by drug therapeutic class ; health care resource utilization during the first cycle was categorized by hospitalization days and outpatient visits . the time to the first clinical event was evaluated using a cox proportional hazards model , with goal achievement status as a time - dependent variable , controlling for patient demographics and other potential confounding factors such as cumulative comorbidity history , resource utilization , and medication use . the associations between goal achievement status in a given study cycle and utilization in the following cycle were assessed using generalized linear regression models ( glms ) with a poisson distribution ; results are reported as adjusted incidence rate ratios with 95% cis . all longitudinal glms accounted for within - patient correlation using a generalized estimating equation approach and controlled for demographics and time - dependent variables such as cumulative comorbidity history , resource utilization , and medication use .", "it includes records for > 445,000 veterans from 10 medical centers and 40 outpatient clinics , with information regarding demographics , vital signs , laboratory results , diagnoses , procedures , inpatient and outpatient services ( e.g. , admission date , length of stay , and emergency room visits ) , drug prescriptions , and database enrollment history . this retrospective observational study was conducted using electronic medical records from the south central veterans affairs health care network ( visn 16 ) , one of the largest of the 23 visns in the veterans health administration ( vha ) . veterans and covers a geographic region of 170,000 square miles , including the states of arkansas , louisiana , mississippi , and oklahoma , and parts of alabama , florida , missouri , and texas . the vha is a national integrated health care system providing a set of comprehensive services to veterans . as of 2010 as in the national vha population , patients in visn 16 are predominantly male ( 90.1% ) . the visn 16 data warehouse is an integrated , de - identified , individual - level database representing 7.8% of u.s . the study protocol was approved by the institutional review board and research and development committee of the southeast louisiana veterans health care systems .", "adult patients ( 18 years of age ) were included in the study if they had two or more diagnoses of t2 dm between 1 january 2004 and 30 june 2010 . patients had at least one measurement of hba1c and ldl - c within 30 days of each other ( paired measurements ) after the first diabetes diagnosis ; the earlier date of the hba1c or ldl - c measurement was defined as the index date . all patients were further required to have at least one more measurement of hba1c and ldl - c within 1 year after the index date , irrespective of the gap between the measurements . the final sample included patients who were enrolled in the database for at least 12 months after the index date .", "average hba1c and ldl - c levels were estimated for each cycle using the area under the curve method ( 24,25 ) . for each cycle , these estimated averages were used to stratify patients into one of four goal achievement categories : dual goal ( average hba1c < 7% [ 53 mmol / mol ] and average ldl - c < 100 mg / dl ) , hba1c only ( average hba1c < 7% [ 53 mmol / mol ] and average ldl - c 100 mg / dl ) , ldl - c only ( average ldl - c < 100 mg / dl and average hba1c 7% [ 53 mmol / mol ] ) , or no goal ( average hba1c 7% [ 53 mmol / mol ] and average ldl - c 100 mg / dl ) .", "patient characteristics as of the first cycle were summarized for the overall population , as well as stratified according to goal achievement status . medication use during the first cycle was categorized by drug therapeutic class ; health care resource utilization during the first cycle was categorized by hospitalization days and outpatient visits . the history of diabetes - related complications ( microvascular , macrovascular , and other ) , comorbidities , and surgical procedures was identified as of the first cycle using icd-9 , clinical modification ( icd-9-cm ) codes . characteristics were compared across the four groups according to goal achievement status using the anova method for continuous variables and tests for categorical variables . demographic information included age on index date , sex , race , bmi , and year of index date .", "the time to the first clinical event was evaluated using a cox proportional hazards model , with goal achievement status as a time - dependent variable , controlling for patient demographics and other potential confounding factors such as cumulative comorbidity history , resource utilization , and medication use . all clinical outcomes were measured from the start of the second cycle until the first event , death , or end of data ; for the analyses of specific clinical outcomes , patients were excluded from the analysis if any clinical event defining the particular outcome occurred before the end of the first cycle . clinical outcomes were selected a priori and comprised 1 ) a composite cardiovascular - related end point ( cerebrovascular disease [ stroke ] , acute myocardial infarction , or cardiovascular death [ defined by a diagnosis of coronary artery disease or cerebrovascular disease on the day of death ] ) , 2 ) a composite end point for microvascular complications ( diabetic retinopathy , nephropathy , or neuropathy ) , 3 ) acute coronary syndromes ( acs ; acute myocardial infarction or unstable angina ) , and 4 ) cardiovascular procedures ( percutaneous coronary intervention [ pci ] or coronary artery bypass graft [ cabg ] ) . for each clinical outcome , goal achievement and patient characteristics were measured in a given cycle and outcomes were assessed for the following cycle .", "dollars according to the medical care services component of the consumer price index ( 27,28 ) . utilization and costs were considered diabetes related if they were associated with diagnoses of any of the following : diabetes , macrovascular complications , or microvascular complications . the associations between goal achievement status in a given study cycle and utilization in the following cycle were assessed using generalized linear regression models ( glms ) with a poisson distribution ; results are reported as adjusted incidence rate ratios with 95% cis . diabetes - related medical service costs were measured in each cycle using the average cost method ( 26 ) . the numbers of diabetes - related hospitalization days and outpatient visits were estimated for each 6-month cycle . the associations between goal achievement status in a given cycle and costs in the following cycle were assessed using glms with a distribution , and adjusted results are reported as annualized incremental cost differences . all longitudinal glms accounted for within - patient correlation using a generalized estimating equation approach and controlled for demographics and time - dependent variables such as cumulative comorbidity history , resource utilization , and medication use . sas software version 9.2 was used to conduct statistical analyses , and a two - tailed level of 0.05 was used to determine statistical significance .", "of the 149,613 patients with at least two recorded diagnoses of t2 dm between 1 january 2004 and 30 june 2010 , a total of 75,646 patients met the selection criteria and were included in the analysis . dual , patients achieving both ldl - c and hba1c goals ; hba1c , patients achieving only the hba1c goal ; ldl - c , patients achieving only the ldl - c goal ; none , patients achieving neither goal . patient baseline characteristics , demographics , comorbidities , complications , medications , and resource use the median duration of follow - up time was 4.5 years from the index date . after adjusting for demographics , diabetes - related complications , comorbidities , surgical procedures , diabetic medication use , and health care utilization , dual - goal achievement , when compared with achievement of ldl - c goal alone , dual , patients achieving both ldl - c and hba1c goals ; hba1c , patients achieving only the hba1c goal ; ldl - c , patients achieving only the ldl - c goal ; none , patients achieving neither goal . * dual - goal achievement was associated with a lower risk of cabg ( 0.62 [ 0.490.79 ] ) and the composite cardiovascular end point ( 0.87 [ 0.810.93 ] ) .", "of the 149,613 patients with at least two recorded diagnoses of t2 dm between 1 january 2004 and 30 june 2010 , a total of 75,646 patients met the selection criteria and were included in the analysis . as shown in table 1 , as of the index date , most patients were older than 55 years ( 84.1% ; mean age 64.7 years ) and had an average bmi of 31.6 kg / m . almost all patients were men ( 97.4% ) , and approximately two in three were white ( 67.4% ) . during the first cycle , 35.1% of patients achieved both goals ( dual - goal achievers ) , whereas 21.6% achieved only the ldl - c goal ( ldl - c achievers ) , 24.6% achieved only the hba1c goal ( hba1c achievers ) , and 18.6% did not achieve either goal ( no - goal achievers ) ( table 1 ) . compared with all other groups , dual - goal achievers were older ( 67.1 vs. 61.464.4 years ) . rates of microvascular complications were lower for dual - goal ( 24.1% ) and hba1c achievers ( 22.4% ) than for ldl - c ( 33.0% ) and no - goal achievers ( 30.2% ) ; similar differences were observed for the usage of insulin ( 10.4 and 7.5% vs. 34.6 and 30.1% , respectively ) and oral antidiabetic drugs ( 67.4 and 64.0% vs. 82.2 and 82.7% , respectively ) . a higher rate of macrovascular complications was observed among dual - goal ( 47.4% ) and ldl - c achievers ( 45.6% ) than among hba1c ( 33.8% ) and no - goal achievers ( 33.9% ) ( table 1 ) .", "the median duration of follow - up time was 4.5 years from the index date . after adjusting for demographics , diabetes - related complications , comorbidities , surgical procedures , diabetic medication use , and health care utilization , dual - goal achievement , when compared with achievement of ldl - c goal alone , was associated with a significantly reduced risk of microvascular complications ( adjusted hazard ratio 0.79 [ 95% ci 0.760.82 ] ) , acs ( 0.88 [ 0.810.96 ] ) , pci ( 0.78 [ 0.670.90 ] ) , and cabg ( 0.74 [ 0.600.92 ] ) , but not of the composite cardiovascular - related end point ( 1.00 [ 0.941.06 ] ) ( fig . dual , patients achieving both ldl - c and hba1c goals ; hba1c , patients achieving only the hba1c goal ; ldl - c , patients achieving only the ldl - c goal ; none , patients achieving neither goal ( see text for details ) . compared with no - goal achievers , dual - goal achievers had a significant 1930% lower hazard of the cardiovascular end point or diabetes - related microvascular or acs - related events , and a 4549% lower hazard of undergoing pci or cabg . dual - goal achievement was associated with a lower risk of cabg ( 0.62 [ 0.490.79 ] ) and the composite cardiovascular end point ( 0.87 [ 0.810.93 ] ) . in addition , relative to no - goal achievers , both groups of single - goal achievers had significant reductions in hazard for all categories of complications and surgical procedures , except microvascular complications among ldl - c achievers .", "2 ) . in particular , compared with ldl - c achievers , dual - goal achievers had significantly fewer hospitalization days ( adjusted incidence rate ratio 0.93 [ 95% ci 0.871.00 ] ) and outpatient visits ( 0.88 [ 0.870.89 ] ) . compared with hba1c achievers , dual - goal achievers had significantly fewer outpatient visits ( 0.98 [ 0.971.00 ] ) , but there was no statistical difference in the number of hospitalization days ( 0.98 [ 0.891.07 ] ) . compared with no - goal achievers , dual - goal achievers had significantly fewer hospitalization days ( 0.81 [ 0.720.90 ] ) and outpatient visits ( 0.86 [ 0.850.87 ] ) . after controlling for demographics , diabetes - related complications , comorbidities , surgical procedures , diabetic medication use , and health care utilization , dual - goal achievers generally used less health care resources compared with single- or no - goal achievers ( fig . similarly , both groups of single - goal achievers also had significantly fewer hospitalization days ( ldl - c achievers , 0.87 [ 0.780.96 ] ; hba1c achievers , 0.83 [ 0.730.94 ] ) and outpatient visits ( ldl - c achievers , 0.98 [ 0.960.99 ] ; hba1c achievers , 0.87 [ 0.860.89 ] ) than patients who did not achieve either goal . dual , patients achieving both ldl - c and hba1c goals ; hba1c , patients achieving only the hba1c goal ; ldl - c , patients achieving only the ldl - c goal ; none , patients achieving neither goal .", "after adjusting for demographics , diabetes - related complications , comorbidities , surgical procedures , diabetic medication use , and health care utilization , dual - goal achievers incurred significantly lower annualized diabetes - related medical service costs compared with those who achieved only the ldl - c goal ( $130.89 ; p = 0.016 ) , but no statistically significant difference was observed between dual - goal achievers and hba1c goal achievers ( $56.17 ; p = 0.404 ) ( fig . diabetes - related medical service costs were significantly lower for dual - goal ( $376.50 ; p < 0.001 ) , ldl - c ( $245.61 ; p < 0.001 ) , and hba1c achievers ( $320.32 ; p < 0.001 ) compared with those who did not achieve either goal . dual , patients achieving both ldl - c and hba1c goals ; hba1c , patients achieving only the hba1c goal ; ldl - c , patients achieving only the ldl - c goal ; none , patients achieving neither goal . *", "the study results showed that , compared with the achievement of only the ldl - c goal , achievement of both hba1c and ldl - c goals is associated with a lower risk of microvascular complications , acs , and cardiovascular surgeries ( pci or cabg ) , lower utilization of health care resources , and lower costs of care , but no additional effect was observed for the composite cardiovascular - related end point . this is the first study to examine the differences between dual- and single - goal achievement in terms of health care resource utilization and costs in patients with diabetes . in addition , dual - goal achievement relative to hba1c goal achievement is associated with a lower risk of the composite cardiovascular - related end point , cabg , and outpatient visits . to our knowledge , this is the first study that was designed to quantify the differences in clinical and economic outcomes between dual - goal and single - goal achievement in patients with t2 dm . the results from our study are generally consistent with findings from previous studies designed to assess the benefits of treatment paradigms aimed at achieving more than one clinical goal in diabetes . in steno-2 , a danish open - label , veterans suggests that the achievement of both ldl - c and hba1c goals is associated with additional clinical and economic benefits , compared with the achievement of either goal alone our results suggest that dual - goal achievement provides additional economic benefits . over ldl - c goal alone , but not over hba1c goal alone .", "to our knowledge , this is the first study that was designed to quantify the differences in clinical and economic outcomes between dual - goal and single - goal achievement in patients with t2 dm . the results from our study are generally consistent with findings from previous studies designed to assess the benefits of treatment paradigms aimed at achieving more than one clinical goal in diabetes . in steno-2 , a danish open - label , we decided to await final consensus on the optimal blood pressure goal for patients with diabetes before creating appropriate models to account for blood pressure goal achievements . the blood pressure level cutoff recommended by major national and international guidelines for patients with diabetes ( < 130/80 mmhg ) may be difficult to achieve , and the benefits of achieving this blood pressure goal are unclear ( 30 ) . current lipid and glycemic goals , however , are relatively easy to achieve , as can be seen from our study , and their effects are therefore easier to take into consideration . lipid - lowering treatments were suggested to have had the greatest contribution to cardiovascular risk reduction , whereas antiglycemic and antihypertensive treatments were considered to have accounted for the greatest reduction in microvascular complications ( 29 ) .", "our findings are in agreement with the results from several large randomized trials that found that the treatments aimed at lowering ldl - c were associated with a reduced risk of cardiovascular events in patients with diabetes ( 610 ) . in our study , our study showed a 6% lower hazard of cardiovascular - related end point for hba1c achievers compared with no - goal achievers . this lack of association between intensive glycemic control and macrovascular benefits has been observed in other large trials , such as action in diabetes and vascular disease : preterax and diamicron modified release controlled evaluation ( advance ) ( 4 ) , action to control cardiovascular risk in diabetes ( accord ) ( 2,3 ) , and veterans affairs diabetes trial ( vadt ) ( 32 ) , except in the case of patients with newly diagnosed diabetes ( 5,33 ) . the 10-year uk prospective diabetes study found that intensive glycemic control reduces the risk of microvascular complications but does not affect the risk of macrovascular disease ( 31 ) . achievement of the hba1c goal alone and the ldl - c goal alone were each associated with a lower risk of cardiovascular surgeries , which is consistent with other research in patients with diabetes which has shown that patients who undergo cabg ( 3436 ) and pci ( 37,38 ) often have elevated hba1c levels , and that lowering ldl - c levels is also associated with lower risks of coronary events ( 6,7,39 ) . our results are also consistent with findings from large randomized trials that evaluated situations analogous to the achievement of single metabolic goals .", "this is the first study to examine the differences between dual- and single - goal achievement in terms of health care resource utilization and costs in patients with diabetes . our results suggest that dual - goal achievement provides additional economic benefits . over ldl - c goal alone , but not over hba1c goal alone . veterans suggests that the achievement of both ldl - c and hba1c goals is associated with additional clinical and economic benefits , compared with the achievement of either goal alone . these findings may facilitate decision making when considering the health and pharmacoeconomic benefits of various treatment strategies to target multiple treatment goals for individuals with diabetes ." ]

[ ", we evaluated the feasibility of ultrasound in predicting difficult laryngoscopy in a chinese han population . due to the portable , noninvasive characteristics , point - of - care ultrasound ( us ) technique has been widely used in the operating room for ultrasound - guided nerve block , central venous access , and pneumothorax diagnosis . with improved visualization of airway structures , endotracheal intubation is one of the most important skills for anesthesiologists in securing the airway during general anesthesia and resuscitation . however , the difficult laryngoscopy and tracheal intubation rate still remains at 1.513% due to poor reliability of traditional protocols , algorithms , and combinations of screening tools in identifying a potentially difficult airway .", "class i is visualization of the hard palate , soft palate , fauces , uvula , and pillars . class ii is visualization of the hard palate , soft palate , fauces , and base of uvula . the thicknesses of anterior neck soft tissue at hyoid bone , thyrohyoid membrane , and anterior commissure levels were obtained transversely across the anterior surface of the neck with a 136 mhz hfl38 linear array ultrasound probe attached to a sonosite s - nerve machine ( sonosite inc . , the modified mallampati score ( mms ) was specified according to the visibility of pharyngeal structures with the patient in an upright sitting position , head in neutral position , mouth wide open , and tongue protruding to its maximum without phonation ( figure 1a ) . the distance from skin to epiglottis midway ( dsem ) between the hyoid bone and thyroid cartilage was measured ( figure 2c , 2d ) . at anterior commissure level , interincisor gap ( iig ) was measured from the upper central incisors to the lower central incisors while the patient s mouth was fully opened . the minimal distance from the hyoid bone to skin surface ( dshb ) was measured ( figure 2a , 2b ) . at thyrohyoid membrane level ,", "receiver operating characteristic ( roc ) analyses were used to calculate the comparable threshold values of dshb , dsem , dsac , tmd , iig , and mms . the best fit lines of dshb , dsem , dsac , mms , iig , and tmd were determined using a least - squares regression technique . the level of statistical significance was p<0.05 , and p<0.0001 was considered to be very statistically significant . continuous data are expressed as means ( standard deviation [ sd ] ) ; categorical data are expressed as numbers of occurrences ( percents ) . comparison analysis was performed using the t - test for continuous variables and chi - square or fisher exact tests , as appropriate , for non - continuous variables . optimal cutoff values were calculated using the youden index ( calculated as : sensitivity + specificity 100 ) .", "the thicknesses of anterior neck soft tissue measured by us were greater in the difficult laryngoscopy group compared to the easy laryngoscopy group at the level of the hyoid bone , thyrohyoid membrane , and anterior commissure . no difference between the aucs of tmd , iig , and the area under the reference line were identified , suggesting that mms , dshb , dsem , and dsac might be better than tmd and iig in predicting difficult laryngoscopy ( table 3 ) . no correlations were found between tmd and dsem , tmd and dshb , and tmd and dsac ( data not shown ) . to further assess the roles of mms , iig , tmd , dshb , dsem , and dsac in predicting difficult laryngoscopy , a total of 203 eligible patients ( 120 females , 83 males ) were included in this study . there were 28 of 203 patients ( 13.8% ) categorized as difficult laryngoscopy , and 50% of patients with difficult laryngoscopy in our study were males . however , no statistically significant difference was found between easy and difficult laryngoscopy groups for tmd and iig . a strong positive correlation existed between dsem and dshb ; moderate positive correlations between dsem and dsac , dshb and dsac ; small positive correlations between mms and dshb , mms and dsem , mms and dsac ; and very small positive correlations between tmd and iig .", "with the rapid expansion of portable us in anesthesia for guiding the placement of central venous catheters and the performance of regional block [ 1113 ] , some preliminary results exploring the feasibility of portable us in airway evaluation and management have been reported , even though the air attenuates us transmission and thereby creates artifacts [ 35,14,15 ] . in the present study , we compared the role of the us measurements and traditional screening tests , including iig , tmd , and mms , in predicting difficult laryngoscopy in a chinese han population . glottis exposure by place laryngoscope is a very complicated procedure , and many subjective and objective factors such as the provider s skills and experience , airway secretions , and abnormalities of anatomical structures are involved in this procedure . we found that strong positive linear correlations existed among the thicknesses of anterior neck soft tissue measured by us at hyoid bone , thyrohyoid membrane , and anterior commissure levels .", "anterior neck soft tissue thicknesses measured by us at the hyoid bone , thyrohyoid membrane , and anterior commissure levels are independent predictors of difficult laryngoscopy . the commonly used screening tests for difficult intubation have only poor - to - moderate predictive power when used alone . combinations of these screening tests or risk factors with us measurements might increase the ability to predict difficult laryngoscopy ." ]

[ "", "w celu oceny wpywu perikardiotomii tylnej na wystpowanie wysiku osierdziowego , tamponady oraz migotania przedsionkw przeprowadzono prospektywne badanie kliniczne z randomizacj .", "badana grupa skadaa si z 96 pacjentw ( 77 mczyzn i 19 kobiet ) w wieku rednio 58,1 9,8 roku . i , n = 30 ) , grupy kontrolnej ( grupa ii , n = 33 ) oraz pacjentw , u ktrych zastosowano tylny drena osierdziowy , ktrzy jednak nie zostali poddani zabiegowi perikardiotomii tylnej ( grupa iii , n = 33 ) .", "czas trwania hospitalizacji pooperacyjnej ( p = 0,03 ; 11,56 10,64 ) oraz czsto reoperacji z powodu tamponady ( p = 0,019 ; 12,1% ) byy znaczco wysze w grupie ii . znaczny wysik osierdziowy wykryto u jednego pacjenta ( grupa ii , n = 1 ) w pierwszym dniu po operacji , u jednego pacjenta w pitym dniu po operacji ( grupa iii , n = 1 ) oraz u jednego pacjenta w 30", "zarwno perikardiotomia tylna , jak i tylny drena klatki piersiowej okazay si skuteczne we wczesnym okresie pooperacyjnym . pacjenci , ktrzy nie zostali poddani perikardiotomii tylnej lub u ktrych nie zastosowano tylnego drenau klatki piersiowej , wykazywali szcztkowy wysik osierdziowy , wymagali duszej hospitalizacji i musieli by ponownie operowani z powodu tamponady .", "pericardial effusion , which is a common complication after coronary artery surgery ( cas ) , may be the cause of significant morbidity . this study aims to investigate the effects of posterior pericardiotomy ( pp ) on the development of pericardial effusion , tamponade , and atrial fibrillation following cas . delayed postoperative cardiac tamponade following an open - heart operation is an infrequent , but potentially serious complication . although previous reports have dealt with the clinical features and management of this problem , an optimal approach to prevent postoperative pericardial effusion and related problems has not been clearly defined [ 3 , 5 ] . it is often benign and small in volume , but can lead to life - threatening events , such as cardiac tamponade .", "the study groups included patients after pp ( group i , n = 30 ) , a control group ( group ii , n = 33 ) , and patients without pp who received posterior pericardial tubes ( the tube was placed behind the heart and sutured to the adjacent pericardial tissue to avoid tube - induced ventricular arrhythmias ) ( group iii , n = 33 ) . this prospective randomized case - controlled study was carried out on 96 patients ( 77 men and 19 women ; age : 35 - 78 years ; mean : 58.1 years ) . we compared the groups with regard to the volume of effusion on postoperative days 1 , 5 , and 30 . the patients , undergoing cas performed by the same surgical team between march 2012 and january 2013 in istanbul mehmet akif ersoy thoracic and cardiovascular surgery research and training hospital , were assigned to 3 groups . if the diagnosis of evident pericardial effusion ( moderate or severe ) was established , tte was performed daily , and the volume of the effusion was observed closely . atrial fibrillation was considered to be persistent and clinically significant when it lasted for more than 5 min . patients with no or small pericardial effusion and an uneventful postoperative course were discharged from the hospital on postoperative day 5 . all patients were continuously monitored with the use of a portable electrocardiogram ( ecg , telemetry ) to detect atrial fibrillation .", "the incidence of moderate to severe pericardial effusion in group i was significantly lower than in the other groups on the 30 postoperative day ( n = 0 , p = 0.028 ) . the length of hospital stay was significantly shorter in group i ( 6.63 2.71 , p = 0.03 ) . the incidence of cardiac tamponade was higher in group ii ( n = 4 , 12% ) , and the differences between the groups were statistically significant ( p = 0.019 ) . in group i , the volume of the fluid evacuated by mediastinal drainage was lower than in groups ii and iii , but the difference was not statistically significant ( table ii ) . comparison of the groups with regard to the volume of pericardial effusion atrial fibrillation was detected in 24 of the 96 patients ( 25% : 6 patients in group i , 11 patients in group ii , 7 patients in group iii ) . four of these patients ( group ii , n = 4 ) underwent drainage of severe pericardial effusion on postoperative days 0 , 1 , 11 , and 17 ; one patient ( group ii ) underwent sternal dehiscence repair . severe pericardial effusion was detected in one patient ( group ii , n = 1 ) on the first postoperative day , in one patient ( group iii , n = 1 ) on the fifth postoperative day , and in one patient ( group iii , n = 1 ) on the 30 postoperative day . the hospital mortality in the study was 2% ( n = 2 ) ; both patients were in group ii .", "the present study also demonstrated that patients undergoing pp required a significantly shorter hospital stay and experienced lower rates of pericardial effusion and cardiac tamponade than the other groups . there are a number of articles favoring the use of posterior pericardiotomy , but no comprehensive comparison has been conducted between the use of a pericardial tube and pp in patients undergoing cas . pericardial effusion and the associated complications are common after all kinds of cardiac surgery due to postoperative bleeding or post - cardiotomy syndrome . however , clinically significant pericardial effusion occurs rarely and can be a crucial risk factor for cardiac tamponade ( 1% ) . posterior pericardiotomy has been reported to reduce the prevalence of pericardial effusion from 40% to 8% with a simultaneous reduction in the prevalence of svt ( supraventricular tachycardia ) .", "this research was carried out on a small set of patients ( n = 96 ) ; therefore , there was an imbalance between men and women enrolled in this trial . group ii had a 2-fold elevation in the number of patients going into af postoperatively .", "in conclusion , pp may be a useful technique in the prevention of pericardial effusion and cardiac tamponade after cas because it is simple , safe , and effective . . \n oral presentation at the 22 \n annual meeting of the asian society for cardiovascular and thoracic surgery that will be held in istanbul on april 3 - 6 , 2014 .", "" ]

[ "this review therefore aims to serve as resource for health professionals to enhance their understanding of ototoxicity as well as their roles within an ototoxicity monitoring programme by providing an overview and description of this condition in patients diagnosed with cancer and receiving cisplatin chemotherapy . cancer places a huge burden on society and has been identified as the leading cause of death in both more and less economically developed countries . south africa , like other developing countries , is also experiencing an increase in the overall burden of disease attributable to cancer , with the number of new cancer cases predicted to increase by 46% by 2030 . all health care professionals managing patients with cancer should therefore be knowledgeable about the ototoxic properties of cisplatin . since its discovery in the 1970s , cisplatin continues to be hailed as one of the most potent cancer chemotherapeutics in children and adults , as it is unique and unmatched in its effectiveness against many cancers , namely , osteogenic sarcoma , medulloblastoma , testicular , cervical , and ovarian cancers .", "the review identified peer - reviewed articles available from january 1975 to july 2015 on the topic of cisplatin - associated ototoxicity and ototoxicity monitoring and included english articles only . this resulted in the following eight areas being included : the mechanisms of cisplatin ototoxicity , clinical presentation , risk factors , incidence rates in adults and children , the effect on quality of life , ototoxicity monitoring , otoprotective strategies , and management of an ototoxic hearing loss . studies were identified using keyword and mesh term searches of electronic databases depicted in table 1 . a manual search of relevant authors and journals a perusal of narrative reviews of other auditory pathologies was conducted in an attempt to determine areas of significance for an overview of cisplatin ototoxicity . the references cited by each publication , review , or book chapter were reviewed in order to locate additional potential publications . in order to be selected , the article had to present data on either cisplatin ototoxicity and/or ototoxicity monitoring in human participants , and no research designs were excluded . running these searches yielded a total of 2106 records , of which 1581 were excluded based on the title and/or abstract as well as duplication . while there are no published studies suggesting one approach to be superior to another , frequency lowering technology has been found to improve audibility and speech understanding of high frequency sounds . the same researcher conducted the literature search and reviewed the abstracts and articles for inclusion in the study .", "the varying incidence rates reported in both adults and paediatrics may be due to the different audiological tests employed in the monitoring of the cancer patient 's hearing status and therefore highlight the importance of the use of extended high frequency audiometry and dpoaes in ototoxicity monitoring . this review has highlighted that cisplatin ototoxicity is a frequent adverse event of cisplatin chemotherapy that may negatively affect the quality of life of patients with cancer . an audiological monitoring programme comprising a team of health care professionals , knowledgeable about cisplatin ototoxicity , may therefore serve to improve evidence - based service delivery to these patients . the different molecular and cellular mechanisms involved in cisplatin - associated ototoxicity highlight the complexity of this condition and the consequent difficulty in identifying an effective otoprotective agent ." ]

[ "was then evaluated to determine the sequence specificity of the reaction , \n leading to the identification of proline as the optimal n - terminal \n amino acid . this mild bioconjugation reaction enables the facile , \n rapid modification of proteins to create a well - defined and stable \n linkage in a single position , and thus should be useful for many different \n applications in chemical biology and the construction of biomolecular \n materials . peptide substrates \n were first used to screen reaction conditions and identify the site \n of modification . a peptide panel with varying n - terminal residues \n the reaction was next applied to protein substrates , showing \n similarly high levels of conversion when an n - terminal proline residue \n was present . herein , we report an oxidative \n coupling pathway that can preferentially \n modify the n - terminus of proteins with fast kinetics . the most common methods for protein modification \n target the nucleophilic side - chains of lysine and cysteine . however , these strategies can \n result in complex product mixtures , as lysine is typically found in \n high abundance on the protein surface and \n uniquely reactive cysteine labeling sites can be difficult to install \n in many instances ( such as thiol proteases and proteins produced via \n the eukaryotic secretory pathway , for example ) . many newer approaches \n for the site - selective modification of proteins \n involve the introduction of artificial amino acids with reactivities \n that are orthogonal to those of the native \n amino acids . along these lines ,", ", we noted that low amounts of background reactivity could be \n observed in aniline - based oxidative coupling reactions when higher \n ph conditions ( > ph 6.5 ) were used . in \n an initial effort to characterize this alternative reaction pathway , \n conditions and reaction times the oxidative coupling \n reaction was also compared to the reaction \n of protein amines with activated esters . the ferricyanide - based reactions \n are presumed to involve an o - iminoquinone as the \n reactive intermediate , as suggested in scheme 1 , or could involve the corresponding o - quinone after \n imine hydrolysis . taken together , the oxidative coupling strategies \n have demonstrated excellent functional group compatibility and the \n ability to join large unprotected biomolecules at low concentrations , \n as demonstrated for the coupling of peptides , polymers , and nucleic \n acids to specific locations on viral capsids and antibody fc domains . while these coupling reactions \n were found to be highly aniline - selective \n under the conditions used , several studies have reported the reaction \n of o - aminophenols and o - catechols \n with native amino acids , dating back to 1949 . we have previously reported \n the chemoselective coupling of aniline \n moieties on proteins to electron - rich aromatic rings , such as o - aminophenols , at slightly acidic ph ( 6.06.5 ) . the reactions \n were compared on creatine kinase , a protein with a native proline \n n - terminus . two fluorophores \n paired for frster resonance energy transfer ( fret , alexa fluor \n 488 c5-maleimide and o - aminophenol functionalized \n rhodamine b ) were thus conjugated to tmv using this strategy to create \n a templated array of chromophores for light harvesting applications . , we are using this \n dual - labeling strategy to introduce more soluble chromophores .", "in this study , we have identified conditions \n for the oxidative \n coupling of o - aminophenols to n - terminal amino acids . \n the fast kinetics of the reaction allow it to be successful even \n at low reagent and substrate concentrations , and suggest that it can \n be used for sterically demanding bioconjugations . the ability of the n - terminal oxidative coupling method to achieve \n this in a single , brief reaction step is highly advantageous , and \n the fact that it can be combined with cysteine modification chemistry \n provides new opportunities for complex bioconjugate synthesis . proline residues work particularly well with this strategy , and are \n therefore strongly recommended when using it . the oxidative \n coupling strategy reported here offers two distinct \n advantages over other n - terminal labeling methods ." ]

[ "the present study was carried out to explore the dimensionality of this scale in an attempt to identify a set of underlying factors that exist and can explain the interrelationships among various manifestations of acute alcohol withdrawal symptoms . the knowledge of these underlying factors may enhance our understanding of aws and better prediction of complications thus management plans . several rating instruments have been used to measure severity of alcohol withdrawal . among them , it has been proposed that alcohol withdrawal symptoms in ciwa - ar appear multidimensional . a pubmed search supplemented with \n alcohol withdrawal syndrome ( aws ) is characterized by varied symptoms that range from mild to severe intensity depending on several factors including the quantity , frequency and duration of alcohol intake , and the number of prior withdrawal episodes , as well as individual differences in the vulnerability [ 14 ] . , we use ciwa - ar as part of the measure for the management of alcohol withdrawal symptoms .", "study sample included 201 , only male fulfilling icd-10 dcr ( world health organization ) for alcohol dependence with currently withdrawal state , aged between 18 and 60 years , admitted within 24 hours of abstinence and patient himself or his guardian consenting for the study . the patients get admitted with varying lengths of abstinence , ranging from hours to days , so we initially took all the ratings of all the patients and arranged them as rating at first 6 hours of abstinence and at every six hours like at 6 , 12 , 18 , 24 , 30 , 36 , 42 , 48 , 52 , 58 , and 64 hours till ciwa - ar scoring reaches below 10 . this was a cross - sectional hospital - based study , conducted at centre for addiction psychiatry , central institute of psychiatry , ranchi , india , a tertiary care referral centre during may 2005 to june 2006 . patients admitted with alcohol dependence syndrome with acute withdrawal were evaluated with ciwa - ar immediately after admission then every six hours , as a routine protocol of the ward . many patients were admitted after overnight , 12 to 18 hours of abstinence , so we included the patients who were admitted with at least 24 hours of abstinence . it has a good reliability , validity , and it is considered as one of the most widely used alcohol withdrawal assessment scale for symptom - triggered therapy .", "nonspecific factor reflected two - item loadings , nausea , and visual disturbances that explained 10.04% of variance and a cronbach 's alpha of .26 . it explained 24.25% of variance and showed moderate internal consistency ( cronbach 's alpha = .66 ) . the third factor named as factor analysis ( extraction method - maximum likelihood ) with the 10 items of ciwa - ar for day three , resulted in initial three factors with eigenvalues greater than unity . it explained 34.34% of variance and showed good internal consistency ( cronbach 's alpha = .91 ) . the second factor named as autonomic factor reflected four - item loading , highest from anxiety , followed by paroxysmal sweats , tremor , and headache or fullness in head . the item frequency and mean of all six hourly ciwa - ar ratings were calculated ; the mean scores of ciwa - ar at 24 hours and at 36 hours are shown in table 2 . based on the frequency variance and total ciwa - ar score we decided to carry out factor analysis with the 10 items of ciwa - ar as on scoring at 36 hours of abstinence .", "we examined the factor structure of the ciwa - ar in a population of adult men hospitalized to a tertiary psychiatric institute for treatment of alcohol dependence . it is advisable not to overdepend on rating scales and it must not replace a thorough clinical evaluation of the patient 's medical status in prediction of those at risk of severe alcohol withdrawal . these results have wider implications for the recognition and management of aws , particularly , for better understanding and identification of the symptom profiles for and differential management plans across subtypes of aws . the use of adrenergic antagonists may have a valuable role in addition to benzodiazepines , in a set of patients with autonomic features . the use ciwa - ar is the most widely accepted alcohol withdrawal assessment scale and selection of abstinent hours was important to allow time for full appearance of symptoms , even though under cover of detoxification medication . firstly , many of the patients come for admission after 12 to 18 hours of abstinence and severe withdrawal , so keeping them drug free was ethically not possible .", "the acute alcohol withdrawal symptoms was most severe at 36 hours of abstinence in our sample . this study finds multidimensionality of alcohol withdrawal symptoms as measured with ciwa - ar ; we found three factors explaining 68.74 percentage of variance and named as delirious , autonomic and nonspecific ." ]

[ "information regarding the amount of liquid intake expressed ( in litres , l ) and daily productivity output ( in tons ) were recorded . wet bulb globe temperature ( wbgt ) values during the 2007 harvest season at montelimar farm descriptive statistics were used to analyse climate data ( temperature ( c ) ; relative humidity ( % ) ; dew point ( c ) ) ; liquid intake and output production . they were also encouraged to drink water and rehydration solutions ( 250 ml ) every 3045 minutes . in total , they were each asked to drink 10 l of liquid ( tap water and rehydration solutions ) per day . in order to facilitate the monitoring of basic heat stress indexes during the 2007/2008 harvesting season , temperature , twenty - two workers were followed up from 15th april to 30th april 2008 during working hours , from approximately 6 am to 3 pm , for a total of 160 working hours . for an eight working hour schedule , all workers were instructed to drink 1 l of the rehydration solutions or tap water at least 30 minutes before they began to work . variables such as heart rate and weight were evaluated at the beginning and at the end of the working day . neither the amount of liquid intake nor productivity was validated . the rehydration strategies were re - structured by decision makers participating in the project and the author of this paper .", "descriptive statistics were used to analyse climate data ( temperature ( c ) ; relative humidity ( % ) ; dew point ( c ) ) ; liquid intake and output production . chi - squared test was used to evaluate liquid intake versus output production by using spss version 13 .", "what is of great concern is that , although temperature increased to maximum values early in the morning , many workers did not follow the rehydration measures and drank less than 6 l , a potentially dangerously low volume . this showed that 13 workers who had the highest production output ( range 68 tons , average 7.45 tons ) were those who drank more than 6 l of liquid ( regular tap water and/or specially formulated rehydration solutions ) in comparison to those who drank less liquid and had a smaller production output . comparison between temperature measurements and daily water intake for 22 sugarcane workers at the montelimar farm . as can be seen , temperature and relative humidity values oscillated from 23.5 to 34.5c and from 40% to 64% , respectively , reaching maximum values as early as 810 am . measurements of heart rate and body weight at the start and end of the working day showed that workers experienced increases in heart rate and loss of body weight as they worked in these hot conditions . climate measurements during 160 working hours of follow - up for 22 sugarcane workers at the montelimar farm . table 2 shows the amount of liquid intake ( including both regular tap water and specially formulated rehydration drinks ) . relationship between production output and daily water intake for 22 sugarcane workers at the montelimar farm .", "the present project evaluated climatic conditions at sugarcane plantations located at sea level , on the southwest coast of nicaragua . there was a significant increase of production , with up to 8 tons per worker during the follow - up period compared to the normal 5.5 tons per worker prior to the change in rehydration measures . however , the ineter humidity data are quite different from the relative humidity registered on the farm located in western managua . this important change in rehydration policies and increase in production output is the result of various efforts of training workers , foremen and managers on heat stress prevention , proper hydration measures and quality of ( working ) life carried out by occupational health and safety professionals ( physicians and engineers ) , human resources departments and top management at sugarcane farms .", "the author has not received any funding or benefits from industry to conduct this study ." ]

[ "we report an adult case of densely calcified , atypical cpp originated from the cpa without connection to the forth ventricle . choroid plexus papilloma ( cpp ) is a rare benign tumor accounting for 0.5% of all intracranial tumors that is more common in childhood , consisting of 1.5 to 6.4% of pediatric intracranial tumors.1 \n", "a 41-year - old man presented with a chief complaint of headache , dizziness , and difficulty with gait that had been gradually worsening for 8 months . computed tomography ( ct ) of the head without contrast revealed a high - density multilobular mass in the right cpa causing mass effect and slight ventricular enlargement ( fig . the patient was discharged after recovery from the dysphagia by appropriate rehabilitation . \n computed tomography without contrast revealed a high - density multilobular mass in the right cerebellopontine angle . magnetic resonance images demonstrated a trilobed solid mass that was in an extra - axial location . magnetic resonance ( mr ) images demonstrated a trilobed solid mass that measured 4.1 cm in maximum diameter ( fig . ct and mr images did not reveal any connection between the tumor and the fourth ventricle .", "cpp reported in this article primarily occurred in the cpa with close proximity to the foramen of luschka lacking continuity of the fourth ventricle . association of ventricular enlargement with the finding of calcification might suggest the possible presence of cpts . the majority of survivors are neurologically intact.19 because of the good prognosis , the preservation of cranial nerve functions should be primarily considered in surgery for benign cpp . as for the atypical cpp gross total removal was performed in our case of atypical cpp , although the tumor adhered to adjacent structures . in the 2007 world health organization classification of tumors of the central nervous system", "the finding of calcification in the cpa should suggest the possible presence of cpp , especially if ventricular enlargement is present ." ]

[ "we demonstrate cases from our current imaging system , where the measurements indicate corruption of the desired signals from multipath signals associated with the base of the tank . we then show experiments that allow us to partially isolate the effects to surface waves propagating along other pathways . we present an initial strategy for minimizing the effects of these signals which may be instructive for designing other near - field imaging systems , including simulations confirming the earlier theoretical discussion and validating our feedline design strategy . equally important in near - field imaging is the multiple paths a signal can take within the imaging zone . we are developing multichannel transceiving arrays for medical microwave imaging which exploit near - field concepts to produce electrical property maps ( permittivity and conductivity ) of tissues of interest [ 8 , 9 ] and have addressed the issue by incorporating ( a ) dedicated mixers for each channel , ( b ) additional solid state switches for isolation , ( c ) double- and triple - braided coaxial cables , and ( d ) compartmentalized rf circuitry .", "in this situation , we are primarily interested in surface waves propagating along the outside of a coaxial cable , and their associated attenuation as a function of distance after the mode has been sufficiently established . for this analysis , we will consider the case of a coaxial line which is abruptly terminated by an open end ( figure 4 ) . a challenging situation occurs when a portion of the transmitted signal propagates along an unwanted path and recombines with the original signal at the receiver . time - gating strategies can sometimes be effective when the nature of the multipath signal is well understood [ 1 , 2 ] . this single contributor analysis serves to give a flavor that the unwanted effects can be significant and is generalizable to multiple sources . a coaxial cable supports a tem - mode electromagnetic field which is incident on the cable opening .", "these results suggest that the unwanted multipath signal effect is the same in both the experimental tanks and the clinical system tests in the previous section and depends on the antenna height from the base of the tank . as discussed in section 1 , surface waves do decay exponentially from the surfaces , and given the proximity of the feedlines and the liquid / plexiglas interface , some coupling is expected . thus , in our experiments , the real source of surface wave attenuation comes from propagation along the outside of the coaxial lines . the behavior is consistent with the three frequencies shown in figure 7 . given that the distance from the antennas to the tank side walls did not change during the experiments , and that the antennas were sufficiently far from the liquid / air interface at all times for any array heights ( 10 cm in the worst case ) , the corruption of these most distantly received signals appears to be caused by multipath propagation associated with antenna tip proximity to the base of the tank most probably due to reflections off of the tank base or surface wave propagation along the dielectric interfaces . in this set of experiments", "surface waves ( relative to signal reflections from the imaging tank walls ) appear to cause the biggest effects as they propagate along the outside of the transmitting coaxial line across the illumination tank floor and back up the coaxial feed lines of the receivers . indeed , we found that antenna tip distances as little as 5 cm from the tank floor maintain receiver signal fidelity across the array provided the surface wave contributions are attenuated through an equivalent feedline length approaching 10 cm . when the imaging tank is deep and the transmitting / receiving antenna tips are sufficiently far above the tank base , the surface wave signals are adequately suppressed relative to the transmissions through tissue . the potentially debilitating effects of unwanted multipath signals is a critical consideration in translating near - field microwave imaging approaches into clinical and commercial systems . for our noncontacting antenna approach , however , reducing the tank depth is of interest for practical reasons and is essential in some settings and appears possible because reflections from the floor of the tank are still too small to degrade the measured signals propagating through tissue . these findings are significant because they indicate that the antenna array and imaging tank geometry can be altered substantially by manipulating the shape of the antenna feed line , which can be exploited to ensure sufficient surface wave attenuation ." ]

[ "jaw cysts are usually painless , but they can increase in size as they absorb neighboring structures . it has been reported that marsupialization and decompression , both of which are conservative treatments that create an opening to reduce pressure within a cystic cavity and induce bone formation , generate few postoperative complications and produce great therapeutic effects3456 . , a surgeon can choose between conservative and aggressive treatments for a large , aggressive , cystic tumor12 . these procedures not only provide good surgical access to smaller lesions , but they also preserve intraoral tissues , maintain pulp vitality , and reduce recurrence rates . for this reason , many surgeons prefer these methods for treating large cysts . this study aimed to analyze and assess the therapeutic effects of decompression for patients who underwent decompression followed by enucleation . enucleation generally induces bone regeneration within a cystic lesion less than 3 cm in diameter and eliminates the lesion ; however , it is difficult to postoperatively predict lesion recurrence and bone regeneration in cases of larger cysts . for this reason", "we reviewed the charts of patients who visited the department of oral and maxillofacial surgery at chosun university dental hospital ( gwangju , korea ) and who had undergone enucleation after decompression . we collected data on their age and gender , location and size of the lesions , preoperative and postoperative histopathological findings , gap in time between decompression and enucleation , and variation in the size of the lesions , complications , and recurrence according to the time gap . we measured the sizes of lesions in pre- and post - decompression panoramic photographs for each patient , measured width and length with a caliper , and multiplied them together to determine the lesion index ( li ) with the aim of simplifying measurement of irregularly sized lesions . to determine the efficacy of decompression , lis were divided into initial and final lis , which were then graded on the basis of nakamura et al . 's formula7 . to assess the extent of reaction to decompression for each lesion , the difference between initial and final lis was divided by the decompression period to measure and analyze the reduction rate in each period . before conducting a biopsy , clinical and radiographic data were used to determine if patients should undergo decompression . in decompression , 1 ) after the treatment , patients were educated on how to wear and remove the device , and they were instructed to clean the device twice a day ( morning and night ) using saline solution .", "we measured the sizes of lesions in pre- and post - decompression panoramic photographs for each patient , measured width and length with a caliper , and multiplied them together to determine the lesion index ( li ) with the aim of simplifying measurement of irregularly sized lesions . to determine the efficacy of decompression , lis were divided into initial and final lis , which were then graded on the basis of nakamura et al . patients were excluded from group review if they had no radiological data , if they had cured soft tissues due to the failure to maintain the window , or if they had been observed for less than six months after enucleation . we reviewed the charts of patients who visited the department of oral and maxillofacial surgery at chosun university dental hospital ( gwangju , korea ) and who had undergone enucleation after decompression . we collected data on their age and gender , location and size of the lesions , preoperative and postoperative histopathological findings , gap in time between decompression and enucleation , and variation in the size of the lesions , complications , and recurrence according to the time gap . 's formula7 . to assess the extent of reaction to decompression for each lesion , the difference between initial and final lis was divided by the decompression period to measure and analyze the reduction rate in each period .", "the window was formed in the buccal alveolar bone region of the jaw , and a biopsy was conducted after excising some portion of the cyst wall . 1 ) after the treatment , patients were educated on how to wear and remove the device , and they were instructed to clean the device twice a day ( morning and night ) using saline solution . before conducting a biopsy , clinical and radiographic data were used to determine if patients should undergo decompression . in decompression , panoramic radiographs were taken every two months for comparison with the baseline panoramic radiograph , and cyst enucleation was conducted when the size of the lesion was determined to no longer be decreasing .", "however , one patient was diagnosed with scar tissue after re - examination , and one patient was diagnosed with periapical cyst due to re - infection of an incomplete root canal treatment . in total , 17 patients ( 7 males and 10 females ) were reviewed , and their average age was 33.1 years ( range , 13 - 76 years ) . the total follow - up period was 1 to 8 years , and 3 out of 17 patients were suspected recurrence . a true recurrence appeared on one nbccs patient 's left maxilla and is currently being followed - up after re - operation .", "since decompression was introduced as a conservative treatment for odontogenic cyst , many cases have been treated with decompression , and various studies have reported high success rates89 . however , the reaction varies depending on the cyst . thus , when a lesion is large , reducing its size via decompression not only allows for conservative treatment , but it can also minimize complications . therefore , even at older ages , if a large cystic lesion exists within the jaw , postoperative complications can be reduced by decreasing size via decompression . therefore , in this study , kcot patients seemed to have a higher sensitivity to decompression since the li was larger than 1,000 mm .", "according to this study , all patients treated with decompression were reported to have shown a reduction in lesion size and higher sensitivity with a larger lesion size . there was no difference in the effect of decompression based on age , and only one patient experienced recurrence of the cyst ." ]

[ "for the first time , the presented data suggest that a variant in the retn gene plays a significant role in acne pathogenesis . we also demonstrate an excess transmission of mutant allele g at retn-420 from 130 trio families using tdt analysis . therefore , we suggest that inherited variation in retn at -420 appears to be associated with heritable acne vulgaris ." ]

[ "this paper reports on the use of nmf in barbier - style reactions with a focus on rates of reaction , stereochemistry , and its use to form enediyne and epoxydiyne skeletal structures.(9 ) we were interested in examining what effect the increase in dielectric constant at lower temperature could have on a barbier - style reaction of the type shown in scheme 2 among others . indium - promoted coupling reactions , however , have been shown to be accelerated under aqueous conditions,(1 ) and the relative acidity of nmf , being higher than that of water , should not hinder the proposed barbier couplings proposed within this paper . we were especially intrigued by the fact that the dielectric constant of nmf increases to 220 as the temperature is lowered from 25 to 0 c .", "coupled with the original indium - promoted barbier reaction , the transformation of starting materials 1 and 4 into enediyne or epoxydiyne compounds proceeded in two steps in an overall 6080% overall yield , offering an efficient , benign , and good - yielding formation of these important skeletal structures . facile synthesis of epoxydiyne and enediyne functional groups under the reported conditions would allow for their use as template structures in organic synthesis , opening access to more sophisticated units for further exploration . in the following pages , we describe the transformation of 1 into either an epoxydiyne ( 5 ) or enediyne ( 6 ) skeletal structure in two steps with high regio- and stereocontrol using nmf as a new solvent to form 2 under barbier conditions , followed by a one - step transformation to yield either 5 or 6 . as shown in scheme 3 , syn-2 can adopt the correct conformation to form a cis - oxirane upon reaction with either me3obf4 or tloet . although nmf has characteristics similar to those of dmf , it also has characteristics similar to water , such as a polar xh bond.(7 ) thus , having found a very polar solvent with properties similar to both water and organic systems , we hypothesized that the 1,2-coupling product could be formed in high yield under short reaction times . we believe a mixture of better solubility coupled with greater solvent polarity results in an additive effect toward increasing the rate of reactions conducted in nmf when compared to water .", "the use of n - methylformamide is shown to be a nice alternative to aqueous conditions in indium promoted coupling reactions between propargyl aldehydes ( 1 ) and -chloropropargylphenyl sulfide ( 4 ) . this paper introduces the use of nmf as s viable solvent in a barbier coupling reaction , revealing increased rates and better selectivity when compared to reactions conducted in water and other organic solvents . the increased efficiency of the barbier coupling reaction as described in this paper allows for facile formation of epoxy - and enediyne skeletal structures in an overall two - step procedure . the introduction of nmf as an alternative solvent in barbier reactions will open new pathways to organic synthetic chemists . further studies to test other halides and aldehyde functional groups under barbier coupling reaction conditions in nmf are currently underway and will be reported in due time .", "a solution of the hydroxy sulfide mixture ( 20:80 syn / anti ) ( 200 mg , 0.72 mmol ) in a 9:1 thf / h2o mixture ( 20 ml ) was treated with a catalytic amount of p - toluenesulfonic acid . a solution of the hydroxy sulfide mixture ( 40:60 syn / anti ) ( 200 mg 0.73 mmol ) in a 9:1 thf / h2o mixture ( 20 ml ) was treated with a catalytic amount of p - toluenesulfonic acid . a solution of the hydroxy sulfide mixture ( 15:85 syn / anti ) ( 250 mg 0.67 mmol ) in a 9:1 thf / h2o mixture ( 10 ml ) was treated with a catalytic amount of p - toluenesulfonic acid . a solution of the hydroxy sulfide mixture ( 25:75 syn / anti ) ( 100 mg , 0.39 mmol ) in a 9:1 thf / h2o mixture ( 10 ml ) was treated with a catalytic amount of p - toluenesulfonic acid . a solution of the hydroxy sulfide ( 200 mg 0.72 mmol ) in a 9:1 thf / h2o mixture ( 20 ml ) was treated with a catalytic amount of p - toluenesulfonic acid . subsequent hydroxy sulfides were treated in a fashion similar to that in ii.b.1 and analyzed in the manner previously described in section ii.a . the general procedure was followed as described in section i.a with the exception that 1 mmol of incl3 was added to the reaction mixture for every 1 mmol of aldehyde used . the general procedure was followed as described in section i.c with the exception that 1 mmol of incl3 was added to the reaction mixture for every 1 mmol of aldehyde used . stereoselectivity was determined upon transformation to the epoxide product : yield = 437 mg ( 1.63 mmol ) = 77% . stereoselectivity was determined upon transformation to the epoxide product : yield = 527 mg ( 2.05 mmol ) = 93% . stereoselectivity was determined upon transformation to the epoxide product : yield = 522 mg ( 2.02 mmol ) = 92% . stereoselectivity was determined upon transformation to the epoxide product : yield = 717 mg ( 1.91 mmol ) = 87% . stereoselectivity was determined upon transformation to the epoxide product : yield = 732 mg ( 1.96 mmol ) = 89% . radial chromatography was performed using a chromatatron . to a solution of 30 mmol of alkyne in 80 ml of thf that had been cooled to 60 c under nitrogen separation was accomplished using radial chromatography on silica gel ( 40:1 hexanesethyl acetate ) to give a mixture of diastereomeric hydroxy sulfides ." ]

[ "the baicalin adjunctive therapy was tested in pediatric sepsis patients , after which the effect was compared based on the renal function assessment from bun and serum creatinine ( cr ) . this study aimed to uncover the effects of baicalin in treating aki in pediatric sepsis patients . we also performed experiments in the cecal ligation and puncture ( clp)-induced mouse sepsis model to investigate the effects and potential mechanisms of baicalin in septic aki . however , few studies have investigated the role of baicalin in septic aki or pediatric sepsis . this study lays the foundation for future application of baicalin in adjunctive therapies for aki in pediatric sepsis . acute kidney injury ( aki ) is a severe consequence of sepsis and mods , and about 1527% of aki in children is generated from pediatric sepsis .", "the 50 patients were randomly divided into 2 groups : control and baicalin , each group containing 25 patients . a total of 50 pediatric sepsis patients ages 14 years were selected from the patients hospitalized from november 2013 to october 2015 . all 50 patients were diagnosed with pediatric sepsis based on the diagnostic standard proposed in 2005 , and with aki at the same time according to the criteria of aki proposed by acute kidney injury net ( akin ) . patients in the control group received basic treatment , and those in the baicalin group received basic treatment plus oral baicalin ( inner chengzi pharmaceutical , chifeng , china ) according to the manufacturer s instructions . the blood samples were collected 1 day before treatment and 15 days after treatment for bun and cr detection by the hospital . clp was performed on male c57bl/6 mice ( spf , age 810 weeks , weight 2226 g ) ( vital river laboratories , beijing , china ) to induce a septic aki model based on the method in a previous report . cell apoptosis in the mouse renal tissue was detected by tdt - mediated dutp nick - end labeling ( tunel ) method with the in situ cell death detection kit , pod ( roche , basel , switzerland ) according to the manufacturer s instructions . thirty individuals were randomly divided into 3 groups : sham , clp , and clp + baicalin .", "the 50 patients were randomly divided into 2 groups : control and baicalin , each group containing 25 patients . all 50 patients were diagnosed with pediatric sepsis based on the diagnostic standard proposed in 2005 , and with aki at the same time according to the criteria of aki proposed by acute kidney injury net ( akin ) . patients in the control group received basic treatment , and those in the baicalin group received basic treatment plus oral baicalin ( inner chengzi pharmaceutical , chifeng , china ) according to the manufacturer s instructions . no significant difference existed in the age between the 2 groups ( 2.580.17 and 2.460.20 ) . a total of 50 pediatric sepsis patients ages 14 years were selected from the patients hospitalized from november 2013 to october 2015 . the following conditions were excluded : patients with kidney injuries caused by prerenal or postrenal factors , and patients with a history of renal diseases such as acute or chronic renal failure . the blood samples were collected 1 day before treatment and 15 days after treatment for bun and cr detection by the hospital .", "mice in the clp + baicalin group were intragastrically administrated with baicalin 200 mg/(kgd ) ( pureone biotechnology , shanghai , china ) for 6 days , after which all the mice were anesthetized and killed for blood and renal tissue sampling . clp was performed on male c57bl/6 mice ( spf , age 810 weeks , weight 2226 g ) ( vital river laboratories , beijing , china ) to induce a septic aki model based on the method in a previous report . the cecum was ligated at 1 cm to the distal end , and double punctures were made to extrude feces into the abdominal cavity . thirty individuals were randomly divided into 3 groups : sham , clp , and clp + baicalin . the mice were resuscitated by intraperitoneal injection of 0.9% saline ( 24 ml / kg ) . then the cecum was relocated to the abdominal cavity , and the abdomen was closed .", "cell apoptosis in the mouse renal tissue was detected by tdt - mediated dutp nick - end labeling ( tunel ) method with the in situ cell death detection kit , pod ( roche , basel , switzerland ) according to the manufacturer s instructions . then , 50 l of converter - pod was added for incubation of 30 min at 37c in the dark , after which 50 l of diaminobenzidine was added to develop positive signals in the dark for 10 min . fresh tunel mix ( 50 l ) was added to the slices for 1-h incubation at 37c in the dark . briefly , the renal tissue of each mouse was embedded in paraffin and cut into 5-m slices . the slices were washed in phosphate - buffered saline ( pbs ) 3 times between steps , each time lasting 5 min . slices were then dehydrated , mounted , and observed with an optical microscope ( olympus , tokyo , japan ) .", "then the synthesized complementary dna ( 20 ng ) was used in qrt - pcr on the quantstudio 6 flex realtime pcr system ( applied biosystems , carlsbad , ca ) with the specific primers for mouse bax ( fw : 5-tgttt gctga tggca acttc-3 and rv : 5-gatgg ttctg atcag ctcgg-3 ) and bcl2 ( fw : 5-gtaga agagg gtgtg acagc-3 and rv : 5-agcac tgact ctggg atcgc-3 ) . data were analyzed by the 2 method with gapdh ( fw : 5-tcaac agcaa ctccc actct tcca-3 and rv : 5-accct gttgc tgtag ccgta ttca-3 ) as an internal control . dna contamination was removed by dnase i ( invitrogen ) and then the quality and quantity of rna samples were examined by nanodrop 2000 ( thermo scientific , carlsbad , ca ) . for each mouse , total rna samples of the mouse renal tissue were extracted by trizol ( invitrogen , carlsbad , ca ) according to the manufacturer s instructions . 1 g of total rna was used for reverse transcription catalyzed by superscript ii reverse transcriptase ( invitrogen ) .", "ecl plus western blotting substrate ( thermo scientific ) was used to develop positive signals . protein samples of mouse renal tissue were extracted by m - per mammalian protein extraction reagent ( thermo scientific ) and quantified by bio - rad protein assay ( bio - rad , hercules , ca ) according to the manufacturers instructions . the blots were incubated in goat anti - rabbit horse - radish peroxidase - conjugated secondary antibody ( ab6721 ) for 1 h at room temperature . the blots were blocked in 5% skim milk for 2 h at room temperature and then incubated in rabbit monoclonal primary antibodies for bax and bcl2 ( ab32503 and ab32124 , abcam , cambridge , uk ) overnight at 4c . the protein samples were separated on sodium dodecyl sulfate polyacrylamide gels and transferred to polyvinylidene fluoride membranes . gapdh ( ab181602 ) was used as an internal control . after washing in pbs 5 times ,", "comparison between groups was performed with one - way analysis of variance and t test in spss 20 ( ibm , new york , ny ) .", "are usually correlated with promoted cell apoptosis , these results further confirmed that clp induced renal cell apoptosis and that baicalin suppressed apoptosis in the mouse sepsis model . the possible mechanism of baicalin in protecting against septic kidney injury of the mouse model was investigated from changes in cell apoptosis . in the treatment of 50 pediatric sepsis patients , 25 received adjunctive therapy of oral baicalin for 15 days and the other 25 patients received only basic therapies . thus , baicalin had suppressive effects on renal cell apoptosis in the clp - induced mouse model . we next performed experiments in the mouse model to analyze the function of baicalin in septic aki .", "in the treatment of 50 pediatric sepsis patients , 25 received adjunctive therapy of oral baicalin for 15 days and the other 25 patients received only basic therapies . results showed that both bun and cr levels in the serum of the control group did not changed greatly after basic therapies ( p=0.2842 and 0.2135 , figure 1a , 1b ) , while those of the baicalin group were significantly decreased after baicalin adjunctive therapy ( p=0.0191 and 0.0077 ) . it could be inferred based on the 2 indexes that the renal functions of the baicalin group were improved , possibly due to the baicalin adjunctive therapy .", "we next performed experiments in the mouse model to analyze the function of baicalin in septic aki . mice in the clp group showed significantly elevated bun and cr levels ( p=0.0001 and 0.0013 , figure 2a , 2b ) , suggesting that the kidney injury occurred after clp . both bun and cr levels were significantly decreased in the clp + baicalin group ( p=0.0181 and 0.0225 ) , indicating that baicalin treatment effectively alleviated kidney injury in the clp - induced mouse sepsis model .", "are usually correlated with promoted cell apoptosis , these results further confirmed that clp induced renal cell apoptosis and that baicalin suppressed apoptosis in the mouse sepsis model . tunel assay showed more apoptotic cells in the clp group compared to the sham group , and baicalin treatment reduced apoptotic cell numbers ( figure 3a ) , with significant differences between groups ( p=0.0087 and 0.0359 , figure 3b ) . the possible mechanism of baicalin in protecting against septic kidney injury of the mouse model was investigated from changes in cell apoptosis . qrt - pcr results showed that bax mrna level was significantly elevated in the clp group ( p=0.0108 ) and then was down - regulated by baicalin treatment ( p=0.0256 , figure 4a ) . bax and bcl2 , 2 factors indicating cell apoptosis , were detected at both mrna and protein levels to verify the changes in renal cell apoptosis . protein level changes of the 2 factors were consistent with their mrnas , as shown by western blot analysis ( figure 4c ) . since up - regulated bax and down - regulated bcl2 thus , baicalin had suppressive effects on renal cell apoptosis in the clp - induced mouse model .", "this study performed investigations in pediatric sepsis patients and in a clp - induced mouse sepsis model to reveal the role of baicalin in aki of pediatric sepsis . baicalin adjunctive therapy in the patients and treatment in the mouse model decreased bun and cr levels . further histological and expression analyses suggested the suppressive function of baicalin in renal cell apoptosis . tunel results showed that baicalin treatment in the mouse model significantly suppressed renal cell apoptosis , and western blot and qrt - pcr analyses indicated consistent changes in the expression of bax and bcl2 . the present study further discovered the protective role of baicalin against aki in pediatric sepsis patients , which was reflected in the reduced bun and cr levels .", "the investigations of baicalin in pediatric sepsis patients and the clp - induced mouse sepsis model reveal the protective role of baicalin against aki in pediatric sepsis . this study provides a potential adjunctive therapy for treating aki in pediatric sepsis , and future research will concentrate on more detailed mechanisms of baicalin . baicalin can inhibit renal cell apoptosis , which may be one of its functional mechanisms ." ]

[ "however , the effects of glycer - ages on other cancer cells remains poorly understood , and the molecular mechanisms behind their effects have not been clarified . in the present study , we examined the effects of glycer - ages on cultured human lung adenocarcinoma a549 cells and showed that glycer - ages enhanced their malignancy rather than their proliferation . it is known that the mode of invasion is one of the markers of the malignancy and prognosis of cancer . in addition , several reports have suggested that rage is associated with cancer malignancy [ 4 , 5 ] . the main cause of treatment failure and death in cancer patients is metastasis the formation of secondary tumors in organs distant from the original neoplastic cell tissue . the advanced stage of the glycation process ( one of the posttranslational modifications of proteins ) leads to the formation of ages and plays an important role in the pathogenesis of angiopathy in diabetic patients , aging , and neurodegenerative diseases [ 69 ] .", "this assay uses the ability of a glutathione s - transferase ( gst ) fusion protein corresponding to the p21-binding domain ( pbd ) of human p21 activated protein kinase 1 ( pak1 ) to specifically bind to the active gtp - bound and not the inactive gdp - bound forms of rac1 and cdc42 . rac1 activity was determined by densitometric quantification of the pulled - down rac1-gtp level and normalizing it to the level of total rac1 detected in the sample lysates . the matrigel matrix of the chambers was reconstituted by adding serum - free dmem for 2 h. in the migration assay , 1 10 cells in serum - free dmem with control unglycated bsa or glycer - ages ( 100 g / ml ) were added into each of the upper chambers for 20 h. in the invasion assay , 2 10 cells in serum - free dmem with control unglycated bsa or glycer - ages were added to each of the upper chambers for 48 h. then , the nonmigrating or noninvading cells on the upper side of the chamber membranes were removed using cotton swabs . the migration and invasion capacity were evaluated in 24-well transwell chambers and biocoat matrigel invasion chambers ( bd biosciences ) , respectively . in both assays , -actin was used as an endogenous control gene in order to normalize target gene expression values .", "we examined the expression of transforming growth factor- ( tgf- ) and mmp-2 mrna and assessed mmp-2 activity with the mmp-2 biotrak activity assay system . neither the mrna expression of tgf- or mmp-2 was significantly increased by the addition of glycer - ages at 24 h ( figures 5(a ) and 5(b ) ) . to investigate whether rage proteins are present in human lung adenocarcinoma a549 cells , we carried out western blot analysis using anti - rage antibody ( n-16 ) . we examined the effect of glycer - ages on cell migration and invasion . in the migration assay , these results suggest that glycer - ages - rage interaction is necessary for cell migration and invasion . pro - mmp-2 activity was also not significantly altered by the addition of glycer - ages at 48 h ( figure 5(c ) ) the glycer - ages - treated cells showed significantly ( 2.7 times higher ) greater migration than the control unglycated bsa - treated cells ( figure 3(a ) ) , and in the invasion assay , the glycer - ages - treated cells showed significantly ( 3.3 times higher ) greater invasion than the control unglycated bsa - treated cells ( figure 3(b ) ) . when glycer - ages were added to the lower chamber", ", we demonstrated that glycer - ages enhanced the migration and invasion of a549 cells rather than their proliferation . we have provided direct immunochemical evidence for the existence of six distinct ages structures within the ages - modified proteins and peptides that circulate in the sera of diabetic patients . these results suggest that glycer - ages play a critical role in cancer malignancy and are potential targets for therapeutic intervention . rage , which is a multiligand receptor , affects diseases such as cancer and diabetes through its ligands . several reports have suggested that rage and amphoterin are closely associated with invasion and metastasis in cancer cells [ 26 , 27 ] ." ]

[ "osseointegrated implants are a practical alternative to traditional prosthodontics ; however , designing an implant - supported prosthesis with function and esthetics is a challenge . the aim of the study was to demonstrate the accuracy and clinical precision of conventional surgical stent protocol for optimum installation of dental implants in terms of position and diameter . a stent is an appliance used for radiographic evaluation of height and width of the available bone during treatment planning for implant placement or during surgical procedures to provide site for optimum implant placement . , it is now possible to construct a surgical implant stent that would allow the clinician to predetermine implant locations virtually and surgically place them without reflecting a tissue flap.[58 ] but the surgical stents prepared with ct and cad / cam technology are very much more cost effective than a conventional surgical stent and require enough time and special center and/or laboratories for their fabrication and later on their correction , if required . in this study , we used the conventional surgical stents to evaluate their efficacy in determining the position and diameter of implants . stents should be made of transparent material , stable and rigid when in position , should cover enough teeth to stabilize its position , and when no teeth are present , stents should extend onto unreflected soft tissue regions . with the use of computed tomography ( ct ) and computer added designing ( cad)/ computer added machining ( cam ) technology malaligned implants often complicate the clinical laboratory procedures employed for fabrication of superstructures . due to improper load distribution ,", "the aim of the study was to demonstrate the accuracy and clinical precision of conventional surgical stent protocol for optimum installation of dental implants in terms of position and diameter .", "all the patients ( 45 patients for whom 89 implants were placed at different sites ) [ figures 1 , 2 ] visiting the department of prosthodontics and oral and maxillofacial surgery for implant supported prosthesis placement and who followed the standard inclusion criteria for placement of implants were included in the study . patients were treated in this study with the conventional surgical stents ; all the implants were placed to the desired depth as planned in virtual implant planning . the study was conducted in the out - patient department of prosthodontics and dental material sciences in collaboration with department of oral and maxillofacial surgery , faculty of dental sciences , csmmu , lucknow . kivanc akea described a modified surgical stent that serves as a guide to proper mesiodistal paralleling of dental implants . the efficacy of stents was then evaluated at the time of surgical exposure for implant placement and after the surgery , with the help of radiographs [ figures 7 , 8 ] .", "roger a. solow showed that a radiographic - surgical template can facilitate consultation with a surgeon and patient , when implant - supported restorations are planned . a template that provides radiographic evaluation of the implant site and precise or modified surgical placement yen - chen ku presented a simple method of fabricating a vacuum - formed matrix filled with clear acrylic resin and a gutta - percha marker . the matrix can be used as not only a radiopaque marker for evaluation but also a surgical guide during the surgical stage for single implant therapy . murat c cehreli suggested the fabrication of a bilaminar dual - purpose stent that facilitates implant placement with improved verification of implant positioning . he also used these mounted casts to determine whether sufficient space exists for a fixed cantilevered implant prosthesis . the outer lamina is designed for use in the computed tomography ( ct ) evaluation using radiopaque markers . kivanc akea described a modified surgical stent that serves as a guide to proper mesiodistal paralleling of dental implants .", "the foremost advantage of the stent used in this study is its surgical ease , simplicity , precise accuracy and low cost . on the other hand , the fixed type screw retained implant stents which are fabricated with the help of ct and cad / cam technology are very costly and require more time and laboratory procedures . it can be fabricated with minimum laboratory procedures which are used in routine dental practice . the stents fabricated with the radiopaque markers provide radiographic as well as clinical ease for optimum implant installation . along with all these advantages the possibility of displacement of stent during implant surgery was minimized by extension of the stent antero - posteriorly to cover enough area over the teeth / tooth present adjacent to edentulous area . in cases where no teeth are present , the drill holes can directly be made through the stent , so the implant surgery may become less traumatic ( with the preservation of soft tissue including the gingival margins of adjacent teeth and the interdental papilla ) with decreased operative time which results in accelerated post - surgical healing , fewer post - operative complications and increased comfort and satisfaction for the patient . stabilization of stent was achieved by extending it over the unreflected areas like retromolar regions .", "this study shows the extreme accuracy of this conventional surgical stent . if each step of this protocol is followed precisely , it is possible to deliver an optimum implant installation in terms of position and diameter and later on function at a very much reduced rate and time , as taken in ct and cad / cam technology which are the most accepted methods" ]

[ "this study investigated a change of peripheral b - cell subsets in patients with t1d , lada , and t2d compared with healthy control subjects . the results show altered frequencies of various b - cell subsets associated with autoimmune diabetes . we hypothesized that an altered phenotype of b - cell subsets is associated with autoimmune diabetes . . clinical manifestation of lada shares the features of classical t1d and type 2 diabetes ( t2d ) ( 2 ) . t1d , lada , and t2d present a spectrum of diabetes . although studies have reported no significant change in total b cells in peripheral blood of patients with t1d ( 21,24 ) , little is known about b - cell subpopulations with distinct immune functions that may play a role in the diabetes spectrum of t1d , lada , and t2d .", "two hundred fifty - eight patients with t1d ( n = 81 , mean diabetes duration 3.1 3.5 years ) , lada ( n = 82 , 6.1 5.9 years ) , or t2d ( n = 95 , 3.0 3.7 years ) and 218 control subjects with normal glucose tolerance ( ngt ) ( table 1 ) were enrolled in the current study from the second xiangya hospital of central south university ( changsha , hunan , china ) . 1 . the following antibodies were used to identify b - cell subsets : cd19 ( pan b marker ) , cd19cd23cd21 ( mzb cells ) , cd19cd23cd21 ( fob cells ) , cd19cd23cd21 ( transitional 2-marginal zone precursor [ t2-mzp ] b cells ) ( 29 ) , and cd19cd5cd1d ( b10 cells ) . diagnosis of t1d was based on acute - onset ketosis or ketoacidosis with immediate insulin replacement therapy ; at least one positive islet autoantibody ( gad antibody [ gada ] , insulinoma - associated protein-2 antibody [ ia-2a ] , or zinc transporter 8 antibody [ znt8a ] ) ; or impaired c - peptide secretion . lada inclusion criteria were 1 ) any positive islet autoantibody ( gada , ia-2a , znt8a ) , 2 ) age 30 years at onset of diabetes , 3 ) insulin independence for at least 6 months after diagnosis , and 4 ) no ketosis or ketoacidosis ( 2,26 ) . b : representative dot plot showing the gating strategy for mzb , fob , and t2-mzp b cells gated on cd19 b cells . the initial cd19 gate was derived from a lymphocyte gate ( defined on fsc and ssc ) followed by single - cell discrimination . c : representative dot plot showing the gating strategy for b10 cells gated on cd19 b cells .", "two hundred fifty - eight patients with t1d ( n = 81 , mean diabetes duration 3.1 3.5 years ) , lada ( n = 82 , 6.1 5.9 years ) , or t2d ( n = 95 , 3.0 3.7 years ) and 218 control subjects with normal glucose tolerance ( ngt ) ( table 1 ) were enrolled in the current study from the second xiangya hospital of central south university ( changsha , hunan , china ) . diagnosis of t1d was based on acute - onset ketosis or ketoacidosis with immediate insulin replacement therapy ; at least one positive islet autoantibody ( gad antibody [ gada ] , insulinoma - associated protein-2 antibody [ ia-2a ] , or zinc transporter 8 antibody [ znt8a ] ) ; or impaired c - peptide secretion . lada inclusion criteria were 1 ) any positive islet autoantibody ( gada , ia-2a , znt8a ) , 2 ) age 30 years at onset of diabetes , 3 ) insulin independence for at least 6 months after diagnosis , and 4 ) no ketosis or ketoacidosis ( 2,26 ) . diagnostic criteria of t2d were 1 ) typical history of hyperglycemia according to who criteria , 2 ) negative for islet autoantibodies , and 3 ) not requiring immediate insulin treatment . study physicians recorded body height and weight , waist circumference , hip circumference , and blood pressure . exclusion criteria for control subjects were secondary diabetes ; inflammation , infectious disease , or other autoimmune disease ; history of immunosuppressive medication or steroids for > 7 days ; pregnancy ; and malignant disease . fasting venous blood samples were tested for triglycerides ( tgs ) , total cholesterol ( tc ) , hdl cholesterol ( hdl - c ) , ldl cholesterol ( ldl - c ) , fpg , hemoglobin a1c ( hba1c ) , and fasting c - peptide ( fcp ) .", "fcp was measured by a chemiluminescence method ( advia centaur ; siemens , munich , germany ) . hba1c was measured by automated liquid chromatography ( variant ii hemoglobin testing system ; bio - rad laboratories , hercules , ca ) .", "the cutoff indices of positivity for gada , ia-2a , and znt8a were 18 units / ml ( who units ) , 3.3 units / ml , and 0.011 ( znt8a index ) , respectively , which were determined as the 99th percentile of 405 healthy control subjects . the positive samples were tested twice for confirmation . the sensitivity of the current gada , ia-2a , and znt8a assays was 78% , 74% , and 70% , respectively , and the specificity was 96.7% , 96.7% , and 98.9% , respectively , in the islet autoantibody standardization program ( iasp2012 ) . gada , ia-2a , and znt8a were measured by radioligand assays as previously described ( 27,28 ) .", "1 . the following antibodies were used to identify b - cell subsets : cd19 ( pan b marker ) , cd19cd23cd21 ( mzb cells ) , cd19cd23cd21 ( fob cells ) , cd19cd23cd21 ( transitional 2-marginal zone precursor [ t2-mzp ] b cells ) ( 29 ) , and cd19cd5cd1d ( b10 cells ) . b : representative dot plot showing the gating strategy for mzb , fob , and t2-mzp b cells gated on cd19 b cells . the initial cd19 gate was derived from a lymphocyte gate ( defined on fsc and ssc ) followed by single - cell discrimination . c : representative dot plot showing the gating strategy for b10 cells gated on cd19 b cells . the intra - assay and interassay coefficients of variation for the percentages of cd19 were 3.71% and 12.15% , respectively . dead cells were excluded from the analysis on the basis of their forward- and side - light scatter properties and propidium iodide staining .", "anova was performed to compare groups after adjustment for potentially confounding variables , including age , sex , and bmi . associations of the frequencies of b - cell subsets with other parameters were estimated by pearson correlations or spearman nonparametric correlations . all the significant differences between groups are the results of adjusted analyses unless stated otherwise . for the statistical analysis , we used spss version 19.0 ( ibm corporation , chicago , il ) and graphpad prism 5 ( graphpad software , san diego , ca ) software .", "we analyzed whether the change of b - cell subsets had any association with the clinical manifestations and found that 1 ) mzb and fob cells were correlated with age , 2 ) t2-mzp b cells were associated with sex , and 3 ) b10 and mzb cells were correlated with bmi ( table 2 ) , regardless of the type of diabetes . of note , fpg was positively correlated with mzb and t2-mzp b cells but negatively correlated with b10 cells . however , fcp showed positive correlations with fob and b10 cells but negative correlations with cd19 and mzb cells . in terms of lipid profile , we found that t2-mzp b cells were positively associated with tg and ldl - c levels but negatively associated with hdl - c level . the control subjects with ngt were younger than patients with lada and t2d but significantly older than patients with t1d . however , patients with lada but not those with t1d had decreased percentages of fob cells compared with the control subjects with ngt and the patients with t2d . in addition to the associations in all participants , we examined the correlations between the various b - cell subsets and clinical manifestations in the different types of diabetes . in patients with t1d , the proportion of cd19 b cells associated negatively with fcp ( r = 0.248 , p < 0.05 ) , and the mzb cells exhibited a negative correlation with age ( r = 0.498 , p < 0.001 ) , bmi ( r = 0.364 , p < 0.01 ) , and hba1c ( r = 0.324 , p < 0.01 ) . in patients with lada , cd19 b cells negatively correlated with bmi ( r = 0.498 , p < 0.001 ) and fcp ( r = 0.248 , p < 0.05 ) , whereas fob cells showed a positive correlation with age ( r = 0.236 , p < 0.05 ) . finally , in patients with t2d , the percentage of t2-mzp b cells was positively associated with fcp ( r = 0.364 , p < 0.05 ) .", "patients with t2d or lada had higher systolic and diastolic blood pressures than patients with t1d and subjects with ngt . patients with t2d had distinctive tg , tc , ldl - c , and hdl - c levels compared with the other groups . the percentage of males in the lada group was higher than in the ngt group . the control subjects with ngt were younger than patients with lada and t2d but significantly older than patients with t1d . the bmi of the ngt and lada groups was lower than the t2d group but higher than the t1d group . the fpg levels were similar in all the patients with diabetes but higher than in the subjects with ngt . there was a significant decrease of fcp in the lada and t1d ( lowest ) groups compared with the t2d and ngt groups .", "however , patients with lada but not those with t1d had decreased percentages of fob cells compared with the control subjects with ngt and the patients with t2d . * p < 0.05 , * * p < 0.01 , * * * p < 0.001 . of note , regardless of the adjustment for age , sex , and bmi , the proportions of b10 cells were significantly decreased in all the patients with diabetes compared with the control subjects with ngt , but these were lowest in the t1d group ( t1d vs. ngt p < 0.001 ; t2d vs. ngt , lada vs. ngt p < 0.05 ) ( fig . the frequencies of mzb cells in the t1d and lada groups were significantly higher than in the ngt and t2d groups ( t1d vs. ngt , t1d vs. t2d , lada vs. t2d p < 0.001 ; lada vs. ngt p < 0.01 ) ( fig . fob cells were less frequent in the t1d group compared with the other three groups ; however , the percentages of fob cells in the t1d and lada groups were decreased after adjustment for age , sex , and bmi compared with the ngt and t2d groups ( t1d vs. ngt , p < 0.001 ; t1d vs. t2d , lada vs. ngt , p < 0.01 ; lada vs. t2d , p < 0.05 ) ( fig . 2b ) . we also assessed the percentages of t2-mzp b cells , which were reported to have a regulatory function ( 29 ) , and found these to be increased in the lada group compared with the ngt and t1d groups ( lada vs. ngt p < 0.001 ; t1d vs. lada p < 0.01 ) ( fig . we did not find any significant changes in the frequency of cd19 b cells among the patient groups , regardless of age , sex , and bmi , compared with the ngt group ( p > 0.05 ) ( supplementary fig . b10 cells were higher in the t2d and lada groups than in the t1d group ( p < 0.001 for both ) ( fig .", "we analyzed whether the change of b - cell subsets had any association with the clinical manifestations and found that 1 ) mzb and fob cells were correlated with age , 2 ) t2-mzp b cells were associated with sex , and 3 ) b10 and mzb cells were correlated with bmi ( table 2 ) , regardless of the type of diabetes . of note , fpg was positively correlated with mzb and t2-mzp b cells but negatively correlated with b10 cells . the proportion of cd19 b cells associated negatively with fcp ( r = 0.248 , p < 0.05 ) , and the mzb cells exhibited a negative correlation with age ( r = 0.498 , p < 0.001 ) , bmi ( r = 0.364 , p < 0.01 ) , and hba1c ( r = 0.324 , p < 0.01 ) . in patients with lada , cd19 b cells negatively correlated with bmi ( r = 0.498 , p < 0.001 ) and fcp ( r = 0.248 , p < 0.05 ) , whereas fob cells showed a positive correlation with age ( r = 0.236 , p < 0.05 ) . correlation between circulating b - cell subset frequencies and anthropometric and metabolic variables and islet autoantibodies correlation analyses between circulating b - cell subset frequencies ( after log transformation ) and anthropometric and metabolic variables were performed using pearson test . however , fcp showed positive correlations with fob and b10 cells but negative correlations with cd19 and mzb cells . in terms of lipid profile , we found that t2-mzp b cells were positively associated with tg and ldl - c levels but negatively associated with hdl - c level . in addition to the associations in all participants , we examined the correlations between the various b - cell subsets and clinical manifestations in the different types of diabetes . in patients with t1d , finally , in patients with t2d , the percentage of t2-mzp b cells was positively associated with fcp ( r = 0.364 , p < 0.05 ) .", "we investigated the phenotype and frequency of various b - cell subsets in the peripheral blood across the clinical spectrum of diabetes . increasing evidence suggests that b cells are as important as t cells in the immunopathogenesis of autoimmune diabetes . the current data demonstrate distinct differences in the frequencies of peripheral b - cell subsets in t1d and lada , which are associated with islet function and glycemia . most , if not all , diabetogenic t cells are known to be t - helper 1 subsets , but little is known about b - cell subsets in autoimmune diabetes . the major finding of this study was a distinct alteration of b - cell subsets across the diabetes spectrum and their association with clinical features .", "" ]

[ "therefore , we proposed to develop a comprehensive reserve on hpv with maximum possible inputs and outputs for the end users . ; however , it is not customized to explore for data analysis , host - pathogen interaction , strain - disease association , drug designing , and sequence analysis , etc . human papillomavirus ( hpv ) , a virus from the papillomavirus family , is capable of infecting humans . about 200 different strains of hpv identified , based on dna homology , have been found to be etiologically linked to cervical , vaginal , vulvar , penile , anal , oral , and plantar infectious lesions and cancers , as well [ 1 , 2 ] . the hpv genome , a double - stranded dna molecule , consists of 8 kilobase pairs ( kbp ) of nucleotides , which comprises 3 regions : 6 early open reading frames ( orfs)-e1 , e2 , e4 , e5 , e6 , and e7 ; 2 late orfs - l1 and l2 ; and an upstream regulatory region . a considerable volume of hpv specific information pertaining to its genome , proteome , structure , and disease association is available scattered on the web with trivial annotations", "this contains nucleotide sequences of few hpv strains and other papillomaviruses , amino acid and nucleotide sequence alignments , analysis , related host sequences , and database communication . amongst the existing 200 strains of hpv , 150 have been sequenced as of now , and their data available at the national center for biotechnology information ( ncbi ) . genome and proteome information of those viral strains was retrieved from ncbi . besides pubmed , various other online resources and published literature we did not find any structural information in that database . in hpvpdb , along with updated protein sequence information , genome and protein structure information is also provided . hpvpdb platform also provides a phylogeny analysis tool to perform multiple sequence alignment and phylogenetic tree construction of selected hpv proteins using the phylogeny .", "hpv strain - specific information , such as strain name , sequencing status , sequencing centre , ncbi accession i d , associated disease information with references , genome statistics ( gc% , at% , a , t , g , c count , genes , and proteins ) , etc . , were curated from various online resources , and protein parameters ( length , molecular weight , isoelectric point ) were calculated using expasy protparam . genome and proteome information of those viral strains was retrieved from ncbi . besides pubmed , various other online resources and published literature amongst the existing 200 strains of hpv , 150 have been sequenced as of now , and their data available at the national center for biotechnology information ( ncbi ) . were also explored for validating genomic , proteomic , as well as strain and disease - associated information on hpv strains .", "modeller9v10 and the swiss - model server were used for protein structure prediction . the stereochemistry of each protein was evaluated through procheck analysis , available at the rcsb validation server ( http://deposit.rcsb.org/validate/ ) , and validated using prosa - web ( http://prosa.services.came.sbg.ac.at/prosa.php ) .", "human papillomavirus proteome database ( hpvpdb ) , the relational reserve , was developed using microsoft sql server 2005 as the back end . the application layer , the web interface , and the backend relational tables were integrated using cgi - perl . html , javascript , and cgi - perl - based web interfaces were employed to execute sql queries .", "the original human papillomaviruses database was developed and hosted by the los alamos national laboratory ( lanl ) between 1994 and 1999 with funding from the national institute of allergy and infectious diseases ( niaid ) . ' human papillomaviruses : a compilation and analysis of nucleic acid and amino acid sequences ' contains four annual data books of papillomavirus information published in both paper and electronic form ( 1994 , 1995 , 1996 , and 1997 ) but has not been updated since 1997 . hpvpdb platform also provides a phylogeny analysis tool to perform multiple sequence alignment and phylogenetic tree construction of selected hpv proteins using the phylogeny . we did not find any structural information in that database . in hpvpdb , along with updated protein sequence information , genome and protein structure information is also provided . this contains nucleotide sequences of few hpv strains and other papillomaviruses , amino acid and nucleotide sequence alignments , analysis , related host sequences , and database communication .", "the outcome of this study might provide a platform for simultaneous structural comparative analysis of these proteins and help in finding out variations in their structures to explore why different strains of hpv have causative associations with different types of cancers . further , this might also help in designing specific drugs or vaccines against specific strains of hpv . hpvpdb brings together comprehensive information on a total of 1,036 protein sequences and 743 predicted structures . currently the hpvpdb is updated manually through online resources and available scientific publication review ; however , to sustain the quality , these data are analyzed and checked before incorporation into this reserve . meanwhile , to provide regular updates , our team is committed to searching for newly sequenced hpv strains , updating this reserve , and serving the users ." ]

[ "according to numerous estimations , 15% to 29% of patients with cataract have 1.5 diopters ( d ) of refractive astigmatism.1,2 cataract surgeons usually prefer to treat cataract and correct refractive ( spherical and astigmatic ) disorders at the time of the surgery . the aim of this study is to report the clinical results of acrysof toric iols implantation for preexisting astigmatism correction and compare the postoperative rotation of the iols one and six months postoperatively . toric intraocular lens ( iols ) implantation was introduced in the 1990 s as an option for astigmatism correction in cataract patients . corneal incision ( astigmatic keratotomy ) and peripheral corneal relaxing incisions ( pcris ) were performed to treat these disorders.3,4 the main drawbacks of these approaches are that the outcome depends on multiple factors as the patient s age , the depth and length of the incision , complications related to wound healing , epithelial defects , or induction of dry - eye symptoms . these parameters affect the visual outcome in a unpredictable way so the corneal incisions are not considered a reliable method for astigmatism correction .", "this prospective study included eyes that had cataract surgery at the papageorgiou general hospital , thessaloniki , greece , between may 2008 and december 2008 . all surgeries were performed by the same experienced surgeon ( it ) using topical anesthesia and a standard divide - and - conquer phacoemulsification technique . because of the intraoperative marker design and the pen mark fading during the operation in several cases , it was difficult to assess the proper alignment of the iol after its placement . because of this difficulty , an image was captured from the real - time streaming recording of the surgery and was assessed blindly by a second operator using a commercially available software ( screen protractor ; iconico , ny , usa ) ( unpublished data ) . to overcome this difficulty we consider that the use of the marker set consisting of beveled degree gauge ( ae-1590 ; asico ) and maloney astigmatism axis marker ( ae-2741 ; asico ) is more appropriate for the whole procedure because it allows maximum visibility . measurements of visual acuity ( using the snellen opto - type at a six - meter distance ) , iop , and comprehensive slit lamp examination were performed at one - day and one- and six - month postoperative visits . at the one- and six - month follow - up , a digital photograph and corneal topography ( only at the one - month visit ) were obtained to estimate the postoperative rotation of the iol using the software tools mentioned above ( figure 1 ) . the on - screen assessment of the axis remains a useful tool for postoperative evaluation of the iol location ( figure 3 ) . outcomes of interest included uncorrected va , cylindrical astigmatism power before and after iol implantation , and the possible rotation of the iol one and six months after the operation ( when the initial desired place was at 0 ) .", "preoperative and postoperative corneal topography showed significant reduction of refractive astigmatism in all eyes after the surgery . it is known that one degree of deviation causes 3.3% reduction of the iol cylindrical power . uncorrected va was found to be 5/10 or more in 26 of 29 eyes ( 89.7% ) and 8/10 or more in 19 of 29 patients ( 65.5% ) . calculated reduction of the desired correction ( in diopters ) because of the observed rotation ( mean value , one and two standard deviations ) for the three iol models is shown in table 1 . the later rotation occurred between one and six months , and was found to be more than one degree ( 1.1 ) only in one eye ( 3% ) and in all other cases was less than this value ( figure 5 ) . twenty - nine eyes of 19 patients ( mean age 63.03 5.42 years ) were enrolled in this study .", "the results of our study corroborate previous studies,11 which demonstrates that proper selection and preoperative examination of patients followed by uncomplicated iol implantation of one - piece hydrophobic acrylic toric iols results in acceptable stability and visual outcome . in particular , the postoperative rotation of toric iols appears to occur in the early postoperative period ( 1 month ) and remains constant later than six months . the lens rotates until a fibronectin and collagen adhesion develops between the iol and the posterior capsule , which prevents any further rotary motion.12 the amount of cylindrical correction reduction due to postoperative rotation was not large enough13 to affect the expected end result in final uncorrected distance va .", "acrysof one - piece hydrophobic acrylic toric iols implantation shows satisfactory stability , acceptable clinical results , and is an exceptional option for correction of refractive astigmatism ." ]

[ "here , we test the gain change of ra projection neurons after exogenous nmda was applied to selectively activate nmda receptors , using whole - cell current clamp recording in adult male zebra finch slices . lman - ra synaptic transmission is necessary for the variability of song in adult zebra finch , suggesting that the activity of nmda receptor on the lman - ra synapses might induce the activity pattern change of ra neurons and change the bursts that control the vocal and respiratory muscles . these results indicate that synaptic activity in lman - ra synaptic transmission is crucial to song plasticity [ 8 , 9 ] , but the detailed mechanism is unclear . it has been observed that ra received excitatory glutamatergic inputs from hvc and lman . two pathways contributed to this behavior are identified in the songbird forebrain : the motor pathway that is required throughout life for normal song production , and the anterior forebrain pathway ( afp ) which is necessary for song learning and plasticity [ 13 ] .", "the steady - state spike rate was estimated by counting the number of spikes in 1 second , and the result was plotted versus the intensity of the injected current ( f - i relationship ) . the amplitude of ahp was quantified as the difference between spike threshold and the lowest point of ahp . throughout the slope of the f - i relationship ( referred to as gain ) was estimated by linear fitting . events with peak amplitude of 50 mv or higher and a rise time of about 0.5 ms were detected automatically , and the results were analyzed with origin pro 8.0 . the series resistance ( rs ) , between 15 m and 30 m , was compensated using the bridge balance . a slice was transferred to a submerge - type chamber where it was continuously exposed to acsf , saturated with 95% o2 and 5% co2 at room temperature ( 2226c ) at the rate of 2.0 ml / min . the potential changes after application of nmda were corrected during the input - output stimulation protocols . slope parameters were estimated separately for individual neurons and that figures 4 and 5 contain mean slope values averaged for the whole groups of neurons .", "previous studies reported that ra projection neurons received glutamatergic and gabaergic inputs [ 23 , 24 ] , which might increase background synaptic activities and modulate the gain of neurons [ 25 , 26 ] . to determine the effect of ampa receptor and gaba receptor on gain modulation by nmda , we examined the effects of nmda in the presence of cnqx , an antagonist for ionotropic glutamate ampa receptors , or / and bicuculline methiodide ( bic ) , a competitive antagonist of gabaa receptors , respectively . these results indicated that the ampa receptor - dependent excitability played a crucial role in the gain modulation by nmda . the gain induced by nmda was significantly decreased by cnqx ( p < 0.05 ) . bic ( 10 m ) accelerated the depolarization by nmda application , but bic alone had little effect on the f - i slope . in the presence of bic ,", "in this study , we showed that nmda increased the gain of ra projection neurons in adult zebra finch . nmda - induced gain increase was limited to firing frequencies less than 40 hz . the effect of nmda on gain was mediated through nmda receptors and might involve synaptic activities . in songbirds , we found that nmda increased the slope of f - i relationship in ra projection neurons , which was completely blocked by dl - apv , a nmda receptor selective antagonist , suggesting that nmda increased the sensitivity of ra projection neurons . our results indicated that the activity of nmda receptor changed the sensitivity of ra projection neuron . these findings suggest a mechanism by which nmda receptor can selectively modulate behaviorally relevant excitatory inputs . therefore , nmda receptor in lman - ra synapse might regulate hvc - ra synaptic transmission , which implicated that nmda receptor is more effective to modulate the syllable online ." ]

[ ", we present a unique case of vascular pythiosis managed with limb - sparing vascular bypass grafts complicated by pseudoaneurysm formation . first described by veterinarians , pythiosis is a serious life- and limb - threatening infection endemic to thailand , but rarely seen in the western hemisphere . known to infect immunocompetent horses , dogs , and other large animals,2 , 3 \n pythium infection was first reported in humans in 1989 in association with thalassemic hemoglobinopathy.4 , 5 human pythiosis is known to present in one of four clinical entities : subcutaneous , ocular , vascular , and disseminated . here", "the patient is a 17 year - old jamaican male with a history of paroxysmal nocturnal hemoglobinuria and severe aplastic anemia refractory to horse anti - thymoglobulin treatment , which was transfusion - dependent . he was taken to the operating room for an extra - anatomic left common iliac artery to the previous femoral popliteal bypass graft using a reverse saphenous vein graft . the patient ultimately received an extra - anatomic left external iliac to superficial femoral artery bypass using a nonreversed greater saphenous vein graft , as the external iliac was the closest available inflow that did not visually appear to be involved with the infection . one month prior to admission at our institution , he went fishing in a fresh water pond in jamaica and his left lower leg was caught in a bush . on the following day , he noticed a small bullae with a black center and later developed severely painful left inguinal swelling . three weeks after his initial surgery , the patient developed new sites of pain along the graft site and repeat imaging showed a 2.5 cm pseudoaneurysm at the proximal anastomosis to the external iliac artery with contrast extravasation ( fig .", "correcting iron overload has been cited as a treatment in infections common in thalassemia , and has also been used in pythiosis . in our patient , in retrospect , he presented with a classic case of vascular pythiosis , with an antecedent history of exposure to surface water and exam findings of vascular insufficiency , including pain out of proportion to exam , distal emboli , and an ischemic ulcer . another treatment modality used to control this infection is iron chelation therapy . given the association between pythium infection in patients with hemoglobinopathies with a long - standing history of blood transfusions4 , 7 and the discovery of a ferrochelatase gene in p. insidiosum , the authors could find no reported cases of confirmed vascular pythiosis treated with limb - sparing procedures.2 , 7 , 11 , 12 medical therapy in the treatment of vascular pythiosis involves antifungal agents , immunotherapy , and iron chelation therapy .", "in conclusion , this patient 's vascular p. insidiosum infection was refractory to optimized medical treatment , immunotherapy with cytokine injections , and surgery . attempted source control with limb salvage necessitating vascular bypass was unsuccessful in treating this case of vascular pythiosis .", "", "a copy of the written consent is available for review by the editor - in - chief of this journal on request.key learning pointsclinicians should maintain a high level of suspicion for vascular pythiosis when presented with a patient with an underlying hemoglobinopathy , exposure to flat water , and exam findings of vascular insufficiency.the most important part in managing vascular pythiosis limb infection is adequate source control with amputation . written informed consent was obtained from the patient 's guardian for publication of this case report and accompanying images . clinicians should maintain a high level of suspicion for vascular pythiosis when presented with a patient with an underlying hemoglobinopathy , exposure to flat water , and exam findings of vascular insufficiency.the most important part in managing vascular pythiosis limb infection is adequate source control with amputation . clinicians should maintain a high level of suspicion for vascular pythiosis when presented with a patient with an underlying hemoglobinopathy , exposure to flat water , and exam findings of vascular insufficiency . the most important part in managing vascular pythiosis limb infection is adequate source control with amputation .", "clinicians should maintain a high level of suspicion for vascular pythiosis when presented with a patient with an underlying hemoglobinopathy , exposure to flat water , and exam findings of vascular insufficiency . clinicians should maintain a high level of suspicion for vascular pythiosis when presented with a patient with an underlying hemoglobinopathy , exposure to flat water , and exam findings of vascular insufficiency.the most important part in managing vascular pythiosis limb infection is adequate source control with amputation . the most important part in managing vascular pythiosis limb infection is adequate source control with amputation ." ]

[ "", "goterm cc = gene ontology cellular component , mf = molecular function , bp = biological process , and up_seq_feature = uniprot sequence feature . goterm cc = gene ontology cellular component , mf = molecular function , bp = biological process , and up_seq_feature = uniprot sequence feature . that is , up - regulated genes in irradiated samples were strongly enriched for functional categories involved in cell death , cell proliferation , oncogenesis , and ubiquitin conjugation . also , down - regulated genes in irradiated samples were strongly enriched for functional categories involved in rna processing and cell division . the 3d epioral tissue is a co - culture organotypic model and consisted of human fibroblasts on the bottom and human oral keratinocytes grown on top of the fibroblasts . in order to induce differentiation and stratification of the keratinocytes of the 3d cultures , tissue culture methods and irradiation procedure have been described in . the three dimensional tissue culture model our article , , emphasizes the differentially expressed genes of tissues that received different amounts of radiation ( i.e. 0 , 2 , or 12 gy ) , while herein we show the profiling of all the transcriptomic data resulting from these treatments .", "the 3d epioral tissue is a co - culture organotypic model and consisted of human fibroblasts on the bottom and human oral keratinocytes grown on top of the fibroblasts . in order to induce differentiation and stratification of the keratinocytes of the 3d cultures , then the tissues were irradiated ( dose of irradiation was 0 , 2 , or 12 gy ) at the city of hope ( duarte , ca ) facility . then one of the tissues was placed in 10% formalin for histopathological studies and the others were used for the extraction of total rna . subsequently the tissues were incubated for 6 h at 37 c with 5% co2 after irradiation . tissue culture methods and irradiation procedure have been described in . the three dimensional tissue culture model ( 3d epioral ) and media were purchased from mattek corporation ( ashland , ma ) .", "the human whole genome onearray v4.3 ( phalanx biotech , san diego , ca ) was used to perform the dna microarray analysis . for this purpose , the rneasy plus mini kit ( qiagen , germantown , md ) was used to extract total rna of at least two identically treated tissues . the integrity and quality of rna was determined by evaluating the a260/280 absorbance ratio using an agilent 2100 bioanalyzer ( agilent technologies , palo alto , ca ) . only rna samples with absorbance ratio , a260/280 > 2.0 , and the raw cy5 intensity signals produced by each of the microarrays were captured using a molecular devices axon 4100a scanner and measured using genepix pro software and stored in gpr format . the rna was converted to double - stranded cdna and amplified using in vitro transcription with t7 polymerase ; the transcription reaction included aminoallyl utp ( aa - dutp ) and the subsequent product was conjugated to cy5 nhs ester ( ge healthcare life sciences , pittsburg , pa ) .", "the error - weighted approach ( which is specifically geared towards combining replicated hybridizations to improve measurement precision and accuracy ) was used to calculate the average expression values . in order to decide whether intensity data was significantly above background , p - values lastly , we also calculated p - values for determining whether genes were differentially expressed . rather than focusing solely on fold changes , were calculated to test the null hypothesis that expression is absent ( called p - value detected ) . a p - value detected < 0.05 indicated that the transcript specific to a given probe was truly present or expressed . rosetta resolver uses error - model - based hypothesis tests , which account for both fold change and expression level . testing was done in triplicate by combining technical replicates while the statistical analyses were done using the proprietary modeling techniques of rosetta resolver . the data from all the arrays of each experimental set were analyzed using rosetta resolver system ( rosetta biosoftware , usa ) .", "goterm cc = gene ontology cellular component , mf = molecular function , bp = biological process , and up_seq_feature = uniprot sequence feature . that is , up - regulated genes in irradiated samples were strongly enriched for functional categories involved in cell death , cell proliferation , oncogenesis , and ubiquitin conjugation . also , down - regulated genes in irradiated samples were strongly enriched for functional categories involved in rna processing and cell division . goterm cc = gene ontology cellular component , mf = molecular function , bp = biological process , and up_seq_feature = uniprot sequence feature . overall , these results confirmed the quality of the microarray data and facilitated further interpretation of the data presented in . our article , , emphasizes the differentially expressed genes of tissues that received different amounts of radiation ( i.e. 0 , 2 , or 12 gy ) , while herein we show the profiling of all the transcriptomic data resulting from these treatments .", "" ]

[ "moreover , including biomarker outcomes can greatly improve the credibility and legitimacy of hiv prevention research . to address the issue of feasibility , we present two case studies of prevention trials with biomarker data collection among adolescents in kenya and zimbabwe . together these studies provide a valuable opportunity to examine the ethical and practical challenges of biomarker procedures within hiv prevention intervention clinical trials in developing countries . we also provide specific suggestions for further research and development in collecting and analyzing biomarker data for adolescent prevention research . building on these findings , our study describes the challenges of collecting hiv and hsv-2 biological data as biomarkers for sexual activity among sub - saharan african youth in prevention trials . we also present the practical challenges of collecting biological samples in resource - limited countries and compare sample collection by blood spots relative to venipuncture . specifically , we describe the challenges faced by investigators in the two cases in developing and implementing ethical procedures for informed consent , biomarker testing , and disclosure of test results . adolescents in sub - saharan africa face high exposure to human immunodeficiency virus ( hiv ) infection . despite all efforts to prevent the disease , prevalence estimates in sub - saharan unaids ( i.e. , the joint united nations programme on hiv and aids ) priority countries range from 1.3 to 15.6 % among young women and 0.56.5 % among young men aged 1524 years ( unaids , 2011 ) .", "both studies were school - based , cluster randomized trials testing school support ( including payment of school tuition and school uniforms ) as a structural hiv prevention intervention for adolescent orphans . in both studies , we collected blood samples from participants for hiv and hsv-2 testing , but they differed as follows : we collected samples by venipuncture with results disclosed to participants and their guardians in kenya , whereas in zimbabwe , we collected samples by finger pricks for dried blood spots ( dbs ) and results were not disclosed . the kenya sample ( n = 837 ) comprised young adolescent male ( 52 % ) and female ( 48 % ) orphans in grades 7 ( 61 % ) and 8 ( 39 % ) enrolled in school in siaya district , nyanza province . we present two clinical trial case studies to examine important issues related to adolescent biomarker data collection in two clinical trials in kenya and zimbabwe ( hallfors et al . , hiv and hsv-2 prevalence was 1 % ( n = 10 ) and 3 % ( n = 28 ) , respectively . among those with positive hiv or hsv-2 test results , 70 % ( n = 7 ) and 64 % ( n = 18 ) , respectively , reported never having had sex . the original sample for the zimbabwe study was orphan 6th grade girls ( n = 328 ) in manicaland province primary schools ; surveys were administered annually during 20072010 ( hallfors et al . , 2011 ) . after securing a project renewal grant , we collected biomarker specimens and a final survey in march through june 2012 , when most participants were 1617 years old . from the original sample , we located 287 ( 88 % ) for the 2012 survey . their mean age was 14.9 ( sd 1.5 ; range 1121 years ) ; 22 % reported ever having had sex . among girls , twenty - three percent reported ever having sex ; 18 % had ever been married and/or pregnant . hiv and hsv-2 prevalence was 4 % ( n = 12 ) and 6 % ( n = 16 ) , respectively . among those with positive hiv or hsv-2 test results , 50 % ( n = 6 ) and 44 % ( n = 7 ) , respectively , reported never having had sex .", "although the protection of adult participants in hiv prevention research is well developed ( national institute of mental health collaborative hiv / std prevention trial group , 2007 ) , we found that clear guidance regarding hiv and other sti testing and disclosure is lacking for children and adolescents . given the lack of national guidelines for adolescent sti testing in kenya [ ministry of health ( moh ) , republic of kenya , 2006 ) , we developed a protocol in conjunction with the siaya district aids and std control office that closely followed hiv guidelines . as an example , our two clinical trials were peer - reviewed by two different nih scientific review panels ; one set of reviewers thought that it was an ethical imperative to disclose hsv-2 as well as hiv results to adolescents , whereas the other was concerned that disclosure of biomarker results might lead to stigma and abuse . these divergent opinions led to discrepant protocols for disclosure , with one trial disclosing and the other not disclosing test results to participants . , 2007 ; nascop , republic of kenya , 2008 ] for hiv in both countries . , we gave referrals to publicly funded hiv care and treatment centers to all adolescents with positive hiv test results , while hiv negative participants were counseled on risk reduction ( nascop , republic of kenya , 2008 ) . we used the national hiv testing and counseling ( htc ) guidelines [ central statistical office ( cso ) & macro international inc .", "the ppv was estimated at 26 % with a 3 % hsv-2 prevalence . the efficiency of dbs for hsv-2 testing with each assay must be evaluated in specific populations prior to use ( hogrefe , ernst , & su , 2002 ) . because the kalon test had not been validated for hsv-2 testing with dbs samples , specimens in the kenya study were obtained by venipuncture . in our studies , the kenya laboratory used the kalon assay , and the zimbabwe laboratory used the focus test . at the time of our studies , neither assay had been validated for dbs by the manufacturer in african populations . the predictive values of all diagnostic tests are strongly influenced by the prevalence of infection in the population , and in low prevalence situations , even a very good test will have a poor positive predictive value ( ppv ) . using the sensitivity and specificity values for the kalon test under the testing conditions employed in our kenya study , that is , we can be confident that about one in four participants with positive test results truly had hsv-2 antibodies present in their blood sample ; however , as many as three in four could have had a false positive test result . the zimbabwe laboratory had validated the focus test with dbs ( mudzori & mutsogoro , 2006 ) . in both studies", "in kenya , we conducted sample collection and htc primarily in local public health facilities near the schools . eighteen facilities participated . in two sites , with permission from the school headmasters and district education officer , we collected blood samples and conducted htc at the school . dbs samples are easy to store and transport and require no processing or refrigeration ( see table 1 for a summary of the study procedures).table 1comparison of biomarker testing procedures in two research studieskenyazimbabweethical considerationswritten guardian consent if < 18/adolescent assentwritten guardian consent / adolescent assentresults disclosed to guardian and adolescentno results disclosedreferrals for carenot applicablecollecting and analyzing biological samples methodvenipuncturedried blood spot hiv testrapid testrapid test hsv testkalon elisafocus elisafeasibility of collection methods time20 min3 min temperature for specimen transportcooler with no iceambienttesting costsreference labreference lab bench fee , supplies , storage , labor us$ 5,784bench fee , supplies , labor us$ 8,000field site lab sample processing , labor , supplies , storage us$ 3,611additional fee us$ 480 other supplies us$ 100 transportation us$ 375 total us$ 9,919total us$ 8,480 \n elisa enzyme - linked immunosorbent assay comparison of biomarker testing procedures in two research studies \n elisa enzyme - linked immunosorbent assay the process was longer for participants with discordant results who needed a tie - breaker test and for participants with hiv positive results . venipuncture was conducted by six skilled phlebotomists trained in htc . to avoid obtaining two separate blood specimens ( finger prick for rapid hiv testing and venipuncture for hsv-2 testing ) we offered all participants and their guardians a snack either before or after specimen collection . sampling and dbs preparation were much less obvious to others nearby , helping to safeguard participant privacy and reduce concerns about witchcraft or other conspiracy theories regarding hiv / aids and blood , which circulate in sub - saharan african communities ( tenkorang , gyimah , maticka - tyndale , & adjei , 2011 ) .", "given the experience we have described , we conclude that it is feasible to obtain hiv and hsv-2 biomarker data for adolescent hiv prevention intervention studies . in particular our experiences conducting research with orphan adolescents in kenya and zimbabwe suggest that collection of hiv and sti test results even in rural , resource - poor settings in sub - saharan africa is a feasible addition to the behavioral research toolkit . research is urgently needed to examine the risks and benefits of hiv testing and disclosure of test results in the context of a research study for adolescents . further development and implementation of sti biomarker assessment techniques particularly pertaining to using dbs is needed to advance hiv prevention science . the use of sti biomarkers can greatly improve the validity of findings from adolescent behavioral intervention trials . second , local departments of health and sti authorities in sub - saharan african countries were much less familiar with hsv-2 pathology and treatment than with hiv and some other stis . even in cases where subjects acknowledge sexual exposure or genital herpes symptoms , local health clinics may not be prepared to provide appropriate treatment or care . given these vexing problems , the wisdom of disclosing hsv-2 results to adolescents after testing within a clinical prevention trial is questionable . in particular , decisions about whether to inform adolescent participants in prevention trials about hsv-2 test results should be made only after prevalence data are available and the predictive values of the test can be accurately assessed . in light of the feedback from the nih study section that raised concerns about possible stigma and abuse of hiv - positive participants in zimbabwe , as well as our own concerns ," ]

[ "stroke is rare in children , however , a common cause of neurological disease , and it is a major cause of death ranks in the top ten in pediatric period11,15 ) . documented incidence has been reported as 2.5 - 8/100000 children / year12,13 ) . however , if all medical treatment is fail to drop the intracranial pressure ( icp ) and deterioration of patient progressed , alternative treatments , such as surgical decompression could be mandatory . medical treatment includes maintaining cerebral perfusion pressure with hyperventilation and osmotherapy , barbiturate coma and in case of thrombotic ischemia , thrombolytic procedure , and anticoagulanttherapy . we will introduce our series about the functional and clinical outcome after decompressive craniectomy to control refractory high icp due to non - traumatic acute stroke in pediatric patient . however , there has not been a definite evidence or standard guideline for decompressive craniectomy for pediatric patient with non - traumatic acute stroke with uncontrolled refractory high intracranial pressure . the common rationale of decompressive craniectomy with or without duroplasty is to let the volume expansion of the swelling brain to extracranial space via removed skull flap and prevent cerebral herniation and secondary damage of brain parenchyme . in case of traumatic brain injury ,", "between march 2004 and december 2006 , decompressive - hemicraniectomy and duroplasty was performed in 5 toddlers and preschool children with non - traumatic , malignant refractory high icp . any patient have no trauma history , and refractory high icp was diagnosed as clinical evidence of acute stroke , massive infarction or hemorrhage with midline shift , compression of basal cisterns in conventional radiologic examination such as computed tomography ( ct ) and magnetic resonance image ( mri ) and , neurological deterioration consisting of decreased level of consciousness or increasing levels of sedation , or somnolence or stupor compared with baseline status at admission17 ) . and craniectomy involved the removal of a largebone flap ipsilateral to the involved hemisphere includingfrontal , parietal , and temporal bone . glasgow outcome scale ( gos)5 ) , and pediatric cerebral performance category scale ( pcpcs)4 ) ( table 2 ) calculated every 6 months after discharge . multiple openings in the dura were made ; a dural patchwas placed and sutured . in every case , intra - cerebral pressure monitor probe was positioned epidural space of bone margin . clinical and neurologic status was evaluated with the glasgow coma scale ( gcs ) . to reduce icp , hyperosmolar therapy", "in all patients , ct or mri was obtained immediately , after stabilization of ventilation and hemodynamicsat first . blood sugar , body temperature , ventilation / oxygenation , blood volume and trans - cutaneous oxygen saturation , arterial blood pressure was continuously monitored and controlled in pediatric intensive care unit . clinical and neurologic status was evaluated with the glasgow coma scale ( gcs ) . to reduce icp , hyperosmolar therapy", "craniectomy involved the removal of a largebone flap ipsilateral to the involved hemisphere includingfrontal , parietal , and temporal bone . multiple openings in the dura were made ; a dural patchwas placed and sutured . in every case , intra - cerebral pressure monitor probe was positioned epidural space of bone margin . a large skin flap was lifted from the skull with meticulous blood control , multipleburr holes were made , large bone flap removed . in the temporalregion , the craniectomies were extended toward the floor of the middlefossa to maximize decompression . the bone flaps were stored in a bone bank and then , following improvement of clinical and neurologic status , cranioplasty was performed 3 to 6 months later . glasgow outcome scale ( gos)5 ) , and pediatric cerebral performance category scale ( pcpcs)4 ) ( table 2 ) calculated every 6 months after discharge .", "five pediatric patients were treated with decompressive hemicraniectomy with duroplasty for non - traumatic and refractory intracranial hypertension after unilateral hemispheric stroke . four cases were caused by ischemic stroke , and another one case was hemorrhagic stroke . the mean follow - up period was 47.6 months ( 36 - 68 months).gos and pcpcs for 5 patients had been measured to evaluate postoperative neurological outcome . one case of ischemic stroke , patient had atrial septal defect ( asd ) . and including this patient three cases of ischemic stroke patients were taken angiography ; however there was no abnormal findings in angiography . in all patients , conventional laboratory result and special serum anti - body test , including anti - phospholipid antibody were within normal rage . at the time of operation , all patients had a gcs score < 8 ( median 7 , range 6 - 8 ) and all patients hadunilateral mydriasis . surgical decompressive hemicraniectomies were performed at a mean of 12 hours ( range 4 - 19 hours ) . in all cases we had performed supratentorial hemicraniectomies . based on the regular follow up gos scores , 5 patients had shown satisfied recoveries : 4 had good recoveries ( gos score of 5 ) , and 1 had moderate disabilities ( gos score of 4 ) . the mean peak icp was 28.6 mm hg ( range 25 - 30 mm hg ) . and the icp of all patients were dropped to normal range within one and half days after operation .", "41 months after surgery , this patient maintained a pcpcs of 2 , and gos of 5 , and she had showed mild left side hemiparesis , mild behavioral disorder and strabismus . a 17-month - old girl was transferred to our emergency department with decreased mentality . neurological examination revealed a stuporous child without occasional spontaneous eye opening . the icp dropped to normal gradually within one day after surgery . at the time of postoperative 3-month , she returned for an elective cranioplasty . the bone flap was secured without any complications . at the end of follow - up , after surgery , she was treated in pediatric intensive care unit with be kept intubated for 7 days . a brain ct at the time of post - operative 7 days revealed sustained brain swelling , but midline shift did not noted anymore .", "hence , if all medical treatment is fail to drop the icp in non - traumatic pediatric acute stroke patient , without hesitation , a decompressive craniectomy could be regarded as next step treatment option . in stroke patient , most common cause of death is due to uncontrolled icp associated with large hemispheric infarctions10,12 ) . when it is present , it is associated with a dramatic increase in mortality . it means that the one of most important goal of acute phase stroke treatment is control the icp and prevent a secondary damage due to brain swelling . in spite of many clinical and experimental trials on medical therapeutic method , now , even in case of pediatric patient with infectious disease in central nerve system , decompressive craniectomy could be considered as life - saving - treatment options . but , for pediatric stroke patient , there is no guideline of this useful treatment method either14 ) . to the best of our knowledge ,", "it also shows that decompressive hemicraniectomy can be lifesaving and can besafely performed in toddler and pre - school children . and young children can get a survival and relatively independence and family satisfaction.decompressive hemicraniectomy should be considered as an alternative therapy for patients with life - threatening brains welling refractory to medical management . in this study , we describes the young pediatric patients have undergone decompressivehemicraniectomy for a non - traumatic acute hemispheric stroke ." ]

[ "the primary objective was to assess albuminuria during different treatments compared with that with placebo ; secondary objectives were to assess effect on 24-h blood pressure , glomerular filtration rate ( gfr ) , biomarkers , and raas components . after washout , patients attended a randomization visit before 2 months of treatment with placebo , 300 mg aliskiren once daily , 300 mg irbesartan daily , or the combination of the two , in random order . change in uaer ( percentage ) versus placebo during treatment with 300 mg aliskiren daily , 300 mg irbesartan daily , or the combination ( p < 0.001 vs. placebo for all treatments ) . from a list of prescreened candidates , 41 patients were screened for study participation ( supplementary fig . correlations between changes in albuminuria and changes in ir - prc were assessed by linear regression analysis within each active treatment ( aliskiren , irbesartan , and aliskiren / irbesartan combination ) and for all active treatments combined . rather , we used active washout : during the first 14 days of all treatments , every patient received 150 mg aliskiren daily to avoid risk of hypotension or a drastic increase in blood pressure in the switch from placebo to combination treatment or vice versa . during the last 3 days of each treatment , patients collected three consecutive 24-h urine samples for assessment of geometric mean uaer . at the last day of each treatment period , patients attended our clinic for assessment of gfr and mounting of standard takeda 24-h blood pressure devices ( tm2421 , version 7 ; a&d medical , tokyo , japan ) . slow - release furosemide in a fixed dose ( mean dose 109 mg/24 h , range 60360 mg/24 h ) was prescribed to prevent blood pressure elevation and fluid retention .", "the log - transformed values of uaer were analyzed by a proc mixed model with sequence , treatment , and period as fixed factors and subject ( nested in sequence ) as a random factor . for 24-h blood pressure data , daytime average , nighttime average , and 24-h average values for systolic blood pressure and diastolic blood pressure were analyzed using a proc mixed model with sequence , treatment , and period as fixed factors and subject ( nested in sequence ) as a random factor . it was estimated that 20 patients completing the study could provide 80% power to demonstrate a significant difference between two treatments in antiproteinuric effect ( uaer ) if the true difference was 15% . this was based on the assumption that intrasubject coefficient of variation for the uaer was 13% . extra analyses were performed to test the assumption of no carryover effect by fitting a carryover effect term into the model . gfr results and all other laboratory assessment data were analyzed similarly to blood pressure data . correlations between changes in albuminuria and changes in ir - prc were assessed by linear regression analysis within each active treatment ( aliskiren , irbesartan , and aliskiren / irbesartan combination ) and for all active treatments combined . fractional clearance was calculated using urine samples collected during gfr measurements ( urinary albumin excretion / serum albumin concentration gfr ) , and log - transformed levels were compared using a paired t test .", "when combined , the activating effect of irbesartan was counteracted by aliskiren , reducing hs - pra , ang i , and ang ii by 88 , 78 , and 56% , respectively , compared with irbesartan monotherapy . whereas combination treatment caused a 1,068% increase in ir - prc versus a 279% increase during aliskiren monotherapy and a 178% increase during irbesartan monotherapy , hs - pra was reduced 47% compared with placebo after combination therapy . aliskiren significantly reduced hs - pra , ang i , and ang ii by 87 , 75 , and 52% , respectively , compared with placebo ; irbesartan had the opposite effect ( table 2 ) . aliskiren treatment led to a significant reduction in albuminuria by 48% ( 95% ci 2762 ) compared with placebo ( p < 0.001 ) but not significantly different from irbesartan , lowering uaer by 58% ( 4270 ) ( p < 0.001 vs. placebo ) . combination treatment reduced albuminuria by 71% ( 5979 ) ( p < 0.001 ) compared with placebo , significantly more than with either monotherapy ( p < 0.001 and p = 0.028 ) . anemia and hypomagnesemia were detected in two patients during the combination treatment . compared with each monotherapy hs - crp was reduced 35% from the placebo level with aliskiren ( p = 0.047 ) and 35% with irbesartan ( p = 0.043 ) .", "studies evaluating mortality and morbidity are ongoing and will provide further information on dual raas blockade with aliskiren . in summary , we demonstrate an antiproteinuric effect of dual raas blockade with aliskiren and irbesartan in combination compared with either treatment alone in patients with type 2 diabetes , hypertension , and albuminuria . in this exploratory study , we demonstrated that treatment with 300 mg aliskiren once daily was as efficient in reducing albuminuria as standard therapy with 300 mg irbesartan once daily . when we combined the two treatments at the same doses , the reduction in albuminuria the synergistic effect on ir - prc illustrates a higher degree of intrarenal raas blockade during combination treatment . our study suggested that the combination of aliskiren and irbesartan had an additional raas blocking effect compared with monotherapy because a synergistic increase in ir - prc was observed with the combination , which was related to the antiproteinuric effect , whereas hs - pra was reduced 50% compared with the reduction with placebo .", "" ]

[ "this review summarizes recent data of effects by nano- and \n microstructured biomaterials and particles in vitro designed for \n orthopaedic application to get a solid \n framework outlining the critical interactions that govern the \n cytocompatibility . \n because biomaterials in orthopaedics are predominantly \n applied on bone , this review is focussed on \n the interactions of osteoblasts \n and bone - marrow - derived \n cells with structured biomaterials . especially , the \n superordinate principles of cellular responses to \n surfaces with a defined \n topography are not well known and poorly understood . \n because many variables \n influence cellular interactions to surface structures , \n it is difficult to draw \n conclusions and formulate general principles for \n nano- and microstructured \n surfaces . although the cytocompatibility of a biomaterial \n is strongly influenced \n by its chemical composition , surface topography plays a \n crucial role for cell - surface \n\n interactions . nanobiomaterials are characterized by constituent \n particles and/or surface features less than 100 nm \n in at least one dimension \n . \n starting with photolithography and dry etching in the \n 1980 's to high - resolution electron beam lithography and other technologies \n in the 1990 's , nanotechnology allows for making surface structures for \n cell engineering and has led to an increasing application in healthcare over the last decades . material surface \n properties have been studied intensively , but \n still lack from reliable data about cytocompatibility . nanotechnology is also applied to modify and improve the surface \n structure in orthopaedic implants to promote their \n osseous integration . however , there are also side effects of nano- and \n microparticles in vivo . \n", "osteoblasts and osteoclasts are mainly \n responsible for the osteointegration of \n nanostructured biomaterials in orthopaedics . \n osteocytes act in a paracrine and mechanosensory manner , and \n can activate osetoblasts and osteoclasts . \n the latter cell type derived from the \n hematopoietic line , has multiple nuclei and is \n responsible for bone resorption . \n osteoblasts derive from \n mesenchymal progenitor cells which are localized mainly \n in the bone marrow and \n periosteum . in contrast , \n osteoprotegerin ( opg ) is a potent inhibitor \n of osteoclasts . they are characterized by cuboidal \n and flat morphology ( diameter about \n 20 m ) , present a large \n amount of rough endoplasmatic reticlum and a large golgi apparatus , \n and are potent to produce osteoid , a collagen i rich matrix \n . \n in addition , these mononuclear cells are also responsible \n for osteoid calcification ( hydroxyapatite ) .", "besides the locotypical \n environment in vivo or in vitro , the surface \n structure and the composition of a \n biomaterial affects cellular attachment , \n adherence , proliferation and migration , \n and also \n differentiation and survival of defined cell types . \n here , information about typical \n parameters such as chemical composition , \n surface structure ( topography , geometry , \n roughness , particle size ) , surface energy , \n hydrophobicity , and the degree of \n solubility in aqueous solutions of a biomaterial \n will help to value and grade a \n defined implant concerning its osteblast promoting potency . considering recent publications , we could assume some general \n principles of cytocompatiblity and cell - surface \n interactions in nano- and \n microstructured surfaces . the \n following review gives an overview of cellular \n reactions to surface structures \n of different orthopaedic biomaterials . ( 2 ) nanostructured surfaces enhance the surface area of \n biomaterials and promote cellular adherence . ( 3 ) the chemical outer functional \n groups of a nanosurface significantly influence cellular \n migration , proliferation , and differentiation but direct \n correlations between \n distinct parameters and cell functions are not entirely cleared . ( 1 ) wettability of a nanosurface influences significantly \n protein adsorption , which is a prerequisite \n of cellular adherence in serum containing \n solutions . ( 4 ) the formation of fc underly a \n dynamic process and influence the motility and migration of cells . ( 5 ) a higher degree of differentiation \n is corresponding to a decreased cellular motility . the composition , type , amount , and \n conformation of adsorbed proteins regulate the \n secondary phenomena such as \n cellular adherence and protein exchange \n [ 3537 ] \n and also following cellular reactions such as migration , \n proliferation , and differentiation . \n" ]

[ "six a17 bac and one fosmid library were used to create mt3.5 ( table s1 ) . five tissues were used for rna - seq analysis with ~10 million illumina 36 bp reads per library ( table s12 ) . most were processed by sanger paired - end sequencing of 3 - 6 kb shotgun libraries . three tissues were used for small rna analysis with ~3 million reads per illumina library ( figures s17-s18 , table s16 , datafile s9 ) . sequences were downloaded in february / march 2009 with scaffolding performed by aligning all bac and fosmid ends against contigs and then anchored and ordered primarily by optical mapping . separately , 25 gb of illumina sequence was generated using short ( 375 nt ) inserts plus 2.1 gb from a 5 kb mate - pair library , then assembled using clcbio ( www.clcbio.com ) and soap ( http://soap.genomics.org.cn/ ) .", "six a17 bac and one fosmid library were used to create mt3.5 ( table s1 ) . most were processed by sanger paired - end sequencing of 3 - 6 kb shotgun libraries . sequences were downloaded in february / march 2009 with scaffolding performed by aligning all bac and fosmid ends against contigs and then anchored and ordered primarily by optical mapping . separately , 25 gb of illumina sequence was generated using short ( 375 nt ) inserts plus 2.1 gb from a 5 kb mate - pair library , then assembled using clcbio ( www.clcbio.com ) and soap ( http://soap.genomics.org.cn/ ) .", "five tissues were used for rna - seq analysis with ~10 million illumina 36 bp reads per library ( table s12 ) . three tissues were used for small rna analysis with ~3 million reads per illumina library ( figures s17-s18 , table s16 , datafile s9 ) .", "" ]

[ "surgical treatment of avascular necrosis ( avn ) of head of femur include core decompression , osteotomies , nonvascularized bone grafting , free vascularized fibular grafts , hip resurfacing , bipolar hip arthroplasty ( bha ) and total hip arthroplasty ( tha).123 tha is indicated in the young individual in avn with acetabular involvement ; however , its role is unclear in cases without acetabular involvement.4 bha was initially limited to be used in hip osteoarthritis , nonunions and acute neck femur fractures.56 bateman7 and giliberty8 were first to use bha in ficat stage 3 avn based on the hypothesis that acetabular floor retains a regenerative property , which regenerates bone in the subchondral region , if stimulation in the form of weight bearing is given through an accurately fitted cup and theorized that preferential motion at inner bearing will decrease the cartilage erosion . papers have been published with both satisfactory91011121314 and unsatisfactory results using bha.5151617 the main limitations sighted are migration of the outer cup ( secondary to the acetabular erosion ) and unpredictable pain relief.3514 incidence of groin pain varied from 11.5% to 42%181920 and incidence of acetabular erosion and protrusio is reported to range from 0% to 45%.1819 the activity of the patient and the duration of followup determine the erosion of acetabulum and appearance of symptoms.21 however , the main issue seems to be motion between the outer cup and the acetabulum , a nonconcentric acetabulum and particulate wear.16222324 to decrease this motion between the outer cup and the acetabulum a gentle reaming of the acetabulum with insertion of tight fitting acetabular cup can be done as suggested above by bateman and giliberty.78 this is thought to decrease the incidence of groin pain and the acetabular erosion and also revision secondary to these issues.2526 in this retrospective series , we have assessed the midterm outcome of bha in young adults ( age < 60 ) with ficat stages 3 and 4 avn .", "the femoral component subsidence was evaluated by measuring the distance between the superior margin of the greater trochanter and the shoulder of the stem.3 medial migration of the bipolar cup was determined from the distance between a line perpendicular to kohler 's line and center of the outer head , whereas superior migration was indicated by a change in distance between the inter teardrop line and the centre of outer head means centre of the circle that is calculated from the circumference of outer cup of bipolar prosthesis that is easily outlined on the radiograph.3 all radiographic measurements were done by either of two authors on ap radiograph of the hip and were compared to the immediate postoperative radiographs . a retrospective study with a prospective followup was planned . 80 consecutive patients below 60 years of age ( 96 hips ) were operated by the senior author between 1995 and 2010 using bha with tight fitting cup technique . patient was asked to sit cross legged on the bed ) , limb length discrepancy and harris hip score ( hhs ) . the radiological evaluation comprised of looking for subsidence of the stem , recording of any evidence of stem loosening in the form of a radiolucent line surrounding the stem and superior or medial migration of the cup . gentle superficial reaming of the acetabulum was done making the acetabulum concentric for a tight fitting bipolar cup [ figure 1a ] . pulse lavage of the prepared acetabulum was done to remove all debris before putting the bipolar cup . surgeries were done in the lateral decubitus position using the posterolateral approach under epidural anesthesia .", "the patients were allowed ambulation with support of a walker or crutches on the 5 postoperative day and were advised to use the same for a period of 4 - 6 weeks . all patients were called for a final followup for clinical and radiological assessment . the clinical evaluation consisted of recording the details of thigh or groin pain , range of movements at the hip ( patient was asked to sit cross legged on the bed ) , limb length discrepancy and harris hip score ( hhs ) .", "the radiological evaluation comprised of looking for subsidence of the stem , recording of any evidence of stem loosening in the form of a radiolucent line surrounding the stem and superior or medial migration of the cup . the femoral component subsidence was evaluated by measuring the distance between the superior margin of the greater trochanter and the shoulder of the stem.3 medial migration of the bipolar cup was determined from the distance between a line perpendicular to kohler 's line and center of the outer head , whereas superior migration was indicated by a change in distance between the inter teardrop line and the centre of outer head means centre of the circle that is calculated from the circumference of outer cup of bipolar prosthesis that is easily outlined on the radiograph.3 all radiographic measurements were done by either of two authors on ap radiograph of the hip and were compared to the immediate postoperative radiographs . a subgroup analysis was also done , by dividing the cohort according to ficat 's class , to evaluate the effect of acetabular involvement on the outcome of the procedure . ap x - rays were taken with the patient lying supine with the hip in neutral and abduction position to check for movement in inner and outer bearing as shown [ figure 1b and c ] .", "the hhs improved from a preoperative value of 39.33 6.11 ( 30 - 54 ) to 89.12 6.68 ( 74 - 96 ) ( p = 0.0001 , paired t - test ) in the postoperative period . according to hhs grades , the final outcome was excellent in 52 , good in 28 and fair in 16 hips . the final hhs score was however not statistically different in both groups indicating good results even in cases with acetabular involvement . the mean followup was 7.52 1.80 years ( range , 4 - 16 ) . comparison of results with various studies on subgroup analysis between the ficat stages 3 and 4 [ table 2 ] it was noted that hips with ficat stage 3 were younger at the time of surgery and also had better final outcome in terms of range of motion . none of the ficat stage 3 patients had any groin pain or femoral subsidence at the final followup while 4 cases of groin pain and 8 cases of femoral subsidence were seen in ficat stage 4 group .", "bipolar hip arthroplasty using tight fitting cup for avn hip has a low incidence of groin pain , acetabular erosion , and revision in midterm followup . surface replacement is an option in younger people with avn , but has limited indications and is a demanding procedure with high cost.27 the results published by for surface replacement are not uniform and a longterm followup is lacking.272829 tha is the method of choice for the treatment of advanced avn of the femoral head;53031 however , its overuse may lead to increased wear and need for early revision in young adults.14 various studies have shown that functional utility of tha reduces to 80% at 10 years , 33% at 16 years , subsequently requiring a revision surgery . this procedure can be used for treatment in young adults with ficat stages 3 and 4 avn of the femoral head to defer a definitive tha . thus , even in cases with acetabular involvement this technique can be used with good clinical results and can defer the need for tha . further large series with long term followups , multicentric randomized studies and reproducibility of results will be needed to establish this method ." ]

[ "the success of valproic acid ( vpa , 2-propylpentanoic acid ) , a short branched chain fatty acid , for the therapy of absence seizures , partial seizures , tonic - clonic seizures , bipolar disorder , schizoaffective disorder , social phobias , neuropathic pain and for the prophylaxis and treatment of migraine headaches has spurred investigation for its use in the treatment of other conditions . while some authors have found a positive correlation between plasma ammonia level and vpa dose or concentration others have found none . treatments for encephalopathy secondary to hyperammonemia as a side - effect of vpa treatment remain empirical and restoration of possible hepatic carnitine deficiency remains controversial . in contrast , later on in the patient 's clinical course her raised venous ammonia levels were found to be slowly down - trending in the presence of sub - therapeutic serum vpa . her elevated vpa levels were associated with elevated ammonia levels as expected of a positive correlation .", "the present case report is about a 25-year - old hispanic female with a history of depression since age of 12 years , bipolar disorder , borderline personality disorder , purging type bulimia and history of suicide attempts at age 12 was admitted to the intensive care unit after attempted suicide by consuming an unknown number of vpa pills . laboratory values of the patient at the time of admission ( a ) valproic acid ( vpa ) and ammonia levels as a function of time ( days ) . this patient had recently started taking vpa ( depakote ) as a mood stabilizer at a dose of 250 mg at bed time about 3 days earlier , after a failed therapy .", "this case report suggests that hyperammonemia , which is known to occur in about 50% patients treated with vpa , may have more than one concurrent etiologic mechanism with different decay kinetics which are not related to hepatic damage or carnitine deficiency . recognition of symptoms of hyperammonemia remains a challenge especially in psychiatric patients . in a review of 11 case reports of symptomatic hyperammonemia in a psychiatric setting it was noted that acute hyperammonemic encephalopathy in psychiatric patients may present in various ways , sometimes with subtle clinical features . hyperammonemia secondary to vpa overdose caused listlessness , lowering of mood , decreased motivation , worsening depression and suicidal ideation . we observed presence of vpa in serum caused increased venous ammonia levels , which eventually trended down to normal after its cessation ." ]

[ "antimicrobials have been used to treat mastitis for more than fifty years , but consensus about the most efficient , safe , and economical treatment is still lacking . the aim of this article is to review current treatments of mastitis during lactation and seek for evidence - based , best practice treatment recommendations for bovine mastitis . intramammary infection ( mastitis ) is the most common reason for the use of antimicrobials in dairy cows . the concept of evidence - based medicine has been introduced to veterinary medicine and should apply also to treatment of mastitis . the impact on public health", "antimicrobial treatment of dairy cows creates residues into milk , and residue avoidance is an important aspect of mastitis treatment . however , activity in vitro does not guarantee efficacy in vivo when treating bovine mastitis . the activity of macrolides , tetracyclines and trimethoprim - sulphonamides has been shown to be reduced in milk . selecting a substance with a low minimum inhibitory concentraton ( mic ) value for the target pathogen antimicrobial susceptibility of coliform bacteria varies but normally is not a limiting factor for therapy . these are lipid solubility , degree of ionization , extent of binding to serum and udder proteins , and the type of vehicle . it is not known if this is due to pharmacologic problems of the drugs used , or virulence factors possibly linked to -lactamase gene of the resistant isolates . using an in vitro -lactamase test for determining resistance to penicillin g of staphylococci before treatment", "an important question regarding the treatment of mastitis is whether the antimicrobial should accumulate in the milk or in the udder tissue . finally , the antimicrobial used for systemic treatment of mastitis must be approved for dairy cattle . efficacy of imm treatment varies according to the causative pathogen , with the best therapeutic response being shown for mastitis caused by streptococci , coagulase - negative staphylococci , and corynebacterium spp .. where to target antimicrobial therapy in clinical mastitis due to different pathogens the systemic route of administration has been suggested to be more efficient than imm for the treatment of clinical mastitis as antimicrobials theoretically have better penetration of the udder tissue by this route . macrolides would have ideal pharmacokinetics , but clinical studies have failed to demonstrate efficacy when used for the systemic treatment of clinical mastitis . in streptococcal mastitis , spiramycin and tylosin have shown reasonable efficacy . in severe mastitis due to coliform bacteria , parenteral administration of antimicrobials has been suggested to combat bacteraemia .", "treatment of mastitis should be targeted towards the causative bacteria whenever possible , but in acute situations , treatment is initiated based on herd data and personal experience . rapid or on - farm bacteriological diagnosis would facilitate the selection of the most appropriate antimicrobial . all mastitis treatment should be evidence based i.e. , the efficacy of each product and treatment length should be demonstrated by scientific studies . clinical mastitis should be treated for at least three days ; this recommended treatment duration is longer than label treatments in many countries . a duration of standard treatment is probably an important reason for poor cure rates in mastitis therapy . a longer treatment improves cure rates , and duration of treatment should generally be extended in mastitis caused by s. aureus and streptococcus uberis . treatment protocols and drug selection for each farm should be made by veterinarians familiar with the farm .", "treating subclinical mastitis with antimicrobials is generally not economical during lactation because of high treatment costs and poor efficacy . in a study with a large number of subclinical mastitis cases , the overall bacteriological cure rate for antimicrobial treatment was 75% and that for no treatment 68% . the marginal benefit applied for streptococcal mastitis only ; in mastitis due to s. aureus , antimicrobials were equal to no treatment . treatment of subclinical mastitis will not affect the incidence of mastitis in the herd unless other preventive measures are taken . studies on treating cows based on high somatic cell counts have generally shown that no effect on milk production has been achieved in herd problems caused by very contagious bacteria such as s. aureus or streptococcus agalactiae treatment of subclinical mastitis is advised ." ]

[ "this current belief stems both from epidemiological data and experimental studies that directly examine the potential for hiv transmission via arthropods ( lawrence 1987 ; lifson 1988 ; bockarie and paru 1996 ) approximately 40 million people are infected with the human immunodeficiency virus ( hiv ) worldwide ( unaids 2006 ) . more to the point , if there are conditions under which hiv could have evolved vector transmission we would do well to understand these , not only from the standpoint of scientific curiosity , but also to prevent such an outcome in the future . in this article , we address the question of why hiv lacks vector transmission , both through a consideration of available empirical data and through the construction of mathematical models . although our results are necessarily speculative , we believe that they shed some light on the evolutionary biology of hiv , and on the evolutionary biology of blood - borne pathogens more generally . ( iii ) why has hiv not evolved the ability to replicate in arthropod vectors ? arthropod ) ? the majority of medical scientists , when asked this question , will offer the following explanations ( bockarie and paru 1996 ) : ( i ) hiv concentrations in the blood are too low during human infection to permit vector transmission ; ( ii ) hiv is unable to survive long enough outside of humans ( or primates ) for vector transmission ; ( iii ) hiv is not able to replicate within arthropod vectors .", "below we review both types of evidence , for both mechanical and biological transmission . mechanical transmission : mechanical transmission : to understand the form and strength of selection shaping the evolution of hiv viremia it is helpful to quantify the important properties of hiv epidemiology in terms of a mathematical model . at present hiv infection is increasing in prevalence in the human population ( unaids 2006 ) . how likely is it that hiv has not evolved vector transmission because of a lack of appropriate genetic variation ? the most direct way to assess this possibility is to determine if genetic variants capable of vector transmission are currently present in the hiv population . if some of hivs close relatives have evolved vector - transmission , then the premise that genetic variation for this route of transmission in hiv does not exist would be significantly weakened . this model will allow for both sexual transmission of hiv as well as insect transmission , and therefore it will also track the number of insects carrying hiv . using w(t ) for the number of insects carrying hiv at time t , and y(a , t ) as the number of hiv - positive people who were infected a years ago , we specify the dynamics as with boundary condition . in equations ( 2 ) , v is the population size of insects free of hiv , a is the insect - biting rate , b1 is the probability of an insect picking up hiv , given it feeds on an infected human , and is the per capita loss rate of infected insects ( which subsumes both insect mortality and the decay of hiv stores in or on the insect ) .", "below we review both types of evidence , for both mechanical and biological transmission . mechanical transmission : a number of studies working directly with hiv have assayed its ability to be transmitted mechanically by arthropods . if some of hivs close relatives have evolved vector - transmission , then the premise that genetic variation for this route of transmission in hiv does not exist would be significantly weakened . how likely is it that hiv has not evolved vector transmission because of a lack of appropriate genetic variation ? biological transmission : despite evidence that mechanical transmission of hiv by arthropods can occur , there is no evidence that biological transmission is possible .", "mechanical transmission : to understand the form and strength of selection shaping the evolution of hiv viremia it is helpful to quantify the important properties of hiv epidemiology in terms of a mathematical model . at there is evidence of genetic variation for differences in viremia in hiv - infected patients ( kanki et al . the above empirical findings suggest that , in principle , hiv is capable of being transmitted mechanically . in practice , however , the typical hiv viral titre in the bloodstream of humans is too low for significant vector - borne transmission to occur ( lifson 1988 ; webb et al . we use some mathematical calculations to elucidate potential reasons why selection might not favor increased viremia and thus mechanical vector transmission in hiv . these considerations provide the conditions required for the spread of a mutant with mechanical vector transmission , but they do not tell us the time frame over which such spread occurs . for example , it would be useful to know by how much arthropods must increase the overall transmission rate of hiv if such strains are to have increased significantly in frequency during the period of time in which hiv has been evolving in humans . the calculations in appendix 2 demonstrate that the factor by which vectors must increase the overall transmission rate of hiv , in order for the relative frequency of the mutant , p/(1 p ) , to increase by a factor of k over a period of t years , is given by all parameters in equation ( 7 ) can be estimated except k , t , and b ( appendix 2 ) , yielding fig . thus , we are forced to ask : why have genetic variants of hiv that induce higher viremia , and thus that transmit mechanically via arthropods , not increased in frequency ?", "main conclusions of the study existing data suggest that the lack of mechanical vector transmission in hiv is not due to genetic constraints . while ecological constraints , such as number of vectors and biting rates , may limit vector transmission in certain areas , these constraints experiments and epidemiological data have unequivocally demonstrated , however , that such vector transmission does not occur at any significant level , and various aspects of hiv biology have been implicated as proximate reasons ( bockarie and paru 1996 ) . one of our aims is to stimulate future research into the evolutionary biology of hiv transmission . from the results presented here , a better understanding of the evolutionary biology of parasite host ranges is an important goal for future research ." ]

[ "in the normal kidney , immunohistochemical expression of contractile protein alpha - smooth muscle actin ( asma ) is limited to the vascular smooth muscle cells . in pathological conditions , the expression of asma the first experimental publication on this subject , by johnson et al , involved a series of clinical studies on the role of asma in diffuse renal diseases . in 1992 alpers and colleagues found higher expression of asma in proliferative types of glomerulonephritis gn . in iga nephropathy , asma expression in interstitium is related to damaged renal function and progression of disease . the expression of asma in interstitial myofibroblasts helps to differentiate between minimal change disease and the early phase of idiopathic membranous gn . in patients with iga nephropathy ,", "this retrospective study analyzed 142 patients 82 adults and 60 children who underwent percutaneous renal biopsy in the department of internal medicine and department of pediatrics , university hospital , split , croatia in the period from 1994 to 2007 . all foci of asma expression in the interstitium ( including atrophic tubules ) , as well as the perimeter of histological slide , were measured in m at 100 magnification ; their ratio was calculated as a percentage of asma expression in interstitium . , pathological diagnoses were classified into 2 categories proliferative glomerulonephritis ( pg ) in 98 cases and non - proliferative glomerulonephritis ( npg ) in 44 cases . in the pg category their ratio was calculated as a percentage of asma expression in glomeruli ( figure 1b ) . in 5 case controls , renal cortex in the highest distance from the tumor area of asma expression in each glomerulus was measured in m at 400 magnification and added together for all glomeruli ( figure 1a ) . positive control samples were normal renal tissues of 5 adult patients who underwent nephrectomy for renal cancer .", "this retrospective study analyzed 142 patients 82 adults and 60 children who underwent percutaneous renal biopsy in the department of internal medicine and department of pediatrics , university hospital , split , croatia in the period from 1994 to 2007 . , pathological diagnoses were classified into 2 categories proliferative glomerulonephritis ( pg ) in 98 cases and non - proliferative glomerulonephritis ( npg ) in 44 cases . in the pg category patients data were collected from the hospital records . due to the small numbers of each type of gn in the sample were : 29 iga nephropathy , 24 mesangioproliferative gn , 11 henoch - schenlein purpura , 9 focal segmental gn , 6 rapidly progressive gn , 6 endoproliferative gn and 6 lupus nephritis , 4 membranoproliferative gn and 1 hemolytic uremic syndrome , 1 alport syndrome and 1 churg - strauss syndrome . in the npg category were : 17 membranous gn , 15 focal segmental glomerulosclerosis , 5 minimal change disease , 2 fibrillar gn , 1 thin basement membrane disease , c1q nephropathy , igm nephropathy , amyloidosis and hereditary nephropathy .", "bp was determined by body size and age using center for disease control and prevention growth charts and data from the national health and nutrition examination survey . serum creatinine was categorized according to the pediatric reference ranges and divided into 3 categories : normal , high and low . the 24-hour urine protein was corrected for body surface area and categorized according to 95% confidence limits . absolute values of blood pressure ( bp ) , serum creatinine ( sc ) , creatinine clearance ( ccr ) and 24-hour urine protein , measured within 7 days before the biopsy , were collected from the hospital records . for adults , absolute values were categorized according to the common terminology criteria for adverse events ( ctcae ) . for children , ccr was determined from sc , the patient s height and proportionality constant using the schwartz method .", "positive control samples were normal renal tissues of 5 adult patients who underwent nephrectomy for renal cancer . paraffin - embedded tissue sections of renal biopsies were deparaffinized in xylol and rehydrated in alcohol gradient . tissue sections were incubated with primary asma antibody ( dilution 1:50 ) for 60 min and peroxidase - labeled secondary antibody for 20 min , followed by 10 min incubation with diaminobenzidine substrate - chromogen solution ( dako , denmark ) . hematoxylin counter - staining was done ; slides were dehydrated in alcohol gradient , cleared in xylol and mounted with canada balsam . asma expression was analyzed by indirect immunohistochemistry ( envision / hrp system ( dako , denmark ) using mouse monoclonal anti - alpha smooth muscle antibody ( asma / hrp dako , denmark ) .", "their ratio was calculated as a percentage of asma expression in glomeruli ( figure 1b ) . in 5 case controls , renal cortex in the highest distance from the tumor all foci of asma expression in the interstitium ( including atrophic tubules ) , as well as the perimeter of histological slide , were measured in m at 100 magnification ; their ratio was calculated as a percentage of asma expression in interstitium . area of asma expression in each glomerulus was measured in m at 400 magnification and added together for all glomeruli ( figure 1a ) . the area measuring 0.14 mm was defined , and glomeruli and interstitium were analyzed in the same manner . in the control kidneys , a computer mouse was used to trace the perimeter of the area of interest on a computer monitor in successive sections , using analysis software ( analysis soft imaging system , usa ) . computer - assisted morphometric image analysis was used to measure glomerular and interstitial asma expression using ibm computer and digital camera ( olympus 4.1 zoom ) connected with olympus bx41 microscope ( olympus , japan ) .", "nonparametric spearman s correlation , mann - whitney test , and analysis of variance ( anova , kruskal - wallis ) were made using graphpad prism statistical software ( graphpad software , inc .", "the expression of asma in glomeruli and interstitium was not significantly different between pg and npg categories of gn in both children and adults ( table 1 ) . the children with high blood pressure had greater expression of asma in interstitium compared to children with low blood pressure ( 10.79.4% vs. 3.74.3% , p=0.014 ) ( figure 2 ) . children and adults with ccr grade ii and iii had higher expression of asma in interstitium ( p=0.0152 and p=0.0007 , respectively ) ( figures 5a , b ) . no significant association between renal expression of asma and 24-hour urine protein was found , regardless of the patient s age . negatively correlated to expression of asma in interstitium ( r=0.375 , p=0.009 ) and positively to expression of asma in glomeruli ( r=1.00 , p<0.001 ) ( figure 4a , b ) . in adults", "the expression of asma in glomeruli and interstitium was not significantly different between pg and npg categories of gn in both children and adults ( table 1 ) .", "the children with high blood pressure had greater expression of asma in interstitium compared to children with low blood pressure ( 10.79.4% vs. 3.74.3% , p=0.014 ) ( figure 2 ) . the difference in expression of asma in glomeruli was not statistically significant between children with high and low blood pressure ( 7.94.4% vs. 15.410.6% , p=0.051 ) . in adults , expression of asma in interstitium and in glomeruli were not significantly different between patients with high and normal blood pressure ( 10.714.9% vs. 9.912.6% , p=0.692 ) and ( 13.69.5% vs. 12.97.8% , p=1.00 ) , respectively .", "in children , positive correlation was found between asma expression in interstitium and absolute value of sc ( r=0.45 , p=0.002 ) ( figure 3a ) . in categorized sc , the negative correlation of sc and expression of asma in glomeruli was not significant ( r=0.154 , p=0.291 ) . in adults , expression of asma in interstitium was correlated to sc ( r=0.528 , p<0.001 ) ( figure 3b ) . the significance was confirmed in categorized sc , where grade iii had higher expression of asma in interstitium ( p=0.0009 ) . significant negative correlation was found between expression of asma in glomeruli and sc ( r=0.395 , p=0.002 ) ( figure 3c ) .", "in children , absolute values of ccr negatively correlated to expression of asma in interstitium ( r=0.375 , p=0.009 ) and positively to expression of asma in glomeruli ( r=1.00 , p<0.001 ) ( figure 4a , b ) . in adults , there were no significant correlations between asma expression in glomeruli and ccr ( r=0.058 , p=0,643 ) . children and adults with ccr grade ii and iii had higher expression of asma in interstitium ( p=0.0152 and p=0.0007 , respectively ) ( figures 5a , b ) .", "no significant association between renal expression of asma and 24-hour urine protein was found , regardless of the patient s age .", "kim in 2001 found correlation between proliferation marker ki-67 and asma in different types of gn . in this study we focused on the connection of asma expression with impaired renal function in glomerulonephritis , measured at the time of biopsy . is linked to the degree of proteinuria and sc , and higher interstitial asma expression is an indicator of poor prognosis . some authors determined the relationship between iga nephropathy , lupus nephritis and other types of gn with expression of asma . increased expression of asma in the interstitium can be found in different diseases such as proliferative gn , diabetic nephropathy and renal transplant rejection . the asma has prognostic value due to the association with interstitial fibrosis , urine protein and sc [ 8,2528 ] . studies of asma expression in renal parenchymal diseases began more than 2 decades ago , when it was noticed that a ) damaged glomerular mesangial cells change their immunophenotype expressing asma and b ) asma - positive myofibroblasts start interstitial fibrosis .", "asma expression in interstitium is associated with sc and ccr and consecutively with decrease of renal function . asma expression in glomeruli is associated with lower values of sc in adults , as well as with normal or higher ccr in children . this correlation suggests that myofibroblastic phenotypic modulation of glomerular cells has a favorable impact on filtration . when calculated with precise computer - assisted quantitative morphometric technology , renal expression of asma the disadvantage of this study is its small sample size with different types of gn ; the next survey should include a much narrower cohort of patients with a specific type of gn , as well as better phenotypic identification of asma - positive glomerular cells ." ]

[ "we report cytomorphology in two cases of chondroblastoma confirmed by histopathology with a brief review of literature . chondroblastoma accounts for < 1% of all primary bone tumors . usually occurring in young adolescents , however , unusual sites of presentation such as patella , talocalcaneal , and temporomandibular joint has been reported . since last decade , fine needle aspiration cytology ( fnac ) has evolved as a simple , safe , and noninvasive preoperative tool in the diagnosis of bone tumors . it is necessary to differentiate chondroblastoma from other giant cell - rich lesions , as chondroblastoma exhibits predominantly benign behavior , though recurrences and metastasis are on record .", "a 16-year - old male presented with pain and diffuse swelling on the knee joint since 2 months . x ray showed typically lytic , centrally placed , sharply demarcated lesion with sclerotic border in the epiphysis . a 10-year - old male presented with diffuse swelling on the shoulder joint of 1-month duration . additionally seen was cartilaginous matrix , plenty of scattered osteoclast - type multinucleated giant cells , and bluish granular calcification surrounding individual cells chicken wire calcification [ figure 1a c ] . smears were highly cellular , polyhedral cells arranged in sheets and small clusters , giving a pebble stone pattern appearance . the individual cells were monomorphic with a well - defined cell membrane , glassy cytoplasm at places showing microvacuolation . histopathology in both the cases showed sheets of polygonal cells with thick cell membranes and fine pale vacuolated cytoplasm . ( h and e , 40 ) ( b ) cytology smears showing polygonal cells with vacuolization in clusters , with calcification seen in the letilower corner .", "a 16-year - old male presented with pain and diffuse swelling on the knee joint since 2 months . x ray showed typically lytic , centrally placed , sharply demarcated lesion with sclerotic border in the epiphysis . swelling was noted in the upper end of tibia measuring 3 cm 3 cm , and was tender on palpation .", "a 10-year - old male presented with diffuse swelling on the shoulder joint of 1-month duration . additionally seen was cartilaginous matrix , plenty of scattered osteoclast - type multinucleated giant cells , and bluish granular calcification surrounding individual cells chicken wire calcification [ figure 1a c ] . smears were highly cellular , polyhedral cells arranged in sheets and small clusters , giving a pebble stone pattern appearance . the individual cells were monomorphic with a well - defined cell membrane , glassy cytoplasm at places showing microvacuolation . histopathology in both the cases showed sheets of polygonal cells with thick cell membranes and fine pale vacuolated cytoplasm . ( h and e , 40 ) ( b ) cytology smears showing polygonal cells with vacuolization in clusters , with calcification seen in the letilower corner . ( h and e , 100 ) ( d ) histopathology section showing cartilage , chicken wire calcification , and polygonal cells with vacuolization of cytoplasm .", "the past decade has witnessed the impressive use of fnac in the diagnosis of bone tumors . despite this , we have a limited case series describing fnac findings in chondroblastoma however , errors in the fnac diagnosis of this rare tumor are known to occur , with the major pitfalls being its association with aneurysmal bone cyst ( abc ) leading to a nonrepresentative aspirate and the occurrence of a plethora of giant cell - rich lesions in the differentials . unusual sites of location include pelvis , patella , talus , calcaneum , and temporomandibular joint . metastases are unusual but occur in the lungs at the time of recurrence . as in most of the cases of bone tumors ,", "the collective application of the knowledge of the cytomorphological features of this rare bone tumor would aid in accurate preoperative diagnosis even in the absence of typical clinical and radiologic presentations . this report reiterates the cytomorphologic findings in chondroblastoma and its differential diagnosis from other giant cell containing lesions of bone .", "", "" ]

[ "suicide is a grave public health issue with a global mortality rate of 16 per 100,000 individuals.1 suicide is one of the top three leading causes of death , particularly among individuals aged 1544 years , which is a productive age group.1 suicide is a complex event that is influenced by biological , cultural , psychological , and socioeconomic factors . the objective of this study was to investigate whether parental bonding is associated with attitudes toward suicide among medical college students in japan . more than 90% of suicide victims were diagnosed with psychiatric problems at the time of death , and approximately two thirds had been diagnosed with depression.2,3 depressed patients tend to consult physicians other than psychiatrists , and a variety of medical professionals , including general practitioners , the staff of emergency departments , and non - psychiatric nurses , are key interveners for preventing suicide . among medical staff members , negative attitudes toward suicide such as although few studies have assessed the relationship between parental bonding and mental conditions among medical staff members,9,10 no study has evaluated the association between parental bonding and attitudes toward suicide . anger could affect nontherapeutic reactions to suicidal individuals.4 furthermore , a belief that suicide is a personal right was negatively related to suicide intervention skills.5 an accurate assessment of the attitudes toward suicide held by medical staff members is relevant . previous studies have shown that difficulties with parental bonding during childhood could be a predisposing factor for the onset of many psychiatric conditions , such as anxiety , depressive states , and maladjusted behaviors.68 parental bonding and premorbid personality traits play an important role in shaping the developmental trajectory of an individual , including his / her ability to adjust to stressful events .", "we employed the japanese version of the attitudes toward suicide questionnaire ( atts ) to assess the attitudes toward suicide held by the study participants.12 we employed a six factor model that was previously developed in studies of japanese attitudes , including was administered to each participant to measure the attitudes and behavior of the parents.11 the pbi is a 25 item self - rating instrument by which individuals over the age of 16 report their experiences of being parented to the age of 16 . students in their fifth year of medical school at hirosaki university , hirosaki , japan , participated in the study . the care dimension of the pbi reflects parental warmth and involvement in contrast to rejection and indifference . the overprotection dimension of the pbi reflects parental overprotection and control in contrast to the encouragement of autonomy . multivariate regression analysis was applied to assess the relationship between parental bonding and attitudes toward suicide .", "students in their fifth year of medical school at hirosaki university , hirosaki , japan , participated in the study . the surveys were distributed to 226 medical students . of the distributed 226 surveys , 160 questionnaires ( 116 males and 44 females ) the demographic data ( age and sex ) were obtained from self - questionnaires and interviews . the data collection for this study was approved by the ethics committee of the hirosaki university school of medicine , and the subjects provided written informed consent before participating in the project .", "the parental bonding instrument ( pbi ) was administered to each participant to measure the attitudes and behavior of the parents.11 the pbi is a 25 item self - rating instrument by which individuals over the age of 16 report their experiences of being parented to the age of 16 . higher scores on the care and protection dimensions reveal that participants perceive their parents to be more caring and/or protective . we employed the japanese version of the attitudes toward suicide questionnaire ( atts ) to assess the attitudes toward suicide held by the study participants.12 we employed a six factor model that was previously developed in studies of japanese attitudes , including impulsiveness.12,13 each item , with the exception of items 10 and 28 , was scored on a five point scale from 1 ( strongly agree ) to 5 ( strongly disagree ) . a total of 12 items measure the dimension of care , and 13 items measure protection , both on a likert scale . the care dimension of the pbi reflects parental warmth and involvement in contrast to rejection and indifference . the overprotection dimension of the pbi reflects parental overprotection and control in contrast to the encouragement of autonomy .", "multivariate regression analysis was applied to assess the relationship between parental bonding and attitudes toward suicide . the data were analyzed using the pasw statistics software program for windows , version 18.0 .", "maternal care approached a statistically significant association with the right to suicide . under the same conditions , maternal care table 1 presents the items included in the six factor atts with their descriptive data . paternal care was significantly associated with paternal protection , maternal care , maternal protection , and right to suicide . maternal care was significantly associated with maternal protection , right to suicide , and common occurrence . right to suicide was significantly associated with common occurrence , unjustified behavior , and preventability / readiness to help .", "the present study assessed attitudes toward suicide and their associations with parental bonding among japanese medical college students . in addition , the multiple regression analysis revealed that participants who reported a higher level of maternal care thought that suicide was a common occurrence and tended to think that people do not have the right to commit suicide . the majority of the participants in our study agreed that anyone could commit suicide ( 88.8% ) and that suicide is preventable ( 86.3% ) . first , we used pbi to assess the child rearing behavior experienced by our participants . second , certain parameters were not assessed in this study personality traits , a history of psychiatric disorders , suicidal behavior , and current mood state could affect the attitude towards suicidal behavior . third , because the participants in our study are medical students , we can not generalize these results to general practitioners . although pbi has shown basic reliability for long periods,20 we could not completely rule out possible influences of the current mood state or recall bias in individuals because pbi is an instrument for measuring recalled parental behaviors .", "participants who have experienced a higher level of maternal care thought that suicide occurs commonly and tended to think that people do not have the right to commit suicide . although parental bonding predisposes these attitudes toward suicide , educational programs could change caretaking practices.21 to achieve more positive attitudes towards suicidal behavior , promoting the best practices for suicide prevention is needed for medical students . our study indicated that the majority of participants seriously believe that anyone could commit suicide ." ]

[ "the low adherence to guideline treatment recommendations has been reported in several studies.46 under or overprescription cause the inappropriate treatment of the disease.4,7 undertreatment of copd has also been reported in turkey.8 the bold study in adana , turkey showed that only 12.3% of the adults with copd used medication for their diseases in 2004.9 the chronic diseases and risk factors in turkey survey reported that 46.1% of the patients clinically diagnosed with copd used regular medication in 2011.10 to date , there has been no study on adherence to the gold guidelines for the treatment of copd among pulmonary physicians in turkey . at the time of the study therefore , stages and treatments in this study are also classified in accordance with the gold 2010.1 the aim of this study is to investigate the adherence rates to gold 2010 recommendations for stable copd treatment by pulmonary physicians with a national survey in outpatient clinics of turkish pulmonary units from different regions of the country . the major objectives of gold are to increase the awareness of copd and to help the millions of people who suffer from this disease and die prematurely from it or its complications by increasing the standards of care . , the patients with copd were still treated according to the gold 2010 guideline recommendations . copd is characterized by persistent airway obstruction , usually of a progressive nature and associated with an enhanced chronic inflammatory response in airways to noxious particles or gases.1 copd is associated with increased mortality and reduced life expectancy.2 of the 3.8 million mortalities caused by chronic respiratory system diseases in 2010 , 2.9 million were by copd.3 the first consensus report for the diagnosis , management , and prevention of copd was published in 2001 by the global initiative for chronic obstructive lung disease ( gold ) committee , and since then it has been updated several times .", "this multi - center , cross - sectional study was conducted with the participation of the pulmonary outpatient clinics of eleven centers ( university hospitals , research and training hospitals , state hospitals , and private hospitals ) from eight cities ( adana , ankara , diyarbakir , erzurum , istanbul , izmir , kocaeli , and samsun ) across turkey . appropriateness of treatment was established in accordance with the 2010 gold guideline recommendations below : \n in stage i , add short - acting bronchodilator when needed.in stage ii , add regular treatment with one or more long - acting bronchodilator ( long - acting 2-agonist [ laba ] or long - acting muscarinic antagonist [ lama]).in stages iii and iv , add regular treatment with one or more long - acting bronchodilator and add inhaled corticosteroid ( ics ) for those experiencing frequent exacerbations ( gold 2010).1 in stage i , add short - acting bronchodilator when needed . in stage overall , 1,125 patients have been recruited , and 719 patients meeting the gold diagnostic criteria ( fev1/fvc < 70% ) were included in this analysis . iii and iv , add regular treatment with one or more long - acting bronchodilator and add inhaled corticosteroid ( ics ) for those experiencing frequent exacerbations ( gold 2010).1 all other treatment approaches ( under- or overtreatment ) were evaluated as inappropriate treatment . the inclusion criteria included doctor s diagnosis of copd , age 40 years , available pulmonary function test ( pft ) results from within the past 2 years and copd treatment data from any time within 6 months of the test , and formal written consent . the study was approved by the institutional ethics committee of ankara university school of medicine ( november 21 , 2010 ; # 24,596 ) prior to its initiation and conducted in accordance with the latest version of declaration of helsinki and international conference of harmonization / good clinical practice guideline .", "data are reported as mean and sd ; median , minimum , and maximum ; or frequency and percentage . monte carlo simulation was used for multigroup comparisons where chi - square test assumptions were not fulfilled . bonferroni - corrected mann whitney u - test was used for subgroup comparisons within numeric variables .", "seven - hundred and nineteen patients ( 614 males , 105 females ) with mean sd age of 62.99.7 years were included . of all the patients , 614 ( 89% ) received treatment containing ics or ics alone . overall adherence to gold guideline treatment recommendations for different stages of copd was 59.5% in the study group . the distribution of patients on bronchodilator alone , treatment containing ics , and no maintenance drug by copd stage is shown in table 3 .", "seven - hundred and nineteen patients ( 614 males , 105 females ) with mean sd age of 62.99.7 years were included . the most common comorbidity was hypertension ( 60.9% ) , followed by cardiovascular diseases ( 43.9% ) , diabetes mellitus ( 22.6% ) and depression / anxiety ( 10.4% ) . of all the patients , 2.2% ( n=16 ) were in stage i , 33.1% ( n=238 ) in stage ii , 48.1% ( n=346 ) in stage iii , and 16.6% ( n=119 ) in stage iv . mean sd fev1 value by stage was 88.6%9.3% in stage i , 60.4%8.1% in stage ii , 39.4%5.6% in stage iii , and 23.9%4.2% in stage iv . there were significant differences between the disease stages in terms of age ( p=0.004 ) and duration of disease ( p<0.001 ) . of the 547 ( 76% ) patients with available data on comorbidities , 412 ( 57.3% ) had at least one comorbidity .", "overall adherence to gold guideline treatment recommendations for different stages of copd was 59.5% in the study group . the inappropriate treatment approaches were one or more long - acting bronchodilator administrations without ics , use of ics only ( 4.3% , n=5 ) , and lack of treatment ( 5.9% , n=7 ) . according to these findings , while 59.5% of all patients has been receiving appropriate treatment according to gold 2010 guideline , 40.5% was inappropriately treated . the cause of inappropriate therapies was due to over - treatment ( 100% ) among stage i. in stage ii overtreatment ( 91.1% ) was the main reason for guideline discordant therapies , followed by undertreatment ( 8.9% ) , and lack of treatment ( 3.8% ) . the most preferred regimens were laba - ics - lama and laba - ics - lama - t combinations ( both 31.1% ) . adherence to gold recommendations was 14.7% ( n=35 ) , and this group was also overtreated by a combination of bronchodilators and icss . in this stage , frequently preferred treatment options were laba - ics - lama ( 47.5% ) , laba - ics - lama - theophylline ( t ) ( 13% ) , and laba - ics ( 12.6% ) . the two most common treatment options were long - acting muscarinic antagonist ( lama ) ( 37.5% ) and laba - ics - lama ( 37.5% ) . in stage ii , the most preferred treatment combination was laba - ics - lama ( 45.1% ) , followed by laba - ics - lama - t ( 27.2% ) . iv , the appropriate treatment rate was also high , as 83.2% ( n=99 ) received dual , triple , and quadruple therapies with bronchodilators and icss .", "the distribution of patients who received ics was 43.8% in stage i , 81.5% in stage ii , 89.2% in stage iii , and 86.5% in stage iv . of the 25 ( 3.5% ) patients who were not on any medication , one patient was in stage i , nine in stage ii , eight in stage iii , and nine in stage iv . there were 327 ( 45.5% ) patients on short - acting bronchodilators used as rescue drugs in addition to maintenance therapy . the most administered treatment regimen was laba - ics - lama combination ( 43.4% , n=312 ) , followed by laba - ics - lama - t ( 22.5% , n=162 ) and laba - ics ( 10.9% , n=78 ) . in patients treated with regular bronchodilators , the most frequently used drug was laba ( n=613 ) , followed by lama ( n=575 ) , t ( n=197 ) , short - acting 2-agonist ( n=13 ) and short - acting muscarinic antagonistic drugs ( n=13 ) , respectively . the distribution of patients on bronchodilator alone , treatment containing ics , and no maintenance drug by copd stage is shown in table 3 . of all the patients , 614 ( 89% ) received treatment containing ics or ics alone . long - term oxygen use rate was 22.4% ( n=112 patients ) in stages iii and iv patients . of all the patients , 56 ( 7.8% ) were on monotherapy , 125 ( 17.4% ) on dual , 350 ( 48.7% ) on triple , and 163 ( 22.6% ) on quadruple therapy .", "this study showed that the pulmonary specialists in turkey have low rates of adherence to gold guidelines for treatment of stable copd patients . new strategies are needed to achieve a standardized approach for the treatment of copd , and thus to improve adherence to guideline recommendations , with particular focus on treatment indications and overtreatment in turkey . while inappropriate treatment regimens were more frequently prescribed for stages i ( 93.8% ) and ii ( 85.3% ) , overtreatment in early stages and high rate of ics administration ( 89% ) in all stages of disease resulted in improper therapeutic approach according to gold 2010 recommendations . in more severe disease stages , major improper approaches were overtreatment in early stages and excessive use of inhaler corticosteroids in all stages of disease . this might be related to a number of factors : \n inadequate time with patients , which leads to opting for combination therapies that can provide a broad - spectrum treatment.concerns about symptom control , exacerbation prevention alongside spirometric staging might influence the treatment choice of the specialist.reimbursement of all copd drugs in turkey , making them easily accessible for patients with health insurance.preferring to prescribe drug groups that are effective in the treatment of both asthma and copd , where a differential diagnosis is not available.increasing number of drugs that are provided in combinations and marketing strategies and publicity efforts that promote their use . this is the first large - scale real - life study in turkey that reflects the clinical practice of pulmonary specialists through an observational analysis of their adherence to treatment recommendations of gold 2010 guideline . a few recent studies have reported similar rates of adherence to guideline recommendations for copd patients ( 37.9%54.7% ) between pulmonologists in other countries.4,5 stage i patients were overtreated with regular long - acting bronchodilators or combination of bronchodilators and icss , while guidelines recommend short - acting bronchodilators as initial therapy . in a study conducted among the pulmonary specialists in italy , corrado and rossi reported that 87.7% of the stage i patients received regular treatment containing long - acting bronchodilators , ics alone , or other treatment combinations of ics plus long - acting bronchodilators.4 in a retrospective database study in the united states , fitch et al reported that only 1% of the stage i patients received ics added to laba and lama , while 6% received ics plus single long - acting bronchodilators , and 76% did not receive any medication in stage i.11 shariff et al reported that 7.7% of the patients in stage i were overtreated and received inappropriate treatment according to the guidelines , in another study on guideline adherence among practitioners and pulmonary specialists.5 in our study , only 14.7% of the patients in stage ii received appropriate therapy , and this was mainly due to overtreatment which was combined long - acting bronchodilators and ics in 77.3% of the patients ." ]

[ "amphotericin b ( amb ) , an amphoteric polyene macrolide , has been considered one of the main options of antifungal therapy for serious and life - threatening mycotic infections for over 50 years despite the introduction of newer antifungal medications such as the azoles ( e.g. , voriconazole ) and echinocandins ( e.g. , caspofungin ) , which have better safety profiles ( 1 , 2 ) . although it is a common event in clinical settings , different aspects of amb nephrotoxicity have not been studied well or in detail in our population . this may be due to the fact that azoles and echinocandins are costly , ineffective against certain pathogenic fungi ( e.g. , candida krusei and candida parapsilosis ) , and not readily available in developing countries such as iran ( 3 ) .", "the purpose of this investigation was to specifically assess the frequency , time onset , and possible associated factors of amb nephrotoxicity in hospitalized patients in hematology - oncology wards in the southwest of iran .", "were checked daily and once weekly for patients , respectively . because most cases of amb nephrotoxicity occur during the first 2 weeks of treatment ( 9 , 10 ) , urine urea , creatinine , sodium , potassium , and magnesium levels were determined at days 0 , 3 , 5 , 7 , 10 , and 14 of the amb treatment . the inclusion criteria for recruiting patients were as follows : 1 ) age 15 years or older ; 2 ) no documented history of acute kidney injury defined by an increase in serum creatinine 0.3 mg / dl within 48 hours , or an increase in serum creatinine by 1.5 times the baseline in the previous 7 days , or a urine volume < 0.5 ml / kg / h for 6 hours ( 7 ) ; 3 ) no documented history of chronic kidney disease ( clearance creatinine below 60 ml / min/1.73 m calculated by the simplified modification of diet in renal disease equation ) ; 4 ) no documented history of peritoneal or hemodialysis for > 3 months ( 8) ; 5 ) no documented history of having received amb by any administration route in the previous 14 days ; and 6 ) having received any formulation of amb intravenously for at least 1 week . they included age , sex , weight , amb dose , duration and indication , duration of amb infusion , type of co - administered medications that may exacerbate or attenuate amb nephrotoxicity , length of hospital stay , and mortality . using the stepwise method , the logistic regression analysis with the odds ratio ( or ) and 95% confidence interval ( ci ) were employed to determine the associated factors of amb nephrotoxicity . in the first step , the possible association of each independent variable , namely age , gender , amb cumulative dose , duration of amb infusion , baseline gfr value , a cross - sectional , observational study was performed over a period of 9 months from august 2015 to april 2016 in 2 hematology - oncology and 1 hematopoietic stem cell transplantation wards of namazi hospital , which is affiliated to shiraz university of medical sciences , shiraz , iran . serum urea and creatinine were monitored daily during the course of the amb treatment . according to routine ward practice , serum potassium and magnesium", "the logistic regression analysis with the odds ratio ( or ) and 95% confidence interval ( ci ) were employed to determine the associated factors of amb nephrotoxicity . in the first step , the possible association of each independent variable , namely age , gender , amb cumulative dose , duration of amb infusion , baseline gfr value , mean daily oral / intravenous sodium supplementation , and the co - administration of aminoglycosides , calcineurin inhibitors , vancomycin , acyclovir , loop diuretics , corticosteroids , and sodium bicarbonate , with amb nephrotoxicity ( as the dependent variable ) was assessed separately by univariate analysis . probable associations between the categorical variables were evaluated by the chi - squared or fisher s exact test . the parametric and non - parametric continuous variables were examined by the independent t- and mann - whitney u tests , respectively . using the stepwise method , continuous data were expressed as either mean standard deviation ( sd ) or mean standard error ( se ) . those with p values of less than 0.4 were then considered together for the multivariate logistic regression analysis .", "the co - administration of neither loop ( p = 0.642 ) nor potassium - sparing diuretics ( p = 0.211 ) was significantly associated with hypokalemia . considering the fact that serum magnesium levels were not measured routinely for most of the patients , determining the rate of renal magnesium wasting was not feasible . amb administration was discontinued permanently in 2 individuals who developed nephrotoxicity , and they underwent emergent hemodialysis . the mean se daily amounts of intravenous potassium and magnesium administered during the course of the amb treatment were 52.43 12.13 and 3.51 2.04 meq , respectively . the mean sd onset of amb nephrotoxicity was 6.73 2.36 days . in accordance with the univariate analysis , amb indication ( p = 0.259 ) , vancomycin co - administration ( p = 0.388 ) , duration of liposomal amb infusion ( p = 0.141 ) , and amount of oral / intravenous sodium supplementation ( p = 0.375 ) prophylaxis of aspergillosis ( 52.5% ) , treatment of aspergillosis ( 17.5% ) , and treatment of mucormycosis ( 12.5% ) were the three most frequent indications of amb administration ( table 1 ) .", "close monitoring of renal function indexes , including serum creatinine , bun , serum potassium , and magnesium , during amb treatment is highly recommended . additionally , implementing approved prophylactic measures , such as saline loading ( 150 meq / day ) before and/or during amb infusion , and exploiting lipid - based formulations of amb ( especially liposomal ) , if available and affordable , should be considered to minimize the possibility of amb nephrotoxicity . only 2 patients in our cohort required emergency hemodialysis due to the severity and persistency of amb nephrotoxicity . it has been suggested that conventional amb should preferably not be administered to patients with two or more of the aforementioned risk factors of amb nephrotoxicity ( 10 , 24 ) . ( 16 ) showed that amb nephrotoxicity led to a dose reduction of this agent in 3.7% of cases . in terms of clinical outcomes , mortality and duration of hospitalization were comparable between patients with and without amb nephrotoxicity in the present population . ( 17 ) demonstrated that 10 ( 76.92% ) of 13 individuals receiving amb alone developed acute kidney injury ( aki ) ; however , the incidence of aki among the patients given amb along with ceftriaxone and/or vancomycin was 86.68% . no studied demographic , clinical , and paraclinical features of the study population were significantly associated with amb nephrotoxicity . among the studied electrolyte abnormalities , hypokalemia and renal potassium wasting were the most notable , affecting about one - half and one - third of amb recipients , respectively ." ]

[ "in the course of the years , n - glycan patterns of several snail species have been presented [ 1417 ] . methylated mannose and galactose residues were found to be frequent constituents . in the present study we determine the main o - glycan structures in snails and characterize a common core - trisaccharide . we present for the first time an overview on o - glycans of some species of the mollusk branch of the evolutionary tree . the glycosylation potential of snails is important in general , because some of them are intermediate hosts of pathogens ( biomphalaria glabrata and lymnaea stagnalis ) or a pest in agriculture even parasites ( helminths and t. cruzi ) display small galnac linked o - glycans . in plants", "cepaea hortensis , planorbarius corneus , arion lusitanicus , limax maximus and helix pomatia were collected by the authors under the supervision of dr . manfred pintar ( department of integrative biology and biodiversity research , institute of zoology , university of natural resources and life sciences , vienna ) in the vicinity of vienna . all chemicals purchased were of the highest quality available from sigma or fluka . while water living snails could be dissected right away , land living snails were extensively washed to remove the extraneous mucous components . the interpretation of the ms data was performed with the help of the software tool glycoworkbench . single glycan structures were pooled and lyophilised . for monosaccharide analysis alditol acetates and for linkage analysis the protein fraction was again precipitated by acetone followed by a similar precipitation by methanol . snail proteins were then reduced by the addition of 500 l of 10 mm dithiothreitol and incubation at 56 c for 45 min .", "compositions are given in terms of hexose ( hex ) , methylated hexose ( mehex ) , n - acetylhexosamine ( hexnac ) and deoxyhexose ( fucose ; dhex ) analyzing snails in detail , it was obvious that the o - glycan trisaccharide core is an important decoration of snail proteins in all investigated species . in five of the analyzed snails ( a. lusitanicus , a. fulica , h. pomatia , l. maximus , c. helena ) this glycan was the most abundant type of o - glycan . the shortened protocol also ensured that no weakly bound modifications , such as sulfate or sialic acids for example , got lost . combining our data on snail monosaccharide analysis , data from previous gc - ms methylation analysis and the fragmentation results of lc - esi - ms / ms analysis of selected snails we could determine the main structures of snail o - glycans and classify them according to their modification of the established core structure into six groups : ( i ) glycans smaller than the core , missing one or both methyl groups or missing one hexose ; ( ii ) the trisaccharide core containing galnac and two 4-o - methylated hexose residues ; ( iii ) the core with additional methylated hexoses ; ( iv ) the core with one or two additional unmethylated hexoses and sometimes one more methylated hexose ; ( v ) glycans containing fucose ; ( vi ) glycans containing one hexnac and up to six unmethylated hexoses . b. glabrata and c. hortensis displayed as their main glycan the trisaccharide elongated by one or two unmethylated hexoses , respectively . 4 ) . combining these data , the main o - glycan structure of a. lusitanicus was elucidated as a trisaccharide containing two terminal 4-o - methylated galactoses which are 3- and 6-linked to an inner galnac residue ( fig . for an overview on the structures see table 1.table 1overview of o - glycan distribution in selected snail species given in [ % ] of total o - glycans .", "we enlarge the current knowledge on glycosylation abilities of lower animals by presenting the first o - glycan analysis of snails , representatives of the mollusk phylum . still the main focus is laid on n - glycans but the interest in o - glycans is growing . during the last decades our knowledge on glycosylation processes - structure of the glycans and the corresponding biochemical pathways including the responsible enzymes - increased enormously , especially for glycans of mammalian origin . so far nothing is known about biological functions of snail glycans . for sure these glycans" ]