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[ "the cyst was unilocular , contained watery fluid , did not communicate with the adjacent intestinal lumen ( fig . the patient was a 41-week - gestational - age infant girl with a birth weight of 3300 g. after an uneventful pregnancy , the patient was delivered spontaneously and healthy until this episode . at 35 days of age , the patient was admitted to our hospital with a one - day history of anorexia , vomiting and recurrent diarrhea . on admission , conscious level was glasgow coma scale e2 v2 m2 , and blood pressure was 104/flat . physical examination revealed a distended and tender abdomen . she failed to respond to medical managements and died 27 hours after admission due to multiple organ failures . microscopic finding of the ileocecal duplication cyst had an undefined mucosal lining though it resembled pyrolic glands or duodenal glands . the patient was suspected intestinal obstruction due to enteritis , antibiotics were started ( abpc / mcipc and amk ) .", "this potential diagnosis should be borne in mind for a patient who complains of abdominal symptoms with an unknown cause , and duplication cyst should be recognized as a fatal cause in infant . sudden unexpected death of infants associated with duplication cysts is extremely rare with only 4 cases reported in medical literature to date ( table 1 ) . resection of duplication alone is the treatment of choice , and in uncomplicated cases laparoscopic resection is advised . infection is suspected to be a risk factor for sudden and unexpected death in infants with duplication cysts . in all cases ," ]

[ "this review will focus on corneal - based surgical strategies to treat presbyopia and in particular how these methods have been or may be used in pseudophakic patients . to improve uncorrected near vision in presbyopia , the two major techniques to alter the cornea generally utilize either an intracorneal inlay device or laser refractive surgery . laser blended vision treatment seems to provide the best compromise in terms of safety and quality of vision . since presbyopia is caused by progressive elasticity changes in the biological crystalline lens , presbyopic surgeries may either directly replace the lens through an intraocular approach or modify extraocular structures such as the cornea or sclera . corneal inlays are devices that are surgically placed within the corneal stroma of the nondominant eye to change the optical properties of the cornea . one of the most popular techniques , laser - assisted in situ keratomileusis ( lasik ) , removes corneal stromal tissue under an anterior flap .", "these anecdotes suggest that cataract surgery can still be successfully performed after inlay implantation , which will be important for those young presbyopes opting for surgical treatment of their presbyopia . four of these patients also underwent simultaneous lasik to optimize their underlying refractive error prior to insertion of a kamra pinhole inlay . there are several case reports describing the opposite sequence of events , where patients with prior corneal inlay implantation subsequently undergo cataract extraction with intraocular lens placement , either with or without initially removing the inlay . these patients had previously received any one of the three major corneal inlay types , including the kamra inlay , presbia microlens inlay , and the raindrop near vision inlay .", "an extensive review of the literature on laser refractive surgery for presbyopia revealed very few studies done in pseudophakic patients , although there are numerous published accounts in phakic patients . various studies examine the efficacy of laser refractive surgery on treating presbyopia in phakic patients . nonetheless , laser refractive surgery has been performed successfully on pseudophakes to correct for ametropias [ 2225 ] , suggesting that laser refractive surgery to address presbyopia is likely to be equally successful in pseudophakic patients who have monofocal iols . clearly , the application of laser refractive surgery to presbyopia in pseudophakia merits more research . similar to the body of literature on corneal inlays , a history of prior intraocular surgery such as cataract extraction typically excluded such patients from studies on laser refractive surgery for presbyopia .", "some of the challenges stem from the prior intraocular surgery itself , such as navigating corneal scars and residual corneal irregularities from prior incisions . although corneal inlays are promoted as removable , long - term follow - up on removed inlays is not available and presbylasik procedures are in general not reversible with the commonly available technology at present . as the first wave of refractive patients begins to require cataract surgery , we may be required to change not only the assessment and technique of cataract surgery for these patients , but also how we counsel these patients who have high expectations for visual acuity and spectacle independence . additionally , iol aberrations may alter laser refractive measurements and calculations normally used on phakic eyes . studies have suggested that the final uncorrected visual acuity after excimer laser or corneal inlay surgery is lower in pseudophakic patients than in typical refractive patients . on the other hand , it is worth noting , however , that because the iol treats most of the spherical error in pseudophakic patients , there would be less keratorefractive - induced effect on the corneal prolate asphericity and quality of vision than in nonametropic phakic patients . in all patients , regardless of phakic status , there are certain considerations to optimize a satisfactory outcome from corneal - based presbyopic surgeries . presbyopic surgery may not completely eliminate the need for reading glasses . given the necessity of fundus viewing for diagnosis and treatment of diseases such as age - related macular degeneration , diabetic retinopathy , or retinal detachments", "nevertheless , presbyopic surgeries will not be ideal for all patients , and appropriately screening patients and managing patient expectations are both key to maximizing satisfactory outcomes . pseudophakic patients who still desire better uncorrected near vision may choose corneal - based surgical therapies , such as corneal inlays or laser refractive surgery . many studies on presbyopic surgeries excluded patients with prior ocular surgery , and the few published studies on pseudophakic patients are limited by short - term follow - up , small numbers , and limited lighting conditions . for patients suffering from presbyopia , there are now exciting surgical alternatives to glasses and contact lenses . undoubtedly , there is a pressing need for more research on presbyopic surgeries in the pseudophakic population ." ]

[ ", there have been seven reported cases of retroperitoneal ed cyst in the english literature . the small intestine is the most common location ; retroperitoneum is an extremely rare site . in general , enteric duplications ( eds ) are uncommon anomalies that can occur at any point of the gastrointestinal tract . diagnosed in the neonatal period or during infancy , they are increasingly diagnosed prenatally ; early prenatal detection is possible .", "a female newborn , vaginally born at 39 weeks of gestation from a 32-year - old mother , gravid 3 , para 3 . prenatal ultrasound at 22 weeks of gestation objectified an abdominal cystic mass located in the left upper abdominal quadrant , associated with fetal pyelectasis . magnetic resonance imaging ( mri ) confirmed the presence of a retroperitoneal cyst occupying the upper left retroperitoneal space ; with mass effect displacing the left kidney down [ figure 1 ] .", "eds occur early in intrauterine life ; their pathogenesis remains unclear ; several hypotheses have been proposed . reported 38 cases of ed cysts ; only one was retroperitoneal communicating with a nonfunctioning right kidney . intraabdominal duplications account for two - thirds of localization , among them , jejunoileal duplications account for 65% . double - wall sign and peristaltism are suggestive of ed and help to differentiate it of differential diagnosis .", "", "", "" ]

[ "bicondylar hoffa fracture involving both the femoral condyles is a rare injury and has anecdotally been reported in the literature [ table 1].234567 most reported cases of bicondylar hoffa fracture have two separate fracture lines and the two condyles are separated from each other . we describe a rare case of conjoint bicondylar hoffa fracture where both the femoral condyles were joined by a bridge of intact bone adjacent to the intercondylar notch . to the best of our knowledge , albert hoffa first described this fracture in 1904.1 these fractures usually involve the lateral femoral condyle .", "a 17-year - old male labourer presented to orthopaedic emergency with the complaint of acute pain and swelling in his right knee following trauma . local examination revealed a painful swollen right knee with a 1 cm 1 cm lacerated wound over the anterior aspect of the knee [ figure 1 ] . noncontrast computed tomographic ( ct ) scan was performed which established the diagnosis of conjoined bicondylar hoffa fracture [ figure 3 ] . cm lacerated wound over the anterior aspect of the knee at the point of direct impact plain anteroposterior and lateral radiographs were inadequate to define the exact fracture pattern axial ct scan cuts showing a bicondylar hoffa fracture joined by a bridge of intact bone the patient was operated in supine position under tourniquet and regional anesthesia . on exposing the knee , a tangential fracture involving both the femoral condyles was noted [ figure 4 ] .", ", we described a rare case of a conjoint bicondylar hoffa fracture managed successfully by open reduction and internal fixation with good clinical outcome at 18 months of followup . the swashbukler ( modified anterior ) approach allows excellent exposure of both the condyles . anatomic reduction and rigid internal fixation allows early mobilization and excellent long term outcome . the specific mechanism of injury that produces hoffa fracture is not known . though a shearing force to the posterior femoral condyle has been postulated , both direct impact and vertical shear with twisting mechanisms have also been proposed and a single mechanism is not agreed upon.9 because of the physiological genu valgum , the lateral femoral condyle is more likely to sustain a direct shearing force , and hence is more likely to get fractured.9 this injury is usually caused when knee is hyperflexed at the time of impact , as during driving motorcycle.9 the exact mechanism of injury of a bicondylar hoffa fracture has also not been described ." ]

[ "the surgical guide is essential to establish a logical continuity among diagnosis , prosthetic planning , and surgical phase . , neither buccolingual width nor angulation can be properly visualized on the most traditional radiographs . in the following case report , an innovative simplified method without radiation even a minor variation in comparison to ideal placement causes difficulties in fabrication of final prostheses . is used to fabricate a three - dimensional model to assess the available bone for implant placement in the mandible .", ". this surgical template can dictate the implant body placement that offers the best combination of support for the repetitive forces of occlusion and esthetics . intraoral impression with acrylic assembly prototype ( extraoral impression ) prototype - extraoral and intraoral impression together with acrylic assembly first generation metal plate assembled metal frame three - dimensional model the accuracy of this method was verified with computed tomography ( ct ) scan . the extraoral impression should record the lower border of the mandible to the medial extent as much as possible [ figure 6 ] fabrication of three - dimensional model the intraoral impression was poured first to get a cast . after the initial setting was over , the entire assembly was poured , and a three dimensional model of the mandible was fabricated [ figure 7 ] . the extraoral impression should record the lower border of the mandible to the medial extent as much as possible [ figure 6]fabrication of three - dimensional model the intraoral impression was poured first to get a cast . after the initial setting was over , the entire assembly was poured , and a three dimensional model of the mandible was fabricated [ figure 7 ] . \n this measurement was same when compared with the available bone in the sectioned cast at the premolar area , at a depth of 14 mm ( premolar root length ) .", "", "" ]

[ "the use of ergotamines causing ischemia of peripheral vessels has been reported , particularly in patients with peripheral vascular disease . ischemic bowel induced by ergotamines is a much rarer event , with few documented cases in the literature . while colitis is always on the differential diagnosis of hospital patients with abdominal pain , the majority of cases are secondary to infectious colitis associated with antibiotic therapy . widespread necrosis , coupled with clinical deterioration , as in this case , mandated immediate surgical intervention to prevent irreversible septic shock . patchy areas of ischemia are often managed non - surgically by discontinuing the offending medication . when suspected , non - occlusive mesenteric ischemia can be treated with anti - coagulation and blood pressure support with intravenous fluids . while abdominal ct scanning is frequently used to assess colonic pathology , findings often lag behind those identified at the time of colonoscopy .", "a 48-year - old woman with a long - standing history of intractable migraine headaches was admitted to our institution 's specialty headache unit for aggressive management . she had no known history of peripheral vascular or cardiac disease but has been admitted multiple times for treatment of her headaches since her initial diagnosis in 2003 . the final diagnosis was gangrenous large bowel , ischemic colitis with thrombi or emboli noted .", "although ischemic colitis is considered a rare side effect of high - dose ergotamine use , it is a very real risk of which clinicians need to remain aware . a diagnosis of ergotamine - induced vasospasm is a diagnosis of exclusion , made when all other etiologies of ischemia have been ruled out . in this case , this is the first reported cases of ischemia progressing to gangrene such that colon resection was required other reports of ergotamine causing ischemic bowel appear in the literature [ 13 , 14 , 15 ] . in previous reported cases of colitis , expectant management with", "this is the fourth reported case of ischemic colitis secondary to high - dose ergotamine use reported in the literature and the first to require colon resection . while dhe can be useful in patients with refractory migraines , patients should be informed of the risks of both peripheral and visceral ischemia before deciding on this treatment . finally , ischemic colitis should be considered in the differential diagnosis of all patients taking ergotamines who present with abdominal pain ." ]

[ "we analyzed all 140 mrsa isolates we obtained during a previous study ( 2 ) and 50 other isolates selected from our collection of nosocomial mrsa isolates obtained in 2003 . the correlation between sccmec element typing and mlst in this study corresponds to findings of previous reports ( 6,1214 ) . enright et al . identified st254-iv mrsa isolates in germany and the united kingdom ( 12 ) , and chongtrakool et al . identified st239-iii and st241-iii mrsa isolates in several asian countries ( 14 ) . characteristics of these 190 isolates are shown in table 1 . * ni , nosocomial infection acquired at national taiwan university hospital ( ntuh ) ; nc , nosocomial colonization at ntuh ; ieoh , mrsa infection detected at ntuh within 48 h after transfer from another hospital . ", "we demonstrate that the predominant mrsa clone at ntuh in early 1990s had the type iv sccmec element . however , the predominant mrsa clones at ntuh from 1994 to 2003 had the type iii sccmec element . although the first study of mrsa with the type iv sccmec element reported that this element was found in community - acquired mrsa ( ca - mrsa ) ( 5 ) , some studies have reported mrsa isolates with this element in a hospital environment ( 12 ) . however , to our knowledge , these reports did not demonstrate that mrsa isolates with the type iv sccmec element became predominant among all mrsa isolates in an institution , especially before the mid-1990s . in addition , st254-iv mrsa isolates have been found in germany and the united kingdom ( 12 ) . whether st254-iv mrsa isolates in our study recently reported the results of sccmec typing of 615 mrsa isolates obtained in 1998 and 1999 from 11 asian countries ( 14 ) ." ]

[ "acute embolic limb ischemia is an urgent clinical condition in which sudden decrease or worsening in limb perfusion causes a potential threat to extremity viability and to life . thorough removal of all occlusive emboli in the arterial tree results in the best outcomes ; hence , some authors favored arteriography after embolectomy for lower limbs . \n this was the first case assessing the intraoperative use of co2 as a substitute for iodine contrast in a patient with known chronic kidney disease and an acute ischemic limb . angiography is traditionally performed with iodinated contrast material , but carbon dioxide ( co2 ) has been studied as an alternative intravascular contrast agent for patients with iodine allergy or renal function impairment . since it is not nephrotoxic , it was considered reasonable to utilize this contrast in a patient with borderline renal function who would be submitted to the noxious stimuli of the reperfused limb after revascularization . \n to the best of our knowledge ,", "a 79-year - old woman presented to the emergency department with acute limb ischemia in her left leg with a 2-hour history . patent popliteal and fibular arteries , occlusion in the mid - third of the anterior tibial artery \n a new embolectomy was then performed . two years before , she had been operated on for acute aortic embolic occlusion , with bilateral femoral catheter embolectomy . figure 1 shows a patent popliteal artery , a patent fibular artery and an occlusion on the mid - third of the anterior tibial artery . control angiography ( figure 2 ) showed complete resolution of the anterior tibial artery occlusion , with contrast up to the foot ( figure 3 ) . back bleeding was not significant , and a decision was made to perform an angiography to better assess the infra - popliteal arterial tree .", "treatment of embolic arterial occlusion with severe limb ischemia is well defined and involves the use of an embolectomy catheter as the best alternative . \n co2 has been used electively in both diagnostic and therapeutic procedures in the femoropopliteal tree , and is reported to be safe and non - nephrotoxic . \n intraoperative angiography was beneficial because it allowed the diagnosis of the arterial tree occlusion after the initial embolectomy . additional removal of clots was performed and the result was documented as complete patency of the anterior tibial artery to the foot . probably , in this case , the deleterious stimuli ( surgical stress , urinary tract infection and septic shock due to pneumonia ) contributed to renal failure and subsequent need for dialysis . the countermeasure ( such as the use of non - nephrotoxic contrast ) we consider co2 to be an alternative to iodine contrast when the decision to perform angiography is made in the acutely ischemic limb . to the best of our knowledge our goal , when using co2 , was to decrease the need for postoperative dialysis .", ", alguns autores defendem a arteriografia aps a embolectomia , para os membros inferiores . \n a angiografia tradicionalmente realizada com contraste iodado , mas o dixido de carbono ( co2 ) foi estudado como um agente de contraste intravascular alternativo para pacientes com alergia a iodo ou alterao na funo renal .", "aps a alta da uti , desenvolveu infeco urinria , piora da funo renal e uremia . os sinais de isquemia ( palidez e hipotermia ) foram imediatamente resolvidos aps a liberao do fluxo arterial .", "consideramos o co2 como uma alternativa ao contraste iodado quando necessria a angiografia para isquemia aguda de membro . neste caso , provavelmente , os estmulos prejudiciais ( estresse cirrgico , infeco do trato urinrio e choque sptico por pneumonia ) contriburam para a insuficincia renal e para consequente necessidade de dilise . a contramedida ( como o uso de contraste no nefrotxico ) poderia ter prevenido a insuficincia renal , se fosse esta uma situao nica ." ]

[ "here we report a case of emphysematous gastritis , diagnosed by computed tomography ( ct ) and confirmed by histopathologic findings associated with invasive gastric mucormycosis that showed angioinvasion , necrosis , ultimately disseminated to the colon and liver , and was fatal despite medical and surgical treatment . to our knowledge , this is the first report of a patient with emphysematous gastritis associated with invasive gastric mucormycosis in korea . however , emphysematous gastritis associated with mucormycotic infection is extremely rare , and only one case has been reported in the english literature ( 15 ) . emphysematous gastritis , which was first described by fraenkel in 1889 ( 1 ) , is a rare disease characterized by the presence of air within the wall of the stomach and diffuse gastric wall inflammation by gas - forming bacteria , which may be also life - threatening due to systemic toxicity . mucormycosis is a rare fungal infection that usually involves the nasopharynx ( 9 ) . among the several forms ,", "rouxen - y esophagojejunostomy with cecocolostomy and segmental resection of the large intestine were performed . the submitted pathological specimen consisted of segments of colon , small intestine , and a portion of liver . reoperation was performed , and the operative findings showed multiple perforations with necrosis in the transverse colon , necrotic change in the liver , hematoma with fluid collection in the peritoneal cavity , and leakage in the anastomotic site . a 43-yr old man was admitted to the emergency room because of diffuse abdominal pain , indigestion , and poor oral intake for 4 days . he had had a 1-yr history of hypertension , operation findings showed nearly total necrosis of stomach wall with dark green colored pus collection around the stomach .", "we report an extremely rare case of emphysematous gastritis associated with invasive gastric mucormycosis in a 43-yr - old man . heavy alcohol abuse and diabetes mellitus were the predisposing factors . ct is the diagnostic procedure of choice of emphysematous gastritis and helps in differentiating with gastric emphysema . mucormycosis is a rare , opportunistic fungal infection that occurs almost exclusively in immunocompromised hosts such as patients with diabetes , leukemia , lymphoma , renal disease , septicemia , burns , malnutrition , and following long - term treatment with steroids and antibiotics ( 10 ) . the symptom of acute abdomen as seen in patients with emphysematous gastritis is usually absent in patients with gastric emphysema ( 5 ) . in general , this patient also had a fatal outcome despite antibiotic and antifungal therapy and surgery . increased awareness of these disease entities may facilitate early diagnosis , prompt medical therapy , and appropriate surgical intervention , and ultimately improve survival rates . moreover , the gastric mucormycosis showed angioinvasion , necrosis , and ultimately , disseminate to colon and liver . in the case of mucormycosis , biopsy of involved areas patients with emphysematous gastritis typically develop acute abdominal pain , as was the case in our patient , usually developing 1 week after initiation , accompanied by diarrhea , nausea , vomiting , and occasionally hematemesis and melena ( 1 , 4 , 12 ) ." ]

[ "nevertheless , the major purpose of the present work is to highlight the novelties in regard to human infection and the disease that can help the general physician from both endemic and non - endemic countries in their medical practice . however , much of the epidemiology and its contribution to morbidity of entamoeba infections remain unknown . in accordance with the 1997 documents of the world health organization ( who ) , amoebiasis is the infection by the protozoan parasite entamoeba histolytica with or without clinical manifestations . the only known natural host of e. histolytica is the human body with the large intestine as the major target organ . there are excellent recent reviews on the molecular epidemiology and intestinal and extra - intestinal characteristics of amoebiasis in the human host that can be consulted .", "we recently have obtained evidence that in at least two endemic countries ( brazil and mexico ) , e. dispar genetic variants have been detected in patients with invasive amoebiasis . in brazil , the new data on the epidemiology of amoebiasis based on frontier technology suggests that genetic variability could be an important tool in the study of geographic distribution of both species and particular strains of entamoeba , which may determine the morbidity rates of different forms of amoebic infection in different geographic areas . e. moshkowskii has been frequently detected in individuals from developed and highly industrialized countries . particularly in regard to this species we are at the beginning of the study of its pathogenic potential and the context in which it is expressed and the epidemiologic significance of infection and its contribution to morbidity rates of diarrheic diseases . the speciation of entamoeba protozoa has been discussed since 1925 when emile brumpt proposed the existence of two distinct species that could infiltrate the human intestine : one associated with symptoms of diarrhea with or without dysentery and the other excreted with feces from asymptomatic individuals .", "what doses of cysts are necessary for colonization of large bowel mucosa ? for the three entamoeba species this is not known with any certainty . , colonoscopy detects the presence of lesions related to the mentioned severe forms of intestinal amoebiasis and allows for differential diagnosis of other pathologies , such as inflammatory bowel disease or colon carcinoma . we have to stress that more than 90% of infections have an asymptomatic course and are frequently auto - limited at different periods of time . after intestinal infection there is no evidence of induction of a long - lasting protective immune response , and in endemic areas , individuals may have several periods during the year of re - infection and clearance of infection . in relation to the susceptibility of hiv and aids patients to the invasive forms of infection , moreover , we do not know which environmental characteristics are permissive for intestinal colonization , and this could be an interesting field for future research . finally , until today , the only species recognized as an etiologic agent of amoebic invasive disease is e. histolytica , which , once in the colon , undergoes excystation and the generation of trophozoites . symptoms more relevant in this instance are periods of abdominal pain ( colic ) and auto - limited episodes of diarrhea alternating with constipation . however , both non - dysenteric amoebic colitis and irritable bowel syndrome are controversial themes in the clinical practice . where endoscopy examination is available , colonoscopy can be of great help in clinical diagnosis of invasive intestinal amoebiasis .", "for example , we do not know the frequency of extra - intestinal invasion after intestinal colonization with virulent e. histolytica additionally , we have to mention that in endemic countries the frequency of mixed abscesses ( pyogenic and amoebic ) is considerable ; in our practice this frequency is approximately 17% ( non - reported data ) . another important fact in medical practice is the coincidence of previous symptoms with the presence of high levels of serum anti - amoebic antibodies more than 90% of amoebic liver abscess patients develop this type of antibody response what circumstances define the extra - intestinal invasive behavior of some e. histolytica strains ? this remains unknown today . . however , in cases of fast development of amoebic abscess these antibodies may not be present . ultrasound images of : b ) single large amoebic abscess and c ) three amoebic hepatic abscesses . a ) thoracic x - ray of a patient with amoebic liver abscess showing the elevation of the right hemi - diaphragm .", "even though some of these diagnosis procedures are also suitable for large epidemiologic trials , it is mandatory to make a careful selection of the diagnosis test when the test has to be applied in the field . in particular , the election has to be directed to those procedures that do not need special conditions for sample preservation or pretreatment of specimens in the working field . in our experience , etiological diagnosis of intestinal parasitic diseases has been mainly performed using direct or concentration techniques for microscopic examination of fecal specimens . while technically simple in approach , some of the current techniques are based on immunological strategies , such as elisa and different modalities of polymerase chain reaction ( pcr ) , with clear advantages in bedside diagnosis and in clinical laboratories of health institutions . tables 1 and 2 have a list of diagnostic tests that have proven to be useful in clinical and laboratory diagnosis of intestinal and extra - intestinal amoebiasis in first and second level health institutions . these techniques require the expertise of highly qualified technicians in the morphological identification of ova , cysts , and helminths to be feasible , and the sensitivity and specificity is no more than 80% . results are reproducible and reliable . in contrast , in epidemiological trials , these techniques can be biased when samples are more than 18 hours old . microscopy and immunoassays for e. histolytica detection pcr assays for e. histolytica and/or e. dispar detection", "the who / paho recommendations published in 1997 contain in detail the actions that who country members have to observe with regard to e. histolytica species infection . treatment of amoebiasis disease in our experience , patients with amoebic liver abscess may not excrete e. histolytica / e . the procedure allows for the establishment of a differential diagnosis with other liver pathologies , especially pyogenic liver abscess , which is common in clinical practice . they highlight the characterization ( when possible ) of e. histolytica and e. dispar ( we now add e. moshkowskii ) to be treated properly . in accordance with the who recommendation only e. histolytica", "prevalence rates of parasite intestinal infections in morelos , mexico efforts in the near future have to be directed on studies focusing the interactions of microorganism in the intestinal environment the study documented the presence of enteropathogenic bacteria , parasites , and viruses in mixed infections , and highlighted the importance of diarrheal disease associated with protozoan infections . . this knowledge will have a positive impact in clinical and laboratory diagnosis of diarrheic syndrome , its treatment , and thereafter the implementation of more reliable control schedules . gastrointestinal infections are responsible for morbidity and mortality rates of children and young adults worldwide . in africa , diarrhea is responsible for 2575% of all childhood illnesses . . a remarkable low prevalence of soil - transmitted helminthiasis was also observed and could be the consequence of a biannual anti - parasitic treatment of school children with albendazole ." ]

[ "engaging in high levels of physical activity is a key strategy for successful maintenance of weight loss . in the current study , we examined the relationship between physical activity variety , defined as the number of different types of self - reported moderate - to - vigorous activities performed in one week , and minutes spent in objectively measured moderate - to - vigorous physical activity ( mvpa ) in two groups of individuals who have successfully maintained their body weight long - term : ( 1 ) weight loss maintainers with previous history of overweight / obesity and ( 2 ) normal - weight individuals without a history of overweight . it is possible that the association between physical activity variety and mvpa could be different for weight loss maintainers and normal - weight individuals . however , based on previous research showing a relationship between physical activity variety and higher physical activity levels across diverse groups and settings [ 14 , 15 ] , we predicted that engagement in a greater variety of moderate - to - vigorous activities would be associated with higher mvpa daily minutes in both the weight loss maintainer and normal - weight groups . thus , strategies that assist individuals in adopting and sustaining high levels of physical activity to help facilitate a healthy body weight are needed .", "participants were enrollees in the cross - sectional lite study that compared weight control behaviors of weight loss maintainers and normal - weight controls . the intensity of sports and recreational activities was determined using the paffenbarger coding scheme . for walking to be counted as an activity the rt3 has shown to be a strong predictor of oxygen consumption during sedentary and treadmill activities [ 20 , 21 ] and a more precise measure of physical activity at the group level compared to its tri - trac predecessor . rt3 nonwear times , defined as periods of 30 consecutive minutes of zero counts ( permitting intervals of up to 2 consecutive minutes registering 1100 counts / min ) , were deleted from analysis . the remaining time was partitioned according to intensity level . based on previous rt3 validation research and a recent study that used the rt3 to compare mvpa patterns in weight loss maintainers , normal - weight , and obese groups independent t - tests were conducted to assess differences between the groups on demographic characteristics , weight , accelerometer daily wear time , mvpa minutes / day , and reported variety / number of different types of moderate - to - vigorous activities performed . linear regression was used to examine the associations of physical activity variety and group status ( weight loss maintainers versus normal weight ) with objectively measured mvpa minutes / day , adjusting for age , gender , years of education , marital status , bmi , and accelerometer daily wear time .", "of 413 participants who were sent an accelerometer and the ppaq , 394 ( 95% ) met valid accelerometer wear requirements and provided complete data on the ppaq . the characteristics of these 226 weight loss maintainers and 169 normal - weight participants are presented in table 1 . we next examined the independent and joint associations of physical activity variety and group status with mvpa minutes per day . given that the physical activity variety group status interaction was not significant ( p = 0.73 ) , the results of the main effects linear regression model for mvpa minutes per day are shown ( table 2 ) . greater physical activity variety ( p < 0.001 ) and weight loss maintainer status ( p < 0.05 ) were independently related to greater daily time spent in mvpa , after adjustment for demographic characteristics ( age , gender , educational level , marital status , current bmi ) and daily accelerometer wear time . both groups were similar in age ( 48.8 12.9 years ) , gender ( 84% female ) , marital status ( 66% married ) , race / ethnicity ( 94% caucasian ) , employment status ( 82% employed ) , and job type ( 95% in professional or clerical positions ) . a greater proportion of normal - weight participants was college educated , compared to the weight loss maintainers .", "this study examined whether performing a greater variety of different types of moderate - to - vigorous physical activities was related to greater time spent in mvpa among weight loss maintainers and normal - weight individuals without a history of overweight / obesity . given the continuing obesity epidemic and growing evidence that indicates greater amounts of physical activity are needed for successful long - term weight control , it is important to identify strategies that can assist individuals in adopting and maintaining high levels of physical activity . , this study examined the relationship between physical activity variety and objectively measured mvpa levels in weight loss maintainers and normal - weight individuals who both had long - term success in maintaining their body weight . in both groups , physical activity variety was related to greater engagement in mvpa and likelihood of accumulating 250 mvpa minutes / week , consistent with physical activity guidelines for optimal long - term weight maintenance . we found that , independent of group , greater variety was associated with higher daily mvpa minutes and meeting the 250 mvpa minutes per week recommendation for optimal long - term weight maintenance ." ]

[ "recently \n we reported on an analysis of the infrared spectrum of \n c2f4 . by observation \n of many combination and difference bands , including many from two c - containing isotopologues , and by comparison with mp2 and \n density - functional calculations , all 12 fundamentals could be assigned , \n although only five are ir active . the geometry \n was deduced from ro - vibrational analysis of strong ir active bands \n and by comparison with theoretical calculations . however , it is also \n instructive to correlate anharmonic constants with some peculiarities \n of the reactions of c2f4 . ( borden also presented an alternative but related description based \n on delocalization of unpaired radicalic electrons to accepting * \n orbitals of cf groups . ) explained this property by positing that the electron attraction \n of fluorine leads to a preference of sp- over sp - type carbon : radical addition converts both \n c atoms from sp to sp hybridization , which \n stabilizes the primary product , lowers the transition state , and thus \n accelerates the reaction .", "the samples in natural isotopic abundance were either taken from \n commercial c2f4 ( hoechst ) , that contained a \n trace of the cyclic dimer , or prepared from c2f4br2 + zn in a high - boiling \n alcohol ( diethylene glycol ) ; the comparison allowed for recognizing \n absorptions of impurities . the present work focuses on anharmonic constants of c2f4 . only where the constants were \n expected to be different for ccf4 and c2f4 ( e.g. , in the case of \n fermi resonance ) the molecular force field at this level of theory \n was shown in the previous study to reproduce the fundamental wavenumbers \n and the isotopic shifts of c2f4 very satisfactorily \n ( for details , see ref ( 1 ) ) , and hence was an appropriate choice for computing xij values . a sample enriched in c to \n 50% was prepared from chclf2 by co2 laser isotope \n separation with enriched cf2 as the primary product . ir spectra of c2f4 in natural isotopic \n abundance \n and isotopically enriched were recorded between 370 and 4000 cm with 0.2 cm resolution by a perkinelmer \n ftir spectrometer in garching . at the \n synchrotron lab , the isotopically enriched sample was measured at \n moderate 0.1 cm resolution in the far ir region \n from 100 to 600 cm ( capturing the band at 210 \n cm ) , and at high resolution for the ir active \n cf stretch bands , see ref ( 1 ) . theoretical values of the anharmonic constants xij were obtained from anharmonic \n vibrational \n frequency calculations performed using gaussian 03 revision c02 at the mp2 level using \n dunning - type correlation - consistent ( cc - pvtz ) orbitals .", "the mp2/cc - pvtz calculations \n reproduced the observed wavenumbers \n and isotopic shifts very well . supporting \n the overall vibrational analysis fermi resonances \n were identified ( see section 4.4 and si ) between:5 and 2+6 ( discussed already in ref ( 1)),1 and 5+6 ( indicated by the hot - band structure \n of 1-combinations , which are different in the mixed \n isotopologue),2 and 27 ( causing irregularities \n in overtone levels of 7 , also contributing to the \n large magnitude of x27 and x77).2 and 23 , identified from the \n mp2 calculations . 5 and 2+6 ( discussed already in ref ( 1 ) ) , 1 and 5+6 ( indicated by the hot - band structure \n of 1-combinations , which are different in the mixed \n isotopologue ) , 2 and 27 ( causing irregularities \n in overtone levels of 7 , also contributing to the \n large magnitude of x27 and x77 ) . 2 and 23 , identified from the \n mp2 calculations . we use eqs 13 to \n obtain the experimental values , and hence , table 2 reports phenomenological xij , some of which show a spread in the values suggestive of fermi \n resonances ( in particular x18 , x26 , and x77 ) . absorbance spectra demonstrating the large x18 derived shifts for hot - bands originating in 8 . combination \n bands allow for a direct assignment , whereas hot bands must be identified \n by their intensity ( controlled by the boltzmann factor ) . in a number \n of cases", "another method of characterizing fermi resonance interactions relies \n on intensity borrowing caused by the mixing of levels . according \n to the mp2 calculations , the great majority of xij change by 1 cm on isotopic substitution the fermi - induced \n repulsion of the levels depends in a nonlinear way on both the magnitude \n of the fermi interaction parameter and on the original ( i.e. , unperturbed ) \n energetic distance of the levels . in fact , \n weak perturbations of the 1 level and its combinations \n by the 1/5+6 fermi resonance are indicated by the slight x18 dependence on the level and on isotopic substitution and \n the change of the hot - band structure of 1 combinations \n in ccf4 , as explained in the si . fermi resonances mix two nearby levels of the \n same symmetry , which differ by three units in the quantum numbers . \n the interaction \n can be bonding in all arrangements . in the singlet case , ( a )", "very recently , \n high - level theoretical studies investigated \n electronic ground and excited states of c2f4 and their dependence on some coordinates , mainly \n to discover the fate of this molecule after electronic excitation \n and make comparisons with a corresponding time - resolved experiment \n ( ref ( 16 ) ) . for the \n ground state , the stabilizing effect of pyramidalization in the twisted \n molecule was confirmed . the facile thermal cc dissociation of c2f4 is due to curve crossing of the ground state \n ( 1ag ) with \n the two - electron excited zwitterionic 2ag state . interestingly , the excited molecule enters \n the s1/s0 conical intersection from the 2ag state , where the molecule has a large one - sided pyramidalization , \n a 90 cc twist and a cc bond length ( 1.51 ) similar to \n that of a single bond . in the present work , . however , the large magnitude of x18 leads us to conclude that the dissociation path bends \n early toward \n q8 , i.e. to trans pyramidalization of the two carbon atoms \n ( figure 2b ) . the crossing \n barely alters the properties of the potential curve ( cut purely as \n a function of cc stretch ) near the equilibrium geometry ; the force \n constant for cc stretching ( 1 in c2f4 , 2 in c2h4 ) is nearly \n identical for the two molecules ." ]

[ "the objective of our study was to examine the relationships between intracranial radiographic abnormalities and preimplantation developmental assessment ( including head circumference ) with postimplant audiometric and language outcomes in children with symptomatic congenital cmv who have undergone cochlear implantation . hearing loss is the most common manifestation of congenital cmv infection making cmv a leading cause of nonhereditary congenital hearing loss . given the relatively large number of children potentially affected by cmv - related hearing loss and the wide range of manifestations of congenital cmv infection , it is difficult to predict how a child with symptomatic cmv will perform with a cochlear implant ( ci ) . cytomegalovirus ( cmv ) is one of the most common congenital viral infections in many regions . in the united states it occurs in 0.51% of live births , or approximately 40,000 infants annually . previous studies suggest that children with symptomatic cmv derive auditory benefit from cis , albeit at a slower rate than other children . the degree to which these children benefit remains somewhat controversial as there is variation in the development of language skills after ci [ 59 ] .", "this study was a retrospective review of children with a diagnosis of symptomatic congenital cmv who underwent cochlear implantation between 2004 and 2010 at a tertiary pediatric cochlear implant center . congenital cmv was diagnosed for most children via urine culture of the virus during the first two weeks of life . the diagnosis of pervasive developmental disorder not otherwise specified was made by interdisciplinary evaluations with speech pathology and psychology using standardized measures to evaluate autism spectrum disorders . diagnosis was also made based on the identification of hearing loss coupled with brain image findings . results from computed tomography ( ct ) and/or magnetic resonance imaging ( mri ) scans of the brain were reviewed , and the findings were classified by type and location of anomaly . medical charts of these patients were reviewed for pre- and postimplantation evaluations and central nervous system imaging findings . biserial correlations were conducted to understand the association between presence and location of brain abnormalities with audiometric and language outcomes .", "\n table 1 lists the fifteen cmv - positive children ( 9 females and 6 males ) who received a ci during the study timeframe . because the iq / dq was associated with both periventricular calcifications ( rb = 0.53 , p = 0.04 ) and hc < 5th percentile ( rb = 0.73 , p = 0.002 ) , the relationship between these factors and language appears to be , at least in part , driven by iq / dq scores . periventricular calcifications were associated with lower receptive language ( rb = 0.75 , p = 0.03 ) and expressive language ( rb = 0.84 , p = 0.008 ) among children with post - ci assessments . all four children with encephalomalacia and all 3 children with cerebellar abnormalities had a diagnosis of cp . in addition to cp , 3 of the 4 children with encephalomalacia and all 3 children with cerebellar abnormalities also had a cognitive disability diagnosis .", "previous studies have shown that brain imaging may be a good predictor of adverse neurodevelopmental outcomes . in one study of children with symptomatic congenital cmv , as we found in our study , the majority of children with symptomatic congenital cmv have associated developmental disabilities . the variability of neurocognitive deficits in these children warrants the examination of this group separately from other children with developmental disabilities . as with children with developmental disabilities , in addition to looking at the associations between cns imaging findings and post - ci outcomes , our study also looked for correlations between preimplantation developmental assessment and cochlear implant performance in these patients . one of the challenges in children with congenital cmv is predicting the sequelae they will develop and the extent of neurological and developmental deficits they will incur . this is not entirely surprising as head circumference relates to brain growth , which can impact developmental outcomes .", "although our study has limitations including its retrospective nature and small sample size , it provides data that may further efforts to identify factors which may help predict which children with congenital symptomatic cmv will benefit from ci . the presence of cerebellar anomalies or greater than one cns abnormality on imaging correlates with poorer outcomes after ci . the location of cns abnormalities , including calcifications , may play a role in audiometric and language outcomes after ci . early measurements such as brain imaging findings , head circumference , and iq / dq may allow for more accurate counseling of families regarding anticipated postimplantation performance in children with symptomatic congenital cmv ." ]

[ ". there have been significant achievements regarding to the millennium development goals ( mdgs ) as a global development target . numerous important issues have been raised by united nation ( un ) , which are poverty and hunger elimination , improving health and education , sustainable cities , combating climate changes , and also ocean and forest conservation . in mdgs , hiv / aids , malaria , and major diseases are clearly mentioned as global development goals . in this case , there will be plenty of diseases that are not a major concern of the world . questions were raised concerning neglected tropical disease ( ntd ) which is definitely out of the highlight . will these diseases be included in the ambitious post - mdgs sustainable development ? the new sustainable development goals ( sdgs ) , known also as the global goals , had been established after world leaders gathered on 25 september 2015 , at the united nations in new york to adopt the 2030 agenda for sustainable development and the broader and further agenda than the mdgs . however , this review describes more than those five diseases and aims to address the magnitude of the problem of ntd in indonesia .", "resistance of m. leprae is a serious problem because of limited effective antimicrobes for leprosy . the problems of leprosy in indonesia are summarized as follows : early detection.development of more effective treatment.development of more effective vaccine.understanding immunopathogenesis of peripheral nerve damage.management of chronic erythema nodosum leprosum ( enl).deformity and stigmatization.deformity and stigmatization are serious problems among leprosy patients in indonesia . leprosy is an infectious disease is caused by mycobacterium leprae , a road shaped bacteria classified in the same genus as mycobacterium tuberculosis it was noted that the significant improvement in leprosy control was because of massive promotion of leprosy prevention and multidrug therapy ( mdt ) intervention in more than 5,600 primary health centers in indonesia .", "yaws eradication problem in indonesia is summarized as follows : early detection by health workers.geographical problem of endemic area.surveillances and reporting system.inadequate confirmatory laboratory test . there are several obstacles to eradicate yaws in indonesia : geographically the yaws patients are in a remote area including rural and small islands which are not easy to handle , difficulty to give benzathine penicillin for children , and also local political condition that is somehow counterproductive to the programs . who planned to eradicate yaws globally in 2020 with adoption of morges strategies . reporting system for yaws incidence is very important to support the best intervention for yaws eradication . yaws is a treponema pallidum subspecies pertenue infection , which may develop as chronic and recurrent disease . insufficiency of this sector may result in delay of yaws eradication and increasing yaws contact population . diagnosis of yaws is commonly based on the clinical findings and serology [ 31 , 32 ] .", "dengue virus consists of four serotypes : denv1 , denv2 , denv3 , and denv4 . the study concerning the two guidelines showed that in surabaya , indonesia , the denco revised clinical management guideline superior in detection of severe dengue cases . these viruses are responsible for infectious diseases with width spectrum of clinical manifestation : dengue fever ( df ) , dengue hemorrhagic fever ( dhf ) , and dengue shock syndrome ( dss ) [ 38 , 39 ] . dengue virus infection is an arbovirus disease , which in indonesia is primarily transmitted by aedes aegypti and aedes albopictus . . however , the proportion of those three clinical manifestations still becomes an enigma , although the awareness to the diseases , surveillance programs , diagnostic tools , and management of denv infection in indonesia have been significantly improved .", "the preparedness to human rabies should be maintained , as the threat of human rabies escalation is still high . rabies is an acute , progressive , incurable viral encephalitis disease that is transmitted from animal , mainly dogs , to human . ten countries of asean have been declared rabies - free asean by 2020 in the occasion of the thirty - fourth meeting of the asean ministers on agriculture and forestry ( 34th amaf ) , on september 2012 . totally there were 133 reported human deaths because of rabies in bali from 2008 to september 2011 . it is caused by rabies virus ( rabv ) , a member of the family rhabdoviridae , genus lyssavirus .", "lymphatic filariasis ( lf ) is caused by worms inhabiting the lymphatics [ 6365 ] . urbanization of vast areas of tropical asia , including indonesia , has resulted in a concomitant rise in the prevalence of both w. bancrofti and b. malayi varieties of filariasis , carried by mosquitoes that breed in nonsylvatic habitats [ 68 , 73 ] . the challenge of mda implementation in indonesia is not the efficacy of the drugs which were given to the community . the efficacy of six annual rounds of mda was studied in alor island , eastern part of indonesia . approximately 65% of total cases are found in the southeast asian region [ 6668 ] . the disease predominantly afflicts poor people in both urban and rural areas with limited resources condition , where mosquitoes as a vector might be found in high density [ 64 , 68 ] . who launched global program to eliminate lymphatic filariasis ( gpelf ) , which relies on mass drug administration ( mda ) approach [ 68 , 71 ] .", "schistosomiasis is a chronic water - borne infection caused by trematodes schistosoma , mainly found in developing countries in africa , south america , the caribbean , the middle east , and asia [ 69 , 74 , 75 ] . in indonesia schistosomiasis control in indonesia has faced many difficulties even though the endemic areas are very limited [ 79 , 81 ] . the core strategy of mda should be coupled with education to the local community , rat and snail surveillance , and support to the environmental management programs including introduction of latrines and suitable water sources . in the future , there should be emphasis to understand the social dynamics and social change related to schistosomiasis , which may provide more information about concrete issues to control transmission of schistosomiasis . lack of intersectoral coordination and collaboration may have occurred , possibly leading to increase transmission and reinfection rates , and be prone to control failure . praziquantel is well - tolerated , associated with few side effects , and has a very high therapeutic index .", "the program targeted preschool and elementary school age . however , until this moment the country still struggles to combat sth . in conclusion , there were efforts and programs concerning ntd that were planed and implemented in indonesia . many factors may contribute to the rendering of ntd elimination in indonesia , such as high population , wide range geographic of the archipelago , and limited resources . by the end of 2015 ntd . the tropical climate of indonesia is highly favourable to support the circulation of soil - transmitted helminths in the country . the survey conducted by ministry of health in elementary schools located in 33 provinces of indonesia showed prevalence of sth was 31.8% . soil - transmitted helminthiasis ( sth ) is an infection with one or more intestinal parasitic worms : roundworms ( ascaris lumbricoides ) , whipworms ( trichuris trichiura ) , or hookworms ( necator americanus and ancylostoma duodenale ) drugs used for deworming , albendazole , and mebendazole are effective and inexpensive to control sth transmission and reinfection ." ]

[ "the study specifically \n examined obese women who had less muscle mass than men and whose heavy weights were likely \n to increase the burden on their lower limb muscles and joints during walking . accordingly , this study aimed to investigate the effect of the use of a trekking pole on \n muscle and cartilage damage and fatigue during downhill walking . however , previous studies on the effects of \n a pole during downhill walking have been limited to the kinetic aspects such as the \n reduction of knee joint forces or the load on the lower extremity joints . in addition , according to a comparative study by \n andriacchi et al . that measured the maximum flexion of the lower extremity joints during \n various routine activities , the flexion of the knee joint was approximately 4 times greater \n during walking down stairs than during walking over level ground11 . taken together , such previous reports suggest that the \n use of a pole during downhill walking may alleviate the burden on lower extremity joint \n cartilages ; however , thus far , there has been no report examining this potential \n benefit .", "each of the eight subjects participated in a total of two trials : one np trial ( walking \n without using a trekking pole ) , and one tp trial ( walking using a trekking pole ) . with the \n treadmill angle set to a decline of 15% based on a study by perrey and fabre12 , the \n experiment used a crossover design to minimize the adaption from the repetitive exercise \n trials , and each trial was separated by 7 days to avoid any transient effects on the \n physiological and psychological conditions of the subjects . the participants were subjected to 30 \n minutes of walking at an exercise intensity of 50% of their heart rate reserve . an adjustable - length trekking \n pole ( 6342011 ; leki , hamburg , germany ) was used , and the length was initially set at 70% of \n the user s height so that the elbow angle was maintained at 90 when the user was standing \n on level ground . when the pole was used for downhill walking , resting heart rate was measured in a seated position using a heart rate \n monitor ( polar a5 ; polar , kempele , finland ) . its length was increased by \n approximately 5 cm . using a 22-gauge needle ,", "in addition , in trial np , the serum ck , serum ldh , and serum comp levels were \n significantly increased at 2hpw when compared with those at the pwb ( p<0.05 ) . np : no trekking pole trial ; tp : trekking pole trial ; \n pwb : pre - walking baseline ; iaw : immediately after walking ; 2hpw : 2 hours post - walking ; \n * p<0.05 vs. pwb .. the serum ck , serum ldh , serum comp , and plasma lactate levels were \n significantly increased iaw when compared with those at the pwb in trials np and tp \n ( p<0.05 ) . the biomarker levels measured are presented in table \n 1table 1.peripheral biomarkers after downhill walking with the use of trekking poles ( tp ) \n and without their use ( np)variabletrialpwbiaw2hpwck(u / l)np260.3 39.1349.1 37.9302.9 42.0tp256.1 42.0312.5 44.9270.9 ", "this study \n measured the levels of serum ck , ldh , and comp to investigate the effect of the use of a \n trekking pole on muscle and cartilage damage during downhill walking . downhill walking can cause muscle and cartilage damage , and it is suggested \n that the use of a trekking pole can reduce temporary muscle and cartilage damage after \n downhill walking . . the rationale could be that the use of a trekking pole alleviated \n the temporary muscle and cartilage damage induced after downhill walking . exercise - induced muscle damage increases in situations involving eccentric muscle \n contractions , such as during downhill walking and/or running4 ." ]

[ "", "periampullary diverticula ( pad ) refer to extraluminal outpouchings of duodenal mucosa that develop within the radius of 2 to 3 cm from the ampulla of vater ( 1 ) . recently , the authors experienced an unusual case of abdominal pain and obstructive jaundice due to extrinsic compression of mid common bile duct ( cbd ) by distended pad filled with pus - like material as a result of impacted intradiverticular enterolith at the pad orifice . pad are largely asymptomatic but they sometimes can cause both pancreaticobiliary and non - pancreaticobiliary complications . rarely , obstructive jaundice can develop secondary to pad in the absence of choledocholithiasis or tumor and is termed lemmel 's syndrome ( 2 ) .", "when the cbd stone was removed by ercp , the stone proved to be brown pigment sludge stone that typically forms in the presence of ascending infection ( fig . biliary cannulation combined with endoscopic sphincterotomy ( est ) was also performed to explore the cbd for other possible causes of obstructive jaundice but no stone , stricture or obstruction by tumor could be found . on endoscopic nasobiliary drainage ( enbd ) these findings were confirmed on endoscopic retrograde cholangiopancreatography ( ercp ) which showed normal biliary orifice ( fig . the axial images of the ct scan demonstrated distal cbd stone with upstream bile duct dilatation ( fig . however , on coronal reconstructed images , the stone was not located within the bile duct but inside the pad and the distended diverticulum was compressing the mid cbd ( fig .", "if the underlying mechanism of lemmel 's syndrome is likely to be due to papillitis chronica fibrosa or sphincter of oddi dysfunction as mentioned above , the simplest and the most appropriate management would be to perform est ( 16 ) . in conclusion , lemmel 's syndrome is a rare cause of obstructive jaundice that should be included in the differential diagnosis of biliary obstruction when pad is present . maintaining a high index of suspicion is imperative to establish an accurate diagnosis since it can mimic other cystic or solid lesions around the pancreas head . diverticula of the gastrointestinal tract are outpouchings of all or part of the intestinal wall which can occur anywhere throughout the alimentary tract . first , diverticulitis or direct mechanical irritation of pad may cause chronic inflammation of ampulla and lead to chronic fibrosis of papilla ( papillitis chronica fibrosa ) ( 4 ) . hepatocholangiopancreatic disease can seldomly occur in the absence of choledocholithiasis and is termed lemmel 's syndrome ( 2 ) ." ]

[ "nonetheless , there can be considerable variation of body weight status within a given group of centenarians , though to our knowledge the extent to which this may be associated with potential differences in dietary intake patterns or selected health conditions has not been explored . thus , the objectives of this study were to explore associations ( 1 ) between bmi and dietary habits and ( 2 ) between underweight or overweight / obesity and health status in a population - based multiethnic sample of centenarians ( 98 years and above ) from northern georgia in the usa . it was hypothesized that overweight / obesity , but not underweight , would be associated with poorer dietary habits and that both overweight / obesity and underweight , as well as dietary habits , would be associated with specific health conditions in this population . thus , it is not known whether the associations between underweight or overweight / obesity and chronic health conditions as observed in previous studies of older adults extend to the very old . conversely , a high bmi , indicative of overweight or obesity , is associated with an exacerbation in age - related physical and cognitive decline [ 3 , 4 ] and with an increased prevalence or risk of many chronic health conditions common in older adults such as diabetes , hypertension , and cardiovascular disease [ 35 ] . a low bmi , or underweight status , is often associated with an increased risk of mortality in seriously ill or hospitalized older adults [ 1 , 2 ] . body mass index is a simple index of weight for height that is frequently used in the assessment of nutritional status . ", "this study was a secondary analysis of data collected by the georgia centenarian study , a population - based multidisciplinary study conducted in 44 counties in northern georgia ( usa ) from 2002 to 2005 . the total food score , ranging from 0 to 5 , was based on comparisons with the dietary guidelines for americans 1,600-calorie meal pattern for sedentary older adults , as previously described . 11 individuals were excluded due to missing data for bmi ( n = 7 ; includes one double - amputee ) , food intake patterns ( n = 1 ) , average grip strength ( n = 1 ) , and/or systolic / diastolic blood pressure ( n = 3 ) . overall characteristics of the 233 centenarians included in the study are given in table 1 . compared to the included centenarians ( n = 233 ) in addition , because bmi can play a causative role as a risk factor for chronic disease , a second series of logistic regression analyses was performed with diabetes , anemia , or other chronic health conditions as the dependent variable and race , gender , residence , and bmi 20 or bmi > 25 as the independent variables ( model 1 ) . bmi calculated from observed / recorded height and weight was used to form three bmi classifications based on the national institutes of health criteria for overweight / obesity and defined as underweight 20 kg / m , normal weight > 20 and < 25 kg / m , and overweight / obese 25 kg / m . a final series of logistic regression analyses was performed with diabetes , anemia , or other chronic health conditions as the dependent variable and race , gender , residence , total fruit , and vegetable intake and bmi 20 or bmi > 25 as the independent variables ( model 2 ) .", "approximately one - third ( 31.3% ) of the centenarians included in the final analytical sample had a bmi of 20 ( underweight ) , 43.8% were classified as being in the normal weight range , and 24.9% met the nih classification for overweight / obesity ( bmi 25 ) . chi - square analysis indicated that those with a bmi 20 were more likely to be women , live in a skilled nursing facility , eat a modified food diet , have experienced a weight change in the past three months , and have anemia as compared to centenarians classified as normal weight or overweight / obese ( table 2 ) . further controlling for total fruit and vegetable intake ( model 2 ) strengthened the associations between bmi 25 and diabetes and systolic blood pressure > 140 mmhg , and resulted in a significant association between bmi 25 and diastolic blood pressure 90 mmhg . bivariate analysis of diet intake patterns suggested that centenarians with bmi 20 had the highest total food scores and were more likely to report eating two or more servings of meat , fish , and poultry per day and three or more total servings of fruit per day as compared with centenarians in the other bmi classifications . being overweight / obese ( bmi 25 ) also tended to increase the odds of having diastolic blood pressure > 90 mmhg ( approximately three - fold ; p = .055 ) or cardiovascular disease ( approximately twofold ; p = .074 ) . ", "to our knowledge , this is the first study to explore associations between dietary patterns and body weight status in the oldest old segment of the population . prevalence of overweight / obesity in this population - based study of centenarians was approximately 25% , which was considerably below the prevalence for these conditions in the overall population of older adults , aged 60 and above , in the usa at the time of data collection ( 69% ; ) . in analyses controlled for gender , race , and place of residence , , this secondary analysis provides evidence of an inverse association between fruit and vegetable intake and body weight status in a population - based study of centenarians . several parameters indicative of a low frequency of fruit and vegetable intake were associated with overweight / obesity ( bmi 25 ) , whereas there were no associations between frequency of intake of meat , dairy , and fruits and vegetables and being underweight ( bmi 20 ) . our initial analysis indicated a greater intake of meat and total fruits in the underweight centenarians , suggesting that they were eating better than those in the normal weight and overweight / obese classifications . thus , associations in centenarians between low bmi and dietary status may be quite complex and influenced considerably by place of residence . in the present study , there was an increase in the relative risk for being overweight / obese in centenarians reporting the lowest frequency of intake of some nutrient dense foods including orange / yellow vegetables and citrus and noncitrus fruits . the present research was part of a large , multidisciplinary study across a range of cognitive , mental , physical , and health - associated domains exploring the role of various factors pertinent to the survival and functioning of centenarians . to decrease testing burden for participants , dietary intake data focused on frequency of intake of specific food groups selected based on the dietary guidelines for americans and age - related associations with nutritional deficiencies and chronic diseases [ 16 , 17 ] . " ]

[ "all data in exposome - explorer was acquired from a careful review and analysis of nearly 500 peer - reviewed publications , with a particular focus on dietary and pollution exposures . these newly emerging trends in exposure science , combined with the growing volume of comprehensive exposure data being published , make the establishment of a centralized , online database on biomarkers of exposure particularly critical . to date it contains comprehensive information on almost 500 biomarkers of exposure with concentrations , correlations with exposure estimates and temporal reproducibility , as well as other details on study population and analytical methods . the comparative toxicogenomics database ( ctd ) is the only online database containing a large number of concentration values in blood , urine and other biospecimens extracted from the scientific literature ( 9 ) . , relatively little effort has been directed to collecting and organizing data on biomarkers of exposure . historically , most biomarkers of exposure have been measured individually using compound - specific assays . however , with the emergence of various omics technologies there is an increasing tendency to characterize exposures more comprehensively .", "publications on intervention studies , analytical method development , associations of biomarker with biological status or disease , biomarkers of biological status ( e.g. inflammation , oxidative stress , disease ) , or animal studies were not considered for this initial stage of development . literature searches were conducted using the web of science ( wos ) . only peer - reviewed publications describing original work with biomarker measurements in observational studies conducted in human populations those rated as relevant were then manually described using a series of attributes ( tags ) related to exposures , study design , type of numerical data , populations , biospecimens , biomarkers and confounding variables to facilitate the selection of references for annotators . all data in exposome - explorer was compiled through extensive literature analysis along with manual curation and computer - assisted validation . the bibdesk smart groups functionality and a combination of criteria based on the tags were used to dynamically generate a priority list of publications for further annotation . adduct ) . for dietary biomarkers , data on the correlations between food or food compound intake and biomarker concentrations reliability , reproducibility , repeatability , intra - subject , inter - subject , within - subject , between - subject. full - record citations from the wos were downloaded in the bibtex format ( http://www.bibtex.org/ ) and handled with bibdesk , an open - source bibliography manager for bibtex libraries ( http://bibdesk.sourceforge.net/ ) .", "exposome - explorer 's annotation interface uses a number of features to help complex , heterogeneous , literature - derived data to be easily and systematically translated into organized electronic data . temporal reproducibility of biomarker measurements in an individual is an important characteristic of the biomarker . controlled vocabularies for compounds , foods , experimental methods , specimens , cohorts and units can be created and are fully documented in both the annotation interface and the database . correlations . to compile data on the correlations between specific biomarker measurements and food or dietary compound intake , the compound used to express the concentration is given if it is different from the compound or compound class being measured ( e.g. polyphenols in urine expressed as gallic acid).correlations . to compile data on the correlations between specific biomarker measurements and food or dietary compound intake , a high reproducibility is required when only one sample per subject is available for biomarker measurement , as in most large cohort studies .", "exposome - explorer 's public user interface allows intuitive browsing and searching of almost any data type in the database ( figure 1 ) . data can be retrieved through the quick search functionality or through specific searches offered on the website 's different menu pages . biomarkers menu lists the biomarkers , biospecimens , analytical methods and cohorts documented in the database . full - text for these publications can be accessed via pubmed links or direct publisher urls . for every annotated publication , the totality of collected data including the bibliographic information , detailed subject descriptions , and biomarker data ( concentration values , dietary intake values , correlation values and reproducibility values ) is displayed in a single page . the data search menu lists all biomarker concentration values and allows searches over all data fields . these correlations can be searched according to the food type , dietary compound , or biomarker .", "ruby on rails is a web framework which employs the model - view - controller ( mvc ) design pattern . website global search is implemented using the wishart 's unearth gem , which uses elasticsearch indexing ( https://www.elastic.co/ ) . hierarchical associations of records ( trees ) are implemented as a nested set model inside a single database column of the tables using the rails gem ancestry ( https://github.com/stefankroes/ancestry ) . the exposome - explorer data is stored in a mysql relational database ( http://www.mysql.com/ ) . the web interface is built with the bootstrap front - end framework ( http://getbootstrap.com/ ) . highly diverse units and their conversions are transparently handled with the phys - units library ( https://github.com/masa16/phys-units/ ) , which is a ruby implementation of the gnu units software ( http://www.gnu.org/software/units/ ) .", "to date , data from a total of 480 publications have been entered into this first release of exposome - explorer . this includes 10 510 concentration values for 692 biomarker entries , among which 8,861 concentrations correspond to 488 single dietary and pollutant biomarkers . almost half of the concentrations are related to fatty acids , followed by carotenoids and polyphenols . with regard to pollutant biomarkers , about two thirds of the concentration data in exposome - explorer approximately one third of these biomarkers are dietary biomarkers ( table 1 ) . for dietary biomarkers , some concentration data are also available for other biospecimens such as hair , nails , adipose tissue or breast milk . are related to pcbs and pbdes , followed by pahs , pcdd / fs and phthalates .", "overall , we believe exposome - explorer will help in the generation of hypotheses for discovery of new biomarkers to be tested in the laboratory . it should also help in evaluating the performance of existing biomarkers and integrating exposure data based on biomarkers with data collected with other technologies . exposome - explorer currently contains the most complete and comprehensive information on exposure biomarkers ever compiled from peer - reviewed literature . exposome - explorer should contribute to the translation of the exposome into practice in epidemiological research . it is also the first publicly available , web - enabled database specifically dedicated to exposure biomarkers . looking both at the range of studied compounds and the number of corresponding studies , exposome - explorer also allows users to quickly identify poorly studied exposures or biomarkers that may require further work for validation . plans for future enhancements to exposome - explorer include its extension to other categories of exposures ( nutritional status , pesticides , occupational exposures ) , the addition of other types of biomarkers ( dna and protein adducts ) , and the inclusion of more information characterizing biomarkers such as their half - life and other pharmacokinetic parameters . plans are also being made to add putative or non - validated biomarkers identified in ( pre)clinical studies , but never measured in populations .", "european commission : exposomics fp7-kbbe-2012 ; nutritech fp7-kbbe-2011 - 5 ; joint programming initiative foodball 201417 ." ]

[ "this paper concentrates on protein glycosylation in a. fumigatus , which will be discussed with respect to the enzymatic pathways involved and their functional importance . furthermore , the utility of a. fumigatus as a model for glycosylation during development of multicellular eukaryotes will be outlined . therefore , a more profound understanding of the mechanisms of cell wall biosynthesis in a. fumigatus would help to improve the efficiency of drug therapies , especially for drugs which target the cell wall . therefore , investigation of glycosylation in the multicellular fungus a. fumigatus not only helps understand the mechanism of cell wall synthesis in this species but also provides insights into the role of glycosylation in the development of multicellular eukaryotes . our knowledge of protein glycosylation comes mainly from investigation of the model yeast s. cerevisiae and of mammalian cells .", "the cell wall of a. fumigatus is mainly composed of -1,3-glucans that are highly branched with -1,6 linkages . together increased chitin synthesis has been known as an important compensatory response to cell wall stress both in s. cerevisiae and filamentous fungi [ 2226 ] . in s. cerevisiae , the cell wall is required to maintain cell shape , which is essential for the formation of a bud and hence cell division . they constitute a three - dimensional network with a large number of nonreducing ends , to which chitin , galactomannan , and -1,3/1,4-glucan are covalently anchored . the cell wall is mainly coated with gpi proteins , which contain n- and o - glycans derived primarily from the process of glycosylation [ 11 , 17 ] . these observations demonstrate that n- and o - glycosylation are important for cwi sensing and thus important for cell wall biogenesis and polarized growth in yeast . therefore , the a. fumigatus cell wall stress sensor molecule remains to be identified and investigated .", "the precursor of all mannose residues found in galactomannan , glycoprotein , and gpi anchor in a. fumigatus is gdp - mannose . pmi deficiency is the cause of carbohydrate - deficient glycoprotein syndrome type ib ( cdg - ib , omim 602579 ) in humans , but the clinical symptoms and aberrant glycosylation can be corrected with dietary mannose supplements . in a. fumigatus , pmi activity is essential for viability and plays a central regulatory role in both glycosylation and energy production . deletion of the a. fumigatus pmi1 gene leads to uncoupling of the link between energy production and glycosylation and accumulation of man-6-p , which then results in defects in cell wall integrity , conidiation , and morphology . although extracellular mannose can rescue the growth of pmi deficient mutants in a. fumigatus , both lower and higher concentrations of mannose lead to a reduction in the levels of -glucan in the cell wall and an accumulation of man-6-p . the interconversion of man-6-p and fru-6-p catalysed by pmi is the first committed step in the synthesis of man - containing sugar chains and provides a link between glucose metabolism and mannosylation .", "this information would be key to understanding the complex compensatory mechanisms participating in cell wall biosynthesis in a. fumigatus , which would serve as a basis to develop new antifungal therapies , as well as help to elucidate the molecular mechanism of human diseases associated with defects in glycosylation . although the phenotypes associated with different n - glycosylation mutants vary , the finding that all of these mutants exhibit phenotypes associated with cell wall defects , abnormal polarization , and morphological changes can all be explained by this proposed model . obviously , more investigations are needed to identify and characterize all of the proteins affected by n - glycosylation in a. fumigatus . the most complete understanding of biosynthesis of the lipid bound precursor has been obtained from s. cerevisiae and from mammals . as far as it is known , the corresponding reactions proceed almost identically in other eukaryotes . subsequently , the dol - pp - linked glc3man9glcnac2 is transferred as a whole to an asparagine residue within an n - x - t / s consensus sequence of a nascent peptide , which is catalyzed by the oligosaccharyltransferase ( ost ) , and then the n - glycosylated proteins are modified in a species - specific manner and transferred through the secretory pathway to the cell surface where they either get exported or anchored to the plasma membrane , to the extracellular matrix , or to the cell wall ( figure 1 ) . these results show that the afams1 gene is required for morphogenesis and cellular function in a. fumigatus . this type of glycoprotein has been intensively studied in many model systems from yeast to human cells with respect to their structure , biosynthesis , and function .", "mutations in human pomt1 , a homologue of the yeast pmt4 , cause walker - warburg syndrome ( wws ) , which is characterized by severe congenital muscular dystrophy , neuronal migration defects , and structural abnormalities of the eye . targeted deletion of pomt1 in mice results in embryonic lethality due to defects in the formation of the reichert 's membrane , the first basement membrane to form in the embryo . further investigation of the pmt mutants will be helpful for understanding their molecular mechanism , which will not only increase our understanding of the function of o - mannosylation in a. fumigatus , but also may deepen our understanding of the molecular basis of the human walker - warburg syndrome ( wws ) which features mutations in pomt1 , a homologue of a. fumigatus pmt4p , and results in a failure of polarized growth during neuronal migration . however , it has also been discovered in one bacterial species ( mycobacterium tuberculosis ) . in mammalian cells , the o - mannosylation most likely occurs in all animals , with the exception of nematodes ( e.g. , caenorhabditis elegans ) ; it is also not detected in plants ( arabidopsis thaliana , oryza sativa ) . is present , namely , oma1 , oma2 , and oma4 . deletion of oma2 , as well as simultaneous deletion of oma1 and oma4 is lethal .", "indeed , this is the first report that a deficiency in gpi - anchor synthesis does not lead to a temperature - sensitive or conditional lethal phenotype in microbes , which provides an opportunity to identify the basic function of gpi anchoring in fungi . gpi anchoring is a conserved glycosylation process in eukaryotes , which enables many cell surface proteins such as cell surface enzymes , receptors , and adhesion molecules to be covalently anchored to the cell membrane . five of them are homologues of putative gpi - anchored yeast proteins that have been shown to play a role in cell wall morphogenesis . in contrast to mammals , gpi anchor synthesis is essential in s. cerevisiae . in s. cerevisiae , many gpi - anchored proteins are known to be involved in morphogenesis and cell wall organization .", ", the framework of the biosynthetic pathways of glycosylation in a. fumigatus has been delineated . moreover , the molecular mechanisms by which glycosylation plays a role in morphogenesis and development of a. fumigatus are vaguely understood . although investigations of the model yeast and mammalian cells have been very useful in elucidating the biochemical features of protein glycosylation , these investigations at the cellular level can not reflect the complicated functions of glycosylation in the development of multicellular eukaryotes . therefore , the future direction would be looking for those key proteins that are affected by glycosylation and identifying the signal transduction pathways that link glycosylation and development , through genetic , biochemical , cell biological , and proteomic studies . it remains unclear where is the evolutionary origin of glycosylation , what is the basic function of glycosylation at the early stages of evolution , and how glycosylation is regulated ." ]

[ "in patients with hf , increased raas contributes to the pathogenesis , and ace inhibitors reduce the activity of the raas by inhibiting the production of angiotensin ii . subsequently , the assessment of treatment with lisinopril and survival study5 investigated whether ace inhibitors had favourable effects on the outcome of patients with hf with reduced ef in a dosedependent manner . in this trial , two benchmark randomized controlled trials , namely the cooperative north scandinavian enalapril survival study7 and the studies of left ventricular dysfunction treatment trial,8 demonstrated that ace inhibitors reduce mortality and improved new york heart association class , exercise capacity and cardiac function in patients with hf with reduced ef .", "angiotensin receptor blockers would be expected to exert beneficial effects on the treatment of hf through the stronger inhibition of angiotensin ii than ace inhibitors . doserelated increase in the development of adverse events in patients receiving both benazepril and valsartan is observed , which is inconsistent with the findings of previous studies using very highdose arb.12 , 13 \n in view of these findings , arbs are considered second choice in patients with hf with reduced ef who are not tolerated to ace inhibitors or mineralocorticoid receptor antagonists in the current guidelines . common side effects of arbs are well known and include hyperkalaemia , hypotension , and impaired renal function , similar to ace inhibitors ; however , arbs are believed to be better tolerated than ace inhibitors .", "moreover , a recent metaanalysis15 suggested that combination therapy of an ace inhibitor with an arb should not be advocated in patients with hf , because the combination does not seem to reduce mortality or hospitalization and was associated with more adverse events . because of the different mechanism of action of ace inhibitors and arbs in blocking the raas , combination therapy of an ace inhibitor and an arb was thought to be attractive for the treatment of hf as well as the monotherapy with an arb . in the valsartan heart failure trial,14 the addition of valsartan to conventional therapy for hf resulted in a significant decrease in cardiovascular events compared to placebo ( relative risk 0.87 , 97.5% ci 0.770.97 , p = 0.009 ) ; however , a post hoc analysis indicated increased mortality and complications in the subgroup taking an ace inhibitor , valsartan , and a betablocker . as described earlier , an ace inhibitor , lisinopril , or an arb , losartan , at high dose produced better clinical outcomes in patients with hf compared with each at low dose but did not decrease mortality significantly.5 , 6 on the other hand , he et al . reports that supramaximal dose of benazepril or valsartan improves not only cardiac function but also survival in patients with dcm compared with the low dose of each medication,16 which indicates that ace inhibitors or arbs at supramaximaldose might produce better outcomes in patients with ef compared with those at high dose ( target dose ) . the sample size is small , but the followup period is long enough to detect the statistical difference in the outcomes of hf among the treatment groups . they should be confirmed with doubleblind multicentre randomized controlled studies . these unique findings are derived from a singlecentre prospective , randomized , and controlled trial .", "recently , ivabradine17 and lcz696 , a combination of the new neprilysin inhibitor sacubitril ( ahu377 ) with valsartan,18 have attracted attention for the treatment of hf . if the efficacy and safety of supramaximaldose valsartan were well acknowledged in this field , it would be helpful to investigate the appropriate dose of lcz696 more precisely .", "" ]

[ "these populations were identified from 4 major linguistic groups namely , austro - asiatic ( aa ) , tibeto - burman ( tb ) , indo - european ( ie ) and dravidian(dr ) spanning 6 geographical regions of habitat ( n , north ; ne , north - east ; w , west ; e , east ; s , south ; c , central ) and different ethnic groups ( lp , large population , caste ; ip , isolated population , tribes ; sp , special population , religious groups ) . the indian genome variation consortium ( igvc ) project , an initiative of the council for scientific and industrial research ( csir)was set up to develop a database of genomic variations in indian population for predictive marker discovery in complex diseases such as diabetes , asthma , neuropsychiatric , infectious and cardiovascular disorders , response to drugs , etc . the phase i of the project was conducted to determine the extent of genetic differentiation in india . toward this genotype data of 405 snps from 75 genes and 4.2 five genetically distinct clusters were identified and a set of 24 populations that represent these clusters were selected for the phase ii of the project . in the phase ii , 3824 snps from 834 candidate gene as well as 50 000 ( affy 50 k array ) genome wide neutral markers this initiative lays the foundation for the integration of global genotype - to - phenotype data ( 6 ) with indian population data and development of a federated database . mb contiguous chromosome 22 regions were studied in 55 contrasting populations ( 4 , 5 ) . further , stringent mating patterns have led to the existence of several endogamous populations , which makes it an important resource for mapping genes ( 3 ) .", "we report that a large fraction of genes are implicated in cardiovascular , metabolic , cancer and immune system - related diseases . thus , the igvc data provide a basal level variation data in indian population to study genetic diseases and pharmacology . \n distribution of markers in 2.41 mb region in human chromosome 1 from igvc data is displayed along with annotation data from different resources . integrated annotation data from primary sources like ncbi , ucsc and hapmap have been linked with variation data from different ethnic populations in india . distribution of markers in 2.41 mb region in human chromosome 1 from igvc data is displayed along with annotation data from different resources .", "the browser implements one of the widely used platform - independent genome annotation viewer generic genome browser ( gbrowse v1.69 ) , developed by stein et al . gbrowse is a combination of database and interactive webpage for displaying genomic information along with providing data interoperability across systems running the same software . integrated annotation data from primary sources like ncbi , ucsc and hapmap have been linked with variation data from different ethnic populations in india . compiled data processed into gff format and complete human genome sequence as plain text files were loaded into mysql relational database management system using a script of gbrowse . online data analysis plugins allows text dumps of visible features using a number of standard formats and also facilitates the download of sequence corresponding to selected region . it allows researchers to upload their own data in gff format and view it along with data available in igvbrowser", "the interactive web browser , igvbrowser , has been created as a central repository for the current and future dataset on indian populations and is being made accessible in the public domain . a possible integration of igvbrowser with hgvbaseg2p ( 20 ) can enable researchers for cross study comparison among different populations of the world for disease gene association study . frequency profiles of markers on disease or drug - related genes that have been generated through the igvc are being used to identify at - risk chromosomes , founders , ld - based mapping , tracing history of diseases in pharmacogenetics as well as reference populations for mapping relatedness ( 3,4,5,819 ) . indian genome variation data would be enormously useful for the dissection of common complex diseases and in pharmacogenomics studies .", "funding for igvbrowser and open access charge is provided by european community 's seventh framework programme ( fp7/2007 - 2013 ) under grant agreement number 200754the gen2phen project . indian genome variation project was funded by the council for scientific and industrial research programme cmm0016 and sip0006 ." ]

[ "additionally , th1 , th2 , th17 , and cd4cd25foxp3 tregs differentiation were detected in pbmc cultures exposed to gal-9 . herein , we investigate serum gal-9 levels in chinese patients with cad , and the severity of coronary arteries stenosis was evaluated by gensini score . furthermore , ifn- , il-4 , il-17 , tgf-1 , high - sensitivity c - reactive protein ( hs - crp ) , and the classical atherosclerosis risk factors were evaluated . in addition , several findings strongly support the original experimental observations that gal-3 plays an important role in the underlying heart failure ( hf ) processes and that elevation of gal-3 is associated with disease progression and poor outcome in hf [ 3739 ] . hence , these findings have showed that cd4 t cell subpopulations play an important role in the initiation and progression of atherosclerosis . thus , it is reasonable to postulate that gal-9 may be involved in atherosclerosis based cad .", "they were divided into four groups : ( 1 ) the control group , which consisted of 50 subjects with nca ( 28 men and 22 women , mean age 56.7 11.7 ) ; ( 2 ) sap group ( 25 men and 15 women , mean age 62.4 10.0 , inclusion criteria : typical chest discomfort that was associated with horizontal or downsloping st - segment depression > 1 mm in an exercise test ) ; ( 3 ) nsteacs group ( 60 men and 30 women , mean age 60.6 9.9 , which included unstable angina pectoris ( uap ) and non - st - segment elevation myocardial infarction ( nstemi ) , inclusion criteria : chest pain at rest with definite ischemic electrocardiographic changes , t - wave inversions and/or st - segment changes , or typical ischemic chest pain which persists for more than 20 min , elevated serum myocardial necrosis markers concentration and dynamic evolution , but not the typical st - elevation electrocardiogram ) ; ( 4 ) stemi group ( 36 men and 16 women , mean age 54.1 12.3 , inclusion criteria : myocardial infarction that was confirmed by a significant increase of serum creatine kinase mb , troponin i levels , and elevation of st - segment ) the stenosis severity of cad was assessed by gensini score as previously described . in the ami group , independent factors were sex , age , ctni , and the metabolic - related variables including bmi , fpg , lipid profiles , and hs - crp . to determine the independent predictors for the presence and severity of cad , all the conventional risk factors associated with cad were tested in multiple stepwise regression analysis . 2013 with suspected or established cad were recruited , including 149 males and 83 females . . furthermore , all participants underwent coronary angiography after admission and completed a standardized questionnaire about previous and present illness , medication history , and smoking status . cardiovascular - interrelated factors , such as age , body mass index ( bmi ) , gender , and ejection fraction ( ef ) were estimated via physical examination , ultrasonic cardiography ( ucg ) , and electrocardiogram ( ecg ) , respectively .", "the prevalence of smoking and the levels of tg , lipoprotein(a ) , fpg , creatinine , hs - crp , and ctni were significantly higher in patients with cad compared to patients with nca group ( all p < 0.05 ) . compared with stemi group , patients in sap and nsteacs groups showed markedly higher hdl - c levels and age and lower levels of lipoprotein(a ) , fpg , hs - crp , and ctni ( all p < 0.01 ) . compared to patients with sap , however , other biochemical results , including tc , hdl - c , ldl - c , and uric acid , were similar between nca and cad patients . the use of aspirin , -blockers , and statins was rare in patients with acs ( all p < 0.05 ) , whereas the levels of lipoprotein(a ) and hs - crp were markedly higher in patients with acs ( all p < 0.01 ) . a significant increase of creatinine levels was observed in patients with stemi compared with nsteacs group ( p < 0.05 ) and an obvious decrease of uric acid levels was found in patients with stemi compared to sap group ( p < 0.01 ) . interestingly , serum gal-9 levels did not differ significantly between patients with nsteacs and stemi ( p > 0.05 ) , nor was there a difference between the sap and nca groups ( p > 0.05 ; figure 1(b ) ) .", ", we have shown that low serum gal-9 levels are associated with the presence and the severity of coronary arteries stenosis . our observations provide evidence of the role of gal-9 in cad and that gal-9 is an independent negative predictor of acs , which may also at least partially explain the protection of gal-9 against coronary atherosclerotic plaque vulnerability . moreover , gal-9 was found to be independently associated with hs - crp , lipoprotein(a ) , and creatinine . in the present study , we found that participants with cad had lower serum gal-9 levels compared with nca . furthermore , serum gal-9 levels in the acs group were significantly lower than those in the sap or nca group . our data showed that cad patients had lower serum gal-9 levels than those without cad , and gal-9 was independently associated with the gensini score in patients with cad . recently , a large number of clinical experiments have reported that hs - crp is not only a biomarker of inflammations and atherosclerosis , but also a marker of atheromatous plaque vulnerability [ 5254 ] . in our study , patients with acs had higher serum hs - crp levels compared to patients with sap . of note , gal-9 was found to be independently associated with hs - crp . to the best of our knowledge , this is the first study to investigate the relation of serum gal-9 levels with the presence and the severity of coronary arteries stenosis ." ]

[ "therefore , it is very important to select the appropriate drugs and dosage to achieve those objectives . it can be challenging to obtain the deep sedation level required to prevent the patient 's movement while maintaining respiratory and hemodynamic stability . the success of sedation for mri has typically been measured by two factors : the safety of sedation procedure ( lack of adverse events ) and its effectiveness ( completion of diagnostic examination ) . the purpose of this retrospective study is to present our institutional experience with dexmedetomidine in relation to efficacy and related side effects . dexmedetomidine has been used at our institution since 2006 for mri and other noninvasive radiologic procedures . dexmedetomidine is a highly selective adrenoceptor agonist with a distribution half - life of six minutes and an elimination half - life of two hours . sedation is often required in young children in order to obtain good diagnostic cross - sectional imaging like computed tomography scan ( ct scan ) and magnetic resonance imaging ( mri ) .", "collection of quality assurance data includes patient demographics , adverse events , physiologic variables , drug dosages , the time required to sedate the patient , time needed to obtain the imaging study , and recovery time . after approval by the institutional review board , we conducted a retrospective analysis of all patients who received sedation for mri from july 2007 to december 2012 . the goal was to achieve a minimum ramsay sedation score ( rss ) of 4 as assessed by a sedation nurse . , intravenous dexmedetomidine was bolused at 2 g / kg over 10 minutes followed by a continuous infusion of 1 g / kg / h . most of the patients were sedated by the end of the bolus ; if not , a second bolus of 2 g / kg was repeated over another 10 minutes prior to the start of the maintenance infusion . discharge time of bradycardia and hypotensive patients was compared with normal cohorts using the t - test . the entire study cohort was divided into three groups depending on dexmedetomidine bolus and additional medications received . monitoring was continued until the patient was awake with a minimum aldrete score of 9 points , and the patient has tolerated clear liquids prior to discharge [ 19 , 20 ] . all the parents were provided with written discharge instructions and a direct phone number for further assistance or to report any adverse effects . peak onset of the sedation was defined as the time from the start of the loading dose to achievement of a ramsay score of 4 . patients who continue to move after the second bolus or while the procedure is in progress , can compromise the quality of imaging and were given additional medications like midazolam or fentanyl as per physician discretion .", "the precise etiology of the bradycardia observed in this analysis can not be delineated as electrocardiogram monitoring is known to be significantly distorted by the magnetohydrodynamic ( mhd ) effect and is nondiagnostic within the bore of any mri magnet . the incidence of bradycardia was high in patients in the age range of 13 years compared with the rest of the cohort . the most common indications included seizure disorder , developmental delay and behavioral disorder , autism , and neoplasia . average discharge time among 165 children with bradycardia was longer and statistically significant compared to the other 372 children in the study population without bradycardia ( 99.08 32.57 min versus 89.74 25.54 min , p = 0.0012 , student 's t - test ) . 382 ( 70.2% ) of the total patients received one - time bolus , while two boluses were given to 162 patients ( 29.8% ) . in the population of 544 patients , additional medications ( fentanyl or midazolam ) initial transient hypertension occurred in 137 patients approximately 20 minutes after the dexmedetomidine bolus and lasted for < 15 minutes . in the population of 544 patients , 165 children ( 30.9% ) had heart rates below the age - specific normal awake range during sedation ( based on the published normal of fleming et al . ) . only in 21 children ( 3.9% of total cohort ) did the lowest recorded heart rate fall > 20% below the given baseline average range .", "we conclude and recommend that , from hemodynamics and respiratory perspective , higher dose dexmedetomidine was well tolerated and is effective to use for successful completion of mri , in the majority of pediatric patients . high dose dexmedetomidine is an attractive and effective medication in children for mri sedation . when using high dose dexmedetomidine as the only agent for pediatric mri , it is not unusual to observe heart rate and blood pressure outside the established , dexmedetomidine appears to provide a useful alternative to propofol for procedural sedation in children , with a longer time of recovery but a lower incidence of adverse effects . all of these studies reported that the use of high dose dexmedetomidine as a sole sedative resulted in high quality radiologic imaging with less use of additional rescue medicines . this is a good alternative to propofol for patients with soy and egg white allergy and also in institutions where use of propofol is strictly limited to be used by anesthesiologists . our study also demonstrated that the use of high dose dexmedetomidine as sole agent is effective for mri sedation ." ]

[ "we have studied the tyrosine - tyrosinase reaction in terms of melanin formation and ros scavenging ability of melanin . in a battery of studies , we found radical formation through the enzyme reaction , and discuss the formation mechanism in this paper . for instance , it was reported that tyrosinase - dependent activation of hydroxybenzenes formed reactive compounds including free radical , and some radicals were produced during the tyrosinase reaction and dopa - melanin formation . however , in these few studies , radical species have not been determined . other than oxidative catalysis of substrates by tyrosinase , a few studies on radical formation by tyrosinase have been reported . inhibitor of tyrosinase , which is a pivotal enzyme for melanin synthesis , has become major ingredient of cosmetics [ 1721 ] .", "then 1 mm tyrosine solution was prepared by mixing 5 l of 200 mm tyrosine solution with 5 l of 1 m naoh and 990 l of 0.2 m pb . dmpo was dissolved in ultrapure water to be 4.5 m. the reaction mixture was prepared to contain different activity of tyrosinase , 20 l of 4.5 m dmpo , 60 l of 1 mm tyrosine and 0.2 m pb which was added to adjust a total volume of 200 l . immediately after mixing the mixture was transferred to an esr spectrometry cell , and the esr measurement was started after 45 s. the measurement conditions of esr ( jes - fa-100 , jeol , tokyo , japan ) were as follows : field sweep , 330.80340.80 mt ; field modulation frequency , 100 khz ; filed modulation width , 0.07 mt ; amplitude , 400 ; sweep time , 1 min ; time constant , 0.1 s ; microwave frequency , 9.430 ghz ; microwave power , 45 mw . immediately after mixing the mixture was transferred to an esr spectrometry cell , and the esr measurement was started after 60 s. as a control , the reaction mixture was prepared to contain 100 l of h2o ( ultrapure water ) , 20 l of 10 u/l tyrosinase dissolved in h2o , 20 l of 4.5 m dmpo dissolved in h2o , and 60 l of 1 mm tyrosine dissolved in h2o , and was similarly subjected to esr measurement . tyrosinase was dissolved in ultrapure water to be 100 u/l . immediately before the measurement tyrosinase was diluted to be 10 u/l with ultrapure water or d2o . the reaction mixture was prepared to contain 100 l of d2o , 20 l of 10 u/l tyrosinase ( 90% d2o solution ) , 20 l of 4.5 m dmpo ( 50% d2o solution ) , and 60 l of 1 mm tyrosine ( 99% d2o solution ) . then 1 mm tyrosine solution was prepared by mixing 5 l of 200 mm tyrosine solution with 5 l of 1 m naoh and 990 l of ultrapure water or d2o .", "( st . louis , mo ) ; 5,5-dimethyl-1-pyrroline - n - oxide ( dmpo ) from labotec ( tokyo , japan ) ; deuterium water ( d2o ) from tokyo chemical industry co. , ltd ( tokyo , japan ) . reagents were purchased from the following sources : l - tyrosine , phosphate buffer solution ( pb , ph 6.5 ) and catalase ( from bovine liver ) from wako pure chemicals ( osaka , japan ) ; tyrosinase ( from mushroom ) , and superoxide dismutase ( sod from bovine erythrocytes ) from sigma - aldrich corp .", "then 1 mm tyrosine solution was prepared by mixing 5 l of 200 mm tyrosine solution with 5 l of 1 m naoh and 990 l of 0.2 m pb . dmpo was dissolved in ultrapure water to be 4.5 m. the reaction mixture was prepared to contain different activity of tyrosinase , 20 l of 4.5 m dmpo , 60 l of 1 mm tyrosine and 0.2 m pb which was added to adjust a total volume of 200 l . immediately after mixing the mixture was transferred to an esr spectrometry cell , and the esr measurement was started after 45 s. the measurement conditions of esr ( jes - fa-100 , jeol , tokyo , japan ) were as follows : field sweep , 330.80340.80 mt ; field modulation frequency , 100 khz ; filed modulation width , 0.07 mt ; amplitude , 400 ; sweep time , 1 min ; time constant , 0.1 s ; microwave frequency , 9.430 ghz ; microwave power , 45 mw .", "immediately after mixing the mixture was transferred to an esr spectrometry cell , and the esr measurement was started after 60 s. as a control , the reaction mixture was prepared to contain 100 l of h2o ( ultrapure water ) , 20 l of 10 u/l tyrosinase dissolved in h2o , 20 l of 4.5 m dmpo dissolved in h2o , and 60 l of 1 mm tyrosine dissolved in h2o , and was similarly subjected to esr measurement . the reaction mixture was prepared to contain 100 l of d2o , 20 l of 10 u/l tyrosinase ( 90% d2o solution ) , 20 l of 4.5 m dmpo ( 50% d2o solution ) , and 60 l of 1 mm tyrosine ( 99% d2o solution ) . tyrosinase was dissolved in ultrapure water to be 100 u/l . immediately before the measurement tyrosinase was diluted to be 10 u/l with ultrapure water or d2o . then 1 mm tyrosine solution was prepared by mixing 5 l of 200 mm tyrosine solution with 5 l of 1 m naoh and 990 l of ultrapure water or d2o .", "if o2 and h2o2 are involved in a downstream of the generation process of h and oh , esr signals of dmpo - h and dmpo - oh generated by the tyrosine - tyrosinase reaction were analyzed in the presence of sod , a scavenger for o2 , and catalase , a cleaving enzyme for h2o2 . representative esr spectra obtained from tyrosine - tyrosinase reaction with different activity of tyrosinase are summarized in fig . 1 the proposed mechanism by which h and oh are generated in tyrosine - tyrosinase reaction is illustrated in fig . neither sod ( 1 u/l ) nor catalase ( 1 u/l ) affected the amounts of dmpo - h and dmpo - oh ( data not shown ) , suggesting that neither o2 nor h2o2 is involved in the generation process of h and oh . then to further examine if h2o is a source of h and oh , esr signals of dmpo - h and dmpo - oh generated by the tyrosine - tyrosinase reaction where d2o was used as a major solvent ( 94% d2o solution ) were compared with those where h2o was used as a solvent . as shown in fig . 2 ," ]

[ "we describe our experience regarding a large - bowel obstruction caused by phytobezoar in a patient with a transplanted kidney . bezoars are masses formed by the condensation of debris or stomach contents in the gastrointestinal tract . there are four major types of bezoars : a trichobezoar consists of hair , a phytobezoar of vegetable and fruit residues , a lactobezoar is formed from dairy products , a pharmacobezoar is caused by medications . it occurs more frequently in the small intestine , particularly in the terminal ileum and jejunum .", "a 39-year - old man was admitted to our hospital for constipation , distension , and severe acute abdominal pain in the lower left quadrant . based on the ct findings , particularly mottled gas pattern and encapsulated wall of the mass , we made the diagnosis of phytobezoar . hence , because of acute intestinal obstruction and to avoid peritonitis , the patient underwent urgent exploratory laparotomy . ( b ) the mean attenuation value of the intraluminal mass is about 10.21 hu the obstructive intraluminal mass in the sigmoid colon was identified ( approximately 4 4 cm in size ) and manually broken down with evacuation of the obstructive material along with large amounts of liquid fecal material .", "plain abdominal radiography and ct scan are used for radiological evaluation of the patients presenting with intestinal obstruction . conservative management is considered in uncomplicated cases of colonic bezoars and consist of digital evacuation , enemas and manual disimpaction . phytobezoars are concretions of poorly digested fruit and vegetable fibres that are found in the alimentary track and are mostly composed of indigestible cellulose , tannin , and lignin from ingested vegetables and fruits . simple abdominal x - ray may reveal air - fluid levels associated with mechanical obstruction , and occasionally it is possible to see the outline of bezoar , which is difficult to differentiate from abscess or feces within the colon . on abdominal ct , 89% of bezoars appear as spherically - shaped masses containing air - fluid levels . if treatment is delayed , colonic bezoars can be complicated by intestinal obstruction and perforation with consequent peritonitis . although endoscopy has an acceptable success rate and fewer complications than surgery , surgical approach is mandatory in case of endoscopic treatment failure , sigmoid volvulus , hematochezia , intestinal obstructions , perforations , or peritonitis .", "bezoar is a rare disorder , however , it must be suspected in case of mechanical intestinal obstruction . our case underlined the importance of early detection and removal of a bezoar to prevent complications such as obstruction , perforation , or peritonitis .", "", "" ]

[ "i , the cluster including the javanese jkt-6423 strain ; ii , the cluster specific to the jkt-6969 and jkt-7043 strains ; iii , the cluster including chinese bavs ; iv , the cluster including the vietnamese 02vn018b strain ; v , the cluster including the vietnamese 02vn180b strain . mosquito collection sites in vietnam . * length , length of each segment in the reference sequence of banna virus ( bav ) from refseq ( nc_004198 , nc_004200nc_004204 , nc_004211 , nc_004217nc_004221 ) ; aligned area , the fragment used to make the alignment and phylogenetic tree . five bav strains were isolated in ha tay and quang bing provinces ( figure 1 ) in vietnam from culex annulus and cx . segments 11 and 12 of the 2 vietnamese strains 02vn178b and 02vn018b were included in cluster iii with chinese bavs .", "we report isolation of bav in vietnam . the nucleotide sequences of the vietnamese isolates genomic rna segments diverged into 2 phylogenetically distant clusters . we also believe that bav is a good candidate for the differential diagnosis of viral encephalitis and meningitis cases of unknown origin in tropical and subtropical asia , where culex mosquitoes are abundant ." ]

[ "this study was undertaken with the purpose to determine if patients with schizophrenia on clozapine monotherapy have higher fasting levels of agrp compared with healthy control . in order to provide more accurate measurements , this is the first study to investigate such combination of these parameters in subjects with schizophrenia treated with clozapine . biochemical and anthropometric measurements were combined with body composition determined using bioelectric impedance analysis ( bia ) , which provides accurate measurements of body fat , lean mass and body water ( bosy - westphal et al . clozapine remains an ultimate option for patients with treatment resistant schizophrenia ( kane 2012 ) . efficacy of clozapine against positive symptoms of schizophrenia was confirmed in numerous studies and meta - analyses ( chakos et al . however , treatment with clozapine is associated with very severe metabolic side - effects ( newcomer 2005 ) .", "data for 24 european caucasian adult hospitalized patients with paranoid schizophrenia ( 295.30 according to dsm - iv , f20.0 according to icd-10 ) was included into the study . control group was 24 healthy subjects and was gender- and age - matched with patients in the clozapine group . these subjects were on clozapine monotherapy for at least two months prior the assessments with a minimum dose of 100 mg / day . elisa assays were performed using commercial kits ( intra - assay : cv < 10 % , inter - assay : cv < 12 % ) manufactured by raybiotech ( usa ) , according to protocol provided by its manufacturer ( all samples were 2-fold diluted ) . metabolic syndrome and abdominal obesity were defined according to international diabetes foundation ( idf ) criteria ( alberti et al . levels of agrp were measured in blood serum using elisa ( enzyme - linked immunosorbent assay ) method . prior to assays , insulin resistance was estimated from fasting glucose and insulin results by homeostasis model assessment and quicki index , using the formula : homa1-ir = ( fasting plasma glucose [ mg / dl ] insulin [ mu / l])/405 . homa2-ir index was calculated using a calculator downloaded from http://www.dtu.ox.ac.uk .", "there were no significant differences for agrp levels between subjects with or without excess body fat ( based on fmi value ) ( p = 0.59 ) , idf - defined metabolic syndrome ( p = 0.33 ) , smokers and non - smokers ( p = 0.15 ) , subjects with bmi < 25 kg / m and with bmi 25 kg / m ( p = 0.09 ) , subjects with and without impaired fasting glucose ( p = 0.16 ) , subjects with and without abdominal obesity ( p = 0.11 ) , subjects with and without dyslipidemia ( p = 0.09 ) , and subjects with and without homa-1ir defined insulin resistance ( p = 0.07 ) . in the control group there were no significant differences for agrp levels between subjects with or without excess body fat ( based on fmi value ) ( p = 0.20 ) , idf - defined metabolic syndrome ( p = 0.44 ) , smokers and non - smokers ( p = 0.35 ) , subjects with bmi < 25 kg / m and with bmi 25 kg / m ( p = 0.12 ) , subjects with and without impaired fasting glucose ( p = 0.36 ) , subjects with and without abdominal obesity ( p = 0.10 ) , subjects with and without dyslipidemia ( p = 0.37 ) , and subjects with and without homa-1ir defined insulin resistance ( p = 0.13 ) . in the whole study group there was no significant differences for agrp levels between subjects with or without excess body fat ( based on fmi value ) ( p = 0.30 ) , idf - defined metabolic syndrome ( p = 0.43 ) , smokers and non - smokers ( p = 0.29 ) , subjects with bmi < 25 kg / m and with bmi 25 kg / m ( p = 0.39 ) , subjects with and without impaired fasting glucose ( p = 0.29 ) , subjects with and without dyslipidemia ( p = 0.11 ) , and subjects with and without homa-1ir defined insulin resistance ( p = 0.33 ) . there was a significant difference for agrp levels between subjects with or without abdominal obesity ( 13.466.50 [ 95 % ci : 9.0917.83 ] vs. 16.926.93 [ 95 % ci : 12.7321.11 ] pg / ml , t = 1.80 , p = 0.04 ) . for group of patients treated with clozapine the mean age was 38.812.6 and 39.912.3 for the control group ( p = 0.62 ) . in both groups there were 12 men and 12 women . in the clozapine group 12 subjects smoked cigarettes and 8 in the control group ( p = 0.38 ) . 1mean fasting agrp serum levels [ pg / ml ] in subjects on clozapine and in the control group ( p = 0.37 ; horizontal bars indicate means ) .", "the main objective of the present study was to find out whether there is a significant difference in fasting serum levels of agrp peptide between patients with schizophrenia on clozapine monotherapy and age- and sex - matched healthy controls . no data are available on the effect of clozapine on blood agrp concentrations in humans . dual - energy x - ray absorptiometry ( dxa ) should be used to measure body composition and adipose tissue mass more accurately . due to complex structure of interactions between anabolic and catabolic neuropeptides , a longitudinal study comparing these interactions are crucial for understanding mechanisms of treatment - induced weight gain . these may indicate the effect of leptin on the expression of agrp , but require further studies ." ]

[ "a commonly used approach is to identify the phenotype - associated recurrent mutations in the study group . due to the data size burden of ngs output , profiling the mutations associated with a certain phenotype or prognosis in a study group by a researcher who does not have a bioinformatics background or facilities is very difficult . currently , there is no user - friendly tool supporting methods for the detection of recurrent or phenotype - specific mutations . in this study , in order to support the definition of recurrent mutations or phenotype - specific mutations from ngs data of a group of cancers with diverse phenotypes , we aimed to develop a user - friendly tool , named mutation arranger for defining phenotype - related snv ( map ) . recently , a number of mutation calling tools , such as varscan , genome analysis toolkit , and mutect , have been developed to detect single - nucleotide variants ( snvs ) or indels from ngs data . however , snv calling from a single cancer case is not the final step for defining clinically meaningful mutations . to define the pathogenic snvs in human cancers , along with the well - known driver mutations , the novel mutations identified by ngs will be useful for predicting the prognosis and molecular characterization of cancers [ 8 , 9 ] . the recent development of next - generation sequencing ( ngs ) technologies has revolutionized the speed and throughput of dna sequencing , which facilitates the discovery of new driver mutations . it is widely accepted that mutation is the main causal factor for diverse tumorigenesis [ 1 , 2 ] .", "map software was designed as a standalone program , compatible in microsoft windows environments with a user - friendly graphic interface , and compiled codes of map can be easily installed . the major steps of map are as follows . \n - generating mutation summary metrics in study subjects- determination of recurrent mutations by frequency- determination of phenotype - specific mutations by association test- graphical illustration of user - selected mutations \n - generating mutation summary metrics in study subjects - determination of recurrent mutations by frequency - determination of phenotype - specific mutations by association test - graphical illustration of user - selected mutations this functionality supports detection of the recurrent mutations in study subjects and identification of the phenotype - specific mutation that occurs significantly in a certain phenotypic subclass . then , map software represents the user - selected mutations graphically in the ' visualization ' tab . to sort the variants by genomic position , p - value , or frequency , users can use the sort function in the ' analysis result ' tab . 1 ) . once data are loaded , the user can filter the data using the ' analysis options ' tab in map software based on annotation information . by using the sample set and analysis options summary metrics include the mutation status for each sample , total mutation frequency , p - values for differences between phenotype groups based on clinical information , genomic position , reference / observed sequence , and additional information , such as read depth by default . map software also displays more detailed information in summary metrics based on the user - selected ' analysis options . ' in the ' analysis result ' tab , map software provides the frequency- or p - value - based filter function . details of the program download , installation , and analysis procedures are available in the user manual .", "mutation calling files from genome analysis toolkit can be used directly as input files for ' sample descriptor . ' alternatively , manually prepared standard variant call format is also available . annotation information files , such as annovar outputs , can be used as input files for sample descriptor . gsf is a comma - separated values text file that describes the input files , such as gatk output files and annovar output files , and phenotype information .", "when users load the input file , map software displays the sample set information and filter options in the ' source ' tab . if any file is not prepared properly , map software informs the user in the ' sample set files ' tab . after data are loaded , the user can filter the data using the ' analysis option ' tab based on annotation information . these mutation metrics are exported into a comma - separated values text file for further investigation . the additional annotations can be hidden using the snp filter option in the ' analysis option ' tab . based on user - selected filters in the ' analysis options ' tab , summary metrics represent additional annotation information , such as gene name , function , known variant , and amino acid change .", "phenotype - specific mutations that occur more frequently in one of two clinical conditions ( e.g. , drug - responder vs. non - responder ) are determined by chi - square test under the user - defined significance level . map also defines the phenotype - specific mutations using the mutation metrics and phenotype information . in the ' analysis result ' tab , map software defines the recurrent mutations in study subjects by frequency . the frequency threshold can be determined arbitrarily by the user in the ' frequency filter ' function .", "the graphic user interface is implemented in the software for users to easily handle large - scale data or access the analysis result ( fig . 2b and 2c ) . the recurrent or phenotype - specific mutations can also be demonstrated visually in heat - map style . for example , the left and right of the heat - map represent the sample name and mutational spectrum , respectively .", "map is a user - friendly program with multiple functions that supports the determination of recurrent or phenotype - specific mutations and provides graphic illustration images to the users . its operation environment , microsoft windows , enables more researchers who can not operate linux to define clinically meaningful mutations with ngs data from cancer cohorts ." ]

[ "lv systolic and diastolic dysfunction in type 2 diabetes and arterial stiffness might partially be due to underlying factors , like overweight , hypertension , insulin resistance , or previous cardiovascular events ( 19 ) . linear regression analyses , adjusted for age and sex , were performed to assess associations of glucose status and arterial stiffness with markers of lv systolic and diastolic dysfunction at follow - up . for investigation of changes in markers , lv systolic and diastolic dysfunction according to glucose status or arterial stiffness , we adjusted all models for baseline values of these markers ( models assessing e / e adjusted for baseline la volume index ) . a set of three markers of lv diastolic dysfunction was determined : la volume index , lv mass indexed to height to the power of 2.7 ( 14 ) , and the ratio of early ( e ) mitral valve flow to early ( e ) diastolic lengthening velocity ( e / e ) using tissue and pulsed wave doppler assessments . additional analyses , adjusted for age and sex , were performed to investigate whether diabetes duration had an effect on markers of lv systolic and diastolic function . associations of arterial distensibility coefficients , systemic arterial compliance , and arterial compliance coefficients were shown per lower unit to reflect associations with greater arterial stiffness . regression models with arterial stiffness as an independent variable were subsequently adjusted for mean arterial pressure to investigate to what extent these associations were explained by elevated blood pressure .", "echocardiography was performed at baseline and follow - up with the use of an hp sonos 5500 echocardiography system ( 24 mhz transducer ) according to a standardized protocol consisting of two - dimensional , m - mode , and pulsed wave doppler assessments as previously described ( 13 ) . at follow - up , this protocol was expanded with tissue doppler assessments of mitral annular velocities . a set of three markers of lv diastolic dysfunction was determined : la volume index , lv mass indexed to height to the power of 2.7 ( 14 ) , and the ratio of early ( e ) mitral valve flow to early ( e ) diastolic lengthening velocity ( e / e ) using tissue and pulsed wave doppler assessments . incident heart failure was considered present if signs and symptoms were accompanied by lv systolic ( lv ejection fraction < 35% ) and/or diastolic dysfunction ( 15 ) . presence of incident lv diastolic dysfunction ( grade 2 or 3 ) was assessed according to international recommendations ( 16 ) .", "additionally , systemic arterial compliance was determined according to the time - decay method and by calculating the ratio of stroke volume to aortic pulse pressure ( 17 ) . in the present analyses , we primarily focused on previously described ultrasound - derived distensibility coefficients of carotid , brachial , and femoral arteries to assess stiffness of the arterial wall ( 10 ) . carotid - femoral pulse wave velocity was approached by measuring carotid - femoral transit time , adjusted for height in the statistical analyses . augmentation index was determined using applanation tonometry . in a subset of the study population ,", "intraobserver intersession coefficients of variation in 10 individuals ( aged 70.3 3.6 years ) were comparable : 4.2 , 13.1 , 4.1 , and 6.1% for lv ejection fraction , la volume , lv mass , and e / e , respectively . reproducibility of arterial ultrasound measurements at baseline was assessed by calculating intraobserver intersession coefficients of variation as previously described ( 10 ) . at follow - up ,", "for assessment of glucose status , all participants except those with previously diagnosed diabetes underwent a standard 75-g oral glucose tolerance test and were classified into ngm , igm ( impaired fasting glucose and/or impaired glucose tolerance ) , and type 2 diabetes groups according to the 1999 world health organization criteria ( 18 ) . health status , medical history , medication use , and smoking habits were assessed by questionnaires ( 10 ) . waist circumference , blood pressures ( systolic , mean arterial , and pulse pressures ) , and levels of cholesterol , insulin , hba1c , and c - reactive protein were determined as previously described ( 10 ) .", "linear regression analyses , adjusted for age and sex , were performed to assess associations of glucose status and arterial stiffness with markers of lv systolic and diastolic dysfunction at follow - up . regression models with arterial stiffness as an independent variable were subsequently adjusted for mean arterial pressure to investigate to what extent these associations were explained by elevated blood pressure . for investigation of changes in markers , lv systolic and diastolic dysfunction according to glucose status or arterial stiffness , we adjusted all models for baseline values of these markers ( models assessing e / e adjusted for baseline la volume index ) . lv systolic and diastolic dysfunction in type 2 diabetes and arterial stiffness might partially be due to underlying factors , like overweight , hypertension , insulin resistance , or previous cardiovascular events ( 19 ) . additional analyses , adjusted for age and sex , were performed to investigate whether diabetes duration had an effect on markers of lv systolic and diastolic function . associations of arterial distensibility coefficients , systemic arterial compliance , and arterial compliance coefficients were shown per lower unit to reflect associations with greater arterial stiffness . product terms were entered to test for effect modification by sex or medication use at follow - up and for interactions of glucose status with arterial stiffness or prior cardiovascular disease . a secondary purpose of these analyses was to investigate potential residual confounding by these factors .", "a total of 394 individuals in the age range of 5087 years were included in the present analyses , 87 ( 22% ) of whom had igm and 128 ( 32% ) of whom had type 2 diabetes . compared with individuals who were not included , interaction analyses showed that type 2 diabetes was particularly associated with a lower lv ejection fraction in individuals with prior cvd . a longer diabetes duration ( per year ) these individuals were younger and less likely to have type 2 diabetes and had more favorable levels of arterial stiffness and lv systolic and diastolic dysfunction at baseline ( data not shown ) . individuals with type 2 diabetes were younger , had higher bmi and blood pressure , and had greater arterial stiffness and more severe lv systolic and diastolic dysfunction at baseline compared with individuals without type 2 diabetes ( table 1 ) . there was no significant effect modification by sex , use of ace inhibitors , or lipid - lowering , glucose - lowering , or blood pressure lowering medication at follow - up on the associations of glucose status or arterial stiffness with markers of lv systolic and diastolic dysfunction ( p > 0.10 , data not shown ) . characteristics according to glucose status the presence of type 2 diabetes was associated with more severe levels of all markers of lv systolic and diastolic dysfunction : lv ejection fraction , la volume index , lv mass index , and e / e ( table 2 ) .", "the presence of type 2 diabetes was associated with more severe levels of all markers of lv systolic and diastolic dysfunction : lv ejection fraction , la volume index , lv mass index , and e / e ( table 2 ) . individuals with type 2 diabetes had a 3.71 ml / m higher la volume index , 5.86 g / m higher lv mass index , and 1.64 higher e / e. these associations were attenuated after adjustment for baseline markers of lv systolic and diastolic dysfunction , but type 2 diabetes was still significantly associated with a higher lv mass index ( 3.41 g / m ) and e / e ( 1.43 ) . individuals with igm compared with those with ngm had a 2.93 g / m higher lv mass index , independent of baseline lv mass index . interaction analyses showed that type 2 diabetes was particularly associated with a lower lv ejection fraction in individuals with prior cvd . after adjustment for age and sex , lv ejection fraction at follow - up was 2.98% lower in individuals with type 2 diabetes at baseline compared with that in subjects with ngm . adjustment for hba1c levels or insulin resistance diminished the associations of type 2 diabetes with lv ejection fraction and la volume index . associations between type 2 diabetes and lv mass index were attenuated after adjustment for waist circumference . markers of lv systolic and diastolic dysfunction at follow - up according to baseline glucose status ( ngm = reference ) associations of type 2 diabetes with markers of lv systolic and diastolic dysfunction were largely independent of blood pressure , lipid levels , renal function , c - reactive protein , and coronary artery disease ( supplementary data table a ) .", "carotid - femoral transit time was measured in a subset of 178 individuals , and lv ejection fraction was 0.14% lower with every second shorter carotid - femoral transit time , though not significantly ( p = 0.13 ) . a higher aortic augmentation index was the only marker of arterial stiffness that was significantly associated with lv systolic dysfunction : lv ejection fraction was 0.21% lower with every percentage point higher aortic augmentation index . greater stiffness of carotid , brachial , and femoral arteries , measured as lower distensibility coefficients , was associated with higher levels of la volume index , lv mass index , and e / e ( table 3 ) . lower compliance coefficients of brachial and femoral arteries , as well as a higher young elastic modulus or pulse pressure , were similarly associated with more severe lv diastolic dysfunction ( supplementary data table b ) . every 10 kpa lower brachial artery distensibility coefficient was associated with a 0.43 ml / m higher la volume index and a 0.09 higher e / e. every 10 kpa lower femoral artery distensibility coefficient was associated with a 0.80 ml / m higher la volume index , a 0.91 g / m higher lv mass index , and a 0.09 higher e / e. these associations were independent of mean arterial pressure , except for associations with e / e. after adjustment for baseline markers of lv diastolic dysfunction , 10 kpa lower distensibility coefficients of carotid , brachial , and femoral arteries remained significantly associated with a 0.29 , 0.38 , and 0.73 ml / m higher la volume index , respectively .", "there was no interaction between glucose status and arterial distensibility coefficients in their associations with lv systolic and diastolic dysfunction ( p values for interaction > 0.10 ) . figure 1 shows the associations of glucose status and sd scores of arterial stiffness ( measured as femoral artery distensibility coefficients ) with sd scores for all four markers of lv systolic and diastolic dysfunction , adjusted for age and sex . there was no significant effect modification by sex , use of ace inhibitors , or lipid - lowering , glucose - lowering , or blood pressure lowering medication at follow - up on the associations of glucose status or arterial stiffness with markers of lv systolic and diastolic dysfunction ( p > 0.10 , data not shown ) . associations of arterial stiffness with lv mass index and e / e did not change significantly either after adjustment for glucose status , despite a loss of statistical significance . associations of glucose status with la volume index , lv mass index , and e / e hardly changed either after adjustment for arterial stiffness . furthermore , each sd higher arterial stiffness score was associated with a 0.14 sd higher la volume index after adjustment for age and sex . standardized associations of impaired glucose metabolism ( black bars ) , type 2 diabetes ( light gray bars ) , and lower femoral artery distensibility coefficients ( dark gray bars ) with markers of lv systolic and diastolic dysfunction , adjusted for age and sex ( left half of each histogram ) and , additionally , for each other ( right half of each histogram ) .", "this study shows that both glucose status and arterial distensibility coefficients were prospectively associated with more severe lv diastolic dysfunction . to conclude , the presence of type 2 diabetes and the presence of arterial stiffness are both associated with deterioration of lv diastolic dysfunction . furthermore , associations of glucose status and arterial stiffness with lv diastolic dysfunction were largely independent of each other and indicated a deterioration of lv diastolic dysfunction compared with baseline . it is likely that type 2 diabetes and arterial stiffness relate to lv diastolic dysfunction through different pathways , since these associations were independent of each other . type 2 diabetes and arterial stiffness were largely independently associated with lv systolic and diastolic dysfunction in the current study .", "our findings that lv systolic and diastolic dysfunction was more severe in type 2 diabetic patients than in individuals with ngm are in line with previous data reporting associations between glucose metabolism and lv systolic and diastolic dysfunction ( 20,21 ) . the type 2 diabetes associated lv diastolic dysfunction at follow - up could not completely be explained by an already more severe lv diastolic dysfunction at baseline . these results imply that lv diastolic dysfunction deteriorates more in individuals with than in those without type 2 diabetes . there was a trend toward more severe lv systolic and diastolic dysfunction in individuals with igm as well , but this was not statistically significant . individuals with a longer duration of type 2 diabetes appeared to have a higher la volume index at follow - up .", "associations of arterial distensibility coefficients with lv diastolic dysfunction were not due to elevated blood pressure , since adjustment for mean arterial pressure only resulted in a small reduction of the associations . peripheral markers of arterial stiffness , like arterial distensibility and compliance coefficients , and brachial pulse pressure were most consistently associated with markers of lv diastolic dysfunction . the first might be due to arterial wave reflections that lead to an increased lv load and decreased coronary perfusion ( 6 ) . associations of arterial distensibility coefficients with la volume index and e / e at follow - up were largely independent of baseline la volume index . , wave reflections seemed especially harmful to lv systolic function , since augmentation index was the only marker of arterial stiffness that was significantly associated with lv ejection fraction , followed by carotid - femoral transit time . this might imply that 1 ) arterial stiffness precedes deterioration of lv diastolic dysfunction or 2 ) stiffening of arteries and lv walls occurs simultaneously . lv diastolic dysfunction seemed to be more coherent to peripheral artery stiffening than to central artery stiffness . the second might be due to coinciding structural changes in arterial and lv walls ( 9 ) . in the current study", "type 2 diabetes and arterial stiffness were largely independently associated with lv systolic and diastolic dysfunction in the current study . to conclude , the presence of type 2 diabetes and the presence of arterial stiffness are both associated with deterioration of lv diastolic dysfunction . a better understanding of the mechanisms behind those different pathways in changes in lv diastolic dysfunction could help identify targets for prevention of heart failure . it is likely that type 2 diabetes and arterial stiffness relate to lv diastolic dysfunction through different pathways , since these associations were independent of each other . lv systolic function was particularly worsened in type 2 diabetic patients with prior cardiovascular disease . since individuals with type 2 diabetes already had a worse cardiovascular profile at baseline , the influence of changes in cardiovascular risk factors earlier in life on lv systolic and diastolic dysfunction may also be worth examining . this might be reflected by the lowered associations between type 2 diabetes and markers of lv systolic and diastolic dysfunction after adjustment for hba1c ." ]

[ "primitive neuroectodermal tumor ( pnet ) , a highly aggressive tumor of the kidney is a rare malignancy with only few cases being reported in literature . we report in this paper , a case of primary renal pnet in a young male . boys and men are more likely to suffer rpnet ( renal pnet ) , and the sex ratio ( male : female ) is about 3:1 . it usually presents at an advanced stage , with distant metastasis and is associated with a poor prognosis .", "a 39-year - old male presented with complaints of hematuria and heaviness in the right flank since 15 days . physical examination revealed a soft lump in the right hypochondrium . ct scan of the abdomen demonstrated a large significantly enhancing right renal lower polar mass with necrosis with thrombosis in right renal vein . on the basis of these clinico - radiological findings , diagnosis of right side renal cell cancer after 6 cycles of chemotherapy , a pet scan showed absence of any metabolically active focal uptake in whole body . a diagnosis of pnet was made based on the above findings , and patient was started on vac ( vincristine , adriamycin , and cyclophosphamide ) alternating with ie ( ifosfamide and etoposide)-based adjuvant chemotherapy regimen which he tolerated well .", "the primitive neuroectodermal tumor ( pnet ) , was first recognized by arthur purdy stout in 1918 , and is a member of the family of small round - cell tumors . pnet arising in the kidney was first reported by mor in 1994 . it is an aggressive tumor that tends to recur locally and to metastasize to lymph nodes , lung , liver , bone , and bone marrow , which entail a worse prognosis . primitive neuroectodermal tumors occurs preferentially in the soft - tissues of the paravertebral region and chest wall , less frequently in extremities , with a slight male predominance . the presenting symptoms and images of rpnet are non - specific and similar to other renal tumors . the differential diagnosis of rpnet includes other small round cell tumors like neuroblastoma , adult nephroblastoma , malignant lymphoma , rhabdoid tumor , small cell carcinoma and monophasic , poorly differentiated , round cell variant of synovial sarcoma , carcinoid , rhabdomyosarcoma , clear cell sarcoma of the kidney , the small cell variant of osteosarcoma , and desmoplastic small round cell tumor ." ]

[ "we conducted a study to identify the facilitators and barriers to linkage to hiv care among the fsws who tested positive in order to design appropriate hiv interventions for this key population group . although the program has over 200 fsws enrolled in hiv care , some of the fsws who tested hiv positive did not enrol for treatment . however , while these barriers have been reported , there is still limited information on linkage to hiv care among sex workers in sub - saharan africa , particularly on effective linkage models to inform scale up of hiv interventions among sex workers . in 2012 , reach out mbuya hiv / aids initiative ( rom ) , a faith - based community non - government organization in uganda , introduced mobile outreach services to promote hiv testing and treatment among fsws and their clients . female sex workers ( fsws ) are at high risk of hiv infection and transmission . sex workers are among the priority populations for expansion of hiv services including art . however , despite the existence of established targeted sex worker interventions , lots of challenges still exist that have hindered many from enrolling into care . only 58% of sex workers have access to hiv prevention and care programmes and less than half of hiv positive sex workers are enrolled into hiv care . unaids reported that , in 2013 , art averted 6.3 million aids related deaths worldwide as a result of the increased number of people receiving art . in 2015 , who released revised guidelines for hiv treatment and recommended initiation of art among all hiv infected individuals irrespective of their cd4 count , for improved treatment outcomes and prevention of hiv transmission .", "this study was part of a larger study that explored the facilitators and barriers to linkage to hiv care among fsws in kampala and wakiso districts in central uganda . in - depth interview ( idi ) participants were selected from 301 hiv positive female sex workers who were registered in the hct registers at the different outreach points between may 2012 and december 2013 . the themes for the key informant interviews included hiv treatment seeking behaviour of the fsws , the challenges of enrolling into care , and the interventions to enhance linkage to hiv care in this population . mobile hct outreaches are conducted in locations surrounding mbuya parish in kampala and wakiso districts in central uganda . we defined linkage to care as having registered within an hiv clinic . the interview themes ( i.e. , sociodemographic , socioeconomic , structural , and hiv - related factors ) rom promotes hiv prevention through peer educators and provides hiv counselling and testing ( hct ) services through established outreach clinics that provide care and treatment for hiv positive fsws . were informed by theoretical constructs from the health belief model and the socio - ecological model and further informed by literature on barriers and facilitators to hiv service access among fsws . ", "the findings have been grouped into two themes : ( a ) facilitators of linkage to hiv care and ( b ) barriers to linkage to hiv care among fsws , as presented below . majority of the participants associated their linkage to care with the good quality of the services including good attitude and friendliness exhibited by the counsellors towards them . the facilitators have been further grouped into two main themes : health system and social network factors ( table 2 ) . ( fsw 20 years , enrolled in care ) barriers were similarly categorized into two themes : health systems and social network factors ( table 3 ) . ( fsw , 29 years , enrolled in care ) almost all the participants cited stigma as a major barrier to linkage to care .", "our study of facilitators and barriers to linkage to hiv care among female sex workers in kampala and wakiso districts in uganda shows that health system and social network factors are the major facilitators and barriers to linkage to hiv care . good quality health services ( especially polite and caring providers , strong follow - up structures using peer educators , and provider telephone calls ) and social network factors ( encouragement from peers and membership of savings group and the need to maintain good health ) were the primary facilitators of linkage to hiv care among fsws . on the other hand , perceived stigma , these findings suggest that efforts to improve linkage and retention in hiv care among fsws should focus on quality of services and improving social support networks . ensuring good quality services , particularly providers who can deliver services in a respectful and no - judgmental manner without undue delays and restrictions and adequate community education and mobilization as well as support structures for retention are key health system issues that can improve the quality of services . using peers to educate communities and follow - up of those who need treatment reduce the burden on health workers and strengthens community engagement . as reported elsewhere , the requirement of a treatment supporter before initiating care and treatment was a barrier to treatment that should no longer be strictly enforced . collectively , these findings suggest that programs targeting fsws should integrate continuous sensitization and provision of tailor made services that address the individual level , community , and health system needs of fsw .", "these findings call for a need to design interventions that utilize a multichannel , multipronged approach to increase access to hiv services among fsws . our study shows that fsws ability to be linked to hiv care is largely influenced by good quality friendly services and community support systems especially from their peers . hiv programs for fsw should focus on enhancing these as well as dealing with the barriers that mainly stem from stigma , ignorance , and work - related challenges ." ]

[ "this report depicts a patient with thalamic alexia with features of deep alexia ( or paralexia ) , the latter which has not been described after review of the english based literature . analagous to semantic paraphasias , semantic paralexias constitute the substitution of content related words during reading . unlike the analogous subcortical aphasias such as thalamic aphasia , subcortical syndromes of alexia have rarely been described . the acquired alexias may be categorized into posterior , anterior , central and deep alexias .", "a 57 year old white , right handed , english speaking woman with 13 years of education , presented to our stroke center with mild right sided numbness and weakness ( graded + 4/5 medical research council grading scale ) with the family reporting transient confused conversation and speech difficulty . the substitution of semantically related words was documented with only mild slowing in her reading ( family corroboration ) . commands100 complex ideational material100articulation ( agility)70recitation ( automatized sequences)100repetition words60 sentences100naming responsive naming100 boston naming test100 special categories100paraphasia100reading matching case and scripts100 number matching100 picture word matching40 oral word reading40 oral sentence reading80 oral sentence comprehension100 sentence / paragraph100 comprehension100wiriting form20 letter choice40 motor facility40 \n notable deficiencies were noted only in speech fluency , articulation , oral word and sentence reading , picture word matching and writing . \n in addition , the test for semantic paralexia prone words were tested with the standard version of the boston diagnostic aphasia examination ( version iii ) ( table 1 ) . in comparison to normative data , the clinical evaluation at our center encompasses a cognitive screening evaluation in all patients followed by psychometric assessment in selected patients described in detail elsewhere .", "a 57 year old white , right handed , english speaking woman with 13 years of education , presented to our stroke center with mild right sided numbness and weakness ( graded + 4/5 medical research council grading scale ) with the family reporting transient confused conversation and speech difficulty . the substitution of semantically related words was documented with only mild slowing in her reading ( family corroboration ) . the clinical evaluation at our center encompasses a cognitive screening evaluation in all patients followed by psychometric assessment in selected patients described in detail elsewhere . cerebrovascular risk factors included a significant smoking history and on investigation hyperhomocyteinemia ( 15.6 mmol / l ) .", "multimodality magnetic resonance imaging investigations revealed a left lateral posterior thalamic infarct , well circumscribed on t2 weighted and diffusion weighted imaging without other brain parenchymal lesion ( figure 1 ) . magnetic resonance angiography revealed a left internal carotid artery stenosis graded 5074% and basilar artery fenestration . \n figure 1left thalamic infarct depicted on diffusion weighted and t2 weighted magnetic resonance scan ( arrows ) . \n left thalamic infarct depicted on diffusion weighted and t2 weighted magnetic resonance scan ( arrows ) .", "in view of the isolated reading impairment , additional psychometric examination was performed on day 3 after the stroke onset , with the boston diagnostic aphasia examination ( third edition - short form ) . in addition , the test for semantic paralexia prone words were tested with the standard version of the boston diagnostic aphasia examination ( version iii ) ( table 1 ) . in comparison to normative data , notable deficiencies were noted only in speech fluency , articulation , oral word and sentence reading , picture word matching and writing . \n commands100 complex ideational material100articulation ( agility)70recitation ( automatized sequences)100repetition words60 sentences100naming responsive naming100 boston naming test100 special categories100paraphasia100reading matching case and scripts100 number matching100 picture word matching40 oral word reading40 oral sentence reading80 oral sentence comprehension100 sentence / paragraph100 comprehension100wiriting form20 letter choice40 motor facility40 \n table 1boston diagnostic aphasia test - version iii.subtests%fluency phrase length30 melodic line60 grammatical form70conversation expository speech100auditory comprehension basic word discrimination100 ", "the commonly referred to syndromic classification of benson and geschwind of posterior alexia ( alexia without agraphia ) , central alexia ( alexia with agraphia ) , anterior alexia ( alexia in association with expressive dysphasia ) and deep dyslexia ( primarily semantic paralexia disorder ) aptly describes most acquired reading deficiencies . similar to subcortical aphasias , the subcortical ( thalamic ) alexia reported here is characterized by atypical alexia syndrome components . although not a routine stroke investigative tool , functional magnetic imaging ( f - mri ) would have been an important additional neuroimaging modality to assess whether the right hemisphere had or had not played a role alexia secondary to isolated thalamic lesion has not been reported other than in combination with left occipital lesions , the latter lesions the usual focus ." ]

[ "thus , the purpose of this study has been to evaluate the current use of pvr classifications in papers dealing with clinical practice and therapy as an indirect measure of the degree of usefulness of existing classifications . therefore , a review of both the classification and the pathogenesis of pvr appears to be appropriate to aid the development of new treatments . proliferative vitreoretinopathy ( pvr ) remains the major complication after retinal detachment surgery [ 13 ] . there is a clinical impression that over the last 15 years clinicians have abandoned current pvr classifications .", "therefore , we investigated if they used all the characteristics ( grade [ a , b , c ] , pvr localization , extension in hours , and type ) of the updated retina society classification or if they were used only partially . we also analyzed how the different authors interpreted the classifications , comparing the results they provided with the original description . a search in pubmed for papers published between january 2000 and january 2014 was undertaken by two independent researchers . a manual search of related articles was also performed through references reported in each article . furthermore , it was also noted whether classifications were used both before and after an eventual pvr pharmacological or surgical treatment . inclusion criteria comprised human studies published in english , french , and spanish on pvr or retinal detachment with specific mention to pvr .", "finally , there were 2 publications ( 1,9% ) in which the standard classifications were used to assess changes in pvr status after any treatment , reporting pvr grade before and after it [ 19 , 20 ] . of the publications documenting only c grade , the classification of subtypes was infrequently used . in 5 of 48 publications ( 10,4% ) cite the two retina society classifications at the same time . among the papers using the updated retina society classification , the most documented was grade c pvr ( 48 articles , 83% ) , while grades b and a were less frequently documented ( 15 ( 26% ) and 7 ( 12% ) articles , resp . ) . were identified [ 13 , 1618 ] : in two papers [ 16 , 18 ] , the authors cite the updated retina society ( 91 ) but in fact they used the first retina society classification ( 83 ) , koerner et al . , after citing the updated retina society classification used a customized one , and roldn - pallars et al . the most used classification was the updated retina society classification ( 58 cites ; 56,3% ) , followed by the first retina society classification ( 35 cites ; 33,9% ) . 103 publications ( 74,6% ) used standardized pvr classifications and they were analyzed in detail .", "as mentioned , one of the aims of this study was to evaluate the usefulness of these classifications for pvr management with surgery and other adjunctive treatments . classifications of pvr were developed to provide clinicians with a useful tool to compare results of treatments . unfortunately , many ophthalmologists did not use the normalized classifications for comparing the outcomes using non - clearly defined terms such as pvr recurrence [ 29 , 30 ] . our findings in this study demonstrate that , in clinical research , investigators are using them inconsistently and reporting limited observations of stages ( mostly grade c ) .", "our findings showed the inconsistent and limited use of the current pvr classifications suggesting that it may be of benefit to produce a revised classification incorporating , if possible , the new knowledge on pvr which has been published since 1991 , pointing out new potential targets for therapeutic agents distinct from those , mainly proliferative agents , targeted by the original description of this disease . thus , it is possible that we could reduce its prevalence after retinal detachment surgery and to improve the anatomical and functional results of this disease which resists the attempts of both basic researchers and clinicians for more than 30 years ." ]

[ "the number of total joint arthroplasties ( tjas ) performed has increased steadily in recent years , with projected numbers for the coming years rising further . consequently according to recent data , peri - prosthetic joint infection ( pji ) incidence constitutes between approximately 0.3% and 1.7% of all total hip arthroplasties ( tha ) , and between 0.8% and 1.9% of all total knee arthroplasties ( tka ) . the risk factors potentially correlated with acute pji infection can be divided into pre - operative ( usually related to patient comorbidities ) , peri - operative and post - operative , which are mainly linked to the behaviours of the surgeon and the hospital staff . the aim of this paper is to review the recent literature , summarising the most relevant risk factors that the surgeon can modify in order to reduce the incidence of peri - prosthetic joint infection . pji can be classified in intra - operative , early post - operative , acute haematogenous and chronic infections , according to both timing and cause of infection . conversely , chronic infections are less influenced by the conduct of the surgeon , as they are most often related to haematogenous diffusion of bacteria .", "pre - operative modifiable and non - modifiable risk factors ; measures the surgeon can adopt to reduce impact of risk factors on development of pji pji , peri - prosthetic joint infections ; bmi , body mass index ; hba1c , glycated haemoglobin ; mrsa , methicillin - resistant staphylococcus aureus ; s. aureus , staphylococcus aureus other potential pre - operative risk factors are intra - articular corticosteroid injections and any infectious disease , particularly urinary tract infection ( uti ) and nasal colonisation with staphylococcus ( s. ) aureus . different authors confirmed that being a high - level nasal carrier of s. aureus is an important and significant independent risk factor for developing ssi with s. aureus . nasal application of mupirocin is widely accepted as treatment for nasal carriers of s. aureus . in a recent randomised controlled trial ( rct ) , the relationship between steroid injections and post - operative pji was evaluated in several studies . the correlation between post - operative utis and pji has been demonstrated . however , the association between pre - operative bacteriuria and early deep infections remains uncertain . several studies demonstrated that some comorbidity can be associated with an increased risk of pji .", "intra - operative factors potentially associated with pjis pji , peri - prosthetic joint infections surgical site preparation also plays a role in reducing pji rate . different intra - operative components may play an important role as risk factors for developing pji ( table 3).the first six hours following surgery are the most important regarding infection , as during those hours the numbers of bacteria multiply exponentially . maintaining a low blood level of bacteria in this period is critical , and for this reason prophylactic antibiotics are infused to decrease bacterial multiplication and to extend this golden period . ultraviolet light seems to be more effective when compared with laminar flow in reducing pji ; however it is characterised by potentially unacceptable health costs to operative personnel . surgeons may also play a role in reducing the rate of pji using power - pulsed lavage or wound lavage at surgery . in a level iv study ,", "despite the lack of literature demonstrating the relationship between dental procedures and pji , the current recommendation of the aaos is to use antibiotic prophylaxis in patients with a tja who are undergoing dental procedures , as well as any other invasive procedure . there is still debate regarding the association between blood transfusion and pji . in a level antibiotic prophylaxis for other surgical procedures before and after tja , such as dental care or urological procedures , seems to play a role as a however , different measures can be adopted to reduce the need for blood transfusion , such as pre - operative screening for anaemia and its treatment , intra - operative accurate haemostasis , minimisation of surgical time and use of tranexamic acid . furthermore , the centers for disease control and prevention guidelines defined peri - operative allogeneic transfusion as a potential risk factor for developing pji , but concluded that the interpretation of the existing literature is difficult due to variations in assessment criteria .", "the surgeon can act to reduce the impact of some reversible comorbidities , for example controlling glycaemia in diabetic patients or improving malnutrition . post - operative risk factors include transient bacteraemia related to dental procedures or other infections , wound care and blood transfusion as well as haematoma , and wound drainage should be controlled with care . infection represents a major challenge in tja , and is costly and demanding to manage for both surgeons and patients . various intra - operative risk factors such as operating theatre traffic , use of light handles , pulsed lavage or number of glove changes may also be related to infection . the main risk factors involved in pji development are divided into pre - operative , intra - operative and post - operative factors .", "no benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article ." ]

[ "\n the use of sodium hypochlorite as toilet detergent is related to a red - brown urine discolouration in patients taking mesalamine.it seems that the red - brown discolouration relates to a harmless reaction.polymerisation of mesalamine and/or metabolites could be a theoretical mechanism of this discolouration . \n", "the exact working mechanism of mesalamine is not fully understood , but it appears to have anti - inflammatory properties . mesalamine is also associated with the renal adrs of renal failure , interstitial nephritis and haematuria [ 1 , 3 ] . in the period from august 2009 to april 2015 , the netherlands pharmacovigilance centre lareb received two case reports of red - brown urine discolouration in association with mesalamine . both cases were reported by patients and the urine discoloured after contact with the toilet bowl . the most common adverse drug reactions ( adrs ) , as described in the summary of product characteristics ( smpc ) , are headache , rash and gastrointestinal symptoms , including diarrhoea , nausea , vomiting and abdominal pain . the drug blocks interleukin-1 and tumour necrosis factor-. mesalamine also inhibits the cyclo - oxygenase pathway , leading to inhibition of prostaglandin e2 in inflamed intestine .", "this case concerned a 38-year - old male with a history of crohn s disease . the patient reported separate several episodes of a red - brown deposit in the toilet bowl after the start of mesalamine in 1999 ( pentasa slow - release 500 mg tablet ) . a red - brown deposit had developed in the toilet bowl and on the seat and the water was unaffected . as the patient wanted more information on the possibility of the discolouration being the result of a reaction with the sodium hypochlorite detergent , he reported it to lareb . most of the time the persistent deposit did not appear directly after contact with the toilet water but developed after a few days , despite flushing the toilet .", "the patient reported separate several episodes of a red - brown deposit in the toilet bowl after the start of mesalamine in 1999 ( pentasa slow - release 500 mg tablet ) . this case concerned a 38-year - old male with a history of crohn s disease . a red - brown deposit had developed in the toilet bowl and on the seat and the water was unaffected . as the patient wanted more information on the possibility of the discolouration being the result of a reaction with the sodium hypochlorite detergent , he reported it to lareb . most of the time the persistent deposit did not appear directly after contact with the toilet water but developed after a few days , despite flushing the toilet .", "this case concerned a 36-year - old woman with ulcerative colitis , for which she is treated with 2 g of mesalamine ( pentasa sachet 2 g prolonged - release granules ) twice daily . the patient is still taking mesalamine and the phenomenon is still present when cleaning the toilet . when the patient added a drop of sodium hypochlorite detergent to her normal - coloured urine in the toilet , the same red - brown discolouration occurred immediately .", "likewise , the disordered haem production in patients with porphyria can result in red - brown discolouration . patient b s gastroenterologist recognised the phenomenon , but it is conceivable that not every gastroenterologist will establish a direct relationship between urine discolouration , mesalamine therapy and the use of a specific detergent . a pubmed search was conducted and it was found that two cases of red - brown urine associated with mesalamine have been reported previously by sacks and davis . since the introduction of the national spontaneous reporting system in 2003 to the general public , consumers have now become the largest group of reporters in the netherlands . both of the male adolescents in these reports experienced the same red - brown urine discolouration after contact with sodium hypochlorite bleach .", "based on the described reports and the case reports in the literature , we suggest a causal relationship between red brown discolouration of urine after contact with sodium hypochlorite detergent and the use of mesalamine . the naranjo assessment scores for cases a and b were 9 and 6 , indicating a certain and probable relationship , respectively . this seems to be a harmless reaction as the patients experienced no physical complaints and in both the lareb cases and those described by sacks and davis , the patients were under the care of a gastroenterologist . in the differential diagnosis it is important to be aware that the use of sodium hypochlorite as a toilet detergent could be the cause of coloured deposits in and on the toilet bowl . thus , to inform and reassure patients , it might be helpful to mention red - brown discolouration in the patient leaflet for mesalamine .", "no financial support was received for the conduct of this study or preparation of this manuscript ." ]

[ "the purpose of this study was to determine whether lbi will alter the integrity of the tjs of arpe-19 cells in culture . diabetic retinopathy ( dr ) is a leading cause of visual impairment and blindness in developed countries . the decrease in vision is due to diabetic macular edema ( dme ) and proliferative diabetic retinopathy ( pdr ) [ 1 , 2 ] . the control of the blood glucose level , vitreous surgery , and photocoagulation are the major treatments used to prevent dr from progressing to the pdr stage . however , the use of a single therapeutic agent is not effective in all cases , and additional treatments or different agents are needed . the blood retinal barrier ( brb )", "prior to the experiments , cells were placed in serum - free media and pretreated with 50 g / ml of lbi or 250500 pg / ml of antibody ( anti - mcp-1 antibody and anti - chemokine ( c - c motif ) ligand-11 ( ccl-11 ) antibody ) for 24 h. to mimic hypoxic conditions , arpe-19 cells were incubated for 4 h with 100 m of cocl2 ( sigma , st . they were then treated with 0.5% triton x-100 for 15 min . to detect the presence of zo-1 , the cultured rpe cells were exposed to rabbit polyclonal anti - zo-1 antibody as the primary antibody and alexa 594 anti - rabbit igg as the secondary antibody . optimum concentration of lbi was defined as 50 g / ml because over 100 g / ml of lbi seems to be toxic ( data not shown ) . for the immunofluorescence studies , cells the levels of the bioactive molecules in the conditioned medium were determined by human il-6 , il-8 , and mcp-1 elisa kits ( r&d systems , minneapolis , mn ) and ccl-11 elisa kit ( biosensis , thebarton , south australia , australia ) . louis , mo ) , which is a chemical hypoxia - inducing agent . after the incubation , an earlier study showed that lbi solutions contain 48.250.3% lecithin - iodine , approximately 10% free lecithin , and 40% phosphatidylinositol . lbi ( jolethin , daiichi pharmaceutical co. , tokyo , japan ) was dissolved in distilled water and diluted to the appropriate concentration for each experiment .", "vegf is a major antigen factor and is biogenic permeability factor which can increase the vascular permeability endothelial cell - cell junctions . finally , to confirm that lbi pretreatment can protect tjs from direct vegf induced stress , after lbi pretreatment these results indicated that there is an increase of the mcp-1 and ccl-11 secretion under hypoxic stress , and all are suppressed by lbi pretreatment . to confirm that lbi effectiveness is related to suppression of mcp-1 or ccl-11 but after pretreatment of lbi , this disruption was decreased which indicates that lbi can also protect tjs from vegf induced damage . these results indicated that both mcp-1 and ccl-11 were important to protect tjs from hypoxic stress and support the effectiveness of lbi .", "our data demonstrate the therapeutic potential of lbi for protecting the integrity of the tight junctions from hypoxia - induced stress . these data suggest a new aspect on the clinical use of lbi in the treatment of dme . our results showed that the hypoxic stress induced by exposure of arpe-19 cells to cocl2 caused a disruption of the tight junctions and that lbi pretreatment can protect the tjs from the hypoxic stress . thus , the possibility exists that lbi can be even used as a safe adjunctive therapy with an anti - vegf drug to treat dme . further investigations into the use of lbi in conjunction with anti - vegf therapy need to be undertaken to determine the effectiveness of lbi in preventing the development or progression of dme . but there still remain patients who do not respond to the anti - vegf therapy and who had a reduction of their vision even after therapy ." ]

[ "a 21-year - old caucasian woman presented to an outside facility with altered mental status after being found lethargic by family . on arrival to the emergency department , plasma glucose was 20 mg / dl . importance of compliance with the treatment and follow - up with an endocrinologist was emphasized . she was successfully treated with diazoxide and discharged home on oral diazoxide 250 mg daily , which she discontinued due to side effects of hirsutism and fluid retention . on current admission , the patient reported repeated episodes of seizures , syncope , dizziness , headaches , palpitations , and sweating around age 12 ; however , symptoms were never formally investigated as she did not seek expert care .", ", this case highlights the pediatric - to - adulthood transition for rare diseases and the key role that coordination and transition of care plays in timely management . our case is unique because it expounds on genetic causes of hypoglycemia in adults . in addition when encountered in the inpatient setting , it is easily recognized as patients already have risk factors such as diabetes mellitus ( dm ) on treatment , sepsis , and end - organ failure . however , for patients presenting emergently with hypoglycemia alone , appropriate investigations are warranted to treat and prevent recurrence . after establishing a diagnosis of hypoglycemia by whipple 's triad ( low plasma glucose , hypoglycemic symptoms , and resolution of adrenergic / neuroglycopenic symptoms with correction of the blood sugar ) , interim treatment and search for risk / causative factors should ensue ( table 1 ) . medical history of ethanol use , surreptitious insulin ingestion , medication use and interaction , autoimmune disease , gastric bypass ( 4 ) , and subtle risk factors such as undiagnosed psychiatric disorder and polypharmacy should be excluded ( 5 ) . in seemingly well patients ,", "after establishing a diagnosis of hypoglycemia by whipple 's triad ( low plasma glucose , hypoglycemic symptoms , and resolution of adrenergic / neuroglycopenic symptoms with correction of the blood sugar ) , interim treatment and search for risk / causative factors should ensue ( table 1 ) . medical history of ethanol use , surreptitious insulin ingestion , medication use and interaction , autoimmune disease , gastric bypass ( 4 ) , and subtle risk factors such as undiagnosed psychiatric disorder and polypharmacy should be excluded ( 5 ) . in seemingly well patients , the timing of hypoglycemic spells ( fasting / postabsorptive or postprandial / reactive ) is required to determine diagnostic studies . a mixed meal tolerance test under supervision is done for postprandial hypoglycemia while a 72-h fast should be done for fasting hypoglycemia . plasma insulin , proinsulin , c - peptide , and beta - hydroxybutyrate levels should be assessed to exclude surreptitious use of insulin or insulin receptor antibodies . intravenous glucagon can be given to distinguish disorders of gluconeogenesis from glycogenolysis ( 5 ) . negative findings suggest non - insulinoma pancreatogenous hypoglycemia syndrome ( niphs ) , which encompasses chi ( 4 , 6 ) . a selective pancreatic arterial calcium stimulation test ( spaci ) done at this time can detect hyperfunctioning of b - cells and confirm the diagnosis of niphs .", "the sheer numbers of existing mutations of the gck gene show it to be a highly mutable gene with varied disease outcomes depending on the type of activation . de novo gck mutations are very rare and exhibit marked variation in phenotypic expression ( 14 ) . are typically inherited in an autosomal dominant pattern , showing variable phenotypic penetrance and expressivity ranging from asymptomatic to marked hypoglycemia ( 11 , 12 ) . over 600 heterozygous inactivating mutations have been reported , causing mild persistent hyperglycemia known as maturity onset diabetes of the young ( mody ) as opposed to only 13 known activating mutations of the gene ( 15 , 16 ) . inactivating forms of the mutation cause varying severity of persistent hyperglycemia depending on zygosity ( 13 ) . activating mutations are usually clustered around the allosteric activator site of the enzyme and led to hyperinsulinemic hypoglycemia by lowering the glucose set point and threshold for glucose stimulated insulin release .", "it is key to blood glucose homeostasis and has been identified as a potential target for anti - diabetic therapy . trials manipulating gck regulatory protein an allosteric switch for gck , which indirectly restores gck activity , are currently underway to evaluate its effect on blood glucose in patients with type 2 dm ( 17 , 18 ) .", "long - term use of glucagon is effective in diazoxide - unresponsive cases or severe / diffuse chi but gastrointestinal side effects and crystallization in infusion tubing have been reported ( 19 ) . treatment of niphs involves lifelong dietary modification consisting of frequent , low carbohydrate meals ( 5 ) , which prevent surges in plasma glucose level , insulin level , and the consequent hypoglycemic spells . glucagon - like protein 1 receptor agonists such as exendin-4 are newer drugs that improve hypoglycemia in diazoxide - unresponsive patients by inhibiting insulin release ( 7 ) . partial pancreatectomy is indicated for medical treatment failure [ suggesting a k(atp ) defect ] and is only curative for focal lesions while extensive resection is reserved for diffuse chi to limit pancreatic burden ( 7 , 8 , 11 , 20 ) . octreotide , a somatostatin analogue ( secretin and insulin inhibitor ) , has been used in diazoxide unresponsive chi with improved blood glucose in these patients ; however , side effects such as gastrointestinal symptoms , dilated gallbladder , necrotizing enterocolitis , and qt prolongation sometimes limit its use ( 7 ) . medications such as diazoxide , octreotide , glucagon , verapamil , and somatostatin , whose actions all involve inhibition of calcium channels , have been employed with varying degrees of success ( 7 ) . diazoxide binds to and activates the sulfonylurea receptor 1 subunit of the potassium adenosine triphosphate [ k(atp ) ] channel , causing calcium channel closure . response to diazoxide therefore varies with genetic mutations [ ineffective in mutations of the k(atp ) channel genes ] ( 8) and with pattern of inheritance ( 7 ) .", "affected patients can present in adulthood ; de novo mutations should be considered given the following:- positive family history of unremitting hypoglycemia- lifelong symptoms of low plasma glucose , even after eating- increased bmi- negative sulfonylurea and autoimmune work up- positive glycemic response to octreotide \n - positive family history of unremitting hypoglycemia - lifelong symptoms of low plasma glucose , even after eating - negative sulfonylurea and autoimmune work up - positive glycemic response to octreotide to our knowledge , only three families with affected adults have been reported . in addition , this case highlights the pediatric - to - adulthood transition for rare diseases and the key role that coordination and transition of care plays in timely management .", "future research into a cost - effective and prompt scheme of patient information dissemination is warranted for uncommon diseases . despite the congenital nature of gck mutations , some patients can go undiagnosed till early adulthood .", "the authors have not received any funding or benefits from industry or elsewhere to conduct this study ." ]

[ "alternatively , the stop - bang questionnaire developed by chung et al . has been widely used as a sensitive screening tool for osa . obstructive sleep apnea ( osa ) is a common public health problem worldwide and it has been shown to be associated with an increased incidence of cardiovascular complications such as death , stroke , or myocardial infarction . however , the cut - off values of this questionnaire are based on the data from caucasians , therefore we hypothesized that to use it in asian population , some adjustments are needed . the authors recommended that if a patient had 3 or more criteria mentioned above , it is strongly suggestive for osa . it is also evident that there are differences in anatomical factors between asian and caucasian population such as retrognathia and oropharyngeal width which are main risk factors for osa . extrapolating data from western population and implementing in the asian populations may not be possible as there are differences in genetic and anatomical factors . the 2014 american heart association / american stroke association guideline recommends that patients with stroke / transient ischemic disorder ( tia ) showed be worked up for osa . in this study , patients who had osa and stroke had an improved outcome with continuous positive airway pressure .", "we compared the clinical features in the stop - bang questionnaire between osa - induced hypertension patients and healthy control subjects . the control subjects filled up the modified berlin questionnaire and epworth sleepiness scale less than 10 and defined as low risk for osa with low scores . demographic data and clinical features of both osa - induced hypertension patients and healthy subjects were recorded and compared . osa induced - hypertension patients were diagnosed by : i ) met the criteria of hypertension ; ii ) having average apnea - hypopnea index ( ahi ) by polysomnography more than or equal 5 times / hours and iii ) no evidence of other secondary hypertension . the sample size was calculated to be 102 subjects ( osa 34 subjects and healthy control 68 subjects ) . due to the incompleteness of the database of medical students , the sample size of the study population was calculated by using the proportion comparison between osa and healthy subjects using winpepi program . 120 healthy controls were selected by systematic sampling from the database ( total of 1174 medical students ) .", "the osa - induced hypertension patients were significantly older ( 59.5 vs 21.0 years ) , with higher proportion of males ( 64.3 vs 59.8% ) , more obese ( 78.6 vs 6.1% ) , higher incidence of mallampati class 3 or more ( 54.8 vs 24.4% ) , larger neck circumference ( 41.3 vs 32.0 cm ) , higher incidence of torus palatinus ( 26.6 vs 0% ) and of torus mandibularis ( 9.5 vs 0% ) . by multiple logistic regression analysis , only two factors bmi and neck circumference , the adjusted odds ratios for both factors were 1.49 ( 95% ci : 1.06 , 2.09 ) and 1.67 ( 95% ci : 1.11 , 2.51 ) , respectively . by the roc curve analyses , in this study , 42 osa - induced hypertension patients and 82 control subjects who had a complete set of clinical data were included . all clinical features of both groups the sensitivity and the specificity for bmi cut - off point were 97.2% and 91.4% , whereas those for the neck circumference were 94.7% and 82.9% . the best cut - off points for the bmi and the neck circumference were 24.5 kg / m ( figure 1a ) and 36 cm ( figure 1b ) .", "public health campaign for osa screening is also needed to reduce morbidity and mortality from osa complications . the present results showed that the stop - bang questionnaire needed to adjust the cutoff values of the bmi and neck circumference suitable for thai population . all hypertensive patients should have their bmi and neck circumference measured to detect the risk factors for osa . the appropriate cut - off points for the bmi and the neck circumference for stop - bang questionnaire were 25 kg / m and 36 cm for asian people . further studies , therefore , are needed to confirm the results of this study and to identify the appropriate cut - off point using the age- and sex - matched controls . also , to increase their sensitivity and specificity , osa patients with other complications than hypertension should be included and compared . whether simple measurement of the neck circumference and the bmi calculation are sufficient to identify osa patients in routine practice by primary health care personnel including physicians , nurses and volunteers should be examined in further study ." ]

[ "this work reports on a patient with metastatic tnbc enrolled in this phase ii study of nab - paclitaxel , bevacizumab , and gemcitabine who experienced a long - term complete remission lasting just under 2 years and a pfs from diagnosis of nearly 3 years . a phase ii study examined the combination of nab - paclitaxel , bevacizumab , and gemcitabine as first - line therapy for patients with her2-negative metastatic breast cancer . currently , nab - paclitaxel is indicated for the treatment of breast cancer after failure of combination chemotherapy for metastatic disease or relapse within 6 months of adjuvant chemotherapy . taxane - based chemotherapy has demonstrated activity in patients with tnbc [ 1 , 2 ] . in the phase iii eastern cooperative oncology group 2100 trial in which in this small cohort of patients with stage iv tnbc , the clinical benefit rate as defined by cr , partial response , and stabilization of disease was 85% .", "the patient was initially seen at the university of miami sylvester comprehensive cancer center and enrolled in the phase ii study of nab - paclitaxel , bevacizumab , and gemcitabine for her2-negative metastatic breast cancer . she continued to receive denosumab throughout her chemotherapy holiday from december 2010 to november 2011 until discontinuing therapy in march 2012 after being transitioned to hospice care . she received her last dose of nab - paclitaxel , bevacizumab , and gemcitabine on may 28 , 2010 . the dose of gemcitabine was reduced to 1,250 mg / m , nab - paclitaxel to 125 mg / m , with no modification of the bevacizumab dose , and treatment was continued once every 2 weeks on a 4 week cycle . throughout her treatment , she received zoledronic acid at 4 mg intravenously every 4 weeks beginning in november 2007 when she began the phase ii study . in may 2010 , , she initiated therapy with ixabepilone , with a minor radiographic response . from august 2010 however , therapy was stopped due to unacceptable toxicity , including diarrhea , dehydration , and severe palmar plantar erythrodysesthesia . after 2 months to december 2010 , she received 8 cycles of treatment with ixabepilone ( 30 mg / m ) administered intravenously every 3 weeks . in december 2010 , the patient requested a chemotherapy holiday .", "this case study demonstrates the potential for triplet chemotherapy with nab - paclitaxel , bevacizumab , and gemcitabine to elicit prolonged responses , potentially prolong os , and improve quality of life for patients with metastatic tnbc . numerous studies have shown that the combination of gemcitabine and a taxane is an effective regimen that is well tolerated with good response rates . there is an unmet clinical need for effective therapies that prolong survival for patients with metastatic tnbc . in the absence of curative therapies for metastatic disease , patients with metastatic tnbc have a very poor prognosis . in a large analysis of 255 patients diagnosed with tnbc at the md anderson cancer center between 1985 and 2004 ," ]

[ "in humans , type i interferons are encoded by ~16 genes and individual genes encoding , , and . their gene products are highly structurally related and all bind to a single receptor ( ifnar ) consisting of heterodimeric r1 and r2 subunits . although there is no evidence for direct recruitment of stat2 to the ifn-r , ifn- signaling can drive the formation of an isgf3-like complex containing stat2 , inhibit viral replication and induce expression of ifn-/ target genes , perhaps through the pairing of phosphorylated stat1 with latent stat2 . thus , stat2 is central to the induction of these genes in response to both ifn-/ and ifn-. in some cases , type ii interferon , ifn- , can mobilize the antiviral response in a stat2-dependent manner . in addition to its role in interferon mediated antiviral effect , stat2 also confers anti - proliferative and apoptotic activities on a variety of cell types in response to both type i and iii interferon . although a fraction of stat1:stat2 heterodimers can translocate to the nucleus and bind atypical gamma activated sequence ( gas)-like elements , the canonical interferon - stimulated gene factor-3 ( isgf3 ) complex of stat2:stat1:irf-9 regulates a large fraction of the interferon pathway genes . stat2 recruitment and activation by both receptors involves tyrosine phosphorylation of stat2 by jak kinases and subsequent oligomerization with stat1 and irf-9 .", "stat2 participates in some aspects of inflammation by autocrine responses to ifn-/ and downstream induction of inflammatory chemokines and cytokines . a cascade of cytokines regulate processes of inflammation that drive both local and systemic activation of immune cells , and this process can be initiated by both pathogen sensing as well as sterile tissue injury . when discussing the role of stats in inflammation , it is perhaps more accurate to discuss their function in the context of distinct cytokine receptors , as most of the stat family members can be activated by multiple cytokines . these results suggest that stat2 may directly contribute to carcinogenesis by promoting expression of proinflammatory cytokines and chemokines . in summary , further , recent studies by tracey and colleagues demonstrated that the ifn-/-induced kinase , pkr , regulates an alternative pathway for inflammasome activation . as a result", "here we discuss the viruses that have particularly acquired the ability to subvert the interferon signaling pathway by targeting stat2 ( summarized in table 1 ) . given the critical nature of the interferon pathway in viral defense , it is not surprising that viruses have evolved to antagonize the antiviral state induced by type i and type iii interferons . thus , the requirement for stat2 interaction for antagonism of interferon response limits the host range of piv5 . dengue virus ( denv ) is another example of how host - pathogen co - evolution has become a host range - determining factor . stat2 in particular is a target of many viral proteins , which in some cases determines viral host range .", ", we will explore how stat2 has emerged as a highly divergent member of the stat family while retaining its ability to exclusively regulate the interferon response in each species . considering the central role that stat2 plays in regulating the intracellular anti - viral response , it represents an important target for viral interference . while speculative , it is likely that lethal pandemic viruses drive stat2 evolution , in some cases , by targeting stat2 directly . the stat family can be traced as far back to rudimentary stat - like genes that exist in slime molds ( d. discoideum ) , thus suggesting that the current members that exist in mammals ( stats 1 , 2 , 3 , 4 5a , 5b and 6 ) arose from a common ancestral gene through duplication . in mammals , given the central role of stat2 in the induction of isgs , it is perhaps surprising that only a restricted subset of viruses have adapted their mechanism of innate subversion to target stat2 . perhaps the unique haplotypes that have been identified in stat2 among east asians and shared with neanderthal point to recent selection events in human evolution ." ]

[ "we report the current guidelines concerning the management of the axilla after slnb and review the different aspects arising from recent studies on the role of micrometastases and itc clusters in sln on decision making . this has arisen because of better understanding of breast cancer behaviour and improved efficacy of combined therapeutic modalities . in this paper axillary status is the most important prognostic factor in breast cancer providing staging information and therefore largely defining treatment strategy . for patients with operable breast cancer , the major prognostic determinant is whether there has or has not been spread to the axilla and the number of involved axillary nodes .", "the american society of clinical oncology ( asco ) expert panel conducted a systematic review of the literature available through february 2004 on the use of snb in early - stage breast cancer in order to develop guidelines for the management of the axilla ( http://jop.ascopubs.org/content/1/4/134 ) , and these are similar to those of the national institute of health and clinical excellence ( nice ) recommendations in uk ( http://www.nice.org.uk/nicemedia/live/12132/43413/43413.pdf ) . itcs detected by ihc are of unknown clinical significance , and when identified , the sln is regarded as negative and no further alnd is required . although ihc is often used , it is not included in routine sln evaluation for breast cancer at this time . it has been suggested that slnb should be carried out by an experienced team in order to minimise false negativity and improve the predictive value of the procedure . in contrast the german guidelines do not recommend axillary clearance for 1 - 2 sln positive in patients with t1 and t2 tumours ( http://www.ago-online.de ) . if the sln is negative , a calnd ( calnd ) is not necessary . asco and nice recommendations for slnb , alnd alone and managing of the axilla after slnb are summarised in table 1 . alnd is the standard of care in those with a macrometastatic or micrometastatic positive sln to maximise local control .", "amaros investigates the benefit of a calnd in comparison to treatment with axillary radiotherapy ( art ) in patients with sln - positive breast cancer . mirror findings support an aggressive treatment approach in patients with either sln micrometastases or itcs . although the majority show no prognostic impact of itcs in the sentinel node , a large dutch investigation with 5-year followup indicated that women with itcs who received adjuvant chemotherapy had a significantly better event - free survival compared with untreated cases with itcs . was identified in 41% of patients with macrometastases and in 18% of patients with either micrometastases or itcs .", "many investigators have studied the incidence of non - sln involvement in patients with sln micrometastases to define which patients may need further axillary treatment . wada and imoto . collected 22 studies from 1999 until 2006 referring to the frequency of sln micrometastases in patients with breast cancer and the prevalence of non - sln involvement in those patients after alnd . the international breast cancer study group trial ibcsg-23 - 01 is a randomised multicentre study designed to determine the significance of minimal ln metastasis in patients with breast cancer . the trial was initiated in april 2001 , and it compares survival between patients with sln micrometastases who undergo slnb alone with those who receive calnd . the largest study ; however , found a significantly worse disease - free survival for women with micrometastases who did not undergo calnd . . most of the studies had small numbers and relatively short followup and tended to conclude that there was no benefit from completion axillary node clearance . additionally , a wide range of non - sln macrometastases was found ( 018% ) . because the prevalence of non - sln micrometastases was low , the prognostic impact was unclear .", ", authors suggested that it is not possible from these results to conclude definitively that calnd should be abandoned for these patients . the long - term effect of the residual axillary disease in the sentinel - lymph - node - positive patient on local and systemic recurrence has not been clearly defined for patients receiving modern radiotherapy and chemotherapy . older studies of patients with symptomatic breast cancers have shown that inadequate axillary surgery does lead to reduced overall survival [ 5760 ] . it is known that the extent of macrometastases in sln is strongly correlated with non - sln involvement .", "several mathematical models have been developed to predict the risk of non - sln involvement in patients with sln - positive breast cancer . the most important prognostic factors for the presence of non - sln metastases in patients with minimal sln involvement are presented in table 4 . several factors correlated with the likelihood of additional non - sln metastasis have been investigated in an effort to distinguish which patients could avoid extensive axillary surgery . molecular profiling of metastatic foci different from the primary tumour could be used as indicator for the selection of patients who might benefit of completion axillary dissection . molecular tests may be proved more sensitive than current intraoperative tests but have not yet been validated . molecular tests based on technology such as oncotype dx ( genomic health , redwood city , calif , usa ) or other multigene arrays developed prognostic and predictive markers aiming to personalize surgical and adjuvant treatment of early breast cancer .", "it provides an opportunity to make an intraoperative diagnosis of sentinel node involvement within 30 minutes , avoiding frozen section and allowing a one - stage procedure . osna is an automated assay for the detection of cytokeratin message , ck19 mrna , present in approximately 98% of breast cancers . the studies indicate a good concordance between results of histopathology and osna . indeed in a study conducted by osaka , comparing osna with frozen section , larger verification studies in which half of the bisected sentinel node was sent for histology and the other half homogenised for osna are shown in table 5 [ 71 , 72 , 7981 ] . it is likely that in time osna will replace histopathological examination of sentinel lymph nodes because of its ease , accuracy , and potential for enabling almost all patients to have a one - stage operation for early breast cancer . the usual reason for discordance between histopathology and osna was an uneven distribution of nodal metastases ( tissue allocation bias ) . ", "recent studies aiming to determine if calnd is beneficial in patients with sln - positive breast cancer and even more in patients with minimal sln involvement have reached contrary conclusions . , most breast surgeons will hardly ever take the risk of avoiding completion axillary dissection in breast cancer patients even with minimal sentinel lymph node metastases . it is important that premature decisions to restrict axillary surgery are not made on a basis of early results from underpowered clinical trials . results from ongoing phase iii trials will perhaps provide new guidelines for the treatment of patients with micrometastases or itcs . many are seeking to find a balance between the needs of the majority to have minimal axillary surgery with minimal postoperative morbidity against the possibility that a minority will suffer relapse , morbidity , and possible increased mortality from undertreatment . " ]

[ "as the first step to make a strategic plan is identifying the needs , the main purpose of this study is to assess the wellbeing services of the staff working in tums first to see if they are satisfactory enough or they need to be changed , and second , to help decision - makers develop services that are essential to improve the well - being of employees , as also the quality and effectiveness of the tums 's wellbeing delivery system . it is because of the lack of a participatory strategic wellbeing delivery plan that is based on prioritized wellbeing needs ( requirements ) . labor wellbeing refers to all efforts of employers , trade unions , voluntary organizations , and governmental agencies , which help employees feel better and perform ( work ) better . hence , it is necessary for organizations to identify the real needs , as a base to provide a wellbeing package for their employees through wellbeing need assessment techniques . davis and gibson emphasize on the importance of a comprehensive wellbeing needs assessment , both for obtaining the required information needed to design the appropriate interventions and also for providing the basic required information to evaluate the effectiveness of the wellbeing program . it is a comprehensive term that refers to the physical , mental , moral , and emotional wellbeing of an individual including intra and extra mural facilities .", "poor announcement , unwillingness to receive the service , undesirability of the service, and undesirability of the receiving process of the service. main parts and the main purpose of asking questions for each part in the second part , the respondents were provided with a list of not delivered wellbeing services to choose which of them is the questionnaire included 45 questions ( 43 close - ended questions and 2 open - ended questions1 ) organized into two separate parts ( cranach alpha = 0.85 ) : according to table 1 , within the first part , the respondents were supposed to mark the wellbeing services if they had ever used any of them . those who used the services were supposed to show their level of satisfaction by choosing from the data was gathered by means of filled questionnaires , and were analyzed with the excel software and spss , by calculating the frequency rate of the staff that used the welfare services and those who did not use the services . the reliability of the questionnaire was determined after thoroughly calculating the cronbach alpha , which was reported to be around 0.85 . in addition , the t - test was used to calculate the satisfaction score for each service used by the staff . subsequently , after improving and clarifying the instrument , the participants of sample group were asked to fill in the questionnaire . the sample size was 98 with a 95% level of confidence and absolute error of 0/01 .", "among all the 98 respondents , almost 46 employees with a mean satisfactory score of 48.46 used the existing services , for which the satisfactory rate was distributed as shown in table 2 . satisfactory scores of categorized wellbeing services the result shows that financial services , including loans for buying a car , emergency loan , loan for buying commodities , awards for staffs children , and two other kinds of non - profit loans in comparison with other categories is considered as the most satisfactory service ( average t = 61.83 ) . among respondents who did not use the categorized services ( 52 persons on an average ) , as shown in the table 3 , the most frequents reasons for not receiving services was , staff 's unwillingness to receive the service ( 38.75 in average ) and poor announcement ( unawareness on the wellbeing services ) ( 37.6 in average ) educational subvention for children of the staff , who were under their patronage is the only non - financial service , with the highest frequency ( 92.85 ) , identified as the most necessary wellbeing service among all . among other services that were mentioned by respondents ( 61 persons of the sample group ) , the provision of discount cards for using other organizations services ( frequency = 12 ) , providing employees with free health care services ( frequency = 7 ) , and contracting with adult higher education institutions ( frequency = 6 ) had the most frequency among other items . . frequency rate of reasons for not receiving welfare services table 4 presents the frequency of wellbeing services and necessity ( delivered by other public / private organizations ) , which were asked to be judged by respondents ( to be added or replaced by the delivered wellbeing services list ) , as follows : frequency distribution of wellbeing services necessity", "as mentioned , the objectives of the study were to measure the staff 's satisfaction with the wellbeing services received , identify the reasons for not receiving the existing wellbeing services , identify the wellbeing services that were not delivered , but were essential as per the staff , and then ask the staff about other wellbeing services that were possible to be delivered and sort them according to their priority . with regard to the first purpose , the results showed that almost half of the respondents used the wellbeing services provided by the wellbeing office of the university , among which almost half of them were satisfied with the services . the findings show that the functional desirability of tums wellbeing services is not satisfactory enough by the staff 's view point . , it can be concluded that the functional desirability of the wellbeing service delivery system of tums was not evaluated as satisfactory enough , because of the almost high dissatisfaction level of services that were used . with regard to the third purpose , the most necessary identified services were related to educational services , and of course , among the identified wellbeing service priorities , provision of educational opportunity was one of the preferences with high frequency , therefore , it was clear that educational and training opportunities were important for a majority of the respondents .", "the following conclusions can be drawn from the present study ; the first major finding is the existence of a big gap between the required wellbeing services ( by employees ) and what is provided by the wellbeing office of tums . the second and the most obvious finding of this study is the importance of the educational and training opportunities from the point of view of the staff , which has not been paid attention to by the wellbeing service provider in tums . it is recommended that the factors that cause dissatisfaction and unwillingness to use services in employees be identified , and also the real needs and wellbeing requirements ( based on employees preferences , job categories , genders , age , and other considerable individual and social factors ) as a strategic basis for redesigning the current wellbeing service delivery system that appears not to be desirable enough in the employees view , be determined . although we tried to assess the overall quality and functional desirability of the wellbeing service delivery system of tums , some further studies are required in the researcher 's view ." ]

[ "bilateral luxatio erecta represents an extremely rare condition , and just a few cases were reported in medical literature . because of a high incidence of related complications such as neurovascular damages early recognition and treatment of this type of dislocation is required by physicians . in this article we describe a case of a bilateral luxatio erecta that was successfully treated without long - term complications . the clinical manifestation is typical and it is characterized by abduction of the affected arm , flexion of the elbow and pronation of the forearm .", "a 70-year - old female was accepted in our emergency department because of a bilateral shoulder pain that onsets after a sudden fall happened in her house . after 8 weeks she recovered the complete function of both shoulders and after a one - year follow - up treatment the patient showed a complete range of motion of both arms . x - ray control revealed a correct anatomic reduction of dislocations and after the reduction no vascular damage were found while paresthesias were still present on the left arm ( fig . 2 ) . an x - ray examination was performed showing a bilateral inferior dislocation of humeral heads in relation with the glenoid fossa ; no fracture was associated ( fig . 1 ) . the anamnestic research showed that the patient tumbled downstairs ; while clinging to both lateral banisters , she slipped down banging her face and chest to the ground . at physical examination", "inferior dislocations are rare ( 0.5% of all shoulder dislocations ) and bilateral inferior shoulder dislocations are exceptional : only 10 cases have been described so far in the literature . according to the literature , luxatio erecta is due to an indirect mechanism such as a violent abduction force on abducted limb resulting in impingement of the proximal shaft of the humerus against acromion . fracture of the acromion , clavicle , inferior glenoid fossa and greater tuberosity represent a complication that should need a surgical treatment ." ]

[ "we report here a patient who complained of chills , fever and right upper quadrant abdominal discomfort . a biloma is a rare abnormal accumulation of intrahepatic or extrahepatic bile caused by traumatic or spontaneous rupture of the biliary tree1 , 2 ) . it is most commonly caused by surgery , percutaneous transhepatic cholangiography ( ptc ) , percutaneous transhepatic biliary drainage ( ptbd ) , and abdominal trauma11 , 12 ) .", "a 78-year - old woman presented to the emergency room with her guardian , with acute fever and chills that developed the day before admission . on the thirteenth day of admission , pancreatico - biliary magnetic resonance imaging ( mri ) revealed a biloma that was connected to the intrahepatic bile duct ( figure 2 ) . on the sixteenth day of admission , the biloma that was connected to the intrahepatic duct and common bile duct the abdominal computed tomography ( ct ) revealed a 9.58.5 cm subcapsular cyst with a clear boundary in the left hepatic lobe and enlargement of the intrahepatic bile duct around the cyst . the drainage tube was blocked and follow - up of the bilirubin in blood and the size of the biloma were assessed . on the 29th day of admission , the amount of drainage did not decrease afterward , and the connection between the biloma and the bile duct was still noted . on the 25th day of admission ,", "they reported a case with extrahepatic bile leakage after trauma to the upper right quadrant of the abdomen ; the bile did not cause peritonitis , but it accumulated in an encapsulated form . one of the patients with a choledocholithiasis who suffered a nontraumatic intrahepatic rupture of the bile duct , had a surgical repair9 ) . there is one report of a case of biloma after trauma7 ) , and 1 case of a biloma after endoscopic retrograde cholangiopancreatography ( ercp)8 ) . surgery is now performed only in cases with a persistent bile leak or for treatment of underlying disease . in this case , a spontaneous biloma with bacterial infection was found after the patient presented in septic shock . the diagnosis of a biloma can be assisted by surgery , a history of trauma with abdominal ultrasonography , abdominal ct and mri ." ]

[ "the public health costs attributed to unintended births in a single year cost taxpayers $ 11.1 billion ( 2006).6 furthermore , previous studies have reported that ups are more likely to result in preterm births and low - birth - weight babies , which would increase health costs for neonatal care and costs associated with long - term disabilities.7 this is particularly relevant for ups in adolescence , which are more likely to result in low - birth - weight births , which can increase health costs.8 over the past few decades , brazil , like many fast - emerging economies , has experienced a fertility transition noted by a dramatic reduction in the total fertility rate , which currently sits at 1.8 births per woman.9,10 furthermore , during the fertility transition , the rate of contraception has also increased.11 despite increased contraception use , the cumulative rate of spontaneous and induced abortion changed very little between 1996 and 2006 , for which population survey estimates are available.12,13 furthermore , a survey of more than 1,000 women aged 1024 years in a single postnatal unit in brazil reported that more than 50% of all births were unintended , suggesting that possibly significant unmet contraception need still exists.8 similarly , for the whole country , the data from the last demographic and health survey ( dhs ) performed in 2006 indicates that 55% of all births were unintended.14 prevention of up using publicly funded programs in high - income countries has proven to generate significant cost savings for health services and public services.15 previous economic studies evaluating the consequences of up have mostly been performed in high - income countries where publicly funded fertility services and abortion legislation are different from those in low-/middle - income countries.15 the aim of this study was to evaluate the cost consequences of up in brazil , an emerging economy with vastly different fertility planning services than most advanced economies and with restrictive abortion laws . to the best of our knowledge , this is the first published study that describes the economics of up , and it is believed that this work can aid decision makers regarding access to contraceptives . however , it is recognized worldwide that direct health costs of up and resulting abortions can significantly impact local health services and the families affected.5 health system and societal costs can also arise from ups that do not end in abortion and are carried to parturition . in the united states , data on prevalence and associated costs of abortion are limited and remain a challenge to collect . the construct of unintended pregnancies ( ups ) is multifactorial and broadly encompasses pregnancies that are either unwanted or mistimed.1 in many instances , ups are likely to end by induced abortion ; worldwide estimates suggest that 50% will be voluntarily terminated.2 in 2008 , it was estimated that 43.8 million abortions occurred worldwide , of which 86% occurred in low-/middle - income countries.3 furthermore , between 2003 and 2008 , the number of induced abortions was found to have decreased in high - income countries but to have increased in low-/middle - income countries . during this same period of time , the proportion of unsafe abortions increased and they were believed to account for 13% of maternal deaths , with the majority of these concentrated in countries with restrictive laws on abortion.4 elective abortion in brazil is considered non - legal , unless the pregnancy resulted from a rape , would cause a life - threatening condition to the mother , or the fetus has anencephaly or any other malformation that is incompatible with the extrauterine life . as a result ,", "the total annual number of pregnancies was estimated using the reported number of live births for the year 2010 and adjusted with estimated percentages of induced abortion and miscarriage.18 the percentages of induced abortions and miscarriage were derived from the population - based 2006 dhs and found to be 1.5% and 8.9% , respectively.19 all induced abortions in the model were assumed to be from unintended pregnancies resulting in an adjusted abortion rate of 2.7% . a model was developed to evaluate the humanistic burden and financial impact of ups in brazil . the analysis factored in costs and outcomes for 1 year post - delivery of ups . the up rate was estimated to represent 55% of all pregnancies.20 maternal mortality rates of 20 , ten , and 30 deaths per 100,000 births were used for miscarriage , vaginal delivery , and c - section delivery , respectively.2123 in addition , a case fatality rate of 100 deaths per 100,000 abortions was assumed.24 for both delivery methods , it was estimated that 7.8% of all deliveries were preterm births and 0.85% were stillbirths.25 the remainder of the deliveries was assumed to be term births . the cost components for each method included antenatal care and labor and delivery.31,32 unit cost for hospitalization readmission during the first year was r$2,794.33 this unit cost was also assumed for neonatal care admission , while cerebral palsy was estimated to be r$19,854.33 cost parameters are summarized in table 1 . differential infant mortality rates were used for term and preterm births , with 8.5 per 1,000 live births for the former and 68 per 1,000 live births for the latter.25,26 the model assessed infant complications , including admissions to neonatal icu , hospitalization during the first year , and cerebral palsy . possible birth outcomes of up included induced abortion , miscarriage , and ongoing pregnancy resulting in birth .", "available data was further separated into vaginal ( 61.0% ) and cesarean section ( c - section ) deliveries ( 38.4%).16,17 outcomes and resulting costs for infants were also followed . these included stillbirths and infant survival and complications from term and preterm deliveries . data from datasus were used when possible to populate the model to reflect the reality of the public health care system . however , for parameters not identified in datasus , other relevant sources were used . all birth deliveries were assumed to have taken place in a hospital within the brazil public health system as reported by datasus , the data system for the ministry of health in brazil . a model was developed to evaluate the humanistic burden and financial impact of ups in brazil . complications included admission to a neonatal intensive care unit ( icu ) , hospitalization during the first year , and cerebral palsy . the analysis factored in costs and outcomes for 1 year post - delivery of ups .", "the total annual number of pregnancies was estimated using the reported number of live births for the year 2010 and adjusted with estimated percentages of induced abortion and miscarriage.18 the percentages of induced abortions and miscarriage were derived from the population - based 2006 dhs and found to be 1.5% and 8.9% , respectively.19 all induced abortions in the model were assumed to be from unintended pregnancies resulting in an adjusted abortion rate of 2.7% . the up rate was estimated to represent 55% of all pregnancies.20 maternal mortality rates of 20 , ten , and 30 deaths per 100,000 births were used for miscarriage , vaginal delivery , and c - section delivery , respectively.2123 in addition , a case fatality rate of 100 deaths per 100,000 abortions was assumed.24 for both delivery methods , it was estimated that 7.8% of all deliveries were preterm births and 0.85% were stillbirths.25 the remainder of the deliveries was assumed to be term births . differential infant mortality rates were used for term and preterm births , with 8.5 per 1,000 live births for the former and 68 per 1,000 live births for the latter.25,26 the model assessed infant complications , including admissions to neonatal icu , hospitalization during the first year , and cerebral palsy . all preterm birth infants were assumed to require neonatal intensive care , compared to 7.6% of term birth infants.27 for preterm infants , the average number of hospitalizations during the first year was 1.7 , mostly from respiratory issues.28 for term birth infants , hospitalization was calculated as a relative risk reduction.29 cerebral palsy occurred in 0.1% and 1.7% of term and preterm births , respectively.30", "however , in this model , it is assumed that the costs are those from the public system , although , in approximately one - quarter of ups , the costs are probably higher when related to women s care covered by insurance or privately . costs of elective abortion were not included in the analysis because these procedures rarely meet the legal requirements and would not be covered by the public health system . the cost components for each method included antenatal care and labor and delivery.31,32 unit cost for hospitalization readmission during the first year was r$2,794.33 this unit cost was also assumed for neonatal care admission , while cerebral palsy was estimated to be r$19,854.33 cost parameters are summarized in table 1 . resource use and unit costs were identified from published sources and the dhs in brazil . in brazil costs of miscarriage were related to the following procedures : pelvic exam , blood test , ultrasound , and dilation and curettage . the public national health system ( sus ) pays for around 70%75% of all reproductive procedures .", "based on the modeled parameters we estimate 1.79 million annual ups and 1.47 million annual planned pregnancies . we estimate annual maternal deaths of 351 , of which 49 ( 14% ) are attributed to abortions and 302 to complications from miscarriages and deliveries . the remainder of birth costs were attributed to infant complications , estimated to be r$2.8 billion ( 70.0% ) , with neonatal costs accountable for approximately r$628 million ( 15.4% ) and hospital readmission in the first year costs of r$2.1 billion ( 52.9% ) of all birth costs annually . based on the national cost estimates and the number of annual ups the total costs attributed to up are estimated to be r$4.1 billion annually , of which approximately r$32.9 million ( 0.8% ) was attributed to miscarriage and r$4.07 billion ( 99.2% ) to births and resulting complications . from the direct birth - related costs , antenatal care accounted for approximately r$233 million ( 5.7% ) of birth costs , with labor and delivery costs responsible for r$988 million ( 24.3% ) . the number of estimated neonatal admissions for the year 2010 associated with up was 224,631 which included all preterm deliveries and 7.6% of all term deliveries . the number of infant deaths within the 12 months following birth was estimated at 32,864 . costs of abortions are not reimbursed in the public health system and are not included in the analysis .", "the cost per up factors in a range of health - related costs attributed to those resulting in abortion and resulting live births for those carried to parturition . the cost consequences of live births attributed to up in adolescents can extend beyond the observed costs of increased prenatal care , preterm births , and abortions . much of the humanistic burden attributed to up relates to maternal mortality and morbidity of women who pursue unsafe abortions . in our analysis for instance , costs associated with post - abortive care are likely to be classified as miscarriages when reported to national authorities . additionally , the long - term societal costs that arise from up and reduced educational attainment and lost productivity of young mothers has not been accounted for in our analysis.3639 our analysis highlights that considerable cost savings can be achieved by reducing up , which are thought to represent 55% of all pregnancies in brazil.20 the analysis accounted for both untimed and unwanted births to estimate the up rate and associated costs , in which live births resulting from unwanted pregnancies represented the largest share of health costs , representing 99% of all costs . studies have noted that adolescent women are more likely to dropout from school following pregnancy . this is believed to be the current most common way of inducing medical abortion and also to be associated with the low rates of severe complications due to abortion , especially infection and hemorrhage , in brazil .", "our analysis illustrates the cost consequences associated with up in brazil . in the past 2 decades , brazil has made considerable progress toward reducing abortion rates , but , despite these efforts , the humanistic and direct economic costs associated with up remain high.58 to achieve economic savings from reducing the up rate will require education , training of providers , and improved access to effective contraceptive measures . it is believed that the research described herein can inform the burden of up and the benefits of improved fertility planning . the cost consequences associated with up in brazil could be investigated in other settings using the same methodology used in this report . it is important to estimate the cost associated to up to initiate actions to reduce the high rate observed in many countries .", "the cost consequences associated with up in brazil could be investigated in other settings using the same methodology used in this report . it is important to estimate the cost associated to up to initiate actions to reduce the high rate observed in many countries ." ]

[ "pmds is a rare form of male pseudo - hermaphroditism characterized by the presence of mullerian duct structures in an otherwise phenotypically , as well as genotypically , normal man . we report the case of a 70 year old man with unilateral cryptorchidism on the right side and left obstructed inguinal hernia containing uterus and fallopian tube ( that is , hernia uteri inguinalis ; type i male form of pmds ) coincidentally detected during an operation for an obstructed left inguinal hernia with right cryptorchidism . the persistence of a large uterus - like paramesonephric duct in a man is in itself clinically unusual , but when it forms a part of the contents of a hernial sac , it must be considered a rarity .", "a 70 year old man presented to our hospital with a painful left - sided inguinal swelling of one day duration . the patient gave history of asymptomatic left inguinal swelling from past 20 years and absence of the right testis since birth . exploration of the inguinal canal revealed an indirect inguinal hernia containing a globular structure resembling uterus , fallopian tubes with an atrophic right testis embedded in the broad ligament and attached to pelvis with a thick fibrous band [ figs . 1 and 2 ] . total excision of the uterus with fallopian tubes and atrophic right testis was performed and the operation was completed with left inguinal hernioplasty [ figs . 3 and 4 ] .", "pmds is a rare form of internal male pseudo - hermaphroditism in which mullerian duct derivatives are seen in men . male pseudo - hermaphroditism is a condition in which the gonads are testes but the internal genitalia are not completely virilized . an element of deciding on intervention is largely based on reducing risk of malignancy , while maintaining maximum reproductive function . in pmds patients with undescended testes ,", "pmds is a rare form of male pseudo - hermaphroditism characterized by the presence of mullerian duct structures in an otherwise phenotypically , as well as genotypically , normal man . , the surgeon should be aware of pmds while dealing with patients who present with unilateral or bilateral cryptorchidism . in summary , in cases of unilateral or bilateral cryptorchidism associated with hernia , as in our patient 's case , since patients are phenotypically male , the diagnosis is usually not suspected until surgery is performed for cryptorchidism or hernia repair .", "", "", "the patient being a major gave a written consent of the same after assuring him that name and hospital mrd no of the patient will not appear in the case report . a written informed consent was obtained from the patient for publication of the case report and various images which may be used with the same .", "bashir a chalkoo , bashir a khan and ab hamid sherwani in the anaesthesia team . all the authors have contributed either as being part of surgical and anaesthesia team or helping in the photography , paper writing , submission etc . afak yusuf sherwani , abdul qayoom shah , abdul majeed wani , farooq ahmad sofi and ashfaq amin wani were in the surgical team . wasim lone , mehmood a sheikh and raj reshi sharma did photography and paper writing ." ]

[ "spider nevi are usually < 2 cm in diameter and rarely grow to assume large size more than 2 cm . we hereby report a case of very large spider nevus in a patient with hepatitis c virus ( hcv ) related liver cirrhosis . spider nevus ( also known as spider angioma or vascular spider ) is a common benign vascular anomaly that may appear as solitary or multiple lesions . they are found in the distribution of the superior vena cava , that is , on the face , neck , arms , and upper trunk .", "thus , a diagnosis of cirrhosis liver with portal hypertension was made ( ctp-9 , class b , and meld 11 ) . a 48-year - old - female presented with a history of abdominal distension and jaundice of 3-month duration . physical examination revealed pallor , icterus , pedal edema , hepatospleenomegaly and tense ascites . she was put on diuretics for the control of ascites but developed hepatic encephalopathy and renal dysfunction .", "spider nevi can be seen in pregnancy , in patients with thyrotoxicosis , rheumatoid arthritis , oral contraceptive use and most commonly , liver cirrhosis . most remain small in size and rarely do they assume the size as seen in our patient . the present case is unique because of its very large size , rare presentation over the forehead and palpable mass like vascular lesion in a patient with nonalcoholic cirrhosis . these frequently appear in alcoholic cirrhotic or when liver function deteriorates in patients of the chronic liver disease . the levels of substance p are elevated which may play an important role in the pathogenesis of spider nevi by causing vasodilatation . electrodesiccation and laser treatments under local anesthesia are effective therapeutic procedures for facial spider nevi ." ]

[ "we performed sympathetic nerve reconstruction surgery using intercostal nerve in 19 patients with severe compensatory hyperhidrosis after endoscopic thoracic sympathetic surgery and evaluated the results of the procedure . since kux performed endoscopic thoracic sympathetic surgery ( 3 ) , it has been popular during the past few decades as the surgical treatment of choice for facial , palmar , and axillary hyperhidrosis ( 4 - 6 ) . primary hyperhidrosis is a common disease that is characterized by excessive sweating of face , palms , or axilla , occurring in 0.6 - 3% of a population ( 1 , 2 ) . although endoscopic thoracic sympathetic surgery offers permanent cure for hyperhidrosis , it is often accompanied by serious complications , such as compensatory hyperhidrosis . in order to decrease compensatory hyperhidrosis , endoscopic thoracic", "patients , reconstruction surgery of sympathetic nerve using intercostal nerve was performed in 19 patients with severe compensatory hyperhidrosis after endoscopic thoracic sympathetic surgery . from february 2004 to august 2007 , we performed endoscopic thoracic sympathetic surgery in 184 patients with primary hyperhidrosis . among theses we reviewed the clinical charts of all patients who underwent sympathetic nerve reconstruction surgery using the intercostal nerve . the patients were in a semi - fowler position with their arms extended . in 18 patients except for one patient with severe pleural adhesion , \" definite \" means that patients felt fully satisfied after the reconstruction surgery , \" mild \" means that patients felt satisfied to a certain extent , and \" absent \" means that patients felt no improvement . patients were followed by telephone questionnaire on the effects of the surgery and postoperative complications .", "r3 intercostal nerve was used for sympathetic nerve reconstruction surgery in 15 patients , r4 intercostal nerve in 2 , r2 intercostal nerve in 1 , and r3 with r5 intercostal nerve in 1 patient . primary hyperhidrosis patients were composed of 9 facial , 8 palmar , and 1 axillary , and one patient had both facial and palmar hyperhidrosis . initial endoscopic thoracic sympathetic surgery for primary hyperhidrosis was t3 sympathicotomy in 5 patients ; t2 sympathicotomy in 8 ; t2 , 3 sympathicotomy in 1 ; t2 , 3 , 4 sympathicotomy in 1 ; t2 clipping in 2 ; t2 , 3 clipping in 1 ; and t2 clipping with t3 sympathicotomy in 1 patient . preoperative and postoperative digital infrared thermographic imagings performed in one patient showed the thermal change in chest and back . postoperative complications were numbness of the chest wall in 2 patients , chest wall pain in 2 patients , and temporary ptosis in 1 patient in whom ptosis spontaneously resolved after 3 months . the median interval between the first endoscopic thoracic sympathetic surgery for primary hyperhidrosis and sympathetic nerve reconstruction surgery was 47 ( range , 4 - 111 ) months . three patients replied that the effects of reconstruction were \" definite \" , 6 responded with \" mild \" , and 8 said \" absent \" .", ", our results suggest that sympathetic nerve reconstruction with intercostal nerve may be one of the useful surgical methods in severe compensatory hyperhidrosis patients . before and after sympathetic nerve reconstruction , we performed the digital infrared thermographic imagings in 22 yr - old man complaining of compensatory hyperhidrosis in chest after t3 sympathicotomy . after the reconstruction surgery , trunk temperature has increased , and this result corresponded with patient 's symptom . even though the number of patients is not sufficient for data analysis , outcome of the reconstruction surgery did not correlate with the interval between the sympathetic surgery and reconstructive surgery . to evaluate the exact effects of sympathetic nerve reconstruction , more cases and longer the reconstruction surgery must be decided very carefully in highly selected patients with severe compensatory hyperhidrosis . postoperative complications of the reconstruction surgery were seen in 5 patients ; prolonged chest wall pain which was tolerable in 2 patients , and numbness of chest wall in 2 patients . thoracoscopic intercostal nerve could be harvested in all patients except 1 patient with severe pleural adhesion , leading us to believe that the intercostal nerve is a useful graft for sympathetic nerve reconstruction surgery ." ]

[ "therefore , to compare the long - term safety and efficacy between laparoscopic surgery and laparotomy in patients with high - risk ec , we conducted a retrospective analysis based on our decade of clinical data using propensity score matching ( psm ) in this research . willis et al have published an article about laparoscopic hysterectomy in a high - risk series of patients with ec , showed that laparoscopy provide all the benefits inherent in minimal access surgery with no compromise in terms of outcomes , but there was no laparotomy data as control . endometrial cancer ( ec ) is one of the most common gynecologic malignancies , occupying the sixth place in malignant tumor throughout the world with an increasing trend . laparotomy is the traditional approach , but laparoscopic surgery is widely proposed recent years since it was first reported using for the treatment of ec in 1992 by childers and surwit . in lots of retrospective and prospective studies , it seems that laparoscopic surgery for ec also has similar recurrence rate and survival outcome with laparotomy procedure . what 's more , data of long - term survival outcomes about laparoscopic surgery remain limited .", "a total of about 400 medical case notes of patients with histologically confirmed ec who has been received surgical treatment in beijing chao - yang hospital affiliated capital medical university from 2000 to april 2014 were reviewed . the collected data of patients included age , body mass index ( bmi ) , the scope of operation , operating time , blood loss , intraoperative and postoperative complications , first flatus time , postoperative hospital stay , surgical stage , histologic type and grade , number of lymph nodes dissection , and clinical outcome . iv ) patients who had undergone comprehensive surgical staging in the form of peritoneal cytology , total hysterectomy , bilateral salpingo - oophorectomy , pelvic lymphadenectomy and para - aortic lymphadenectomy or sampling , + / cytoreductive surgery by the same experienced surgical team via laparotomy ( total abdominal hysterectomy , tah ) or laparoscopy ( total laparoscopic hysterectomy , tlh ) . we selected subjects according to the following criteria : high - risk ( grade 2 , histologic nonendometrioid , myometrial invasion 1/2 , positive pelvic or para - aortic nodes or stages ii eight covariates entered in the propensity model , including age , bmi , the scope of operation , myometrial invasion , pathologic type and grade , lymph node metastasis , and surgical stage . the overall survival ( os ) was defined as the period from the date of surgery to death or the date of last contact for living people .", "three hundred eighty - two case notes were reviewed including 255 patients with high - risk ec . among these 225 patients , the patients received transfusion during surgery in laparotomy group was statistically more than that in laparoscopy ( p < 0.01 ) . for the incidence of transferred to icu on account of poor cardiopulmonary resuscitation , it was also statistically higher in patients treated by laparotomy than by laparoscopy . moreover , no injury to bladder , ureter , or large vessels occurred in both 2 groups , only 1 patient in laparotomy group had the intestine injury because of heavy pelvic adhesion that had been received intestinal repair . finally , a total of 220 patients with high - risk ec met the study criteria , 107 were treated by laparotomy and 113 by laparoscopy . it showed that no significant difference between laparotomy and laparoscopy cohorts ( 75.8% vs. 85.3% , p = 0.97 ) . the mean blood loss were significant less in laparoscopy group ( 107 ml ) than laparotomy group ( 414 ml ) ( p < 0.01 ) . the kaplan meier estimate for survival rate in laparotomy and laparoscopy at 5 years was 89.2% , 85.3% and at 10 years was 75.8% , 85.3% , respectively .", ", significant differences were not found in age , myometrial invasion , pathological type , and grade and lymph node metastasis between 2 groups but in bmi , scope of operation , and figo stage which could be the confounding factors . after matching , 81 pairs of patients were matched successfully . in the matched cohorts three hundred eighty - two case notes were reviewed including 255 patients with high - risk ec . among these 225 patients , finally , a total of 220 patients with high - risk ec met the study criteria , 107 were treated by laparotomy and 113 by laparoscopy . 31 individuals with severe cardiopulmonary disease , other malignancies or uterus 12 weeks of gestation were excluded ; 4 individuals with missing surgical or pathological data were deleted . table 1 provides details of patient characteristics across the laparotomy and laparoscopy group pre- and postpropensity score matching . before matching", "the mean operative time was similar between 2 groups , 253 minutes in laparoscopy group and 258 minutes in laparotomy group . the mean blood loss were significant less in laparoscopy group ( 107 ml ) than laparotomy group ( 414 ml ) ( p < 0.01 ) . the laparoscopy cohort also has significant shorter first flatus time ( 2.0 days vs. 2.4 days , p < 0.01 ) and postoperative hospital stay ( 14.7 days vs. 17.7 days , p = 0.02 ) than laparotomy which meant that patients received laparoscopic surgery had more rapid recovery than that received laparotomy . however , the mean numbers of para - aortic lymph nodes were comparable between 2 groups ( p = 0.11 ) ( table 2 ) . the mean numbers of pelvic lymph nodes dissected by laparoscopy were 16.6 compared 21.9 by laparotomy with significant difference ( p < 0.01 ) .", "intraoperative complications were significant different between the 2 groups ( 6.2% for laparoscopy and 25.9% for laparotomy , p < 0.01 ) . none of the laparoscopic cases was converted into open procedures . the patients received transfusion during surgery in laparotomy group was statistically more than that in laparoscopy ( p < 0.01 ) . for the incidence of transferred to icu on account of poor cardiopulmonary resuscitation , it was also statistically higher in patients treated by laparotomy than by laparoscopy . moreover , no injury to bladder , ureter , or large vessels occurred in both 2 groups , only 1 patient in laparotomy group had the intestine injury because of heavy pelvic adhesion that had been received intestinal repair . six patients developed pe in laparotomy group compared 1 in laparoscopy with no statistically difference ( table 3 ) . dvt occurred more often in laparotomy patients than laparoscopy patients , 14.8% versus 3.7% ( p = 0.01 ) .", ", there were 16 ( 9.9% ) recurrences which were similar between the 2 treatment cohorts , 7 ( 8.6% ) were observed in laparotomy group at peritoneal , liver , lung , vaginal , and abdominal incision versus 9 ( 11.1% ) in laparoscopy group at peritoneal , liver , lung , and vaginal . the kaplan meier estimate for survival rate in laparotomy and laparoscopy at 5 years was 89.2% , 85.3% and at 10 years was 75.8% , 85.3% , respectively . twenty patients died , 11 in the laparotomy group and 9 in the laparoscopy group . the median follow - up was 45 months ( rang 5176 ) . during the follow - up time it showed that no significant difference between laparotomy and laparoscopy cohorts ( 75.8% vs. 85.3% , p = 0.97 ) . no statistically significant difference was found between the 2 groups when os was compared ( p = 0.97 ) ( figure 1 ) .", ", it seems that laparoscopic surgery is as effective as laparotomy in the long term and can be safely carried out in patients with high - risk ec for surgery treatment . this retrospective study demonstrated that laparoscopic technique is effective and even safer compared with laparotomy for patients with high - risk ec . in 2009 , gynecologic oncology group ( gog ) compared laparoscopy and laparotomy for comprehensive surgical staging of ec in a randomized multicenter trial which involved 2616 patients and reported that laparoscopic surgery resulted in fewer complications and shorter hospital stay but longer operation time . in another large randomized trial published in 2010 , laparoscopic surgery was associated with a shorter hospital stay and less amount of blood loss , but no beneficial effect was observed in terms of major complications and operation time . for accurately estimating the effect of intervention , randomized controlled trial ( rct ) is considered the optimal approach but often limited by ethic and other problems . furthermore , other long - term follow - up data on high - risk ec of randomized trials is still needed to confirm these results . when randomized trial was limited by the objective conditions , psm might be a feasible alternative to reduce selection bias . in conclusion psm can eliminate the imbalance between groups and reduce the effects of confounding to achieve a random effect in observational studies . in the present study ," ]

[ "syringomyelia is the development of a fluid - filled cavity within the spinal cord . despite different etiologies that cause syringomyelia the term does not imply the absence of a cause but just the absence of a cause that can be detected using standard diagnostic methods . we present our experience in the management of cases of syringomyelia due to dorsal spinal arachnoid bands and review the current available evidence of the diagnostic work - up and management of this etiology . , it is largely agreed that the alteration of cerebrospinal fluid ( csf ) flow dynamics plays an important role in the development of a syrinx . there are very few reports in the literature describing arachnoid bands / webs as causes of idiopathic syringomyelia .", "note inadvertent bubble of air that ascended superiorly to the level of arachnoid web , which was useful in confirming the presence and level of the web postoperatively , the patient recovered well from the operation and there was gradual improvement in his symptoms with normal gait and return of normal function of hands . six months after the surgery , the patient reported complete symptom resolution and follow - up mri scan [ figure 1 ] showed significant reduction in the size of the syrinx . preoperative ( top row ) and postoperative ( bottom row ) mri for case 1 showing cervical significant syrinx prior to surgery and collapsed down following surgery . the postoperative scan was done 6 months after the surgery preoperative ct myelogram and axial mri for case 1 . the abrupt change in cord caliber / displacement demonstrated by the myelogram was not evident on mri studies . intradurally , we found a dorsal arachnoid band that was excised and histology confirmed arachnoid tissue . the postoperative scan was done 12 months after the surgery preoperative ct myelogram for case 2 demonstrating the cord displacement and change in caliber by now , the patient had developed right lower limb spastic weakness along with left radiating leg pain .", "a 43-year - old male was referred with a 2-year history of progressive dissociative sensory loss in his lower limbs with myoclonic twitches . note inadvertent bubble of air that ascended superiorly to the level of arachnoid web , which was useful in confirming the presence and level of the web postoperatively , the patient recovered well from the operation and there was gradual improvement in his symptoms with normal gait and return of normal function of hands . six months after the surgery , the patient reported complete symptom resolution and follow - up mri scan [ figure 1 ] showed significant reduction in the size of the syrinx . he had been investigated previously in another neurosurgical center and the magnetic resonance imaging ( mri ) scan revealed a cervicothoracic syrinx but in the absence of any apparent cause ; the patient was managed conservatively for 2 years till he was eventually referred to our center for a second opinion .", "intradurally , we found a dorsal arachnoid band that was excised and histology confirmed arachnoid tissue . a ct myelogram [ figure 4 ] was performed that revealed displacement of the spinal cord at t3 to t5 and compression to the left likely secondary to either arachnoid band or cyst . the postoperative scan was done 12 months after the surgery preoperative ct myelogram for case 2 demonstrating the cord displacement and change in caliber by now , the patient had developed right lower limb spastic weakness along with left radiating leg pain . mri scan [ figure 3 ] revealed a lower thoracic syrinx with some signal change in spinal cord . follow - up imaging after 18 months showed no change . however , 4 months later the patient reported increasing discomfort and numbness in both the arms with subjective lower limb weakness and gait disturbance . his follow - up mri [ figure 3 ] at 6 months postoperatively revealed significant reduction in the syrinx size .", "we report a very uncommon and hence under - recognized cause of symptomatic syringomyelia . whilst arachnoid bands / webs have previously been reported as the etiologic factor for idiopathic syringomyelia this once again highlights the importance of exhaustively looking for a rectifiable surgical targets , such as arachnoid webs and cysts in the presumed idiopathic syrinxes , which would otherwise have be treated with shunts . we recognize that myelography is an invasive procedure with potential morbidity and with recent significant advancements in mr technology , it may be prudent to investigate symptomatic idiopathic syringomyelia with mri csf flow studies in the first instance and failing that , to proceed to myelography . in fact , most patients with any short segment arachnoid pathology causing primary spinal syringomyelia , generally have good outcomes after surgical decompression / detethering procedures . first reported the importance of recognizing occult arachnoid webs , pouches , and cysts in idiopathic syringomyelia . in a large series of 28 patients with thoracic arachnoid pathology ,", "arachnoid webs / bands are a rare and hence often underdiagnosed cause of idiopathic syringomyelia , leading to delayed diagnosis and treatment . in symptomatic ct myelography should be performed if these studies do not yield answers or also if the surgeon feels further information is needed prior to definitive treatment , especially as myelography provides more robust localization of the level of block . conventional mri should always be augmented with mri csf flow studies in the sagittal plane and if needed in multiple axial planes to aid in the diagnosis . / deteriorating patients with idiopathic syringomyelia , imaging studies should be closely inspected for the presence of a transverse arachnoid web . focussed surgical decompression and excision of the offending arachnoid tissue usually leads to good clinical and radiological outcomes .", "", "" ]

[ "the goal of this study was firstly to assess the validity of rhpth treatment in a cohort of postmenopausal women with severe osteoporosis ; secondly , to evaluate the improvement in qol and pain symptoms after several months of rhpth therapy . a follow - up qualeffo-41 questionnaire was used to quantify the patient s pain and the affect on qol after rhpth therapy . this has a marked negative impact on the quality of life ( qol ) and functional impairment of the affected patients . osteoporosis is a systemic disease leading to progressive decrease in bone mineral density , decreased bone strength , and increased risk of skeletal fractures . quality of life ( qol ) can be measured to compare the effect of different treatments for osteoporosis . more recently , some specific instruments have been developed to measure the qol in osteoporosis more accurately .", "groups were randomized to daily treatment with 20 g s.c . of recombinant human parathyroid hormone ( rhpth 134 ) , self - administered injections ( group a ) or 70 mg per os of alendronate every week ( group b ) . the qol questionnaire of the european foundation for osteoporosis ( qualeffo ) was administered at baseline and at the end of the study to evaluate the impact of rhpth on health - related qol . the study was a 18 months , randomized prospective cohort study conducted at department of molecular and clinical endocrinology and oncology , university of naples federico ii , naples , italy . biochemical markers of bone turnover were dosed in all the selected female patients : alkaline phosphatase ( alp : 35104 data are expressed as mean sd or percentage ; moreover , to assess the affect of teriparatide treatment on markers of bone turnover , bone mineral density , and on health - related qol , pearson correlation coefficients were computed in the 2 study groups . therefore , percentage changes of biomarkers , bone mineral density , and qualeffo results were calculated . inclusion criteria for this study consisted of back pain , postmenopausal osteoporosis ( t - score 2.5 at lumbar spine or femoral neck ) , the presence of 2 osteoporotic vertebral fractures , previous treatment for osteoporosis .", "the aim of this study was to evaluate percentage changes from baseline in biochemical markers of bone turnover , values of bone mineral density ( measured at lumbar spine and proximal femur ) , and measurements of qol . lumbar spine bmd increased by 12.4% in group a compared with group b in which it increased by 3.85% . there was no significant difference in these characteristics between the 2 groups . in the group a , 39 ( 93% ) out of the 42 recruited women completed the study : 2 patients discontinued the drug therapy because of lack of compliance with the study treatment ; 1 patient discontinued because of a new vertebral atraumatic fracture . as a consequence of pain relief , the consumption of nonsteroidal anti - inflammatory drugs also decreased in 29 women of group a , while it did not decrease in group b.", "in group a serum levels of pinp increased of 90% , 145% and 127% at t3 , t12 , t18 , respectively ; bone alp levels increased of 57% , 79% and 65% ; ntx levels increased of 53% at t3 , of 100% at t12 , of 110% at t18 . in group b percentage changes from baseline of serum levels of pinp were 50% , 70% and 74% at t3 , t12 , t18 , respectively ; bone alp levels decreased of 30% , 48% and 41% ; ntx levels were reduced by 55% at t3 , of 69% at t12 , of 72% at t18 . mean percentage changes from baseline are shown over time for all 3 biochemical markers in figures 1 and 2 .", "the bmd in the femur increased from baseline at month 18 , in group a , by 5.2% and by 1.99% in group b. in group a , mean femoral neck t - score was 3.070.60 at baseline and mean t - score at t18 was 2.910.63 at the end of the study ( r : 0.87 ; p<0.001 ) ; in group b , mean femoral t - score was 3.020.61 at t0 and 2.960.64 at t18 ( r : 0.99 ; p<0.001 ) . lumbar spine bmd increased by 12.4% in group a compared with group b in which it increased by 3.85% . specifically , in group a mean t - score at t0 was 3.870.71 and mean t - score at t18 was 3.390.72 ( r : 0.88 ; p<0.001 ) ; instead , in group b , mean t - score at t0 was 3.900.73 and mean t - score at t18 : 3.750.72 ( r : 0.98 ; p<0.001 ) . by the end of the study period , the bmd values expressed in terms of t - score in our total pool displayed important changes ( figure 3 ) . at month 18 ,", "at t0 , all patients of groups a and b showed baseline vertebral fractures . patients treated with teriparatide were more protected against new fractures , compared with patients treated with bisphosphonates ; in fact , only 1 new vertebral fracture occurred in group a ( 2.4% ) at study endpoint ( t18 ) vs 6 new vertebral fractures that occurred in group b ( 15.7% ) at t18 .", "the most - common reported adverse effects were back pain worsened in the first month of treatment that was reported by 14% of women ; nausea , reported by 10% ; headache and dizziness that were reported by only 1 and 2 women . the reported adverse effects were abdominal pain in 9 patients , arthralgia in 4 patients , and dyspepsia in 1 patient .", "a ) result indicated a serious reduction in pain ( 22% ) after treatment with rhpth : mean scores measured was 729.2 at start and 5614 after 18 months ( r : 0.61 ; p<.001 ) compared with group b ( 9.7% ; 718.7 at t0 and 6511 at t18 ; r : 0.53 ; p<.001 ) . for everyday activities ( domain b ) , an average of 5513.6 was measured at t0 and of 4022.9 at t18 ( r : 0.44 ; p<.01 ) in group a which had a total improvement of 27.3% , while the improvement was of 11% in group b ( 61.118 at t0 and 54.315.7 at t18 ; r : 0.68 ; p<.001 ) . as a consequence of pain relief , the consumption of nonsteroidal anti - inflammatory drugs also decreased in 29 women of group a , while it did not decrease in group b. we evaluated the teriparatide impact on several aspects of qol by administering the patients qualeffo-41 test at t0 and t18 ( figure 4 ) . first domain ( domain the mean score of domain d ( locomotor function ) was of 48.410 at baseline and 30.214.3 at the end of the study that indicates a percentage change of 37.8% in group a compared to group b where the change was of 11.5% ( 46.88.6 at t0 ; 41.410.05 at t18 ; r : 0.69 ; p<.001 ) . the performed domestic job domain ( domain c ) showed an improvement of 29% in group a ( 6010.7 at t0 ; 42.613.3 at t18 ; r : 0.68 ; p<.001 ) and of 2.9% in group b ( 62.113.3 at t0 ; 60.313.7 at t18 ; r : 0.88 ; p<.001 ) .", "our results demonstrate that daily injections of rhpth for 18 months are an efficacious and generally well - tolerated therapy in postmenopausal women with severe osteoporosis . more importantly , in our experience rhpth therapy results in decreased fractures and pain symptoms in patients with osteoporosis , and , our study evidences that the use of rhpth influences all considered domains of qol ; in fact , pain , physical and social functions , mood significantly improved in nearly all patients treated with rhpth at the end of the study . our data clearly demonstrate that rhpth is more effective than bisphosphonates in acting on back pain and all the domains of qol . treatment with teriparatide resulted in a greater increase in bone mineral density ( bmd ) .", "therefore , this study evidences that this anabolic agent represents a valid therapeutic option in severe postmenopausal osteoporosis ; moreover , patients after this treatment experience , improvements not only in pain relief , but also in certain aspects of emotional functioning , activities of daily living , and leisure activities , improve qol considerably . our results demonstrate that rhpth increases bone mineral density considerably , reduces the occurrence of new fractures , and the need for analgesic therapy ." ]

[ "the tte revealed that the device was not in the defect and it had embolized to the pulmonary artery . the defect was closed through a right femoral route with a 30 mm asd occluder after balloon sizing with tte . in the cineangiography and tte a 22 years old female patient was admitted to our outpatient clinic with a complaint of dyspnea for the previous three years . early after the procedure , the device was observed to be in the correct position ( fig . the patient was referred to the cardiovascular surgery unit and underwent surgery promptly . under general anaesthesia a right bundle branch block was detected on her electrocardiogram . in the transthorasic echocardiography ( tte ) ,", "percutaneous asd closure is a widely used and has been performed successfully throughout the world in recent years . the most important factor for success in percutaneous closure is the correct patient selection . in patients with secundum asd , percutaneous secundum asd is the most common type , which accounts for 50% to 70% of all asds and located in the fossa ovalis . sinus venosus type asd is located at the upper portion of the interatrial septum where the vena cava superior opens . however , it should be kept in mind that improper patient and device selection may result in deadly complications like device embolization , cardiac perforation and tamponade ." ]

[ "the present study investigated the expression of selected immunological lineage - specific markers and selected vesicle - related markers on five major leukocyte subpopulations , namely , cd4 t cells , cd8 t cells , nk cells , b cells , and monocytes . the expression was determined for leukocytes present in freshly isolated whole blood and on cultured isolated leukocyte subpopulations and compared to the presentation of these markers on the corresponding leukocyte - derived evs . however , as these markers may be present on several types of evs and as the intracellular origin of the characterized evs was not determined , the ev subset investigated in the current study was denoted by small evs ( sevs ) . the ev array , used for phenotyping of evs , is optimized for detection of small evs with a size below 150 nm that present cd9 , cd63 , and/or cd81 , such as exosomes and exosome - like vesicles . extracellular vesicles ( evs ) are a heterogeneous group of vesicles that can be subdivided based on their size , biogenesis , and molecular composition . using the biogenesis as a classification tool thus , identification of a specific molecular signature of evs released by immune cells can provide knowledge that can lead to the use of evs in a therapeutic setting .", "the acquired data files were analyzed by flowjo vx.0.7 ( treestar , ashland , usa ) , first by adding a leukocyte - gate based on morphologic characteristics ( fsc / ssc ) and subsequently by the use of the lineage - specific markers ; cd3 and cd4 for cd4 t cells ; cd3 and cd8 for cd8 t cells ; cd16 and cd56 for nk cells ; cd19 for b cells ; and cd14 for monocytes . for the production of the protein microarray , microarray printing was performed on a spotbot extreme protein edition microarray printer with a 946mp4 pin ( arrayit , sunnyvale , ca , usa ) . the detached cells were washed once in growth medium and adjusted to 3 10 cells / ml . from the cd4 depleted pbmcs , b cells were isolated using the dynabeads untouched human b cells kit ( life technologies ) according to the manufacturer 's instructions . from the cd8 depleted pbmcs , monocytes were isolated using the dynabeads untouched human monocytes kit ( life technologies ) according to the manufacturer 's instructions . human nk cells were isolated from pbmcs by negative selection according to the manufacturer 's instructions ( dynabeads untouched human nk cells kit , life technologies ) . blood samples were obtained from ten healthy volunteers at the department of clinical immunology , aalborg university hospital . from each donor two blood samples were collected , one tube containing edta ( k3edta , vacuette , greiner bio - one , austria ) for immediate analysis of noncultured leukocytes and one tube containing cpda ( vacuette , greiner bio - one , austria ) for the vesicle analysis ( plasma ) . the antibodies listed above were diluted in pbs containing 5% glycerol and printed at a concentration of 180200 g / ml . as a positive control , 100 g / ml of biotinylated human igg in pbs with 5% glycerol was printed . as a negative control , the cells were harvested in pbs , washed , and resuspended in pbs with 0.5% bsa and 0.09% nan3 , followed by a subsequent surface marker staining . for the ev array , isolated leukocytes were adjusted to 3 10 cells / ml and cultured in either 12-well ( 3 10 cells / well , 1.5 ml / well ) or 24-well plates ( 1.5 10 cells / well , 1 ml / well ) ( nunc , thermo scientific , carlsbad , ca , usa ) for 4448 hours at 37c and 5% co2 .", "the present study investigated the sevs produced by the different subpopulations of mononuclear cells found in peripheral blood and compared the vesicular phenotype to the cellular phenotype . the purity of the different subpopulations throughout the three individual experiments was 9799.5% for the cd4 and the cd8 t cells , 8295% for the b cells , 6894% for the monocytes , and 8597% for the nk cells . all cultured lymphocyte subpopulations expressed cd63 and cd81 at low - to - intermediate levels , while the monocytes expressed high levels of both markers . even though the levels varied , the expression patterns of cd63 and cd81 on the cultured leukocyte subpopulations were similar to the patterns observed on leukocytes present in freshly isolated blood . based on the obtained minimum and maximum mfi values , it was clear that the expression level of the three markers varied between the individuals illustrating a natural variation . in order to investigate the phenotypic homogeneity between the sevs and the parent cells , the cellular expression patterns of selected lineage - specific and vesicle - related markers were compared to the vesicular presentation of these markers ( figure 4 ) . in relation to the selected lineage - specific markers , cd3 , cd14 , cd16 , and cd19 leukocytes can be subdivided based on morphological characteristics upon staining into polymorphonuclear cells ( the granulocytes ) and mononuclear cells ( the lymphocytes and the monocytes ) . could not be detected on sevs from cultured t cells , monocytes , nk cells , and b cells , respectively , indicating that not all cell surface molecules are transferred to the sev surface . it was investigated whether sevs from isolated leukocyte subpopulations presented the lineage - specific markers that define the parent cells .", "overall , these findings are in agreement with previously described results [ 5661 ] . when looking at both the cellular and the vesicular presentation of these markers , it is clear that , for the majority of the cultured subpopulations , the presentation of these markers was comparable . however , for the nk cells , the b cells , and the monocytes , the cellular expression of cd63 was very different from the presentation observed on sevs . a comparison between the presentation of cd9 , cd63 , and cd81 on whole blood leukocytes and plasma evs is a more complex procedure that needs to take into account that plasma evs are a very heterogeneous group of evs that emanate from multiple cell types . the phenotype of five different subsets of leukocyte - derived sevs was determined and related to both the phenotype of sevs present in plasma and the cellular phenotype of the leukocyte subpopulations . the results showed that none of the included lineage - specific markers could be detected on the sevs released from b cells , nk cells , and monocytes in monocultures ( cd19 , cd56 , and cd14 , resp . ) . the presence of fas - l on evs from t cells has also been observed in other studies [ 5254 ] , but to the best of our knowledge , studies observing ctla-4 on evs from leukocytes have not previously been published . upon evaluating the presence of markers on evs , it is important to consider the natural variation in the molecular composition of the ev pool that exists between healthy individuals as visualized by the ten plasma samples . the ev array , used for the investigation of the phenotype of sevs , is a protein microarray technique that provides the opportunity to detect and characterize sevs for up to 60 markers in a high - throughput manner and with high sensitivity [ 37 , 38 ] .", "thus , the protein composition is related to the functionality of evs , why phenotyping of evs can be used to gain knowledge about the functionality . in summary , the presented data regarding the lineage - specific markers and the tetraspanins support the accumulating observations suggesting that the transfer of molecular cargo into evs is tightly controlled . a tightly regulated sampling of molecules to evs would match with the fact that evs play an important role as systemic regulators , traveling through tissues providing key intercellular communication as well as transfer of biologically active components . surface molecules on evs are responsible for the biodistribution and the ligation to target cells ." ]

[ "in march 2014 , an unprecedented \n outbreak of ebola virus disease \n ( evd ) began in western africa that as of july 2015 is ongoing and \n has claimed more than 11000 lives . , \n we have conducted an initial evaluation of ebola virus persistence \n within wastewater to address uncertainty and inform ongoing risk assessments . \n a current ebola virus outbreak strain from guinea ( makona - wpgc07 ) \n the ebola virus - containing wastewater was \n sampled for 8 days , and the viability of ebola virus was determined \n in these samples . the potential for transmission of ebola virus via wastewater \n is currently unknown . to address uncertainties regarding ebola \n virus persistence in wastewater the necessity of evaluating ebola virus persistence \n in wastewater matrices has previously been highlighted , as wastewater \n in ebola virus outbreak settings may be temporarily held in open containers \n or disposed of in open sewers .", "stock virus ( ebola virus guinea \n makona - wpgc07 , 10 tcid50 ml ) was handled as described previously . the ebola virus concentration in sewage has not been \n previously measured or estimated ; thus , two separate concentrations \n were utilized to cover possible concentration scenarios . tcid50 is an end point dilution series that is used to determine \n at what dilution 50% of the infected wells produce cell death . an approximation of focus - forming \n units ( ffus ) can be made from a poisson distribution utilizing the \n formula tcid50 0.69 , assuming each ffu is formed \n from a single virus . the region from which \n the sample was collected uses a combined sewer system that experiences \n significant infiltration , and the determined composition is typical \n for the region . untreated wastewater was \n collected from an anonymous regional wastewater \n treatment facility in western pennsylvania that receives wastewater \n from seven communities ( combined population of approximately 60000 ) . \n the natural \n logarithm of c / co tcid50 was plotted and fit with a linear trendline for estimation \n of the inactivation constant ( k ) . the wastewater \n was frozen at 80 c to minimize compositional changes \n prior to analysis .", "specifically , \n these findings highlight the value of a precautionary approach to \n wastewater handling within an outbreak scenario , in response to both \n ebola virus and other emerging viruses . these \n results demonstrate a persistence of ebola virus in wastewater greater \n than what has previously been suggested and the potential of a wastewater \n exposure route to infectious ebola virus . the results of this \n study suggest a potential \n exposure route to infectious ebola virus via wastewater ; however , \n any assessment of potential exposure routes must consider the effects \n of wastewater composition , dilution of contaminated wastewater , and \n inactivation of ebola virus during treatment and holding ." ]

[ "the final objective is an additional increase in the radiation dose within the tumour volume together with maximum protection of the adjacent normal lung parenchyma . respiratory tumour motion is a big challenge for radiotherapy , especially for high precision techniques . these developments also include online imaging with a linac - integrated cone beam ct . the particular advantages of magnetic resonance imaging ( mri ) are the high soft - tissue contrast , differentiation of tumour and atelectasis , the possibility to choose the optimal plane for motion quantification and the possibility to integrate further dynamic parameters , e.g. lung perfusion or o 2 \n quantification , into one imaging session . the temporal resolution is already reasonably high for monitoring lung tumour motion in real - time . \n four - dimensional imaging using computed tomography ( 4d - ct ) is under development for optimization of radiotherapy by integration of motion [ 24 ] . integration of the knowledge about lung and lung tumour motion is essential for planning of high precision radiotherapy . thus modern techniques of adaptive radiotherapy will greatly benefit from devices which take lung and tumour motion into account in radiotherapy planning .", "fast - low - angle - shot ( flash ) sequences with a temporal resolution of one image per second demonstrate chest wall motion per se and postoperative changes of respiratory motion , i.e. changes of the cranio - caudal distance before and after lung volume reduction surgery . parallel imaging techniques make use of the different spatial sensitivities for the receiver coils in order to employ them for the simultaneous acquisition of image data , significantly reduce the phase encoding steps and achieve a marked improvement in spatial and temporal resolution . continuous improvements and new developments in mr scanner technology , such as high performance gradient systems and pulse sequences , have made this possible and address the inherent challenges of mri of the chest , such as low proton density with an unfavourable signal to noise ratio and short t2 relaxation times with \n substantial susceptibility artefacts . novel mri techniques allow for non - invasive acquisition of the motion of lung and pulmonary tumours during the respiratory cycle with high spatial and temporal resolution [ 8 , 9 ] . modified true - fast - imaging - with - steady - state - precession ( truefisp ) sequences , widely used in cardiac mri , were successfully applied in volunteers ( fig . 1 ) . by adding a mathematical model , a continuous quantitative measurement of lung volume was achieved , which again showed a high correlation with spirometry . \n\n thus , important requirements were met to measure the respiratory movement of the lung quantitatively .", "after successful tests in volunteers , dynamic mri was transferred to patients with solitary pulmonary tumours in order to visualise lung tumour motion by mri in two dimensions ( fig . the diaphragmatic length was particularly useful in the assessment of respiratory mechanics and the respective effects of pulmonary tumours . in addition , the knowledge about deformation of nodules and changes in volume during the respiratory cycle has substantial impact on the accuracy of volume measurement during the follow - up of pulmonary nodules and attempts to calculate nodule doubling times . \n motion of pulmonary nodules can be visualised and quantified in all three axes in order to be transferred in potential treatment concepts . changes in tumour volume are associated with deformations and changes of the main rotation axes of the nodules .", "radiotherapy very quickly leads to a significant , often temporary reduction of motion of the treated hemithorax when compared to the situation prior to radiotherapy . this ipsilateral reduction is compensated for by an increased motion range of the contralateral lung . further studies are warranted to demonstrate which patients might benefit from preventive treatment , e.g. to prevent clinical aggravation . \n obviously , such changes between right and left lung can not be detected by global lung function tests .", "motion of pulmonary tumours can be measured in two or three dimensions , effects of respiration on volume and shape can be calculated . additional split lung analysis is feasible revealing important insights into differences between right and left lungs undetectable by global pulmonary function tests . however , presently the evaluation of such data sets is extremely time - consuming . \n", "substantial portions of this paper and the figures were originally published in plathow c , meinzer hp , kauczor h - u .", "lung motion is reflected by measuring the distance from the apex to the top of the diaphragm ( l ) . respiratory cycle from maximum expiration to maximum inspiration within 1 s. top row shows a healthy volunteer with synchronous movement of both lungs . bottom row shows a patient with lung cancer on the left and subsequently reduced motion range of the left lung . \n cranio - caudal lung tumour motion is measured with regard to the intervertebral space t 6/7 ( 1 ) ; antero - posterior motion with regard central anterior margin of the spine ( 2 ) ; and medio - lateral motion with regard to the centre line of the spinal processus ( 3 ) . \n maximum lung tumour motion ( mm ) during shallow breathing in cranio - caudal ( cc ) , medio - lateral ( ml ) and antero - posterior ( ap ) direction depending on tumour localization in the upper , middle or lower lung zone . \n " ]

[ "a 21-month - old male patient , 75 cm in height and 10 kg in weight , experienced tricuspid valve regurgitation ( tvr ) and was scheduled to undergo tricuspid valve plasty . the tvr was discovered in a follow - up test 1 year after he had undergone ventricular septal defect repair surgery . before tricuspid valve plasty after tricuspid valve surgery , the patient was weaned from the cardiopulmonary bypass by reducing the perfusion rate of the machine and starting mechanical ventilation . phenobarbital was administered until 19 days after surgery under the suspicion of a connection between the ocular deviation and the convulsions . on the postoperative day 28 , when the flash visual evoked potential ( fvep ) and mri had been planned , the patient 's eyes refocused . he was able to recognize the objects in front of his eyes , could walk and avoid things in his path , and was able to recognize his guardians . there were complications due to the adhesion of the svc and ivc near the surgical site .", "when cortical blindness is suspected , the ophthalmologist and neurologist should perform a combined examination , being cautious of permanent sequelae . in conclusion , with the reported visual loss in our pediatric patient , surgeons should consider the possibility of visual loss and cerebrovascular injury after a cardiac surgery using cardiopulmonary bypass . the early indicators of brain damage after surgery are age , the complexity of surgery , metabolic acidosis , increase in lactate , and artery acidosis . diagnosing cortical blindness is simple when the patient makes a complaint but as in our case , a pediatric patient has limited ability to communicate . therefore , conducting an eeg , fvep , angiography , and funduscopy can assist in making a diagnosis . in this case , the eeg did not show the abnormal finding of a loss in alpha rhythm . however , computed laminography revealed an infarction in the occipital cortex there were also cases of temporary cortical blindness reported after post - cardiac surgery angiography . in the case of children , considerable effort is required to reduce neural sequelae after pediatric cardiac surgery , such as visual loss . visual loss after a cpb might be caused primarily due to emboli , severe low blood pressure , acute anemia , hypoxia or a combination of these factors . in the present case braekken et al . reported that cardiac surgery using extracorporeal circulation causes microemboli in most cases ." ]

[ "rostami et al . have reported that the rescue chances of the babies who have received preventive nasal continuous positive airflow pressure ( ncpap ) are three times higher than the other babies . considering that an analytical and comprehensive study has not been done about the role of neonatal risk factors and the therapy given for hospitalized neonatal death in west azerbaijan , one of the most important issues in babies death is suitable management and timely referral of newborn babies with high - risk levels and being hospitalized in neonatal intensive care unit ( nicu ) . about 1.3% of all neonatal deaths are caused by hmd or its complications in premature newborns . nicu is a critical section in a hospital , dealing with infections ( e.g. septicemia , pneumonia , surgical infections , and other infections ) that are difficult to control . in the usa , , the index of neonatal death in iran is 16 - 20 deaths out of 1000 survived births , which is higher than that in developed countries . who has urged iran to halve its neonatal death rate by 2015 . management , appropriate care , and supportive cares are the important factors in preventing babies death .", "the study is case control study , wherein the case group included 250 died babies who were hospitalized in the nicu during 2007 - 2009 . the control group also included 250 newborn babies who were hospitalized in the same unit and were discharged alive and healthy after they were given appropriate treatment . only the newborn babies from shahid motahhari therapy - training center were selected in order to homogenize the sample and eliminate some threatening factors ( factors involved in referral , death , etc . ) . the questionnaire contained six sections ( mother 's and baby 's demographic information , causes of hospitalization , during - treatment complications , therapeutic actions , and causes of death ) for alive babies and five sections for dead ones . data collection was carried out through a researcher - designed questionnaire which was designed based on other studies and scholars points of view . inclusion criteria included the babies complete profiles , and the criteria for exclusion included their incomplete profiles .", "multiparity led to a decrease in the death of neonates hospitalized in the nicu [ table 1 ] . based on single - variable analysis , neonatal risk factors affecting the newborn babies hospitalized in the nicu are as follows : 51.6% of case babies and 18.3% of control babies had first - minute apgar score of less than 6 , which proved to have a significant correlation with babies death ( p < 0.001 ) . the results showed that the or of neonatal death was 4.02 times greater for neonates with first - minute apgar score of less than 6 compared to those with first - minute apgar score of 6 and more , for asphyxia , the or was 6.16 , for hmd it was 4.08 , and for sepsis it was 6.42 . applying ncpap and , the results of the study also showed that having ncpap played a significant role in decreasing death of babies hospitalized in the nicu ( p < 0.001 ) . congenital anomalies have been recognized as one of the significant risk factors of death of babies hospitalized in the nicu .", "in the present study , the most important neonatal risk factors affecting neonatal death were found to be sepsis , birth asphyxia , hmd , first - minute apgar score of less than 6 , congenital anomalies , and delivery method . in our study , this spread of sepsis has been reported to be in 1 - 10 cases out of 1000 live births , but 10 - 50% of deaths occur because of it . the second risk factor in the present study was at birth asphyxia , which is in line with tariq and kundi 's study which mentioned sepsis and neonatal asphyxia as the main causes of death , but in the studies carried out by sereshtedari et al . , it was the cause of the 16% deaths in 18 provinces of the country , in bangladesh approximately 26% of neonatal deaths are caused by asphyxia . the study of abdul in malaysia showed that this problem with sepsis is the most important cause of infants death . one of the causes of infant death , low apgar score at birth , is increasingly mentioned in many studies to be a risk factor . the other serious clinical problem is respiratory difficulty , and in this study , it manifested as respiratory distress and hmd . in our study , it was the third risk factor of infant death .", "the major risk factors in this study ( sepsis , asphyxia during birth , hmd , congenital anomaly , and apgar score less than 6 in the first minute of birth ) are considered as the major complications of preterm labor and preterm infants . so , strict preventive programs should be undertaken for premature preterm labor and preterm infants ; taking care of the infants in four stages ( before conception , during pregnancy , during delivery , and thereafter ) can be highly effective as well ." ]

[ "lung cancer remains the leading type of cancer worldwide and in latin america [ 1 , 2 ] . recent findings indicate that inflammation plays a key role in tumor progression and survival across several cancer types . this is the rationale for further research into other molecular and cellular factors of the immune system that could be effectively targeted to develop novel therapeutic strategies for the management of advanced nsclc . cancer related inflammation affects many aspects of malignancy including proliferation , survival , angiogenesis , and tumor metastasis . the immunotherapy approach has opened new therapeutic options in advanced nsclc with the advent of antibodies against immune checkpoints [ 29 , 30 ] . conventional therapies are based on chemotherapy and radiotherapy but with low efficacy . over the last decade , there have been advances in the study of molecular pathways underlying tumor development leading to the development of targeted therapies such as tyrosine kinase inhibitors ( tkis ) and antibodies directed against the two main actionable genes in nsclc up to now : mutations in the epidermal growth factor receptor ( egfr ) gene targeted by tkis like gefitinib [ 13 , 14 ] , erlotinib [ 9 , 15 , 16 ] , and afatinib [ 1719 ] and translocations involving the anaplastic lymphoma kinase ( alk ) gene treated with the tki crizotinib , alectinib , and ceritinib .", "macrophages within the tumor microenvironment are called tumor - associated macrophages ( tams ) . tams however , in prostate , lung , and brain , increasing tams is associated with regression of tumors . there is an association between the number of macrophages and prognosis in a variety of human tumors . have a complex relationship with tumor cells ; at an early stage they attack tumor cells avoiding tumor spread ; however , over time they begin producing reciprocal growth factors and establish a symbiotic relationship with tumor cells .", "innate immunity in lung involves alveolar macrophages ( ams ) which act as a barrier avoiding penetration of pathogens . the antitumor activity of alveolar macrophages from lung cancer patients decreases with increased metastasis , tumor size , and development of pleural invasion . ams with defective phagocytosis lead to chronic inflammation and significantly increase the likelihood of developing chronic obstructive pulmonary disease , lung injury , and cancer ( figure 1 ) . the onset of malignant disease triggers the immune response recruiting tams into the tumor site . conversely , macrophages contribute in part to the pathogenesis of lung disease due to toxic particles ingestion , releasing lysosomal enzymes that can kill the macrophage itself , or contribute to the recruitment of new macrophages inducing chronic inflammation . clinical evidence has indicated that the activation of alveolar macrophages by sio2 produces rapid and sustained inflammation characterized by the generation of monocyte chemotactic protein 1 , which , in turn , induces fibrosis .", "neutrophils are also polarized into n1/n2 subgroups , n1 being proinflammatory , while n2 is anti - inflammatory . n1 and n2 represent a dichotomy in neutrophil subpopulations present in patients and animal models with cancer where they play distinctive roles in the pathogenesis of disease . thus , neutrophils apoptosis and clearance is a critical limiting factor for the successful resolution of inflammation . in colon adenocarcinoma cell line , so far , the possible mechanisms by which neutrophils are increased in nsclc patients have not been described ; despite this , these cells are dysfunctional ; increased levels of il-8 could explain this accumulation ; however , the mechanisms by which this occurs are not known . if apoptotic neutrophils within the tissues are not removed in an efficient and timely manner , they will become necrotic and release cytotoxic granule proteins that may perpetuate host tissue damage .", "cd47 has also been identified as a tumor marker , and its dysregulation contributes to cancer progression and evasion of antitumor immunity [ 9194 ] . the dual role of cd47 in promoting inflammation through neutrophil migration and recognition of self through blocking phagocytosis in macrophages plays a role in the development of cancer and later in tumor immune evasion . , cd47 can regulate the function of cells in the monocyte / macrophage lineage [ 8082 ] . nowadays , therapies are developed to block the interaction of tumor cells with macrophages through cd47 , thereby offering an opportunity to turn tams against nsclc cells by allowing the phagocytic behavior of resident macrophages .", "monoclonal antibodies specific for tumor cell antigens , coupled with appropriate cytokines , may provide rational basis for designing trials to employ the neutrophil cytotoxic potential as adjuvant therapy in cancer patients . currently the only fda - approved immunotherapies for the treatment of nsclc are nivolumab and pembrolizumab . these antibodies switch on immune system cells mediated by t cells , increasing their ability to recognize and destroy cancer cells [ 128 , 130 ] . ctla-4 is thought to regulate t cell proliferation early in an immune response , primarily in lymph nodes , whereas pd-1 is upregulated in current smokers and suppresses t cells . glycodelin ( gene name paep ) is a proliferation suppressor and apoptosis inducer of t cells , monocytes , b cells , nk , and regulated pulmonary immune response in asthmatic inflammation .", "chronic inflammation seems to play a major role in the onset and development of cancer . understanding the interaction between the cellular and molecular factors that mediate inflammation in nsclc , including on the other hand , the potential side effects should be addressed by careful selection of patient populations based on biomarkers such as tumor cd47 overexpression . may reduce inflammation thereby preventing cancer , and blocking the antiphagocytic signal of cd47 on the surface of tumor cells can overcome immune suppression , harnessing the immune system to target malignant cells more effectively . the rather unexplored components of innate immunity such as macrophages and neutrophils , can elucidate novel targets affecting key oncogenic pathways in this malignancy and allow preventing cancer cell proliferation , angiogenesis , and metastasis . inhibiting cd47 as promoter of neutrophil extravasation and migration" ]

[ "we investigated to evaluate whether biochemical response using serial plasma cga is reliable in concordance with the tumor response based on response evaluation criteria in solid tumors ( recist ) criteria in gep - nets irrespective of chemotherapeutic agents . chromogranin a ( cga ) , a glycoprotein contained in secretion granules of neuroendocrine cells , is the most abundant granin in gep - nets and widely used as a circulating tumor marker , but only few studies have been published on the role of cga in patients with gep - pet , and the range of sensitivity were variously reported [ 8 - 10 ] . gastroenteropancreatic neuroendocrine tumors ( gepnets ) are rare malignant neoplasm with an incidence ranging from two to five cases/100,000/yr . the ability of the imaging method to localize primary or metastatic site of gep - net also has some limitations . therefore , non - invasive parameters , indicating gep - pet , are needed for diagnosis , following - ups and prognosis .", "a total of 27 cases in 18 patients , who were pathologically diagnosed in gep - nets , were analysed between march 2011 and september 2013 . for all cases , partial response ( pr ) was defined as 50% decrease in plasma cga compared to the baseline cga ; stable disease ( sd ) was defined as a decrease < 50% or as an increase < 25% ; and progressive disease ( pd ) was defined as an increase 25% . chromoa is based on sandwich enzyme - linked immunosorbent assay , using two monoclonal antibodies ( the same antibodies as cga - riact ) directed against the central domain of the molecule ( 145 - 245 ) , which is less sensitive to proteolysis . the tumor size was measured by using a ct or magnetic resonance imaging by recist criteria ver . 1.1 . the following clinicopathological characteristics of all 18 patients were collected : age , sex , primary site , tumor grade in accordance to the 2010 world health organization ( who ) classification , liver metastasis , number of metastatic site , site of metastasis , and information of chemotherapy . progression - free survival ( pfs ) was measured as the time from the date of chemotherapy to the date of first documented disease progression or death . biochemical efficacy was estimated according to the criteria proposed by the italian trials in medical oncology ( itmo ) group for evaluating markers ( biochemical response ) . non - functioning was defined to the absence of clinical syndromes of hormonal hypersecretion , such as hypoglycemia , peptic ulcer , diarrhea , steatorrhea , acromegaly , cushing s syndrome , and gallstone .", "a total of 27 cases in 18 patients , who were pathologically diagnosed in gep - nets , were analysed between march 2011 and september 2013 . for all cases , non - functioning was defined to the absence of clinical syndromes of hormonal hypersecretion , such as hypoglycemia , peptic ulcer , diarrhea , steatorrhea , acromegaly , cushing s syndrome , and gallstone . the following clinicopathological characteristics of all 18 patients were collected : age , sex , primary site , tumor grade in accordance to the 2010 world health organization ( who ) classification , liver metastasis , number of metastatic site , site of metastasis , and information of chemotherapy . systemic chemotherapies for gep - net included octreotide , vip ( vincristine , ifosfamide , cisplatin ) , xelox ( capecitabine , oxaliplatin ) , ep ( etoposide , cisplatin ) , pazopanib , sunitinib , everolimus , and xeliri ( capecitabine , irinotecan ) .", "biochemical efficacy was estimated according to the criteria proposed by the italian trials in medical oncology ( itmo ) group for evaluating markers ( biochemical response ) . partial response ( pr ) was defined as 50% decrease in plasma cga compared to the baseline cga ; stable disease ( sd ) was defined as a decrease < 50% or as an increase < 25% ; and progressive disease ( pd ) was defined as an increase 25% . the level of cga was determined from venous blood samples drawn into edta - containing tube after overnight fasting and collected before systemic treatment . chromoa is based on sandwich enzyme - linked immunosorbent assay , using two monoclonal antibodies ( the same antibodies as cga - riact ) directed against the central domain of the molecule ( 145 - 245 ) , which is less sensitive to proteolysis . the tumor size was measured by using a ct or magnetic resonance imaging by recist criteria ver . the plasma cga level was measured by cga - ria ( chromoa assay , cis bio international , saclay , france ) with a normal range of 27 - 94 ng / ml .", "progression - free survival ( pfs ) was measured as the time from the date of chemotherapy to the date of first documented disease progression or death . were employed to compare the sensitivity and rate of concordance in different groups . in all statistical tests , group comparisons were performed using a nonparametric test of mann - whitney or kruskal - wallis , followed by a dunn multiple comparison test , as appropriate . comparisons of paired values were performed using a nonparametric test of wilcoxon . the chi - square test and the fisher exact test ( for value less than 5 ) the pfs were estimated using the kaplan - meier method with log - rank analysis .", "the rectum was the second most common site of gep - net ( 22.2% ) in this study . according to who classification , ten of the 27 cases ( 37% ) were grade 3 neuroendocrine carcinoma . 3 ) . a subgroup analysis of pfs between responders and non - responders , in accordance to recist response , tumor grade , and primary site , were not statistically significant , but showed longer pfs in the biochemical responder group ( fig . there was a significant difference for pfs between responders and non - responders ( 35.73 months vs. 5.93 months , p=0.05 ) based on the biochemical criteria ( fig . the concordance of response between recist criteria and biochemical criteria were 74% ( table 3 ) . compared with the baseline values , a decrease of 50% in the cga level measurable lesions were found on ct images in 18 out of the 27 cases . among the 27 cases included in this study , no difference in the basal cga level the overall response rate ( rr ) by recist criteria was six out of the 27 cases ( 22.2% ) and eight out of the 27 cases ( 29.6% ) for biochemical rr . were observed in three out of six cases ( 50% ) with pr by recist criteria ( figs .", "the rectum was the second most common site of gep - net ( 22.2% ) in this study . according to who classification , ten of the 27 cases ( 37% ) were grade 3 neuroendocrine carcinoma . grades 1 and 2 nets were nine ( 33.3% ) and eight ( 29.6% ) , respectively .", "among the 27 cases included in this study , no difference in the basal cga level was observed in terms of gender , primary tumor site , tumor grade ( who classification ) , liver metastasis , number of metastatic site , and line of chemotherapy with serial cga monitoring . the plasma cga level ranged from 33.18 to 895 ng / ml ( table 1 ) .", "the overall response rate ( rr ) by recist criteria was six out of the 27 cases ( 22.2% ) and eight out of the 27 cases ( 29.6% ) for biochemical rr . there was a significant difference for pfs between responders and non - responders ( 35.73 months vs. 5.93 months , p=0.05 ) based on the biochemical criteria ( fig . 3 ) . a subgroup analysis of pfs between responders and non - responders , in accordance to recist response , tumor grade , and primary site , were not statistically significant , but showed longer pfs in the biochemical responder group ( fig . the concordance of response between recist criteria and biochemical criteria were 74% ( table 3 ) . compared with the baseline values , a decrease of 50% in the cga level were observed in three out of six cases ( 50% ) with pr by recist criteria ( figs . the concordance of disease control between recist criteria and biochemical criteria were 94.1% ( fig .", "a recognized international standard for cga assay is not available and variations in assay types may influence results . nevertheless , this analysis identified the usefulness of serial cga monitoring as a biomarker that predicts treatment response and survival . this study showed that the change of the cga level was correlated with tumor response in nonfunctioning gepnets . additionally , biochemical response based on serial cga may be a predictive marker for pfs in gep - nets . however , it is still controversial whether serial cga changes reflect tumor response for treatment . thus , cga monitoring may be helpful in assessing the response to the different therapeutic options . in some studies ,", "this study revealed that the changes of the plasma cga levels were associated with tumour response . additionally , biochemical response based on serial cga may be a predictive marker for pfs in gep - nets ." ]

[ "however , we hypothesized that the specific types of scc might differ between mci and vamci , due to the differing pathologies of these two disorders . differences in functional impairment between individuals with mci and those with vamci , which may be overlooked by objective cognitive testing , may be predicted by an analysis of significance of scc . in the current study , we compared the profile of scc in individuals with a diagnosis of mci to those with vamci using the neuropsychological impairment scale ( nis ) . subjective cognitive complaints ( scc ) are quite prevalent among older adults , with some estimates suggesting that between 25% and 50% of all older adults have self - perceived memory impairment [ 1 , 2 ] . in clinical practice , it is often difficult to assess the veracity and severity of subjective cognitive complaints , primarily because such complaints vary widely from individual to individual . as a result a review conducted by jonker and colleagues showed that memory complaints may be predictive of dementia or alzheimer 's disease onset within two to four years , especially in individuals with a diagnosis of mild cognitive impairment ( mci ) . although the direction of causality between many of these variables remains unclear , scc should be considered in a clinical setting because of their associations with objective impairment , dementia , depression , low quality of life , and functional ability .", "rather , patients were assigned to the vamci group if scans showed evidence of white matter lesions , lacunar infarcts , and/or moderate to severe microangiopathic change . subjective cognitive complaints were assessed using the neuropsychological impairment scale ( nis ) [ 20 , 21 ] . the mini - mental state examination ( mmse ) was used to measure cognitive performance from a general perspective . functional ability was objectively assessed using the older american resources and services ( oars ) activities of daily living questionnaire . cognitive testing and data intake occurred during the patients ' initial visits to the clinic . twenty patients with mci and twenty patients with vamci matched on demographic characteristics ( age , education ) were recruited from the memory disorders clinic at st . this questionnaire assesses fourteen activities of daily living ( adls ) : seven basic adls ( eating , dressing and undressing , grooming , walking , getting in and out of bed , bathing , and going to the bathroom ) and seven instrumental adls ( using the telephone , traveling , shopping , preparing meals , doing housework , taking medications , and handling money ) .", "performance on all subcategories of the bna ( attention , memory , naming , visuospatial function , and executive function ) was similar between mci and vamci groups . . scores from subcategories of the bna were also compared between groups to look for specific areas of cognitive impairment ( table 2 ) . the mci and vamci groups achieved markedly different results when subjective cognitive complaints were assessed by the nis . in general , objective cognition function was measured by the mmse and the bna ( table 2 ) . functional ability , as measured by the oars questionnaire , was also similar between the two groups ( p = 0.919 ) ( table 2 ) . overall bna scores were also similar between the mci and vamci groups ( p = 0.177 )", "mci and vamci are clinical conditions that precede the development of neurodegenerative disorders including alzheimer 's disease and vascular dementia , respectively . apart from differences on neuroimaging there has been very little study of how these two clinical conditions differ in terms of their subjective and objective clinical profiles . taken altogether , our findings from the mmse , bna , oars , and nis show that despite similar levels of functional ability and objective cognitive function , vamci subjects have significantly more scc than mci subjects . our study has demonstrated that vamci patients may be exhibiting particular cognitive deficits in memory , verbal learning , and cognitive efficiency , separate from those exhibited by mci patients . our findings support the existing view of mci and vamci as disorders with similar presentations with regard to objective function , but ultimately different etiologies . as well , vamci - specific deficits should be related to neuroimaging findings , in order to associate deficits with particular locations and severities of white matter disease ." ]

[ "evolution of amoxicillin - clavulanic acid nonsusceptibility of escherichia coli from blood isolates , spain , 20032006 . evolution of consumption of outpatient penicillin/-lactamase inhibitors ( world health organization code j01cr02 ) , spain , 20002006 . after amc , the most used -lactam antimicrobial agents in the community in spain were amoxicillin , cefuroxime , and cefixime ; their consumption did not vary or slightly decreased from 2002 through 2005 ( 6 ) .", "the increased amc resistance of e. coli isolates from blood observed in this study is of serious concern from clinical and epidemiologic standpoints because amc is the first - choice antimicrobial treatment for many invasive e. coli infections . previous treatment with amc is a risk factor for the development of amc resistance ( 10 ) . increased amc resistance coincided with growing amc consumption at the community level . in urinary infections , amc resistance mechanisms ( -lactamase overproduction , ampc cephalosporinase hyperproduction , and inhibitor - resistant penicillinases ) ( 11 ) might be favored by strong amc consumption ." ]

[ "a 51-year - old caucasian female was referred to our institution because of an abnormal nodule detected in her right lung . she received 4 cycles of chemotherapy for the sigmoid adenocarcinoma before she was referred to us for excision of what was believed to be a single metastatic nodule . although the radiologic findings supported a benign tumor , neither positron emission tomography - ct nor any other procedure to attempt to diagnose the nodule this had at first been detected four months earlier when she underwent an urgent hartmann procedure due to refractory adenocarcinoma of the sigmoid colon ( pt4n1 stage ) . due to the urgency of the surgery , the patient underwent video - assisted thoracoscopic ( vats ) wedge excision of the tumor .", "the prognosis of patients with rare sfts of the lung depends on the completeness of the tumor resection . variants of sfts of the lung that are malignant or suspected to be malignant should be managed as lung cancer with regard to the surgical resection of the tumor and follow - up strategy . less than 20 cases of intraparenchymal sfts have been reported in the english literature [ 1 - 5 ] . to prove and establish the fact that these lesions are indeed of pulmonary origin , it is important to consider the clinical , radiologic , and pathologic findings to demonstrate the lack of continuity with the visceral pleura and to exclude an endophytic growth in a pleural - based lesion . sft is the preferred term for an uncommon , but histomorphologically distinctive spindle cell neoplasm , that was identified in the past as fibrous mesothelioma , localized fibrous mesothelioma , localized fibrous tumor , localized mesothelioma , pleural fibroma , solitary fibrous mesothelioma , or submesothelial fibroma . resection with clear margins is curative and final diagnosis and prognosis can be defined only after surgical resection ." ]

[ "hence , the present study is aimed to synthesize agnps from a. digitata fruit pulp extract , characterize and to know the potentiality of agnps against different microbial pathogens . synthesis of metal nanoparticles with the help of plant extracts is an emerging field of nanotechnology , due to their novel properties , terrific applications in biomedicine and its eco - friendly nature . in recent past synthesis of agnps from stem bark and leaf extract of a. digitata acts as excellent reducing agents and show potential antimicrobial activity against different microorganisms . it has different biological activities such as antimicrobial , anthelmintic , antilarvicidic , antioxidant , anticancer , anti - inflammatory , hepatoprotective , and wound healing activity . the high content of vitamin c in fruit pulp is recommended to pregnant women s for daily intake . in recent times , different scientists prove different activities of pulp such as hepatoprotective , antimicrobial , antiviral , antioxidant , antidiarrheal , hypoglycemic , anti - inflammatory , and antioxidant activities . due to high medicinal values and mythological significance of this plant however , the potentiality of fruit pulp mediated synthesis of agnps is not carried out so far .", "the antimicrobial activity of biologically synthesized nanoparticles are analyzed on seven pathogenic bacteria such as bacillus subtilis atcc 6633 , staphylococcus aureus atcc 6538 ( gram - positive ) , escherichia coli atcc 25922 , klebsiella pneumonia atcc 43816 , proteus vulgaris atcc 13315 , pseudomonas aeruginosa atcc 15442 , salmonella typhimurium atcc 14028 disc diffusion method was followed for testing antimicrobial activity against biologically synthesized agnps , and comparative studies were made with plant pulp extract , 1 mm agno3 as negative controls and streptomycin or fluconazole as a standard for bacteria and fungi , respectively . 20 and 40 g / ml concentration of agnps show minimum inhibitory effect and 80 g / ml concentrations of agnps show maximum inhibitory concentration . due to this , we prefer 80 g / ml concentrations of agnps to check the antimicrobial activity on different microbial organisms . apart from these , a 5 , 10 , 20 , 40 , 60 , 80 g / ml concentrations of synthesized agnps are tested separately to know the minimum inhibitory concentration . transmission electron microscopy ( tem ) using hf-3300 advanced 300 kv tem / stem from hitachi .", "cut open the fruit and separate the seeds adhesive to pulp . grounded the collected pulp with the help of mortar and pestle , sieved the content for the synthesis of nanoparticles 2 to 4 kg weight mature fruits possess a great amount of pulp is collected from acharya ranga agricultural university , tirupati and cross checked by herbarium ( voucher no : svu362 ) deposited in department of botany , sri venkateswara university , tirupati .", "1 filter paper and stored at room temperature . from this , 5 ml of the extract is taken into 250 ml of erlenmeyer conical flask and titrated against with the solution of 1 mm agno3 at a 60 - 80c temperature . the contents are cooled and centrifuged at 10,000 rpm for 20 min to avoid the presence of any biological impurities , and it is used for further characterization and antimicrobial studies . for synthesis , 25 g of fruit pulp is extracted with 100 ml of distilled water on boiling water bath for 30 min , filter the content with whatman no .", "purity of agnps was analyzed by fei quanta 200 feg high resolution ( hr)-scanning electron microscopy ( sem ) machine equipped with edax instrument . to know the size , shape , agglomeration pattern , and dispersed nature of the nanoparticles confirmation of synthesized nanoparticles is agnps by ultraviolet ( uv)-vis spectrophotometry absorption spectra using a spectro uv 2080 double beam , between the wavelength scan range of 190 - 700 nm , 1200 l / mm spectrophotometer , analytical technologies , india . to know the possible bio - molecules responsible for reduction and stabilization of agnps by fourier transform infra - red ( ftir ) spectra in the scan range of 4,000 to 500 cm transmittance with an alpha interferometer , bruker , ettlingen , karlsruhe , germany by kbr pellet method . x - ray diffraction of synthesized nanoparticles is examined by an x - ray diffractometer ( xrd ) ( shimadzu , xrd-6000 ) equipped with cu ka radiation source using ni as a filter at a setting of 30 kv/30 ma to know the crystalline nature of agnps . transmission electron microscopy ( tem ) using hf-3300 advanced 300 kv tem / stem from hitachi . are done by atomic force microscopy ( afm ) by nova nt - mdt solver next , russia .", "20 and 40 g / ml concentration of agnps show minimum inhibitory effect and 80 g / ml concentrations of agnps show maximum inhibitory concentration . due to this , we prefer 80 g / ml concentrations of agnps to check the antimicrobial activity on different microbial organisms . freshly prepared nutrient agar media for bacteria and potato dextrose agar media for fungi disc diffusion method was followed for testing antimicrobial activity against biologically synthesized agnps , and comparative studies were made with plant pulp extract , 1 mm agno3 as negative controls and streptomycin or fluconazole as a standard for bacteria and fungi , respectively . the plates are swabbed with 100 l of microbial cultures and placed the previously prepared discs ; the experiment is carried out in triplicates . the plates are incubated at 37c for 24 - 48 h , and then the zone of inhibition is measured with the help of a scale and tabulated the results . apart from these , a 5 , 10 , 20 , 40 , 60 , 80 g / ml concentrations of synthesized agnps are tested separately to know the minimum inhibitory concentration . the antimicrobial activity of biologically synthesized nanoparticles are analyzed on seven pathogenic bacteria such as bacillus subtilis atcc 6633 , staphylococcus aureus atcc 6538 ( gram - positive ) , escherichia coli atcc 25922 , klebsiella pneumonia atcc 43816 , proteus vulgaris atcc 13315 , pseudomonas aeruginosa atcc 15442 , salmonella typhimurium atcc 14028 ( gram - negative ) , and five fungal pathogens such as alternaria solani atcc 32904 ,", "the highest inhibition zones were observed in p. vulgaris followed by k. pneumoniae , p. aeruginosa , s. typhimurium , e. coli , b. subtilis , and s. aureus . whereas in the case of fungi , the highest inhibition zones were observed in t. harzianum , followed by a. niger , a. flavus , p. chrysogenum , and a. solani . reduction of ag into ag nanoparticles was observed visually by means of a color change pattern of the reaction medium . the saed pattern of synthesized agnps shows the spots had been corresponding to 111 , 200 , 220 , and 311 of the crystallographic nature of face - centered cubic structures [ figure 6a ] . 20 nm resolution studies with 300 kv electron energy passing through nanoparticles coated thin films on copper grid show the nanoparticles are polydispersed , spherical in shape and size range from 3 to 7 nm [ figure 6b ] . to know the antimicrobial potency of biologically synthesized agnps from fruit pulp of a. digitata a. digitata fruit pulp having thick cream color , upon synthesis the color change from creamy to light yellow indicates the formation of nanoparticles .", "euphorbia hirta leaf mediated synthesis of agnps having a spherical shape with 40 - 45 nm size shows good antifungal efficacy . in our studies also 3 - 57 nm size , spherical shaped agnps produced from a. digitata pulp extract confirmed by hr microscopic studies with afm , sem , and tem proved these agnps are eco - friendly antimicrobial agents against different microorganisms . the same type of results was observed in myristica fragrans seed extract mediated synthesis of agnps . from this ftir study , clearly reveals hydroxyl groups of phenols and amide groups of proteins from plant extract forming a layer to the nanoparticles and acting as a capping agent to prevent agglomeration and providing stability in the medium . based on these ftir studies , we suggest that the bio - molecules present in plant extracts play dual role in formation and stabilization to agnps . silver is a precious metal used as an effective antimicrobial agent before the advent of agnps . due to overuse of silver products , nm size , spherical shaped agnps synthesized from emblica officinalis fruit extract shows potential antimicrobial activity against s. aureus , b. subtilis , e. coli , and k. pneumoniae .", ". 3 to 57 nm size , spherical shaped , polydispersed nanoparticles are produced from a. digitata pulp extract confirmed by afm , sem , and tem prove this plant extract as an effective reducing agent for the production of narrow range of nanoparticles by industrial scale . further antimicrobial studies reveal that small size , spherical shaped particles have immense activity against different microbial pathogens and acts as eco - friendly antimicrobial agents . in the present study , we report an eco - friendly , non - toxic , cost - effective method for synthesis of agnps from a. digitata pulp extract as reducing agent . in this method , naturally occurring materials are acts as reducing agents such as bio - molecules such as phenols and proteins present in plant extract as a simple and alternative to complex physical or chemical synthetic procedures" ]

[ ", we report an unusual case of renal malakoplakia involving the perirenal space and extending to the descending colon in a 65-year - old korean woman with secondary adrenal insufficiency and diabetes mellitus . malakoplakia is a rare chronic inflammatory disease that occurs most commonly in the genitourinary tract , especially the urinary bladder . most patients have associated conditions characterized by some degree of immunosuppression , as seen in solid - organ transplants , autoimmune diseases requiring steroid use , chemotherapy , chronic systemic diseases , alcohol abuse and poorly controlled diabetes.1 ) despite some characteristic histological features including the presence of large histiocytes with clusters of michaelis - gutmann ( mg ) bodies , malakoplakia of the kidney is difficult to diagnose because of its rarity and varying histological pictures.2 ) to our knowledge , there have been no case reports of malakoplakia of the kidney in a secondary adrenal insufficiency from korea . here", "in march 2010 , a 65-year - old woman was transferred from the national police hospital ( nph ) to our facility , shinchon severance hospital ( seoul , korea ) via the emergency room ( er ) , presenting with a decreased level of consciousness . according to her medical history abdomen - pelvis computed tomography ( ct ) scan was performed , which showed the mass - like lesion in the left renal area suspecting abscess . while being treated with ciprofloxacin , she developed a decreased level of consciousness . upon physical examination on the day of the admission to our hospital , secondary adrenal insufficiency due to exogenous steroid was suspected . a low dose adrenocorticotropic hormone ( 1 g cosynthropin ) stimulation test was conducted to diagnose the secondary adrenal insufficiency . radiological reading of the abdomen - pelvic ct conducted on the second day after admission showed that there was an ill - defined inflammatory lesion with multifocal abscess pockets in the left perirenal space , which was suspected of actinomycosis of the descending colon , extended to the left kidney ( figure 1a ) . compared to the abdomen - pelvic ct finding performed outside , the lesion seemed to have decreased slightly in size . she had been taking dexamethasone ( 5 mg , once a day ) for the degenerative arthritis for approximately five years up to the time of admission .", "malakoplakia is an uncommon but distinctive type of chronic granulomatous inflammation . upon microscopic examination , , renal malakoplakia should be taken into account in the differential diagnosis of a patient who presents with urinary tract infection , fever , abdominal pain , and abscess - like lesion in ultrasonography or ct , especially if the patient concerned has diabetes mellitus and a long history of use of exogenous steroids . it is considered that family physicians ' early diagnosis would enable prompt treatment and regular monitoring , leading to avoidance of long - term morbidity and mortality . individuals with diabetes mellitus have a greater frequency and severity of infection . from the earliest reports on studies of adrenocortical function" ]

[ "the objective of this study is to investigate and compare the functional role of ghrelin on the regulation of energy balance in children with cyanotic and acyanotic congenital heart disease and the association of ghrelin with tnf- , il-6 , that were not entirely confirmed in literature by now . although \n nutritional and growth status were investigated in children with cyanotic and acyanotic heart disease , serum ghrelin levels have not been established . the relationship between congenital heart disease ( chd ) , malnutrition , and growth \n retardation is well documented . infants with congenital heart disease are prone to malnutrition for several reasons including decreased energy intake , \n increased energy requirements , or both . different types of cardiac malformations can affect nutrition and growth to varying degrees . ghrelin , a 28-amino - acide peptide , is a potent stimulator of growth hormone release that \n has been implicated in the control of food intake and energy homeostasis in \n human begins and rodents \n [ 15 ] . il-6 is generally considered to be an important cytokine in the network of cytokines that regulate immune reactions and acute phase responses .", "the study was conducted on 47 children with acyanotic chd , 21 children \n with cyanotic chd , and 25 healthy children . all patients ' cardiac diagnoses were \n made on the basis of clinical and laboratory examinations . serum ghrelin , tnf- , and il-6 levels were analyzed with \n elisa kits ( tnf- , il-6 kit was purchased from bio - source international inc . body mass index ( bmi ) \n was calculated as the ratio of body weight ( kg ) and squared height ( m ) . all blood samples were drawn at 08 - 09 am and stored 20c \n until the procedure . the given data were compared between groups using one - way anova , followed by post - hoc ; bonferroni test .", "in 47 acyanotic patients , mean age was 30.518.4 months , in 21 cyanotic patients was 28.415.6 months and in 25 control subjects was 31.115.1 months . serum ghrelin levels were significantly higher than in acyanotic and cyanotic groups compared to in the control group ( p<.0001 ) ( table 3 ) . \n serum ghrelin levels in the acyanotic patients were significantly higher than in the cyanotic patients \n ( p<.0001 ) . \n ghrelin levels were not related to il-6 in the acyanotic and cyanotic patients with chd ( r=.263 , p>.05 and r=.398 , p>.05 , resp . ) . serum il-6 levels were higher than in cyanotic and acyanotic patients with chd compared to in the control groups ( p<.0001 , p<.001 , resp . ) . in both acyanotic and cyanotic groups , tnf- levels were not related \n to bmi in the acyanotic and cyanotic patients with chd .", "we observed the mentioned correlation , both in children with cyanotic heart disease and in children with acyanotic heart disease . although the cyanotic patients had a more pronounced retardation in both height and \n weight than in the acyanotic patients , we found that serum ghrelin levels \n significantly elevated in the acyanotic patients than in the cyanotic patients \n ( p<.0001 ) . serum ghrelin level is elevated in cyanotic and acyanotic patients \n with chd . increased ghrelin levels we found that serum tnf- significantly increased in the cyanotic patients and in \n the acyanotic patients . additionally , the relation of ghrelin with cytokines \n may be explained by the possible effect of chronic congestive heart failure and chronic shunt \n hypoxemia ." ]

[ ", this study was carried out to ascertain the prevalence of rotavirus , adenovirus , and norovirus infection in young children with diarrhea in two primary health centers in edo state , nigeria . the reason(s ) attributed to this may be as a result of the poor health care system in the country where important health issues are taken for granted such as the aforementioned case . thus , as a result of the nonperformance of viral tests for diarrheal patients , information on viral enteropathogens is lost and thus measures to implement control strategies become difficult . against this background it also aimed at assessing the coinfection rates of the viral agents , age , seasonal distribution of infection , and the association between clinical symptoms and viral diarrhea . viral intestinal infections are the most common cause of acute infectious diarrhea in the pediatric group and accounted for approximately 70% of episodes of acute infectious diarrhea in children . enteric viruses are major etiologic agents of acute gastroenteritis among infants and young children worldwide . there is paucity of information as regards viral enteropathogens of diarrhea in many developing countries including nigeria .", "the two primary health centers are aduwawa and evbomodu primary health centers and they are neighboring communities with a fast growing population made up of indigenes with new residents from the main city alongside other inhabitants from other parts of the country . a total of two hundred and eighty - two ( 282 ) stool specimens comprising 223 diarrhea and 59 nondiarrhea stool specimens were collected from children aged between 0 and 36 months attending two primary health centers . as regards children with diarrhea , males were 121 while females were 102 . this study was carried out in two primary health centers located in ikpoba - okha local government area of edo state , nigeria . cases attended to include malaria , diarrhea , immunization of infants and children , antenatal and postnatal cases , and other minor health issues within the scope of the health personnel . rotavirus , adenovirus , and norovirus were detected by the immunochromatographic technique ( ict ) . rotavirus and adenovirus were detected using vikia rota - adeno rapid test device manufactured by biomerieux , france . sterile wide mouth specimen containers were used for specimen collection and they were processed within 6 hours of collection .", "the prevalence of rotavirus , adenovirus , and norovirus infections was investigated among children with diarrhea . the results of this study when compared to other studies carried out in nigeria and other parts of the world showed that the incidence of viral agents varied from one locality to another . a total of 223 children with diarrhea were tested for three viral agents ( rotavirus , adenovirus , and norovirus ) .", "the fact that viral diagnostic tests are not routinely done or rarely done in any of the hospitals in this locality means that such vital information on viral diarrhea is missed out due to the poor attention given to health care in the country . coinfection of viral agents was found to be 7.6% and the most common clinical symptom was vomiting . this is worrisome considering the burden of these viruses on the young children in this locality . finally , the primary health care centers should be provided with all the necessary diagnostic test materials to address cases of viral diarrhea . thus , there is need to test stool specimens of clinically confirmed diarrheal patients for enteric viruses as this will go a long way in reducing the wasteful use of antibiotics which are used as blind treatment for persistent diarrhea that may be of viral origin ." ]

[ "alpha ( )2-adrenoceptor agonists have been used as adjuvant to anesthetic agents in peri - operative period for its several beneficial actions . these drugs improve hemodynamic stability during endotracheal intubation and surgical stress by its central sympatholytic action , and thus reduce anesthetic and opioids requirements . the primary objective of our study was to evaluate the effect of continuous infusion of dexmedetomidine alone , without use of opioids , on sevoflurane requirement during general anesthesia with continuous monitoring of depth of anesthesia by entropy analysis . inhalation agents were titrated based on either hemodynamic criteria and/or bispectral index values in studies done earlier , and none of them demonstrated the effect of dexmedetomidine alone on requirement of sevoflurane with the use of entropy as a measure of depth of anesthesia . the analgesic effect of dexmedetomidine is qualitatively different as compared to opioids and can be used as an alternative to opioids in general anesthesia . opioids , when used as analgesic in general anesthesia , are known to decrease mac value of sevoflurane . the anesthetic sparing effect of dexmedetomidine demonstrated in earlier studies is confounded by the use of opioids . dexmedetomidine , the pharmacologically active d - isomer of medetomidine , is highly selective and specific 2-adrenoceptor agonist .", "the patients in group b received dexmedetomidine(2 ml diluted in 48 ml of saline ) iv in a dose of 1 mcg / kg over10 minutes through infusion pump prior to induction . patients in group a received fentanyl 2 g / kg intravenous slowly , 2 minutes prior to induction . after arrival in the operating room , glycopyrrolate 0.004 mg / kg and ondansetron 0.15 mg / kg intravenous ( iv ) were given as pre - medication in both the groups . the anesthesiologist was permitted to treat hemodynamic events , defined as heart rate and blood pressure more than 20% of baseline , in spite of increasing sevoflurane concentration to 2.5% and dexmedetomidine infusion to 0.8 mg / kg with supplemental analgesia in the form of fentanyl 1 mcg / kg . if rise in heart rate and blood pressure persisted further after supplementation with fentanyl , anesthesiologist was permitted to administer incremental doses of metoprolol 2 - 5 mg . we excluded patients older than 55 years , those with a history of psychiatric / neurological illness , cardiovascular disease , hypertensive patients , morbid obese patients , pregnant and nursing women , with known allergic reaction to any of the study medication , recent use of sedatives or analgesics , and with significant laboratory abnormalities . the study population comprised of 60 patients , aged 18 - 55 years , with american society of anesthesiologists ( asa ) status of 1 and 2 , undergoing major elective surgical procedures .", "bradycardia was observed in 2 patients in group b within 10 mins post - extubation , which promptly responded to atropine 0.6 mg iv . changes in sbp and dbp at various time points post - intubation ( pi - post - intubation , sbp - systolic blood pressure , dbp - diastolic blood pressure ) changes in hr at various time points post - intubation ( pi - post intubation , hr - heart rate ) in our study , none of the patients in either group required supplemental analgesia or anti - hypertensive drugs intra - operatively . fraction of inspired sevoflurane at different time interval ( pi - post - intubation , fi - fraction of inspired ) end tidal sevoflurane at different time intervals ( pi - post - intubation ) during anesthesia maintenance , group b showed a statistical significant decrease in heart rate , systolic and diastolic blood pressure from baseline at all time points as compared to the group a ( p < 0.05 ) . an average 6.5% fall in heart rate from baseline in group b as compared to 3.7% rise in the group a , 8% fall in systolic blood pressure from baseline as compared to 3.6% rise in the group a , and 8.16% fall in diastolic blood pressure from baseline as compared to 3.3% rise in the group a was observed [ figures 3 and 4 ] . the two groups were similar regarding age , sex , weight , and asa physical status [ table 1 ] . pre - induction heart rate , systolic and diastolic blood pressures were similar between two groups ( p > 0.05 ) .", "the major observation in our study was that dexmedetomidine infusion as an adjuvant in general anesthesia causes decreased requirement of sevoflurane without compromising adequate depth of anesthesia , thus it has anesthetic - sparing property . to conclude , the continuous infusion of dexmedetomidine , as adjuvant in general anesthesia , significantly decreases the requirement of sevoflurane for maintaining adequate depth of anesthesia . dexmedetomidine by its sympatholytic action decreases heart rate and blood pressure , thus assessing the depth of anesthesia by hemodynamic parameters would be unreliable in evaluating its effect on requirement of inhalational agent . several electroencephalogram - dependent indices such as bispectral index and entropy have been used to measure the depth of anesthesia . studies measuring plasma concentration of dexmedetomidine should be undertaken to establish the precise correlation between its dose and inhalational agent 's requirements . . showed decreased requirement of sevoflurane with continuous infusion of dexmedetomidine during general anesthesia . in our study , we used entropy to measure the depth of anesthesia , thereby eliminating the bias of evaluation by hemodynamic parameters as in earlier studies . a study done on patients undergoing hysterectomy showed a 30% reduction of maintenance concentration of isoflurane ." ]

[ "", "we demonstrated that nucleosome redistributions are widespread , transient , and dna - directed , . these results demonstrate that while nucleosomal positioning remains relatively constant between chromosomes at each timepoint , nucleosomal occupancy changes in a chromosome specific manner . these two chromosomes show clear increases in the nucleosome occupancy relative to the other chromosomes . at the other end of the scale , chromosomes we discovered that nucleosome occupancy values change in a chromosome specific manner ( fig . we next wanted to determine if nucleosome redistributions showed chromosome specific changes in a time dependent manner . we utilized a high - resolution dna microarray , which we customized to contain 1 kb upstream and downstream of the transcription start sites of 462 immunity - related genes .", "rkshv.219 virus is latently infected in islk.rkshv219 cell line , derived from islk cell line , as previously described by . rkshv.219 cells were seeded at 5 10 cells into 150-mm dish ( one day prior to induction ) . for induction of kshv reactivation , the previous medium is replaced with 1% fbs dmem media containing a final concentration of 0.2 g / ml doxycycline . kshv reactivation was induced at 0 , 6 , 12 , 24 , and 48 h. the 0 h sample was treated identically to other timepoints , however doxycycline was not added . two independent biological replicates for each timepoint in islk.rkshv219 cell lines were processed and behaved similar for the nucleosome distribution assay .", "following doxycycline induction of kshv reactivation , islk.rkshv219 cells were harvested at 0 , 6 , 12 , 24 , and 48 h at 2.5 10 cells . media was aspirated and then 1% formaldehyde in pbs was incubated with the cells for 10 min at room temperature , to cross - link the chromatin structure . 125 mm glycine was then added to stop the formaldehyde cross - linking reaction . nucleus isolation buffer , 0.3 m sucrose , 2 mm mgoac2 , 1 mm cacl2 , 1% nonidet p-40 , 10 mm hepes , and ph 7.8 were then added to islk.rkshv219 cross - linked cells . the cells were scraped and placed within a 50 ml conical tube , and the nuclei were isolated by centrifugation at 1000 g for 5 min at 4 c .", "micrococcal nuclease , mnase , is a internucleosomal cleavage reagent , which does not cleave the dna protected by a nucleosome . a titration of mnase concentrations was utilized to ensure nucleosomes that are more and less readily cleaved are equally represented . mnase digested dna for all samples was resolved on a 2% agarose gel , and mononucleosomally protected dna , ~ 150 bp , was isolated by gel excision . following gel excision , the mononucleosomally protected dna was purified by electroelution , and for each sample 's mnase titration the mononucleosomally protected dna was combined . the mononucleosomally protected dna was further purified with phenol chloroform extraction and precipitated with alcohol .", "we utilized a high - resolution dna microarray , which we customized to contain 1 kb upstream and downstream of the transcription start sites of 462 immunity - related genes . sequences were repeat - masked around the tsss , and only probes containing unique sequences for both the forward and reverse dna strands were printed on the microarray . nimblegen 's 12-plex and hd2 design were utilized for the custom dna microarray 100319_hg19_immunity_jd_cgh array . the samples were fluorescently labeled : nucleosomally protected dna with cy3 and bare genomic dna ( reference ) with cy5 . oligonucleotide probes , sized at 60 bp , were tiled on each subarray with a mean spacing of 47 bp overlap . approximately 180 probes of spacing of 12.5 bp were printed on the microarray for each locus . samples were hybridized to the dna microarray according to nimblegen 's instructions ( http://www.nimblegen.com/technology/index.html ) .", "dennislab.r was used to generate summary statistics on the range of nucleosome distribution values for each individual chromosome . finally , we analyzed the nucleosome distribution changes at the 24 hour timepoint on a per chromosome basis , by calculating the t - statistic and p - value ( assuming unequal variance ) for the pairwise comparison of the range of values between all chromosomes . specifically , loess spatial correction was applied to the raw data ; background correction was used to determine and adjust the signal data for noise using specifically designed background control probes ; and qspline normalization was applied to compensate for inherent differences in cy3 and cy5 signal . the resulting .tiff files were used for microarray data feature extraction , primary data analysis and generation of initial data files using the nimblegen deva software version 1.2 cgh workflow . the ratio between nucleosomal ( cy3 ) and bare genomic cy5 signals was then calculated and stored as a general feature format , .gff subsequent analysis was performed using a software developed in our laboratory dennislab.r , which runs in the r environment for statistical computing .", "these two chromosomes show clear increases in the nucleosome occupancy relative to the other chromosomes . at the other end of the scale , chromosomes 1 and 12 are statistically indistinguishable , yet different from all other chromosomes . these results demonstrate that while nucleosomal positioning remains relatively constant between chromosomes at each timepoint , nucleosomal occupancy changes in a chromosome specific manner . we were next interested in calculating the statistical significance of the chromosome specific nucleosome occupancy changes that we had identified at the 24 hour timepoint . most of the ranges of nucleosome occupancy values are not statistically significantly different from one another ( fig . 1c , yellow highlights ) . we next wanted to determine if nucleosome redistributions showed chromosome specific changes in a time dependent manner . we discovered that nucleosome occupancy values change in a chromosome specific manner ( fig . conversely , chromosomes 1 , 2 , 9 , 10 , 12 , 15 , and 17 show the lower median nucleosome occupancy values at the 24 hour timepoint ." ]

[ "primary pleuropulmonary synovial sarcoma ( ppss ) is a rare soft tissue malignancy representing only 0.1% - 0.5% of all primary lung malignancies . we report a case of ppss that eventually metastasized to the heart in a 17-year - old female . the frequency of cardiac metastasis from soft tissue sarcomas ranges from 3.5% to 35% with only two cases of metastatic synovial sarcoma of the heart reported : one involving the right ventricle and the other the left ventricle .", "the diagnoses of a localized fibrous tumor of the pleura , malignant mesothelioma , metastatic pleural malignancy , and rare primary pulmonary sarcoma ( e.g. , pleuropulmonary synovial sarcoma , fibrosarcoma , leimyosarcoma , sarcomatoid carcinoma , malignant nerve sheath tumor , hemangiopericytoma , and malignant fibrous histiocytoma ) were considered . a final diagnosis of a monophasic synovial sarcoma from the visceral pleura was made based on the histological and immunohistochemical findings . therefore , they agreed to operate surgical resection to treat pericardial mass without obtaining cardiac mri . although mri is the most accurate technique for demonstrating cardiac mass , oncologists found the following mri might be ineffective for choosing further treatment for the pericardial mass due to high cost .", "ppss is a rare mesenchymal spindle cell malignancy representing a type of pulmonary sarcoma that comprises 0.1% - 0.5% of all primary lung malignancies . ppss with cardiac metastasis is also extremely rare , and only two such cases have been reported . combination chemotherapy consisting of doxorubicin and ifosfamide has been associated with higher rates of survival in patients with synovial sarcoma ( 6 ) . in summary , ppss is a very rare , aggressive malignancy that must be considered in the differential diagnosis of lung and pleural malignancies . a history of asbestos exposure and the presence of pleural plaques are indicative of malignant mesothelioma . additionally , a literature review of soft tissue sarcomas included only 105 cases of cardiac metastasis . in that review ," ]

[ "", "the work is self - sponsored by the first author who conceptualized and designed and wrote the manuscript . the second author assisted in the surgery provided some literature review and made necessary correction which lead to the final manuscript .", "the ethical committee of first choice specialist hospital where the authors carried out the procedure approved the work .", "he understood that part of his images will be published and also understood that due to the rarity of the case , that it is worthwhile publishing it for education and for health care delivery .", "the second author assisted during the surgery , provided immediate care , provided some literature review and made necessary correction which lead to the final manuscript .", "" ]

[ "a number of skin disorders have been described in patients with acquired immunodeficiency syndrome ( aids ) . among them , secondary infections are common , but their incidence has decreased considerably following the introduction of combined therapies targeted to the human immunodeficiency virus ( hiv ) . some clinical presentations may be puzzling , particularly in secondary syphilis exhibiting lesions showing a marked tendency to polymorphism .", "a 29-year - old woman with a three - year history of aids presented with polymorphic papules on the face and abdomen . the skin lesions were asymptomatic but the patient complained of discrete malaise , stiff neck , myalgia headache , and mild fever . a biopsy specimen was taken from a papule on the abdomen . the envision ( dakopatts , glostrup , denmark ) polymer - based revelation system and fast red ( dakopatts ) staining were used . a series of 5-m thick sections were cut from the formalin - fixed paraffin - embedded biopsy . an immunohistochemical assessment was performed using a rabbit polyclonal antibody directed to treponema pallidum ( 1:200 biocare medical , walnut creek , ca , usa ) . negative immunohistochemical controls were performed by omitting or substituting the primary and the secondary antibodies in the laboratory procedure .", "dermal homing of t. pallidum on immunohistochemistry : ( a ) multiple interstitial clumps of spirochetes ( 200 ) ; ( b ) vascular trapping of spirochetes ( 400 ) ; ( c ) prominent accumulation of spirochetes in the microvasculature wall ( 400 ) . dermal homing of t. pallidum on immunohistochemistry : ( a ) multiple interstitial clumps of spirochetes ( 200 ) ; ( b ) vascular trapping of spirochetes ( 400 ) ; ( c ) prominent accumulation of spirochetes in the microvasculature wall ( 400 ) . early syphilis . the dermoepidermal junction contained a band - like infiltrate composed mostly of lymphocytes , histiocytes , and plasma cells . a deeper cell infiltrate of similar composition extended along the microvasculature , hair follicles , and sweat glands . their presence inside the lichenoid infiltrate was associated with a dense superficial and deep perivascular cuff of spirochetes .", "in the present case , skin immunohistochemistry shed some light on the diagnosis of syphilis in an aids patient and showed the dermal homing and the microvascular tropism of t. pallidum . the present finding was assumed to illustrate the migration of t. pallidum toward the microvasculature during early syphilis . in summary , t. pallidum were abundant and heavily clustered in some specific portions of the skin . the peculiar homing of t. pallidum in the skin appears quite specific as it has not been reported for any other infectious microorganism ." ]

[ "finally , this epidemiological field study is also eventually intended to be used to organise a network of highly specialised cares . according to the first epidemiological study carried out in france , in association with ( i ) the results of the literature review that defined the list of hadrontherapy indications and ( ii ) the indications chosen for proton therapy in france , the number of cases in the rhne - alpes region eligible for hadrontherapy is estimated at 200 per year ( the rhne - alpes region is home to 10% of the french population ) . since 2004 , no other epidemiological studies have been published for hadrontherapy . in 2011 , however , the japanese team from the national institute for radiological sciences ( nirs ) , pioneer in carbon therapy , published the results of its 1994 to 2011 clinical activity . an initial study assessing recruitment potential for proton therapy was conducted in 1998 in italy , showing an incidence of 10 825 cases / year . finally , again in 2002 , in the context of the project for the construction of the cnao centre in italy , an epidemiological study was conducted , estimating the incidence of cases eligible for carbon therapy at 3694 cases / year and proton therapy at 1885 cases / year . .", "the secondary goals are ( 1 ) to characterise the affected population , ( 2 ) to describe the characteristics of the observed cancers , and ( 3 ) to describe the characteristics of the treatments implemented when hadrontherapy is unavailable . the main goal is to asses , within the rhne - alpes region , the incidence of cancers with hadrontherapy indication .", "multidisciplinary tumor board ) groups of the rhne - alpes region in france , that offer a therapeutic strategy for cancers for which hadrontherapy is an alternative . \n this is a prospective , multicentre incidence study , lasting 24 months , conducted with the rcp ( runion de concertation pluridisciplinaire this study required the involvement of a part - time consultant epidemiology engineer , who totalled one woman - year of work to provide ( 1 ) phone canvassing to identify and involve regional cancer research players ; ( 2 ) the protocol construction and testing phase , along with the data collection tools ; ( 3 ) meetings with 3c ( cancer coordination centres ) coordinators and rcps ; ( 4 ) investigator centres inclusion meetings . local relapse or local recurrence ( these two terms are synonymous ) : it means the redevelopment , at the same site as initially , of a previously effectively treated tumour ( dictionary of medical terms , garnier - delamare ) . \n", "the estimated incidence of cancers eligible for hadrontherapy in the rhne - alpes region in 2010 , regardless of disease , is of 8.5/100,000 inhabitants . the study involves 13 clinical research technicians , 50 rcp coordinating physicians and 12 cancer coordination centres ( see table 3 ) . this preliminary data collection , conducted over a one - year period , reported 53 cases of hadrontherapy indications , compared to the estimated cap of 200 cases . this led to a sense of ownership and motivation on the part of the centres . as a whole , the study covered the region 's 11 hospital areas and involved 52 groups , out of some sixty listed , of cancer specialists with expertise in the diseases that were to identify . during the study , the study mobilises 27 rhne - alpes region healthcare centres , of which 8 university hospitals , 1 regional cancer centre , 1 public - private cancer institute , 12 general hospitals , the lyon paediatric oncology hospital institute , and 4 private clinics .", "the diseases to identify in this study are little known , their distribution has not been studied , and we are unaware of any epidemic outbreaks . moreover , considering that the cancers to identify are rare , it is likely that the number of cases to identify per investigator centre will be very low ( estimated incidence of at the most 1 to 5 cases / year ) . finally , the primary goal of the rcp groups is to provide an immediate therapeutic solution . finally , the published studies were conducted in attractive institutions , specialising in cancer care and selected for this reason ; this may bias the assessment of prevalence . under these conditions , it is easy to confuse incidence and prevalence . the prognosis and risk of metastatic development were difficult to estimate considering the lack of knowledge for these rare diseases . case identification for an observational study is thus unusual in the context of an rcp . because of this the individuals involved in study organisation were in charge of systematically directing each cancer patient to the elective experts .", "one of the most valuable outcomes of this study has been to make the existence of some particularly rare diseases known and to provide information concerning an innovative treatment : hadrontherapy , whose existence will doubtless have a favourable effect on the very knowledge of these diseases . an additional benefit of this approach has been to open the way for a new treatment system in a region of france that is home to approximately 10% of the country 's population . at last this study of hadrontherapy healthcare decision networks in the rhne - alpes region , able to identify areas not properly covered by rcps , should enable us to analyse the potential effect of this lack on the outcome of the patients of these areas . they shed no light on posttreatment medical activity : follow - up visits , medical imaging , and other care beyond the irradiated activity per se . , these elective indications will have to be validated by health authorities to register them as part of the good professional practices of oncology and give an equal chance to each patient to receive hadrontherapy through the well - established decision process of the rcps . this information should serve both to improve diagnosis procedures , medical care , and the surveillance of these rare diseases . all cancers have their own development pattern , and , in this respect , the literature provides few elements concerning diseases eligible for hadrontherapy ." ]

[ "the aim of the present article was to review the barriers to achieving optimal blood glucose control in asian patients with type 2 diabetes who have declining renal function and to discuss the treatment modalities that might be appropriate for the management of these special patient populations . , the impact of diabetes on healthcare resources and personal expenditure , as well as the financial implications associated with loss in productivity and disability , is enormous11 . in taiwan , type 2 diabetes continues to present a public health burden across the world , and asia is considered to be at the epicenter of this diabetes epidemic , with 60% of the disease burden borne by this region1 . the increase in diabetes prevalence across asia has been rapid , fuelled by increasing obesity , aging populations and urbanization , which in turn have been driven by rapid economic development , a sedentary lifestyle and increased consumption of refined foods3 . in fact , the risk of allcause mortality ( cardiovascular and noncardiovascular ) is higher in diabetic than nondiabetic patients9 . consequently , the rapidly growing prevalence of diabetes in asia is likely to result in large increases in diabetesassociated mortality10 . from an economic perspective it is widely recognized that diabetes is a major source of morbidity , mortality and economic burden6 .", "given that the prevalence of hypertension in asia is increasing , and that diabetes and hypertension commonly coexist ( type 2 diabetes patients are twice as likely to have elevated blood pressure than nontype 2 diabetes patients ) , screening these highrisk patients for ckd early might help slow the course of renal function decline and reduce the greater cardiovascular mortality risk observed in such individuals47 . indeed , cvd remains the main cause of death in patients with ckd rather than kidney failure , and it is estimated that cvdassociated mortality is 1030fold higher in patients with advanced ckd receiving dialysis than the general population46 . of the diabetesassociated complications , the most debilitating is chronic kidney disease ( ckd ) and its pathogenic progression to endstage renal disease ( esrd ) that requires dialysis or transplantation23 . the presence of ckd is also associated with a high cvd risk , which is further exacerbated by the presence of diabetes and hypertension45 . incidence of endstage renal disease ( esrd ) as a result of diabetes in selected countries across southeast asia in 2008 .", "microalbuminuria is the earliest clinical manifestation of ckd in type 2 diabetes and persistent microalbuminuria represents an early clinical marker for the development of diabetic nephropathy ( dn)27 . although the number of studies exploring the epidemiology of microalbuminuria across asia has been limited , the microalbuminuria prevalence study ( maps ) of 6,800 hypertensive diabetic patients from 10 countries in the region reported an overall prevalence rate of 39.8% ( 95% confidence interval [ ci ] 39.240.5)22 . the effect of an intensive , stepwise multifactorial intervention , targeting hyperglycemia , hypertension , dyslipidemia and microalbuminuria , on the initiation and progression of microvascular complications in type 2 diabetes patients with microalbuminuria was assessed in the steno2 study . interestingly , in a separate study of taiwanese type 2 diabetes patients with microalbuminuria , almost 36% of patients achieved remission to normoalbuminuria following a tight , multifactorial target control approach40 . there was a significant reduction in the progression of nephropathy and other microvascular complications ( retinopathy ) after intensive insulin therapy ( p < 0.05)35 .", "incidence of endstage renal disease ( esrd ) as a result of diabetes in selected countries across southeast asia in 2008 . these data are based on figures compiled by the us renal disease system ( figure adapted from 2010 us renal disease system annual report chapter 12 international comparisons ; volume 2 ; pages 383396 ) . for singapore , indeed , cvd remains the main cause of death in patients with ckd rather than kidney failure , and it is estimated that cvdassociated mortality is 1030fold higher in patients with advanced ckd receiving dialysis than the general population46 . given that the prevalence of hypertension in asia is increasing , and that diabetes and hypertension commonly coexist ( type 2 diabetes patients are twice as likely to have elevated blood pressure than nontype 2 diabetes patients ) , screening these highrisk patients for ckd early might help slow the course of renal function decline and reduce the greater cardiovascular mortality risk observed in such individuals47 . worldwide , rates of ckd have been increasing , and have accompanied the increasing prevalence of type 2 diabetes , hypertension and cvd . nephropathy is a common complication of asians with type 2 diabetes , as reflected by the accelerating prevalence and incidence rates of observed ckd23 .", "hypoglycemia is a particular challenge in the management of type 2 diabetes , especially in patients with a decline in renal function . despite the advent and availability of a range of antidiabetic and blood pressure lowering agents , many patients in asia remain suboptimally controlled and therefore at risk of developing complications . in the maps study , just 10.6% of type 2 diabetes asian patients with microalbuminuria achieved blood pressure targets below 130/80 mmhg and mean hba1c levels of 7.9%22 . this is a major issue in moderate to severe ckd ( stages 35 ) when renal dysfunction is particularly pronounced55 . an aging population provides additional challenges in managing type 2 diabetes , as aging itself is associated with changes in kidney structure and function , and these agerelated renal changes can be accelerated by the presence of comorbid conditions52 . for instance , diabetic patients with ckd are twice as likely to experience hypoglycemic events than those without kidney disease56 . furthermore , a study of the hong kong diabetes registry revealed how long disease duration and complexity of treatment regimens might also play a role in suboptimal glycemic control54 .", ". linagliptin might therefore represent an important addition to the currently limited therapeutic armamentarium for achieving glycemic control in type 2 diabetes patients with declining renal function . in recognition of the favorable clinical profile of dpp4 inhibitors , longterm studies to assess the impact of dpp4 inhibitors on reducing the risk of diabetes complications are awaited . thus , type 2 diabetes patients , particularly special populations like those who are renally impaired , benefit from the emergence and evolution of newer antidiabetic agents , such as the dpp4 inhibitors , that address the limitations of older therapies , and allow for a more tailored and effective approach to disease control . however , in practice , the use of antidiabetic medications in achieving these glycemic targets is often challenging58 . recent international guidelines recommend dpp4 inhibitors as an option in both firstline ( when fpg and ppg levels are elevated ) and combination therapy82 . in addition , oral sodiumglucose transporter 2 ( inhibitors are currently in development ( empagliflozin , dapagliflozin ) . despite the range of medications available for the treatment of type 2 diabetes and its complications , many of these require dose modification or avoidance and close monitoring55 .", "in addition , the lack of dose modification requirements and ease of dosing ( one dose , once daily ) further support the suitability of linagliptin in these difficulttotreat populations . within this drug class , linagliptin , a novel dpp4 inhibitor , possesses favorable and comparable profiles in terms of both efficacy and adverse events , and is indicated for use in all patients with type 2 diabetes . the favorable pharmacokinetic profile of linagliptin has advantageous implications given the importance of addressing the decline in renal function in asian patients with type 2 diabetes early . dpp4 inhibitors represent a good choice of oad for patients with type 2 diabetes . many antidiabetic therapies are often of little use in renallyimpaired type 2 diabetes patients because of contraindications or increased risk of hypoglycemia . furthermore , linagliptin is the only dpp4 inhibitor that is not predominantly dependent on renal metabolism ." ]

[ "the pcr has shown very promising results for early and rapid diagnosis of the disease due to its detection limit of one to 10 bacilli in various clinical specimens.6 the present study was undertaken to evaluate the efficiency and effectiveness of different laboratory diagnostic modalities along with the role of pcr in the diagnosis of clinicoradiological suspected cases of pott 's disease . the typical tubercular lesions of the spine can be diagnosed by radiological methods as their sensitivity is increased by the advent of newer imaging techniques like computed tomography and magnetic resonance imaging ( ct and mri ) . pott 's disease accounts for 50% of the cases of skeletal tuberculosis ( tb ) , 15% of the cases of extrapulmonary tuberculosis ( eptb ) and 2% of all cases of tb.1 the diagnosis of pott 's disease is mostly based on clinicoradiological observations substantiated by staining and culture methods to detect the causative organism . these techniques give sufficient information about lesions in the bone and tissues ; although the definite diagnosis is based on tissue / pus examination.2 the conventional bacteriological examination includes ziehl - neelsen ( zn ) microscopy and culture for acid fast bacilli ( afb ) .", "62 clinicoradiological suspected cases of pott 's disease with neurological complications [ table 1 ] were prospectively enrolled in this study , from 2008 to 2011 in the department of neurosurgery , at a tertiary care hospital , india . the therapeutic response was observed by clinical improvement in the form of healing sign that is an improvement in motor power / spasticity , sensory loss of limbs , autonomic dysfunctions and constitutional symptoms [ table 2 ] . the final diagnosis was established by using the collective results of zn microscopy , bactec culture , histopathological findings and response to att . the radiological assessment was done by using followup mri , the first at the end of 6 months of the commencement of the att and was compared with pretreatment images by the same senior radiologist of our institute . the cases were labeled as definite tb if at least one performed test ( zn microscopy / bactec culture / or histopathology ) was found positive . ( 2 ) prevertebral cervical abscess with difficulty in respiration and deglutition , seemingly difficult resolution on chemotherapy during conservative treatment . ( 3 ) worsening of already present neurological complications during the treatment . clinicoradiological evidence of suspected pott 's disease we included clinicoradiological suspected cases of pott 's spine who underwent either open biopsy or ct guided aspiration at our institute .", "the therapeutic response was observed by clinical improvement in the form of healing sign that is an improvement in motor power / spasticity , sensory loss of limbs , autonomic dysfunctions and constitutional symptoms [ table 2 ] . ( 2 ) prevertebral cervical abscess with difficulty in respiration and deglutition , seemingly difficult resolution on chemotherapy during conservative treatment . ( 3 ) worsening of already present neurological complications during the treatment . we followed the following major indications for surgical intervention in our setup : ( 1 ) advanced cases of neurological involvement such as marked sensory or sphincter disturbances , flaccid paralysis or severe flexor spasms . the patients were switched to modified att with the addition of ofloxacin and streptomycin and modification in doses of isoniazid and rifampicin or discontinuation of them . a four drug regimen chemotherapy consisting of isoniazid , rifampicin , pyrazinamide and ethambutol ( hrze ) were given to all patients in their appropriate doses according to the weight of patients as per departmental protocol , following or along with surgery . polymerase chain reaction is6110 gene for detection of mycobacterium tuberculosis complex at 2% agarose gel .", "the positive concordance between traditional tools and pcr were assessed using the kappa coefficient ( > 0.75 , excellent agreement ; < 0.4 , poor agreement ; 0.4 and 0.75 , good to a fair agreement)13 and significance difference was analyzed by the chi square ( 2 ) test with the help of the spss 15.1 version . the final diagnosis was established by using the collective results of zn microscopy , bactec culture , histopathological findings and response to att . the cases were labeled as definite tb if at least one performed test ( zn microscopy / bactec culture / or histopathology ) was found positive . the efficiency of test tools was calculated as ( total positive cases / total number of cases ) 100 .", "the study group consisted of 62 specimens from suspected pott 's spine individuals . on the basis of histopathological examination , the present study , the combination of ( a ) zn microscopy with bactec , the total 31 positive cases due to only 20 cases positive on zn microscopy and an additional 11 cases were positive on bactec culture . ( d ) the total 45 cases were positive in combination of zn microscopy + bactec culture + histopathology .", "the zn microscopy was positive in total 20 ( 36.4% ) of 55 cases ( 18/37 cases in pus and 2/18 cases in tissue specimens ) . the received specimens included 31 ( 56.4% ) pus and 15 ( 27.3% ) tissues through open biopsy along with 6 ( 11% ) pus and 3 ( 0.54% ) tissues were obtained through ct guided fna . the desired amplification of pcr is6110 was positive in 37 ( 67.5% ) of 55 cases ( 30/37 cases in pus and 7/18 in tissue specimens ) [ table 3 ] . the kappa coefficient of pcr with zn microscopy ( = 0.37 , [ p = 0.001 ] ) showed poor agreement and with the bactec culture ( = 0.57 , [ p < 0.001 ] ) it showed a good agreement [ figure 2 ] . the bactec culture was positive 27 ( 49% ) of 55 cases ( 22/37 in pus and 5/18 in tissue specimens ) . result of laboratory findings bar diagram showing kappa coefficient concordance between pcr and traditional tools . the overall collected specimens were consisted 37 pus and 18 tissue specimens ( either open biopsy or by ct fna ) were analyzed .", "on histopathological results ; 39 ( 71% ) cases were positive and 16 ( 29% ) were negative for tb thus , the false negative and positive of pcr was found to be 8 ( 14.4% ) and 6 ( 11% ) respectively . . out of 39 positive cases , 31 ( 56.4% ) were positive on pcr also . therefore , the kappa coefficient of pcr with histopathology was ( = 0.4 [ p = 0 . 004 ] ) slightly good [ figure 2 ] .", "in 55 cases , it was possible to reach a final diagnosis through the combined result of all performed tests ( without consideration of pcr results ) and with att response . although pcr showed 67.3% ( 37/55 ) sensitivity at the final diagnosis , while pcr showed 37/45 positive and no any false positive out of 10 negative cases by all traditional tests . hence , among all 55 cases , 45 ( 82% ) cases were tb positive test and 10 ( 18% ) were negative by all tests carried out ( zn microscopy , bactec culture and histopathology ) . therefore , the kappa coefficient of pcr with the combined results of all traditional tests ( = 0.63 [ p < 0.001 ] ) ultimately reached to a fair positive agreement [ figure 2 ] .", "the present study , the combination of ( a ) zn microscopy with bactec , the total 31 positive cases due to only 20 cases positive on zn microscopy and an additional 11 cases were positive on bactec culture . ( c ) bactec culture with histopathology , the total 45 cases to be positive due to 39 cases positive on histopathology and an additional 6 cases were positive on bactec culture , where the histopathology was negative . ( b ) zn microscopy with histopathology , the total positivity showed 43 cases due to 23 cases more positive on histopathology against zn microscopy . ( f ) bactec culture with pcr , the total 38 positive cases due to only 27 cases positive on bactec culture and additional 11 cases were positive on pcr . ( g ) histopathology with pcr , the total 45 cases positive on this possible battery due to 39 cases positive on histopathology and an additional 6 cases were positive on pcr . ( e ) zn microscopy with pcr , the total positivity was 38 cases , in which 18 more cases were positive on pcr method . ( h ) the battery of zn microscopy + bactec culture + histopathology + pcr showed ultimately 45 cases were positive because pcr could not give any more positive against the mentioned battery d and g [ table 4 ] .", "as culture takes long incubation time for results , the combination of pcr and histopathology can be applied for rapid detection of pott 's disease . to conclude , for diagnosis of pott 's disease , the combined results of zn microscopy , bactec culture and histopathology are most appropriate . however , for rapid diagnosis the combination of pcr amplification and histopathology offer a better prospect . the combination of bactec culture and histopathology has detected a maximum of 45 cases . while the combination of pcr and histopathology has also detected same number of cases table 4 . hence , a combination of diagnostic battery is required for rapid diagnosis and better results . it is the rapid , sensitive and efficient method for the isolation of mycobacterium in a clinical laboratory as compared to solid medium lowenstein pott 's disease , accounts for 2% of all tb infections.1 the diagnosis of pott 's disease is principally based on classical clinical manifestations of spinal infection supplemented by modern imaging like ct and mri.1415 the ct and mri in particular can detect the subtle changes in the spine , from initial changes in the intensity pattern of the vertebrae to the extreme changes like deformity of the spine including soft tissue shadow , granulation tissue and pus etc.16 however , the various pathologies including neoplastic and other inflammatory conditions simulate with pott 's diseases on imaging ." ]

[ ", the pongo - das server ( ) provides topology annotation for the all - alpha membrane proteins of the human genome . automatic topology annotation for membrane proteins has been included among the efforts of the biosapiens european network of excellence ( ) with the specific aim of taking into consideration different predictors for annotating membrane proteins in the human genome . the annotation is carried out using four selected predictors , namely ensemble1.0 ( 6 ) and prodiv ( 7 ) , in order to allow a direct comparison of the topology prediction for the sequence at hand . recently developed web technologies ( e.g. ajax ) are used to improve the user interface . the topological models computed by the different predictors can be directly obtained simply by pasting in a box the sequence of interest and looking at the results . the novelty of our web server is to include in the same framework ensemble ( 6 ) and prodiv ( 7 ) , two powerful methods that became available only recently .", "the website implements the following predictors : memsat is a new version of the memsat predictor of transmembrane helices in proteins ( 4 ) . this predictor has performance similar to the most widely used signalp ( 11 ) , and it has been included since it is quite common that signal peptides are mispredicted as transmembrane helices . in the context of the biosapiens project , we downloaded the uniprot dataset ( september 22 , 2004 ) which consists of 33 135 human protein sequences , and for future use also the ipi dataset ( august 5 , 2004 ) which consists of 46 782 human proteins . the union of the predictions obtained with the four methods gives a set of likely membrane proteins , while the intersection contains those chains on whose annotation as membrane proteins all the predictors agree upon . , the system cuts the corresponding predicted segment and processes the remaining part of the sequence with the four transmembrane predictors . the union of the two datasets comprises 50 600 sequences from the human genome . tmhmm2.0 which is a predictor of transmembrane helices in proteins based on hidden markov models ( 5 ) . prodiv_tmhmm_0.91 is a recent predictor of transmembrane helices in proteins ( 7 ) which uses a hidden markov model similar to tmhmm , but exploits the evolutionary information derived by multiple sequence alignment .", "the website implements the following predictors : memsat is a new version of the memsat predictor of transmembrane helices in proteins ( 4 ) . ensemble takes also advantage of the evolutionary information derived by multiple sequence alignment , both for the neural network and the hidden markov model systems . prodiv_tmhmm_0.91 is a recent predictor of transmembrane helices in proteins ( 7 ) which uses a hidden markov model similar to tmhmm , but exploits the evolutionary information derived by multiple sequence alignment . tmhmm2.0 which is a predictor of transmembrane helices in proteins based on hidden markov models ( 5 ) . ensemble1.0 is an ensemble of two hidden markov models and one neural network ( 6 ) . spep is a signal peptide predictor based on combination of neural networks ( 10 ) . this predictor has performance similar to the most widely used signalp ( 11 ) , and it has been included since it is quite common that signal peptides are mispredicted as transmembrane helices . it has been shown that it performs quite well taking into account that it uses only single sequence information .", "in the context of the biosapiens project , we downloaded the uniprot dataset ( september 22 , 2004 ) which consists of 33 135 human protein sequences , and for future use also the ipi dataset ( august 5 , 2004 ) which consists of 46 782 human proteins . the union of the predictions obtained with the four methods gives a set of likely membrane proteins , while the intersection contains those chains on whose annotation as membrane proteins all the predictors agree upon . the choice of annotating uniprot sequences is well justified from the fact that ensembl gene products ( in contrast to the uniprot entries ) are not stable ; for instance , only 60% of the sequences are common ( and conserved ) between the ensembl releases 34 and 35 , respectively . we then use four state - of - the - art predictors already described in the literature in order to identify the most probable integral membrane proteins . in this way the union of the two datasets comprises 50 600 sequences from the human genome . the system cuts the corresponding predicted segment and processes the remaining part of the sequence with the four transmembrane predictors .", "pongo - das accessing the pre - computed annotations using keywords or das queries ; pongo - pred that is an enhanced and modern version of a standard through - the - web server application . in the case of pongo - das we implemented two types of result visualization : \n by means of a das , which is a client server system in which a single client integrates information from multiple servers . pongo has two different usage options : \n pongo - das accessing the pre - computed annotations using keywords or das queries;pongo - pred that is an enhanced and modern version of a standard through - the - web server application . conversely , pongo - pred provides the user with a unique framework for membrane protein topology and signal peptide predictions .", "the pongo homepage . on the left - side it is possible to follow the status of the different queries and the starting of a new action ." ]

[ "we describe here a patient who developed hepatosplenomegaly and pancytopenia at 2 years of age but achieved automatic recovery . the epstein barr virus ( ebv ) infects b cells . in most cases , ebv - positive patients develop a severe form of infectious mononucleosis which typically manifests with fever , tonsillopharyngitis , lymphadenopathy and hepatosplenomegaly . although ebv - associated hlh carries a high mortality rate , quick diagnosis and appropriate treatment can subside the disease . deficiencies may be characterized by abnormal activity of lymphocyte function leading to hemophagocytosis and multi - organ failure . , there was a clinical suspicion of ebv - induced hlh and the patient was given the option of treatment with rituximab .", "she is now considered to be an acceptable candidate for transplantation from an hla matched sibling donor . \n ( the patient was negative for mutations in il-2-inducible t cell kinase ( itk ) ) . based on clinical symptoms and lab tests ( table 1 ) , bma was performed once again and the result raised suspicion of ebv - induced secondary hlh . rituximab was injected once and the patient developed a blood ebv load of zero within one week . in order to control abnormal stimulation of the immune system , the patient was investigated for mutations in il-2-inducible t cell kinase ( itk ) and negative test results were received .", "finally , treatment - refractory patients , transplant candidates , patients with familial type of hlh , or recurrent disease undergo chemotherapy for 8 weeks . patients who respond favorably to treatment do not undergo transplantation but those who experience relapse and exhibit neurological symptoms are considered for transplantation . however , it may also be seen in patients with immune system defects . , 4 secondary hlh is a known complication of ebv infection , particularly in patients with x - linked lymphoproliferative disease . hlh can be divided into two subgroups : primary or familial hlh and secondary hlh . the most common causes of secondary hlh are viral infections by ebv , cmv , prob19 and hiv .", "severe infection of ebv is not associated with life - threatening condition , but our case study needs urgent treatment . in patients with long - term ebv infection , pancytopenia , coagulopathy and hepatosplenomegaly , thus , the main aim of treatment is to reduce the rate of mortality in patients with hlh . rituximab can be used when hlh is associated with ebv to inhibit the immune response . bma will be performed and the serum ferritin level will be measured as well . for patients with secondary hlh ," ]

[ "we used data from the hoorn study , a population - based cohort study on glucose metabolism and other cardiovascular risk factors in a general caucasian population , which has been described in detail previously ( 12 ) . in brief participants without representative urine samples available ( n = 45 ) and/or who did not complete at least 7 of the 10 autonomic function tests ( n = 31 ) , had a history of neurological disease ( n = 5 ) , and were using ace inhibitors ( n = 33 ) and/or drugs known to influence autonomic nerve function ( namely antiparkinson drugs , phenytoin , antihistamines , or parasympatholytic , parasympathomimetic , and sympathomimetic drugs ) ( n = 49 ) were excluded from the analyses . the present study , therefore , consisted of 490 individuals : 305 with normal glucose metabolism , 71 with igm ( including those with impaired fasting glucose and/or impaired glucose tolerance ) , and 114 with type 2 diabetes . an extensive metabolic and cardiovascular investigation was performed in an age- , sex- , and glucose tolerance stratified , random subsample of 631 participants ( 89% of those invited ) , which is used in the present study ( 12 ) . bmi , waist - to - hip ratio ( whr ) , sbp and diastolic blood pressure ( dbp ) , levels of fasting plasma glucose ; a1c ; insulin ; total , hdl , and ldl cholesterol ; triglycerides ; creatinine ; and smoking status were measured as described elsewhere ( 5,9,12 ) . glomerular filtration rate was estimated by the short modification of diet in renal disease equation . tests were performed under three conditions : during spontaneous breathing over 3 min in the supine position ( mean of all normal to normal r - r intervals [ meannn ] , sd of all normal to normal r - r intervals [ sdnn ] , low - frequency [ lf ] power , high - frequency [ hf ] power , and lf/(lf + hf ) ) , during six deep breaths over 1 min in the supine position ( expiration - inspiration [ ei ] difference and baroreflex sensitivity [ brs ] ) , and during an active change from lying to standing ( sbp difference , r - r interval maximum [ rrmax ] , and r - r interval maximum divided by minimum [ rrmax / min ] ) ( for further explanation of measurements , see supplementary table a1 , available in an online appendix at http://care.diabetesjournals.org/cgi/content/full/dc08-1544/dc1 ) .", "tests were performed under three conditions : during spontaneous breathing over 3 min in the supine position ( mean of all normal to normal r - r intervals [ meannn ] , sd of all normal to normal r - r intervals [ sdnn ] , low - frequency [ lf ] power , high - frequency [ hf ] power , and lf/(lf + hf ) ) , during six deep breaths over 1 min in the supine position ( expiration - inspiration [ ei ] difference and baroreflex sensitivity [ brs ] ) , and during an active change from lying to standing ( sbp difference , r - r interval maximum [ rrmax ] , and r - r interval maximum divided by minimum [ rrmax / min ] ) ( for further explanation of measurements , see supplementary table a1 , available in an online appendix at http://care.diabetesjournals.org/cgi/content/full/dc08-1544/dc1 ) . we thus obtained results in four tests that reflect heart rate or blood pressure changes due to certain maneuvers , in this case deep breathing or standing up ( i.e. , ei difference , rrmax , rrmax / min , and sbp difference ) ( 14 ) , five tests of spectral analyses of heart rate variability ( hrv ) [ i.e. , meannn , sdnn , lf power , hf power , and lf/(lf + hf ) ] ( 15 ) , and one brs measurement ( 16 ) . glomerular filtration rate was estimated by the short modification of diet in renal disease equation . hypertension was defined as sbp 140 mmhg and/or dbp 90 mmhg and/or the use of antihypertensive drugs . bmi , waist - to - hip ratio ( whr ) , sbp and diastolic blood pressure ( dbp ) , levels of fasting plasma glucose ; a1c ; insulin ; total , hdl , and ldl cholesterol ; triglycerides ; creatinine ; and smoking status were measured as described elsewhere ( 5,9,12 ) . microalbuminuria was present if the albumin - to - creatinine ratio ( acr ) was in the range of 2.030 mg / mmol ( 5 ) . in addition , these tests were grouped into those representing predominantly parasympathetic ( i.e. , ei difference , rrmax , and hf power ) , sympathetic ( i.e. , sbp difference ) , or both functions ( i.e. , mean - nn , sdnn , lf power , lf/(lf + hf ) , brs , and rrmax / min ) ( 15,16 ) .", "data on the participants ' vital status up to 1 january 2005 were collected from the mortality register of the municipality of hoorn . information on cause of death could not be obtained for 20 of the deceased individuals . information on cause of death was extracted from the medical records of the general practitioners and the local hospital and coded according to the icd-9 . cardiovascular mortality , including sudden death , was defined by icd-9 codes 390459 and 798 . all subjects were followed until death or end of follow - up , at which time they were censored .", "kaplan - meier survival curves were plotted for cardiovascular mortality among individuals with normoalbuminuria versus microalbuminuria and similarly across tertiles of the c - ad total score , and differences between groups were tested with a log - rank test . cox proportional hazards regression models were used to calculate the crude and adjusted relative risks ( rrs ) and respective 95% ci of microalbuminuria ( versus normoalbuminuria ) and of the c - ad total score ( per sd [ = 0.605 ] increase ) for cardiovascular and all - cause mortality . baseline characteristics between survivors and nonsurvivors were compared with the use of student 's t or tests . all z scores ( except sbp difference ) were inverted and averaged into a total score ( c - ad total score ) , so that higher values reflect greater c - ad . we computed z scores ( [ individual 's observed value population mean]/sd ) for each of the 10 measurements of c - ad . the association between microalbuminuria and c - ad total score was investigated with multiple linear regression analyses .", "finally , we found no evidence of effect modification by gts in the association between cardiovascular mortality and c - ad total score or microalbuminuria ( pinteraction > 0.4 in both cases ) . both microalbuminuria and c - ad total score were also associated with all - cause mortality ( table 3 , model 1 ) . however , after adjustment for age , sex , gts , and other cardiovascular risk factors , microalbuminuria ( rr 1.33 [ 95% ci 0.832.13 ] ) , in contrast to c - ad total score ( 1.52 [ 1.112.09 ] ) , was not independently associated with all - cause mortality ( model 3 ) . kaplan - meier survival plots for cardiovascular mortality . among individuals with normo- versus microalbuminuria ( a ) and across tertiles of c - ad total score ( b ) . association between microalbuminuria and c - ad * model 1 : univariate analysis ; model 2 : adjusted for sex , age , and gts ; model 3 : model 2 plus adjustments for hypertension , whr , estimated glomerular filtration rate , ldl , hdl , triglycerides , smoking , and prior cvd .", "c - ad total score was associated with microalbuminuria ( = 0.33 [ 95% ci 0.160.51 ] ) ( table 2 , model 1 ) . after adjustment for potential confounding factors , c - ad total score was still borderline associated with microalbuminuria ( 0.16 [ 0.01 to 0.33 ] ) ( table 2 , model 3 ) . indicates the difference in c - ad score between individuals with microalbuminuria vs. normoalbuminuria . comparable results were obtained when tests were combined on the basis of their methodology or on the part of the autonomic nervous system they predominately represent . association between microalbuminuria and c - ad * model 1 : univariate analysis ; model 2 : adjusted for sex , age , and gts ; model 3 : model 2 plus adjustments for hypertension , whr , estimated glomerular filtration rate , ldl , hdl , triglycerides , smoking , and prior cvd . all individual c - ad tests , except lf/(lf + hf ) , were positively associated with microalbuminuria ( although not all statistically significantly so ) ( data not shown ) .", "were also associated with all - cause mortality ( table 3 , model 1 ) . however , after adjustment for age , sex , gts , and other cardiovascular risk factors , microalbuminuria ( rr 1.33 [ 95% ci 0.832.13 ] ) , in contrast to c - ad total score ( 1.52 [ 1.112.09 ] ) , was not independently associated with all - cause mortality ( model 3 ) . these associations were attenuated after adjustment for age , sex , and glucose tolerance status ( gts ) ( 2.23 [ 1.164.29 ] and 1.81 [ 1.112.94 ] , respectively ; model 2 ) . further adjustment for other cardiovascular risk factors only slightly further attenuated these rrs ( model 3 ) , and when the c - ad total score or microalbuminuria was added to these models , the rr attributable to microalbuminuria remained practically unchanged and both microalbuminuria ( 2.13 [ 1.094.17 ] ) and c - ad total score ( 1.76 [ 1.052.94 ] ) were independently associated with cardiovascular mortality ( model 4 ) . kaplan - meier survival plots for cardiovascular mortality . among individuals with normo- versus microalbuminuria ( a ) and across tertiles of c - ad total score ( b ) . both microalbuminuria and c - ad total score both microalbuminuria ( rr 3.49 [ 95% ci 1.876.53 ] ) and c - ad total score ( 2.54 [ 1.604.04 ] ) were associated with cardiovascular mortality ( table 3 , model 1 ; fig . association of microalbuminuria or c - ad with cardiovascular and all - cause mortality * model 1 : univariate analysis ; model 2 : adjusted for sex , age , and gts ; model 3 : model 2 plus adjustments for hypertension , whr , estimated glomerular filtration rate , ldl , hdl , triglycerides , smoking and prior cvd ; model 4 : model 3 , with additional adjustment for , respectively , c - ad or microalbuminuria .", "these additional analyses showed that overall all different groups of tests were associated with increased mortality risk , that these associations were attenuated when further adjusted for age , sex , gts , and other risk factors ; and that none of the specific group of tests explained the association between microalbuminuria and mortality . the associations described above were also investigated by examining autonomic function tests combined on the basis of their methodology or on the part of the autonomic nervous system they predominantly represent ( supplementary table a2 , available in an online appendix ) . the associations reported in table 3 did not materially change after additional adjustment for use of lipid- or blood pressure lowering drugs and the presence of leukocytes in urine ( tested by microscopy and scored as positive whenever there were more than five leukocytes per high - power field ) or when the dichotomous variable hypertension used in those models was replaced by either sbp or pulse pressure ( a marker of arterial stiffness ) or when analyses were adjusted for prior coronary heart disease instead of prior cvd ( data not shown ) . finally , we found no evidence of effect modification by gts in the association between cardiovascular mortality and c - ad total score or microalbuminuria ( pinteraction > 0.4 in both cases ) .", "in this prospective study we found that both microalbuminuria and c - ad ( estimated from the mean of 10 standardized tests ) were independently associated with cardiovascular mortality in a cohort of elderly , caucasian subjects with and without diabetes . therefore , c , we have shown that both microalbuminuria and c - ad are independently associated with cardiovascular mortality in an elderly , caucasian population of individuals with normal glucose metabolism , igm , and diabetes . these results suggest that microalbuminuria and c - ad are related to cardiovascular mortality by different biological pathways . therefore , it may be useful to treat not only microalbuminuria but also c - ad in populations at high risk of cardiovascular mortality . - ad does not explain why microalbuminuria is related to cardiovascular mortality in either the general population or in diabetic subjects .", "" ]

[ "the objective of this study was to determine the effects of explanatory variables on the survival of cervical cancer patients using parametric regression model . in some cases , furthermore , the suitability of the weibull model can be easily assessed using a log - cumulative hazard plot . in this study , parametric models are more informative than the cox model such as the baseline hazard and survival estimates are known ( can be estimated ) . the analysis from published studies was often limited to the frequently used cox proportional hazard regression model when examining the relationship of the survival distribution to covariates ( 17 , 1921 ) . cervical cancer is the third most common cancer after breast and colorectal cancer and the fourth leading cause of death among women in malaysia(1 - 3 ) . it remains to be one of the major cancers that burden worldwide particularly in under - developed and developing countries ( cervical cancer incidence rate increased with age after 30 years and has its peak at ages 65 - 69 years . according to ethnicity in malaysia , women of indian ethnic group have the highest incidence for cervical cancer followed by chinese and malay ( 3 ) .", "international federation of gynecology and obstetrics ( figo ) system was used in staging patients with cervical cancer . the husm , located in kubang kerian , kelantan has been long regarded as the referral centre for the east coast region of malaysia . the variable of interest was time ( in months ) which was measured from the patient was diagnosed with cervical cancer up to the time of death . the inclusion criteria were histopathologically and clinically diagnosed with cancer of cervix between 1 july 1995 and 30 june 2007 , and received at least one treatment related to cervical cancer in husm . the study design was retrospective in nature in which patients records were reviewed retrospectively to obtain the data . factors that were considered in the analysis were ethnicity ( non malay , malay ) , lymph node involvement ( negative , positive ) , metastasis ( with metastasis , without metastasis ) , histology ( squamous cell carcinoma , adeno cell carcinoma ) , primary treatment ( surgery , radiotherapy and/or chemotherapy ) , age at diagnosis ( < 40 , 40 59 , 60 ) and stage ( stage i & ii , stage iii & iv ) .", "the index plot of deviance residuals ( rdi ) was performed to identify the presence of subjects who was poorly predicted by the model ( 31 ) . it is worthwhile to note that while the stratification allows separate baseline hazard function to each metastasis group , the coefficient of the predictor variables are assumed to be the same within each metastasis group ( 29 ) . the log - cumulative hazard plot characteristics of patients treated in husm ( n=120 ) univariate analysis of weibull model with prognostic factors multivariate analysis of weibull model with prognostic factors output of weibull model under stratification the hazard ratio for variable stage stratified on metastasis the estimated scale parameters ( ) for the first and second stratum were 1 = 1.11 and 2 = 0.733 respectively . however , it was noted that metastasis ( p=0.032 ) did not satisfy the proportional hazard assumption and a stratified model was then considered . based on the forward selection procedure in multivariate analysis , two variables namely stage and metastasis was found to be significant factors ( table 3 ) . outliers and influential observations are not observed in the plot thus implying a good fit of the model .", "in this study , the weibull model was used instead of the cox model because the log - cumulative hazard plot has confirmed that the survival time followed the weibull distribution . multivariate analysis through forward selection method found that the most feasible model to describe the survival of cervical cancer patients was dependent upon the covariates namely , stage and metastasis . as the metastasis variable did not meet the proportional hazard assumption , the stratified weibull model was applied . this study found that patients who were diagnosed at stage iii & iv have greater risk of death compared to those who were diagnosed at early stage , stage i & ii for both stratum , with and without metastasis . it is worthwhile to note that a study of 515 cervical cancer patients by dueas - gonzlez et al . showed a significant result for advance stage iii & iv with adjusted hazard ratio of 1.54 ( 95% ci= 1.11- 2.14 ) ( 16 ) , indicating that patients with advanced stage of disease had a 54% higher risk of progression or death at any time than earlier stage patients .", "besides , this study also demonstrates the solution to time - dependent covariates problem , or when the proportional hazards assumption is violated . cervical cancer dataset that comprise of the national data may be obtained to give a more general prognosis and a better description of the survival pattern of all cervical cancer patients in malaysia . after applying the stratified model , this study found that the prognosis of cervical cancer patients was dependent upon the stage at diagnosis . these findings provide useful knowledge on the understanding of the survival of cervical cancer patients .", "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 ." ]

[ "according to the european society of endodontology ( 1994 ) , the assessment of endodontic treatment requires clinical as well as radiological follow - ups at regular intervals . the radiographic evidence of success is the presence of a normal periodontal ligament space around the root . if radiographs reveal that a lesion has remained the same or has only diminished in size , the treatment is not considered a success.1,2 it is generally accepted that the outcome of endodontic treatment is positively correlated with the technical quality of the root filling , expected to provide an hermetic seal against bacterial ingress.3,4 however , it has been suggested that the quality of the coronal restoration may also have an impact on the periapical health of root - filled teeth;5,6 when the restoration quality is good , this may allow for a favorable outcome even when the root filling quality is poor.7 attention has been focused on the prevalence and the technical quality of root fillings through the evaluation of intraoral810 or panoramic radiographs.2,11,12 epidemiologic studies have been performed on the root canal morphology in turkish populations.13,14 information about the prevalence and technical standard of root - canal treatment , and the occurence of periapical lesions in turkey are scarce.12,15 moreover , there is only one investigation about quality of root fillings and coronal restorations in turkish population.16 the aim of the present study was to relate the quality of root canal treatment and coronal restorations to the periapical status of root filled teeth in adult turkish population based on radiographic examination .", "evaluation of the periapical status and the quality of root filling in the present study was made independently by two examiners ( fnp , bg ) using the same examination procedure after a calibration session . for calibration 20 the incidence of root fillings was recorded along with the periapical status of all teeth with the exception of third molars . was present , the type of coronal restoration ( crown or filling ) was recorded . all participants underwent a panoramic radiograph and additional periapical radiographs of endodontically treated teeth were processed . the inter - examiner agreement scores gave cohen s kappa of 0.68 for quality of filling and crown restoration , 0.83 for adaptation of fillings to canal walls , and 0.86 for length of root fillings . the worst score of all roots was taken to represent pai score for multirooted teeth . in case of a root filling the sample consisted of 400 subjects , aged 38.7013.80 years , 138 males ( 34.5% ) and 262 females ( 65.5% ) , presenting consecutively as new patients seeking routine dental care in department of oral diagnosis and radiology , faculty of dentistry , marmara university , istanbul , turkey , between 2005 and 2006 .", "the sample consisted of 400 subjects , aged 38.7013.80 years , 138 males ( 34.5% ) and 262 females ( 65.5% ) , presenting consecutively as new patients seeking routine dental care in department of oral diagnosis and radiology , faculty of dentistry , marmara university , istanbul , turkey , between 2005 and 2006 . the criteria for inclusion in the study were that the patients should be attending for the first time . patients younger than 20 years and patients having less than eight remaining teeth were excluded . all the patients gave written informed consent for the study .", "two radiographers using the long - cone paralleling technique , setting of 70 kv , 10 ma , a film - focus distance of 30 cm took all periapical radiographs . all participants underwent a panoramic radiograph and additional periapical radiographs of endodontically treated teeth were processed . kyoto , japan ) and evolution x 3000 - 2c x - ray unit ( new life radiology srl , italy ) , respectively . all panoramic and periapical radiographs were taken with a veraviewpocs hi - sped ( j. morita mfg . , kg , bissingen , germany ) , kodak medical x - ray processor ( eastman kodak company , rochester , ny , usa ) , general rapid medical developer and fixer ( general a. . , istanbul , turkey ) ) were used in this study .", "evaluation of the periapical status and the quality of root filling in the present study was made independently by two examiners ( fnp , bg ) using the same examination procedure after a calibration session . for calibration 20 the inter - examiner agreement scores gave cohen s kappa of 0.68 for quality of filling and crown restoration , 0.83 for adaptation of fillings to canal walls , and 0.86 for length of root fillings . the incidence of root fillings was recorded along with the periapical status of all teeth with the exception of third molars . was present , the type of coronal restoration ( crown or filling ) was recorded . the worst score of all roots was taken to represent pai score for multirooted teeth . in case of a root filling the quality of the restoration was assessed radiographically and classified as inadequate if the restoration was absent or if open margins , overhangs or secondary caries were detectable .", "p values of less than .05 were interpreted as significant , and the level in confidence intervals was 95% . descriptive statistical methods ( mean and standard deviation ) were used for the evaluation of the data . the data were analyzed with spss ( statistical package for social sciences ) for windows 10.0 statistical package software .", "apical periodontitis was found in 75.5% of teeth with adequate length of root filling , whereas if the filling was too short or long , periapical lesions were present in 72.8% and 96.2% of teeth , respectively . 72.8% of the teeth with adequate filling restoration had ap , whereas if the filling restoration was inadequate , ap was present in 72.3% of the teeth ( p : 0.92 , odds ratio : 0.97 , ci : 0.621.54 ) . root filled teeth without voids had ap in 72.9% of cases , whereas if voids were detected , ap was present in 74.7% of the teeth ( p : 0.54 , odds ratio : 1.09 , ci : 0.811.48 ) . the total number of root - filled teeth was 890 ( 9.39% ) ; of which 658 ( 73.9% ) teeth had ap . 75.9% of the teeth with adequate coronal restorations had ap , whereas if the coronal restoration was inadequate , ap was present in 74.2% of the teeth ( p : 0.70 , odds ratio : 0.91 , ci : 0.581.45 ) . there was a significant correlation between the presence of periapical pathology and inadequate root canal fillings ( p<.05 ) . a total of 9460 teeth were examined , an average number of 23.634.35 remaining teeth per subject . the relationship between the adaptation of root filling to canal walls and periapical status is shown table 2 .", "the results of the present study revealed that the quality of the restoration did not significantly affect the treatment outcome . the subjects included in this study were adult patients attending for general dental treatment for the first time . a total of 890 teeth had root fillings , accounting for 9.39% of all teeth . patients with eight or fewer remaining teeth were excluded because they often had periodontal disease and it was impossible to determine the role played by the endodontic treatment in the occurrence of a radiographic periapical lesion.17 although studies comparing panoramic and periapical radiographs for detecting periapical lesions indicate similar overall diagnostic accuracy,21,22 panoramic radiographs are claimed to show lower sensitivity when detecting periapical lesions of the anterior teeth and mandibular molars compared with periapical radiographs.23 therefore , there is a possibility for loss of information when endodontic conditions are recorded based on panoramic radiographs only in some studies.2,11,17,2426 however , other epidemiological studies have used a combination of panoramic and periapical radiographs.4,8,9,27 as panoramic radiographs do not reveal details and inter - observer variability is greater with panoramic radiographs.28 in this investigation , therefore , all participants underwent a panoramic and additional periapical radiographs of affected teeth were processed . root filling length was found to be adequate in 24.5% of the teeth and the adaptation of fillings to the canal walls in 27.1% of the teeth . in this respect ,", "in the present study , the frequency of endodontically treated teeth was found lower than other studies . the technical quality of root fillings and restoration in a turkish subpopulation was poor and was consistent with a high prevalence of apical periodontitis ." ]

[ "we hypothesized that the potential effect of neighborhood sep may most likely occur by way of sociocultural processes , and therefore would have significant positive associations with general cognitive ability and with crystallized cognitive domains , including vocabulary . neighborhood sep was hypothesized to have relatively weaker , if detectable , associations with fluid cognitive domains , including memory , reasoning , speed , and everyday cognition . neighborhood effects may support some dimensions of cognition more strongly than others , in addition to influencing general cognitive status . the present study aimed to identify whether neighborhood effects on cognition were global , or specifically related to particular cognitive domains such as memory , reasoning , processing speed , everyday cognition , or vocabulary . the present study sought to examine whether neighborhood socioeconomic position ( sep ) shows bivariate relationships with baseline cognitive level and immediate response to cognitive training , beyond individual - level predictors of cognition . many of these outcomes have also been identified as correlates of late life cognition , yet few studies to date have specifically investigated the role of the neighborhood in cognitive aging . while neighborhood effects on late life cognition have received less attention , neighborhood effects on early - life cognitive development are relatively well documented . is strongly influenced during childhood , adolescence , and young adulthood , effects of current neighborhood sep on crystallized abilities may also reflect , in part , effects of early - life neighborhood sep .", "the cognitive measurement model for the present study dimensionalized cognition into several domains , for which the active dataset was well designed , having captured at least three measures each of specific cognitive domains including memory , reasoning , processing speed , and everyday cognition , or measures of cognition related to everyday abilities . preparatory to examining the relationship of neighborhood sep to active cognitive outcomes , factor analytic constructs representing neighborhood sep and baseline cognition were developed . the sep and cognition factor models were combined in a structural equation model estimating regression paths from sep to the each of the cognitive factors . the cognitive domains measured in actve included memory , inductive reasoning , processing speed , everyday cognition , and vocabulary ; descriptive statistics on the sample performance for measures within each domain are illustrated in table 1 . information on potential covariates was collected , including demographic variables , mmse , recent depressive symptoms , and general health . the primary objective of active was to test the effectiveness and durability of three cognitive interventions .", "the present paper sought to characterize both general and specific domains of late life cognition . the measured variables ( figure 2 ) related to memory were combined to represent a memory factor ; measures of reasoning combined to form a reasoning factor ; guided by preliminary exploratory analyses , measures of processing speed optimally first combined into separate factors based on test , which were then combined to form a speed factor , and individual measures of everyday cognition combined on a factor representing everyday cognition . because these cognitive domains were represented by latent factors ( making them repeated - measures mixed effects analyses of variance were used to estimate whether neighborhood sep predicted differences in training - related gains , beyond practice - related gains , on posttraining measures of memory , reasoning , and speed . g , reasoning , speed , everyday cognition , and vocabulary ( a path could not be estimated for sep or any covariates to memory ) . the sep and cognitive measurement models were combined in a structural equation model ( figure 2 ) estimating regression paths from neighborhood - level sep to the cognitive constructs of after controlling for individual - level predictors , sep remained a significant predictor of vocabulary alone ( p < 0.01 ; table 5 ) .", "the present study sought to examine the relationship between current neighborhood - level socioeconomic position ( sep ) and cognitive level , including several specific cognitive domains in the active study , and response to cognitive training . the findings demonstrated that , after controlling for individual - level demographic predictors , census - defined neighborhood socioeconomic position independently predicted differences in late life vocabulary as measured in active , but not differences in general cognition ( g ) , reasoning , everyday cognition , or speed . national historical data will allow investigators to use county information to explore whether and how distal environmental influences ( i.e. , county - level sep and educational laws during primary schooling years ) might predict contextual neighborhood characteristics and cognitive outcomes later in life . the results also demonstrated that neighborhood sep does not predict individual differences in the immediate response to cognitive training in memory , reasoning , or processing speed .", "as discussed above , future research should investigate how associations between early life neighborhood context and cognitive development may influence cognitive function and neighborhood selection in late life . there was a lack of association between neighborhood sep and fluid cognitive abilities , as well as between neighborhood sep and immediate cognitive change following training . this paper adds to the body of research examining neighborhood - cognition associations in late life , and extends previous findings by looking beyond general cognition or cognitive status to examine effects of neighborhood across specific cognitive domains . the finding that neighborhood sep predicts crystallized cognitive abilities ( specifically , vocabulary ) suggests that neighborhood effects may be most related to sociocultural influences on cognitive development ." ]

[ "this article will not significantly address the sociology of psychostimulant abuse , which involves diverse events ranging from the use of amphetamines by japanese soldiers in world war ii , to the formulation of crack as a less expensive version of cocaine in the united states , to the introduction of prescription formulations to regulate eating habits or to treat attention deficit - hyperactivity disorder . however , the appearance of these substances in western societies has been relatively recent , cocaine having debuted as both a local anesthetic and a psychostimulant in the 19th century . over the course of the next century , it became increasingly clear that the amphetamine - like psychostimulants carried serious abuse liability , as well as producing a prominent paranoia - like syndrome among many individuals who chronically used this class of drugs . cocaine and other amphetamine - like psychostimulants have been a significant part of the human pharmacopoeia for thousands of years . rather , we will review the basic pharmacology of amphetamine - like drugs , integrate these molecular mechanisms into the brain circuitry of reward , and describe how these drugs are thought to create pathological changes in reward and learning circuitry finally , this knowledge will be amalgamated into a vision of future pharmacotherapies for treating psychostimulant addiction . the abuse liability of these drugs has resulted in sociological use patterns that have been described as epidemics , such as the methamphetamine epidemic in japan in the 1950s , the cocaine epidemic in the united states in the 1980s , and the crack cocaine epidemic of the 1990s . \n the high abuse liability of this class of drugs relies on both pharmacological properties and the sociological characteristics of how the drugs are introduced into various societies around the world .", "the defining mechanism of action of amphetamine4ike psychostimulants as a class of drugs with high abuse liability is the ability to bind to dopamine transporters ( dat ) . , this class of drugs dramatically elevates extracellular dopamine , and this action is thought to be the initiating molecular event that reinforces drugseeking behaviors , ultimately culminating in addiction . \n dopamine transporters are a member of a class of proteins that eliminate monoamines , including dopamine , from the synaptic cleft after neuronal release .", "thus , the neutral stimulus now causes dopamine release in a manner predicting arrival of a motivationally relevant event . based upon these data , the role for dopamine release in the mesocorticolimbic brain regions is twofold : ( i ) to cue the organism that a novel motivationally relevant event is occurring and that adaptive behavioral responses need to be engaged ( eg , approach a reward or avoid a stress ) ; ( ii ) once the behavioral response is established , dopamine release is antecedent to the appearance of the motivationally relevant event and is triggered by environmental associations that the organism has made with the event as part of learning the adaptive behavioral response . in this way , dopamine serves to alert and thereby prepare the organism for an impending important event . an important characteristic of this brain - environment interaction is that the ability of a given stimulus to increase dopamine cell firing and release decreases with repeated presentation of the stimulus . however , it can be shown that if a motivationally neutral stimulus ( such as a light or tone ) is associated with the motivational event in such a manner that the neutral stimulus predicts arrival of the motivational event , the ability of the motivational stimulus to release dopamine is transferred to the neutral stimulus . it is this overlearning of drugseeking behaviors by progressive associations formed between repeated drug - induced dopamine release and the environment that is thought to lead to increased vulnerability to relapse .", "a variety of studies have linked this activation of corticofugal glutamate transmission with craving in psychostimulant addicts or drug - seeking in animal models of addiction . thus , relapse can be induced by dopamine release in prefrontal and allocortical brain regions , and reflects the aforementioned physiological role of dopamine release as a predictive antecendent to stimulus ( drug ) delivery . what this implies is that chronic release of dopamine by repeated psychostimulant administration may be modifying cortical and allocortical regulation of behavior . \n this possibility is supported by animal models in two ways : ( i ) if animals that have been trained to self - administer cocaine are left in abstinence for an extended period , drug - seeking is augmented , and in this case inhibition of the prefrontal cortex or amygdala no longer inhibits drug - seeking induced by drug - associated stimuli . however , inhibition of the dorsolateral striatum is still effective at blocking drug - seeking ; ( ii ) as training of an animal in drug - seeking paradigms progresses it is possible to show a gradual increase in dopamine released into the caudate in favor of release into the nucleus accumbens . as outlined above , psychostimulant - induced dopamine release is responsible for reinforcing behaviors designed to seek and administer the drugs .", "given the apparent critical role played by glutamatergic affrents to the nucleus accumbens in initiating drugseeking or craving , recent studies have identified a number of enduring cellular changes in glutamate transmission that may be critical pathological neuroadaptations to psychostimulant use , and may serve as targets for pharmcotherapeutic intervention . in general thus , the large psychostimulant - induced release of glutamate has been hypothesized to be a pathological and perhaps critical mediator of relapse . thus , there remain many apparent contradictions in the literature regarding changes in specific proteins , and in the overall direction of synaptic grading ( ie , is postsynaptic glutamate transmission augmented or inhibited by chronic psychostimulant administration ) . as mentioned above , drug - seeking is associated with a large release of prefrontal glutamate into the nucleus accumbens .", "pharmacotherapeutic targets for regulating the pathological synaptic glutamate release seen in the accumbens of psychostimulant - seeking animals can be placed into two categories : ( i ) targets based upon psychostimulant induced changes in proteins regulating synaptic glutamate release ; ( ii ) proteins that produce a general decrease in excitatory transmission . the primary drugs in the category of nonspecific inhibitors of synaptic glutamate release include a variety of -aminobutyric acid ( gaba)-mimetic compounds . as outlined above , given our current state of knowledge it is more likely that pharmacotherapeutic restoration of normal glutamate release may be a more successful approach than manipulating postsynaptic proteins responsible for and/or associated with changes in the fidelity of postsynaptic glutamate transmission . in part , this is due to the relatively contradictory status of the emerging literature on postsynaptic plasticity . these range from relatively specific agonists at gabab receptors , such as baclofen , which inhibit synaptic glutamate release to a host of less selective compounds known to increase gaba transmission via interactions with synthetic or elimination mechanisms , such as topiramate or vigabatrin .", "this review has endeavored to transport the reader from the initiating molecular actions of amphetamine - like psychostimulants on dopamine systems in the brain to enduring neuroplasticity produced in glutamate transmission responsible for communicating from prefrontal and allocortical brain regions through the nucleus accumbens to motor regulatory systems . moreover , by examining molecular neuroplasticity produced in excitatory synapses by chronic psychostimulant administration , it is possible to make some deductions about potential pharmacotherapeutic interventions . indeed , there already exists an emerging literature supporting this approach in developing potential pharmacotherapies for treating psychostimulant addiction . importantly , this is a nascent and emerging science , and while much has been discovered , the cutting edge of discovery into the neuroplasticity produced by psychostimulants is understandably contradictory . as further discoveries are made that allow us to understand the nature of these contradictions , it should follow that additional targets will emerge to provide potential novel pharmacotherapies for treating psychostimulant addiction ." ]

[ "the roots of zapoteca portricensis is a common remedy in the treatment gastrointestinal disorders used by tradomedical practitioners in eastern nigeria .", "this study was aimed at evaluating the possible antiulcer activity of the root of this plant in experimental rats .", "different groups of albino rats of male sex were given three doses ( 50 , 100 , 200 mg / kg ) of the extract .", "the ethanol model produced an average ulceration in rats with reduction of ulcer ( 50% , 75% and 90% ) seen in all the extract treatment . a dose dependent inhibition of ulcer was seen in all doses of the extract with doses 100 and 200 mg / kg produced a significant reduction compared with control . in the indomethacin model , inhibition of ulcer ( 57.1% , 65.7% and 80.0% ) was seen in the treatments with the extracts in a dose dependent manner .", "this study has shown that roots of this plant ( zapoteca portoricensis ) possess potent antiulcer activity ." ]

[ "the online version of this article ( doi:10.1007/s10815 - 012 - 9815-x ) contains supplementary material , which is available to authorized users .", "the development of assisted reproductive technology ( art ) has recently enabled the direct observation of human oocytes , revealing various mysterious phenomena involving the beginning of life . however , it is undeniable that frequent microscopic examinations of human early embryos may have negative effects on them , making it difficult to obtain reliable detailed information of human embryonic development from still images . we therefore developed an in vitro culture system for time - lapse cinematography ( tlc ) , based on payne et al . herein , we provide the results of this second detailed tlc analysis , which we believe confirms the existence of a novel mechanism for the prevention of polyspermy . this system enables non - invasive and continuous imaging of human oocyte fertilization and embryonic development . we therefore consider that the phenomenon described herein differs from previously proposed mechanisms for polyspermy block , prompting us to re - analyze all of our tlc data covering the fertilization process . our previous dynamic analyses of the fertilization process in human oocytes and of human embryonic development using the in vitro tlc system confirmed for the first time the detailed time course of sequential events during embryonic development and revealed novel phenomena [ fertilization cone , cytoplasmic strand , and splitting of the inner cell mass ( icm ) ] under culture conditions in vitro [ supplementary movie 1 ( online resource 1 ) ] . in addition , the oocyte membrane block occurs in seconds , while an oocyte membrane depolarization block has not been detected in studies of mammalian oocytes . our further observation of the movie revealed another novel phenomenon that is likely to be involved in the mechanism of polyspermy block , wherein once the leading sperm has penetrated the zona pellucida ( zp ) and attached to the oocyte membrane , any following sperm within the zp stop penetrating immediately . to date , two types of polyspermy block were thought to exist in marine animals and mammals , including human ( oocyte membrane block and zona reaction ) .", "one oocyte was randomly selected from each couple and 122 oocytes were tested . in the tlc images obtained from these oocytes , penetration of the leading sperm into the zp and attachment to the oocyte membrane was confirmed in the 22 oocytes . among these , only three oocytes showed both the leading and following sperms within the zp in the same frame , and these tlc data were therefore used to evaluate the dynamic changes in both sperms until the leading sperm attached to the oocyte membrane during the fertilization process . , we mechanically and gently removed the cumulus cells from around the oocytes , so as not to damage the tails of the sperm that penetrated into the zp , at 1 h after the in vitro insemination ( approximately 50 10 sperm per oocyte ) . the in vitro culture system for tlc has been described in detail elsewhere . in brief we displayed movies at 30 frames per second to analyze the fertilization process and elucidate the mechanism of polyspermy block . before the commencement of tlc observation images were acquired at 10-s intervals for the first 2 h , and thereafter at 2-min intervals , based on our preliminary study that showed most of the sperm penetrating the zp within 3 h after the in vitro insemination .", "the time course of the change in zona pellucida penetration distance of the leading sperm ( blue line ) and the following sperm ( red line ) shows that the zona pellucida penetration of the following sperm was inhibited when the leading sperm attached to the oocyte membrane ( indicated by the arrow ) after zona pellucida penetration in all oocytes ( oocyte 1 , 2 and 3 ) used in this analysis the time course of the change in zona pellucida penetration distance of the leading sperm ( blue line ) and the following sperm ( red line ) shows that the zona pellucida penetration of the following sperm was inhibited when the leading sperm attached to the oocyte membrane ( indicated by the arrow ) after zona pellucida penetration in all oocytes ( oocyte 1 , 2 and 3 ) used in this analysis change in the distance between the surface of the zona pellucida and leading or following sperm . the images were acquired in 10-s intervals . with regard to oocyte 1 shown in the upper panel , both the leading and following sperm penetrated into the zona pellucida from the beginning of imaging to shortly prior to the attachment of the leading sperm to the oocyte membrane ( a , b ) . the leading sperm attached to the oocyte membrane 1,850 s ( 30.8 min ) after the beginning of imaging ( c ) , and the penetration of the following sperm was inhibited at 1,860 s ( d ) , which is within 10 s after the attachment of the leading sperm to the oocyte membrane . with regard to oocyte 2 shown in the middle panel and oocyte 3 shown in the lower panel ,", "the findings of our tlc analysis indicate the existence of a novel mechanism of polyspermy block , which takes place in the zona pellucida and differs from the oocyte membrane block to sperm penetration ( fast block to polyspermy ) and the zona reaction ( slow block to polyspermy ) a proposed mechanism for a fast zona - block to polyspermy during the human fertilization process . the findings of our tlc analysis indicate the existence of a novel mechanism of polyspermy block , which takes place in the zona pellucida and differs from the oocyte membrane block to sperm penetration ( fast block to polyspermy ) and the zona reaction ( slow block to polyspermy ) we are planning to elucidate the details of this novel mechanism by further observing the fertilization process of human oocytes using our tlc system . we revealed a novel phenomenon that is likely to be associated with the polyspermy block in human oocytes . this new mechanism involved cessation of the following sperm penetrating the zp within 10 s of the leading sperm penetrating the zp and attaching to the oocyte membrane . this was despite the following sperm retaining active tail movement and both sperm traveling at a similar velocity within the zp before penetration . the difficulty in obtaining tlc images in which both the leading and following sperm within the zp were clearly identified precluded analysis of their respective behaviors in more than three oocytes .", "by use of our original tlc system , we have succeeded in demonstrating the possible existence of a novel mechanism of polyspermy block in human oocytes . however , the details of this mechanism of polyspermy block are not yet fully understood , and the mechanism we have revealed in this study may be a small part of a highly complicated system . we will continue to analyze the fertilization process of human oocytes by use of the tlc system to reveal the details of this novel mechanism of polyspermy block in human oocytes .", "movie 1this is the first movie to successfully demonstrate the dynamic process of fertilization in human oocytes in vitro whereby once the leading sperm was attached to the oocyte membrane , the following sperm stopped further penetration within the zp . ( mpg 12897 kb ) this is the first movie to successfully demonstrate the dynamic process of fertilization in human oocytes in vitro whereby once the leading sperm was attached to the oocyte membrane , the following sperm stopped further penetration within the zp . this phenomenon prompted our hypothesis that a novel mechanism could exist for the polyspermy block in the human fertilization process .", "this article is distributed under the terms of the creative commons attribution license which permits any use , distribution , and reproduction in any medium , provided the original author(s ) and the source are credited ." ]

[ "one anterior segment from each pair received recombinant human stc-1 at concentrations of 5 , 50 , or 500 ng / ml ( dissolved in h2o ) , while the fellow eye received vehicle and served as the control . treatments were daily in one eye for 7 consecutive days with 5 l of latanoprost - free acid ( 100 m dissolved in 1:1000 dmso in pbs ) or 10 mm y27632 ( dissolved in phosphate - buffered saline ) . in the contralateral eye , vehicle was added daily in the same proportion as the treated eye for 7 consecutive days . anterior segments from human donor eyes ( age 75.5 17.5 years , range : 51 to 98 years ; n = 8) were perfused in culture with dmem within 10.2 4.4 hours of death as previously described . after achieving a stable baseline pressure , we recorded iop in both eyes three times daily at 1 , 4 , and 23 hours following treatment . primary schlemm 's canal cells were grown to confluence , treated with 100 nm latanoprost for 15 minutes , 1 , 2 , 4 , or 6 hours , and harvested . selected wedges of tissue 180 apart that included the trabecular meshwork and schlemm 's canal were isolated and fixed with 4% paraformaldehyde in 0.1 m phosphate buffer ( ph 7.2 ) . primary schlemm 's canal cells were grown to confluence , treated with 100 nm latanoprost for 6 hours , and harvested . we added stc-1 and vehicle using a gravity - driven constant pressure method of anterior chamber exchange followed by continuous perfusion . additionally , wild - type mice ( n = 7 ; charles rivers laboratories , wilmington , ma , usa ) were treated with 5 l of topically administered recombinant human stc-1 ( 0.5 mg / ml ; biovendor research & diagnostic products , asheville , nc , usa ) or vehicle ( phosphate - buffered saline ) daily for 7 days to examine the effect of stc-1 on iop . in all animals ,", "primary schlemm 's canal cells were grown to confluence , treated with 100 nm latanoprost for 15 minutes , 1 , 2 , 4 , or 6 hours , and harvested . primary schlemm 's canal cells were grown to confluence , treated with 100 nm latanoprost for 6 hours , and harvested . primary human schlemm 's canal cell lines were grown to confluence in six - well plates ( bd falcon , franklin lakes , nj , usa ) containing dulbecco 's modified eagle 's medium ( dmem ; life technologies , grand island , ny , usa ) ; 10% fetal bovine serum ( mediatech , manassas , va , usa ) ; and 1% penicillin / streptomycin ( life technologies ) in 5% co2 at 37c . confluent cells were washed twice with phosphate - buffered saline and incubated in serum - free dmem for 24 hours to synchronize the growth potential of the cells . cells were incubated with latanoprost ( de - esterified free - acid form at 100 nm final concentration ; cayman chemical , ann arbor , mi , usa ) or vehicle ( ethanol , final dilution 1:1000 ) in dmem containing 1% penicillin / streptomycin .", "primary human schlemm 's canal cell lines were grown to confluence in six - well plates ( bd falcon , franklin lakes , nj , usa ) containing dulbecco 's modified eagle 's medium ( dmem ; life technologies , grand island , ny , usa ) ; 10% fetal bovine serum ( mediatech , manassas , va , usa ) ; and 1% penicillin / streptomycin ( life technologies ) in 5% co2 at 37c . confluent cells were washed twice with phosphate - buffered saline and incubated in serum - free dmem for 24 hours to synchronize the growth potential of the cells . cells were incubated with latanoprost ( de - esterified free - acid form at 100 nm final concentration ; cayman chemical , ann arbor , mi , usa ) or vehicle ( ethanol , final dilution 1:1000 ) in dmem containing 1% penicillin / streptomycin .", "primary schlemm 's canal cells were grown to confluence , treated with 100 nm latanoprost for 6 hours , and harvested . we performed qpcr amplification with a predenaturation step at 95c followed by 45 cycles of denaturation at 95c , annealing at 63c , and extension at 72c . total rna was extracted using an rna isolation kit ( rneasy total rna isolation kit ; qiagen , hilden , germany ) . approximately 250 ng of total rna was reverse transcribed into cdna using a synthesis kit ( iscript cdna ; bio - rad laboratories , inc . , hercules , ca , usa ) . quantitative real - time polymerase chain ( qpcr )", "primary schlemm 's canal cells were grown to confluence , treated with 100 nm latanoprost for 15 minutes , 1 , 2 , 4 , or 6 hours , and harvested . lysate was centrifuged at 13,000 g for 10 minutes , and total protein was quantified by the bradford assay . antibody / antigen complexes were detected using ecl western blot signal detection reagent ( ge healthcare ) . chemiluminescence film ( biomax xar ; eastman kodak , rochester , ny , usa ) was used to visualize protein signals . each film was digitized with a photographic scanner ( epson perfection 2400 ; epson america , inc .", "treatments were daily in one eye for 7 consecutive days with 5 l of latanoprost - free acid ( 100 m dissolved in 1:1000 dmso in pbs ) or 10 mm y27632 ( dissolved in phosphate - buffered saline ) . in the contralateral eye , vehicle was added daily in the same proportion as the treated eye for 7 consecutive days . additionally , wild - type mice ( n = 7 ; charles rivers laboratories , wilmington , ma , usa ) were treated with 5 l of topically administered recombinant human stc-1 ( 0.5 mg / ml ; biovendor research & diagnostic products , asheville , nc , usa ) or vehicle ( phosphate - buffered saline ) daily for 7 days to examine the effect of stc-1 on iop . in all animals , we recorded iop in both eyes three times daily at 1 , 4 , and 23 hours following treatment . nh , usa ) was used to measure iop in conscious mice . for iop measurements , after 1 week of baseline iop measurements , stc-1 mice were treated with latanoprost ( n = 10 ) or rho kinase inhibitor y27632 ( enzo life sciences , farmingdale , ny ; n = 10 ) . the right eye served as the vehicle control eye while the left eye received study drug ( latanoprost , y27632 , or stc-1 ) . three independent measurements were obtained daily at similar time points and were averaged to obtain the daily iop value for each eye .", "after achieving a stable baseline pressure , one anterior segment from each pair received recombinant human stc-1 at concentrations of 5 , 50 , or 500 ng / ml ( dissolved in h2o ) , while the fellow eye received vehicle and served as the control . anterior segments from human donor eyes ( age 75.5 17.5 years , range : 51 to 98 years ; n = 8) were perfused in culture with dmem within 10.2 4.4 hours of death as previously described . we added stc-1 and vehicle using a gravity - driven constant pressure method of anterior chamber exchange followed by continuous perfusion . hourly pressure readings were obtained from the average of 60 , one - minute pressure measurements using a custom - designed software program . the experimental eye was typically the right eye and the control was the left eye .", "for human anterior segments , selected wedges of tissue 180 apart that included the trabecular meshwork and schlemm 's canal were isolated and fixed with 4% paraformaldehyde in 0.1 m phosphate buffer ( ph 7.2 ) . , peabody , ma , usa ) . for mouse eye histopathology , whole eyes were enucleated from euthanized mice following termination of the experiment . eyes were placed in 4% paraformaldehyde in 0.1 m phosphate buffer ( ph 7.2 ) overnight , and processed for light microscopy as described above for human anterior segment wedges . tissue wedges were dehydrated in a series of ascending ethanol concentrations , cleared with 100% acetone , infiltrated and embedded in epon araldite , and sectioned at 0.5 m . tissue sections on copper film grids were examined using a transmission electron microscope ( jeol-1400 ; jeol usa , inc . eye tissue sections were stained with toluidine blue and examined using a light microscope ( nikon corp . , additional 100-nm sections were placed on copper film grids , and stained with uranyl acetate and lead citrate . additional tissue wedges were sectioned at 100 nm , placed on copper film grids , and stained with uranyl acetate and lead citrate . processed sections were obtained following examination under a light microscope ( nikon corp . ) and a transmission electron microscope ( jeol usa , inc . ) .", "the effect of latanoprost was expressed as the change in outflow facility ( c ) for each anterior segment . variations in daily iop are graphically presented as the mean daily iop of the vehicle and treated eyes . significance of iop change was assessed between experimental and vehicle - treated control eyes using student 's paired t - test for data sets with normal distribution and wilcoxon sign - rank test for nonparametric data sets . prior to initiation of statistical analysis , all data sets were evaluated for distribution assessment using the shapiro - wilk test . for animal studies ,", "these results indicate that stc-1 may be a molecule within the latanoprost signaling pathway that can be therapeutically targeted to lower iop . these data suggest that stc-1 has a unique and key role in latanoprost signaling mediated iop reduction . because of its multifunctional properties and ability to act in an autocrine and paracrine fashion similar to prostaglandin analogs , we examined the role of stc-1 in downstream signaling following latanoprost treatment in vivo using stc-1 mice and congenic wild - type controls . these results suggest that stc-1 has iop - lowering properties when used as a standalone agent .", "preliminary findings from confluent primary human schlemm 's canal cell lines treated with latanoprost identified stc-1 , a secreted phosphoglycoprotein hormone with multiple functions , as a gene consistently upregulated following latanoprost treatment . cell lysates isolated from latanoprost - treated primary human schlemm 's canal cells at various time points showed an increase of stc-1 protein expression of 1.9-fold at 2 hours and approximately 5.0-fold at 4 and 6 hours , correlating with increased mrna expression levels identified by qpcr ( fig . quantitative pcr studies in human schlemm 's canal cells showed an 18.1 4.3-fold ( n = 3 ) induction . 1 ) . induction of stc-1 in schlemm 's canal cells following treatment with latanoprost .", "because of its multifunctional properties and ability to act in an autocrine and paracrine fashion similar to prostaglandin analogs , we examined the role of stc-1 in downstream signaling following latanoprost treatment in vivo using stc-1 mice and congenic wild - type controls . these data suggest that stc-1 has a unique and key role in latanoprost signaling mediated iop reduction . intraocular pressure in wild - type and stc-1 mice following treatment with latanoprost and rho kinase inhibitor rho kinase inhibitor y27632 reduces iop in stc-1 mice .", "these results indicate that stc-1 may be a molecule within the latanoprost signaling pathway that can be therapeutically targeted to lower iop . recombinant human stc-1 and vehicle - treated eyes had similar morphology and ultrastructural appearance suggesting no apparent detrimental side effects of recombinant stc-1 treatment . to determine if stc-1 would influence iop reduction by itself , we perfused human anterior segments with several concentrations of recombinant stc-1 for 24 hours . morphologic analysis showed viable and healthy cells in the trabecular meshwork and schlemm 's canal of control and treated eyes ( fig .", "to determine if stc-1 has ocular hypotensive activity in vivo , wild - type c57bl/6 mice were treated with recombinant stc-1 ( 0.5 mg / ml ) or vehicle daily for 7 days ( fig . stanniocalcin-1 reduced iop by 15.2% 3.0% when compared to vehicle - treated contralateral eyes ( range of iop reduction from 5.1% 5.2% [ day 1 ] to 21.4% 5.3% these results suggest that stc-1 has iop - lowering properties when used as a standalone agent . wild - type mice ( n = 10 ) were treated topically with recombinant stc-1 ( 0.5 mg / ml ) or vehicle ( phosphate buffered saline ) . the daily iop was recorded as the average of iop measurements at 1 , 4 , and 23 hours following stc-1 treatment .", "together , these results suggest that stc-1 is a critical and unique effector molecule for the latanoprost signaling pathway that is necessary for latanoprost - induced iop reduction and that stc-1 by itself can act as an ocular hypotensive agent . we identified stc-1 as a transcript and protein that is highly induced following treatment of human schlemm 's canal cells with latanoprost . topical latanoprost significantly reduced iop in wild - type controls while stc-1 mice demonstrated no iop reduction to topical latanoprost . in contrast , rho kinase inhibitor y27632 demonstrated iop reduction in both wild - type and stc-1 mice , indicating that stc-1 is a unique and important downstream signaling molecule necessary for the ocular hypotensive properties of latanoprost . additionally , recombinant stc-1 by itself also increased outflow facility in human anterior segments and reduced iop in vivo in wild - type mice ." ]

[ "= 10 v , and the conductance versus position provides a measure of local accumulation or depletion of carriers in the device . the silicon ( si ) nanowires were synthesized at 450460 c using silane ( sih4 ) as the silicon reactant source , hydrogen ( h2 ) as the carrier gas , and phosphine ( ph3 , 1,000 p.p.m . in h2 ) and diborane ( b2h6,100 p.p.m . in h2 ) as the n- and p - type dopants . in a typical synthesis of uniform n - type , 80 nm kinked silicon nanowires , cadmium sulphide nanowires were grown in a three - zone furnace by evaporating cds power at 650720 c , with nanowire growth by gold nanocluster catalyzed vls method at 550 - 500 c . devices were fabricated on silicon substrates ( nova electronic materials , n - type 0.005 cm ) with 100 nm thermal oxide and 200 nm silicon nitride at the surface . p - n silicon nanowires were 500:1 for both p - and n - type segments . in n - kink - n - kink-(n - n ) dopant modulated silicon nanowires , the silicon - phosphorus feed - in ratios were 200:1 and 10000:1 for n- and n - type segments , respectively , and the n- segment was grown for 30 s. germanium nanowires were synthesized at 270290 c , 40 torr , with germane ( geh4 , 10 % in h2 ) and h2 as the reactant and carrier gas , respectively . electrostatic force microscopy and scanned gate microscopy measurements were carried out with a digital instruments nanoscope iiia multimode afm and metal coated tips ( nanosensors , ppp - nchpt ) . the electrostatic force microscopy surface potential maps and scanned gate microscopy conductance maps were acquired in lift mode with lift heights of 40 and 20 nm , respectively . in the surface potential measurements , the p - n diode was reverse - biased at 5 v and the tip voltage was modulated by 3v at the resonance frequency . in scanned gate measurements , the tip functions as a local gate vtip", "the silicon ( si ) nanowires were synthesized at 450460 c using silane ( sih4 ) as the silicon reactant source , hydrogen ( h2 ) as the carrier gas , and phosphine ( ph3 , 1,000 p.p.m . in h2 ) and diborane ( b2h6,100 p.p.m . in h2 ) as the n- and p - type dopants . in a typical synthesis of uniform n - type , 80 nm kinked silicon nanowires , cadmium sulphide nanowires were grown in a three - zone furnace by evaporating cds power at 650720 c , with nanowire growth by gold nanocluster catalyzed vls method at 550 - 500 c . p - n silicon nanowires were 500:1 for both p - and n - type segments . in n - kink - n - kink-(n - n ) dopant modulated silicon nanowires , the silicon - phosphorus feed - in ratios were 200:1 and 10000:1 for n- and n - type segments , respectively , and the n- segment was grown for 30 s. germanium nanowires were synthesized at 270290 c , 40 torr , with germane ( geh4 , 10 % in h2 ) and h2 as the reactant and carrier gas , respectively . the flow rates of sih4 , ph3 and h2 were 12 , 210 and 60 standard cubic centimetres per minute , respectively , and the total pressure was 40 torr and purge duration was 15 s ; the minimum pressure during the purge cycle was ca . 3 10 torr . the dopant feed - in ratios ( silicon : boron / phosphorus ) in kinked the purge cycle used to form kinks in the germanium and cadmium sulphide nanowires was typically 15 s. monodisperse gold nanoparticles ( ted pella ) were dispersed on sio2/si or sapphire growth substrates ( au surface coverage : 0.010.1 particles/m ) , which were placed within the central region of the quartz tube reactor . single - crystalline kinked nanowires were synthesized by the nanocluster - catalyzed vls method described previously18,19 in quartz tube connected to gas manifold and vacuum pump and heated by a temperature controlled tube furnace .", "zeiss ultra55/supra55vp field - emission sems and jeol 2010 field emission tem were used to carry out sem and tem analyses , respectively . for sample preparation , kinked nanowires were gently sonicated in isopropyl alcohol and dispersed onto heavily doped silicon substrates ( 100 nm oxide/200 nm nitride , 110 cm resistivity , nova electronic materials , carrollton , tx ) or lacey carbon grids ( ted pella ) .", "= 10 v , and the conductance versus position provides a measure of local accumulation or depletion of carriers in the device . electrostatic force microscopy and scanned gate microscopy measurements were carried out with a digital instruments nanoscope iiia multimode afm and metal coated tips ( nanosensors , ppp - nchpt ) . the electrostatic force microscopy surface potential maps and scanned gate microscopy conductance maps were acquired in lift mode with lift heights of 40 and 20 nm , respectively . in the surface potential measurements , the p - n diode was reverse - biased at 5 v and the tip voltage was modulated by 3v at the resonance frequency . in scanned gate measurements , the tip functions as a local gate vtip devices were fabricated on silicon substrates ( nova electronic materials , n - type 0.005 cm ) with 100 nm thermal oxide and 200 nm silicon nitride at the surface . devices were defined by electron - beam lithography followed by ti / pd ( 1.5 nm/100 nm ) contact deposition in a thermal evaporator . current - voltage ( i v ) data were recorded using an agilent semiconductor parameter analyzer ( model 4156c ) with contacts to devices made using a probe station ( desert cryogenics , model ttp4 ) .", "" ]

[ ", we describe a case where a patient with a posterior fossa arachnoid cyst complained of visual field defect , visual disturbance , and mild headache ; no ataxia and unsteady gait were reported . arachnoid cysts are benign , non - neoplastic and extra - axial lesions ; most of them are clinically silent and unchanged in size . in previous studies112131524 ) , the incidence of arachnoid cysts has been estimated to range between 0.3% to 1.7% . however , the advanced neuroimaging techniques have facilitated the diagnosis of arachnoid cysts , which , in turn , has led to an increase in the number of patients2121415 ) . in some cases , an arachnoid cyst arouses symptoms and its clinical presentations vary according to the size and location of the cyst . , seizures , cognitive dysfunction , developmental delay , and intracranial hemorrhage can be also presented . in this report the most frequent symptom is headache , which is caused by the local mass effect , increased intracranial pressure ( icp ) , and/or hydrocephalus15 ) . above this", "a 39-year - old male patient presented at our emergency room after a traffic accident and the brain computed tomography ( ct ) scan indicated an incidental arachnoid cyst on posterior fossa . at that time , the patient complained only of facial abrasions and the left knee pain , but not of headache or visual disturbance . in eight months , however , he revisited our department of ophthalmology to check the decreased visual acuity , visual field defect , and headache . on the ophthalmologic examination , bilateral papilledema ( fig . the blind right eye improved to recognize the light and the blurred left eye improved to acknowledge the silhouette of an object ; thus , it did not fully recovered to the prior , normal condition . after the dural incision , the arachnoid cyst was exposed and cystic fluid was expelled . one week afterwards , we checked the brain ct scans and the removal of the cyst and the decreased ventricle size were confirmed . on the ophthalmologic examination , his right eye was completely blind , whereas his left eye recognized only light ( fig . nevertheless , visual acuity and visual field improved slowly and slightly ( fig . 2c ) .", "in addition to headache , gait imbalance , seizure , and visual changes can also be presented according to the location and size of the arachnoid cyst . consequently , both visual acuity and visual field were influenced by the posterior fossa arachnoid cyst . when the patient first visited our department of ophthalmology , his visual symptoms and headache were not severe and the patient could walk and drive . besides , the brain ct scan showed no changes as compared to previous ct scans , so we could not predict a risk of rapid deterioration . the patient 's refusal to have an operation and the surgeon 's wrong prediction delayed the appropriate on - time treatment ; ultimately , the patient 's vision was severely damaged during the critical seven days . after the operation , the patient 's visual acuity , visual field , and papilledema were slightly improved ; however , we regard that the patient 's vision will unfortunately not fully recover . , visual acuity was affected by the papilledema , which was caused by the increased icp .", "unlike gait disturbance and ataxia , visual symptoms do not frequently occur in the patients with posterior fossa arachnoid cysts ; this is so because the cyst is located away from the optic nerves . however , the disruption of csf flows can indirectly induce visual symptoms and these symptoms can rapidly deteriorate . considering the results of our case , it should be emphasized that the patients with posterior fossa arachnoid cysts could develop a rapid neurologic deterioration . therefore , in the event of the development of symptoms , an early intervention or close observation are crucial ." ]

[ "we performed a closed reduction with a percutaneous leverage technique and internal fixation method with k - wires to treat angulated radial neck fractures in children . these techniques include closed reduction , percutaneous pin reduction , intramedullary pin reduction with elastic stable intramedullary nailing or kirschner - wires ( k - wires ) , and open reduction with or without internal fixation . our goals for treatment are to avoid incision , reduce the fracture adequately with no reduction loss , and achieve good postoperative function .", "a 1.6- or 2.0-mm k - wire was inserted from distal to proximal of the elbow percutaneously . in this procedure , the k - wire was inserted into the fracture site . the k - wire was used to lever the fracture and to orient the proximal part horizontally with the lateral condyle plane . complications with ulnar olecranon fracture and medial epicondyle fracture were present in 3 cases and 2 cases , respectively . no blood vessel or nerve trauma was evident . from january 2011 to april 2013 , we treated 16 cases of angulated radial neck fractures in 12 boys and 4 girls . was attained , two 1.2 mm k - wires were percutaneously inserted from the articular surface through the fracture site to the opposite cortex for fixation ( fig . ( a ) the kirschner wire ( k - wire ) was inserted percutaneously into the fracture site . typical case : femail , 12 years old , and right side . a long - arm cast or brace was used for 3 to 4 weeks after the procedures , with the elbow in 90 of flexion and the forearm in supination . the shortest time from trauma to surgery was 4 hours and the longest time was 6 days .", "a 1.6- or 2.0-mm k - wire was inserted from distal to proximal of the elbow percutaneously . in this procedure , the k - wire was inserted into the fracture site . ( a ) the kirschner wire ( k - wire ) was inserted percutaneously into the fracture site . the k - wire was used to lever the fracture and to orient the proximal part horizontally with the lateral condyle plane . was attained , two 1.2 mm k - wires were percutaneously inserted from the articular surface through the fracture site to the opposite cortex for fixation ( fig . typical case : femail , 12 years old , and right side . a long - arm cast or brace was used for 3 to 4 weeks after the procedures , with the elbow in 90 of flexion and the forearm in supination . ( c ) one 1.2 mm k - wires was percutaneously inserted from the articular surface passing through the fracture site to the opposite cortex . ( b ) the inserted k - wire was used as a lever to reduce the fracture .", "cases were followed up for an average of 3 years 7 months ( range 2 years 6 months to 4 years 10 months ) . 12 cases were excellent , and 4 cases were good . according to the metaizeau clinical classification , 14 cases were excellent , and 2 cases were good . the postoperative reduction was assessed by roentgenograph within 1 week after surgery . no infection or nerve damage occurred in the short - term follow - up . no radial head necrosis or synostosis of the proximal ulna and radius was seen in the long - term follow - up . there was no disclosure of the epiphysis or valgus of the elbow during the follow - up . according to the metaizeau reduction classification , ( a ) the preoperative x - ray showed the severe tilt and displacement of radial neck .", "the insertion site should be carefully selected to avoid damage to the deep branch of the radial nerve . we usually choose 1.2 mm k - wires to prevent damage to the epiphysis . one method uses an elastic stable intramedullary nailing to indirectly reduce and fix the fracture site . however , we found that it was difficult to reduce the displaced radius head through rotating the distal part of the elastic intramedullary nail . the k - wires should be appropriately sized , with a diameter no greater than 1.5 mm .", "we recommend the percutaneous leverage technique during closed reduction and internal fixation using k - wires for the treatment of angulated radial neck fractures in children . this is a simple method with little trauma to the patient and a satisfactory clinical outcome ." ]

[ "the knowledge regarding symptoms , transmission , and prevention has been shown to be greater among the urban population in pakistan 's punjab province compared to the rural population . tuberculosis in the united states has declined in the twentieth century , and several factors such as improved nutrition status , socioeconomic status , overall public health , and new drug regimens have been thought to play a major role . however , in the mid-1980s a resurgence occurred which reached its peak in 1992 , especially in urban areas among the homeless and incarcerated population ( 18 ) . information about infectious diseases and how they spread in the community can help the individuals to protect themselves , but knowledge about the slums and the infectious diseases panorama is also crucial for local physicians . all of these shortages can be a threat to the residents health and be a possible breeding ground for infectious diseases . health - seeking behaviour was also better among the urban population , in the aspect of when to seek medical advice for early diagnosis and potential treatment ( 19 ) . they need to know how to look for the correct diagnosis , even if their diagnostic tools might be limited . traditionally cities can offer many advantages compared to rural settings , but under certain circumstances they can rather be a health hazard .", ". a better understanding of how to prevent uncontrolled growth in rat population can potentially lead to a decline of these zoonotic diseases . large megacities all over the world have large rat populations , but the surveillance and local knowledge seem to be inadequate good hygiene practices and good sanitary conditions have lowered the prevalent levels of contamination . in the brazilian city of salvador , with a population of 2.5 million , an improvement of sewerage coverage from 26 to 80% of the households led to an estimated overall reduction of diarrhoeal diseases of 22% ( 23 ) . neglected tropical diseases can cause substantial health problems in developing countries , and some of these diseases have a faecal - oral transmission pathway . the environment in urban cities has proven to be favourable for the rat population ( rattus spp . ) and close encounters between rats and humans can lead to transmission of zoonotic infectious diseases . the changes in human population with increased urbanization and urban poverty has also altered our perception of some zoonoses linked to the rat population . these infections are among the most important causes of physical and intellectual growth retardation in the world and have a major impact on public health ( 22 ) .", "control programs and adequate surveillance is of importance , but in rapidly growing cities and slums it can be tough to implement such measures . emerging infectious diseases can also make the jump to stable transmission in the urban surroundings and surveillance of these can potentially prevent major health concerns and high cost for the health care services . who can play a major role in the fight for better control and knowledge . the growing trend of urbanization around the world has shifted some infectious diseases , which have traditionally been perceived as rural , to urban settings . the world health organization ( who ) has published a list of 17 neglected tropical diseases . it has been shown that it is a growing health problem and the ongoing urbanization has contributed to the increase ( 44 ) . if the different vectors can adapt to the urban environment and man - made resources , the potential health implications can be of major concern . numerous of the neglected tropical diseases play a major role in the developing world , which is currently experiencing a much faster pace of urbanization compared to the developed world safe and targeted assistance can be a huge factor for overall health ; such assistance could be an effective vaccine or safe and easy vector control programs . lf still has its major impact in rural settings , but the increasing urbanization in the developing world has made lf an infectious disease that also has to be considered elsewhere .", "the example of sars shows that food markets in southern china can be the origin of a worldwide health crisis . , international tourism arrivals will continue to increase , and in 2030 the figure is expected to be 1.8 billion ( 45 ) . with the pace of modern travel , highly contagious infectious diseases can be a potential threat in a completely different setting compared to the original outbreak . international trade and travel can potentially also contribute to the occurrence of a worldwide pandemic . international travel has connected the world in the last century , and this mobility creates a potential threat of many emerging diseases .", "ebola virus disease ( evd ) has had a profound impact on the world in 2014 . since the spring of 2014 , closer contact with humans and fruit bats are thus risks for a new global health crisis and the severity of an ebola epidemic has already been witnessed . human influence on the ecosystems creates meeting points for new and potential zoonotic diseases , which could have a profound impact for both local and global health . a better understanding , surveillance , and prevention of zoonotic diseases would be of great value , to both prevent and manage this upcoming threat for global health . new housing in the outskirts of big cities can potentially be meeting points for new and already known zoonotic diseases .", "a study in tanzania has compared the knowledge about certain zoonotic diseases among general practitioners in urban and rural areas . malaria has historically been and is still a major health concern in large parts of the world . who estimates 198 million cases ( 124283 million ) of malaria and 584,000 deaths ( 367,000755,000 ) in 2013 . studies in chengdu and shanghai , china , have shown risk perception about stis and hiv and aids is profoundly changed in rural - to - urban migrants ( 79 , 80 ) . the knowledge about sexually transmitted diseases ( stis ) among bangladeshi adolescents was higher among people in urban areas compared to rural , both in general and hiv and aids ( 77 ) . the same results about hiv and aids have been found among a canadian population ( 78 ) . high coverage can prevent epidemics in large cities and save many lives ; however , immunization needs to be available both for the rural and urban population to achieve the greatest benefit . different factors , such as education , direct primary care services , and the governments capacity for rapid response to upcoming health threats , can contribute to the opportunities in a city . campaigns to improve the public knowledge are useful to fight the threat of infectious diseases .", "are overall better in urban environments compared to rural settings ; better housing , sanitation , ventilation , and social services all play an important role in this improvement . certain pathogens can , however , adapt to the different conditions and thus create a new challenge for both local governments and the global community . urbanization is an ongoing process in the world at the moment , but the pace of the process is not universal . the developed countries , which have traditionally been thought of as high - income countries , are already urbanized , and it is in the developing world that the rapid rise is taking place . surveillance is of primary importance to monitor the burden of disease and will give both local authorities and the global community a chance for a quick response to public health threats . these new settlements create new and closer encounters with wildlife , which can be a potential source of zoonotic diseases . these can be both previously known or new pathogens , which make the shift from their animal host to generate infections in humans . but some countries do not have the resources and because these diseases can be of global concern , it is also the international community 's responsibility to help and support with knowledge and resources . the rapid urbanization has also interfered in previously untouched ecosystems . infectious diseases still have a big impact on the global health , and urbanization is now altering the characteristics of these diseases . living conditions in cities the capacity for surveillance , control programs , prevention , and public knowledge programs is far better in cities .", "the author have not received any funding or benefits from industry or elsewhere to conduct this study ." ]

[ "we focused on using markers for detecting cell death in neurons , loss of myelin and loss of neurofilaments in axons , and , activation of astrocytes and microglia / macrophages . in order to better understand the unique cellular and dti imaging alterations associated with secondary wallerian degeneration relative to the onset and progression of direct ischemically damaged brain , it is necessary to compare their progression directly at multiple time points . in the current study we hypothesized that dti imaging would provide measures of progressive tissue changes within axonal tracts distal to the ischemic injury distinct from those in directly injured brain ( e.g. cerebral cortex ) and these differences would correspond with specific tissue morphological alterations in response to ischemia this was investigated by using a neonatal rat model of unilateral transient cerebral hypoxia ischemia and measuring dti changes in the parietal cerebral cortex compared with its associated descending corticospinal tract axon fibers within the cerebral peduncle . we recently demonstrated that following neonatal hypoxia with unilateral transient ischemia there is evidence for early wallerian degeneration visible as either decreases in the apparent diffusion coefficient ( adc ) and magnetization transfer ratio or increases in dw or t2 ( lama et al .", "these regions of interest were manually defined in the mr images and histological sections and included the cerebral peduncle ( 0.30.4 mm ) , pons ( within the central gray and mesencephalic trigeminal nucleus regions , 0.60.9 mm ) and parietal cortex ( 0.71.0 mm ) for areas both ipsilateral and contralateral to the lesion containing hemisphere . once the ischemic infarct had progressed towards cavitation and cyst formation ( i.e. 1 and 4 w post - hypoxia ischemia ) , homologous measures of cortical tissue were not possible and therefore were taken adjacent to the cyst a peri - cyst cortical region ( 0.40.6 mm ) . brains from 44 rats were processed and stained for 5 different cellular or injury markers within sections containing the parietal cortex , posterior cerebral peduncle and central gray region of the pons . thus , the parietal cortex was selected as a representative brain region of direct hypoxic ischemic damage or infarction . the vannucci model of neonatal cerebral hypoxia ischemia ( vannucci and vannucci , 2005 ) produces ischemic damage and infarction within the distribution of the middle cerebral artery territory . a moderate unilateral ischemic lesion with hypoxia ( vannucci and vannucci , 2005 ) was produced as described previously ( lama et al . brain near the aqueduct in the posterior pons was selected as a control region generally unaffected by the hypoxia ischemia . the posterior cerebral peduncle supplied by the posterior circulation was selected as a region of secondary injury remote to the hypoxia sections ( 6 m thick ) were cut at the level of the posterior cerebral peduncle and parietal cortex using the brain atlas and anatomical landmarks to match sections to the mr slices and measure staining changes in equivalent regions of interest to those for the mr images .", "as discussed in more detail , the tissue alterations following ischemia and axonal degeneration had a complex relationship with changes in fa , parallel diffusivity and radial diffusivity . thus , this systematic study is informative regarding the optimal dti mr imaging parameters to probe axonal injury following hypoxic / ischemic brain damage in developing brain in addition to aiding our interpretation of dti parameters for detecting various stages of wallerian degeneration . the results are first to characterize the correspondence of the progression of cellular and dti changes within the cerebral peduncle of the descending corticospinal tract following hypoxic ischemic damage to the cortex . novel is the demonstration of the differing progression of dti alterations in a directly damaged ischemic region such as parietal cortex versus that in associated subcortical tracts . the results demonstrate that in general , diffusivity changes and histological responses within directly damaged ischemic brain precede and are often larger in magnitude than corresponding alterations in a region of secondary axonal degeneration , such as the cerebral peduncle . with the progression of damage over one or more weeks , dti components such as fa and radial diffusivity are better than mean adc for detecting ischemia associated axonal injury indicative of wallerian degeneration ." ]

[ "although not much literature is available on the aspect of how family stress has influenced the productivity of the indian workforce , the author is of the opinion that absenteeism , alcoholism , gambling , heavy debts among employees are a reflection of bruised familial systems . india 's policies on family and child welfare have been focused more in terms of health care , nutrition , reproductive health , sexuality and venereal disease . relationship - focused education for young adults in the workforce has not been on top of the agenda for india 's policy makers . the effect of family on workforce is an important though often overlooked issue for work organizations , with implications for the morale , stability and productivity of the workforce .", "the author conducted individual interviews with family - intervention experts in bangalore city in order to better understand the changing family patterns that they were observing . among the professionals , there were two clinical psychologists , two psychiatric social workers , two psychiatrists and one divorce lawyer . the key person interview ( kpi ) cue statements to initiate discussions with the experts were as follows [ table 1 ] : description of key person interview participants \n changes that you are seeing in the nature of problems that families are coming to you with in comparison to the nature of problems brought up a decade agoname some culture - specific areas that need to be kept in mind while preparing the family life education programsome areas that you feel need to be essentially covered by a family life education program for single young adults . \n changes that you are seeing in the nature of problems that families are coming to you with in comparison to the nature of problems brought up a decade ago name some culture - specific areas that need to be kept in mind while preparing the family life education program some areas that you feel need to be essentially covered by a family life education program for single young adults .", "it is interesting to note that among the changes noticed by family experts in relation to the aspect of family issues , is the ability to recognize issues early on in the marriage and to seek help for the same . it is also interesting to note that the family experts were able to clearly point out the need for any family life education program to be sensitive to indian culture in terms of how it viewed the role of the joint family . the recognition of sexual dissatisfaction by , and the unwillingness to stay in a marriage on the part of , the female spouse was also another prominent change that experts were noticing . themes from key person interview with family experts leadership and decision - making issues in the joint family largely arose due to the inability to face up to , or communicate with , authority figures within the family , thus leading to frustration and passive aggression .", "relationship - focused family life education programs for the target group of employees at the workplace may actually serve to fulfill this purpose , whereby employees , through group interaction and experiential learning , can be taught skills to deftly handle family - life conflicts either by themselves or through the support of mental health professionals . family issues that eat into employees ' ability to perform or affect his cognitive and emotional state of being need to be addressed . a promotive and preventive strategy rather than a curative one would have to be adopted for this purpose . thus a mental health professional need not be there merely to diffuse a difficult situation arising out of deviance of an employee . he or she may act as a preventive agent of avoiding such deviance from arising , by tackling the problem at the root by pre - equipping the family with the necessary psychoeducation and skills ." ]

[ "although small renal leiomyomas can be found in about 5% of autopsy specimens , clinical incidence of these lesions is much lower . in this report , we discuss the first case of simultaneous occurrence of a multilocular cystic rcc and a leiomyoma in the same kidney . macroscopically , renal cell carcinomas ( rccs ) generally present as either solid or cystic mass . among cystic rccs , multilocular cystic rcc represents a rare entity that was recognized in 1982 , with a reported incidence of 1 - 4% of all rccs . renal leiomyomas are benign tumors of the kidney originating from smooth muscle cells of the renal capsule , pelvis , calices , or blood vessels .", "a 38-year - old man was referred for treatment of a right renal cystic mass found incidentally . since multilocular cystic rcc could not be excluded , the patient underwent right laparoscopic radical nephrectomy . macroscopically , in the mid pole , a well - circumscribed mass showing a multicystic feature with thin fibrous septa and without expansile tumor nodules was noted . physical examination on admission revealed no palpable mass , and laboratory data were negative . computed tomography of the abdomen showed a about 5.4 4.6 cm poorly enhancing cystic mass with enhancing septa in the polar area of the right kidney ( fig .", "this present case is the first report of synchronous renal neoplasms with different histogenesis ( multilocular cystic rcc and leiomyoma ) in a patient without any symptoms . these results illustrate that multilocular cystic rcc originates from the distal nephron , although the precise pathogenesis of cystic formation in multilocular cystic rcc has not been elucidated clearly . since it is often difficult to differentiate cystic rccs from benign cystic lesions , a definite diagnosis can in most cases only be established by histopathologic examination . the significance of the relationship between multilocular cystic rccs and leiomyomas is not well understood and needs further exploration ." ]

[ "confidence levels for individual branches of the resulting tree were assessed using the bootstrap test in which 1,000 replicate trees were generated from resampled data . plasmid dnas were extracted using the dna hybrid - qtm plasmid mini dna isolation kit ( geneall , seoul , korea ) . cultured mycelia , filtered through 2 layers of miracloth ( calbiochem , la jolla , ca , usa ) , were ground in liquid nitrogen , and genomic dna was extracted using the cetyltrimethylammonium bromide method . the size of basidiospores from the korean cultivated yeongji strains was determined using a fluorescence microscope ( axio observer a1 ; carl zeiss , jena , germany ) and a 5% koh solution as a mounting medium . the sequences of the its rdna were aligned for phylogenetic analysis using the program bioedit ( http://www.mbio.ncsu.edu/bioedit/bioedit.html ) . pcrs were performed using a premixed polymerase kit ( taq premix ; tnt research , anyang , korea ) in a 20 l reaction mixture containing 1 l of dna . recombinant clones were identified , and the presence of inserts was confirmed by ecori restriction enzyme digestion and sequencing ( using the sp6 and t7 promoters ; genotech , daejeon , korea ) .", "the ganoderma strains listed in table 1 were obtained from the korean collection for type culture ( ktct , jeongeup , korea ) , the american type culture collection ( atcc , rockville , md , usa ) , the korean agricultural culture collection ( kacc , suwon , korea ) , the mushroom division of the rural development administration ( eumseong , korea ) , the centraalbureau voor schimmelcultures ( cbs , utrecht , netherlands ) , incheon university ( incheon , korea ) , and konkuk university ( seoul , korea ) . ganoderma species were cultured on potato dextrose broth ( difco , detroit , mi , usa ) and incubated at 30 for 2 wk .", "amplification of the its region was carried out using a thermal cycler ( takara , tokyo , japan ) at the following conditions : 5 min at 94 for initial denaturation , followed by 30 cycles of 30 sec at 94 for denaturation , 30 sec at 56 for primer annealing , and 1 min at 72 for extension , and 10 min at 72 for a final extension . cultured mycelia , filtered through 2 layers of miracloth ( calbiochem , la jolla , ca , usa ) , were ground in liquid nitrogen , and genomic dna was extracted using the cetyltrimethylammonium bromide method . pcrs were performed using a premixed polymerase kit ( taq premix ; tnt research , anyang , korea ) in a 20 l reaction mixture containing 1 l of dna . pcr products were detected by electrophoresis on 1.2% agarose gels in 0.5 tris - acetate ethylenediaminetetraacetic acid buffer .", "recombinant clones were identified , and the presence of inserts was confirmed by ecori restriction enzyme digestion and sequencing ( using the sp6 and t7 promoters ; genotech , daejeon , korea ) . plasmid dnas were extracted using the dna hybrid - qtm plasmid mini dna isolation kit ( geneall , seoul , korea ) . ligation products were transformed into the escherichia coli dh5 competent cell ( rbc , taiwan ) by heat shock . pcr products were ligated into the pgem - t easy vector ( promega , madison , wi , usa ) according to the manufacturer 's instructions .", "confidence levels for individual branches of the resulting tree were assessed using the bootstrap test in which 1,000 replicate trees were generated from resampled data . the phylogenetic trees were constructed by using the mega5 program and the neighbor - joining method . nucleotide sequences were deposited in the national center for biotechnology information genbank database ( table 1 ) . the sequences of the its rdna were aligned for phylogenetic analysis using the program bioedit ( http://www.mbio.ncsu.edu/bioedit/bioedit.html ) .", "the size of each spore was calculated , and the mean value was used in the description . the size of basidiospores from the korean cultivated yeongji strains was determined using a fluorescence microscope ( axio observer a1 ; carl zeiss , jena , germany ) and a 5% koh solution as a mounting medium .", "the results of this study also reveal that korean g. lucidum was clustered into one group together with chinese g. sichuanense and chinese g. lingzhi ( both formerly g. lucidum ) , and it was clearly separated from g. lucidum from europe and north america . the comparison of the its rdna sequences and the estimation of the basidiospores size presented in this study confirm previous findings and contribute additional evidence that suggests the naming korean cultivated yeongji strains of ' g. lucidum ' should be renamed as g. lingzhi . group a included all the korean g. lucidum strains , as well as the g. lucidum strains from bangladesh and japan , and chinese g. sichuanense and g. lingzhi . the phylogenetic analysis of ganoderma species in this study was generally consistent with the findings reported by the group from china ." ]

[ "therefore , this comparative study analyzed rates of postoperative infection , rejection , long - term survival , and relapse of hepatitis b in hepatitis b carriers receiving slkt at the organ transplant center of the shanghai first people s hospital . however , few studies have reported the effectiveness of slkt and hepatitis b recurrence in hepatitis b carriers receiving slkt . a previous study reported that slkt for hepatitis c , non - alcoholic steatosis and hepatocellular cancer could be associated with worst outcomes compared with other slkt indications . while hepatitis c is the leading cause in western countries , hepatitis b is the most prevalent type in china . successfully conducted the first simultaneous liver - kidney transplant ( slkt ) in 1983 on a patient with chronic kidney allograft rejection and liver cirrhosis , this procedure has become the most effective method for the treatment of combined end - stage liver disease and renal failure .", "this was a retrospective analyses in 21 patients ( male : 19 , female : 2 ) who underwent slkt at the organ transplant center of shanghai first people s hospital , shanghai jiaotong university , between january 2001 and may 2005 . recipients of slkt were selected based on the following criteria : 1 ) irreversibly compromised renal function confirmed by preoperative examination , including serum creatinine levels > 133 mol / l lasting for 1 month continuously ; 2 ) high - risk factors for kidney diseases , such as diabetes and hypertension ; and 3 ) massive proteinuria and/or requiring renal replacement therapy for more than 3 weeks . the diagnosis of acute renal allograft rejection was primarily based on recipients clinical presentation , biochemical indicators ( a 25% increase of serum creatinine levels or more ) , and histopathological biopsy . the diagnosis of acute hepatic allograft rejection required increases in serum ast levels and/or in total bile acids , and was confirmed by liver biopsy . the study period also included 25 patients who underwent lt alone with renal insufficiency ( preoperative serum creatinine levels > 133 mol / l ) . preoperative nucleoside analogue therapy was followed by intraoperative hbig 2000 u. postoperative combined therapy was administered with maintenance hbig twice per week . within 6 months of transplantation , when patients with hepatorenal syndrome were on dialysis for < 4 weeks , liver transplant alone was performed .", "this was a retrospective analyses in 21 patients ( male : 19 , female : 2 ) who underwent slkt at the organ transplant center of shanghai first people s hospital , shanghai jiaotong university , between january 2001 and may 2005 . recipients of slkt were selected based on the following criteria : 1 ) irreversibly compromised renal function confirmed by preoperative examination , including serum creatinine levels > 133 mol / l lasting for 1 month continuously ; 2 ) high - risk factors for kidney diseases , such as diabetes and hypertension ; and 3 ) massive proteinuria and/or requiring renal replacement therapy for more than 3 weeks . liver and kidney allografts for the same patient came from the same donor , whom was not necessarily a relative . the study period also included 25 patients who underwent lt alone with renal insufficiency ( preoperative serum creatinine levels > 133 mol / l ) . twenty - five recipients developed renal insufficiency due to hepatorenal syndrome without acute tubular necrosis and renal parenchymal disease . panel reactive antibody ( pra ) class i of recipients was 028% , and class ii was 017% .", "criteria for slkt : 1 ) end - stage liver disease and irreversible kidney failure ; 2 ) congenital diseases involving the liver and kidney ; 3 ) liver failure and chronic kidney disease ( ckd ) with gfr 30 ml / min ; 4 ) acute kidney injury ( aki ) with creatinine levels 176.8 mol / l and dialysis 8 weeks ; or 5 ) liver failure and ckd and biopsy demonstrating > 30% glomerulosclerosis or fibrosis . if there was no evidence to prove irreversible renal damage , liver transplantation alone was preferred . whether patients with hepatorenal syndrome should undergo slkt was controversial , and each patient was discussed . when patients with hepatorenal syndrome were on dialysis for < 4 weeks , liver transplant alone was performed .", "biochemical indicators ( including serum creatinine , total bilirubin , and aspartate aminotransferase ( ast ) levels ) were followed up for 5 years in all transplant recipients . lt patients were stratified according to the severity of aki as described by the risk , injury , failure , loss and endstage kidney disease ( rifle ) classification : risk , injury or failure . early- and late - stage postoperative complications , postoperative infections , rejection , and long - term survival were also recorded .", "the diagnosis of acute renal allograft rejection was primarily based on recipients clinical presentation , biochemical indicators ( a 25% increase of serum creatinine levels or more ) , and histopathological biopsy . treatment of acute allograft rejection mainly relied on methylprednisolone sodium succinate pulse therapy , an increase in the dose of immunosuppressants , and/or change of types of immunosuppressive agent . the diagnosis of acute hepatic allograft rejection required increases in serum ast levels and/or in total bile acids , and was confirmed by liver biopsy .", "the induction regimen of anti - cd25 monoclonal antibody ( daclizumab or basiliximab ) was prescribed to all patients . nucleoside analogues coupled with low - dose hepatitis b immunoglobulin ( hbig ) were given to prevent hepatitis b relapse . slkt recipients received a triple maintenance therapy of calcineurin inhibitor ( cni ; cyclosporine and tacrolimus ) , mycophenolate mofetil ( mmf ) and prednisolone ( pred ) , while lt recipients received the steroid - free regimen of cni + mmf . preoperative nucleoside analogue therapy was followed by intraoperative hbig 2000 u. postoperative combined therapy was administered with maintenance hbig twice per week . within 6 months of transplantation ,", "survival rates of recipients and allografts were analyzed using the kaplan - meier and log - rank methods . continuous data were analyzed using the student s t - test , and categorical variables using the chi - square test .", "multivariate analysis revealed that postoperative renal failure ( p=0.003 ; or 48 ; 95%ci : 3.65631.76 ) and higher rifle stage ( p=0.012 , or 8 ; 95%ci : 1.5638.22 ) were independent risk factors for mortality after liver transplant ( table 6 ) . the early death recipients after lt had higher rifle stage than survivors ( 75% vs. 11.8 , p=0.004 ) . compared with survivors , patients who died during the study had significantly higher preoperative meld scores and child - pugh scores . in addition , a higher incidence rate of postoperative renal failure ( 24% ) was associated with mortality compared with that of survivors ( 4% , p=0.001 ) . meld scores , child - pugh scores , and incidence of preoperative dialysis were not significantly different between slkt and lt recipients . however , slkt recipients had lower egfr ( p=0.003 ) and higher preoperative serum creatinine levels ( p=0.004 ) , lower serum ast levels , and lower total serum bilirubin levels than lt recipients ( table 2 ) . slkt recipients and lt recipients demonstrated sero - clearance of hbsag within 3 months after surgery . however , slkt recipients experienced a significantly higher rate of hepatitis b relapse ( 38.1% , p=0.007 ) compared with lt recipients . the patients had serologic hepatitis b virus ( hbv ) dna test results that showed undetectable levels of hbv ( table 4 ) .", "meld scores , child - pugh scores , and incidence of preoperative dialysis were not significantly different between slkt and lt recipients . however , slkt recipients had lower egfr ( p=0.003 ) and higher preoperative serum creatinine levels ( p=0.004 ) , lower serum ast levels , and lower total serum bilirubin levels than lt recipients ( table 2 ) .", "kaplan - meier survival analysis showed that slkt recipients had a higher survival rate than that of lt recipients ( p=0.025 ) , particularly at 1 year post - transplant ( figure 1 ) . recipients had a 1-year survival rate of 90.5% , a 3-year survival rate of 81.0% , and a 5-year survival rate of 81.0% ( table 2 ) . recipients had a 1-year survival rate of 60.0% , a 3-year survival rate of 56.0% , and a 5-year survival rate of 56.0% ( table 2 ) . four slkt recipients died : 2 died due to hepatitis b relapse and graft - versus - host disease within 2 months of surgery ; 1 discontinued lamivudine against medical advice and died due to hepatitis b relapse and subsequent acute liver failure 14 months after surgery ; and 1 died due to systemic infection 24 months after surgery . another 2 patients died due to tumor recurrence during long - term follow - up .", "seven cases of hepatic allograft rejection occurred among the slkt recipients ; 4 developed rejection within 1 month of surgery , and the others developed rejection at 12 months , 18 months , and 37 months after surgery , respectively . four lt recipients developed allograft rejection ( table 2 ) : 2 cases of allograft rejection occurred within 1 month of surgery , while the other 2 cases occurred at 6 months and 12 months of surgery , respectively . slkt recipients had significantly longer stay in the intensive care unit ( icu ) and longer total length of hospital stay , compared with lt recipients . on the other hand univariate analyses revealed that slkt recipients had a higher but insignificant incidence of infection at an early postoperative stage , compared with lt recipients . , lt recipients demonstrated higher incidence of renal failure and higher mortality at an early postoperative stage compared to slkt recipients ( p=0.005 ) ( table 2 ) .", "slkt recipients and lt recipients demonstrated sero - clearance of hbsag within 3 months after surgery . however , slkt recipients experienced a significantly higher rate of hepatitis b relapse ( 38.1% , p=0.007 ) compared with lt recipients . following the treatment , the patients had serologic hepatitis b virus ( hbv ) dna test results that showed undetectable levels of hbv ( table 4 ) . steroid therapy for other subjects was discontinued , and nucleoside analogues coupled with high - dose hbig ( hbig 20 000 u / d14d ) were given .", "the early death recipients after lt had higher rifle stage than survivors ( 75% vs. 11.8 , p=0.004 ) . compared with survivors , patients who died during the study had significantly higher preoperative meld scores and child - pugh scores . in addition , a higher incidence rate of postoperative renal failure ( 24% ) was associated with mortality compared with that of survivors ( 4% , p=0.001 ) . patients who died at an early stage after surgery had significantly higher preoperative serum creatinine levels ( 239.5107.7 mol / l ) than survivors ( 146.021.6 mol / l ) , and had significantly lower egfr levels ( 30.812.7 ml / min/1.73 m ) than survivors ( 47.18.7 ml / min/1.73 m ) . risk factors for high mortality ( 32% ) at an early stage after lt were analyzed using univariate and multivariate analyses . according to univariate analyses ( table 5 ) , multivariate analysis revealed that postoperative renal failure ( p=0.003 ; or 48 ; 95%ci : 3.65631.76 ) and higher rifle stage ( p=0.012 , or 8 ; 95%ci : 1.5638.22 ) were independent risk factors for mortality after liver transplant ( table 6 ) .", "the effectiveness of slkt in patients with hepatitis viral infection had not been thoroughly examined previously . in western countries , it is essential that patients with liver failure with worsening rifle class should be considered for slkt . reasonable treatment can achieve hbv - dna sero - clearance in patients with hepatitis b relapse without affecting long - term survival . singal et al . have reported that slkt for hepatitis c , non - alcoholic steatosis and hepatocellular cancer could be associated with worst outcomes compared with other slkt indications ; however , they did not include patients with hepatitis b , which is the most common indication for liver transplantation due to liver failure in china . the use of steroids has been reported as a risk factor for hepatitis b relapse and for poor survival and hepatitis c relapse . hepatitis c carriers who received slkt have demonstrated a 5-year survival rate of 68% . however , in asian countries , including china , most liver transplant recipients are hepatitis b virus carriers , in whom the outcome of slkt is less understood .", "despite longer hospital stay and higher infection rate at an early stage after surgery , slkt demonstrated satisfactory long - term survival rates in patients with hepatitis b infection . despite a higher rate of hepatitis b relapse following slkt , therefore , slkt can achieve good long - term outcomes in patients with hepatitis b , end - stage liver disease , and renal insufficiency . timely and reasonable treatments were able to prevent hepatitis b relapse from affecting long - term prognosis . for lt recipients with renal failure , postoperative renal failure and rifle stage were independent risk factors for postoperative deaths ." ]

[ "we have taken advantage of this unusual feature to characterize the dinoflagellate plastid transcriptome , and find that our analysis fully supports a highly reduced plastid genome for the peridinin - containing dinoflagellates . furthermore , the evolutionary ancestor of the peridinin - containing plastids is suggested from molecular phylogenetic reconstructions using plastid - encoded genes to be a red alga ( 3,4 ) , a conclusion supported by phylogeny of nuclear - encoded plastid - directed genes ( 5 ) . in general , these findings are also consistent with phylogenetic reconstructions of the host cells as determined from non - plastid - directed genes ( 6,7 ) . despite widespread acceptance of a red - algal origin for the peridinin - containing plastid genome architecture may be different from the phylogeny of the plastid genes themselves , and in the case of the dinoflagellates , quite remarkably so .", "the 16s probe was prepared against an est sequence from our library ( see below ) , while the atpb probe was prepared using previously described amino acid microsequence data ( 22 ) to design two degenerate oligonucleotides 5-ttyticargciggiwsigargt-3 and 5-acytcigciacraaraaiggytg-3 ; the 500 bp pcr product was confirmed as atpb by sequence analysis . the 3 end sequences of atpb and psba transcripts were obtained from cdna synthesized from poly(a ) rna tailed in vitro with rgtp by poly(a ) polymerase . poly(a ) rna was purified from lingulodinium and amphidinium using oligo(dt ) chromatography ( 23 ) and hybridized to a psba and 23s probes as described ( 22 ) . minicircle dna was amplified by inverse pcr using outwardly directed oligonucleotides 5-gtattcggtcaagaggatg-3 and 5-caggagcaaggaagaaag-3 ( psba ) or 5-gtggtcgtaagattgagagg-3 and 5-gatgagagcgttggcatac-3 ( atpb ) . for cdna preparation , 10 g poly(a)-enriched rna was used as a template for first strand synthesis using a commercial kit ( stratagene ) but replacing the usual oligo(dt ) primer with 5-(ga)10actagtctcgag(a)18 - 3. sequences were identified using the blast algorithm ( ) and have been deposited in genbank under the accession nos . dq264844 through dq264867 . all sequence alignments and analyses were performed using macvector ( accelrys ) except for rna secondary predictions that were made using a web server ( ) . statistical analysis using rarefaction ( 25 ) to determine the likelihood that our sample size was sufficient to detect all different cdnas in the library was made on a web server ( ) . the genomic psba sequences from lingulodinium were obtained using tail - pcr ( 24 ) using three nested internal psba oligonucleotides ( 5-gctgcttggccagttattggtatctg-3 ; 5-tctggtttacagcacttggtgttag-3 ; 5-gtccataattgattcatcaggtcatc-3 ) to amplify a fragment from at - rich dna purified by bisbenzimide - cscl gradients . to obtain the 3 end of genomic sequences from amphidinium , amphidinium carterae ( ccmp 1314 ) and lingulodinium polyedrum ( ccmp 1936 , formerly gonyaulax polyedra ) were obtained from the provasoli guillard culture center for marine phytoplancton ( boothbay harbor , maine ) and cultured as described ( 22 ) .", "we began our analysis of the dinoflagellate plastid transcriptome by fractionation of rna into poly(a)-enriched and depleted fractions by oligo(dt ) chromatography . we propose that binding of these polyuridylylated mrnas to the longer and more prevalent poly(a ) tails of nuclear transcripts is responsible for their presence in poly(a)-enriched rna fractions obtained by oligo(dt ) cellulose chromatography . , we conclude that the genome of this photosynthetically active chloroplast is likely to encode only the transcripts identified here . to address the mechanism underlying site selection for poly(u ) addition we originally thought that the tails might be heterogeneous , similar to the 3 termini in chloroplasts and cyanobacteria rna formed by polynucleotide phosphorylase ( pnp ) ( 21 ) , since the presence of nucleotides other than adenine in the 3 tails might inhibit cdna synthesis more than oligo(dt ) chromatography . to test this , we guanylated our poly(a)-enriched rna using poly(a ) polymerase , and performed rt pcr with a primer pair allowing specific amplification of the psba 3 end ( figure 2a ) . the majority of the transcripts correspond to photosystem ii components ( psba - d ) and 16s rna .", "we have found that the plastid transcripts in two species of peridinin - containing dinoflagellates are characterized by an unusual 3 polyuridylylation . we report here that an oligo(da)-primed cdna library has a remarkably low complexity , with only 12 different clones identified in 300 randomly selected polyuridylylated sequences ( table 1 ) . this modification differs dramatically from the poly(a ) tails of nuclear - encoded transcripts , and so provides a facile method for cataloging the plastid transcriptome . this concordance between two independent methods ( characterization of the minicircular genome and the transcriptome analysis reported here ) suggests that the minicircular gene format is likely to be the only genome architecture in the plastid .", "", "", "dinoflagellate plastid messages are located in poly(a)-enriched rna . total rna samples ( t ) from the dinoflagellates lingulodinium ( a ) and amphidinium ( b ) were resolved into fractions enriched ( a+ ) and depleted ( a ) for poly(a ) rna by chromatography on oligo(dt ) cellulose . only transcripts from known minicircle genes are polyuridylylated in lingulodinium various patterns of substitutional editing are found in dinoflagellate plastid transcripts all different polyuridylylated 3 terminal sequences corresponding to sequences identified in the library were aligned at the site of the poly(u ) modification and at each of two potential conserved sequences ( underlined ) . rna blots were challenged with gene probes for either psba , 23s rna or 16s . the progression of the number of random sequences as a function of the number of different clones ( inset ) suggests over a thousand sequences would be required to identify any potentially new clone in the library ." ]

[ "several prospective , randomized , controlled clinical trials regarding cervical artificial disc replacement ( c - adr ) have been published . however , the number of c - adr patients with long - term follow - up for more than 4 years is still sparse . the purpose of this systematic review is to provide a summary of the available literature reporting long - term follow - up of c - adr and to elucidate whether the favorable outcomes seen in the short - term continue after 4 to 5 years .", "exclusion criteria : ( 1 ) non - fda trials comparing c - adr with acdf ; ( 2 ) follow - up < 4 years . outcomes : neck disability index ( ndi ) , pain in the neck and arm ( visual analog scale [ vas ] ) , quality of life ( sf-36 physical component score [ pcs ] ) , adjacent segment disease ( asd ) , neurological success , subsequent surgeries , and complications . search : pubmed , cochrane collaboration database , and national guideline clearinghouse databases ; bibliographies of key articles . does single - level unconstrained , semiconstrained , or fully constrained c - adr improve health outcomes compared with single - level acdf in the long - term ? inclusion criteria : ( 1 ) fda trials comparing c - adr with anterior cervical discectomy and fusion ( acdf ) ; ( 2 ) follow - up 4 years .", "exclusion criteria : ( 1 ) non - fda trials comparing c - adr with acdf ; ( 2 ) follow - up < 4 years . outcomes : neck disability index ( ndi ) , pain in the neck and arm ( visual analog scale [ vas ] ) , quality of life ( sf-36 physical component score [ pcs ] ) , adjacent segment disease ( asd ) , neurological success , subsequent surgeries , and complications . study design : systematic review . search : pubmed , cochrane collaboration database , and national guideline clearinghouse databases ; bibliographies of key articles . inclusion criteria : ( 1 ) fda trials comparing c - adr with anterior cervical discectomy and fusion ( acdf ) ; ( 2 ) follow - up 4 years .", "two randomized , multicenter fda trials comparing outcomes following c - adr and acdf with follow - up > 48 months were found ( fig . c - adr indicates cervical artificial disc replacement ; fda , us food and drug administration ; and ns , not statistically significant . asd indicates adjacent segment disease ; c - adr , cervical artificial disc replacement ; fda , us food and drug administration ; ndi , neck disability index ; and ns , not statistically significant . function , pain , and health - related quality of life ( table 2 ) at 48 months in the bryan trial , patients in the c - adr group showed significantly greater mean improvement in ndi , vas neck and arm pain , and sf-36 pcs measured at 48 months compared with patients in the acdf group . at 60 months in the prestige trial , only mean improvement in ndi scores was significantly greater in the c - adr group ( 38.4 vs 34.1 , p = .022 ) ; however , for the remaining three outcomes , mean improvements were slighter greater following c - adr versus fusion . success , asd , and return to work ( table 3 ) at 48 months in the bryan trial , overall success and ndi success , were achieved in a significantly greater proportion of c - adr patients compared with acdf patients ( p = .004 and .003 , respectively ) . at both 48 months in the bryan trial and 60 months in the prestige trial , overall , a total of 1004 adult patients ( 47% male ) with a mean age of 44 years were included .", "the magnetic resonance images demonstrated a large herniated disc at the level of c5/6 , eccentric to the right side ( fig . a 43-year - old woman presented with cervical myelo - radiculopathy that did not respond to medical treatment for 6 weeks . her symptoms improved significantly after surgery and x - rays taken 2 years postoperatively demonstrated very good range of motion at the index level ( fig . her vas arm pain score improved from a preoperative score of 8 to a postoperative score of 1 at 2-year follow - up . ", "limitations : a small number of studies with long - term data comparing c - adr with cervical acdf were available . in both prospective studies , the follow - up rates were 68.7% ( 318/463 ) in the bryan disc study at 4 years and 50.1% ( 271/541 ) in the prestige st study at 5 years . these studies demonstrate the durability of the c - adr procedure ; however , it may still be too early to detect implant - related failures . future studies should examine issues such as wear - related failures , device fatigue , or delayed spinal instability . the c - adr cohort maintained statistical improvement in validated clinical outcome measurements at 48 and 60 months and preserved segmental motion at the operated level . these high rates of lost to follow - up may alter the study results if those patients lost to follow - up had late - onset clinical or radiographic issues . rates of revision and supplemental fixation surgeries were lower in the c - adr group .", "significantly greater mean improvement from baseline in all outcomes in the bryan c - adr group compared with the acdf group at 48 months . overall success and ndi success , which were only reported by the bryan trial , were achieved in a significantly greater proportion of c - adr patients compared with acdf patients at 48 months . at both 48 ( bryan ) and 60 months ( prestige ) only the ndi showed greater mean improvement from baseline in the prestige c - adr group compared with the acdf group at 60 months . the rates of asd at 48 ( bryan ) and 60 months ( prestige ) were not statistically different between treatment groups . at both 48 ( bryan ) and 60 months ( prestige ) , more patients were working following c - adr compared with acdf . significantly fewer revisions , supplemental fixations , and use of external bone growth stimulators were reported in the prestige c - adr compared with the acdf group at 60 months . rates of who grade 3 or 4 adverse events were similar between groups at 48 months in the bryan trial .", "cervical arthroplasty is a viable treatment option for cervical herniated disc / spondylosis with radiculopathy . the inclusion / exclusion criteria of us fda trials should be followed . c - adr achieves neural decompression and preserves normal segmental motion at the operated level at 4 to 5 years follow - up . adjacent level degeneration may be decreased with arthroplasty versus acdf , but further study is warranted on this topic ." ]

[ "gupta et al . used spirogyra species for removal of cu(ii ) with the maximum adsorption capacity of 133.3 mg g. use of adsorbents like mg pellets has also been reported for co(ii ) removal from water and the adsorption capacity has been found to be 15.8 mg g. the aim of this work is to study the best condition of temperature , sodium hydroxide concentration , and time required for synthesis of na - p1 zeolite from the local pumice raw material and utilize the synthetic zeolite as an adsorbent for removing ( cd , fe , cu , and co ) ions from synthetic solutions in a batch laboratory system . zeolite is a natural porous mineral described as hydrated aluminosilicates containing exchangeable alkali and earth alkaline cations ( na , k , ca , or mg ) and could be synthesised from the aluminium silicate materials as clay minerals and pumice by alkali attack [ 13 ] . the heavy metals contamination of water by the discharge of industrial wastewater of electroplating , metallurgy , chemical manufacturing , mining , and battery manufacturing is a worldwide environmental problem . also , the effect of experimental conditions such as contact time and initial zeolite dose was described . adsorption process provides an attractive alternative treatment to other removal techniques because it is more economical and readily available [ 1012 ] . a good number of adsorbents have been used for cd(ii ) , fe(ii ) , cu(ii ) , and co(ii ) removal from water .", "the adsorption isotherm shows the equilibrium relationship of concentration in the adsorbate - adsorbent system at constant temperature . sio2 , al2o3 , and na2o are the main oxides in the pumice under investigation ( 93.69% ) confirming the mineralogical constituents , whereas tio2 , mno , mgo , fe2o3 , and cao analyzed in the pumice under are calculated as 3.88% ( table 1 ) . the concentrations of heavy metals in all samples were determined according to apha using atomic absorption spectrometer unicam model 939 with graphite furnace accessory , equipped with deuterium arc background corrector . freundlich isotherm is an empirical equation that can be described as the reversible adsorption onto heterogeneous surface at sites with different energy of adsorption and is not restricted to the formation of the monolayer of adsorbate . the optimum conditions required for synthesis of na - p1 zeolite from locally produced pumice raw material are one molar naoh concentration , temperature at 80c , and one week as a crystallization time . xrf shows that quartz , cristobalite , and albite are the main constituents in the pumice ( figure 2 ) . deviations from the basic assumption of the langmuir model do limit interpretation of the values for qm and kl in terms of absolute surface areas and sorption free energies . the free energy of adsorption , g , can also be evaluated from the parameter kl according to the expression g = rtlnkl .", "adsorption isotherm and kinetics of co , cu , fe , and cd on the synthetic zeolite were investigated using batch experiments . the arrangement of heavy metals according to dose required for the reduction of metal concentrations in freundlich equation is cd > fe > cu > co. the adsorption isotherm data were fitted well to the langmuir model from langmuir model equations . in order to investigate the adsorption kinetics of heavy metals on the prepared zeolite adsorbent phase composition and microstructure of the synthetic zeolite studied by xrd ( figure 2 ) and sem reveal that the zeolite p1 is the only phase formed during these conditions of alkali treatment during the alkaline hydrothermal attack of locally produced pumice raw material at the optimum condition of synthesis . the maximum sorption capacity ( kl ) represents monolayer coverage of sorbent ; according to the kl ( mg / g ) parameter , monolayer capacities of zeolite are arranged in the following sequence : cd > fe > cu > co. these metals seem to reach saturation , which means that the metal had clogged possible available sites in zeolite and further adsorption could take place only at new surfaces . it is evident that the treatment with naoh has a significant efficiency on the physicochemical properties of synthesized adsorbent na - zeolite p1 .", "the alkaline treatment of very cheap local pumice leads to the formation of na - zeolite p1 which has the high degree of crystallinity , the ph is higher than the phpzc , and the surface of the adsorbent is negatively charged , favoring the adsorption of cationic species ( co , cu , fe , and cd ) . the adsorption kinetics study of the heavy metals followed a pseudo - second - order model . both the langmuir and freundlich models fit equilibrium data well implying the existence of a monolayer adsorption and a heterogeneous surface existence in na - zeolite p1 , showing a strong adsorption capacity for ( co , cu , fe , and cd ) ions reaching a maximum capacity for cd . heavy metal ions uptake is the result of a combination of several interfacial reactions , namely , ion exchange , chemisorption , and adsorption as potential determining ions . results found showed that the modified zeolite shows a good potential as adsorbent for ( co , cu , fe , and cd ) ions ." ]

[ ", we evaluated remote ( pulmonary ) changes in lox expression and activity in response to surgery and their contribution to tumor cell seeding and metastasis . surgical resection of tumors is a common therapeutic procedure , especially for early - stage localized , and potentially curative , disease . it has been reported that 25%30% of colorectal cancer patients who have no visible metastasis at the time of diagnosis will develop distant metastases within 5 years after primary tumor resection , which in some cases may be related to the effects of the surgery ( van der bij et al . , 2009 ) . however , the contribution of lox to tumor cell seeding and subsequently to metastasis soon after surgery is unknown . the host response to anti - cancer therapy and its contribution to tumor ( re)growth and metastasis has been evaluated following chemotherapy ( daenen et al . , 2011 , gingis - velitski et al . , 2011 ) , radiotherapy ( barcellos - hoff et al . , 2005 , while surgery can ultimately cure many patients , such as those with early - stage disease , distant macroscopic metastasis can emerge in others months to years later ( demicheli et al .", "thereafter , we evaluated the levels of circulating bone - marrow - derived proangiogenic cells over time and the extent of local angiogenesis following surgery . a significant increase in the number of viable circulating endothelial cells ( cecs ) and endothelial progenitor cells ( ceps ) the number of gfp+ tumor cells present in the lungs of mice that underwent surgery was substantially elevated in comparison to control mice ( figures 1c and 1d ) . taken together , our results suggest that enhanced tumor cell seeding is a result of remote changes occurring , in part , in the pre - metastatic ( lung ) tissue in response to surgery . we next evaluated the host - derived effects of surgery on tumor cell seeding and growth in metastatic sites . previous clinical studies indicated that both systemic and local angiogenesis are induced in response to surgery when compared to laparoscopy ( bono et al . , 2010 ) . increased metastases after localized tumor resection in some cases could be due to systemic changes that affect various host tissues in response to surgery .", "lox activity and expression are substantially enhanced in the lungs of mice following surgery , as well as in mice pre - conditioned with plasma from donor mice that underwent surgery . we demonstrate that mice that undergo abdominal surgery and are subsequently injected with tumor cells via the tail vein succumb to extensive metastatic lesions earlier than controls . , our study reveals that lox induction contributes to the rapid formation of a permissive niche for metastatic cell seeding in response to surgery . we find that the host , in response to surgery , conditions potential metastatic sites to facilitate tumor cell seeding . accordingly , we find that the surgery is associated with release of lox to the circulation from the hypoxic wounded site , which in turn induces the formation of the pre - metastatic sites .", "an experimental pulmonary metastatic model was obtained using female balb / c or c57bl/6 mice , 810 weeks of age , intravenously injected through the tail vein with 2.5 10 gfp - expressing emt/6 ( emt/6-gfp+ ) or gfp - expressing llc ( llc - gfp+ ) cells , respectively . briefly , a reaction solution containing 50 mm sodium borate ( ph = 8.2 ) and 4 u / ml horseradish peroxidase was mixed with lung extracts to obtain a protein concentration of 250 g / ml . the lysate extracts were obtained from mice treated with bapn , anti - lox , recombinant lox , or rabbit polyclonal antibody using the same concentrations as above . furthermore , lysate extracts of lungs or peritoneum obtained from control mice or mice that underwent surgery were treated with bapn , anti - lox antibodies , recombinant lox , or rabbit polyclonal antibody and used as controls for the lox activity assay . cecs , ceps , emt/6-gfp , and 4t1-mcherry+ were analyzed by flow cytometry as previously described ( shaked et al . , 2005 ) . plasma from colorectal cancer patients , who underwent open abdominal surgery , was provided by the department of pathology at the eio . murine lewis lung carcinoma ( llc ) , emt/6 and 4t1 mammary adenocarcinoma , and human mcf7 breast carcinoma cell lines were purchased from the american type culture collection ( atcc ) . plates coated with collagen ( 20 g / ml ) , fibronectin ( 20 g / ml ) , or laminin ( 20 g / ml ) were incubated with plasma from control , post - surgery mice or plasma from post - surgery mice depleted of lox . after 4 hr , the plasma was washed and mcf7 cells ( 7 10/well ) were seeded and cultured for 24 hr . mcf7 cells were then removed , and lysates were prepared to evaluate paxillin and p - pax expression by western blotting . bapn ( sigma - aldrich ) was injected intraperitoneally at a dose of 100 mg / kg daily for seven consecutive days , or as indicated in the text , as previously described ( bondareva et al . , 2009 ) .", "c.r .- t . , p.h . , and y.s . conceived and designed all experiments ." ]

[ "ohrqol is highly subjective and has to be assessed within the framework of patients conditions , sociocultural environments and own experiences and states of mind : because ohrqol is related to daily life and is unique to each individual , even patients with severe conditions can report having good quality of life . furthermore , quality of life is by itself multi - faceted , showing variation over time for each individual . these conditions may be life - threatening ( e.g. oral cancers ) or not , progressing ( caries , periodontitis , etc . ) or not , dealing with aesthetics ( staining in anterior teeth such as molar incisor hypomineralisation ( mih ) ) or pain ( pulpitis , mih in posterior teeth , etc . ) . ohrqol should therefore be assessed longitudinally to take into account changes over time , using versatile tools .", "this may subsequently lead us to consider the impact of dentin hypersensitivity ( dhs ) or exposed cervical dentin ( ecd ) on ohrqol of those individuals being assessed . the initial 49-question form was constructed to assess the social impact of oral disorders . many limitations can be found to the current validation testing , including relevance of the questions , validity and sensitivity to change , risk of misinterpretations ( role of the ethnocultural environment ) , problems of translation of english questionnaires and difficulty to interpret the significance of a psychometric measurement when reported simply as a numerical score or a mean [ 1 , 2 ] . should provide the opportunity to measure the extent or intensity of the changes in ohrqol . oral health outcome measures developed before 2007 ( adapted from locker and allen ) the ohip , also called ohip-49 , is the most widely used , and this has enabled investigators to modify forms that can be subsequently adapted to populations or conditions .", "very few studies have been devoted to this aspect of dhs / ecd as recently shown , with only two papers written in english specifically dedicated to the evaluation of ohqol in dhs / ecd patients . should be conducted by experienced and calibrated examiners using established guidelines for conducting dhs / ecd clinical studies . such studies should also be based on a randomised clinical study design and include both placebo or control groups . these questionnaires should be patient - centred and derived from interviews with patients who are expected to complete the questionnaire [ 4 , 10 ] . furthermore , if these studies also attempt to evaluate the efficacy of desensitising agents in reducing dhs / ecd and its subsequent impact on ohqol , then it is imperative that the condition should be clearly diagnosed by trained and calibrated dentists experienced in conducting clinical studies using recognised and accepted clinical criteria for the evaluation of dhs / ecd . due to the cultural and language differences between countries , one paper provided results using a generic questionnaire and the second paper constructed a specific questionnaire to evaluate ohqol in dhs / ecd patients but provided no epidemiological results . these studies are more extensively described in an accompanying paper . in the future , studies using validated questionnaires specifically constructed to evaluate the impact of the condition on ohqol should be employed .", "patients suffering from dhs / ecd have been reported to have a significantly impaired ohrqol ; this may however be improved following treatment with a desensitising agent as reported by several authors . it is therefore of the upmost importance that the use of the ohrqol as a quality control tool in the dental office be established in robust clinical studies . furthermore , because of its ability to reflect a patient s satisfaction with any proposed treatment , it may prove to be a valuable asset for practitioners when assessing their patients quality of life before , during and after treatment of various clinical conditions such as dhs / ecd .", "" ]

[ "rats were divided into 4 equal groups and injected physiological saline ( twice daily subcutaneously in morning and evening ; group i ) , morphine sulfate ( 10 mg / kg twice daily subcutaneously ; group ii ) , fosaprepitant ( 30 mg / kg once by intraperitoneal route ; group iii ) , and finally , the last group was co - administered both morphine and fosaprepitant ( group iv ) in the same doses as in group ii and iii , respectively , for a week . in the last group , fosaprepitant was injected 30 min before the morphine injection . the dose of fosaprepitant ( 30 mg / kg ) was higher than that used in an earlier study ( 25 mg / kg ) . hot plate latency or the thermal escape behaviour was determined in the morning , 40 min after saline ( group i ) , fosaprepitant ( group iii ) , or morphine injection ( group ii and iv ) . the rationale for selecting a higher dose was the rapid conversion of fosaprepitant to aprepitant ( half - life ~30 min ) in the rat compared to dogs and humans . the predictability of this test to clinical situations is high for morphine and related opioid substances . the hot plate test is commonly employed for screening the putative antinociceptive property of drugs . the advantages of this test are the brief nature of the nociceptive stimulus , which does not produce any tissue damage and that multiple testing can be done in the same animal .", "each group had 6 animals quantitative image analysis of the expression of substance p and calcitonin gene - related peptide ( cgrp ) shows that morphine + fosaprepitant treatment led to higher substance p expression compared to all other groups including the morphine treated group . p expression of both substance p and calcitonin gene - related peptide was noted over the superficial laminae ( i - ii ) . quantitative image analysis revealed increased sp expression in the morphine + fosaprepitant treated group compared to others [ figure 3 ] . however , co - administration of fosaprepitant with morphine increased the antinociceptive effect of morphine ( days 14 ) and also attenuated tolerance ( days 1 and 3 ) . cresyl violet staining showed the different laminae of the gray matter of the cervical region of the spinal cord ( top panel ) . immunohistochemical study revealed the expression of sp and cgrp over the superficial laminae ( laminae i - ii ) of the dorsal horn [ figure 2 ] .", "identical result was reported with a chimera possessing both opioid agonist and nk1r antagonist properties . the results of this study show that combining morphine with fosaprepitant ( group iv ) delayed the development of morphine tolerance and concurrently increased the antinociceptive effect compared to the control group . as mentioned earlier , this could be due to decreased binding of sp to the nk1r . similarly , the potentiation of the antinociceptive effect of morphine by fosaprepitant is also lost on continued administration ( day 5 onward ) . moreover , the factors can differ depending upon the specific -opioid receptor agonist used for producing the tolerance . previously , injection of a bifunctional peptide having both -opioid receptor agonist and nk1r antagonist properties relieved pain in neuropathic rats without producing tolerance . in a different study ,", "the results indicate that addition of fosaprepitant to morphine can delay morphine tolerance for a limited period of time . to the best of our knowledge , this is the first report on the novel antinociceptive effect of morphine + fosaprepitant combination . further studies are required to further elucidate this novel antinociceptive effect of morphine + fosaprepitant combination .", "", "" ]

[ "importantly , uio-66-[fefe](dcbdt)(co)6 was found to be a highly active hydrogen production catalyst \n in photochemical arrays with [ ru(bpy)3 ] as \n a photosensitizer and ascorbate as an electron donor . the catalytic \n performance of the mof exceeds that of an analogous homogeneous reference \n system . x - ray absorption \n spectroscopy ( xas ) was used to confirm the coordination environment \n of the fe2 site in the mof . decoration of complex 2 at the bdt ligand with two carboxylates results in complex 1 which can be introduced into mofs by pse of 1,4-benzenedicarboxylate \n ( bdc ) ligands , which is a common ligand linker in many mofs ( figure 1 ) . [ fefe ] hydrogenase active site model complexes [ fefe](dcbdt)(co)61 and [ fefe](bdt)(co)62 and the bdc ligand", "if \n complex 1 was only being included into uio-66 via sorption \n into the pores , then inclusion would not be expected to be strongly \n solvent dependent . taken together , these experiments provide strong \n evidence , consistent with reported pse studies , that the iron cluster \n is becoming part of the uio-66 framework via a ligand pse process \n and that the data do not support simple inclusion of the cluster into \n the pores of the mof . in order to further demonstrate the incorporation \n of the intact \n fe2s2 dinuclear cluster into the mof , we employed \n fourier - transformed infrared spectroscopy ( ftir ) and diffuse reflectance \n uv vis spectroscopy . as for all photochemical reduction \n schemes based on [ ru(bpy)3 ] , one - electron \n photochemistry needs to be coupled \n to a two - electron catalytic process . with the limited availability \n of reductant , having observed that pse could be used to incorporate \n complex 1 into a robust mof , we explored the suitability \n of this material \n as a catalyst in photochemical hydrogen production schemes . here , the fe2 site in uio-66-[fefe](dcbdt)(co)6 has an undisputable \n advantage over the homogeneous system , as its incorporation into the \n mof spatially protects from unproductive charge recombination . , it is well established that the electrochemical \n reduction of 1 , and its bdt derivative 2 , is a two - electron process due to inverted electrochemical potentials . \n disproportionation as well as protonation needs to occur before the \n reduced species recombine with oxidized ascorbate .", "we employed pse as an efficient and mild approach to obtain the \n first mof that contains a multinuclear , organometallic , nonprecious - metal - based \n proton reduction catalyst . uio-66-[fefe](dcbdt)(co)6 exhibits \n high efficiency for photochemical hydrogen evolution , exceeding that \n of the homogeneous reference system in terms of rate and total hydrogen \n production yield . [ fefe](dcbdt)(co)6 ( 1 ) is among the most complex structure that \n has ever been introduced into a mof , and its presence and molecular \n integrity within the uio-66 framework could be confirmed by exafs , \n ftir , and other methods . the resulting uio-66-[fefe](dcbdt)(co)6 is a hybrid material that combines the advantages of molecular \n catalysts with a highly ordered and stable inorganic support . incorporation of the fe2 complex in uio-66-[fefe](dcbdt)(co)6 results in a higher stability under the photocatalysis conditions , \n protects reduced species from nonproductive charge recombination , \n and may promote disproportionation reactions to produce catalytically \n active dianion 1 ." ]